COVER STORY

Amanda Shaffer looks at a mirror to check the work Dr. David Jacobson did for her in the PAES Clinic.

"Here is a sound I know you're looking forward to hearing," Dr. David Jacobson says jokingly, drill in hand, to patient Amanda Shaffer as she settles into a dental chair in the School of Dentistry's Patient Admitting and Emergency Services (PAES) Clinic.

Shaffer has come to the Clinic for treatment of a fractured tooth.

"My mother told me about what the dentists and dental students do here to help patients and urged me to come to get this taken care of. So here I am," she says with a smile.

A few minutes earlier, Jacobson, the Clinic's director, introduced himself, asked Shaffer questions about her condition, and explained what he would be doing to help.

Moments later, Shaffer hears the whirring sound of a drill as Jacobson begins his work.

During the next twenty minutes, he frequently pauses to ask questions, usually to determine if Shaffer is feeling any pain and if she's comfortable. He also takes time to explain what will happen next.

When he finishes, Jacobson asks Shaffer to look at a hand-held mirror he gives her. She looks into the mirror, opens her mouth, checks her teeth, smiles, returns the mirror, and thanks Jacobson for his help as she gets up and leaves the Clinic.

"A Very Busy Place"

PAES Clinic Patient Visits  For the past four years, more than 11,000 patients annually have come to the School of Dentistry's PAES Clinic to receive oral health care. Many live within a 30- or 40-mile radius of Ann Arbor. However, others drive two, three, four, and sometimes five hours to receive care.  

Shaffer is one of thousands of patients who come to the PAES Clinic each year for oral health care.

In recent years, the number of patients seen at the Clinic has consistently exceeded 11,000 annually.

Dr. Stephen Stefanac, associate dean for patient services who oversees the Clinic's activities, says the Clinic, "more often than not, is a very busy place."

Between 50 and 60 patients are seen daily. However, there have been times when those numbers have been higher. A record 99 patients were seen on a single day in late February 2003. Although he doesn't remember the reasons for the surge, Jacobson says, "because of the work of the staff, their commitment, and the loyalty of the students, we were able to help every one of the patients who came here that day."

It's a demanding environment, even in the best of times, for Jacobson and two other full-time staff dentists, Drs. Vernon Rife and Juan Johnson, and part-time dentists Drs. Justin Dugas, Aaron Ford, and John Seago.

Located on the first floor of the dental school, the Clinic is the gateway to better oral health that serves the public in two important ways.

One is to help patients who need emergency care, typically walk-in patients who do not have a scheduled appointment, but need prompt attention to alleviate pain. As the chart shows, the PAES Clinic has treated more than 5,000 patients annually in this category for the past four years.

The other is to screen patients seeking comprehensive care who are interested in receiving longer-term, on-going treatment at the dental school. More than 6,000 patients annually are in this category.

Emergency Care

When a patient needing emergency care arrives, Jacobson, or two other staff dentists, and fourth-year dental students, spend time listening to the patient and asking questions about their condition.

In emergency situations, patients are told that only their particular problem will be addressed.

"Our objective is to get the patient out of pain," Jacobson says. But on any given day, he adds, "about half of our walk-ins are referred to oral surgery for extractions."

Some of these patients, Jacobson says, involve "an alarming number of young people with rampant caries due to their consumption of soda pop and other soft drinks."

Other patients, however, may be referred to other clinics such as periodontics or orthodontics or endodontics for specific procedures.

It is not uncommon during the course of an emergency examination for a patient to be told that he or she will need comprehensive care that will have to be provided over an extended period of time.

Comprehensive Care

The PAES Clinic screens every new patient who makes an appointment to receive long-term comprehensive care. Although many of these individuals are new patients, there are some who have not been to a dentist for some time, in some instances, five or even ten years.

When first-time patients arrive, they watch a new six-minute video that describes what they will experience and how the Clinic works.

A significant portion of the initial screening amounts to what Jacobson describes as "a free consultation."

Each patient receives a cursory examination to see if there are any problems that might require immediate treatment and a screening examination for oral cancer. If there are no immediate problems, the information that is gathered is used to assess the patient's needs and discuss what needs to be done. Emergency radiographs are also ordered, when necessary, for the PAES Clinic.

However, these new patients do not receive any preliminary treatment. Instead, they are assigned to a dental student in one of the School's four comprehensive care clinics.

The clinics give students in all four dental classes and the three dental hygiene classes opportunities to work together, with faculty supervision, to achieve high levels of clinical experience and competence. Also known as Vertically Integrated Clinics, students obtain basic clinical training that prepares them for more advanced clinical experiences during their final years in the dental and dental hygiene programs.

However, patients may also be referred to a specialty clinic.

Regardless of whether a patient is treated in a specialty clinic or a comprehensive care clinic, they are told about the major differences between being treated at the School and a private practice.

"We emphasize to patients that because we are a teaching facility, everything will take longer than it would in a private office," Jacobson says.

"However, they are happy to learn that the School's fees are approximately one-half of what area dentists and specialists charge for the same procedures," he adds.

"Providers of Last Resort"

Many patients who come to the PAES Clinic live within a 30- or 40-mile radius of Ann Arbor.

However, others drive two, three, four, and sometimes five hours to receive care. Those patients typically come from the western part of the state, the Upper Peninsula, and northern lower Michigan. A few even come from outside Michigan.

"With Michigan's economy what it is now because of corporate downsizings, especially in the automobile and automotive supply industries, we're seeing more patients than ever who have nowhere else to go to be treated for their conditions," Stefanac says. "In many instances, we're the providers of last resort."

Compounding the problem is that, in recent years, many oral health care providers have decided not to offer dental care to Medicaid patients because their cost to do so, including supplies, substantially exceeds reimbursement from the state.

According to the Michigan Department of Community Health, the number of Michigan dentists accepting Medicaid payments has declined 39 percent, from 1,578 in 2000 to 961 currently. Only about 15 percent of the state's 6,500 dentists take Medicaid.

The state currently spends about $8 billion on Medicaid, nearly twenty percent of its budget, to provide health care coverage, including dental care, to about 1.46 million low-income children, adults, and seniors. Of that amount, approximately $80 million, or one percent of the budget, is for dental-related services.

Given this confluence of developments, it is common for patients scheduling their first appointment to wait six to eight weeks for initial visits that are required prior to receiving comprehensive care.

Student/Staf Dentist Teamwork

Fourth-year dental student Brian Shaughnessy (left) discusses his plans to treat a patient who has come to the PAES Clinic for emergency oral health care with PAES Clinic Director Dr. David Jacobson.

The PAES Clinic, though, is not just a treatment facility. It provides dental students with learning opportunities while offering services to patients, many of whom feel they have no where else to go.

Fourth-year dental students are required to be in the Clinic for at least 10 half-day sessions. They triage, examine, and administer emergency care to walk-in patients.

However, dental students in other classes may visit and observe as often as they wish.

"We want the fourth-year students to see as much pathology as possible," Jacobson says. "In fact, the sheer volume of patients who are treated here insures students will see cases they generally don't experience in one of our comprehensive care clinics." Dental students agree.

Staff dentists attempt to frame each experience in the context of how it might be handled in a private practice.

Jacobson will often present students with this situation: "Suppose you're in the middle of a crown prep and a patient walks in..." at which point he describes other activities occurring in the dental office that need resolution.

"We want students to look at these urgencies with a creative problem solving mindset," he says. "It's not a case where there are necessarily right answers. Instead, we would like them to consider a number of options from which to choose," he says.

Jacobson, Rife, and Johnson work with the dental students. More often than not, however, they keep a low profile so the dental student learns how to manage the psychology of a patient's pain from the moment they greet the patient. The reason for this approach is to allow each student to develop their skills, increase their comfort level with difficult issues, and, ultimately develop their own style.

Dr. Juan Johnson and fourth-year dental student Nathera Balachandran review radiographs and discuss options to treat a patient receiving care.

But when a procedure is beyond the scope of a student's training, staff dentists are there to perform the treatment. In these instances, the student will watch, or perhaps assist a staff dentist. However, in similar future cases, they are expected to do more.

"We're there as a safety net for the dental students and we know when to intervene," Jacobson says, "but we want each to develop their own style and their own way of working with a patient." That includes explaining their findings, diagnoses, and discussing treatment options with each patient.

The staff dentists say all of these experiences make it easy to remain enthusiastic.

"I thoroughly enjoy the opportunity to practice dentistry here at Michigan, teaching students in the Clinic, working with faculty, and handling a large variety of patient cases," Dr. Juan Johnson says.

Dr. Vernon Rife, who is in private practice, but once thought about becoming a teacher as an undergraduate, says, "the opportunities I have daily to educate new patients who come to our Clinic for treatment, as well as mentoring the dental students who help here, is the best of both worlds."

Crucial Collaboration

Dr. Vernon Rife adjusts a patient's denture after the patient's mandible was fractured in an accident making it difficult to use. The adjustments allowed the patient to use the denture until a new set of custom-made dentures was available.

Playing a major role in the success of the PAES Clinic are the School's patient care coordinators (PCCs).

These individuals are intermediaries between the students and the patients. They work with the clinic directors to ensure that all patients receive the care they need, and that the students get the support and experiences they need to become competent and are prepared to take state-required licensing examinations prior to graduation.

Jacobson, Rife, and Johnson frequently work with the coordinators to help patients and dental students.

Dental students who learn of an appointment cancellation by one of their patients have an opportunity to "fill" their empty chair

Working with the PCCs, the PAES staff matches those students looking for work with patients needing help. "That dental student may be able to proceed immediately with a comprehensive oral exam and treatment plan that otherwise would occur during the patient's next visit," Jacobson says. "It's a win-win situation. We save the patient a visit and provide a student with a learning and treatment opportunity."

The PAES Clinic maintains an open door policy. Anytime a dental student has free time and is looking for something to do, they can stop at the PAES Clinic. "The patient care coordinators have allowed us to try this out, and it works," Jacobson says.

With all the activity in the Clinic, Jacobson says, "we are constantly measuring and trying to improve what we are doing here."

"It's an exciting time to be here in the PAES Clinic," he adds. "We have received a lot of support from Dean Peter Polverini, patients tell us they appreciate receiving the quality of care they're getting, and the interaction with the students continues to be highly rewarding. For me, it's incredibly gratifying when you can both help a patient and teach a student something new about the art and science of dentistry."

Accomodating Special Needs Patients

Although most patients seen at the PAES Clinic can walk into the Clinic without assistance, there are those who can't, primarily patients in wheelchairs. Their special needs are being accommodated.

A special cubicle is available for those patients. In addition, a device is being used that makes it easier for both the patient and the dentist.

The new device is a dental headrest. It's clamped to the handles of a wheelchair so these patients don't have to be physically transferred from their wheelchair to a conventional dental chair. The headrest allows patients to comfortably tilt their heads backwards.

"We want our students to get more experience treating special needs patients so they develop a sense of comfort and acceptance that will carry over to their private practice," says Dr. David Jacobson.

In May, 48-year-old Michael Flynn arrived in a wheelchair needing emergency treatment. When he was 16, Flynn broke his neck and severed his spinal cord in a diving accident.

Jacobson performed a pulpectomy on Flynn, much to his relief. When it was over, Flynn thanked Jacobson telling him, "that was a very painless procedure. Very well done." "You've made my day, I appreciate that," Jacobson said as Flynn left the Clinic.

A headrest that attaches to wheelchairs makes it easier for both the patient and the dentist.

A special cubicle in the PAES Clinic allows patients using wheelchairs to be treated.

Fourth-Year Dental Students Say PAES Clinic is "A Very Valuable Experience"

Fourth-year dental student Sarah Miller says she feels more confident diagnosing and dealing with patients who have emergency dental needs following her experiences in the PAES Clinic.

Instead of taking a month off between the end of her third year and the start of her fourth year in the predoctoral program, Miller chose to work in the PAES Clinic two days a week. She did so to learn more about the types of cases the Clinic handles and also learn more about the admitting process for new patients.

"The Clinic was much faster paced, and I saw more patients than usual, sometimes about ten a day," she said.

Fourth-year dental student Nathera Balachandran agreed, adding the range of treatments patients needed was revealing.

"More Variety"

Fourth-year dental student Sarah Miller and PAES Clinic staff dentist Dr. Juan Johnson review a patient's radiographs to try to locate the source of the patient's oral pain.

"There's a lot more variety in the PAES Clinic that you don't see in the comprehensive care clinics," she said. Balachandran said she often came to the Clinic as a third-year student when some of her patients didn't show up for their appointments in the comprehensive care clinics.

In addition to learning more about emergency dental situations, Miller said she too observed and helped patients with a range of dental problems. "Some were minor, like questions about bruxism or temporaries falling off, but there were some major trauma cases," she said.

One major trauma case involved two anterior tooth avulsions with maxillary alveolar fracture and nasal fracture. "I learned there are many ways of dealing with a case like this, as well as many factors that go into the prognosis of an avulsed tooth," she said. Because of the severity of the case, the patient was ultimately referred to the hospital for follow-up treatment and care.

Mostly, however, Miller said she saw and treated patients with a range of endodontic problems. Some had reversible pulpitis. Others were irreversible. And there were many patients with cases of pulpal necrosis. "Up to this point, I had not seen an endodontic case within my patient pool in the comprehensive care clinic, and had no real dental emergencies to speak of," she said.

Miller's experiences with dental emergencies in the PAES Clinic instilled confidence. "I'm much more confident in testing, diagnosing, and giving a patient all the options available about their specific problem," she said.

Her PAES Clinic experiences were beneficial for another reason.

"It also allowed me to see what it was like to be in a more 'real life' setting with numerous patients to examine and care for," she said. "I feel much more confident of my skills diagnosing and dealing with emergency dental problems as a result."

Medical Residents Learning About Dentistry First-Hand

The medical profession is gaining a better understanding and appreciation of the importance oral health plays in a patient's overall health and well being.

For the past year, several medical residents from the U-M Hospital have come to the dental school to learn more about how to deal with common dental emergencies they often see in the hospital's emergency room.

"This is an elective for them, so it's totally voluntary if they want to be here, and they're free to come and go as they please," said PAES Clinic director Dr. David Jacobson.

"However," he continued, "most find the time they spend with dental students in our clinic and with specialists in our oral surgery clinic is very informative and helpful."

Jacobson said he, along with Drs. Vernon Rife and Juan Johnson and dental students, try to help the medical residents recognize the reasons for a patient's pain and offer advice on choosing the proper medication when necessary.

"We're focused on the basics, primarily, how to help the patient and get him or her out of pain," Jacobson said.

Brett Russell, MD

Now in the third year of his four-year residency program at U-M Hospital, Dr. Brett Russell said, "We see just about everything in the hospital's emergency room, but having this opportunity to focus on dental-related emergencies was very helpful to me."

Russell said he "was surprised at just how awesome the PAES Clinic is and what the staff dentists and dental students do to help patients in pain." In addition to observing what takes place in the Clinic, Russell also spent time in the School's oral surgery clinic.

The experiences, he said, helped him recently evaluate a patient who came to the hospital's emergency room complaining of pain.

Russell said that probably the most important thing he learned during his two weeks at the dental school "was becoming familiar with the dental blocks that are used to help patients in pain."

He said he also learned important lessons about distinguishing between patients "who are truly in pain and need some kind of medication to lessen that pain and those who may be complaining of pain but, upon further questioning and examination, are not in pain and may be trying to obtain a prescription for other purposes."

Kurt Hessen, MD

Dr. Kurt Hessen, now in the second year of his four-year residency program at U-M Hospital, spent about two weeks at the dental school earlier this year.

"It was a great learning experience," he said, "not just in the PAES Clinic, but also in the oral surgery clinics at the hospital and the dental school."

Hessen said he and others "see a fair amount of pain with patients who come to the U-M Hospital, problems like fractured teeth, pain from cavities, and things like that. So learning more about these conditions and what we as physicians might be able to do in these cases was a great learning experience," he said.

Hessen said he also learned, from watching dental students and their clinical supervisors, how important it is for emergency room physicians to ask patients about their oral history and any medications they may be taking.

2 New Videos Produced for PAES Clinic

Krystal Gore and her father, Larry, watch a video that explains what takes place in the PAES Clinic and what patients can expect when they are treated.

"It gives us more time to devote to the other functions of the PAES Clinic while also precisely conveying the same information to everyone who seeks comprehensive care as a new or returning patient," said Dr. David Jacobson of a video all new patients see moments after arriving at the PAES Clinic.

Produced by Jacobson with help from the School's Digital Learning Laboratory, the six-minute video includes still photos with Jacobson explaining in detail what patients can expect.

He begins with an overview of the School's dental education program and how the dental students in the PAES Clinic work with patients, under faculty supervision, to provide care; the process of treatment, that begins with a comprehensive oral exam; the treatment options that are available to a patient following their visit; and information about fees and payment options.

Time vs. Cost Tradeoffs

"Everything a student does must be evaluated and approved by a clinical instructor," Jacobson says in the video. He notes that students are required to stop at prescribed points and ask an instructor to check and evaluate their work. As a result, he adds, "this is a time-consuming process where appointments can often last up to three hours."

However, in return for their time, Jacobson says that patients are compensated with lower fees "that are about half of what a private dentist in this region would charge for the same procedure."

Before their treatment begins, patients are told a comprehensive oral examination is required. It includes taking blood pressure and radiographs, if necessary; compiling information about the patient's medical and dental history; checking the patient's head and neck; conducting an oral cancer screening; and assessing the patient's oral hygiene.

In the video, Jacobson tells patients there is no charge for a brief screening exam or a limited consultation with a staff dentist they will receive.

The screening, which takes less than five minutes in most cases, determines the patient's overall needs and treatment options. The vast majority of patients are assigned to predoctoral students in the School's comprehensive care clinics. However, others may be referred to one of the School's graduate specialty programs, such as orthodontics or periodontics, or to the Dental Faculty Associates Clinic, a facility in the School where faculty members with dental or specialty degrees treat patients.

Second Video Tells Dental Students What to Expect

"We want all of our fourth-year dental students to get an idea of how closely the PAES Clinic mimics what goes on in a private practice while also giving them an idea of what to expect before actually setting foot in this Clinic."

That's how Dr. David Jacobson, PAES Clinic director, describes a new half-hour video fourth-year dental students must watch before beginning their rotation in the clinic on the main floor at the School of Dentistry.

Crediting Dr. Stephen Stefanac "with bringing us into the Twenty First Century as dental educators," Jacobson says the video, now being used for a second year, has been beneficial.

"Previously, we would present an orientation to each new group of fourth-year dental students," he adds, "but that slowed down taking care of patients and also raised the possibility of omitting some vital information."

As part of their video orientation, dental students also receive a list of questions to answer before their first rotation.

The video has been so well received that Jacobson also sends it to third-year dental students to encourage them to stop by the Clinic to observe or lend a hand.

Words of Wisdom and Suggestions

"The psychology of the patient in pain is something you will be managing from the moment you say 'hello'," Jacobson tells the students in the video.

"These patients will pick up on your cues...They are looking for a sense that you have seen their distress before, that you know what it is, that you know what you're going to do about it, that they are in good hands, and that you're going to get them out of pain," he adds.

Students are told that their responsibilities involve data gathering, including information about a patient's medical and dental histories, conducting diagnostic tests, making a diagnosis, explaining the diagnosis, and discussing treatment options.

However, before explaining their findings to a patient, Jacobson advises students to choose their words carefully. Because they will not treat most of those patients themselves, students are advised not to make any promises that other students or departments have to keep.

Although three staff dentists are available to help, Jacobson says, "As time goes on, we hope that you will gain an awareness of your progress and development. Ultimately, we want you to be able to refer to yourself as 'doctor' with confidence."

Dr. David Jacobson

PAES Clinic Director

"My father practiced dentistry in New York City for nearly forty years and I grew up thinking I would become a dentist like him," said Dr. David Jacobson. "But a funny thing happened to me on my way to dental school...I became interested in other things I didn't want to preclude."

After earning a bachelor's degree from U-C Berkeley, Jacobson came to U-M and earned a master's degree in environmental education. He worked for non-profit organizations on projects that included recycling, food production and nutrition, and "doing my part to save the planet while working toward dentistry," he said.

In Ann Arbor, he found outlets for his other interests. A stained glass artist who displayed at the annual Ann Arbor Art Fairs, he has maintained a glass studio for 30 years, is a self-taught musician, plays in a local band, and builds instruments.

Hired as a clinical instructor in prosthodontics and periodontics after earning his DDS from U-M in 1988, Jacobson has been PAES Clinic director since 1995.

He enjoys being an educator. "Every case is a learning opportunity for the student. I hope to challenge them to draw upon everything they've learned, and set it in a context of their own office someday," he said. "When students learn something new while helping patients in pain, that's a good day for me."

Jacobson plans to leave dentistry and pursue his other creative passions in three years when he turns 56. "Meanwhile, I'm having a fabulous time while looking forward to the next chapter of my life."

Dr. Juan Johnson

Staff Dentist

"I thought I would be here for a year, perhaps two at most, but now it's been ten years and I'm still enjoying myself," said Dr. Juan Johnson (DDS 1991).

"I enjoy the opportunity to practice dentistry at Michigan, teach students in the Clinic, work with faculty, and handle a large variety of patient cases," he added.

Although he works forty hours a week in the PAES Clinic, Johnson also has a part-time private practice in Ann Arbor.

Raised on the island of Okinawa and fluent in Japanese, Johnson said his interest in dentistry began in high school.

"On Okinawa, I talked to many military dentists and liked the fact they had a level of autonomy while practicing," he said.

Johnson also thought about becoming a fighter pilot, but "they flew where and when they were told," he said. "When I told them I was also considering dentistry, they suggested becoming a dentist and earning a private pilot's license so I could fly whenever I wanted." Johnson hasn't obtained a private pilot's license, but does return to Okinawa every year to spend time with his family.

Johnson came to U-M for his bachelor's degree and then a dental degree. For the first two years, he practiced dentistry in a public health clinic and then learned about the need for a staff dentist in the PAES Clinic. "I was very interested in working in PAES, especially since I knew the director, Dr. David Jacobson," Johnson said. "We have many similar interests and that makes being in the Clinic even more enjoyable."

When he's not practicing dentistry, Johnson enjoys running, playing basketball, chess, and his biggest passion, golf. "You might say dentistry supports my golf habit," he said.

Dr. Vernon Rife

PAES Clinic Dentist

"I've been a dentist here in the PAES Clinic since 1993 and continue to enjoy the interaction with the patients, helping them understand their dental condition, discussing optimal treatment plans, and referring them to those in the School who can best help them," says Dr. Vernon Rife.

After earning his dental degree from U-M in 1975, Rife practiced dentistry for 18 years in Hartland, Michigan, before returning to his alma mater.

"I enjoyed dentistry, but disliked doing the paperwork, making the hiring decisions, and all the other things that are a part of a private practice," he said, "so when I learned of the need for a staff dentist here, I applied and sold my practice once I accepted the job here."

Rife said he enjoys another part of his work in the PAES Clinic, teaching.

"I thought about becoming a teacher when I was an undergraduate, or perhaps working in medicine or dentistry," he said. "The opportunity I have daily to educate new patients who come to our clinic for treatment, as well as mentoring the dental students who help the patients in the PAES Clinic, is the best of both worlds."

When he's not at the School of Dentistry, Rife works part-time at a private practice in Belleville and directs a men's chorus at his church in Highland, Michigan. "I also direct a volunteer choir at Christmastime. I've been singing since I was in grade school and still have a lot of fun doing it," he said.

Adjunct Faculty Teach Students, Help Patients

In addition to three staff dentists in the PAES Clinic, several private practice dentists return to the Clinic one day a week to teach students and help patients.

Justin Dugas, DDS

"I had some amazing instructors when I was a dental student, especially Drs. Joe Kolling and Dan Edwards," said Dr. Justin Dugas (DDS 2005).

"They wanted me to succeed, to understand what I was doing and why. They took the time, even after hours, to explain procedures or techniques when I had questions. I'm trying to emulate them, so that's why, since January, I have been here one day a week," he added.

Dugas, who practices in Dearborn four days a week, spends Tuesdays in the Clinic helping patients, when needed, but mostly supervising dental students and guiding them.

But his counsel extends beyond dental plans and treatment.

"Because I'm so close in age to the fourth-year dental students, I often find that I'm a resource for career advice," he said. Many students, he said, have questions about being in a private practice or whether they should enter an AEGD or GPR program, "so I'm glad to answer those questions too. I want to make the same difference in their lives that Drs. Kolling and Edwards made in mine."

John Seago, DDS

"It's a great honor to give something back to this School and this University for the great education I received," said Dr. John Seago (DDS 1986).

"Being here in the PAES Clinic every Wednesday is my way of showing my appreciation and, I hope, will inspire some dental students to think about also doing this as their way of giving back in the future."

Seago, who runs a private practice in St. Clair Shores four days a week, has been an adjunct instructor in the Clinic for nearly two years. "I keep returning because it seems there's something new everyday," he said. "This is also a great learning environment for the students and I enjoy the many opportunities I have during the day to pass along some of what I have learned to help them."

Aaron Ford, DDS

Unlike his two other adjunct colleagues, Drs. Justin Dugas and John Seago, Dr. Aaron Ford is "the new kid on the block." After earning his dental degree in May, he began working in the PAES Clinic a month later.

"It feels a bit strange seeing and talking to some of my former dental classmates," he said. "But I'm excited to be here at the School and helping patients."

Ford, who is in the Clinic on Thursdays, spends his other four days providing oral health care in downtown Detroit as a part of Dr. Amid Ismail's oral health disparities program.

Eventually, Ford said he would like to work in a private practice after his wife completes her emergency residency program at Henry Ford Health System in Detroit.

From November 2000 to May 2001, Ford was with the U.S. Army as a medical platoon leader at Camp Doha, Kuwait, where he oversaw the treatment of over 900 patients and 20 MEDEVAC situations.