By the time Pat Goodnough found Eastman Institute for Oral Health, her adult son, David, had been traumatized hundreds of times by dentists who had little experience working with individuals with developmental disabilities.
David has had severe dental problems his entire life. Dentists had capped his teeth when he was four years old and had made Goodnough feel as though she was not brushing his teeth well enough and that she was not taking good care of him. In reality, David was lacking an enzyme in his saliva and nothing Goodnough did would have helped him.
“Four years ago (a dentist) told me we needed to put David in the operating room and just have all his teeth pulled,” Goodnough recalled. “When I told David that he just went crazy and he begged me not to do that. I didn’t know what to do and so I stressed over it a long time.”
Goodnough could not put her 37-year-old son through any more monthly dental visits, where half the time they did not allow her in the room while he was being worked on. But a blessing in disguise would send her and her son to Eastman Institute’s urgent care center when David’s face began to swell from a bad tooth.
“They were so sweet and nice there,” Goodnough said.
When Goodnough called for an appointment the next time David had a dental problem she was told that a new facility had opened and it would be perfect for his condition. University of Rochester Medicine’s Complex Care Center treats adults with complex childhood onset conditions, specializing in cystic fibrosis, autism, cerebral palsy and others. Patient care runs the gamut from routine physical exams to treatment of chronic diseases to dental care.
“David and I cried when we first went there,” Goodnough said, adding how comforted she felt by her son’s dentist, Adela Planerova, the hygienists and the receptionist at the center. “(They) make you feel like it will be OK—we’re here for you guys.”
100 years of dentistry
Helping the community was George Eastman’s goal when he donated the funds in 1915 to open a dental dispensary in downtown Rochester. Rochester Dental Dispensary was dedicated and opened in 1917.
“In 1920 they asked George Eastman to support a medical school here and he said ‘I’ll do it only if it will be medicine and dentistry’,” said Eastman Institute director and professor Eli Eliav. “George Eastman did not stop here in Rochester. He opened dental dispensaries in London, Brussels, Stockholm, Rome and Paris. All of them but the one in Brussels are still active.”
Legend has it that Eastman’s fondness for dentistry came from seeing his mother suffering from dental pain. Another story had Eastman believing that good oral health would help his business. Either way, his philanthropy would pave the way for one of the nation’s pre-eminent training institutes.
Eastman’s $4 million gift matched a $5 million grant by John D. Rockefeller Jr., making possible the University of Rochester’s School of Medicine and Dentistry. But lack of student interest stymied the dental component of the school. In 1928, the University of Rochester Dental Fellows Program was developed.
The following year the Rockefeller Foundation provided fellowships to UR to support dental research and training and a consultation dental clinic was established in the hospital’s outpatient department.
When Eastman died in 1932 he bequeathed another $1 million to the Rochester Dental Dispensary. Nine years later the institution was renamed Eastman Dental Dispensary, and in 1951 a master of science program with a major in dental science was established at UR.
UR created the Department of Dentistry and Dental Research in 1955 and in 1965 the name of the dispensary was changed to Eastman Dental Center. By that time EDC’s clinical training programs had become world renowned.
In 1971, a clinical teacher training program was initiated between UR and EDC, with the objective of training the highest quality of dental teachers and researchers. In 1978 a new Eastman Dental Center opened on Elmwood Avenue.
In 1997 EDC and UR merged and became partners in providing oral health care, graduate education and research. In 2009, the Eastman Institute for Oral Health was established, replacing EDC as a division within UR.
To be clear, Eastman Institute does not provide a dental degree. Rather, it offers eight different advanced, postdoctoral educational programs that attract dentists from around the globe. After earning a dental degree, dentists can apply for one of less than 50 program openings each year.
“We have 1,200 applicants for 40-something positions every year,” Eliav said. “There are many reasons for that but I think mainly it’s the reputation that we have around the world. Even in this area we provide so much care and people don’t know. It’s one of the best kept secrets of the area.”
A native of Jerusalem, Eliav was named director of the institute in 2013. Prior to joining Eastman Institute, Eliav served as director of the Center for Temporomandibular Disorders and Orofacial Pain and as chairman of the Department of Diagnostic Sciences at the University of Medicine and Dentistry of New Jersey.
Eastman Institute trains dentists in advanced education in general dentistry, pediatric dentistry, orthodontics, oral and maxillofacial dentistry, TMJ disorders and orofacial pain, prosthodontics, periodontics and general practice residency. More than 60 percent of the institute’s students are international, and each year 100 specialists-in-training serve the Rochester community and advance dental research.
In addition to its post-doc programs, Eastman Institute has a top-tier oral biology research component. All faculty are required to be involved in a certain level of research and scientific scholarly activity. Main areas of research include infectious diseases, skeletal and dental tissue regeneration, periodontal diagnosis and therapy and others.
When Antonio Bello was considering a graduate dental program, he had a choice between Eastman Institute and a school in California. In the early 1980s, when Bello was applying to schools, Eastman Institute had roughly three student openings a year, while the school in California had six.
Bello was wowed by Eastman Institute’s reputation for being a pioneer in oral research, an area he was most interested in.
“I knew I would get a very private type of education. And that’s what made me go to Eastman,” Bello said. “Once I went there I had these faculty members; we had a great chairman who also was a pioneer in the field of complete dental prosthodontics. So I got to get a very private type of education on a first-hand basis with these icons in prosthodontics.”
Upon graduation in 1984, Bello returned to his home in Mexico, where he had a prosthodontics practice. He said his time in Rochester was fascinating because he met dental students from around the world, all of whom traveled as far as necessary in order to be educated at Eastman Institute.
His education in Rochester allowed Bello to pass on his knowledge of dentistry to students in Mexico, and Bello’s mentors at the institute taught him to provide for the needy and help others who may not have the privilege or position to receive quality dental care, something he continues to do some 30 years later.
Eastman Institute offers robust clinical services in all dental specialties, with a strong community orientation. The institute’s clinical facilities see roughly 180,000 patients annually, Eliav said.
The institute has clinics in a number of community locations, including one at School 17 Enrico Fermi in the Rochester City School District that serves both students and neighbors of the school. Eastman Institute also is working on opening a dental clinic at East High School.
The institute also has three SMILEmobiles that are trailers, as well as a recreational vehicle retrofitted for dental work. The trailers are parked at locations such as schools for a month and then moved to another location, Eliav explained.
The RV unit is designed to treat patients with wheelchairs and special needs.
“We can go to group homes. We can go to nursing homes and treat patients there that would never be able to get any treatment,” Eliav said.
More than 40,000 children have received oral health care services through the SMILEmobile program since its inception 50 years ago.
Eastman Institute also has developed a teledentistry program. In New York, dental patients in some rural areas are underserved. With teledentistry, a nurse can cover a rural area and through the internet allow a dentist in Rochester to view and advise on a patient’s dental issues. In this way, patients are not forced to drive to an appointment to be looked at and then drive back another day for treatment.
“We cannot provide care with teledentistry, but we can save visits,” Eliav said.
The future of dentistry
Teledentistry is one way in which the institute is trying to fill a need within the industry: a lack of dentists.
Talking about the big picture in America, we don’t have enough dentists in America,” Eliav said. “If you look at the number of dentists per 100,000 people, in Europe it’s 100. Where I came from it’s 110. In the United States it’s about 60. But most of them are accumulating in big cities.”
When given a choice, an oral care provider probably would practice in Rochester versus a small town in the Southern Tier, Eliav explained, which means an entire region is not being served properly.
“The care that is provided to people in rural areas is not of the quality that we provide here,” he acknowledged. “This has to be stopped. It cannot be in the 21st century in this country.”
Eastman Institute is funded primarily through grants from the National Institutes of Health, as well as some private funding. Next year the institute will receive roughly $9 million in grant funding. Since 2013, the number of grants Eastman Institute has received has doubled, Eliav said.
“Rochester has one of the best rates of funding. Rochester is a leading university in research and NIH funding,” Eliav said. “But we know for every three, four or five (grant) submissions we will maybe get one.”
One grant in particular that Eliav is excited about helps Eastman Institute’s students, which in turn helps the community.
“One of the problems that we have in dentistry is a dentist that is finishing a dental school, usually the average loan that they will have is more than a quarter of a million (dollars),” Eliav said. “And that does not include specialties because they have to pay tuition for specialties.”
At Eastman Institute, Americans receive a stipend for tuition, but foreigners may rack up huge debt to receive an advanced education.
“So we got a grant that’s paying tuition for faculty that we want to keep. The condition that we got is that we are also responsible for the development of their career, which fits very well with what we want,” Eliav explained. “We have five in the program and the sixth is coming in, that all of them are having clinical expertise and research interest and we’re trying to build them into the best faculty members we can.”
Each of the students, who are clinicians and researchers, must stay here at least five years, Eliav added.
Another grant will help fund training in the area of special needs. The $3.5 million grant will expose 100 dentists to treating patients with intellectual and developmental disabilities, patients with complex diseases and the elderly.
It is an area that will continue to help families like Goodnough and her son. Goodnough called the staff who takes care of David “angels.”
“I tell them every time I go over there, you guys think this is just a job, but you have changed David’s life,” Goodnough said. “Just the way they treat us makes me trust them.”
Oral health is the No. 1 unmet health care need among patients with special needs, Eliav said.
“We have 12,000 patients with intellectual and developmental disabilities. Most live in community-based residences,” Eliav said. “So our goal is to increase the amount of patients we see and see less patients under general anesthesia. That’s something to achieve.”
To that end, Eastman Institute will undergo a $9 million renovation beginning in December at its Elmwood Avenue facility. One floor of the building will become a clinic, with one component for patients with special needs and another for interdisciplinary work.
A simulator clinic will be added to the top floor in order to train dentists before they do complex procedures, and the institute is adding an area for residents.
Eastman Institute has evolved through the years as the field of dentistry has evolved. Renovations and increased funding will continue to help the institute attract the world’s best dentists.
“After all these years, I know my life would not be the way it is right now, which is a very beautiful life I have, if it were not for the time I spent in Rochester,” Bello said. “I found everything I needed to excel in the field of dentistry.”
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