Miles of Smiles

“I've grown up an hour-and-a-half from everywhere,” Dr. John “Chip” Perrine ('84) said of his home among the hills.

It’s a common sentiment among West Virginia natives, and for good reason. The Appalachian Mountains envelop the state, making for curvy roads and long drives (and awe-inspiring scenery). The rugged terrain also contributes to two-thirds of West Virginians living in rural communities. And 50 of 55 counties are in health professions shortage areas and/or are medically underserved.

“In rural West Virginia, we've been ‘saved’ so many times by people who come in and then they're gone, but we're still here,” Perrine said. “So, we can be standoffish and accept our own first. There's a lot to be said for introducing students to a rural lifestyle. How else can you know unless you've had a period of time to experience it?

“I questioned if a student doesn’t want to be in a rural location, why would someone want them in their clinic. But another faculty member said there’s something to be learned. And he was right. I took that to heart. There is something there for everyone.”

And Perrine did take it to heart.

He and his colleagues in the West Virginia University School of Dentistry created a unique opportunity — a rural rotation. The program guarantees dental and dental hygiene students gain experience providing care at private practices and community clinics before they graduate.

Thirty years later, the clinical experience has become one of the School of Dentistry’s most successful, and most beloved, programs. Not only does it provide valuable experience for students outside of typical classrooms, labs and clinics, it develops service-oriented practitioners who are discovering solutions that reduce oral health disparities in West Virginia.

CREATING IMPACT THROUGH HANDS-ON EXPERIENCE

For fourth-year Doctor of Dental Surgery student Zach Lynn, the rural rotation has been a valuable experience for building on skills learned in class. He is one of more than 1,500 dental students, soon-to-be alumni, who have participated in the program and been surprised by how much they grow as a provider during the short six- to eight-week opportunity.

Lynn, who completed a rotation during fall 2023 at Tebay & Associates in Vienna, explained that the hands-on experience helped him feel more confident in performing procedures and working with patients.

“It’s been very interesting,” Lynn said in between treating patients during his rotation more than 100 miles from the student clinics in Morgantown. “I’ve gotten to see different kinds of procedures and have learned that

“I’m capable of doing them. I’ve gotten so much practice, and I feel a lot more confident in my ability.”

That’s not to mention developing skills in hiring, training and supervising as well as appointment control, maintaining patient accounts and fee establishment.

A native of Parkersburg, Lynn has always had an interest in healthcare and ultimately chose to study dentistry after shadowing at the same practice he completed the rural rotation.

“It was actually shadowing in this office where I kind of fell in love with dentistry,” Lynn said. “I looked at other professions, but here we’re able to change people’s smiles, we’re able to make them happier, have a better quality of life and then we also get to be a little artistic in our work.”

Dr. Harry Talbott Tebay ('70), the owner of Tebay & Associates and a WVU School of Dentistry graduate, said he chose to partner with the School as a rural rotation site to provide students with valuable hands-on experience. He believes that being in a real-world setting is necessary to prepare students for practice after graduation.

“I remember when I wanted to practice in a clinic and didn’t have anywhere to go,” he said of his time in school prior to the Rural Rotation Program. “They get great teaching and great skills. When they come, they’re being exposed to conditions that they would never get in a classroom.”

Dr. Matthew Stump ('11, '12), who practices part-time at Tebay & Associates, said the rural rotation allows opportunities for mentorship between alumni and current students.

He would know. Stump graduated from the WVU School of Dentistry with a Doctor of Dental Surgery degree in 2011 and a Master of Science degree in 2012 when the program had been going strong for almost two decades.

“Even though we have these students for a shorter period of time than we may want, the impact is very meaningful in terms of what it does in being able to mentor and give back what you received,” he said. “It’s kind of a chain that helps form and create that next generation of dentists and the level of care you want to provide to patients.”

He says the rural rotation is also a chance for students to learn more about dentistry and meet other practitioners.

“I was very lucky to have two important mentors in my journey. You think about how that mentorship impacts your life and how it impacts your career trajectory, and that’s when I think about this rural program.

“This is the 30th anniversary, and the success of it can’t be denied. The impact that it’s had is not only from the standpoint of training future clinicians — it’s helping facilitate career movement for them and networking capabilities. It’s multifaceted, and the student is benefitting greatly from the experience, but also the community they’re working in.”

THREE DECADES IN THE MAKING

The 2023-24 academic year marked 30 years of the successful "welcome to the real world" experience for students who are about to begin their careers in oral healthcare.

The beginnings of the Rural Rotation Program started in 1991 when faculty recognized the unique needs of patients in West Virginia and the importance of teaching rural dental care to future practitioners. They felt students should be encouraged to find solutions to problems outside of the classroom and report back their findings. This method of teaching would prepare them for clinical training and onsite practice.

A grant from the Kellogg Foundation was originally intended to provide training opportunities for medical students but was expanded to include the School of Dentistry as a way to increase interdisciplinary efforts across WVU Health Sciences.

When private practitioners open their offices to students from the School of Dentistry, it opens the doors for more patients to access treatment.

What started as three practice sites quickly grew as more offices wanted to become involved. Today, the School collaborates with more than 90 dental practices statewide and has impacted more than 275,000 individuals and provided more than 286,000 dental procedures.

As part of required curriculum, both dental surgery and dental hygiene students complete a rural rotation in a private practice setting in West Virginia as a service-based learning opportunity that supports the School’s mission of increasing access to care and retaining practitioners in rural parts of West Virginia. The clinical partners provide space, patients, and often a dental assistant for students during their rotation, allowing students to develop skills and learn about a provider’s role in the community.

Dr. Mary Beth Hinkle (’08), a dentist in Buckhannon, explained that the rural rotation provided a unique experience to learn more about dentistry from the providers she has known her whole life.

“Prior to applying to dental school, the rural rotation was one of the things I looked forward to most because I really looked up to the dentist in my hometown, and their office was one of the practice sites,” Hinkle said. “Completing the rural rotation in my hometown was so much fun. I got to spend a lot of time with family and friends, and I knew everybody at the office and got to treat people in my own community. The rural rotation experience was part of why I wanted to stay in the state to practice.”

Hinkle is now a dentist at the office where she completed her rural rotation and looks forward to having students from the School complete their rotations there. She explained that Doctor of Dental Surgery students rotating at the office practice restorative work, operations, fixed bridges, dentures, and restoring implants while dental hygiene students practice routine maintenance cleanings.

“I was actually the first student that went on rotation at our practice, and now we have been hosting students for about 10 years. We love to work with students and help them develop skills so that when they graduate, they feel more comfortable in practice. We like to take them around the community and show them our town. We also have a list of patients who prefer to see students because they like to meet new practitioners.

“I plan to be part of the program as long as it’s here and take as many students as possible to keep this program rolling because I think it's a great thing. Our state provides so many opportunities for our local populations, and we really need dentists to stay in our towns and communities.”

EXPANDING DENTAL CARE FOR GENERATIONS

As West Virginia continues to experience a shortage of dentists, there is an increased need for graduates to stay in the state to practice. The West Virginia Department of Health and Human Resources Oral Health Program reports 49 dentists per 100,000 individuals compared to the United States average of 61.

“There’s definitely a need for practitioners in our state,” Dr. Valerie Perrine (’09), associate dean for student affairs, community health, and outreach, said. “In the last 10 or 15 years, we’ve had a lot of dentists retire, so patients are having to wait to be seen, and we need new graduates to fill those roles.”

Like her father, Chip, she is a graduate of the Doctor of Dental Surgery Program. As her dad’s practice was one of the first offices to be involved with the Rural Health Program in Dentistry and Clinical Assessment, Valerie saw the impact it had on students and patients, inspiring her to become involved when she was appointed as a faculty member in the School.

“Our School of Dentistry was a pioneer in the development of this type of integrated outreach and has made this service-learning program one of a kind and one to emulate,” she said. “It is the premiere model nationwide thanks to the vision and care taken to form, cultivate, and grow the program coupled with the unwavering Mountaineer spirit and loyalty of our WVU alums, and the commitment to service from our School of Dentistry students.”

For Chip, seeing his daughter work with a program that he helped start and has been involved with for the last 30 years has been a rewarding experience.

“I’m extremely proud of her,” he said. “She has so much on her plate with her own practice and life, but she wanted to contribute to something bigger because she knows how much it means to people who have worked on this program.”

BUILDING THE FUTURE OF RURAL CARE

At a 30th-anniversary celebration for rural rotation at the Erickson Alumni Center on the Morgantown Campus, practitioners, faculty, staff, and students had the opportunity to gather and reflect on three successful decades and continued growth.

Alumni Dr. Eric Brannon (’84) and Dr. Regina Brannon (’83) as well as Chip Perrine and retired faculty member and Department Chair Dr. Richard Meckstroth were recognized for their contributions to the program and service to West Virginia.

Meckstroth, who helped grow the program through the addition of practice sites, explained the importance of rural rotations not only for students but also for patients.

“The rural health program is why I stayed at the school as long as I did,” he said. “It meant a lot to me. We’re making a difference in the lives of West Virginians. A student will go out and, especially somebody who is not from West Virginia and who has preconceived ideas, and will realize these are good people. Some of them have said, ‘I'm planning on practicing in more of a rural area than I was before.’ Many associateships were developed as a result of the rural health program, and that helps keep people in West Virginia.

“When I moved here from southern California, I had been in practice there for a couple of years. I came here with the idea of going back into practice, but after being at the School for a year, I enjoyed academic dentistry and I stayed here.

“When I retired, there were over 100 rural faculty and about 80 offices. Over $65 million in uncompensated care was provided to patients, and about 20% of that care was provided by students and the rest by rural faculty.”

Meckstroth’s advice to students preparing for their rural rotation is to enjoy the experience and become involved in the community as much as possible while learning about dental practice.

“It’s never been about the numbers for me,” he said. “That never crossed my mind when we set this up. I only added that amount of uncompensated care because the students would come back and say, ‘man, we're doing a lot of dentistry.’ But I think if I would have said this is an expectation to start with, all those offices wouldn’t have done it. They do it out of the goodness of their heart for the people that come in and helping the students get the experiences they need.”

Looking toward the future, the School and its students are hopeful that the rural health program can continue to provide a unique educational experience while serving the patients of West Virginia.

Practitioners and School leadership believe the program will result in graduates choosing to keep their talent and skills in the Mountain State. Like a number of students, Zach Lynn’s plans include staying in West Virginia as a provider in the familiar clinics of Tebay & Associates.

He will join the more than 80% of practicing dentists in West Virginia who are graduates of WVU, giving back to the communities that help them fulfill their dreams.

“We have been able to retain several excellent clinicians who had already decided to leave the area, but their experience in one of our hometowns changed their minds. That’s the beauty of this program.”