Featured in the Penn Dental Journal

For the University of Pennsylvania School of Dental Medicine Community

It is Tuesday and that means the dentist is in at the LIFE Center, thanks to a new partnership launched this September between the School of Nursing and Penn Dental Medicine that has brought dental care services to the Center. One day each week, a group of Penn Dental Medicine students join Dr. Alisa Kauffman (D’85). Clinical Assistant Professor in Penn Dental Medicine’s Division of Community Oral Health and Director of Dental Services at LIFE, to treat senior citizen at the Center.

The first patient this morning is a 66-year-old man getting partial upper and lower dentures. He is a typical patient-bags of denture to be given out that day crowd a table. Dr. Kauffman, lively and talkative, inserts the dentures, asks about the fit, then hands him a mirror to see the outcome. “You look great. Go to lunch and come back if it hurts.” Dr Kauffman advises as he leaves the room with a big smile.

There are more than 20 patients on the schedule for dental care that day at LIFE, all of them elderly, many with infirmities, some with canes, and a few with dementia. LIFE, which stands for Living Independently for Elders, is a program run by Penn’s School of Nursing that provides a wide range of on-site services to help elderly residents receive care in the community, enabling them stay in their homes rather than moving to nursing homes.

Now in its 12th year, the program is nationally recognized innovative nursing model of care, according to Eileen Sullivan-Marx, PhD, CRNP, FAAN, RN, Shearer Term Associate Professor for Healthy Community Practices and Associate Dean for Practice and Community Affairs in the School of Nursing. The facility at 45th and Chestnut streets serves residents of West and Southwest Philadelphia.

“I was introduced to the LIFE program and the nursing faculty involved many years ago through mutual involvement in the Bridging the Gaps program, an outreach program in which medical, nursing, dental and social work students work in teams to provide health promotion activities at community sites,” says Dr. Joan Gluch, Director of Community Health at Penn Dental Medicine. When LIFE moved to its now, larger location in March 2007, space became available for a dental office, she adds, opening the door for a collaborative clinical program. The LIFE program previously utilized a mobile dental company to serve its members.

“Pen Dental expressed an interest in increasing learning opportunities in geriatric dentistry and we had a need to bring dental care within the LIFE Center,” says Dr. Sullivan-Marx, “so between conversation among faculty, associate deans and deans, we met and launched a contractual agreement for Penn Dental Medicine to provide dental services to our LIFE members.” Those discussions were first initiated last spring between Penn Dental Medicine’;s Morton Amsterdam Dean, Dr. Denis F. Kinane, and the School of Nursing, and by summer, work was underway to turn Room 200 of the LIFE Center into a state-of-the-art dental treatment room.

THE HOUSE CALL GERIATRIC DENTIST COMES TO LIFE.

Enter Penn Dental Medicine alumni Dr. Kauffman, who practices geriatric dentistry two hours north in New York City. Since her days as a student at Penn Dental Medicine, when she liked to spend time in the denture lap, and continuing to her first professional job treating nursing home patients, Dr. Kauffman has had a particular affinity for the needs and rewards for working with geriatric patients.

So in 1988, she decided to establish “NYC House Call Dentist” – a home-based geriatric dentistry who need dental treatment, but cannot leave their homes. She notes that it is a challenge to practice under these circumstances – using mobile equipment, she dies everything from general restorative care to extractions in chairs, sometimes even in beds – but most of her patients otherwise would not receive dental care at all.
Dr. Kauffman spends three days each week treating geriatric patients in their homes through her practice, one day working at four nursing homes, and now since the fall, one day at the LIFE Center as the Director of Dental Services.

The opportunity for Penn Dental Medicine to partner with LIFE came up after Dr. Kauffman had met Dean Kinane at alumni event in fall 2009 and expressed interest in becoming more involved with Penn Dental Medicine. Soon after, she lectured to last year’s sophomore class about her unusual practice. It was fortuitous timing and a perfect fit.
Dr. Kauffman was thrilled at the thought of spending one day a week in her hometown and with her alma mater to help launch the dental collaboration at LIFE, treating patient and teaching dental students who rotate there each week. Despite having to get up at dawn on Tuesday to catch the 7:25 train to Philadelphia, she relished the opportunity to get involved in a fantastic Penn project,” as well as the chance “to give back to Penn Dental the gift of knowledge they had given me 25 years ago.”

A RICH LEARNING ENVIRONMENT.

Indeed, the collaboration at LIFE between Penn Dental Medicine and the School of Nursing benefits all the parties involved – along with the elderly patients who receive high-quality dental care in a convenient location, there is great education benefit for both dental and nursing students.

For dental students, LIFE offers a hands-on learning opportunity to gain experience treating the geriatric population. It is one of three required community health rotation for Penn Dental Medicine students: the others are Penn Smiles and the Elwyn Institute, which provide dental care, respectively, for Philadelphia public school students and and disabled adults. Typically, two or three fourth-year students go to LIFE each week, and speaking to her in early March, Dr. Glunch estimated that at that time more than 60 Penn Dental Medicine students had completed a rotation at the Center.

Isaac Alkolomber (D’11), one of the fourth-year dental students working at LIFE recently, said this and the School’s other community health rotations offer valuable experience and perspective. “It’s really important for dental students to work with lots of different populations,” he says. “And it encourage students to graduate and give back to the community.”

“Providing clinical service in collaboration with nursing is a natural fit for dentistry within the philosophy of LIFE, which stresses healthy living and independence for seniors.”

Dr. Gluch notes. “Although dental students gain experience with older patients in our dental school clinics and in their Oral Medicine rotations, we are very happy to have an additional community-based clinical rotation to allow students to treat older patients, given the demographic projections for growth with this population, especially in the community setting.”

More fundamentally, she adds,

“Penn Dental Medicine’s presence at LIFE signifies a commitment to the School of Nursing, LIFE, and the local community to provide increased access to oral health care at the highest quality level through interprofessional collaboration.”

Nursing students benefit from the collaborative approach because of the patients’ dental care needs, notes Dr. Sullivan-Marx. “Patients with limited chewing and nutritional intake due to oral and dental disease can be treatment to improve nutrition, chronic dental pain can be alleviated, and risks factors for poor health outcome due to diabetes, hypertension, and smoking can be ameliorated by preventing deterioration in oral health.”

At LIFE, “nursing students are learning increased skills in oral health assessment and dental students are learning about geriatric dental care,” she continues. “And both are learning to work across disciplines.”

The experience also offers new opportunities for students who are beginning to plan their careers, Jessica Meier, (D’12) a third-year student who expressed an interest in geriatric dentistry to Dr. Gluch and got the opportunity to participate at LIFE ahead of when she normally would rotate their, credits her positive experience at the Center for her decision to focus her career in geriatric dentistry. “It open my eyes to an entire field of dentistry that I otherwise
might not have been expose to,” she says.

She notes that not only did she get to practice such clinical skills as taking denture impressions, cementing crowns, and screening for oral cancer, Meier also learned about the challenge of working with an elderly population, particularly, she says, the need for patience and good communication skills with these clients.

“The rewards of working with this underserved population are endless,” she says, while crediting Dr. Kauffman as an excellent teacher. “It’s wonderful that students can work with her and learn her innovative methods of patient care and dentistry.”

Back in Room 200 on that March morning, there is still a long day ahead for Dr. Kauffman – the hallway is crowded with waiting patients, but she greets each one like an old friend. Although she is working with a similar population as her house-call practice, she appreciate that at LIFE she is working alongside other healthcare professionals and that she has access to state-of-the art equipment.

“The program is working well; I love it,” says Dr. Kauffman. “The students are engaged and eager to learn the unique aspects of treating geriatric patients, and the LIFE members are delightful. It’s a productive, fun and environment for all.”

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Dr. Alisa Kauffman was recently honored by one of her students in the Penn Dental Journal of Medicine.Dr. Houston plans to provide comprehensive oral exams and basic dental care, including prophylaxis and periodontal treatments, simple operative procedures, basic extractions, and removable options. She was inspired by the success of Penn Dental Medicine graduate and clinical director, Dr. Alisa G. Kauffman (D’85), who has proven the viability of a mobile dental practice. “Access Home Dental, my Washington, D.C.-based mobile practice, remains in its infancy,” Houston says. “However, I hope to follow in the footsteps of Dr. Kauffman, whose mobile dental practice has already made a huge impact in both our industry as well as her community.”

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