Quynh Nguyen started to cry as she peered into the patient's mouth. "He was crying in pain and had all the symptoms of a methamphetamine addict—teeth crumbling, mouth ravaged by infection. When I examined his gums more closely, pus spewed out."
Her preceptor, the School of Dental Medicine faculty member overseeing her work, came to her side and talked her through the fine points of healthy detachment.
Community ACTS clincs
Hard lessons are learned when the fourth-year dental students enter into the 20-week Advanced Clinical Training and Service (ACTS) program. They leave the two-patient-a-day atmosphere of the campus clinic for the community ACTS clinics where they sometimes see eight patients a day, many with complex medical problems.
Nguyen once had to drill a tooth for a patient with Parkinson's tremors. "If I tried to steady the head, the tremors increased, so I had to learn to drill in a kind of rhythm. My heart was palpitating."
Nguyen, who graduated in 2008, is now a preceptor herself in a dental clinic that serves the uninsured in Denver. "I love my job," she says. "If it hadn't been for ACTS, I wouldn't feel the same about dentistry. The ACTS program showed me what I could do."
Nguyen also travels to her parents' homeland, Vietnam, to volunteer at orphanages and has long-term plans to work as a dentist in third-world and developing nations. "I've taken a huge pay cut, but I like helping those who are less fortunate."
Her parents left Vietnam for the United States to escape the communists in 1978, enduring 41 days at sea and brutal attacks by Thai pirates. Nguyen was born in Colorado and spoke only Vietnamese until elementary school.
"When I was eight, I wanted everything. When I was a teenager, my father took me to Vietnam so I could see how lucky I was. When I saw how others had to live, I never wanted anything again."
ACTS has its roots in the work of Larry Meskin, former dean of the School of Dental Medicine, with Rich Call and Kerry Maguire, longtime SDM faculty members. For more than 15 years since then, Rob Berg, associate professor and chair of Applied Dentistry, has directed the ACTS program. His interest in public health was piqued when he first worked with Native American communities as a dental student and later practiced as a tribal health director.
"The Advanced Clinical Training and Service program substantially broadens and deepens the students' experience and develops their self-confidence and good judgment," Berg says. "Their evaluations tell me the program has helped them both to grow and to realize how capable they really are."
The School of Dental Medicine's ACTS program came to the attention of health leaders in 1998, when Berg presented to the American Association of Dental Schools. Howard Bailit, a researcher in health care delivery to the underserved, and Allan Formicola, dean of the Columbia University College of Dental Medicine, persuaded a senior program officer at the Robert Wood Johnson Foundation to visit Colorado and see ACTS in action.
After visits to the Plan de Salud del Valle clinics in Fort Lupton and Frederick, the Woods foundation granted $20 million to promote a national program of community-based dental education.
Leading the way
Other dental schools have since developed similar clinical training programs. However, the School of Dental Medicine's program, with its 20 weeks of required ACTS affiliations for all graduates, is still the nation's largest overall commitment to community-based dental education.