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MyView: Never say never

September 18, 2017

By Niki Carter, D.M.D.


Niki Carter, D.M.D.
It was like any other beautiful autumn day working in my small dental practice in Little Rock, Arkansas, until I received a phone call asking if I'd be interested in helping the University of Arkansas for Medical Sciences develop a general practice residency program in dentistry. Now that was a question I never thought I would hear.

A national study indicated Arkansas ranked very low in dental patient accessibility and practitioner distribution. Since there is no dental college in Arkansas, the plan to elevate dental health in the state was to develop educational programs by creating advanced dental training using a residency program.

At that time, having been in private practice 24 years and loving my practice, the answer was, "No, thank you." Then after some persuasion, I agreed to listen to exactly what this request entailed. After that conversation, my reply was, "Let me think about this for a few days."

The next several days were filled with thought and reflection about the general practice residency in which I participated. Recalling the many unique experiences, progressive training concepts and immeasurable knowledge gained caused me to realize how exceptional the opportunity to participate in a general practice residency had been. Little did I realize this walk down memory lane would lead me to say "Yes" to the University of Arkansas' offer.

Within a few weeks, the process of designing and developing a general practice residency program to submit for initial accreditation began while I maintained my practice. Accreditation was a brand new concept for me. The day the document of standards was delivered to my office, I wondered what on earth I had gotten myself in to. Saying I had no idea what an accreditation process encompassed was a huge understatement.  

The process of accreditation taught me a great deal about systems of education, how institutional processes work and also about management of people. To date, our residency operates without a dental college thanks to some very talented and giving dental colleagues. I asked several dental colleagues around the state to become adjunct faculty to supervise, instruct and advise our residents.  

From my perspective, the biggest challenge was bringing dentistry to the University of Arkansas Medical Sciences. It isn't just dentistry, but the addition of what dentistry means to the university in terms of having an inclusive institution that treats patients from all over the world. The residents have added service and awareness to the medical sciences and to our medical colleagues. The interprofessional education is in full force while the residents work with other residents in the hospital and rotate through various medical rotations during the one-year program.

The key message in our educational program is that by providing advanced training to residents to treat patients who are medically compromised, this raises the bar for the skill and depth of dental care taught, exceeding dental school training. It also dramatically increases knowledge and awareness of oral health as it relates to patient's overall health status.

Many people do not realize oral health is actually a measure of a patient's overall health, including risk factors and social determinants for a person's general health and well-being. Poor oral health has been linked to many chronic conditions including cardiovascular disease, dementia, respiratory infections, diabetes and complications during pregnancy. The status of oral health is associated with and determined by gender, age, education level, income, race, and ethnicity, access to insurance and geographic location. By reducing many of these barriers to better oral health, it improves the overall health of our citizens.

Arkansas ranks 50th in the nation for oral health. Access to dental care is related to the maldistribution of dentists versus a shortage of dental health care providers in our state. By providing an advanced general dentistry program, this enables more highly trained dentists to practice in our state. Specifically, the residents are trained to provide care for a variety of patients, including those who are medically compromised or have other special needs. Upon completing the residency, these highly trained dentists can practice in a rural area of the state and provide comprehensive care, or apply for hospital privileges and treat patients who can't receive treatment in the traditional practice office setting.  It is a first step in addressing the maldistribution dilemma that exists in Arkansas.

It would be easy to write multiple pages regarding how wonderful an institution the University of Arkansas Medical Sciences is or also about the challenges which come with developing and incorporating a dental program into a well-established medical institution. Working interdisciplinary has been fascinating and intriguing. Adding a post-doctoral program in general dentistry to a hospital in a state without a dental school has not been easy but worth the effort.

This entire process has been an incredibly fulfilling experience. It's a true statement: when you give, you get so much more in return. Dentistry has been very rewarding, and it is a privilege to give back to such a great profession. Many of our colleagues have worked extremely hard in this project of making our general practice residency program state-of-the-art. It's a privilege to be in the dental profession and be a small part of the overall objective of taking dental education to the next level in Arkansas.

A version of this editorial, reprinted with permission, appeared in the Spring 2017 issue of Arkansas Dentistry. Dr. Carter is the director of the University of Arkansas for Medical Sciences Foundation Oral Health Clinic and director of the school's general practice residency program.