Table of Contents

Practice Building
Roundtable
Continuing Education
Esthetics
Restorative

Inside Dentistry

January 2012, Volume 8, Issue 1
Published by AEGIS Communications

D. Walter Cohen, DDS

The former dean of the University of Pennsylvania Dental School who spearheaded the Penn Experiment shares his thoughts on dentistry and dental education.

Interview by James B. Bramson, DDS

Inside Dentistry (ID): Among your many achievements, what are you proudest of in dentistry?

D. WALTER COHEN (DWC): Among the opportunities I recall with pride was one that enabled women to ascend to more senior positions both in medicine and dentistry. I had left the University of Pennsylvania Dental School to become president of the Medical College of Pennsylvania in the 1980s, when there was a glass ceiling that was obvious in both academic disciplines. With a $75,000 grant from the Jessie Ball DuPont Foundation, we first surveyed American deans in both medicine and in dentistry to verify the need, then started what was called the Executive Leadership Program for Women in Academic Medicine and Dentistry—ELAM. This 1-year, three-session program began with a group of 45 women—40 from medicine and five from dentistry—who were associate professors or above. Over the last 16 years, we’ve had over 700 graduates from this program, and they have been eminently successful—many of them have become chairs, and many of them have become deans. In fact, one third of the deans in dental schools today are graduates of the ELAM program, and some have gone even higher—including one university president. It’s been very gratifying to see how this program has changed their lives, as has been recounted many times.

ID: Much has been said about the Penn Experiment. What was that and how did it come about?

DWC: This was a program that completely changed Penn’s approach to educating dental students and is described in detail in our book, Educating the Dentists of the Future: The Pennsylvania Experiment. I would trace its real beginnings to 1971, when the University of Pennsylvania was preparing for a major campaign of programs for the 1980s. At that time, I was meeting with a search committee on my candidacy for the deanship, and I had to convince the administration that the dental school would have a positive future amid concern that the caliber of the dental school wasn’t high enough. It was one of the hardest things I’ve ever done, but it demonstrated to the university that the dental school was on the right track.

However, the Penn Experiment really began to take shape when I took the faculty away for a retreat, where we saw an opportunity to do something unique. There we came to the realization that we were not succeeding well enough at what should have been our mission—educating highly competent generalists. Our solution was to devise a different approach. Students were placed in what we called general practice groups, in which they remained for their third and fourth years. In the traditional system, the third- and fourth-year students had certain requirements; for example, they had to complete X number of restorations, Y number of root canals, Z number dentures. In the new group system, we did away with these requirements and had the students complete the needs of the family of patients who were assigned to them, working with an outstanding faculty member as their group leader. We also put the students and faculty in a different relationship; instead of having the student assist while the faculty member delivered care to the patient, they switched roles. It became apparent that we needed to change the ratio of
1 to 10 faculty-to-students to 1 to 5. However, this would mean we would either have to double the faculty or half the 160-member student body, which is what we eventually did, although some federal grants were contingent on keeping the student enrollment at least 140. We also changed the dental school curriculum, eliminating a lot of duplication, thus enabling students to start their clinical experience in the middle of their second year. We put the entire student body into different groups—including some in faculty-based practice, which provided a new source of income to help offset the tuition lost when we cut the size of the student body. We also created a program called Model A for economically disadvantaged patients, which added a fifth-year general practice residency (GPR), called Model B, which was the first time a fifth-year GPR was discussed.

ID: As a former dean, what do you consider the major challenges facing dental education and what changes would you recommend?

DWC: First, I would generally try to promote innovation. I would have the whole dental team train together, instead of having separate programs for dental hygiene and dental specialties. I would suggest that dental students, like medical students, have at least a 6-week hospital experience in their third year, when they correlate the basic sciences with the clinical sciences. I believe dental schools should also consider adding a fifth-year postdoctoral experience—especially a general practice residency—and encourage more dental graduates to take residencies at the postdoctoral level.

I think dental faculty should be allowed to participate to a greater extent in faculty-based practices as they are in the medical education system. Those medical school-affiliate practices provide high-quality care while giving students an opportunity to observe their faculty at work. This is an incentive for students and is also more convenient for faculty, who can see patients at just one location.

I would further mention that I am very concerned about the high cost of dental education today. Dental students are leaving school with debt levels close to $200,000, which is compromising some of their plans. In my opinion, the fact that we have 400 open positions in American dental schools does not bode well for the future.

ID: Tell us about The D. Walter Cohen Middle East Center for Dental Education in Israel, which promotes peace and education exchange.

DWC: Back in the 1950s, when they were talking about starting a dental school in Israel, I was approached about starting a faculty and fellowship exchange between Penn and Hebrew University to offer their faculty advanced training in different specialties. After raising almost $500,000, we brought over 18 full-time faculty members to train at Penn in specialties including endodontics, periodontics, perio-prosthesis, and oral surgery. We became very close; it really became the Penn-Israel Project. Then in 1996, at a meeting in Israel, I suggested that one way we could bridge the peace was by possibly starting a Middle East center for dental education, where dentists throughout the Middle East could come to Jerusalem and spend 6 weeks or more taking advanced courses from the faculty at the Hebrew University Hadassah School. They liked that idea and the program got started, and that was the beginning of the Middle East Center for Dental Education. For several years we had dentists from all over the Middle East—including Gaza, Jordan, Cyprus, and Turkey—enrolled in six-week courses, and all of them were very grateful for the education. Then, several more dentists enrolled in full-time graduate programs leading to advanced degrees—the Center was growing. About six or seven years ago, the deans at the Hebrew University and the Al-Quds, which is the Palestinian dental school on the West Bank, got together and thought that this would be a great way to exchange dental students and faculty between the two schools as a way to promote both peace and dental education. Now the Al-Quds dental school has four or five of their faculty taking two- to three-year, full-time programs in various dental specialties at the Hebrew University. They will then go back to Al-Quds to teach what they have learned. The Center really is living up to its mission to “bridge the peace” through dental education, which is extremely gratifying.

ID: What do you consider the biggest changes in either the practice or the science of periodontics? What changes do you think we can expect in the next decade?

DWC: I think we’ve learned a lot, thanks to research and the creation of many departments in dental schools after World War II, as well as the application of the scientific method to periodontal disease. Especially significant is the work of Sigmund Socransky on understanding the microbiology in greater detail and linking periodontal disease to cardiovascular disease, diabetes, and pre-term and low-birth-weight babies. I consider these real advances and I think it’s due to the fact that the National Institute of Dental and Craniofacial Research has been so supportive of investigations.

However, I have mixed feelings about the current trend in implantology, where implants seem to be the treatment of choice in patients with significant periodontal disease. I know implants have changed the field greatly, but having been in practice for 60 years, one of the things that concern me is that not enough effort is made to maintain the natural dentition. In the past, we managed to keep teeth considered to have a negative prognosis for 40 or 50 years. Today, teeth like that are condemned very early; they are taken out and replaced with implants. I have to see implants doing as well over 40, 50, or 60 years to be convinced. We should try harder to clear up the periodontal problems and see if we can maintain the natural teeth as we have done in the past.

As for what to expect in the coming years, tissue engineering is playing a very interesting role in changing the field. I think with regeneration, the ability to regenerate the periodontal tissue—maybe even regenerating new teeth—may come about as a result of efforts using stem cells. My hope, however, is that in the next decade, there will be a greater emphasis on prevention, and meeting the needs of the underserved populations, who have so much of the disease.

ID: What advice do you have for practitioners on how to keep up with all the new science, and how to remain current on new techniques?

DWC: There are many ways to face the challenge of keeping up with information and demonstrating competency. Dentists should be doing more reading and keep up with the articles. I think this should be part of every dentist’s experience after dental school. I always encourage graduates to join a journal club or a study club as they generally have more time for learning after they’ve received their doctoral degree. The Seattle Study Clubs, which have developed all over the country, are helping dentists increase their skills and keep up with all the new contributions to the field. John Kois, DMD, has a small continuing education center in Seattle, where dentists can take clinical courses to improve their knowledge and skills. Those who participate say they are gratified by how much their ability as dental providers improves.

I think periodic evaluations of practitioners are an important part of keeping up with a field and maintaining quality. This is one of the reasons I became involved in The Compendium for Continuing Education in the 1970s.

For background information, I recommend a new book that describes what’s going on in periodontal research and periodontal treatment by Robert Genco and Ray Williams. It’s called Periodontal Disease and Overall Health, and, because it is underwritten by the Colgate-Palmolive Company, it is available in print and on disc at no charge.

ID: As someone who has been both a student and an educational leader, what qualities do you seek in such individuals?

DWC: As a student, I learned to look for mentors and try to emulate them. First was my father, who graduated from Penn in 1923 and practiced general dentistry for 15 years. In 1938, he took the summer program given by Samuel Charles Miller at New York University, and he became the first full-time periodontist in Philadelphia. It was my good fortune, through his guidance, to take my training with another mentor, Henry Goldman, in Boston from 1950 to 1951, after which I joined my father in the practice where I have been for 60 years.

When I look for a leader, I look for someone who is a visionary and role model, who works hard, has respect for the team, and is not afraid to take risks. As both a leader and an educator myself, I think it is important to have respect for your students and to treat them as colleagues. This kind of collegiality—rather than competition—should be promoted among the students as well. Dr. Morton Amsterdam and I became very close to our students in the 3-year graduate program in periodontal prosthesis we started, as well as those in the Pennsylvania Experiment. We considered it a privilege to work with students of their caliber and thought this type of collegial approach to working with them made them better dentists.

ID: What is the most unusual experience you had during your long career?

DWC: I was fascinated by the history of the Penn Dental School—especially Thomas Evans, a wealthy Philadelphian who had taken courses at Jefferson Medical School in the 1800s before there were dental schools, and who eventually became the royal dentist to Louis Napoleon. Dr. Evans left his fortune to build what became the University of Pennsylvania Dental School and a museum on the site of his home. The museum contained Dr. Evans’ instruments, his great Bible collection, and many of the gifts and artwork he had received from royalty. While visiting the museum as a junior, I was taken with a writing table given to Dr. Evans by Czar Nicholas II. In it were photographs of Nicholas, Alexandra, and their children.

By the time I was dean, the dental school had overtaken what had been the museum. Wanting to find that table, I searched for it with a curator from the art museum. Although the table was badly warped, we found many paintings, including this beautiful painting of flowers and a brioche signed “Manet.” It turned out that an authority on Manet, who knew that Dr. Evans had owned three paintings, was able to verify the authenticity of “La Brioche,” which triggered a search for the others. In the warehouse where some of the museum contents were stored, we also found “Flowers in a Crystal Vase,” and I learned that the third one, “Beach, Low Tide”—taken in lieu of a fee by the lawyer who settled the Evans estate—was in the Rockefeller Collection. The two paintings were sold for $1 million and $1.1 million, respectively. This story was written up by Ann Hanson in Art America in an article entitled, “The Story of the Missing Manets” in April 1976.

ID: What kind of work is exciting to you these days?

DWC: I’m very excited about my volunteer activities, which bring together so many aspects of my career over the years. After the deanship at Penn, I took a sabbatical at the University of California in San Francisco as their first presidential scholar. While I was there, I was recruited to become the president of the Medical College of Pennsylvania, which was originally Women’s Medical College of Philadelphia, the first medical school in the world to educate women. It is now Drexel University College of Medicine. In 1998, I met with Drexel’s president, Constantine Papadakis, offering to help raise funds for endowed chairs. So for the last 13 years, I’ve been chancellor emeritus. I’m in the Institute for Women’s Health and Leadership, which is where the ELAM program is based today. Given that I’ve always felt that physicians didn’t get as much information about oral health as they should, I started an elective, “An Oral Health Initiative For Medical Students.” We meet once a month; students also go over to Temple University’s Kornberg School of Dentistry, and they observe in the emergency room and in different clinics. It’s been very gratifying to see how helpful it has been to physicians to learn more about the oral cavity.

ID: If you were going to give a graduation speech tomorrow to a group of newly minted dentists, what would you be telling them?

DWC: Well, I would tell them they’re entering a great profession, one in which they’ll be respected by their patients. I’d also advise them to volunteer in their communities in different ways, to raise funds, and help those who are underserved.

Given that this is part of the Einstein Series, I want to share a small anecdote relating both to volunteering and the series’ namesake. In 1952, I was invited to a luncheon in Princeton, where the guest of honor was Albert Einstein, the most distinguished scientist of the last century. At that luncheon, which was sponsored by the American Friends of the Hebrew University, a member of the Bronfman family pledged $250,000 to the Hebrew University. Then he said if Professor Einstein would shake hands with his wife, he would double the gift. Einstein rose so quickly to shake her hand, he dropped his glasses. He showed that despite the magnitude of his achievements, he was willing to lend his celebrity to raise funds for a philanthropic cause, thus setting an example we might all be advised to follow, to make sure that we’re helping those who are, unfortunately, underserved. Einstein wrote in his biography that he felt like the Hebrew University’s pet bull and whenever they wanted to show him off, he was available.

About Dr. COHEN

D. Walter Cohen, DDS, currently serves as dean emeritus of the University of Pennsylvania School of Dental Medicine, and chancellor emeritus of Drexel University College of Medicine. During his 35-year career at the University of Pennsylvania’s Dental School, he established the school’s department of periodontics and served as its first chairman. He has received the Legion of Merit from France, was named president of the Medical College of Pennsylvania, chair of the Pennsylvania Diabetes Academy, and president of the National Museum of American Jewish History. He is also the author of Educating the Dentist of the Future: The Pennsylvania Experiment. He has received 8 honorary doctorates from universities around the world and he is one of 23 dentists honored with membership in the Institute of Medicine of the National Academies of Science.