M - Dentistry Spring 2023

Dr. Nelson Smith: The rewards and importance of practicing dentistry in the Upper Peninsula

As someone who grew up in the urban landscape of Chicago, Nelson Smith would seem an unlikely fit for thriving in the mostly rural, small-town life of Michigan’s Upper Peninsula.

He came to the University of Michigan in 1960 as a big-city boy with a talent for math and science. He spent a decade in bustling Ann Arbor, deciding to pursue dentistry during his undergraduate years, then earning a DDS in 1967 and an MS in orthodontics in 1970. When it was time to decide where to start his career, Smith and his wife Dawn made a decision that was perhaps surprising given his city-based life up to that point. They chose Escanaba, which is halfway across the U.P. on the north shore of Lake Michigan.

A large part of the decision was the recommendation of friends Smith met in in dental school who were from the Escanaba area and had returned there to practice. The couple decided that it was a good opportunity because there was no orthodontist in the town of what was then about 15,000 people. But that meant Smith couldn’t take over a retiring dentist’s patient base or join an existing practice; he had to start from scratch.

At first, it was a struggle. But within a few years, with the help of references from his

general-dentist friends, it was a busy practice with patients coming from a wide geographic area. Along the way, Smith fell in love with the U.P. life – the great outdoors, the scenic Great Lakes and the camaraderie among people who choose to live away from the urban centers in a place where the fabulous summers give way to the shared challenges of northern Michigan winters.

By the time Smith retired in 2001 after 31 years of practicing, he had the deep satisfaction of having treated and improved the smiles of hundreds of patients from a wide area. During a recent interview from his winter home in Sarasota, Florida, he said he is grateful for the path his life has taken as he and his wife raised three children and built the successful orthodontics career. The couple still spend much of the year at their home in Gladstone next to Escanaba where they are close to their extended family (two of their three children live in the area) and the many friends they’ve made by being mainstays in the community for more than 50 years.

A man of good humor and many stories, Smith brings a positive and self-deprecating tone to his tales. And in their telling, without really trying, he provides an enthusiastic endorsement for dentistry as a career, the University of Michigan and its dental school, and life in the U.P.

And in the first few months, it seemed as through the faculty prediction might come true. Dawn, whose background was as a dental assistant, was the office manager but there weren’t many patients to manage. Smith puts it this way: “We got up there and I got started in September of 1970. In February of ‘71 I thought I wasn’t going to eat anymore. I thought I was going to starve to death.” What the couple didn’t know was that U.P. residents typically don’t want to start projects, such as a series of orthodontic appointments, in the winter because the extensive snowfall and ice often make travel difficult. “Because of that, you don’t see a lot of new patients in January, February and part of March,” Smith said. “And then it picks up after that. It’s kind of a cyclical thing during the year. But it was just a matter of getting patients in, getting their treatment going, getting the payment schedules up and running. It all worked out. Not only did I survive, I thrived.”

The unique U.P. geography meant Smith’s patients often drove long distances of an hour or more, from Iron Mountain, Menominee and Manistique, among others. To reward his patients’ loyalty, over the years Smith began making house calls for some of his most-distant patients. If the next step of the orthodontic treatment plan was a relatively simple procedure that required only a brief in-office appointment, Smith would instead plan a fishing trip to a lake or stream near the patient’s home. He would drive to their home near Newberry, for example, and make the simple ortho adjustment so they wouldn’t need to make the 230-mile roundtrip to Escanaba. Then he’d be on his way to his fishing spot. He also occasionally visited hospitalized patients to complete an adjustment if they were not going to be able to make their next scheduled appointment.

Living in the U.P. generates camaraderie, Smith said. “People are so appreciative of having quality health professionals in the U.P., particularly in our early days because that wasn’t so much the case back then. They were so appreciative of anything you did for them. Everything you did was perfect as far as they were concerned. So it was a terrific place to practice. When we would go into a restaurant, people were always buying us a beer or a drink. People were so giving. They wanted to do something for you because you did something for them.”

Deciding on dentistry

Smith’s journey into dentistry began after he came to U-M in 1960 for his undergraduate studies. He considered medicine and dentistry. “I’m better at math and science than I am at everything else,” he says. “Math and science made sense to me. There was only one result if you did things right.” He began leaning toward medicine because there were “an awful lot of smart guys” in his fraternity who were going to med school. Then one day, in an example of how little things can sometimes change a life’s direction, Smith learned something from a player in a pick-up basketball game at the Intramural Building. His usual group of basketball buddies was joined by a talented new player. When the group invited the new guy to join them more often, he said that wouldn’t be possible: “This is the first afternoon I’ve had off in three months. I’m in med school and we work 24-7. It’s just ridiculous.”

“And I thought, hmmm, this doesn’t seem like the life for me,” Smith recalls. “So I started taking an interest in dental school.” It helped that the wife of Smith’s brother Marshall was a dental assistant for an orthodontist in suburban Chicago. Smith visited that office and it helped focus his interest on dentistry and orthodontics.

Gaining admission to the U-M School of Dentistry was not a problem given his excellent math and science grades and the strong demand for dentists. He was admitted after only three years of undergraduate study, which was not uncommon then. “In 1963 when I went in, if you walked by the dental school, they had people out there grabbing you by the arm and saying, ‘Hey, why don’t you come on in and be a dentist?’” he says with a laugh, only half joking. “There wasn’t the competition for getting into dental school that you have now. It wasn’t anything at all like it is now.”

What does he remember about his days in dental school? “Fun. I had fun. I thought dentistry was a neat profession. Of course it was science-based and I was always good in science. I didn’t think it was particularly hard. I just seemed to adapt to it really well. I enjoyed the hands-on work. I enjoyed the clinical work.”

His faculty mentors included Drs. Fred Kahler and Charles Cartwright, both in Operative Dentistry, and Jim Harris in Orthodontics. As his DDS graduation approached, faculty and administrators offered Smith an instructor position in Operative Dentistry, which became a valuable year. “When you teach techniques in clinic, you do a lot of learning because, first of all, you are around such quality dentists on the staff. And, second, you are trying to relay these thoughts and your techniques to the students. By all that repetition, you become very good at what you do.”

After teaching for a year, he enrolled in the orthodontics residency, earning his MS two years later in 1970, and then it was on to Escanaba.

U.P. connections

Smith credits friends who were dental students with influencing his decision to move north. Dr. Robert Johnson was in Smith’s DDS Class of 1967 and started his career in Menominee, in the U.P. on the Wisconsin state line. Two other friends who were in the year behind Smith – Drs. Bill Knudsen and Mike Kelly (both DDS 1968) – were just up the road from Menominee after they graduated. Knudsen was practicing in Escanaba and Kelly had joined his family practice next door in Gladstone. They and another Escanaba dentist, Dr. Vernon Johnson, then president of the Michigan Dental Association, encouraged Smith to consider the Escanaba area.

Yet another influence for the decision, Smith says with benefit of hindsight, are two public service programs he participated in while at the dental school. The summer after earning his DDS degree, and again the summer after he finished his MS degree, he participated in a state health program that provided dental care to school-age children on Beaver Island. The isolated community, which lies in northern Lake Michigan about 30 miles northwest of Charlevoix, didn’t have a resident dentist, so the summer program bridged the gap in dental care. Smith also was part of a community service outreach summer program for children and adults with disabilities at the Bay Cliff Health Camp north of Marquette along Lake Superior. Smith said both experiences impressed on him the widespread need for good oral healthcare and his ability to have a positive impact on patients in rural settings who have less access to dentists.

That need in the U.P. has not lessened over the years. Smith recognized the importance of recruiting dentists to the U.P. as far back as the mid-1990s. He approached the School of Dentistry with a financial gift in order to start a scholarship fund, initially as a way to help the son of one of his dental assistants who was admitted to the dental school. It morphed into a much broader initiative called the Upper Peninsula Dental Society Scholarship Fund that has been supported financially by dentists across the region for the last 25 years.

The purpose is to promote dentistry to promising students from the U.P., then help fund their dental school costs as incentive for them to return to the U.P. to practice. More than 60 have benefitted from the scholarship program. Recipients are not required to practice in the U.P., but most have.

The very first recipient, Dr. Steve Ouwinga (DDS 1998), purchased Smith’s orthodontics practice in Escanaba when Smith retired. The importance of passing-the-torch from retiring dentists to new dentists is a major concern of dentists across northern Michigan and the U.P. “It is really, really needed in our area in Delta County,” Smith said. “We only have about 16-18 dentists in the Escanaba and Gladstone area. And that hasn’t changed. There were about that many when I got there and it’s still about the same. So many of the dentists – about 10 – want to retire. So it’s important to get kids into dental school who are interested in having a career there. We need that because we’re going to be really hurting in about five years when dentists start retiring.”

Nelson Smith and his grandson Ben Kelly, an entering D1 this year at the School of Dentistry. Kelly's Class of 2027 will be 60 years after Nelson graduated in 1967.

Smith is pleased to report that he knows at least two students entering dental school this year who plan to practice in the U.P. once they graduate. His grandson, Ben Kelly, and Ben’s fiancée will be first-year dental students at U-M this year.

In an interesting mix of dental school history and family genealogy, Ben is also the grandson of Nelson Smith’s longtime friend from dental school, Mike Kelly. The families were linked when one of Nelson and Dawn’s daughters, Jessica, married Mike’s son, Dr. Scott Kelly, who continues the Kelly family practice in Gladstone. Ben will be the fourth generation of the Kelly family dentists dating to his great-grandfather George, and he’ll be the third Smith generation after Nelson and his nephew, Dr. Aric Smith, an endodontist in Grand Rapids, Michigan.

Nelson Smith knows family traditions alone won’t supply enough new dentists, so it’s important to cast a wider net. That’s why he isn’t shy about sharing his testimonials for dentistry in the U.P. “The opportunity is there. Trust me,” he says. “It is a wonderful area to build a practice. If you are not from there, you don’t fully realize the potential.”

Smith frequently encounters his former patients who contribute in myriad ways to the fabric and success of the Escanaba/Gladstone area. They are confirmation of the importance of providing easily accessible and excellent oral healthcare across the region.

“I was fortunate enough to have Steve Ouwinga come back and purchase my practice, and he’s doing it even better than I did,” Smith said. “So it’s a good feeling to see what you built and have someone come in and make sure it is done with the same quality and to the same satisfaction of the patients.”

He says he is still an interested observer of how Dr. Ouwinga is doing with his former practice, but retirement has its benefits. “I still go into the office,” he says, pausing for effect. “I go in and eat their doughnuts and drink their coffee.”