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Community-Based Collaborative Care and Education program benefits students, expands dental care throughout Michigan
From the Elk Capital of Michigan in the far northeast corner of the Lower Peninsula to the busy urban landscapes of Grand Rapids and Kalamazoo, School of Dentistry students are taking their dentistry skills on the road to benefit a wide variety of the state’s residents.
The school’s vibrant Community-Based Collaborative Care and Education Program (CBCE) has come a long way since the days when students would leave the school only rarely for brief field trips to county health departments or to treat patients at the state prison or migrant farm worker camps.
The program has evolved into a year-round program that is a graded course in the curriculum, sending fourth-year students to clinics around the state for 12 weeks, usually for two weeks at a time. Third-year students also participate in CBCE, with fewer rotations for shorter periods of time. Students are assigned to 15 external clinic locations around Michigan, with two more coming online later this year. Most are Federally-Qualified Health Care (FQHC) clinics providing dental care to underserved patients. Some are Dental Service Organization (DSO) clinics, and some have more narrow patient populations, for children or military veterans. Regardless of the type of patients, all of the clinics enhance the broad diversity of patients and dental treatments beyond the normal patient pool scheduled by students at the dental school.
The number of locations, the length of rotations and the program’s status as required curriculum make CBCE one of the most extensive external rotation programs of any dental school in the country. Only a few others have mandatory external rotations; others provide short-term voluntary rotation opportunities, which is the minimum accreditation requirement.
U-M dental school leaders have long been committed to the educational value of external rotations as a supplement to the standard in-house clinical training that dates to the origins of dental schools. Dr. William Kotowicz, dean from 1995-2002, secured funding from various public and private agencies to broaden the piecemeal Community Outreach Program that had been in place for many years. Another significant upgrade came in 2006 when Dean Peter Polverini appointed faculty member Dr. Bill Piskorowski to lead and significantly expand the program. In 2017, after Piskorowski left the school, Dr. Mark Fitzgerald was appointed director and the program was renamed CBCE.
The early versions of the program had much the same goals as these today:
• To introduce students to community-based clinical education via FQHC dental centers, DSOs and Non-profit Outreach Facilities.
• To foster the integration and application of what students have learned so far into a community-based clinical environment.
• To provide exposure to the needs of underserved populations.
• To provide a focused opportunity to care for children in underserved communities.
Fitzgerald, now the school’s Senior Associate Dean in addition to CBCE director, says the program is crucial to the curriculum in terms of academic content and professional growth.
“The didactic and real-life exposure to social determinants of health and well-being help our students become more aware of the importance of these issues and better capable of meeting the needs of others,” Fitzgerald says. “Immersion into different communities, many with very different social and cultural backgrounds, helps to broaden their perspective of their role as health care professionals. The clinical experiences of our students not only provide a valuable repetition of clinical care but also an exposure to different practice environments and the demands of ‘real life’ dentistry.”
Another important aspect of CBCE is that school leaders have documented that it contributes to more students choosing community dentistry as the starting point of their careers. Students have frequently reported over the years that their perception of providing dental care shifted markedly after their rotations. Treating patients at FQHCs or in clinics in communities with large populations of underserved patients often provides new insight for students regarding the vast number of people who have serious and longstanding dental needs but have no insurance or the means to pay for treatment or preventive care.
School leaders survey graduates each year to record their initial career choices. Dating to the early 2000s when the external rotation program began expanding, the percentage of U-M graduates choosing community service grew steadily and has continued to be significantly higher than the national average. Over the years it has been common for about 15 percent or more of the U-M graduating class to start their first dentistry job in settings such as FQHCs, inner city clinics, the National Health Service Corps, the Indian Health Service or the military. The comparable national average during those years was often in the low single digits. For U-M’s 2023 DDS graduating class, the registrar’s survey shows 11 percent chose community service dentistry, compared to 8 percent nationally, according to the American Dental Education Association.
External Rotation History
Today’s comprehensive, statewide CBCE external rotation program can be traced to a curriculum commitment and expansion that began about 25 years ago. In earlier years, dental students participated in a few external programs but nearly all of their training was done at the dental school.
1930s Fourth-year students take one-week “field trips” to county health departments with support from the Kellogg Foundation.
1950s D4 and Dental Hygiene students treat inmates at the Michigan State Prison in Jackson and at the Federal Correctional Institution in Milan. At Bay Cliff Health Summer Camp, students serve children and adolescents with intellectual and developmental disabilities.
1970s Treatment of patients with special needs, particularly children with hemophilia; treatment of migrant farm workers and families in the summer using mobile units in Adrian, Stockbridge and Traverse City.
2000s A major change is implemented when Dean William Kotowicz and Assistant Dean Jed Jacobson convert the various external initiatives to a year-round Community Outreach Program. It included a $2 million funding initiative through organizations including the Michigan Department of Community Health, the Michigan Primary Care Association, the Michigan Dental Association, the Delta Dental Foundation, the Michigan Campus Compact and the Josiah Macy Jr. Foundation in collaboration with the W.K. Kellogg Foundation’s Civic Engagement Program.
2002 D4s begin 4-week rotations at five sites: Battle Creek, Grand Rapids, Marquette, Muskegon Heights and Saginaw.
2006 The external rotation program, still called the Community Outreach Program, steadily grows after it is placed under the direction of faculty member Dr. Bill Piskorowski by Dean Peter Polverini.
2014 The program begins charging clinics a “per-student, per-day” fee to cover students’ transportation and lodging so that it is self-supporting.
2017 Dr. Mark Fitzgerald takes over as director and the program name is changed to Community-Based Collaborative Care and Education.
2019 Prior to the COVID-19 pandemic, the program was rotating students through more than 20 external clinics, but the pandemic and various other changes at clinics reduced the number to 14 by 2023.
2024 The number of CBCE clinics has returned to 15, with 2 more scheduled to come online later this year.
Expanding the reach
The growth of CBCE has always been predicated on its mission statement: Enhancing education through community-based dental service while increasing access to care for underserved populations.
The program has been enormously successful in “increasing access to care” for Michigan citizens throughout the state. In 2005-06, when external rotations were still called the Community Outreach Program and totaled only three weeks, students completed 15,724 treatment procedures annually. Today that number has swelled to nearly 74,000 because of the 12-week rotation requirement and assorted other outside clinic opportunities.
The growth has come with changes to what many dental school alumni may recall from their days at the school. Graduates from the 1970s through the 1990s, for example, probably remember summer rotations to the Traverse City area to treat migrant farm workers and their families. Led by faculty member Dr. Robert Bagramian for many years, about 25 students would go north each summer and set up temporary clinics with portable equipment. Today, CBCE still treats migrant workers but advancements in social programs allow migrant workers to obtain dental treatment in clinics rather than in the field.
Another growing subset of the CBCE is the Victors for Veterans Program, or V4V, led by faculty member Dr. Howard Hamerink. Started as a student Pathways Program project in the Traverse City area in 2012, it has expanded to clinics in Brighton and Pontiac, with a fourth location set to open this year in the Lansing area. Students volunteer for short rotations at the various locations to provide comprehensive care to disabled, homeless or uninsured veterans who have incomes at or below 200 percent of federal poverty guidelines.
Another new CBCE clinic experience for students involves an innovative collaboration between the dental school and the United Way of Northwest Michigan. The United Way program in Traverse City expanded on its longtime role as a fund-raiser for a variety of non-profit organizations and funded a new United We Smile dental clinic. It primarily treats underserved children in the Traverse City area, but it also has a veterans component for V4V, allowing CBCE students to gain experience in both areas during their rotations there.
The logistics of CBCE
Implementing CBCE is a complex and non-stop operation as students continually move through their year of rotations.
Perhaps the most difficult aspect is at the very beginning of each new academic year when Program Manager Tracy Darnell and her team plot out the entire year-long schedule for every student before the year has even started. Using the dental school and university calendars as the baseline, they plug in the rotations for each of the approximately 130 fourth-year students, as well as lesser schedules for third-year students. Darnell must also consider each external clinic’s schedules and its required number of students for each week, while avoiding dental school and university holidays, end-of-term breaks or days of licensure exam preparation, for example.
Students are assigned to external rotations throughout the year, except during August and December when the school takes its longest breaks between terms. Many of the rotations are two consecutive weeks, then four weeks off for the student to be at the dental school, then two more weeks often at the same external clinic as the first two weeks. Also factored in are some shorter single-day or two-day “local” rotations within the dental school and at area community clinics that don’t require overnight stays.
For the longer rotations, depending on the size and patient load of the clinic, the minimum number of students assigned is two and the average is four. Students usually are scheduled for four 9- or 10-hour days, or five 8-hour days.
Once the annual schedule is completed, students must obtain permission to switch their assignments with other students for a very limited number of CBCE-approved reasons.
The program’s annual operating expense in the academic year that ended this spring was about $1.6 million. The majority of that total is for travel to the clinics around the state and for the hotel rooms where students stay. CBCE has contracts with hotels that provide discounts on room rates. CBCE leases cars from the university so that students can carpool to the distant clinics, with reimbursement for gasoline costs. Students can choose to drive their own vehicles at their own expense.
Revenue to cover the program’s expenses comes from several sources. All the external clinics have service agreements with CBCE that are approved by the university’s Vice Provost of Engaged Learning. Each external clinic pays the dental school a per-student, per-day rate for providing the students. CBCE is not involved in patient billing, which is handled by each external rotation site. The program also receives revenue from grants and foundations interested in promoting community dentistry.
The benefits for students
CBCE rotations help students improve their treatment skills, which, like any other course in the curriculum, are graded with input from preceptors in the external clinics. Students are rated on established School of Dentistry competencies in 13 key areas, including caries detection, treatment planning, patient management, clinical knowledge, communication and overall diagnostic skills.
Interviews with numerous students yield a consistently common list of what they consider positives about the external rotations, beyond the graded technical proficiencies:
• The variety of patients and treatments are broader than at the in-school clinics, thus bolstering the students’ experience and skillset.
• The pace in the “real-life” clinics is faster, with more patients scheduled each day, which requires students to work faster, providing a good transition to what they will experience in private practice.
• Preceptors are hired as adjunct clinical instructors at the external clinics and abide by the same standards as faculty within the dental school. However, students say they somehow feel that they have more freedom in assessing patients and determining their treatment plans. This bolsters their confidence, they say.
• While dentistry is dentistry, each external clinic has its own policies, procedures, equipment and methods of operating. Adapting to those differences from the
dental school operation is helpful and often opens students to alternatives they weren’t aware of.
• Students say they have gained a much greater understanding of the need for dental care in every community they visited. In particular, underserved patients with low incomes and-or no dental insurance are common even in more affluent communities, resulting in a steady flow of patients with serious dental conditions. Often patients express deep gratitude to students for treatment that may be their first visit to a dentist in decades.
Faculty member Dr. Sarah Tomaka, associate director of CBCE, relates to all of those student views because she also went through the program prior to her graduation in 2015. She remembers enjoying the “real people in the real world” feeling during rotations in Petoskey, Flint, Saginaw and Mt. Pleasant, among others. It helped bolster her interest in public health – she has a master’s degree in it – and led her to work six years in the same community clinic in Saginaw where she was assigned for CBCE. Last year she joined the dental school faculty and now helps students navigate the CBCE program while also teaching various courses that touch on social determinants of health.
Tomaka believes the value of CBCE for students goes beyond gaining experience with dental procedures. “The value is becoming more worldly,” she said. “It’s learning about other people. It’s not necessarily about learning how to do an amalgam. It’s learning about how other people live, why they need to be served, and how you can contribute. You start to understand the plight of the patients and how you can make their experience better. That’s really the overall value of it. Anyone can learn to do the actual dentistry, but to be a compassionate, comprehensive provider, that takes a lot more than being just in the school exclusively.”
Dr. Phil Yancho of Traverse City is one of about 130 preceptors who supervise students at the CBCE clinics around the state. He is also a Regional Program Administrator for CBCE, supervising preceptors in the northern district of CBCE, covering clinics from Cadillac to Traverse City to Atlanta. He coordinates with clinics to ensure consistency of student supervision and care.
“All the preceptors who have been doing this find, as I have, that this is rewarding.” Yancho said. “I’ve been doing dentistry for going on 39 years and I think that what I do as a preceptor is up there with the best dentistry I’ve ever done because it is so rewarding to be a teacher and see the students and how they respond. It is so rewarding to see the patients and how they not only respond to the treatment, but afterwards because we are changing some people’s lives with this program. They came in with no teeth and they are leaving with teeth. One guy got a job promotion that he attributed to his new smile built by students.”
The CBCE program is helping students meet the high demand for dental care throughout the state, Yancho said. Students are often treating children, veterans or other patients who have never seen a dentist. “Without this program, these children have no dental home anywhere. It’s not like we’re cutting into the patient supply of northern Michigan. This is a patient supply that is untouched. The veterans have no dental care, have lots of different health issues and no ability to pay. And they are so grateful. It’s unbelievable how positively they respond to this program.”
Dental student Alyssa Evans, who graduated in May, said her CBCE rotations brought more of many things she needed to transition toward her career, which will come after a pediatric residency in Boston. She saw more types of procedures, worked faster in team settings, gained experience with four-handed dentistry thanks to more time with a dental assistant, gained a comfort level with extractions because she did more of them, and dealt with more walk-in patients who were in pain. She experienced the differences of an FQHC at Cherry Health in Grand Rapids, a grant-sponsored clinic at United We Smile in Traverse City and corporate dentistry at an Aspen Dental clinic in Traverse City.
“Just seeing the different models and practice styles. It’s all dentistry, but it’s all done very differently. You gain a lot more confidence in dentistry. I feel I know a lot more now than as a D3, for sure,” she said with a laugh on one of her last rotation days at United We Smile. “It’s different materials. Different clinics. Learning how to work in a different space. It’s all just dentistry, but it does push your boundaries and comfort level and your barriers. I can do this at the school, but can I do it somewhere else? And the answer is yes, you can.”
Student views of external rotations
This experience taught me the great value of patient advocacy and education, as the family was unaware of more local treatment options for their child. Having a child with a complex medical history is difficult enough; navigating the healthcare system alone can be a frustrating and daunting experience. Thus, I will continue to be an advocate for my patients, providing them with the necessary resources to receive streamlined and excellent healthcare, in the dental chair or not.
Through this transformative rotation experience, I have gleaned invaluable insights into the multifaceted challenges encountered by underserved populations in accessing healthcare. It has underscored the imperative for a concerted, multifaceted approach that encompasses policy reforms, advocacy efforts, and community engagement initiatives to dismantle the barriers impeding access to care. As I continue on my professional journey, I am fortified in my commitment to championing the cause of health equity and advocating for the creation of a healthcare system that is truly accessible and inclusive for all individuals, regardless of socioeconomic status or background.
Thunder Bay Community Health Service: A rural region's extraordinary resource
On a freezing cold morning in late March, it’s clear this little town named Atlanta doesn’t have much in common with its big-city namesake in Georgia. Swirls of light snow are blowing across highway M-32 as traffic makes its way past the city limits sign declaring Atlanta the “Elk Capital of Michigan.” The town’s only traffic light is a two-way blinking red stoplight for the occasional motorists passing through the main downtown intersection.
This is Montmorency County in the forest lands of the northeast corner of the Lower Peninsula, about 70 miles southeast of the Mackinac Bridge. It is the eighth least populated county of the 83 in Michigan, with 9,600 residents, 700 of whom live in Atlanta.
U.S. Census figures from 2022 show that about 16 percent of county residents live in poverty, the 12th highest poverty percentage in Michigan. When the figures are broken down for children, 35 percent live in poverty, the highest of any county in the state. In the midst of this rural and relatively low-income county sits a healthcare gem on the west edge of Atlanta – the Thunder Bay Community Health Service clinic. It is a thriving one-stop resource for local residents needing a doctor, dentist, pharmacist or optometrist, with additional services for behavioral health, women’s health, and recovery and addiction treatment. Montmorency County is one of seven area counties served by a network of Thunder Bay clinics.
On this particular morning, three fourthyear U-M dental students – Sydney Cinal, Miranda Eberle and Seema Sabbagh – have arrived for their CBCE rotation at the Atlanta clinic. They are busy bantering with and treating patients in the dental clinic portion of the building. One man is worried his tooth is broken and will have to be pulled; Cinal discovers it is a cracked filling with a sharp edge, so she replaces the filling, smooths out the rough spot and the man leaves, happy that it was an easy fix.
Eberle deals with a patient who is missing a large filling on an upper right tooth. All of his teeth are in poor shape with many fillings because during previous appointments he hasn’t been able to afford crowns or other more longer-term solutions. Worried about cost again this appointment, he tells Eberle, “If you can’t fill it, we’ll just rip it out of there.” Eberle takes radiographs and tests the tooth to make sure it is still vital, then assures the patient that an extraction won’t be necessary, that a new filling is a good –and affordable – solution for the time being. Another happy customer.
Later, the three student dentists sit next to each other at computers on a long table, recording their just-completed treatment actions and studying the dental records for new patients who are in their next wave of appointments. They consult about various patients with Dr. Joseph Carlu, interim dental director and preceptor for the clinic. He practiced in southeast Michigan for many years, then moved to Montmorency County to retire. That lasted three weeks. He found the dental clinic at Thunder Bay and has continued his dentistry career in a place that he says needs all the dental care it can get because so many local residents have poor dental health.
It’s a conversation that resonates with the three students, who say that working with patients in community clinics has impressed on them the realities of treating and communicating with underserved and lower-income patients who often choose cheaper solutions like extractions when better solutions are too expensive.
“That’s a difference we see a lot between the dental school and our rotation sites,” Cinal says. “A lot of times, patients here aren’t interested in saving a tooth, for one reason or another. We’ve heard it all, I think at this point, with the biggest one being financial. A better treatment might mean referring them to a specialist elsewhere, but oftentimes that’s a little further than patients want to travel to get that done. So they’d rather be out of pain and be able to solve that problem today.”
CBCE students assigned to the Atlanta dental clinic, and its smaller satellite office 26 miles north in Onaway, work with the small in-house staffs. In Atlanta, Dental Operations Manager Dana Arnold oversees one full-time and two part-time dentists, along with several hygienists and dental assistants. Arnold says the U-M student “interns,” as the clinic calls them, are vital to helping Thunder Bay complete its community health mission.
“Our need is great,” Arnold said. “Having the U-M students here has been a big win for us in meeting the need. Access to care has always been an issue in our area.”
She said patients appreciate the U-M interns so much that they will sometimes ask that their next appointment be timed to wait until the next rotation of students are going to be at the clinic. “Patients will tell us: ‘The students were wonderful. You need to hire them.’”
And that’s exactly what Thunder Bay did with Dr. Chase McNamara, who earned his DDS from U-M in 2022. As a student, one of his CBCE rotations was at Thunder Bay. He found the community dentistry aspects rewarding, and the Midland native was well-experienced in the rural life of northern Michigan, having attended Michigan Tech in Houghton for his undergraduate degree. He is the clinic’s full-time dentist and two days a week he is a preceptor for the U-M students.
“This just felt right, it just felt natural, it was just something I was super-interested in,” he says of choosing Thunder Bay over private practice. “People are very appreciative of the work you do here. They don’t take it for granted. It’s a lot more helping people who are in pain, rather than some of the more esthetic areas of dentistry. It’s just really nice to go in there and know you are making a healthy difference in peoples’ lives. It’s just an area that I find very rewarding and satisfying – to take someone who says they haven’t slept for three days because of their pain and be able to get them comfortable. That feels good.”
Dr. Carlu says the constant flow of U-M students from the CBCE program energizes the clinic. A world map on the wall above the students’ computer table is dotted with pins showing the hometowns and home countries of students who have made the 200-mile trek north from Ann Arbor to Atlanta in recent years. Pins are scattered across the U.S. with Michigan completely covered; international locations include Italy, Egypt, Iran, India, Pakistan, China and Korea, among others.
As he deals with students about to begin their professional careers, Carlu has a lifetime of dentistry experience to share. His persona in conversing with students about patient treatment mixes the quiet confidence from a veteran dentist who has seen it all with friendly, can-do support that encourages the young dentists to trust their training and abilities no matter what they encounter. “I tell them: This is real-world dentistry here,” he says.
Family Health Center: The daily diversity of a thriving urban clinic
It’s a sunny and bright spring day in Kalamazoo, Michigan, and U-M dental student Oluwatobi “Tobi” Dauda has drawn the corner cubicle with floor-to-ceiling windows wrapping around two sides of her work space at the Family Health Center. Outside the windows, traffic whizzes by on a busy city street, but Dauda is too focused on her patient to notice. She’s steadily going through the many steps of preparing an older man for a tooth extraction – examining his dental history, filling out forms, taking his blood pressure, setting out the dental instruments she will use. The extraction seems to go well, but then things take a turn as Dauda and Dr. Aubrey Deibert, one of the clinic’s staff dentists, monitor the patient’s post-procedure condition. He reports feeling light-headed. They take his blood pressure and it has spiked. After several minutes without improvement, the clinic’s Code Blue emergency procedure is implemented. Almost immediately a crowd of about 10 clinic staff members gather to provide additional input and support. These symptoms could lead to cardiac arrest and require CPR, use of a defibrillator or calling an ambulance. Slowly, however, as the team talks with the man, he begins to feel better and his blood pressure starts coming down. After about 15 minutes, the emergency is over, though the patient continues to be monitored at length before being released to return home.
As Dauda joins a group of colleagues headed downstairs to pick up lunch, she is asked how her morning went. She flashes her trademark smile and quips in an understatement, “It was interesting.” Later, as Dauda and U-M classmate Jennifer Zhou finish lunch in a staff room, they talk with a veteran oral surgeon from the clinic staff who assisted during the Code Blue. The surgeon takes them through a mental checklist of emergency procedures, reinforcing the importance of being prepared in advance. It’s just another day in the life of a CBCE rotation, says Dr. Julie Saracina, the Chief Dental Officer of the Family Health Center. Saracina, a 2003 graduate of the U-M dental school, says the busy pace and wide variety of dental needs of patients at the Federally Qualified Health Center provide invaluable experience for the students in the CBCE rotations. In return, the students help the center meet its mission of providing a safety net of healthcare for people who either don’t have insurance or are under-insured – which Saracina estimates at a daunting 70,000 in Kalamazoo County.
“I think the rotation here gives the students a beautiful perspective on the range of patients they may see, and it gives them an idea of who they can help give healthcare access to when they decide how they are going to practice dentistry,” she says. “They may not have had that type of exposure prior to coming here. They may have had no idea that public health was even an option, including working for the Department of Corrections or working in Indian Health Service or options like that.”
Students learn that going to the dentist is not a simple task for many people who may not even have the means to easily travel to the clinic. “How did they get here for their appointment?” Saracina asks, listing the obstacles some patients face. “They had to organize getting out of work. They had to organize their bus token. They had to organize a baby-sitter. They had to organize whether or not whether they can eat breakfast that day because they had to get on the bus so early. Then how are they getting home? How are they picking up their prescription? That’s not the same struggle of other people who are patients in private practice. I think there is a different relationship between public health providers and their patients than private practice and their patients.”
Other learning opportunities for students, Saracina notes, include working faster to keep up with a steady stream of patients, compared to the slower pace of the dental school, and dealing with short-notice walk-in patients. Navigating dentist-patient communication when the patient doesn’t speak English is a surprisingly frequent obstacle given that Kalamazoo’s diverse population includes cultural enclaves with residents who speak Spanish, Arabic, Mandarin and French.
Saracina said it is rewarding to see how students grow even during their relatively short rotations. They may shy away from procedures they haven’t done before, but Saracina and her staff encourage, empower and assist students in learning new skills.
“Those are good experiences,” she says, “because when it was successful and the patient has left and we get to high-five about it, the students are feeling much more empowered to be able to make a decision like that on their own later.”
That confidence-building aspect of CBCE is confirmed by students, including Dhivyalakshmi Manavazhagan, who came to the dental school from India as part of the of the Internationally Trained Dentist Program. She said her time at Kalamazoo and her other CBCE rotations strengthened her confidence as she approached graduation in May and as she considered job opportunities in Illinois or Georgia.
“Being here (in Kalamazoo), I get a flavor of how it is going to be outside. Here I know the pace that it will be outside, so it has given me a little bit of practice as to how my life is going to be outside after dental school,” she said. “That’s the biggest advantage. It’s like a mini-practice before going out to the real world.”
New clinic helps students experience the unique demands of treating children
Dental students assigned to CBCE rotations at the United We Smile Clinic in Traverse City treat patients in a beautiful and innovative facility that opened last September.
Designed primarily as a pediatric clinic, it is the brainchild of Jennifer Kerns, a Registered Dental Hygienist who for many years was part of healthcare programs that included a stint touring northern Michigan in a mobile van to treat underserved patients. She learned first-hand that even in the relatively affluent part of Michigan around Traverse City there was a huge population of underserved patients. She was particularly concerned by the needs of children she treated, who oftentimes had never been to a dentist or used a toothbrush. She saw man special needs children with physical or mental limitations who were particularly in need of a special place to call their dental home.
Kerns approached United Way of Northwest Michigan with a novel idea. Would the agency, known primarily for raising funds for various non-profit community organizations, be interested in sponsoring a brick-andmortar dental clinic for treating children? Once United Way agreed, Kerns designed an airy six-bay clinic with large windows and an interior design scheme that feels like a giant aquarium. Floor-to-ceiling wall murals feature dolphins, whales, turtles, manta rays and all sorts of fish swimming by in ocean scenes. Two private “quiet rooms” separate from the main clinic offer the soothing sounds of ocean waves and many colors of soft LED lighting designed to put young patients at ease. The clinic atmosphere is also relaxing for the military veterans who are also treated there by CBCE students. As clinic director – or more formally Director of Health Initiatives for United Way of Northwest Michigan – Kerns brings a seemingly limitless amount of creativity and patience to providing dental care for children, much of it before the children ever sit in the dental chair. She prepares students in advance for what to expect from kids who have visited the clinic previously, and she shares lots of general advice for befriending the young patients and building their coping skills.
Many of the youngest children are scared, so loud crying, often for extended periods, is common. Kerns stresses that creating a fun experience to smooth the immediate appointment will likely have long-term benefits as well, with the children being less afraid and maybe even looking forward to visiting the dentist, which is important for their future health.
Kerns says experience is the best teacher for the CBCE students who have limited experience with treating children at the dental school. “It is so rewarding to have these students here. To watch them on their first Monday, and then at the end of the two weeks, it’s an enormous difference. It’s amazing.”
