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SUNY Downstate Geriatric Fellowship Program
Geriatric Dentistry Clinical Program and Curriculum
The National Agenda for Geriatric Education White Paper reports that the need for clinician-educators in geriatrics is probably the greatest in dentistry of the three areas covered in this program and that "the dental delivery system is least equipped to meet the needs of the growing number of frail and functionally dependent elders." Although the American Dental Association provides no specific guidelines for geriatric dentistry, this program is designed to conform to their recommendations for a two-year general practice residency with specific content designed to meet the needs of dentists interested in specializing in geriatrics. Dental fellow will receive most of their practical experiences under the supervision of Dr. Julius Berger at Kings County Hospital Center Department of Dentistry and Kingsbrook Hosptial. The overall goal is to provide the fellows with training in geriatric dentistry with the knowledge, skills and attitudes so that they will be able to:
Dental fellows will gain knowledge about age-related changes specific to masticatory apparatus, masticatory function and nutrition, and prosthetic treatment planning specific to the elderly including legal and ethical issues.
1. Ambulatory Hospital-Based Rotations
These rotations will focus on developing skills with respect to the prevention and treatment of oral disease in older patients.
Kings County Hospital Center: a 17-chair facility. In addition to standard equipment, the dental clinic is equipped with digital radiography, periapical and panoramic, rotary endodontics, a CO2 laser and an implant suite. Ethnically, the population treated is 5% White, 78% African American, 15% Latino, and 2% other. Approximately 40% of the patients are geriatric. There are 30,000 annual patient visits. It is staffed by 14 dentist and 8 dental surgeons. Drs. Berger and Joseph will provide supervision to fellows. Fellows spend 4 hours per week and follow selected patients throughout their training.
The Dental Clinic at Kingsbrook Hospital: a 6-chair unit with 6000 patient visits annually. It provides a full range of general dental services to include periodontics, endodontics, oral surgery, dental hygenics, as well as specialized and emergency dental care. The clinic has fully equipped dental stations and an on-site laboratory that enable the appropriate level of services to be given quickly and efficiently to each patient. It is supervised by 8 attending dentists. It serves a large minority and indigent population, with 60% African American, 30% white, and 10% Latino. Approximately 25 hours per week during the first year.
2. Community Outreach
Although treating patients in Downstate and King County Hospital clinics are significant elements in gaining proficiency in geriatric dentistry community outreach programs will give fellows direct experience and knowledge on how socioeconomic issues affect total health in general and oral health in particular; e.g., interrelationships between oral health, systemic health, living conditions, education, annual income, age, and cultural factors. They also learn how those problems can be solved with the resources available.
Community clinics (2): (Satellite Community Clinics in East New York and Brownsville). Located in dentally underserved areas of Brooklyn, trainees will learn to deal with special problems unique to older persons from minority backgrounds. Fellows will spend 4 hours per week at each site (one site per year).
Outreach Site: (Bowery Residents' Committee Senior Program). This provides an opportunity to learn to work with homeless older adults and to provide dental care outside of a formal office setting. Fellows will spend 4 hrs per week for 12 months at this site.
Home visits (Brooklyn Alzheimer's Disease Assistance Center): Fellows will accompany team on home visits to dementia patients and will assess and address dental problems. Fellows spend 3 months on this rotation.
3. Long-term Care
Rutland Nursing Home: Fellows will conduct dental screening exams on patients residing at the nursing home. Rutland Nursing Home, is a 500 bed facility, is a part of Kingsbrook Jewish Medical Center that is a fully functional and accredited hospital facility. The Dental screenings are conducted at the patients' bedside. However, if there is a need for treatment, the patient will be scheduled in the Dental Clinic, which is described above. Generally, the patient will be escorted to the clinic by hospital escorts since the majority of the patients need the assistance of a wheelchair. Approximately 25% of the screened patients come to the clinic without escort since these people are able to ambulate independently. The geriatric patients seen at Rutland Nursing Home are 80% African American, 15% Caucasian Jewish and 5% Caucasian (other) and Latino. Treatment rendered included prophylaxis with and without Cavitron scaling, minor oral surgery, Operative and prosthetic fabrication. In at least 50% of the cases, medical clearance was needed for prophylaxis and oral surgery procedures. Approximately 5 hours per week. Drs. Mark Drugart and Berger provide supervision.
Susan Smith McKinney Nursing and Rehabilitation Center: Patients are seen both in the clinic and at bedside. Bedside dental visits are primarily consultation and screening, whereas the clinic is reserved for actual treatment ranging from prophylaxis to minor oral surgery procedures. All invasive procedures are referred to the Dental clinic at King's County. The inpatient residents at this nursing home and rehabilitation facility are approximately 80% African Americans, 15 Hispanic and 5% Caucasian and other. 4 hours per week during 1st year.
4. Dementia Clinic (Brooklyn Alzheimer's Disease Assistance Center at SUNY Downstate):
This site provides the dental fellow with an opportunity to learn more about the diagnosis and care of dementia patients. The dental fellows work along with the psychiatry and medicine fellows, and they conduct oral examinations on patients. They also provide advice to caregivers regarding oral care and nutrition. Fellows arrange referrals for patients to see them at the SUNY dental clinic. This is a 3-month rotation for 4hrs per week that includes home visits described above.
5. Geriatric Psychiatry Clinic at SUNY Downstate:
This site provides trainees with opportunities to learn about the psychiatric and behavioral syndromes that commonly affect older adults. Fellows also provide assessments and advice on oral health problems, particularly oral side effects that accompany the use of some medications. Fellows arrange referrals for patients to see them at the SUNY dental clinic. This is a 3-month rotation for 4hrs per week.
6. Physical Medicine and Rehabilitation Clinic (Susan Smith McKinney Nursing and Rehabilitation Center & Kings County Hospital Center):
This rotation will give fellows the opportunity to work with older persons with serious physically disabilities, to learn about various medical conditions that affect these individuals, and to develop strategies for addressing the dental needs. Fellows will spend 4hrs per week for 3 months on this rotation. Supervisor: Dr. Edward Gregory.
7. Palliative Care and End of Life Care--Kings County Hospital:
Required 1-month rotation for 4 hours per week at Kings County Medical Center under the supervision of board-certified internists (Dr. Sarah Egan, Dr. Cho). They will attend bedside visits and family meetings with the team, which are then followed by case conferences and discussions. The team includes a nurse practitioner and a palliative care physician. This rotation exposes the fellows to patients with terminal conditions/diseases and to the factors that are important to the care and comfort of these patients. 56% of patients seen are over age 65 and 62% have some form of cancer. Of these patients, 91% are African American/Afro-Caribbean, 6% Hispanic, 2% Caucasian, and 1% are Asian.
8. Geroneurology Clinic:
Required 1-month rotation for 4 hours per week. The faculty consists of a board-certified neurologist (Dr. Howard Crystal). Educational activities include observation and participation in the care of elderly patients in an outpatient neurology clinic that focuses on older persons with cognitive disorders and neurological disorders with comorbid cognitive and behavioral problems. Dental fellows will assist with cognitive assessments and provide oral examinations of patients.
9. Geriatric Medicine Clinic:
Required 1-month rotation for 4 hours per week. The faculty consists of five board-certified internists (Drs. Reid-Durant, Lawrence, Price, Kaner), four with added qualifications in geriatrics. Educational activities include observation and participation in the care of elderly patients attending the geriatric clinic under the supervision of one of the faculty. Fellows receive on-site precepting by attending geriatricians, and interact with other members of the health care team in developing and achieving goals for the patient, such as maintaining function and independence, and obtaining health care screening, and receiving ongoing treatment of chronic and inter-current medical problems. They will work closely with the geriatric medicine resident. Emphasis is also placed on developing well-coordinated care and continuity of care for patients who have not previously achieved this goal.
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The fellow will have about 20% time in the first year and 30% time in the 2nd year for conducting research.
Dental Fellows will have opportunities to develop research projects with SUNY faculty members, both from dentistry and in the College of Medicine. Fellows attend a research seminar, and scientific sessions at annual meetings. In recent years a number of topics have emerged in geriatric dentistry that may serve as a basis for research for the fellows. In previous years, our fellows have conducted pilot studies of Alzheimer's patients, older psychiatric patients, and older persons with schizophrenia. The first two studies are near completion and the latter has been presented at national meetings and been submitted for publication. However, some topics that we have considered exploring in recent years and that would be appropriate to our community are listed in the table below:
Dental Research Topics
*current research topic
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Geriatric Dentistry Conferences and Didactic Programs
Core Lecture Series - 1st year (Fellows in Medicine, Psychiatry, Dentistry):
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Journal Club (Fellows in Medicine, Psychiatry, and Dentistry)
In this joint fellow conference, fellows are assigned a specific topic or review article to present to other trainees and attendings. Following the presentation, the fellow is expected to give a short discussion outlining his/her level of understanding of the topic and raises areas of controversy or uncertainty. This interactive part of the presentation includes input by other trainees and attending faculty.
Additional Specialty Lecture Series
The specialty clinical lectures (2hrs/monthly) will be under the direction of Albert Joseph, DDS and Julius Berger, DDS. The lecture topics are listed below
Geriatric Dental Lecture Series
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Geriatric Dentistry Two-Year Program
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