Spring 2013 - Tufts University School of Dental Medicine

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a specialist, they can come back here to have regular checkups. They can save the long distances for restorative care.” Desjardins’ teams, both at St. Apollonia and Academy, use technology to make obtaining dental care as convenient as possible. When a toddler bumped into a coffee table and knocked a baby tooth out of place, staff from Academy emailed Jonathan Shenkin, a pediatric specialist in Augusta, a photo of the injury. Within minutes, Shenkin was able to advise them about how to proceed. “We did a little tele-dentistry,” says Desjardins. “It was great to be able to get his expertise that way.” While this happened at the private practice, Desjardins says she could easily see a similar scenario unfolding at St. Apollonia. Convenience is not the only reason Kathy brings her children to St. Apollonia, though. Each of them has a disability. Christopher is autistic and can be unpredictable at times. Other clinics, ill-equipped to manage his behavior, have turned him away. St. Apollonia “never hesitated to take him,” Kathy says. Yvonne Tardie is also grateful to have a dental clinic closer to home. It takes just 10 minutes to get to St. Apollonia from her home in Washburn. Before, the Tardie family, who rely on the state’s public insurance program, known as MaineCare, had to travel an hour to Eagle Lake to find a clinic that would accept their insurance. “My husband had to take half a day off from work,” she says in slightly French-accented English. “Not everybody takes MaineCare.” For some residents, even living next door to a dental clinic wouldn’t guarantee access to care. Beyond the scarcity of providers, many Mainers can’t afford to pay out of pocket, and few clinics accept public insurance. Maine’s rural residents tend to be older, sicker, poorer and less well educated than their urban counterparts. That demographic creates a perfect storm: residents of the state’s sparsely populated counties are more likely to have poor oral health and less likely to have dental insurance. The situation only worsened with the economic downturn. Even though a new report commissioned by the state of Maine found that a greater percentage of the total population had dental coverage in 2010 than in 2006, fewer had it through a private insurer. That means MaineCare picked up the tab for more and more patients, covering about 20 percent of the state’s rural residents. Between 2006 and 2010, the public insurer paid out an average of $31 million annually for dental care, an amount that represents less than 2 percent of the public insurer’s total spending. (Eligibility requirements vary by age, circumstances and size of family; for example, a family of four is eligible for free dental and medical coverage if its monthly income is less than $2,882. But TufTs ExTErnship siTEs in MainE uring their third or fourth year of school, all Tufts dental students embark on a required five-week Community Service Learning Externship at one of more than 30 sites nationwide. These off-campus training periods are designed to give students real-world appreciation for access-to-care issues as they hone their clinical skills. Cynthia Yered, D90, associate clinical professor of public health and community service, expects about a dozen members of the class of 2014 to be assigned to one of four such sites in Maine. Katahdin Valley Health Center in Millinocket is the northernmost clinic and is still more than 100 miles south of Presque Isle, where Norma Desjardins, D92, operates her low-cost pediatrics clinic. As soon as she has another operatory, Desjardins hopes St. Apollonia Dental will be able to host Tufts externs. The other Maine extern sites are Caring Hands Maine, in Ellsworth; Penobscot Community Health Care Center in Bangor and Community Dental with five locations in southern Maine. Main Street, downtown Presque Isle. 22 tufts dental medicine spring 2013
even among the 110,000 children enrolled in the program, more than 53,000, just under half, went without dental care in 2010, according to the Maine Department of Health and Human Services. That likely has to do with MaineCare’s low dental reimbursement rates, which rank 38th in the country. Desjardins estimates the public insurance pays about half of what she’d normally charge for many dental procedures; for some dentists, the reimbursement rate is as low as 25 percent. Small wonder then that fewer than half of the state’s dentists accept MaineCare, and twothirds of general dentists who do so limit the number of publicly insured patients they treat. That’s part of the reason Maine ranks 34th among the 50 states and the District of Columbia in the number of residents who have seen a dentist in the last year. the Big iDea It was in 2009 that Desjardins first thought about opening a clinic to serve children with no place else to go. She had been asked to serve on a health services advisory board of the Aroostook County Action Program, an umbrella organization that helps connect low- and moderate-income families with such services as health care, job training and home repair assistance. Desjardins attended one meeting that focused on the difficulty of finding dental providers for local children enrolled in Head Start, the federal program that promotes school-readiness among toddlers from low-income families. Federal law requires all Head Start children to have a dental exam within 90 days of enrolling in the program. With the shortage of dentists in Maine, that can be tough. “There just aren’t enough hands to do the work. It had really been that way for years,” says Desjardins, a former Head Start child herself. “Also, these little ones who have a hard time getting into an office, they also have the greater need.” Desjardins was never one to shy away from hard work—she was among the top students in her dental class, even though she gave birth to her two children, Emily, now 24, and Gerard, 22, while she was in school. She began laying the groundwork for the low-cost clinic, writing grants for funding and making presentations to local groups, including the Rotary Club, the Kiwanis and the Knights of Columbus, in search of donations. Her big idea came along at the right time. Years of doing lengthy dental procedures had begun to take a toll on her health. The pain she had been experiencing in her neck, shoulders and arms began to worsen and affect her legs. Eventually, she was diagnosed with fibromyalgia, a nervous system disorder that can result in soft-tissue pain well as fatigue. “I went from somebody who had endless energy to someone who couldn’t walk from the bedroom to the kitchen without feeling like I needed a nap,” she says. Realizing she would have to limit the number of hours she cared for patients, Desjardins was devastated, at first. “I had worked with pain for a long time. I was worried I wasn’t going to be able to practice anymore. Now I’ve learned I have something to offer besides the way I was doing dentistry before.” She began devoting one day a week to getting the low-cost clinic up and running. After teaching herself to write grant applications to private foundations in Maine, she secured $65,000. She created a PowerPoint presentation, which she used with groups such as the VFW and the American Legion. The clinic became the Presque Isle Rotary Club’s special project, which helped raise another $38,000. “They presented us the check, and that’s how that first operatory became feasible,” she says. “From the beginning, this wasn’t going to be ‘Norma Desjardins’ clinic,’ ” she says. “This clinic is going to be the community dental health clinic.” Once St. Apollonia had an operatory, Desjardins, needed to hire a dentist, and one who embraced community service in a big way. A native of upstate New York, Keely O’Connell, a 2012 graduate of Creighton University School of Dentistry in Nebraska, answered the call. O’Connell moved to Presque Isle eager to take on lots of responsibility early in her career. “It has been wonderful to have her as our inaugural dentist,” says Desjardins. “This year has gone by so fast. I have to admit every day presents new challenges,” says O’Connell. A challenge for Desjardins is the reality that her dreams for St. Apollonia require dollars. She estimates the clinic needs an annual operating budget of $350,000. She wants St. Apollonia to become self-sustaining, like a private practice, running off income from the services provided—a lofty Whilenearlytwo-thirdsofMaineresidents liveinruralareas,just13.5percentofthe state’s dentists practice in those regions. goal, given MaineCare’s reimbursement rates. To get there, says Desjardins, “we have to create an environment where [patients] are coming in with less decay.” Amid all the new beginnings for Desjardins in 2012, there were endings, too. Between Thanksgiving and Christmas, her mother-in-law, Lorraine, and her father, Normand LaJoie, passed away. Now, more than ever, she sees the clinic as a tribute to the values her parents and her husband’s parents instilled in their children. “There are so many stories—so many things us kids don’t know—about our parents helping other families,” says Desjardins. “Now that my dad’s gone, I feel even more of a sense of responsibility to honor him and my mom by continuing this work. Both her and her husband’s mothers took advantage of the Head Start program when their children were small, and both women remained deeply involved with the program well after their kids were grown. That’s one reason Desjardins remains committed to providing dental care for Head Start preschoolers, though she says she is equally steadfast about helping “anyone who is trying to make their way, anyone who is struggling for whatever reason.” St. Apollonia’s is “meant to be here as long as these kids need it,” Desjardins says. “Unfortunately, I think that’s going to be a long time.” tDm Jacqueline Mitchell, a senior health sciences writer in Tufts’ Office of Publications, can be reached at jacqueline.mitchell@tufts.edu. spring 2013 tufts dental medicine 23
Page 1 and 2: MAGAZINE OF THE TuFTs uNIvErsITy dE
Page 3 and 4: contents SprINg 2013 voLuMe 17 No.
Page 5 and 6: from the dean No Simple Issue greet
Page 7 and 8: where patients thought to have slee
Page 9 and 10: the A smattering of dentistry tidbi
Page 11: “WHAT’SREALLYSPECIALABOUTTHEEPI
Page 14 and 15: Tufts Dental Medicine: So your firs
Page 17 and 18: Buoyed by economic and social chang
Page 19: actively engaged professionals, the
Page 22 and 23: ike many of the country’s rural r
Page 26 and 27: A world war was raging, money was s
Page 28 and 29: Left, the exterior of Tufts College
Page 30 and 31: Below, Erna and Alfred Heininger in
Page 32 and 33: Thanh-Trang Nguyen, D01, with her m
Page 34 and 35: painless. That was the first time I
Page 36 and 37: on campus knew he was good at scien
Page 38 and 39: on campus Revolution Afoot 21st-cen
Page 40 and 41: on campus onekneeland In case you h
Page 42 and 43: on campus 1 2 The Most Valuable Too
Page 44 and 45: on campus vaLUabLe, continued from
Page 46 and 47: advancement giving. growth. gratitu
Page 48 and 49: alumni news staying connected Chang
Page 50 and 51: alumni news Above: Derek Wolkowicz,
Page 52 and 53: alumni news out&about Golden Gate G
Page 54 and 55: alumni news class notes Stephen M.
Page 56 and 57: alumni news have three children, Ga
Page 58 and 59: Courses fill quiCkly! register earl
Page 60 and 61: SPORTS FOR SCHOLARSHIP OPEN Join th
Page 62: School of Dental Medicine 136 Harri

Spring 2013 - Tufts University School of Dental Medicine

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