The Road Less Taken
words by merry sue baum / photographyby david howarth
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f you judge by distance, Steven Toth, DMD, practices fairly close to where he grew up. From his hometown in Morris County, NJ, to his dental office in Galloway near Atlantic City, it’s roughly 150 miles. Nevertheless, the UMDNJ-New Jersey Dental School (NJDS) ’07 alum says he feels as if he’s a world away.
“I come from a typical suburban setting,” Toth says. “Most people there have good jobs and don’t think twice about going to the dentist. Here, many people are either underinsured or have no insurance. And there’s a sizeable HIV/AIDS population. It’s like night and day.”
He had his first glimpse of this very different environment as a student in the NJDS CODE (Community Oriented Dental Education) program, which offers 11 fourth-year students the opportunity to complete their clinical requirements at one of two extramural clinics comprising the school’s Statewide Network for Community Oral Health. Under faculty supervision, the seniors provide general dental care to underserved patients in either the Northfield clinic in Atlantic County or at the Somerdale clinic in Camden County, where Toth was assigned. It was there he met and treated his first HIV-positive patient.
“When I saw her I was taken aback; she looked just like anyone else,” he says. “That put an end to my stereotypical thinking. I realized HIV/AIDS has no particular face. Anyone can have it.” After graduation, when he was offered a job as a full-time dentist at the Galloway clinic, he jumped at the chance.
Shortly after beginning his new job, the 27-year-old was invited to join the NJDS faculty. The school had gotten a grant to fund a second program, CODE II, which would allow all fourth-year students to do two-week rotations at one of the clinics. Jill York, DDS, director of the Statewide Network and associate professor in the Department of Community Health, asked Toth if he would be willing to add teaching to his duties. He agreed and became a clinical instructor. Although Toth says he never imagined himself as a faculty member, he’s truly enjoying it.
“Every two weeks we get a new group of students, most a little unsure of themselves, but by the time they leave, they are confident and competent,” he says. “Many are surprised when they realize anyone can have HIV/AIDS. I had one student show me a 12-year-old boy’s chart that contained laboratory results — a signal that it’s an HIV/AIDS patient — and asked if there had been a mistake. He didn’t know a child that age could get this disease.”
Students become adept at managing the special oral health care needs of HIV/AIDS patients. They interpret laboratory results and correlate them to patients’ treatments. For patients with compromised immune systems, some procedures, such as a deep cleaning, can result in bacteria entering the blood stream and potentially causing life-threatening infection. Students learn which prophylactic antibiotics should be administered. They also learn that some of the medications used to treat the disease cause xerostomia, or dry mouth, greatly increasing the probability of tooth decay. The student-dentists learn when to prescribe antimicrobial or fluoride rinses that help minimize decay.
Students gain additional experience by seeing patients from group homes or special care facilities. Many are on Medicaid or fixed incomes, and some patients have no teeth or teeth beyond repair. Working with the patients, students determine the best type of prosthesis, and then go about fashioning new teeth. “Our patients have big needs and big dreams,” says Toth. “We start by getting rid of infection and then we rebuild their smiles. You can see them becoming happier and more confident as they get closer to the finish line. They can also eat healthier foods.
“A few weeks ago, we had a patient who actually cried when her work was completed, that’s how pleased and grateful she was. It’s so humbling to be able to make someone that happy.”
That feeling seems to be contagious. Following their two-week stints, last year’s Galloway CODE II students volunteered to stay on in order to finish the treatment plans they’d begun. Many spent their Christmas and spring breaks at the clinic, and several worked right up until graduation, simply because they wanted to. Their extra time at the clinic collectively totaled 58 weeks, or the equivalent of having 5.5 students there for an entire year. One of the 2009 CODE II students took a job in the Statewide Network after graduation, and when he told his dentist-father about it, the elder practitioner began volunteering at Northfield. “All of that speaks volumes about what we’re doing here,” says Toth.
While caring for patients is the number one priority, Toth stays very busy after clinic hours. He is currently doing research on whether there is a stigma attached to having HIV/AIDS and, if so, how to lessen it. He helps write the grants that fund the Ryan White program, oversees quality assurance and patient satisfaction surveys, and is part of the Statewide Network advisory council. He’s active outside the clinic as well, attending support group meetings primarily for HIV/AID patients, where he presents talks about proper dental care and informs people about the clinic. This December, he and other employees of the Statewide Network, along with the CODE students, will participate in World AIDS Day in Atlantic City.
Although Toth loves what he does, he realizes it’s not for everyone. “I don’t expect every student to decide to treat only people with HIV/AIDS or other patients with special needs,” he says. “But if they glean one or two things that help them feel more comfortable, I’ll be happy — I’ve done my job.”.