General Practice Residencies: A Bridge Between Oral and Systemic Health

01 Feb General Practice Residencies: A Bridge Between Oral and Systemic Health

It didn’t take me long to realize I was ill-equipped to treat medically compromised patients. It was only week one of our two-week hospital dentistry rotation at the University of Michigan Hospital. “The U Hospital” was and still is a mecca of medical enigmas and syndromes. I saw patients there that I had only read about previously and was assured I would rarely see in private practice–Treacher Collins Syndrome, Self-Inflicted gun shot survivors, and every level of disability imagined. It was our job to clean these patients’ teeth and understand their needs. We were dental students, under the guidance of amazing dental and medical staff, serving a population often referred there because no one else knew how to care for them. We were many parents’ last hope.

It was part fear and part empathy that led me to apply for several General Practice Residencies (GPR’s) as I approached graduation–a GPR is no more than a very intense, extended form of a hospital dentistry rotation as experienced in dental school. I knew I wanted to be ready to care for these challenging patients because places like “The U” already had month-long waiting lists, and two-week rotations were not enough. I knew I needed to know more about medicine, about diseases, and most importantly, I knew I needed to face my fears of treating patients with severe medical disabilities. I needed to be confident that even though these high risk patients could die more easily in my hands because of all of their complications or disabilities, I would know how to handle their needs as safely as possible.

Thankfully, I was selected and matched with the Ann Arbor Veterans Administration Hospital residency program. This meant more time in “The U” and new experiences in the Veterans Hospital because our training time was split between both hospitals and within the dental clinic. This experience did indeed help me build confidence in treating patients with disabilities. And, it did so much more than ever anticipated for my growth as a practitioner. I have to attribute my understanding of overall health to the early training I received in this program. I began to understand the hospitals’ systems and interactions with one another. I learned their language, their expected ways to communicate to one another, and I learned that no one knows everything about everyone. It is a team effort to get the patient what they need.

One big “I get it” moment came during a week-long rotation through the E.R. While following a medical resident around like a puppy all night, I realized he called specialists for everything: Lip laceration–oral surgeons got a call. Pregnant woman in pain–ob/gyn got a call. Severe facial wounds–plastics got a call. There was a very interdependent culture there, and I admired their willingness to call and ask for help and guidance. I also realized why it took so damn long to go in and out of an emergency room. That resident and I literally spent 15-20 minutes waiting for ob/gyn residents to call us back or waiting for other docs to return calls and provide the needed answers. As a student of communication, I observed the way communication was taking place as much as I was learning about the actual patient’s medical issues. It was fascinating to say the least.

Right now in dentistry there is a lot of discussion about connecting the gap between oral and systemic health. I would hope that somewhere in the discussion, a recommendation to expand or require a General Practice Residency experience for each dental student makes it to the table. Yes, it would require a lot more residencies to be created and it would cost money and it would be expensive and…and…and. But, I know I am saving a lot of time and money for my patients in their health care costs because I am a dentist who looks at the patient as a whole human being and can piece the patient back together more quickly and sometimes without expensive testing or equipment. Because of that, I can make recommendations to patients based on observations I see, hear, and sense in patients. This kind of expanded training and interaction with physicians and hospitals served as one of the cornerstones in my communication and dental expertise. I am ever grateful to the late Dr. Jonathan Ship, Dr. Samuel Zwetchkembaum, Dr. James Pikulski, Dr. Sean Edwards, Dr. Keith Rottman, Dr. Deb DesRosiers, Dr. Ken Shay, Dr. Ghezzi, Al and Nelson (two outstanding lab technicians) and many, many others who took time to help me learn and become confident in treating anyone.

Until we have a renaissance in dentistry and provide GPR opportunities for everyone, I hope I can help others bridge the gap between oral and systemic health with the knowledge I have. IntentionalDental Consulting is providing my platform for additional speaking and writing opportunities to share this knowledge, along with private lessons being offered to dentists who really want intensive training on communication and oral and systemic health guidance.

The more we think beyond 32 teeth, and let go of our fears to treat people beyond their 32 teeth, the faster our healthcare system will change and the better our patients will receive overall care, both dentally and medically. It’s all connected.


For Further Understanding: Here is a YouTube video from a Dr. Bicuspid interview. I hope I  demonstrate why the oral and systemic link is so important and why being intentional about choices really pays off.

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