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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:

  • Deliver excellent dental care to diverse elderly populations in a variety of settings by the end of the fellowship
  • Provide this care in conjunction with professionals from other medical and health related disciplines
  • Be able to embark on a successful career in academic geriatric dentistry

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.

Clinical Training

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

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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Research Experiences

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

  • Oral health care for dementia patients *
  • Oral health and nutritional status in older adults
  • Oral health care for older persons with schizophrenia *
  • Dental status and prosthetic needs in persons with Parkinson's disease.
  • Alzheimer's disease/cognitive impairment and the management of patients for dental treatment
  • Attitudinal studies of dentists about older patients.
  • Growing older and using dental prosthesis;
  • Dental care of older persons with chronic mental illness
  • Survey of perception of aging and keeping one's natural teeth – cross-cultural analyses
  • Screening for oral cancer in older adults
  • Periodontal disease and health in the elderly.
  • Attitudinal studies of dentists about older patients.
  • Factors that facilitate health promotion of oral health in older minority adults.
  • Oral health care in older psychiatric patients
  • Racial and socioeconomic disparities in oral health of older persons.
  • Dental care of older persons with diabetes.

*current research topic

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Geriatric Dentistry Conferences and Didactic Programs

Core Lecture Series - 1st year (Fellows in Medicine, Psychiatry, Dentistry):

  • Seminar in Dementia and other Cognitive Disorders: Review of the evaluation of neurological assessment, neuropsychological assessment, delirium, types of dementia, pathogenesis; symptoms, treatment and management strategies, current research advances, complications of dementia and its identification, e.g., depression, delusions, psychosocial issues for patients and caregivers, community resources, cross-cultural issues. Carl Cohen, M.D., Georges Casimir, M.D., Kim Kelly, Ph.D., Howard Crystal, M.D., Sharon McKenzie-Reece, Ph.D., Lorna Walcott-Brown, MS. 1 hour weekly for 12 weeks.
  • Seminar in Common Psychiatric Disorder of Older adults: Depression and Other Mood Disorders, Suicide, Bereavement, Psychoses, Anxiety Disorders, and Personality Disorders in Older Adults: Review of the assessment and management of depression and mania, diagnostic and treatment issues specific to older populations, psychopharmacology, dynamic and supportive psychotherapy, cognitive behavioral approaches to treatment, research advances in pathogenesis and treatment, use of ECT and other somatic treatments, issues of bereavement. Diagnosis and treatment of anxiety disorders including use of CBT. Recognition and treatment of bipolar disorders. Recognition and treatment of schizophrenia and other psychoses in later life. Georges Casimir, M.D., Carl Cohen, M.D., Nancy Talavera, M.D., Michael Berzofsky, Ph.D., Steven Friedman, Ph.D. 1 hour weekly for 9 weeks divided into 2 blocks of 5 weeks and 4 weeks.
  • Seminar in Cross-Cultural Aspects of Geriatrics: Review of cross-cultural aspects of aging, growing old in other cultures, review of special populations in Brooklyn e.g., West Indian (French and English-speaking), Latino, Jewish, Russian, and African American. Georges Casimir, M.D., Nancy Talavera, M.D., Carl Cohen, M.D., Jay Sokolovsky, Ph.D., Sharon McKenzie-Reece, Ph.D., Lorna Walcott-Brown, MS, Andreas Adams, Ed.D., MSW,.1-hour weekly for 5 weeks.
  • Seminar in Inter-Generational, Aging, Sexuality, and Human Development: Overview of biological, psychological, sociological, theories of aging; theories of life-span development, sociocultural context of families and human development; parenting, cognitive changes over life course; personality development and change, gender issue; grandparenthood, cross-generational interplay of illness and dependency, caregiving; family therapy issues. Carl Cohen, M.D., Barbara Lawrence, Ph.D., Marion Dunn, Ph.D. 1 hour weekly for 5 weeks.
  • Seminar in Medical and Oral health Issues in Older Persons: Topics include: surgical issues, medical assessment, neurological assessment, prescribing issues, oral health care, pharmacokinetics and pharmacodynamics, falls and gait disorders, renal disorders and incontinence, palliative care, end of life decisions, alcoholism. Everton Prospere, M.D., Steven Kaner, M.D., Judith Ahronheim, M.D., Edmund Bourke, M.D., Jacob Dimant, M.D., John Weigan, M.D., Julius Berger, D.D.S., Alfred Joseph, D.D.S. Stuart Lazow, DDS, Allen Carver, M.D., Chris Harghel, M.D., Sarah Egan, M.D., Howard Crystal. M.D., Girardin Jean-Louis, Ph.D., Georges Casimir, MD. 1-hour weekly for 14 weeks.
  • Seminar in Ethical, Legal, Health Financing, and Administrative Issues of Elderly Persons. Topics include: ethical issues, administrative psychiatry and health financing, legal issues George Casimir, M.D., Martin Petroff, JD, Judith Ahronheim, M.D. 1 hour weekly for 3 weeks
  • Seminar in Educational Methods and Doctor-Patient Interaction with Older Patients. Topics include: doctor-patient interactions, education of patients, teaching methods, development of teaching portfolio. Barbara Lawrence, Ph.D., Gerald Adler, M.D. 1½-2 hours weekly for 3 weeks
  • Seminar in IT, Web sites development, use of virtual patients, IV, and embedded lectures. Topics: use of video, webcasting, publishing of web sites, and other IT skills.Faculty include Dr. J Neil, J Lubrovich and L. Ebarb
  • Seminar in Administration: Topic include health management managing in complex organizations, organizational change, and health policy. Dr. Howard Berliner

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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

  • Geriatric Dentistry; An Overview
  • Nutrition and dentition in the elderly
  • Oral Cancer in the Geriatric population
  • Periodontal disease and the elderly
  • Oral restorations for the geriatric population
  • Dental considerations for the medically compromised geriatric patient (Pt. I )
  • Dental considerations for the medically compromised geriatric patient (Pt. II)
  • Medication side effects on the oral health of the elderly
  • Managing the dental patient with Alzheimer's disease
  • Working in long-term care settings
  • Dental Implants for the geriatric patient

Course Textbook:

  • Holm-Pedersen P, Walls A, and Ship J A. Textbook of Geriatric Dentistry. 3rd Edition. Blackwell Pub.
  • Budtz-Jorgensen, E (1999). Prosthodontics for the elderly: Diagnosis and treatment. Quintessence Pub Co, Chicago, IL.

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Geriatric Dentistry Two-Year Program

Clinical Rotations
Site Description Time Faculty
KCHC Dental Clinic Outpatient geriatric dentistry 12 months
4 hrs/wk
Dr. Julius Berger, Dr. Albert Joseph
Dr. Nicole Fleming, Dr. Lazlow; Dr. Fried
East New York Treatment & Diagnostic Center Outpatient satellite clinic of KCHC 12 months
4 hrs/wk
Dr. Warren Williams
Dr. Nicole Fleming
Kingsbrook Jewish Hospital* Hospital inpatient and clinic 12 months
25 hrs/wk
Dr. Berger,
Dr. Mark Drukertz
Rutland Nursing Home* Long-term care 5 Hrs/wk Dr.Berger, Dr. Mark Drukertz
Bowery Residents’ Committee Senior Program* Program for older homeless adults 12 months
4 hrs/mo(2nd year)
Dr Berger, Dr. Angela Kedzior
Susan Smith McKinney
Nursing Home & Rehabilitation Center*
Geriatric dental treatment for long term care residents 12 months
4 hrs/wk
Dr. Julius Berger
Dr. Aninyar
Edward Gregory
St. Albans Extended Care* Dental care of older veterans in long term care 12 months
4 hrs/wk(2nd year) elective
Dr. Stephan Bergen
Brooklyn Alzheimer’s Disease Assistance Center at SUNY Downstate* Dementia assessment and treatment 3 months
4 hrs/wk
Dr. Cohen & Staff

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