Promise to Presence

Promise to Presence

The Editors:
The U of M Veterinary Medical Center's dentists address every clinical challenge human dentists do, including gathering forensix evidence from a gunshot wound.

In the September-October 2004 issue of Northwest Dentistry, we introduced you to the University of Minnesota Veterinary Medical Center’s newly established dental and oral surgery service and its director, Dr. Gary Goldstein. Fast-forward to 2010, and it turns out the impulse to catch up with old friends includes wearing track shoes. The dental service has grown and expanded into a busy, internationally recognized, successful, and academically sound department. The dental and oral surgery service also continues to advance the philosophy of whole-body health both at the VMC and in collaboration with the School of Dentistry. Growth, leadership, presence, and a shared spirit are the day-in, day-out formula that brings it all together .So the next time someone asks, “Do dogs really smile?” you can tell them yes, they do. We have it on the best authority.
The Editors


Officer Patrick Murphy stayed by his canine partner, Boomer, during the surgery. The oral and maxillofacial surgery component of the dental service is a focus for growth.

NWD: We’d like to start with introducing each of you to our readers. Dr. Goldstein?
Dr. Goldstein: I graduated from the University of Minnesota College of Veterinary Medicine in 1984, and I have been interested in veterinary dentistry from the very beginning of my career. I went to Houston, Texas to work with Dr. Don Ross for two years before I opened up my own referral practice in veterinary dentistry. I was away from practice for awhile managing veterinary hospitals for Banfield, the Pet Hospital. I then returned to practice and joined the Veterinary Medical Center at the University of Minnesota eight years ago, starting the veterinary dental and oral surgery service. In the first month we were very productive, and we have grown on average 20% each of the last seven years.

One reason we have grown consistently is in part the outstanding client service and quality of dentistry we provide. When we did this interview five years ago, I was only doing dentistry. What has changed is that several years ago I took on a more administrative role as one of the Associate Medical Directors of the Veterinary Medical Center. Half my time is spent in administration and half my time is spent in clinics. And I am no longer the only practicing boarded veterinary dentist in Minnesota, as Dr. Kevin Stepaniuk joined us in September 2009 as our second veterinary dentist and oral surgeon.

We have very good relations with the dental school, including both Dean Lloyd and Buchanan. We also work closely with Dr. Jim Hinrichs in the periodontal department. We also have several research projects ongoing there, which is exciting for our service as we continue to grow.

The dental service itself has grown to two residents, and in September we hired a second dentist/oral surgeon, Dr. Kevin Stepaniuk, from Seattle, Washington. With this growth we can support our three-part mission of clinical service, teaching, and research, as well as seeing more cases and treating more animals.

Dr. Stepaniuk: I am an American but grew up in Canada and went to the University of Calgary as an undergrad. I graduated from veterinary school in 1998 in Oklahoma, did a rotating internship in medicine and surgery at Washington State, I was in private practice in general medicine and emergency, and while in private practice did my dental and oral surgery training program with my mentor, Loic Legendre, DVM, FAVD, Dipl. AVDC, Dipl. EVDC. I became board certified in veterinary dentistry and oral surgery. In September of 2009 I joined the University of Minnesota Veterinary Medical Center full time.

Marsha: I am a 1981 dental hygiene graduate from Thomas Jefferson University. I became a licensed veterinary technician thinking I would pursue my DVM. I worked at the University of Pennsylvania to develop a dental program with Dr. Colin Harvey, then left to work with Gary in his Houston specialty practice, and now here we are.

 


Students use state-of-the-art equipment. Client contact is a central part of the service and the teaching.

NWD: Please talk about how the idea of this specialty happened, and its place in your own national professional organization.
Marsha: It all started in 1984 with the recognition and demand and need for veterinary dentistry.

Dr. Goldstein: In the early 1980s there were literally a handful of people who performed veterinary dentistry work. My mentor was considered one of its fathers. First the American Veterinary Dental Society was formed, where anyone could join. Then the Academy of Veterinary Dentistry was formed, where clinicians would have to be credentialed and take an examination to become an Academy member. Finally, several years after that our American Veterinary Dental College was created, making this a fully accepted veterinary specialty with board certified diplomates.

Dr. Stepaniuk: I am the current president-elect of the American Veterinary Dental Society. Membership runs about 1,000.

Dr. Goldstein: From 1990 to 2000 it grew steadily, but it took awhile to get the word out, to become visible. We started the service here in ’02.

In the last eight to ten years veterinary dentistry has really taken hold. There had been three universities with full-time dental services: Illinois, Penn, and Davis. From ’02 to the present there are at least a dozen in North America. The significance of that is that more and more students receive the exposure to the idea that dentistry is important. They are educated, and they in turn educate veterinarians where they go to work.

Bringing in the human side, because people hear so much about the importance of dental care for themselves, they are now demanding the same care for their pets, not to mention an increasing amount of publications and marketing. I was recently an author on a 50,000 dog study done over one year about how periodontal disease is related to cardiac disease and other systemic disease. We know there are these relationships in people, but this is the largest study of its kind proving that there are similar relationships in dogs. There is a six-times correlation between advanced periodontal disease and heart disease.

Dr. Stepaniuk: The dental society has addressed the need for boarded faculty to teach veterinary dentistry by piloting student chapters at various schools, and this is growing to increase dental awareness and education as well as the need for boarded faculty increases.

Dr. Goldstein: Another new advance in veterinary dentistry is the development of a veterinary dental
technician specialty where veterinary technicians who have an interest in pursuing more specialized veterinary care can apply for, credential in, and take an examination to become certified.

 


Discovering what can be done and what needs to be done for an array of clients is challenging and satisfying.

NWD: Let’s explore this evolution. Has the program found its “fit” within the operation of the VMC?
Dr. Goldstein: Yes we have, becoming a de facto second opinion on the whole-body health of the animal.

Dr. Stepaniuk: Coming here was an easy fit for me, too. There was already a good foundation of understanding of and respect for dentistry here, and thus much more collaboration. The other services are open to our opinions.

Marsha: Students, interns, residents included.

Dr. Goldstein: The foundation here involved Dr. Betty Kramek, a surgeon of some 20 years who also did the dentistry and is currently still on staff as a board certified surgeon. We worked hard, and continue to do that, to be open, available, visible, and more and more are promoting the connection between systemic disease and oral disease.

Marsha: As we say so often, it all starts in the mouth.

Dr. Goldstein: Originally the program’s focus was clinical: seeing cases in order to get a resident, then another, and build that way. That in turn will allow time to explore the kind of research possibilities I had to forego previously for simple lack of time. The next step in our program as well as throughout the world is the development of equine dentistry, which is still very early in its infancy. We are starting some clinical studies in January, and we hope to publish more papers and research studies. That and growing the equine dentistry side of the business are our next big challenges, which of course include funding for residents specializing in the latter. There is a huge demand for it — Hennepin County has the greatest number of horses per capita in the country.

Marsha: Equine health has the same starting place — the mouth. Horse owners’ awareness will drive demand.

Dr. Stepaniuk: As far as research, I would add that we hope to collaborate more with the dental school, including using dogs as research models for human disease. We need to develop those relationships.

NWD: Has the clinical work space changed?
Dr. Goldstein: Not really. We’re still about 450 square feet, with two dental operatories. Equipment has changed to digital radiology and updated highspeed units. What has really changed is that now this is going Monday through Friday, and we make better use of that space. We’ve had a lot of equipment donated, because corporations recognize the service, and how busy we are, and the number of students who will be exposed to that equipment.

NWD: Position the VMC in relation to the School of Dentistry for us.
Dr. Goldstein: Dean Lloyd is accessible, and very interested and supportive of veterinary dentistry, as is Associate Dean Judith Buchanan. We’ve collaborated on several projects, one of which is to develop a haptic interface technology program. From that initial idea has come a variety of other projects to better train students in the field of veterinary dentistry and oral surgery. We are in the process of developing a working dental model for dogs as well as several other training modules such as a tooth and skull atlas. The dental school has agreed to partner with us and is supportive for us to utilize their brand new dental simulation center. We help teach an advanced perio course with Dr. Jim Hinrichs. We have submitted a couple of joint studies in the possibility of collaborating on research studies using dog models. That is our next step. We have also worked with the School’s oral pathologist, Dr. Michael Rohrer.

NWD: You had a focus on the practice/business model as well, and that was new in 2004. Has that been incorporated successfully?
Dr. Goldstein: Yes. The model is based on human dentistry, on not just teaching students to be good veterinary dentists but to be successful in practice. That has been my philosophy from day one. Veterinary medicine and human dentistry are very similar - students graduate and go to work for someone else, usually in a small practice. Human dentistry has figured out the efficiency strategies, how to utilize staff and so on. That’s why it is important for me to teach our students how to communicate with clients and understand how business and leadership are important in being successful in practice. Our feedback is very positive, so this is not going to change. It will remain a priority.

 

NWD: This close relationship with the students is integral to all aspects of the program.
Dr. Goldstein: The dental rotation is two weeks. For seven years I’ve given the same talk on dentistry every two weeks, and I never get tired of it, because I enjoy teaching as well as the stimulation the students provide by their interest in wanting to learn more. Several years ago we were involved the “selectives” course, where students from the dental school would come over four to eight hours a week during the summer between their first and second years, and we loved having them. I wish they would do that again.

Marsha: They asked a ton of questions, and we had so much fun. And now we’re seeing veterinary students with a strong interest in dentistry, not just “Oh, it’s something we have to do”. We have students who want to do dentistry residencies, research, or spend their time off on our service. Our feedback includes how approachable we are, and that “we let them do things”.

Dr. Goldstein: It’s an elective rotation, but there is a waiting list, and that’s significant.

NWD: What do you personally find most exciting, challenging, satisfying?
All three: All of the above!

Dr. Stepaniuk: I’ll add to “most satisfying” that I took a circuitous route — everyone thought I would go straight to academia. I taught from private practice, but my days here with student contact are the best, and I miss that when I don’t have it.

NWD: What is your place in the U as a whole, then?
Dr. Goldstein: I would miss the University setting. I love having the other disciplines around, the MR capabilities et al, but also, when I hear President Bruininks say we hope to be among the top five research institutions in the country, I think yes, I have to be a part of that. You can’t help but be energized by that.

NWD: What are some of your current challenges?
Dr. Goldstein: Despite the economy, we have grown, so when the economy improves, we’ve positioned ourselves to continue to grow. One focus is more oral/maxillofacial surgery - Kevin loves that and periodontal surgery, and we need to get stronger with the latter, so oral surgery will be a focus. The gunshot wound to police dog Boomer’s face is a strong example of that need. Finding enough hours in the day is always a challenge, but as staff grows we’ll have opportunities to deal with that.

NWD: How about treatment acceptance?

Dr. Goldstein: It’s good. Clients have come to understand the service we provide.

Dr. Stepaniuk: It has become another good teaching opportunity — how to talk to clients and relate value.

 


NWD: How about dealing with patient behavior?
Dr. Stepaniuk: Occupational hazard. Students and clients continue to learn that despite our best efforts in the exam room, we usually find more that needs attention when the animal is under anesthesia.

NWD: Let’s talk about what you can do, the capabilities and goals being pursued.
Dr. Goldstein: More oral surgery, with advanced surgical techniques. Crowns. Orthodontics.

Dr. Stepaniuk: More periodontal surgery, bone regeneration, guided tissue regeneration. “In a dog?” people ask. We have the capacity now to regrow bone around strategic teeth such as the upper fourth premolar or the canines. You’ve seen dogs whose tongues deviate from the mouth. We can address that. We can save a lower premolar that’s important for chewing. Clients now want to do these things. Simply, we can save teeth.

Marsha: We also are involved in forensics, such as dog bite models for evidence. With Boomer, the police were there with us in the operating room, taking every shred of that bullet as we removed it for forensic evidence.

NWD: Let’s do a wish list. What are you aiming for, and what do you dream of being able to do?
Dr. Goldstein: Another resident. Equine dentistry. More research.

Dr. Stepaniuk: If equine dentistry takes off, I would like to build a relationship with the alpaca/llama people, the food and fiber group. These animals live a long time and require much of the same dental care as do other animals we currently work on.

NWD: What would you like our readers to know about the program right now and for the future?
Marsha: I’d like to thank the dental school, especially Dr. Buchanan and Dean Lloyd, for allowing us to work with them, opening up and seeing their simulation center, connecting us to exploring this kind of information, because we’re trying to develop this for veterinary dentistry. It’s all about teaching students via virtual reality now.

Dr. Goldstein: We love to have people come visit the practice. The more we educate human dentists and dental students, the better for all concerned. Please come visit any time. We love our counterparts in human dentistry.

 


On April 9, 2009, Saint Paul canine police officer Boomer was shot in the muzzle while apprehending a suspect. Bleeding profusely, he was rushed to the Veterinary Medical Hospital, where Dr. Gary Goldstein performed emergency surgery.

The top photo shows Boomer undergoing reconstructive surgery. “Boomer was lucky in the sense that the bullet that entered the upper jaw missed the eye/orbit and several of the very strategic teeth that police working dogs need in their line of work,” said Dr. Goldstein. “Boomer had a good portion of his upper jaw blown apart and lost quite a bit of blood during his two surgeries, but once we were able to stabilize him and remove much of the metal, pieces of teeth, and a large portion of his upper jaw, we were able to reconstruct the upper jaw and suture closed. Boomer did very well, and did not require any additional surgeries. He was back to work within a month.”