Wisdom of the Ages

The elderly patient looked in the mirror, gave herself a tentative smile, and started to cry. For years, she had a front tooth that stuck out because it was longer than the others. Now Lillian Mitchell, D.D.S., and her UAB School of Dentistry students had shortened it and polished it to blend in with the rest of her teeth. “I can smile again,” the patient said.

Moments like this “are when students realize they can change a life,” says Mitchell, director of geriatric dentistry at UAB. There have been many such moments since the day in 2010 when she first arrived at Birmingham’s Fair Haven Retirement Community with a small group of students eager for some hands-on experience. They had little but their own equipment and the spin brushes Mitchell had picked up at a discount store. Since then, the operation has grown into a dedicated, full-service dental clinic—the only one inside a retirement community anywhere in Alabama—providing cleanings, extractions, fillings, dentures, crowns, radiographs, and care for prostheses and implants. Support from Fair Haven, the School of Dentistry, the Community Foundation of Greater Birmingham, and Henry Schein Dental makes the clinic possible.

Three days a week, third- and fourth-year dental students see residents at Fair Haven as part of their clinical rotations. The geriatric clinic provides them with a unique setting to connect with patients and learn from them as well, Mitchell says. “One student told me, ‘These patients let me take my time, and they listen, and I can listen to them,’” she says. “For the students, it takes their initial fear out of treating patients because the patients appreciate what’s being done for them.”

The rotation also gives dental students opportunities to discover how the aging of America’s population will affect their future practices. “When they come to Fair Haven, it becomes more real to them,” Mitchell says, noting that one in four dental patients will be over the age of 65 in the next 25 to 35 years.

 

Mitchell acknowledges that geriatric dentistry appeals to some students more than others. “Geriatric dentistry isn’t sexy,” she says. “It’s not bleaching teeth to make them white or putting on veneers. For these patients, it might take three or four appointments just to get all their teeth clean, because they might not be able to tolerate it healthwise, or tolerate it psychologically, because they get scared. It’s down and dirty work.”

Third-year dental student D’Andrea Nekelle Holmes, who began shadowing in the clinic during her second year, didn’t need any convincing to get involved. “Some people have the perception that working with older patients will be a hassle, and it does pose challenges you wouldn’t have with younger patients,” says the Montgomery native. “But I can handle it.”

Holmes explains that a key obstacle is working with patients who suffer from dementia and who might not be able to communicate or even cooperate during exams and other dental procedures. Some other patients must receive treatment in their wheelchairs. On the flip side, however, Holmes is drawn to the chance to work with a population that is paradoxically underserved but also in great need of professional oral care.

“Geriatrics doesn’t get enough attention, but it’s one of the most important areas of dentistry,” Holmes says. “Older people’s dental health has a direct influence on their overall health. If they can’t chew, then it affects how they eat, and they won’t get the nutrition they need. Or if they take a lot of medications, that can cause things like dry mouth. Serious periodontal diseases are also common. So as much as older Americans go to their physicians, they need to visit the dentist as least as much.” Oral health also has links to diabetes, heart disease, stroke, arthritis, dementias, and aspiration pneumonia.

The relationship between UAB and Fair Haven has created new ways to learn about, and practice, holistic patient care, Mitchell says. Through the award-winning Interprofessional Clinical Experience for Healthcare Professions in a Nursing Home Setting initiative, created in 2011 as part of the federally funded UAB Geriatric Education Center, dental students meet weekly with counterparts from disciplines such as optometry and occupational therapy to create comprehensive care plans for patients. Separately, UAB medical interns also rotate through the geriatric clinic, learning to conduct oral exams and assist with procedures; they, in turn, share their knowledge with dental students.

“This is the way of the future for health care, to look at a person holistically and not in a silo,” Mitchell says. “It’s a wonderful opportunity for the students to learn about one another’s disciplines so that when they’re out there practicing, they’ll have a better idea of who can help when different issues come up. We want to teach the students to examine the mouth and teeth, but they also have to look at the whole person. The geriatric clinic gives them the opportunity, resources, and time to do that.”

To that end, Mitchell encourages students to engage with the Fair Haven seniors beyond the clinic. Students sometimes eat lunch with the residents in the dining room or escort them back to their rooms after dental visits. Some—including those who have not yet done rotations at Fair Haven—have volunteered for Valentine’s Day parties and other events for the retirement community’s residents, showing up to dance and socialize with them.

Mitchell hopes that some of the students who work in the clinic will make older patients a focus in their future practices, which would help meet the growing need for geriatric dental care. Holmes is considering it, saying she may practice in a retirement community at least part-time after she graduates. “I want all the dental students to recognize the gift they receive in rotating here,” Mitchell says.

It’s the gift of experience and knowledge—but also the gift of appreciation from an elderly woman who can smile once more. “Dr. Mitchell has so many stories about needing to have patience,” says Holmes, “but she always emphasizes the reward.”