School of Dentistry Community Report 2015 by University of Alberta Faculty of Medicine & Dentistry

Building a

COMMUNITY

Community Report 2015

Chair’s Message The School of Dentistry at the University of Alberta is changing. First, we moved out of our historical digs into new state-of-the-art facilities. We then fully embraced a Comprehensive Care Delivery model that transformed the way we deliver patient care and the student learning experience. We are now embarking on a legacy project to completely redesign the doctor of dental surgery (DDS) and dental hygiene (DH) curriculum. The curriculum renewal project will be a four-to six-year initiative wrapping up just in time for our accreditation review period in 2021. We believe the timing is right with many internal and external factors driving this need for change. Our main objective is to create a program that provides our students with enhanced learning experiences in today’s world. This year’s Community Report provides a unique look into our research portfolio—everything from systemic diseases and the oral cavity to community research involving children and senior’s oral health. Moving research from the labs into practical applications at clinics is the continuum we strive for. Strong foundational sciences - complemented by new recruits, equipment and facilities have truly elevated our ability to move forward. More students are getting involved with research and there is a level of excitement generated from the novices that is inspirational and motivating. In addition to getting involved in research, our students are active in the community. The stories in this year’s report capture our students’ experiences and the immeasurable impact these activities have in shaping their future careers. What they do is impressive, selfless and reflective of who they are as individuals. We are fortunate to have such talented students. As I continue to learn from the students graduating from our programs, it is a partnership and educational relationship I treasure.

Paul Major DDS, MSc, FRCD(C) Professor & Chair, School of Dentistry Senior Associate Dean, Faculty of Medicine & Dentistry

OUR VISION

OUR MISSION

To become one of the top-tier schools within Canada and beyond.

Student-focused learning that promotes patient-centred care and community outreach through research, scholarship and partnership in an environment of trust, respect and integrity.

Community Report 2015

What’s inside Community Care

HIV research to identify cell interaction to prevent progression of deadly disease Page 12 & 13

ORAL CARE VITAL TO PRESERVING SENIORS HEALTH

GPR PATIENT HAS BEEN VISITING THE CLINIC FOR THE PAST 43 YEARS

SHOWING THE COMMUNITY WE CARE

DENTISTRY STUDENTS RAISE $42,000 FOR LOCAL CHARITY

DRY MOUTH CAN REVEAL MANY LINGERING HEALTH ISSUES

DENTAL STUDENTS PROVIDE CHARITABLE CARE IN KENYA

BOYLE MCCAULEY COMMITTED TO INNER CITY RESIDENTS

Programs Airways clinic offers interdisciplinary network of specialists to treat children Page 14

First class of DDH students attend AKU Page 29

Accessing dental care made easier Page 31

ADVANCED PLACEMENT PROGRAM OFFERS DDS GRADUATES OPPORTUNITY TO ENHANCE SKILLS

SMILE PROGRAM TEACHES CHILDREN IMPORTANCE OF GOOD ORAL HEALTH

CCD MODEL PUTS PATIENTS FIRST

PEDIATRIC CLINIC PROVIDES PREVENTATIVE DENTAL TREATMENT THROUGH SCHOOL VISIT PROGRAM

CDE SERVES AS RESOURCE CENTRE FOR DENTAL PROFESSIONALS

SHINE CLINIC CONTINUES SHINING BRIGHT IN LOCAL COMMUNITY

Research Matters 15

LINKING PERIODONTAL DISEASE AND HEART DISEASE

SOLVING THE FACIAL TISSUE REPAIR MYSTERY

BRINGING ORAL HEALTH TO THE FOREFRONT, ONE COMMUNITY AT A TIME

FINDING WAYS TO ALLEVIATE CHRONIC INFLAMMATION IN PATIENTS

WORKING ON ESTABLISHING ORAL HEALTH PROTOCOL FOR ELDER CARE

FIXING THE ROOT OF THE PROBLEM

Student Success

Advanced placement program offers DDS Aspiring dentists study and train at colleges around the world. When they decide to bring their practice to Edmonton, the University of Alberta’s School of Dentistry offers them a step up to seamlessly transition into the Canadian dental community. The two-year Doctor of Dental Surgery (DDS) Advanced Placement program helps dental students trained outside of Canada to update their skills and their licence to practise dentistry. Most often these students have graduated from dental programs that are not accredited by the Commission of Dental Accreditation for Canada. With the placement program being highly competitive, each

“I was searching for a new adventure and new dreams.” Kifah Alyassin

year only eight students are admitted. These students are then integrated into the third year of the regular DDS undergraduate program. Searching for new adventures and a place to build new dreams, the program caught the interest of Kifah Alyassin who had been practising dentistry for nearly 20 years in Iraq. “I knew the U of A could train me to be an even better dentist,” says Alyassin, adding he could have written the dental exam without going through the program. However he would have missed out on key learning opportunities like the ins and outs of how to operate his own dental office. He graduated with a master’s degree in orthodontics in 2013.

“The job prospects are much higher once completing this program.” Nishu Joshi

“The program prepares you better for being a dentist.” Banmeet Kalra

COMMUNITY REPORT 2015 5

graduates opportunity to enhance skills “The U of A has all of the educational requirements to make graduates more confident in their future career,” he says. “While basic dentistry is the same in all places, having a diverse background is beneficial in being able to provide the best service to patients.” Nishu Joshi’s decision to enroll in the program was simple. Having graduated from dentistry school in India, and moving to Canada, she wanted to ensure she integrated into the dental profession easily. “Every country has its own rules and regulations to practise a certain profession. I wanted to learn them in a proper manner before developing my own practise,” she says. “Dentistry is an

“So much has changed in dentistry over the years. The program helps fill those gaps.” Nisha Arora

evolving field and there is a lot to learn every day. I wanted to learn the most recent practical skills before I start practicing in Canada.” Joshi, who is graduating from the program in 2016 and plans to eventually open her own practice, says it’s a privilege for her to learn from such experienced faculty members. “I am learning about all the latest technology being used in dentistry, record keeping and patient management. It’s an opportunity I would not have had if I pursued the direct licence exam,” adds Joshi.

“The program provides good clinical practice.” Jimmy John

Patient Experiences

Oral care vital to preserving senior’s health According to Government of Alberta estimates, the number of seniors in the province is expected to more than double by 2031. It’s projected there will be more than 923,000 seniors – meaning about one in five Albertans will be a senior. To prepare for this demographic shift, the School of Dentistry’s dental hygiene students are already being trained to understand and care for our aging population. The School takes pride in community engagement and strives to provide timely and accessible oral health care – particularly to our seniors. The ElderSMILES program and the community-based education module are two programs specifically designed to provide oral health care to seniors. Both programs involve dental hygiene students working with and directly assessing oral health in senior’s residential facilities, hospitals, dental clinics and long-term care facilities. “Access to health care is paramount to seniors,” says Arlynn Brodie, assistant clinical professor with the dental hygiene program. “We, as a school, find that from a philanthropic aspect there is an important role for health-care professionals to the community. Really, we belong to and are part of the community.” By venturing into the community and providing patient care, students learn to assess oral health, document their findings, create daily oral care treatment plans and recommend treatment. Dental hygiene students in the ElderSMILES program visit between 155-175 senior residents over the school year at two long-term care facilities in the Edmonton area. Dental hygiene students in the degree program visit 120 residents for either oral assessment or hygiene treatment. “There’s a social responsibility tied to this program,” says Brodie. “By sending our students into the community to provide oral care in 6 COMMUNITY REPORT 2015

Dental student Michel Marchand explains to patient Kenneth Glasier how he will take a measurement for his new dentures. facility care settings, it’s a good opportunity for them to treat seniors and learn. Residents get the care they need and students receive hands-on training,” “So, once our students graduate and begin their careers, they have the necessary experience to continue offering these services.” Understanding elder care is no different for dental students either. The School of Dentistry’s general practice clinic, located in the Kaye Edmonton Clinic, also helps provide vital and timely care for our seniors. For seniors like Kenneth and Jean Glasier, access to the clinic offers them a financial break compared to private clinics. Suffering from a series of mini strokes and dementia, Jean says it’s dental students like Michel Marchand who understand the importance of patience required in caring for patients like Kenneth. “Michel is good with him,” says Jean,

during a recent visit to the clinic where she was having a filling completed while Kenneth was being fitted for dentures. “The students take the time needed to care for us, which is good for both the patient and student.” A fourth-year dental student, Marchand says working with seniors, especially Kenneth, has taught him how fragile life can be and the importance of respect in relationships. “The love and trust he has for his wife is inspiring. As strange and confusing as our appointments must be for him, he just goes with it. When he looks at her, she lets him know it’s going to be alright. He then just calms down and lets me work,” says Marchand. “I would love to be a dentist people respect, and for that to happen I know you have to respect your patients first.” Seniors often become a neglected demographic because they become less vocal about what they require as they age, explains Marchand. “They deserve the best care possible.”

Ellen Berglund has been a patient at the School of Dentistry’s general practice residency clinic for decades.

GPR patient has been visiting the clinic for the past 43 years If Ellen Berglund hadn’t given in to her craving for caramelized popcorn last year, she’d probably still have the bridge she received from the School of Dentistry’s Patient Clinic more than 43 years ago. “They told me not to eat anything sticky, and for 40 years I didn’t,” she laughs. “I don’t know what I was thinking.” But wait. There’s more to Berglund’s story – much more. “Just look up my patient history, it’s all there, every single dental detail,” the 93-year-old states. “I’ve been extremely well looked after here. Coming here is a great option for seniors.” Berglund came to the clinic by chance. During the Second World War, Berglund was working as cafeteria staff and happened to be living at St. Joseph’s College. Once her own dentist informed her that she was “living right across from the best dental school” she finally became a patient.

“He was a graduate of the dentistry program so he knew,” she explains. While Berglund’s dental history — which includes crowns, cleanings, and dentures is well documented — her personal story is just as diverse. She served as a supply technician with the Royal Canadian Air Force, received the 2012 Queen’s Diamond Jubilee Medal for her community work and tirelessly volunteered with 12 different organizations – the Youth Enrichment Centre being her favourite. Berglund was also a regular five-pin bowling competitor in the Canada Senior Games. “I danced until I was 85,” says the great grandmother of 21 children. “I’ve never driven a day in my life. I took the bus everywhere. Ultimately, I learned not to be a backseat driver.” This year, Berglund will take the bus all the way to Alaska where she’ll attend the 12th Royal Canadian Air Force Air Women reunion. COMMUNITY REPORT 2015 7

Community Involvement

Showing the

community we care

Local dentist office opens doors to Edmonton homeless youth and offers free dental care Edmonton youth from the YESS (Youth Empowerment & Support Services) were treated to free dental care thanks to a special dental day put on by Abbotsfield Dental. After volunteering for Homeless Connect in October, a biannual event held at the Shaw Conference Centre that provides Edmonton’s homeless youth access to health-care services, the clinic decided to take its community involvement one step further. Dentists Yousif Chaaban and Julia Rutkowski, along with dental hygienist Amanda Yehya and office manager Chantelle Auclair, offered their services to those most in need at no cost as a means to give back to the community. Patients were referred to them by YESS. “Dentistry is a basic need that everyone requires. Because our skills as dentists are so unique and specialized, it’s important to give back to our community,” says Rutkowski, a 2013 School of Dentistry graduate. Rutkowski is deeply committed to paying it forward after participating in missions to Costa Rica, Peru and Nicaragua, As an undergraduate student, she became involved in Kindness in Action, a non-profit volunteer organization that provides free dental care around the world. Seeing young people get their smiles and confidence back is priceless, says Rutkowski of the missions. She specifically recalls treating a 16-yearold girl with severely decayed front teeth.

Dentists Yousif Chaaban (not pictured) and Julia Rutkowski (right), along with assistant Lina Jouma’H (left), and office manager Chantelle Auclair (not pictured) from Abbotsfield Dental offered their service for free to inner city youth.

After restoring the girl’s front teeth, despite the language barrier, Rutkowski says she could clearly see the difference it would make in her life. “She saw her smile in the mirror and couldn’t stop smiling. The missions make you realize how much of an impact you have on someone’s life when they can finally smile and eat. It’s nice to go to a different country and provide this service, 8 COMMUNITY REPORT 2015

but we also have a need for charitable care right here too in Edmonton,” she said. “It’s important for all of us to give back to the community any way we can.” In the end, the clinic was able to help three youth who were in most need of the services. They spent the entire day providing full dental treatment. “Hopefully we’ve inspired other dental clinics to do the same,” she said.

Doctor of dental surgery students spent the winter 2014 break in Tacloban, Philippines volunteering with Kindness in Action.

Dentistry students raise $42,500 for local charity School of Dentistry students have raised $42,500 for Dentistry For All. This is the fifth year the Dental Students’ Association (DSA) has raised money for organizations like Dentistry For All and Kindness in Action – both non-profit volunteer organizations that provide free dental care in areas around the world for those who have limited or no access to dental care. The annual Winter Charity Ball organized by DSA members is a major fundraising initiative for these missions. The students raised more than $33,000 for Kindness in Action in 2013, and $35,000 for Dentistry For All in 2012. The DSA alternates between supporting the two charities each year and this year’s event had a record attendance with 285 people. For third-year dental students Jameel Popatia and Muhamed Jomha, the missions provide an opportunity to gain real-life experience they wouldn’t be

exposed to otherwise. The duo was in Tacloban, Philippines over the winter holidays as part of the Kindness in Action mission. The area was devastated following the tragic 2013 typhoon. Treating nearly 700 patients over their six-day mission, Popatia says it was the most humbling experience he’s ever had. “As soon as we got there hundreds of people started lining up,” he said. “You could tell that these people are the ones that needed dental care the most and they truly appreciated that we were there.” While students are responsible for their own airfare, donations are used to help pay for items like supplies and equipment. “Going there will change the way you practise dentistry,” says Jomha. “The volume and the type of cases you saw there you wouldn’t see here.” This year, 15 dental students in their third and fourth years are expected to

participate in dental missions. Using professional skills to give back to the global community is an important lesson, say dentists and Dentistry for All representatives Trudy and Blaine AuCoin. “It’s not only about dentistry,” says Blaine. “The funds raised are used to help build a community. For large populations at home and abroad, dental care is out of reach. This is one way we can use our skills to give back.” The Dentistry For All charity was founded by the School’s former faculty member and doctor of dental surgery graduate Denis Bedard and his wife Bev in 1995. Today, the charity provides nearly 60,000 procedures for more than 20,000 people at 16 locations around the world on annual basis. Kindness in Action was started in 1993 by doctor of dental surgery graduate Amil Shapka, who also participates in dental missions around the world. COMMUNITY REPORT 2015 9

Patient Experiences

Dry mouth can reveal many lingering health issues Deborah Berry visited numerous health-care professionals, but none of them were able to accurately diagnose or treat the many lumps and cuts inside her mouth. Berry, who suffers from the autoimmune disease – systemic lupus erythematosus, eventually accepted it as a possible side effect of this condition. However, a visit to the School of Dentistry’s oral pathology clinic – the only one of its kind in Alberta – quickly changed all of that. She came to the general practice clinic for a professional cleaning. After a quick oral exam by her hygienist she was referred to oral pathologists Ed Peters and Seema Ganatra who provided the answers she sought. Berry was diagnosed with xerostomia, more commonly known as dry mouth. Dry mouth, if left untreated, can often lead to or be a sign of other lingering health problems. Dry mouth is the result of a decrease in saliva produced by the salivary glands in your mouth. “I never really knew what to do about the mouth sores,” says Berry, who had spent more than 10 years looking for answers. “My problem just seemed to be getting worse. It would be painful at times. When you don’t make enough saliva, even eating is difficult.” Dry mouth is a common issue. Twenty per cent of the general population and 50 per cent of seniors are said to suffer from dry mouth. It can often be caused by prescription medications, untreated diabetes, radiation therapy and autoimmune diseases. Since beginning her treatment, Berry has strictly followed the treatment plan and uses the medications and products prescribed by Ganatra. “Saliva helps prevent tooth decay and keeps your teeth healthy. It neutralizes 10 COMMUNITY REPORT 2015

Deborah Berry has suffered from dry mouth for more than 10 years. It wasn’t until she came to the School of Dentistry and met oral pathologist Seema Ganatra that she started receiving effective treatment for her condition. the acids and bacteria in your mouth and washes away food,” says Ganatra. “If you don’t produce enough saliva, you can become more prone to cavities.”

complain as it progressively worsens. Chewing gum after a meal for at least 15 minutes helps get the saliva flowing and cleans your teeth at the same time.”

Preventing cavities is key for patients with dry mouth. High fluoride toothpastes, home fluoride treatments and fluoride teeth varnishes assist in alleviating dry mouth. Saliva substitutes are helpful for some patients, also.

Berry says since becoming a patient at the clinic, she no longer has as many sores and her life has dramatically changed as a result.

“The consequences of dry mouth can be reduced by making dietary changes,” says Ganatra, who recommends avoiding high sugar drinks like pop, juice and even coffee. Drinking more water and chewing sugar-free gum with Xylitol (a natural sweetener) can help keep the mouth moist. “People realize they have dry mouth, but only tend to

The School’s oral pathology clinic sees roughly 2,400 patients a year. What makes the clinic unique to Alberta is its Oral Pathology & Maxillofacial Pathology Laboratory. The laboratory offers dental and health care communities the opportunity to receive diagnostic and consultation services in head and neck pathology for patients with temporomandibular disorders, oral facial pain, oral pathology and non-surgical oral diseases.

Community Involvement

SMILE program teaches children importance of good oral health Studies show that children with poor oral health are more likely to miss school and have trouble concentrating in class because of tooth pain or infections. To help teach children the importance of good oral health, the School of Dentistry’s dental hygiene students recently offered tips and tricks to a class of Grade 5 students at the Millwoods Christian School through the SMILE initiative. Established in 2012, SMILE is a student-led volunteer initiative that aims to provide oral health education by visiting schools and hospitals across Edmonton. Samantha Dalpe, a fourth-year dental hygiene student and SMILE program leader, educated more than 53 students on proper brushing and flossing techniques, gum disease, and the importance of eating tooth-friendly foods. Also volunteering were dental hygiene students Melissa Chiscop and Harley LaRocque.

Dental Hygiene student Samantha Dalpe shows Hannah Berg, a Grade 5 student at “Instilling the importance of Millwoods Christian School, how to properly brush her teeth as part of the SMILE program. dental health at a young age will enable the students we see to going to try flossing more and eating side effects on your teeth and people become more involved in their dental healthier food.” wouldn’t know or see it.” care,” says Dalpe, who was inspired to be a leader for SMILE after taking The presentation sparked a flurry of According to the Canadian Institute a public health education class. “So questions from students ranging from for Health Information (CIHI), early much of what children learn today “How much sweet stuff is too much?” to childhood caries (a disease affects them as adults. This is very true “Does freezing my mouth damage my characterized by severe decay in the in regards to dental health.” teeth?” and “If somebody smokes once teeth of infants or young children) during a happy time like a wedding, will account for about one-third of all day For students Hannah Berg and they get gum surgeries performed on Canadian Joshua Nieves, both aged 10, the disease?” children between the ages of one and presentation provided them with a five. great list of do’s and don’ts to help Nieves is on board with Berg and says keep their teeth healthy. he’ll definitely incorporate flossing into “Prevention of dental diseases is his daily dental routine. so important. Hopefully with the “I was shocked to learn that too much knowledge we are offering these milk can be terrible for your teeth,” “I’m going to start flossing correcting children through this initiative they says Berg, adding she was also and gently,” says Nieves. “I learned will be able to prevent dental disease surprised to learn that smoking that it’s really easy to get infections and and not just treat it,” added Dalpe. cigarettes causes gum disease as well. flossing is almost like brushing your “But I liked that they walked us through teeth. Smoking can have really bad how to brush and floss our teeth. I’m COMMUNITY REPORT 2015 11

HIV research hopes to identify mechanisms to prevent progression of deadly disease

Research Matters

Researcher Shokrallah Elahi monitors an infant’s vitals as part of his research on infant immune systems. Shokrollah Elahi is dedicated to improving health care for two of the world’s most vulnerable populations: individuals infected with HIV and newborn babies. Elahi spent his career studying HIV, specifically long-term non-progressors or elite controllers— these are individuals infected with HIV who do not develop AIDS due to natural protective immunity. HIV is difficult to combat because most people can’t fight the virus as well as other common germs. Approximately one in 100 HIV-infected people fight HIV in the absence of treatment: their viral load stays low, their HIV target cells (CD4 count) stays high and they do not show any disease symptoms. “Basically, we try to better understand the mechanism of resistance in these rare individuals,” Elahi explains. “We have already shown that their killer T cells (CD8 T cells) remain functional during the course of infection and therefore kill all the HIV-infected cells to ensure that the virus cannot reproduce to the extent that is associated with HIV progression and AIDS. We have shown that killer T cells are different in these individuals compared with others.” He is collaborating with Stanley Houston, director of the Northern Alberta HIV Program, to study how elite controllers resist HIV and stay healthy for long periods of time, sometimes up to 30 years. Elahi is investigating how killer T cells interact with other immune system components to identify the features that successfully prevent HIV progression. “If we can understand exactly what’s going on, we might be able to apply this in the context of HIV to make people resistant to AIDS and that kind of progression,” Elahi says. “Or we might determine a novel approach for developing a vaccine against HIV.”

Additionally, Elahi is looking to decode infant immune systems. “We all know, in all species, that babies are more susceptible to infection,” he says. “This has been the assumption: that their immune system is not fully developed, not unlike other bodily functions.” Instead he discovered that babies are born with fully developed immune systems that are actively suppressed by an abundance of immature red blood cells. The study findings were documented in the Nature International Weekly Journal of Science in 2013. It may seem counterintuitive, but it actually helps in the colonization of microbiota or “good” bacteria in the gut that shape the immune system. “Imagine that the baby, from a clean in-utero environment, with no memory or exposure comes into a dirty world full of germs. If the immune system thinks that all these bugs are enemies, then it tries to fight back. It would be detrimental for the baby,” he explains. “That’s why the suppressor cells are there: to allow for a swift transition from a clean environment to a dirty one.” In the future, Elahi hopes to examine children in Edmonton, Uganda and South Africa to determine how long these cells are present in the body and determine what effect, if any, they have on immune response to vaccines and viral infections. Elahi also aspires to connect his two specialties to understand how immature red blood cells impact infant susceptibility to HIV. “About 40 per cent of babies get infected with HIV if the mother is positive,” he notes. “Scientifically, the transfer mechanism is not well-known. I think immature red blood cells play a role in making babies more susceptible to HIV infection.” COMMUNITY REPORT 2015 13

Research Matters

Airways clinic offers interdisciplinary network of specialists to treat children Emily Meikle always snored as a child. At first, her mother Lucille didn’t worry about it much because Emily still maintained a good sleep routine. However, even with said routine, and frequent naps, Emily still woke up tired. As such, the Meikles started looking for answers. Their family doctor referred them to the Inter-Disciplinary Airway Research Clinic (I-ARC) in the School of Dentistry. After going through a series of tests, Lucille found the answers she was looking for: 14-year-old Emily had sleep apnea. After completing a team evaluation and facial scan, she underwent adenoid removal – a procedure that is typically more required and beneficial in much younger children.

The Meikle family has been working with the Inter-Disciplinary Airway Clinic to treat Emily’s sleep apnea.

“The ongoing treatment is improving my everyday life and activities,” says Emily, who recently had an expander placed in her mouth to widen her jaw. She may eventually require orthognathic jaw surgery, also. “I’m not as much of an aggressive sleeper anymore and hopefully by the end I’ll be getting a good night’s sleep often.” Lucille has brought Emily to the clinic for two years and says the improvement in her sleep and mood is noticeable. “She was always irritable. Now, her sleep is improving and her energy is coming back. We were happy to work with this team and, because it’s a multidisciplinary process, we felt well looked after,” says Lucille. The I-ARC is a specialized team established three years ago to conduct 14 COMMUNITY REPORT 2015

research and provide innovative treatments in the area of sleep disorders to patients like Emily. Pediatric respirologist in sleep medicine Manisha Witmans, I-ARC director and orthodontist Michael Major, and pediatric otolaryngologist Hamdy El-Hakim work collaboratively to provide help for parents and professional caregivers of children to achieve better sleep, better health, and ultimately a better quality of life. Sleep disordered breathing in children is a common health problem that also affects growth and behaviour if left untreated, explains Major. This includes altered facial growth and orthodontic problems that must eventually be corrected. “Obstruction in the airways is a common problem that leads to sleep-related issues. While parents might miss some of these signs,

dentists can more easily identify them,” he explains. Symptoms of sleep disordered breathing include snoring, gasping for breath while sleeping, daytime sleepiness, bed wetting, behavioural problems and an inability to breathe through the nose. Sleep disruptions in teenage children often get overlooked for a number of reasons, says Witmans. The most common is that their sleep isn’t being monitored. “If teens wake up still tired, are sleepy during the day or if you notice they have trouble focusing at school, you should start asking questions and talk to your doctor,” she says. “Sleep deprivation can affect your overall health. Keeping a consistent sleep schedule will improve the quality of your sleep.”

Researcher Maria Febbraio and her team – graduate student Mohamed Omar (left to right), research associate Maria Alexiou, technician Amy Barr, and undergraduate student Konrad Lehmann – are working to uncover the link between periodontal disease and heart disease.

Linking periodontal disease and heart disease What do your gums and heart have in common? More than you might think, according to professor Maria Febbraio. Febbraio is working to uncover the link between periodontal disease and atherosclerosis, a cardiovascular disease characterized by the thickening of artery walls in response to accumulation of fat-loaded white blood cells. The epidemiological connection has been present in the literature for more than 20 years: “If you were to look at people that had severe periodontal disease, they often had bad cardiovascular disease,” she says. “We are looking for a mechanistic biological link, and we think it’s the interaction of CD36 and Toll-like receptor.” Found on the surface of cells, CD36 and Toll-like receptor are innate immune receptors involved in pathogen sensing. Febbraio and her research group— comprised of research associate Maria Alexiou, undergraduate student Tina Ganeva, graduate student Mohamed Omar and a former postdoctoral fellow, Paul Brown, from Febbraio’s days at the Cleveland Clinic—study how Porphyromonas gingivalis, a bacteria that causes periodontal disease, interacts with these cells to promote inflammation.

“We’re studying how the bacteria interacts with the cell to promote inflammation. It’s this inflammation that can cause oral bone loss and periodontal disease,” Febbraio notes.

process of foam cell formation (lipid-laden cells look foamy under the microscope) in the vessel wall. This plaque build up in the arteries is otherwise known as atherosclerosis.”

What they discovered was surprising.

The big question is whether treating the periodontal disease patients will also treat patients’ cardiovascular risk. Though study results from several years ago suggested there was little to no effect on cardiovascular risk after vigorously treating patients with periodontal disease, Febbraio believes the study timeframe wasn’t long enough. In this regard, she likens periodontal disease to smoking.

First, they discovered that CD36, which had previously been thought to interact with only gram positive bacteria, somehow interacted with Porphyromonas gingivalis, a gram negative bacteria, to optimize signaling through Toll-like receptor. Toll-like receptor activates NF-kB, an important mediator of inflammation that controls transcription of DNA. This leads to the generation of a cytokine known as IL-1β, a protein important in the etiology of both atherosclerosis and periodontal disease, which is released into the bloodstream. “We found that CD36, co-operating with Toll-like receptor, is increasing IL-1β, which not only promotes periodontal disease but also promotes cardiovascular disease,” Febbraio explains. “In the vasculature, CD36 has a second role in promoting cardiovascular disease, by taking a modified lipid, what we call ‘bad LDL.’ It takes that up and begins the

“You can stop smoking today, but it takes more than 10 years for you to reduce the risk of cardiovascular disease to the point of someone who has the same amount of disease who has never smoked,” she says. “It seems periodontal disease is similar to that. “We can say it’s similar to molecular memory. Even though the risk has been removed, [the cells] still have the memory of that risk.” She goes on to explain that her lab believes—and hopes to investigate—whether stem cells carry this memory of risk through a change in DNA. COMMUNITY REPORT 2015 15

Research Profiles

Anthea Senior Clinical associate professor Anthea Senior’s digital manual - Dental Radiography: Quick reference guide for intraoral images - is improving the student learning experience. The digitally formatted manual has improved the quality of X-rays being taken by dentistry students, and is reducing the need for retaking images on patients. She is now collecting data and analyzing how effective it has been as a training tool.

Giseon Heo Statistician and associate professor Giseon Heo is finding ways to accurately diagnose obstructive sleep apnea (OSA) in pediatric patients using craniofacial 3D-photographs. OSA is a serious health problem in children, and even mild forms of untreated pediatric OSA can cause high blood pressure, behavioural challenges or alter the patients’ overall growth.

Reena Talwar-Povoledo Associate professor in oral and maxillofacial surgery Reena Talwar-Povoledo started a pilot-project aimed at helping diagnose possible at-risk patients for Crohn’s disease using oral biopsies. After successfully using the Caspase-1 protein as a label/marker in oral mucosa specimens from Crohn’s patients, her goal is to provide at-risk patients with a less-invasive procedure in a dental office as a diagnostic test.

Carlos Flores-Mir Professor and division head for orthodontics, Carlos Flores-Mir is dedicated to mentoring researchers and students in advancing their goals. Flores-Mir believes that a key component in making any research output meaningful is knowledge translation. He is working with different dental associations to make published research easier to access and understood by dentists.

Ava Chow Ava Chow’s taking a deeper look into the bacteria in your mouth. The assistant professor in dental hygiene is pinpointing the effects bacteria found in the mouth has on the rest of the body. Understanding and locating the bacteria that buries itself in the body’s cells, which can then not be treated by the body’s antibodies or by antibiotics, will help patients deal with reoccurring periodontal disease.

COMMUNITY REPORT 2015 17

Research Matters

Solving the facial tissue repair mystery Our faces hold many mysteries. Mysteries that Daniel Graf, associate professor in the School of Dentistry, is eager to unravel.

Graf has dedicated much of his career to understanding Bone Morphogenetic Protein (BMP) signaling networks, the complicated molecular signaling pathways that play a role in the development and repair of teeth, bones, organs and other tissue in the body. “Eventually we would like to understand how these mechanisms are being used in situations where tissue needs to be repaired,” he explains. “If you understand the mechanisms by which the tissue has been formed in the first place, you can better rationalize how tissues are repaired and determine better treatment realities.” Graf is specifically looking at how BMPs influence the development of craniofacial features. Loss-offunction mutations in the BMP signaling pathway are often fatal, he says, and are not usually compatible with life. However, more subtle mutations that are within the range compatible with life, may result in physical malformations like cleft palate or dental malformations. Often such malformations are part of a syndrome. According to Graf, the majority of congenital syndromes have a craniofacial component: in one lab model where one particular molecule from the BMP signaling network is missing, symptoms like shorter skull, reduced bone formation, reduced nasal and vision function, and neurological delays are all observed. These symptoms not only align with Stickler syndrome — which is characterized by distinct abnormal facial features, hearing and vision 18 COMMUNITY REPORT 2015

Associate professor Daniel Graf’s research focuses on understanding the development of tissue in the human body. loss, and joint problems — but the very genes that are mutated in Stickler syndrome patients are all deregulated in this BMP mutant. Those afflicted with congenital syndromes like Stickler often display distinct facial appearances as part of their ailments. “When keeping in mind that there are molecules that are important for the development of many different body structures including the face, this is not really surprising. If a molecule does not function well in your craniofacial structures, it probably

won’t function well in your other tissues, like the heart, ear or brain,” Graf explains. Graf hopes that demystifying BMP signaling networks will one day lead to personalized treatment strategies for patients with tissue injuries, oral health challenges or syndromes. “I think the goal is to understand what went wrong with the biology so people can receive appropriate counselling and medical treatments can be optimized based on the biology,” he says.

Research Profiles

Ysidora Torrealba Assistant professor in restorative dentistry Ysidora Torrealba is working to integrate computer-aided design and computer-aided manufacturing (CAD/CAM) technology into the doctor of dental surgery curriculum for third and fourth year students. She is also integrating the Compare 3-D Educational Software to second-year students to improve the self-assessments of the different criteria to prepare teeth for fixed restorations. Further, Torrealba is testing the durability of new CAD-CAM dental materials used on natural dentition and dental implants.

Sheila Passos Postdoctoral fellow Sheila Passos is currently evaluating different treatments available for restorations when crowns and bridges are made of zirconia and covered in porcelain. Clinically improving the compatibility and bonding mechanism of these two materials would solve the continued problem of porcelain chipping and fracturing over time.

Manuel Lagravere Orthodontics assistant professor Manuel Lagravere is finding ways to apply 3-D printing and scanning to the field of dentistry to help make dental treatment more efficient. By utilizing the new technology available to dentists, patients will be able to receive a full dental scan and the images within minutes at the School’s general practice residency clinic. The printers will be able to print out dental molds and eventually appliances for more detailed treatment.

Minn-Nyoung Yoon Assistant professor Minn-Nyoung Yoon’s research looks at improving oral health in vulnerable populations. She is currently developing an oral health assessment tool that can be easily used by frontline healthcare practitioners to address the oral needs of patients in long-term-care facilities.

Neel Kaipatur Assistant clinical professor Neel Kaipatur’s research has him comparing the different types of orthodontic appliances currently used to correct moderate to severe overbite in school-aged children. Over a two-year period, he will monitor 95 patients and compare the effect of orthodontics based on the patient’s experience, gum health and jaw joints.

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Associate professor of pediatrics Maryam Amin is working with immigrant populations to help them make oral health a priority for their children.

Bringing oral health to the forefront, one community at a time

An associate professor of pediatrics in the School of Dentistry is breaking down psychosocial barriers to optimal oral health for children in high-risk vulnerable populations.

Maryam Amin leads a research team of graduate students, undergraduate students and research assistants, as well as fellow faculties, into communities considered the most vulnerable: Aboriginal and recent immigrant populations who are struggling with assimilation and, as a result, are unable to prioritize the oral health of their young children. “One of our goals is to integrate oral health into existing primary health care in order to increase uptake within these communities,” says Amin. This can be a challenge for a number of reasons, including but not limited to access to safe and affordable housing, education and employment. Additionally, immigrant populations with different normative values may not have learned that the oral health of their children should be one of their priorities. To help address the myriad of challenges that newcomer families face 20 COMMUNITY REPORT 2015

when seeking dental care for their young children, Amin and her team conduct community-based integrated workshop programs that leverage community leaders and their influence to engage the newcomers in oral health promotion activities for their children.

Workshops are provided to communities that express an interest in having dental assessments completed for their children, usually at their community centre or place of worship. Amin and her team provide screening for the pediatric patients and identify children in urgent need who are then referred to the School of Dentistry for pro bono dental care. For non-urgent cases, patients and parents are provided with guidance on oral health best practices. “We want to empower community leaders to be part of this communication process,” says Amin, whose team also develops education toolkits in the respective community groups’ native language and shares them with designated community leaders. “Community leaders have their own resources and we wanted them to use this toolkit in their own programs.” Those leaders then provide a critique of the

toolkit, which Amin says provides invaluable feedback. “There are four components of the educational materials we develop for these families,” she says. “We want to highlight the importance of oral health practices and the etiology and consequences of dental diseases; the influence of oral hygiene and diet; and what a dental visit actually entails. These are all critical factors that influence decision making for parents on prioritizing their children’s oral health.” The next step for Amin and her team is to develop a web presence that will incorporate the new education materials and serve as a resource of indirect support. “When patients, community members and community leaders feel ownership of the program, they are engaged,” says Amin. “We are effectively providing a double-pronged approach through education and prevention, as well as advocacy. With these measures, we are confident that we will improve children’s oral health.”

Research Matters

Finding ways to alleviate chronic inflammation in patients Patrick Flood and his research team are finding ways to treat and stop the progression of chronic inflammation diseases like Parkinson’s and periodontal disease in patients. The associate chair of graduate studies and research says his research is not focusing on what causes these diseases, but how to effectively relieve individuals from them. “Acute inflammation is good and it relieves the body of infections. However, when the inflammation becomes chronic, it can cause degeneration of the nerves causing diseases that attack the central nervous system,” says Flood. “We’re looking at developing anti-inflammatories that inhibit the progression of these diseases.” Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s. Research shows that inflammation is a key factor causing the disease and a prime target for therapeutic relief. Periodontal disease, more commonly referred to as gum disease, is an inflammatory condition of the gum and bone support surrounding the teeth. Working with biotechnology companies, Flood has discovered that anti-inflammatory therapies that include compounds like cytokines, inhibitors to the important pro-inflammatory molecule NF-kB, or some morphine-like compounds can slow down or halt the progression of chronic inflammation. Recently, Flood found that compounds that deactivate the beta-2 adrenergic receptor, such as those found in medicines used to treat COPD, can also slow down chronic inflammation. “We’ve been able to demonstrate the effectiveness of these compounds and how and why they work. Further, by using these compounds, we’ve developed ways of suppressing the activation of the cells that cause inflammation by stopping their essential functions.” Flood says the drug companies will now take the research findings and apply them at the clinical level. “At the laboratory level we’ve developed a number of different approaches, particularly in relation to Parkinson’s disease, where we can stop and reverse the disease. Now, we’re trying to do the same for periodontal disease,” he said.

Stopping the progression of chronic inflammation in patients who have periodontal disease or Parkinson’s can be done using certain compounds, says researcher Patrick Flood. COMMUNITY REPORT 2015 21

Research Matters

Working on establishing oral health protocol for elder care Sharon Compton, director of dental hygiene program, and her dental hygiene colleagues Minn Yoon and Arlynn Brodie are assessing ways to improve seniors’ oral health. Specifically, the oral health-care of residents in long-term residential facilities. “The institutionalized elderly often have poor oral health,” she says. “This is a group of people who are among our most vulnerable, and addressing their oral health concerns is complex and incorporates a variety of factors.” Compton and her colleagues are working to establish a role for dental hygienists as part of the team of health care professionals providing care in long-term facilities. Dental hygiene is not part of the medical model of care even though it is recognized that oral health is vital to overall health and well-being.

Estella Stelter (left) is one of many seniors in long-term residential facilities who would benefit from introducing oral health education to caregivers. Dental hygiene program director Sharon Compton (right) is working to train care aides on proper oral care techniques.

“We need to work on establishing an oral health protocol so on-site health care teams can effectively and efficiently deliver the daily dental care for residents.”

Compton and others implemented a program in long-term care facilities in 2011. Dental hygiene students in the program visit long-term residential care facilities in Edmonton where they work to educate health-care aides on how to provide oral care for residents. The students also work with residents to complete oral assessments and daily oral care. An advanced practicum was implemented in 2012 for the dental hygiene students in the BSc program. These students help provide selective oral care at bedside. “By immersing our students in these facilities, they are truly provided with enriching experiential learning opportunity,” says Compton. “The students see firsthand the oral health needs in the facilities and become 22 COMMUNITY REPORT 2015

passionate about helping address the issue. It has a huge impact.” For Compton, it’s critical that the existing policies to address the oral health of long-term care residents are strengthened. This would include stronger directives on oral health protocols and standards, including consistent monitoring to ensure directives are being implemented.“ Currently, there is a gap in the standards that Compton says must be addressed. “While there is mention of oral health protocols in the continuing care standards for facilities, it needs to be stronger,” she says. “There are three things we must do to improve the oral health of older seniors and residents in assisted living and long-term care facilities: research; building inter-professional teams in facilities with dental hygienists; and finally, providing quality oral care.”

Research Matters

Tarek El-Bialy (centre), associate professor of orthodontics and biomedical engineering, explains the problem of induced tooth root resorption to doctor of dental surgery students Banmeet Kalra and Mohamed Sharshar.

Fixing the root of the problem Anyone who has had braces can become an unknown victim of teeth root shortening or “orthodontically induced tooth root resorption,” as dentists like to call it. “Sometimes the effect is minimal and goes unnoticed, but sometimes it can be severe in patients,” says Tarek El-Bialy, associate professor of orthodontics and biomedical engineering at the School of Dentistry. “If the teeth roots get shorter, they can become mobile and in the long run, patients may lose them.” Teeth root shortening happens almost for all patients receiving orthodontic treatments due to the pressure put on teeth from things like braces. El-Bialy says patients shouldn’t worry, however, because

he’s found a way to prevent and possibly regenerate lost parts of the roots.

El-Bialy and his research team have determined that therapeutic ultrasounds can prevent root resorption, but they can’t regenerate the roots of teeth. Therefore, injecting cells into the area where root shortening has occurred may be the answer. “We are now proposing, based on preclinical models, that we can take part of the patient’s gum and isolate the stem cells in a lab. We can condition it in a way where we can simulate tooth root forming like-cells,” he says. “When we inject these cells back into the patient’s gums, we would be able to see if we can regenerate tooth root.” COMMUNITY REPORT 2015 23

Dental students provide charitable care in Kenya

Each year, roughly 15 doctor of dental surgery students volunteer their time for dental missions across the world.

Sam is a 14-year-old boy from a Maasai village in Kenya. Despite already having his tooth extracted, he always found his way back in to the A Better World volunteer dental clinic. During one particular visit, dental student Leanne Grinde asked him if he had become a Maasai warrior yet – protector of his community. His response surprised her. Sam said no. Not only that, he also expressed interest in becoming a dentist. So Grinde did the only thing she could, she let him stay and observe the volunteers. Besides, he proved to be a great translator for them, too. Sam’s story is just one of the many experiences dental students have when they return home. Each year, roughly 15 students take part in missions around the world with non-profit organizations 24 COMMUNITY REPORT 2015

like A Better World, Kindness in Action and Dentistry for All. “Even though you might just be pulling a tooth, they are so happy and thankful,” says Grinde. “It was nice to see dentistry in the realm of healthcare.” Grinde, along with dental students Mika Wierenga and Stephanie McCorkill, were in Kenya from February 7 to 22. Clinics were setup in three remote regions and nearly 200 locals received charitable dental care. “Many of them walked for hours to see us,” says Wierenga. “What’s amazing is that as dental students we were able to share the importance of oral health internationally. Going to a different country changes you. You could definitely see that a smile is universal.” The personal growth each student

experienced is priceless. Understanding the cultural beliefs around oral care in the Maasai people was invaluable. Many of these people have their lower central incisors taken out as children, and they believe canines are bad luck. Most of these procedures are done without local anesthetic and with just a knife and rock, Wierenga explains. Patients with common conditions like infections, decayed teeth, and abscess were treated, and preventative oral hygiene was taught using their tools – an Acacia tree branch for brushing teeth. “Seeing some of the patients was shocking,” says McCorkill. “Some of the kids’ faces were swollen shut because of abscess. We don’t see kids like that here. Having little experience with this, it helped increase our skills.”

Student Success

CCD model puts patients first Becoming a good dentist isn’t only about studying hard and mastering techniques. It’s also about patient management and relationship building. It’s about respect and learning to deal with the demands of dentistry professionally. Comprehensive Care Delivery (CCD) is a patient-centred care clinical education model. Mentored by experienced general dentists students learn how to manage patients more effectively through fewer appointments and more productive use of clinic time. There is less focus on specific treatments and more on overall patient care. The School of Dentistry’s implementation of this model started in 2012 with a move from paper-based reporting to electronic record keeping so patient needs could be effectively tracked. Now, three years later, both the patient and the student are benefiting from this general practice model. “Before the CCD model was implemented, it was difficult for overall patient care to be the primary focus. With the lack of structured mentorship and tracking capabilities overall patient care was often delayed and many times incomplete,” says Loretta J Hursin, director of integrated patient care at the School of Dentistry. She adds that the cultural shift from requirement based clinical curriculum to comprehensive- care was an important step in embracing the patient-centred care model. The CCD model involves third and fourth year dental students. With this model of clinical education, patients are managed by a CCD leader who is an experienced general dentist. CCD clerks book and manage appointments based on patient needs and student requests. Students deliver treatment under the guidance of their CCD leaders and divisional instructors.

Comprehensive Care Delivery leader and professor Edward Krause reviews patient files with doctor of dental surgery students Nicholas Teoh and Kevin Luft. The most important component of the model is the students now have an experienced dentist who provides mentorship. Through mentorship, students develop professionally and gain an understanding of the values and responsibilities that are the foundation of dentistry.

over individual technical procedures, which not only benefits the patient but enhances student learning.”

“What CCD provides is more timely care and more equal distribution of patients. It also ensures dental clinics are operating at full capacity. Patients no longer slip through the cracks and students have a mentor to help them deal with stress,” she said. “The model places an emphasis on patient care

“We are at the point now that we can maintain this. Keeping new faculty and division heads informed about the model is key,” says Hursin. “We are now giving the students the tools they need to provide excellent patient management.”

To ensure the CCD model remains successful, Hursin says protocols must be put in place to ensure the model is carried forward at the School.

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Community Involvement

The Boyle McCauley Dental Clinic sees roughly 96 patients annually and is the only non-profit community owned and operated health centre.

Boyle McCauley committed to inner city residents Housed in the basement of the Boyle McCauley Health Centre – the only non-profit community owned and operated health centre in Edmonton – the School of Dentistry has been running its dental clinic at this location for the past 20 years to help improve the oral health of inner city residents.

environments with more complex needs and have the opportunity to give back to society,” says Alexandra Sheppard, dental hygiene clinical associate professor. “With this rotation, we are able to provide a service to a group of people who would not access our care service normally.

The Boyle McCauley Heath Centre Dental Clinic’s service area includes the neighbourhoods of Boyle Street, McCauley and Norwood. Patients of the dental clinic often face a variety of hurdles, including poverty, homelessness and mental illness. They are seen by appointment, but walk-ins are welcome and seen only if they can be accommodated. Last year, 96 patients accessed the clinic which runs on Mondays and Tuesdays each week. The dental clinic operates solely on donations of time, money and/or clinic supplies.

“The clinic provides an opportunity for the dental students to receive more individualized learning and to practise their skills with a population that is outside of their comfort zone,” says Sheppard, adding many of these patients require complicated work that they wouldn’t see as part of their regular curriculum. “Students are provided with an adequate learning experience and are able to ask questions in a safe environment.”

Dental hygiene students working at the clinic not only learn the importance of social responsibility as working professionals, they also get intense one-on-one work experiences. “Students learn to work in 26 COMMUNITY REPORT 2015

Feeling scared and nervous is common for dental hygiene students going to the Boyle McCauley Health Centre for the first time. But there’s a bit of excitement mixed in as well say dental hygiene students Caitlin Couronne and Mario Ivanov. “It’s essential to include programs like Boyle in our curriculum because

it demonstrates what giving back to the community consists of, as these people reside in severely underserved areas and this population experiences extreme dental conditions,” she said. “Without this rotation, these people would otherwise not have been able to have access to hygiene care and this is very rewarding.” Both students agree the Boyle clinic rotation provides an extremely valuable learning experience. They are able to escape their comfort zone and see patients they normally wouldn’t. “I learned a lot of things that I wouldn’t have been able to through reading about it in a textbook or having it explained to me through a teacher in a classroom,” says Ivanov. “I was able to see patients with complex dental needs that I wouldn’t be able to see at the School’s clinic and provide treatment.” Couronne and Ivanov say they also benefited from more one-on-one experience with the instructor which allowed for a lot of clinical growth, learning, and improvement of their skills as dental hygienists.

Patient Experiences

PEDIATRIC CLINIC provides

preventative dental treatment through SCHOOL VISIT program More than 1,300 children aged four to 17 visit the School of Dentistry’s Pediatric Clinic each year. While roughly half of these children are regular patients, other children are also bussed in from underserved areas identified by Alberta Health Services as part of the school visit program. Through this novel approach, basic dental treatments are provided free of charge for these patients. “It’s the best way to give back to the community,” says Maryam Amin, associate professor of pediatric dentistry. “The school visit program is a win-win for us and the community.” Located in the Kaye Edmonton Clinic building, the pediatric clinic is held once a week for half a day. School-aged children are also seen during Dental Camps organized and held at various locations in Edmonton by Amin and her team – all thanks to a mobile dental unit. “Going out into the community locations enables us to screen and identify children who require treatment,” she says. “Once children in need are identified, we refer them to the university clinic to receive the required care. They are then scheduled to come in once a year for a regular checkup until they are 18.” As the popularity of the clinic continues to grow, Amin says they are now working towards expanding the program. While all of the admitted children received preventive treatments, including oral hygiene instruction, roughly 1,000 restorative dental procedures were also performed for those in need. For the 70 third- and fourth-year dental students working in the clinic under the tutelage of 12 pediatric instructors, being in an educational environment and expanding the clinic will be of the biggest benefit to the students.

Fourth-year dental student Kaylyn Sissons and her pediatric patient Harparinaz Aujla complete an appointment during the School’s pediatric clinic day.

“We want our students to learn how to work with pediatric patients and to manage more complicated cases. Many of our school visit and community patients need advanced treatments, which are rarely seen in our regular patients,” explains Amin. “Our students will have much more confidence providing these same procedures and services after they graduate. Many young dentists are reluctant to see children; we are one of the limited resources for the community.

Community Involvement

CDE serves as resource centre for dental professionals To keep dentists up to date on the latest techniques and skills, the School of Dentistry’s Continuing Dental Education (CDE) platform offers didactic programs to those in the field of dentistry across the country.

dentists, dental hygienists, dental assistants and dental laboratory technicians. Hands-on, competencybased and lecture-based specialized education and certification programs are available throughout the year.

“We’re training dental professionals to utilize the latest technology available in their private practice and their knowledge,” says James Yacyshyn, director of continuing dental education at the School. “Everyone in the health-care field must always learn the latest skills or upgrade their current skillset. We are a strong resource for practitioners.”

Programs cover a variety of subject areas. There are courses in nitrous oxide and oral sedation, emergency airway management, clinical orthodontic procedures, local anesthetic, business in dentistry and practice management, neuromodulators, oral pathology and restorations.

CDE offers programs to postgraduate

Another course is Cone Beam CT (CBCT) certification, which is CDE’s

Continuing Dental Education programs like nitrous oxide and oral sedation help dentists and dental hygienists stay up to date on their education.

longest-running program and a national standard across Canada. “Another new course we’re offering in neuromodulators is in Botox. It can be used therapeutically in dentistry to relieve headaches and jaw joint disorders. This course is unique because it involves dermatology, nurses, family doctors and dentists” says Yacyshyn. The biggest advantage offered to dental professionals by attending these courses is they receive instruction in the School’s clinic and dental simulation laboratory. “CDE enables us to translate knowledge into practice,” he says.

Aga Khan University in Pakistan admitted its first 10 students into the newly developed diploma in dental hygiene program.

First class of DDH students attend Aga Khan University With ongoing support from and collaboration with the University of Alberta’s School of Dentistry, Pakistan’s Aga Khan University (AKU) admitted its first group of students into the Diploma in Dental Hygiene (DDH) program earlier this year. “This is a dream come true,” says Saida Rasul, an internationally recognized and celebrated dentist and humanitarian on a recent visit to the School. “We conceptualized this program nine years ago, and on January 1, we admitted our first class of 10 students.” The oral hygiene needs of Pakistan‘s citizens are innumerable. According to the World Health Organization, more than 93 per cent of Pakistanis over the age of 65 have periodontal disease. Further, dental caries (or tooth decay) is the most common chronic childhood disease in the country. Oral cancer rates in Pakistan are the second highest in the world, possibly due to the socially acceptable habit of chewing the stimulant paan and its derivatives. More alarming is the fact that 90 per cent of all oral diseases remain untreated in the country. The lack of oral

health promotion and prevention measures, along with timely access to care and affordability of tertiary care are some of key reasons for this grim state of oral disease in this region. In response to these challenges, the DDH program places a large focus on education and awareness of receiving oral health care to help prevent these diseases. Dental hygiene program director and professor Sharon Compton, and student affairs associate chair and professor Thomas Stevenson, worked with Rasul and clinical associate professor Karima Bapoo-Mohamed to initiate the program. Bapoo-Mohamed played a pivotal role in researching, developing and implementing components of this new academic program at AKU. Leading a team of other North American dental hygienists, she has been actively involved in the DDH program proposal submission, curriculum development, interprofessional collaboration with AKU campus faculty and recruitment of DDH teaching faculty. The School also provided course guides, equipment, expertise and numerous

other in-kind donations. “The dental hygienists will be such an asset to Pakistan,” says Rasul. “The value you give to your patients will go up.” Rasul admits that raising the profile and importance of maintaining good oral health in Pakistan has a long road ahead, but with dental hygienists working alongside the dentists it’s a step in the right direction. “I hope this program will be trail blazing in Pakistan. Our students pay the minimum because they can’t afford it, but have the skills and marks to apply. So, we subsidize the tuition by having them work in the community and letting people know about the importance preventative oral care,” she explains. Thirty-nine Pakistani students applied for the dental hygiene program based on Aga Khan University’s regular admission requirements. Of these students, 16 were interviewed and the top 10 were accepted after passing an entrance test. Next year, Rasul hopes to admit 14 students. “The future of this program is so bright. I want to see it go from a diploma to a degree,” says Rasul. COMMUNITY REPORT 2015 29

Community Involvement

SHINE clinic continues shining bright in local community The Student Health Initiative for the Needs of Edmonton, or the SHINE clinic as it’s commonly referred to, has been providing dental services to city residents for just over a decade. The SHINE clinic, which provides services to the inner-city population and new immigrants, is located in the Boyle McCauley Health Centre. SHINE clinics run every Saturday and the team consists of students from each of the four-years of the dentistry program and a preceptor. The preceptor is a licensed dentist from the community who volunteers their time. Most often, they are also School of Dentistry graduates. Dental students Lindsay Patterson, Caila Bruzzese and Alisa Hackney appreciate the importance of giving back to the community. In addition to SHINE’s important promotion of good oral health, all three agree the clinic provides a learning experience that can’t be replicated in the classroom. “Dentistry is an important service that should be available to everyone,” says Bruzzese. “While patients receive needed treatment, as students we gain a lot of experience from the one-on-one learning environment.”

Caila Bruzzese (DDS 2017), Alisa Hackney (DDS 2016), Lindsay Patterson (DDS 2016) and first time SHINE patient Melanie Hulme after her appointment.

After volunteering at the clinic for the last few years, all three students say they’ve noticed a steady increase in the number of patients using its services. “We’re getting a lot of word-of-mouth referrals and new immigrant families,” says Patterson, adding if patients require more complicated or regular ongoing treatment they are referred to the School of Dentistry general practice clinic. “I like helping people who would not normally have access to dental care. By volunteering, you also get to experience how it would feel to be a working dentist.” Once Hackney graduates and if her work keeps her in Edmonton, she says she’ll definitely continue to volunteer as a preceptor. “The community outreach gets me back to the basics of why I chose dentistry. Talking to the patients and learning their stories is essential to being a dentist. The continuing care and referrals to the School enables us to treat the root of the problem,” she adds. 30 COMMUNITY REPORT 2015

Eddie Pavlenko (DDS 2016) and Bruzzese providing dental care to Hulme.

Alex Polkovsky is lifted into the dental chair at the Glenrose Dental Clinic with the help of a medilift chair.

Accessing dental care made easier Alex Polkovsky has multiple sclerosis (MS) and is wheelchair bound. As such, getting safely in and out of regular dental offices was becoming increasingly difficult for him so regular dental care quickly became a thing of the past.

At least until a homecare aide referred him to the Glenrose Rehabilitation Dental Clinic. “There is nothing like this place. There’s so much optimism here that you feel like you will get better soon,” says Polkovsky. “I’m so glad the clinic is here. Getting regular dental care for overall health is important. I don’t think there is any dental place that can get me safely in a dental chair other than the Glenrose.” The Glenrose Dental Clinic is specifically designed and tailored for patients who require more time and care. Equipped

with a Medilift, the clinic’s facilities accommodate patients who are medically compromised or have impaired mobility. No referrals are needed to access the clinic. “We have patients who drive in from Vegreville because we provide treatment that other private clinics cannot,” says Iris Kuc, instructor and dentist at the Glenrose Dental Clinic. “We are more experienced in dealing with patients who require more time and care. We can do everything from basic restorative treatment to dentures and root canals all right here.” The clinic’s facilities are especially important to patients who have safety concerns says Polkovsky. Getting in and out of a wheelchair is not easy for him, which is why the medilift is such a help. “As an MS patient, it’s important to have

resources available that are safe. Regular dental care proved a barrier for me,” he added. “Maybe after coming here, some student will decide to open an office with a little more access for patients like me. But I have to say, the staff and students here are awesome.” Dental hygiene clinical instructor Donna Kawahara says the clinic is a well-kept secret. “There are many practices that don’t realize we have this care available,” says Kawahara. “The most positive thing for the students is that they are able to treat these patients. They take what they learn as part of their work experience and give back to their community at the same time.”

COMMUNITY REPORT 2015 31

www.dentistry.ualberta.ca Kaye Edmonton Clinic 8th Floor, 11400 Univserity Avenue Edmonton, Alberta T6G 1Z1

Edmonton Clinic Health Academy 5th Floor, 87 Avenue NW Edmonton, Alberta T6G 1C9

Katz Group Centre for Pharmacy and Health Research Office: 7-020H Edmonton, Alberta T6G 2E1