- Email: [email protected]
Urban Dentistry: Challenges and Rewards
Challenges and Rewards atients arriving at the Salvation Army’s medical clinic on Chicago’s Near West Side pass through the front foyer and take a left down the hallway at the rear. From the hallway ceiling an unlit bulb hangs between two metal frames th at once held EXIT signs. Farther on a bit, down the stairs, the door to the left opens on to the clinic’s reception room: red vinyl chairs, some pocked with cigarette burns, stand in tight tidy rows facing the front desk. Posters, pictures and penned signs line the two-tone pink walls. Panning right to left: portraits of Martin Luther King Jr, Gandhi; a handmade sign, warning, “Don’t Share Needles (spikes, works) Help Prevent AIDS”; and, painted on the left wall, an excerpt from Proverbs 23, “Who hath woe? Who hath sorrow? Who hath contentions? . . . ” from a different world, at least Seven m en—white, black, Hispanic, ranging in age from their early 30s to maybe their late 60s— await medical attention. A insofar as they ’ve experienced few keep their eyes trained on the front desk; others survey the brown-speckled many things I haven’t. ” linoleum floor tile; and one lies stretched across four chairs, his right arm crossed over his eyes. It’s only a quarter to noon on this early October morning, but already it’s been a very busy day for Dr. Michael Murzyn, the clinic’s sole dentist.
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o far today I’ve seen eight patients, two of whom were emergencies,” said Dr. Murzyn. “On the average I’ll have about ten or 12 a day and the number is constantly growing.” Dr. Murzyn staffs the clinic Mondays, Wednesdays, and Thurs days from 8:30 am to 2:30 pm. Afterwards, he’ll travel to his private practice in Chicago’s Loop, where he’ll see patients until about 7 pm, and where he works the rest of the week. “The people here at the clinic come from a different world, at least insofar as they’ve experienced many things I haven’t,” said Dr. Murzyn, whose slow and easy manner of speaking projects an aura of confidence and compassion. “But we get along very well. It’s a very relaxed atmosphere, and it can be very rewarding because there’s a lot of disease to correct.” About 15% of Dr. Murzyn’s patients at the clinic are in the Salvation Army’s drug and alcohol rehabilitation programs in adjoining buildings. The others come from the city's poor neighborhoods. If they have jobs they have no dental insurance; and if they’re retired or unemployed, relying on government assistance, they have little money to spend on dental treatment. Still, except for emergencies, the clinic has a policy of requiring payment for services. “We lower the price if they have very little money,” said Dr. Murzyn, who receives a salary for his work there. “At $15 per filling, for example, it’s practically free dental service. And the people save their money for treatment because the clinic has a good reputation in the community for providing services at a reasonable cost.” What motivates most of the patients to save for dental care is a history of neglect that invariably has left their teeth in poor condition. “Everyday,” said Dr. Murzyn, “I see people with acute abscesses. They’re often in terminal dentition on their way to full dentures. “I know that some dentists might be surprised to think that people like that will suddenly begin to take care of their teeth,” he continued. “But by the time they come here, they’ve often made up their minds that they’re going to turn themselves around.”
Meeting the complex clinical challenges of patients with scant funds often involves inventive solutions. For example, said Dr. Murzyn, “I can perform a quick and inexpensive single root canal so that it’s not too costly to put in an overdenture or a post there. And I’ll often do a large amalgam buildup or large anterior composites rather than crowns. I always try to maintain as many mandibular teeth as I can.” It’s about a 10-minute drive east from the clinic to Dr. Murzyn’s office downtown, which he opened two years ago. Although he readily admits his practice has grown slowly, it has proceeded at a steady pace. “Working in your own solo practice is exhilar ating,” said Dr. Murzyn, who graduated from Loyola University dental school in 1978, and afterwards served three years in the Air Force before practicing as an associate with other dentists. Competition in a city the size of Chicago can be a tough proposition, but Dr. Murzyn doesn’t think that should discourage recent graduates considering setting up shop there. “It’s not as difficult as one might think,” he said. “There is a very large population base. And besides, there are ways to cut down on overhead. What I did was get a very small office, bought used equipm ent—which looks brand-new— and opened up with less than $20,000. My patients are quite happy with the work I provide, and with my salaried position at the clinic to supplement my income, I’m content to grow slowly.” One of the prime advantages of working in an urban area, Dr. Murzyn pointed out, is the contact with both peers and patients. Discussion with dentists who teach at nearby universities
helps him keep in touch with the latest developments in the world of dentistry; and many of his patients from foreign countries kindle his interest in the world beyond dentistry. “A fair number of my patients g- are from China, Mexico, Vietnam, ^ and Eastern Europe,” said Dr. ^ Murzyn. “ In fact, one of my t patients and his father escaped | from Romania by swimming across | the Danube River. “It’s always interesting to see where the level of dentistry is at in other countries. Some people will come in with stainless steel crown bridges, for example. But they’re all very quick to take advantage of the highest standards of dental care here. In a very short time after they arrive, they’ll often be interested in sending their children to an orthodontist.”
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nteresting patients— many of them young professionals, artists, and actors— and access to a variety of dental specialists also figure prominently on Dr. Martha Connell’s list of advantages of working in Manhattan. Dr. Connell, a 1976 graduate of New York University dental school, practices on the first floor of a twin-towered apartment building on Central Park West, directly across from Central Park’s Strawberry Fields. “I see about 35 to 40 patients a week,” said Dr. Connell, who works with two assistants and a hygienist. Dr. Connell’s office is open three days a week from 8 am to 6 pm, and another day until the early afternoon. “When I first started out I used to work Saturdays and it was just a disaster. People would cancel if they found something else to do. Many leave the city on the weekends, so it’s just not a big day for dental appointments. Although I know it’s different in the suburbs.” Prior to coming to Manhattan 4'A years ago, Dr. Connell worked at St. Luke’s-Roosevelt Hospital Center in New York City, and as an associate in a smalltown practice in upstate New York. The contrast between patients in a smaller community and those in a large urban area can sometimes be striking. Dr. Connell recalled URBA N D E N T IS T R Y ■ 245
that those in the small town “seemed more grateful and accept ing of what you want to do. They weren’t very demanding in terms of the dental work, and they were more trusting, as if to say, ‘Oh, you're the doctor; just go ahead and do what you think is best.’ “But in New York, people read a lot about everything; they’re always asking a lot of questions, and you really have to be on your toes. It’s not really a problem; you just have to realize that’s how you have to deal with patients here.” Occasionally, though, work pressures can mount. To help allay stress, Dr. Connell makes a point of taking her time with each appoint ment. “I don’t try to get people in and out every 15 minutes,’’ she said. “I see each patient for an average of 45 minutes, and I try to give myself enough time to do a good job. If I have a halfhour cancellation, I’ll try to get out of the office and take a walk.” The biggest challenge to working in New York City, said Dr. Connell, is keeping up with expenses. “Bents and malpractice insurance rates are very high. When I started practicing,
insurance was about $300 a year.” Today, she added, it’s closer to $6,000. “For those who might be interested in working in a large city like New York,” continued Dr. Connell, “I’d say go ahead, but just make sure that you have a really solid financial base. If
construction stood empty, monuments to the lagging local economy. “There were quite a few new e buildings going up, but because | there were no people in them they °b becam e known here as ‘see§ through’ buildings,” said Dr. | Eggleston. ^ “I understand that for a lot of * the new construction completed S in 1986, it was cheaper for the S contractor to go ahead and finish | the project than to be sued for ^ not honoring the contract. The buildings were beautiful, but they just sat there, empty.” Local officials were determined to do more than sit. They laid plans to diversify Houston’s economy. “City planners decided that they didn’t want Houston to be a one-industry town,” said Dr. Eggleston. “So recently, for example, a new convention center has opened, tourism is being promoted, and the space center has been expanded. All of these things and more have helped. The see-though buildings are just starting to fill up now, my patient load has improved, and I hear that the oil companies have also started to hire again.” With the increased business pace, though, comes increased stress— for patients and dentists alike. It’s not unusual, said Dr. Eggleston, to see a patient whose oral health had previously been fine suddenly show signs of deterioration. “I’ll see bleeding gums and ask if they’ve been under a lot of stress lately, and they’ll admit they have,” said Dr. Eggleston. “It’s the combined pressure of heavy workloads and limited time.” Moreover, those pressures are beginnning to show in the dental office in other ways, said Dr. Eggleston. “Just this morning I was talking to my receptionist about this,” he continued. “For the first time in 17 years, we’re starting to get patients who want to know exactly how long they’re going to be here. More people today seem to be very time conscious. “But I couldn’t imagine going to a doctor’s office and talking to him or her about time. When I’m being treated I want quality work; I want it to be right, not rushed. So what I do with these patients is tell them that we want to do a quality job, and that if there’s a time problem today maybe we should reschedule. It’s I |
you have large outstanding loans and you go into debt trying to build up your practice you could go under. I’ve seen it happen. “On the other hand, it’s a very stimulating place to work. And I really don’t feel the competition here because there are so many people. Our days are always full.”
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n Houston, though, it wasn’t so long ago that dentists saw their patient rolls start to shrink. During the early 1980s, when the US oil industry saw its profits dissipate due to lower-priced competition from abroad, Houston’s economic base began to crack. Early retirements and layoffs plagued the city’s workers. From 1982 to 1986, the city lost 240,000 jobs. “I'm situated in the downtown area,” said Dr. Frank Eggleston, a general practitioner in Houston for 17 years. “Within a few blocks of my office are the headquarters of Shell Oil, Exxon, and Texaco. So my practice is probably 80 percent oil related.” It took only about nine months from the day Dr. Eggleston opened his office for his practice to reach full capacity. For the remainder of the decade and edging into the ’80s, his patient base continued to grow. By 1982 he had about 50 people on a waiting list. From 1982 to 1985, though, not only did the surplus patients disappear, but for the first time in his career Dr. Eggleston’s work schedule showed gaps of an hour or two a day. “I actually had patients who would not come for their regular recall visits; they said they were afraid to leave their desks at work to go to the bathroom because they might find a pink slip there when they returned.” Houston’s frenetic growth began to fizzle. New
U RBA N D E N T IS T R Y ■ 247
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“For somebody starting out, one o f the key challenges is to become known, ” hard enough doing quality dentistry w ithout being put under tim e constraints.”
said Dr. Drumwright. “You can’t do that by
a problem we were very much concerned.” For one, patients from surrounding sitting in the office looking out the window. areas were too intimidated to enter the s with Dr. Eggleston, who grew up in he stresses the importance of young dentists’ neighborhood or be treated in a dental office A Houston, Dr. G. Wells Drumwright, a becoming involved in their community. that also served AIDS patients. Dr. Gross began “For somebody starting out, one of the key to wonder if he’d be able to stay in business native of Washington, DC, also set up a practice in his hometown. challenges is to become known,” said Dr. at that address. “A number of patients have After graduating from Georgetown University Drumwright. “You can’t do that by sitting in died and a number have moved to other the office looking out the window. You have dental school in 1947, Dr. Drumwright opened practitioners,” he said. his office with family and friends forming the to go out and become active in the PTA or civic In addition, keeping staff also presented some foundation of his practice. Today, in his office clubs, for example.” problems. “We have had a couple fill-in at 1747 Pennsylvania Ave— a block down from In his lifetime, Dr. Drumwright has witnessed assistants and dental hygienists who were Washington, DC, play an increasingly important the White House— Dr. Drumwright still sees unable to cope with the prospect of working role in national and international affairs. With with AIDS patients, and one even left after some of his original patients, but has since Franklin Roosevelt’s New Deal policies during completing a day,” said Dr. Gross. managed to build a strong client base in a town known for quick exits. the 1930s, the federal government swelled with Since the first news of AIDS, Dr. Gross “My office is located across the street from new programs and authority as the country tried continued, the initial hysteria seems to have the headquarters of the World Bank Interna to find its way out of the Depression. died down. “From early on we’ve stayed in touch During World War II, the city not only became tional Monetary Fund,” he said. “And those with the University of California at San people are here for a few years and then they’re the headquarters for US mobilization, it also Francisco’s medical center, which provides served as the coordinating center for supplying programs to help make people aware of the gone. Also, the political appointees in the federal government serve for one administration, Allied armies. Today, Washington is host to an hazards and necessary safeguards. And I also or a part of it, and then they’re gone, too. So unending shuttle of government officials keep up with continuing education courses on we have a lot more turnover of patients than worldwide. the subject.” “It seems like something is always happening dentists in smaller communities.” When treating patients, Dr. Gross wears here,” said Dr. Drumwright. “There are a lot gloves, glasses, and, when using the handpiece, of advantages to working in a large urban area he uses a mask. “We’re also disposing of items such as Washington. There certainly are a lot such as matrix bands, which we previously had of cultural attractions, and I think I’ve been reused," he added. “And, in general, these days fortunate in being able to meet people from we dispose of a fair amount of items, which all over the world. . . . I just like it here; it’s I’m sure is state of the art.” home.” The procedure is the same with all patients. “I don’t think working with AIDS patients entists in all urban areas, of course, involves any special treatment,” said Dr. Gross. D have long faced challenges such as “We have had a couple in who are in very fragile increased competition and stress. The health, and there’s not a lot you can do for degree or the particulars might vary from city them. If they’re in pain, obviously you try to to city, but their essential features are help them. But as far as my interacting with constants. More recently, though, urban dentists them, their condition doesn’t seem to be a lot especially have been faced with a new challenge. different than other illnesses. Nineteen years ago, Dr. Paul Gross, a 1966 “I think as long as everyone on the staff is graduate of the University of California at San doing his and her part, we’re reasonably safe Dr. DRUMWRIGHT Francisco dental school, opened his office at from infection and the patients are safe from cross-contamination.” the corner of Castro and Market Streets in San While acknowledging the professional advan Francisco. tages of having deep roots in Washington, Dr. “The neighborhood has gone through a lot Drumwright noted that it was important, too, of changes,” said Dr. Gross. “When I first came The opinions expressed or implied in this article here it was a fairly undistinguished neighbor are strictly those of th e interview participants, and to make his own connections. He joined organizations such as the Civitan Club, a hood. Since then, though, it’s become a very do not necessarily reflect the opinion, official policy, business professionals’ service association. And heavily gay neighborhood. When AIDS became or position of the American Dental Association.
248 ■ JADA, Vol. 120, M arch 1990
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o far today I’ve seen eight patients, two of whom were emergencies,” said Dr. Murzyn. “On the average I’ll have about ten or 12 a day and the number is constantly growing.” Dr. Murzyn staffs the clinic Mondays, Wednesdays, and Thurs days from 8:30 am to 2:30 pm. Afterwards, he’ll travel to his private practice in Chicago’s Loop, where he’ll see patients until about 7 pm, and where he works the rest of the week. “The people here at the clinic come from a different world, at least insofar as they’ve experienced many things I haven’t,” said Dr. Murzyn, whose slow and easy manner of speaking projects an aura of confidence and compassion. “But we get along very well. It’s a very relaxed atmosphere, and it can be very rewarding because there’s a lot of disease to correct.” About 15% of Dr. Murzyn’s patients at the clinic are in the Salvation Army’s drug and alcohol rehabilitation programs in adjoining buildings. The others come from the city's poor neighborhoods. If they have jobs they have no dental insurance; and if they’re retired or unemployed, relying on government assistance, they have little money to spend on dental treatment. Still, except for emergencies, the clinic has a policy of requiring payment for services. “We lower the price if they have very little money,” said Dr. Murzyn, who receives a salary for his work there. “At $15 per filling, for example, it’s practically free dental service. And the people save their money for treatment because the clinic has a good reputation in the community for providing services at a reasonable cost.” What motivates most of the patients to save for dental care is a history of neglect that invariably has left their teeth in poor condition. “Everyday,” said Dr. Murzyn, “I see people with acute abscesses. They’re often in terminal dentition on their way to full dentures. “I know that some dentists might be surprised to think that people like that will suddenly begin to take care of their teeth,” he continued. “But by the time they come here, they’ve often made up their minds that they’re going to turn themselves around.”
Meeting the complex clinical challenges of patients with scant funds often involves inventive solutions. For example, said Dr. Murzyn, “I can perform a quick and inexpensive single root canal so that it’s not too costly to put in an overdenture or a post there. And I’ll often do a large amalgam buildup or large anterior composites rather than crowns. I always try to maintain as many mandibular teeth as I can.” It’s about a 10-minute drive east from the clinic to Dr. Murzyn’s office downtown, which he opened two years ago. Although he readily admits his practice has grown slowly, it has proceeded at a steady pace. “Working in your own solo practice is exhilar ating,” said Dr. Murzyn, who graduated from Loyola University dental school in 1978, and afterwards served three years in the Air Force before practicing as an associate with other dentists. Competition in a city the size of Chicago can be a tough proposition, but Dr. Murzyn doesn’t think that should discourage recent graduates considering setting up shop there. “It’s not as difficult as one might think,” he said. “There is a very large population base. And besides, there are ways to cut down on overhead. What I did was get a very small office, bought used equipm ent—which looks brand-new— and opened up with less than $20,000. My patients are quite happy with the work I provide, and with my salaried position at the clinic to supplement my income, I’m content to grow slowly.” One of the prime advantages of working in an urban area, Dr. Murzyn pointed out, is the contact with both peers and patients. Discussion with dentists who teach at nearby universities
helps him keep in touch with the latest developments in the world of dentistry; and many of his patients from foreign countries kindle his interest in the world beyond dentistry. “A fair number of my patients g- are from China, Mexico, Vietnam, ^ and Eastern Europe,” said Dr. ^ Murzyn. “ In fact, one of my t patients and his father escaped | from Romania by swimming across | the Danube River. “It’s always interesting to see where the level of dentistry is at in other countries. Some people will come in with stainless steel crown bridges, for example. But they’re all very quick to take advantage of the highest standards of dental care here. In a very short time after they arrive, they’ll often be interested in sending their children to an orthodontist.”
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nteresting patients— many of them young professionals, artists, and actors— and access to a variety of dental specialists also figure prominently on Dr. Martha Connell’s list of advantages of working in Manhattan. Dr. Connell, a 1976 graduate of New York University dental school, practices on the first floor of a twin-towered apartment building on Central Park West, directly across from Central Park’s Strawberry Fields. “I see about 35 to 40 patients a week,” said Dr. Connell, who works with two assistants and a hygienist. Dr. Connell’s office is open three days a week from 8 am to 6 pm, and another day until the early afternoon. “When I first started out I used to work Saturdays and it was just a disaster. People would cancel if they found something else to do. Many leave the city on the weekends, so it’s just not a big day for dental appointments. Although I know it’s different in the suburbs.” Prior to coming to Manhattan 4'A years ago, Dr. Connell worked at St. Luke’s-Roosevelt Hospital Center in New York City, and as an associate in a smalltown practice in upstate New York. The contrast between patients in a smaller community and those in a large urban area can sometimes be striking. Dr. Connell recalled URBA N D E N T IS T R Y ■ 245
that those in the small town “seemed more grateful and accept ing of what you want to do. They weren’t very demanding in terms of the dental work, and they were more trusting, as if to say, ‘Oh, you're the doctor; just go ahead and do what you think is best.’ “But in New York, people read a lot about everything; they’re always asking a lot of questions, and you really have to be on your toes. It’s not really a problem; you just have to realize that’s how you have to deal with patients here.” Occasionally, though, work pressures can mount. To help allay stress, Dr. Connell makes a point of taking her time with each appoint ment. “I don’t try to get people in and out every 15 minutes,’’ she said. “I see each patient for an average of 45 minutes, and I try to give myself enough time to do a good job. If I have a halfhour cancellation, I’ll try to get out of the office and take a walk.” The biggest challenge to working in New York City, said Dr. Connell, is keeping up with expenses. “Bents and malpractice insurance rates are very high. When I started practicing,
insurance was about $300 a year.” Today, she added, it’s closer to $6,000. “For those who might be interested in working in a large city like New York,” continued Dr. Connell, “I’d say go ahead, but just make sure that you have a really solid financial base. If
construction stood empty, monuments to the lagging local economy. “There were quite a few new e buildings going up, but because | there were no people in them they °b becam e known here as ‘see§ through’ buildings,” said Dr. | Eggleston. ^ “I understand that for a lot of * the new construction completed S in 1986, it was cheaper for the S contractor to go ahead and finish | the project than to be sued for ^ not honoring the contract. The buildings were beautiful, but they just sat there, empty.” Local officials were determined to do more than sit. They laid plans to diversify Houston’s economy. “City planners decided that they didn’t want Houston to be a one-industry town,” said Dr. Eggleston. “So recently, for example, a new convention center has opened, tourism is being promoted, and the space center has been expanded. All of these things and more have helped. The see-though buildings are just starting to fill up now, my patient load has improved, and I hear that the oil companies have also started to hire again.” With the increased business pace, though, comes increased stress— for patients and dentists alike. It’s not unusual, said Dr. Eggleston, to see a patient whose oral health had previously been fine suddenly show signs of deterioration. “I’ll see bleeding gums and ask if they’ve been under a lot of stress lately, and they’ll admit they have,” said Dr. Eggleston. “It’s the combined pressure of heavy workloads and limited time.” Moreover, those pressures are beginnning to show in the dental office in other ways, said Dr. Eggleston. “Just this morning I was talking to my receptionist about this,” he continued. “For the first time in 17 years, we’re starting to get patients who want to know exactly how long they’re going to be here. More people today seem to be very time conscious. “But I couldn’t imagine going to a doctor’s office and talking to him or her about time. When I’m being treated I want quality work; I want it to be right, not rushed. So what I do with these patients is tell them that we want to do a quality job, and that if there’s a time problem today maybe we should reschedule. It’s I |
you have large outstanding loans and you go into debt trying to build up your practice you could go under. I’ve seen it happen. “On the other hand, it’s a very stimulating place to work. And I really don’t feel the competition here because there are so many people. Our days are always full.”
I
n Houston, though, it wasn’t so long ago that dentists saw their patient rolls start to shrink. During the early 1980s, when the US oil industry saw its profits dissipate due to lower-priced competition from abroad, Houston’s economic base began to crack. Early retirements and layoffs plagued the city’s workers. From 1982 to 1986, the city lost 240,000 jobs. “I'm situated in the downtown area,” said Dr. Frank Eggleston, a general practitioner in Houston for 17 years. “Within a few blocks of my office are the headquarters of Shell Oil, Exxon, and Texaco. So my practice is probably 80 percent oil related.” It took only about nine months from the day Dr. Eggleston opened his office for his practice to reach full capacity. For the remainder of the decade and edging into the ’80s, his patient base continued to grow. By 1982 he had about 50 people on a waiting list. From 1982 to 1985, though, not only did the surplus patients disappear, but for the first time in his career Dr. Eggleston’s work schedule showed gaps of an hour or two a day. “I actually had patients who would not come for their regular recall visits; they said they were afraid to leave their desks at work to go to the bathroom because they might find a pink slip there when they returned.” Houston’s frenetic growth began to fizzle. New
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“For somebody starting out, one o f the key challenges is to become known, ” hard enough doing quality dentistry w ithout being put under tim e constraints.”
said Dr. Drumwright. “You can’t do that by
a problem we were very much concerned.” For one, patients from surrounding sitting in the office looking out the window. areas were too intimidated to enter the s with Dr. Eggleston, who grew up in he stresses the importance of young dentists’ neighborhood or be treated in a dental office A Houston, Dr. G. Wells Drumwright, a becoming involved in their community. that also served AIDS patients. Dr. Gross began “For somebody starting out, one of the key to wonder if he’d be able to stay in business native of Washington, DC, also set up a practice in his hometown. challenges is to become known,” said Dr. at that address. “A number of patients have After graduating from Georgetown University Drumwright. “You can’t do that by sitting in died and a number have moved to other the office looking out the window. You have dental school in 1947, Dr. Drumwright opened practitioners,” he said. his office with family and friends forming the to go out and become active in the PTA or civic In addition, keeping staff also presented some foundation of his practice. Today, in his office clubs, for example.” problems. “We have had a couple fill-in at 1747 Pennsylvania Ave— a block down from In his lifetime, Dr. Drumwright has witnessed assistants and dental hygienists who were Washington, DC, play an increasingly important the White House— Dr. Drumwright still sees unable to cope with the prospect of working role in national and international affairs. With with AIDS patients, and one even left after some of his original patients, but has since Franklin Roosevelt’s New Deal policies during completing a day,” said Dr. Gross. managed to build a strong client base in a town known for quick exits. the 1930s, the federal government swelled with Since the first news of AIDS, Dr. Gross “My office is located across the street from new programs and authority as the country tried continued, the initial hysteria seems to have the headquarters of the World Bank Interna to find its way out of the Depression. died down. “From early on we’ve stayed in touch During World War II, the city not only became tional Monetary Fund,” he said. “And those with the University of California at San people are here for a few years and then they’re the headquarters for US mobilization, it also Francisco’s medical center, which provides served as the coordinating center for supplying programs to help make people aware of the gone. Also, the political appointees in the federal government serve for one administration, Allied armies. Today, Washington is host to an hazards and necessary safeguards. And I also or a part of it, and then they’re gone, too. So unending shuttle of government officials keep up with continuing education courses on we have a lot more turnover of patients than worldwide. the subject.” “It seems like something is always happening dentists in smaller communities.” When treating patients, Dr. Gross wears here,” said Dr. Drumwright. “There are a lot gloves, glasses, and, when using the handpiece, of advantages to working in a large urban area he uses a mask. “We’re also disposing of items such as Washington. There certainly are a lot such as matrix bands, which we previously had of cultural attractions, and I think I’ve been reused," he added. “And, in general, these days fortunate in being able to meet people from we dispose of a fair amount of items, which all over the world. . . . I just like it here; it’s I’m sure is state of the art.” home.” The procedure is the same with all patients. “I don’t think working with AIDS patients entists in all urban areas, of course, involves any special treatment,” said Dr. Gross. D have long faced challenges such as “We have had a couple in who are in very fragile increased competition and stress. The health, and there’s not a lot you can do for degree or the particulars might vary from city them. If they’re in pain, obviously you try to to city, but their essential features are help them. But as far as my interacting with constants. More recently, though, urban dentists them, their condition doesn’t seem to be a lot especially have been faced with a new challenge. different than other illnesses. Nineteen years ago, Dr. Paul Gross, a 1966 “I think as long as everyone on the staff is graduate of the University of California at San doing his and her part, we’re reasonably safe Dr. DRUMWRIGHT Francisco dental school, opened his office at from infection and the patients are safe from cross-contamination.” the corner of Castro and Market Streets in San While acknowledging the professional advan Francisco. tages of having deep roots in Washington, Dr. “The neighborhood has gone through a lot Drumwright noted that it was important, too, of changes,” said Dr. Gross. “When I first came The opinions expressed or implied in this article here it was a fairly undistinguished neighbor are strictly those of th e interview participants, and to make his own connections. He joined organizations such as the Civitan Club, a hood. Since then, though, it’s become a very do not necessarily reflect the opinion, official policy, business professionals’ service association. And heavily gay neighborhood. When AIDS became or position of the American Dental Association.
248 ■ JADA, Vol. 120, M arch 1990