After 110 years of training future dentists, Northwestern’s School of Dentistry shut its doors for the last time after Saturday’s graduation. But NU isn’t the only private university moving away from dental education.

Six private institutions have closed their dental programs within the last 12 years because of competition with public universities that receive state funding to operate dental schools.

University President Henry Bienen said many factors went into the closing of NU’s dental school, including high new capital costs, budget deficits and lagging research.

“Many private dental schools had closed and the public schools were heavily subsidized by the states,” Bienen said. “I asked for a plan when I saw the problems, and the plan was to create a new clinical practice group to increase revenues.”

Bienen said that although that plan was implemented for two-and-a-half years, it failed because it increased costs. The administration was left with making the “difficult decision” to close the school.

But dental officials, students and alumni aren’t smiling about NU’s decision. They accuse of NU of contributing to a disturbing pattern emerging within dental education – choosing costs over care.

ECONOMICS OF DENTISTRY

Randall Grove, director of the Chicago Dental Society, lamented the loss of what was once one of top five dental schools in the nation.

“Northwestern’s closing will have an impact because we’ve lost the prestige of having one of the finest dental schools in the country being within our boundaries,” Grove said. “It was a matter of economics, no question about it.”

But Dental School Dean Lee Jameson said multiple factors contributed to the school’s closing.

“Everybody looks for a single cause, but the administration is really the one who made those decisions,” he said. “From a dental education standpoint overall, six schools preceded us in closing. And all of them happened to be private schools.”

Because dental schools are required to prepare students for their license exams, universities have to invest in operating a clinic so students can learn through hands-on experience. Medical school students, on the other hand, receive their training in hospitals that are not funded by the university.

Jameson said dental programs are the most expensive component of any private school because of the operating costs of clinics.

But E. Steven Smith, NU’s former forensic dental education director who now serves as interim dean of University of Nevada at Las Vegas’ dental program, said even private schools have to buy into national needs.

“Maybe NU felt it wasn’t their responsibility to contribute to dentistry,” Smith said. “But I would have been more proactive. The decision to close down NU’s dental school doesn’t make much sense to many people in dental education today.”

As a public university, UNLV will receive millions of dollars from the Nevada Legislature to fund the dental school. The 1999 legislature set aside an initial $12 million for the school, and UNLV is asking this year’s legislature for a $35 million building bond. According to the American Dental Association, running a dental school with fewer than 250 students could cost about $62,000 per student annually.

Private schools, however, don’t have the public funding option.

Officials from Washington University in St. Louis, which closed its dental school in 1991, said there are no avenues for private schools to compete in dental education because of changing times.

Dental students at Georgetown University, Emory University and Washington University began transferring to state schools because of lower tuition in the late 1980s. All of these private institutions closed their dental schools after having problems retaining their top students in addition to dealing with budget deficits.

Washington University officials said the decline in class size forced tuition upward to a level that did not allow the school to compete.

Smith said that even though NU doesn’t get governmental funding, it should have explored more options, including getting rid of the dental school’s expensive lakefront property in downtown Chicago and building a new clinic in Evanston.

NU Dental School graduate Natalia Cenzano, ’01, said she believes the administration saw their investment wasn’t paying off and didn’t try to make an effort to bring dentistry back.

“The school had a great tradition, and now the cradle of dentistry has died,” Cenzano said. “I don’t consider NU my alma mater anymore. It’s the dental school that was my school.”

DENTISTRY NUMBERS IN DECLINE

With about 350 students, NU’s Dental School produced 2 percent of the nation’s annual dental graduates.

Greg Johnson, director of professional services for the Illinois State Dental Society, said 4,200 students graduated from U.S. dental schools last year. Johnson said Illinois will have about 125 dental graduates this year, coming from the University of Illinois-Chicago and Southern Illinois University – the only two dental programs left in the state.

Officials from Georgetown University, which closed its dental school in 1990 after 89 years, said progress in dentistry during the last century has contributed to a decline in the need for many dental services. Improved dental hygiene and prevention, the wider use of fluoridation and technological advances have improved dental efficiency.

But 1975 dental school graduate Tom Frymark, who practices restorative and cosmetic dentistry in McHenry, said an influx of immigrants has brought unique dental problems that need to be addressed.

“A school like NU has a responsibility to serve the world, not just a small section of Chicago,” Frymark said. “Dentistry is more in demand because it has become a global problem.”

According to the Pew Health Professions Committee, there is a nationwide average of one dentist per 1,631 people. Nicole Sheffler, a dental student at the University of North Carolina and chairwoman of the American Dental Education Association Council of Students, said more dental schools need to be built to allow dentists to serve more patients.

“There needs to be more schools to provide as many dentists, rather than cutting back care,” she said. “Access to care is a very big issue with it being so difficult to have enough dentists throughout the regions for every patient.”

But UNLV’s Smith said he remains hopeful. UNLV’s dental school is set to open with 75 students in Fall 2002, and a dental school at the Kirksville College of Osteopathic Medicine in Arizona was initially approved last week.

Smith said the southwestern United States has “great dental access problems” and predicts a shortage of dentists down the road.

“With our exploding population and the number of people going to the dentist, it is becoming a huge industry,” he said. “There are almost two dentists retiring for every one dentist graduating, so that makes dentistry an incredible profession for anyone to go into.”

CHICAGO CARE CONCERNS

In the Chicago area, dental officials aren’t sure what the effect of fewer graduates will mean with the closing of NU’s Dental School.

Chicago Dental Society’s Grove said the closing won’t have a great impact in terms of the number of dentists in Chicago because many students at the dental school leave the state to practice.

“Of Northwestern’s graduating class, less than 20 percent set up practices in Chicago,” Grove said. “But (the closing) does concern me because access to care continues to be a big problem in our area.”

NU’s student training dental clinic and a Saturday morning clinic providing affordable care to low-income families have both closed along with the school’s educational facility.

Jameson said he is concerned about where the patients who came to the clinic are getting their dental care now. The clinic served about 5,000 patients for an annual fee of $20.

“They are basically the voiceless group,” Jameson said. “The patients at the Saturday morning program would be the most desperate. We were the only contact for the oral health of those young kids.”

Cenzan
o, who worked at the clinic during her first year of dental school, said she will remember the experience “forever.”

“(The clinic) was really special, but now I don’t know where patients can go since the program has died,” she said. “It’s a big problem for inner-city kids, because without dental insurance, it’s impossible to get affordable care.”

With the closing of NU’s clinic, the University of Illinois-Chicago’s program has been forced to pick up the slack.

Frank Licari, associate dean for patient care and clinical education at UIC, said his university’s clinics are trying to treat as many people as possible. The clinical program at UIC sees about 46,000 patients per year at half the cost of private dentists.

“We are working to increase our capacity,” Licari said. “We haven’t expanded our hours yet, but we are reassessing what the needs will be. We will base our changes on what the needs of the population are.”

Licari said the UIC clinic, which already treats 250 patients a day, has been receiving new patients referred by NU. But patients requiring routine dental care are put on a one-to-two-month waiting list because of excess demand for care.

Jameson said he doesn’t blame UIC for not being able to accommodate all of NU’s previous patients. It all comes down to the issue of numbers, he said.

“There really are no programs out there to help keep these clinics going and offset the cost of running them,” Jameson said. “It’s just not a priority in the political economics of our society right now.”

Licari said his program is trying its best amid the obstacles.

“UIC feels a deep commitment to serving the community of Chicago,” he said. “The responsibility of what we have to do is even more now.”

PAST MEMORIES, FUTURE PROMISE

Frymark, the alumnus practicing in McHenry, said he felt a sense of loss when he found out three years ago that the dental school was closing.

Frymark’s father also attended the dental school, graduating in 1944. Because two generations of his family are alumni, Frymark said he realizes the sense of history that went along with the school.

“Dentistry is the world’s best profession,” he said. “It’s sad to see NU turning its back on such a necessary and needed service.”

Although the dental school has closed, some dental classes in oral and maxillofacial surgery will continue to be offered as part of NU’s Medical School. And when administrators decided to close the school, they created a dental science and engineering program in the Biomedical Engineering Institute planned by the Medical School and McCormick School of Engineering and Applied Science.

In a 1998 press release announcing the closure of the dental school, Provost Lawrence Dumas said administrators chose to relocate some programs from the dental schools to other parts of the university after discussing options with faculty, staff, students and alumni.

Frymark said that although alumni are upset, he believes administrators tried hard to save the dental school.

“I regret the closing tremendously, but I firmly believe everybody tried their best to sustain the school,” he said. “They think they made the necessary decision; I’m just not in agreement with that decision.”

He also said he developed a close relationship with staff and faculty throughout the school.

“The dental school was very strong because it taught the fundamentals and prepared all of the students for the new technology to come,” Frymark said. “Losing the school is like the ship sinking. We may all be surviving in separate lifeboats, but it will never be the same.”

But the success of continuing dental education programs at other private universities which have closed their dental schools gives hope that NU’s plan of holding classes through the Medical School can be accomplished.

At Emory, Continuing Dental Education Program Director Sheila Parks said innovative programs have focused on keeping dentists in the community abreast of new developments. Emory’s dental school closed in 1988 after 101 years.

Parks said attendance depends on the program offered.

“All of our people are practicing dentists, so we hold seminars and conferences,” she said. “It’s only about 10 percent of what we did while the dental school was in existence, but we are just trying to continue education.”

Washington University’s dental alumni group sponsors several events throughout the year, including an annual lecture. Although upset with the decision to close the school in 1991, alumni have tried to maintain a connection to the university despite the fact that no dental curriculum exists at the school, staff members said.

With the opening of UNLV’s school next year and the possibility of the new dental program in Arizona, the ADEA’s Scheffler said she is becoming optimistic again.

“I used to think dental students’ options were becoming more limited, but now hopefully they are not as bad,” she said.

UIC’s Licari said schools have to do more to promote their dental programs despite NU’s closing.

“The surgeon general says you aren’t healthy unless you have oral health,” he said. “Dentistry is a very important part of health science. There just has to be a greater commitment to educating the dentists of the future.”