Dental Students Learn Tools of the Trade

There are no stickers or balloons given out after appointments at the Harvard Dental Teaching Clinic. And the 40 sterile cubicles where dental students "practice technique" on real patients are a far cry from the small, cozy offices where private dentists wield their drills.

Most students opt out of the clinic--run as a training ground for students at the School of Dental Medicine (SDM). Those who chose the Harvard dental plan often go to the University Health Services (UHS) for treatment rather than trekking across the river to the Longwood campus. Some say they do not trust the less experienced dental students.

But many administrators--and even some patients--say the clinic offers service that equals or surpasses anything a private practice has to offer.

While the cost for those insured through the Harvard program is the same at UHS and at the clinic, for those without insurance the clinic provides the same services at about half the price. UHS, a much smaller facility, sometimes sends patients to SDM to handle overcrowding, according to Dean of Dental Education Dr. Howard Howell.

"As more and more people choose to come here instead of going to Holyoke, we're feeling increasingly like a genuine part of the University community," Howell says.

Payment in Time

Doctors and patients at the clinic say there are disadvantages to working with students but they say a lower level of care is not one of them.

"There's no sacrifice in terms of quality, but in a teaching clinic you have to expect things to take longer," says Dr. Morton Sobel, senior tutor at SDM.

This means that the primary examination--a process that might take 45 minutes at a private dentist's office--is slated to last three hours at the clinic, according to Julius T. Park, a third year student at SDM.

Rather than simply asking patients to fill out a short form and answer a few simple questions, dentists at the clinic typically review medical history for around one hour, Sobel says. X-rays and a full oral examination are also a part of every initial exam.

But Sobel claims the time lag is one of the clinic's strengths as well as its weaknesses.

The more exhaustive procedure, Sobel says, often allows the doctors at the clinic to catch problems that might be overlooked in a shorter exam.

"The economics of time in a regular practice may preclude such a complete examination," Sobel says.

Park , who has worked in the clinic since early fall, says treatment at the clinic compares favorably to his experience in the world of private dentists. "You definitely get really good quality care which you normally wouldn't get at any place other than a teaching practice," Park says.

A Calculated Risk

The inexperience of the students who work at teaching clinics has historically made many wary of such clinics.

At New York University, the dental teaching clinic required patients to sign waivers forfeiting the right to sue in exchange for the care they received until a court decision invalidated the practice in 1990.

But administrators at the Harvard clinic say the school's small size and high student to faculty ratio have had a great effect in allowing the clinic to provide a high level of care.

One of the smallest graduate schools at the University, SDM has only about 33 students in each class, allowing teachers to closely monitor students' work.

But in the past 10 years, the clinic and the faculty practice downstairs have forked out money in eight malpractice lawsuits.

"I can't say exactly how our payments compare to other schools, but I look at all these numbers and reports and I think we're doing a darn good job," says Assistant Dean for Clinical Services John Brouder. He adds that 500,000 patients have passed through the two clinics in the past decade.

SDM student Peter A. Costalos cites the school's grading system as another factor in raising the teaching clinic's level of care.

"The pass/fail system means that there's no problem with asking an instructor for help. Students learn to do things the right way," Costalos says.

To learn procedures, dentists-in-training listen to lectures, spend their time in the lab working on mannequins to refine their technique, and on occasion even practice on each other.

Before injecting a patient with anaesthetic, students trade shots to learn the proper technique.

Park says that although there is no question that the students in the clinic are not yet fully-qualified dentists, he says the school prepares them adequately for their clinical work.

"We need to have opportunities to get experience somehow," Park says.

Jo Ann Ong, an MIT student who has been going to the clinic since July says she sees no difference between the students at the clinic and practicing dentists.

"They're very professional," she says. "I have no complaints."

Patients at the clinic are often older people without insurance or on the MassHealth plan provided by the state, according to Brouder.

Brouder says the clinic serves an important function in helping those who might not otherwise get dental care.

"It provides a real public service," Brouder says.