UCSF

The School of Dentistry at the University of California, San Francisco: Service to Humanity

Charles N. Bertolami, DDS, DMedSc

Copyright 2002 Journal of the California Dental Association.

Author
Charles N. Bertolami, DDS, DMedSc, is professor of oral and maxillofacial surgery and dean of the School of Dentistry, University of California, San Francisco.

UCSF defines its mission as the achievement of excellence in teaching, research, patient care, and public service. For many years, UCSF has been world-renowned for scientific discovery and research, teaching, and innovative delivery of health care. However, we are not satisfied to rest on our reputation. Our faculty and administration are both catalysts for and responsive to scientific, social, and economic changes, and are committed to preparing students for careers in a rapidly changing environment.

-- J. Michael Bishop, chancellor

Mission

The dental profession, like the other healing arts, is best understood as a calling to help people in need, doing so in a highly specialized way. The lofty goal of service to humanity -- whether through patient care, research, or teaching -- remains the keystone of the dental programs at the University of California at San Francisco.

Recognizing the importance of the dental profession in serving the public and promoting a healthy and humane society has penetrated the school’s core identity and has deeply influenced our educational philosophy and curriculum. Thus, the school’s mission is to establish the highest quality academic environment for development, application, and dissemination of knowledge necessary to prevent, treat, or cure orofacial diseases and malformations.

History and Setting

The founding of the School of Dentistry at the University of California, San Francisco, occurred in 1881 when Samuel W. Dennis petitioned the regents of the University of California to permit the formation of a dental department. From its inception, the School of Dentistry was a component of the University of California.

It patterned itself after and was assisted by the existing dental schools at Harvard University, the University of Pennsylvania (of which the founding dean was an alumnus), and the University of Michigan. After the school had been announced as an integral part of the university, donations were solicited from the city’s practitioners; and their generosity yielded $510 -- enough to furnish the clinic, lecture rooms, library, and a pathologic museum.

Today, 121 years later, the school is located on the UCSF campus in the Parnassus Heights region of San Francisco -- one of nine campuses making up the University of California system, and the only one dedicated exclusively to the health sciences. The campus as a whole consists of four research-intensive professional schools -- dentistry, medicine, nursing, and pharmacy -- and a graduate division. Also at the Parnassus site are two acute-care hospitals, a psychiatric hospital, and one of the largest ambulatory care facilities in California. UCSF enterprises are distributed throughout the city, including subsidiary campuses at the UCSF/Mt. Zion Medical Center; a Laurel Heights campus; a community dental clinic on Buchanan Street; and active clinical sites at our affiliated institutions, San Francisco General Hospital and the San Francisco Veteran’s Administration Hospital. During 2002, a major new campus -- nearly the size of the Parnassus site -- will open in the Mission Bay section of San Francisco.

Academic Program: Dental Predoctoral, Postgraduate, and Graduate Academic

The school admits 80 students per year into its four-year DDS curriculum, 18 students per year into its two-year bachelor’s degree in dental hygiene curriculum, 15 students per year into its unique Postbaccalaureate Program, and 16 students per year into its International Dentist Program. Advanced educational programs (postgraduate and specialty) are offered in general dentistry, orthodontics, pediatric dentistry, periodontology, prosthodontics, oral medicine, dental public health, endodontics, and oral/maxillofacial surgery. Soon, the school will initiate a hospital-based General Practice Residency program.

In collaboration with the campus’s Graduate Division, the school offers graduate academic programs such as the master of science and the doctor of philosophy degrees in oral biology. Our community relations and continuing education unit provides cutting-edge courses for dental professionals, both on our home campus and in outreach venues as well.

Central to the school’s clinical educational and service programs are its 14 dental clinics, which are responsible for more than 130,000 patient visits per year and generate roughly $12 million in clinical income.

Our predoctoral curriculum offers dental and dental hygiene students the opportunity to become outstanding clinicians and seeks to cultivate in them the self-identity of being men and women of science. The intent is to train competent dentists and dental hygienists who understand the relationship between the craniofacial complex and the rest of the body and who see themselves as contributing significantly to improving oral health by integrating basic, behavioral, and clinical sciences for individuals and communities. Our postgraduate and graduate academic programs aim to educate clinicians in the various dental specialties as well as to become educators and scientists.

Organization and Funding of Academic and Research Programs

Organizationally, the school is highly decentralized, consisting of four departments which, in turn, are composed of 15 divisions. The structure has allowed the school to be highly responsive to opportunities in an ever-changing environment. By way of example, the UCSF School of Dentistry has ranked first in overall National Institutes of Health research funding among the 55 dental schools in the United States for each of the past 10 years, with an overall research budget today of approximately $25 million. This decentralized organization is illustrated in Table 1.

In addition to programs based in our four departments, the internationally known Center for the Health Professions is administered by the UCSF School of Dentistry.

Space does not permit detailing the plethora of research projects in which our faculty are engaged, but it is important to emphasize that much of this research is clinically based and aimed at improving the practice of dentistry, not only here at home, but abroad as well.

In addition, UCSF School of Dentistry considers itself the research institution with a heart, so many of our research projects are aimed at doing our part to try to improve the human condition.

UCSF Dentistry’s Oral AIDS Center is one of the word’s leading centers for the study of the oral manifestations of HIV infection. Research to fight this terrible health problem is not a new commitment on the part of our UCSF faculty: the Oral AIDS Center was established in 1986 by a group of investigators and clinicians who had been working together since the early days of the AIDS epidemic. Director Dr. John Greenspan pointed out "The Oral AIDS Center comprises many of the leading clinicians and investigators in the field of oral and dental aspects of AIDS; several of these people were responsible for the discovery of hairy leukoplakia, its association with Epstein-Barr virus, and its relationship to HIV infection and AIDS."

"Our group," Greenspan added, "was among the first to describe the periodontal infections associated with HIV. Also, we were the first group to initiate a systematic study of the oral features of simian AIDS."

In addition to the Oral AIDS Center, the UCSF AIDS Specimen Bank was created more than 20 years ago. Yvonne De Souza, assistant director of the Specimen Bank, explained its function as "a repository for tissue biopsies and serum specimens for investigators involved in the search for the causative agent of this disease."

There are many other examples as well, including the school’s NIH-funded Comprehensive Oral Health Research Center of Discovery, directed by Dr. Caroline Damsky; its new $11 million Center to Address Disparities in Children’s Oral Health, under the direction of Dr. Jane Weintraub; its Oral Cancer Research Center, headed by Dr. Randall Kramer; and several NIH-funded research training initiatives, under Dr. Grayson Marshall.

Diversity and Outreach

Our school strives to assemble a diverse student body that accurately reflects the population of California. At present, 45 percent of DDS students are women. Total minority student enrollment is 67 percent; total underrepresented minority student enrollment is 12 percent. We operate a number of outreach and recruitment programs designed to increase the numbers of economically disadvantaged students and students from underserved areas. These programs augment our involvement in local career fairs, recruiting visits to high schools and colleges, and our Dental Aptitude Test preparation course.

The centerpiece is the Postbaccalaureate Program -- the only one in dentistry in the United States. Admitting 15 students per year, the program targets disadvantaged students who have failed to gain admission to a U.S. dental school. The one-year curriculum provides both residential and academic experiences to increase academic competitiveness. In the four years of the program’s existence, 100 percent of postbaccalaureate students successfully gained admission to at least one U.S. dental school.

Other programs include the Dental Mentorship Program, which is designed for students who have an interest in the health professions and who wish to participate in career exploration activities. It provides students with limited hands-on experience in a clinical setting, matching them with a faculty or dental student mentor. Up to 25 students are selected to participate each academic year.

The UCSF Health Sciences Enrichment Program is a six-week residential summer offering designed to increase the math and science proficiency of economically disadvantaged high school students. This is done in the hope that they will become more academically competitive in college and, ultimately, consider applying to dental school. Students are recruited from three UCSF partnership high schools in San Francisco and two in Oakland.

The UCSF Summer Research Training Program is an intensive 10-week summer experience for undergraduate college students designed to address the under-representation of minorities and disadvantaged students in the biomedical and behavioral sciences. Students are placed in research laboratories of faculty with well-funded, highly organized research programs.

The UCSF Undergraduate Mentorship Program allows undergraduate college students, primarily from economically disadvantaged backgrounds, to spend an intensive seven-week summer session working with dental school faculty on clinical and research projects. The goal of the program is to target potential applicants for dental school at an early phase in their undergraduate academic development, to foster an appreciation and understanding of the dental profession, to understand the process of becoming a health care provider, and to become familiar with the UCSF School of Dentistry. The program accepts 30 college students each year from targeted colleges throughout the country that have a partnership with the UCSF School of Dentistry.

Community Service

UCSF has a history of community service dating back to the 1906 earthquake and fire that destroyed much of San Francisco: Dental students and faculty helped care for the injured. Building on that tradition, today’s dental students are active participants in community service activities, expressed most commonly through the school’s consistent tradition of providing care for the indigent.

Inasmuch as our patients are largely people on public assistance, people on fixed incomes, and the working poor, fees in our student clinics are set at 50 percent to 75 percent of that of community practitioners. Eighteen percent of our overall clinical income is from DentiCal, with some of our clinics posting DentiCal income in the 36 percent to 59 percent range. In 2001, 53 percent of DentiCal procedures done at all California dental schools were done at UCSF.

The most popular elective course in the school is one that allows students to take part in a clinic for the city’s homeless; roughly 100 dental and dental hygiene students participate each year. Visiting citywide shelters, students have the opportunity to conduct screenings and interviews for approximately 80 to 100 patients per month. Following the screenings, selected patients are transported to campus one night a week for operative care provided by students supervised by volunteer faculty. There is no charge for the services, since the students raise money for supplies and supervising faculty are volunteers.

Students who provide this care do so voluntarily. "It is hard to motivate yourself to come to the clinic for the homeless on the one Thursday night a month when I don’t have to be in the clinic for school," said fourth-year student Gladys Lim. "But then I remember how genuinely appreciative of our work these people are. So I go."

Mary Anne Baysac, a second-year student, explained that her decision to attend UCSF was based partially on our school’s commitment to this Community Clinic. "I did research before I came to UCSF, and one of the big reasons I am here is because I wanted to go to a dental school where I’d have a chance to be involved in community service."

Baysac is one of the student coordinators at the clinic. As such, she has the opportunity and responsibility to be involved with the organizational and logistical aspects of this outreach project. Steven Silverstein, DDS, who has been supervising students at the Community Clinic for nearly a decade, said, "Students have a chance here to be involved not only with the clinical aspects of providing quality dental care, but the logistical ones as well. I’m impressed, not only with how they find the time to be here, but with the quality of their work."

UCSF School of Dentistry outreach efforts extend to a whole variety of sites and diverse patient populations. The school is in a unique position to offer expert dental care to HIV-positive San Franciscans. We have multiple sites convenient to all neighborhoods of the city and are fortunate to have internationally renowned faculty and students who are well-experienced in providing expert, sympathetic treatment to patients with HIV disease. The program is funded under a Title I Ryan White contract with the city of San Francisco to provide $434,000 per year of dental care to HIV-infected city residents.

Our Alumni and Our Mission

One of the important outcomes measures of any school of dentistry is the quality of its human product: its graduates. Our graduates evince a commitment to lifelong learning and service to others.

"Continuing to learn keeps us energized in our profession," said Rob Huntley, DDS, president-elect of the UCSF Dental Alumni Association "This tradition of learning is important to UCSF Dental Alumni Association members, not just as dental professionals, but as human beings."

As a public institution, the school had a time when it relied relatively little on the generosity of its alumni, patients, and friends to support its core activities. That has all changed in recent years. In fact, only about 8.8 percent of the school’s overall budget comes from state funds. Alumni play an ever-increasing role in providing quality education for the young women and men who will be joining them as UCSF graduates.

With technological advances, altered disease patterns, and changing health care delivery systems, dentistry has undergone substantial change in recent decades. The UCSF School of Dentistry has embraced these changes, and it seeks to help lead them. In so doing, it hopes to continue to contribute to the health and quality of life of all Californians.

Acknowledgments

The author wishes to gratefully acknowledge the contributions of Dr. James Anderson and Dr. Troy Daniels in carefully reviewing and revising the original manuscript and for making useful additions.

Legends

Figure 1. Dental Clinics Building at the University of California, San Francisco.

Figure 2. Dr. David Graham, UCSF faculty member, conducts demonstration in a laboratory.

Figure 3. Pediatric dental resident Dr. Phyllis Kawada, right, works with young guests during Take Our Daughters to Work Day.

Figure 4. UCSF faculty, rear row, welcome first-year students by presenting them with white coats at the annual dedication ceremony.

Figure 5. Student Christian Lee presents a table clinic at the UCSF Dental Alumni Association’s annual Scientific Session.

Figure 6. UCSF dental students prepare for graduation.