Gatekeepers of Health

It’s a damp, drizzly day in Boston. Fog floats atop the skyscrapers, and the view from the 15th floor of One Kneeland Street barely extends beyond Chinatown. It’s the kind of day that—if you grew up in Wales, at least—brings back the feel of home and the desire for a proper cup of tea.

Huw F. Thomas, the 16th dean of Tufts University School of Dental Medicine, was into his second month on the job. Since arriving from the University of Alabama at Birmingham over the summer, Thomas had experienced the tremors of an East Coast earthquake, the fury of Hurricane Irene and a fire alarm at his high-rise apartment building that sent him racing down 20 flights of stairs at 2:30 in the morning. And on this particular afternoon, the Red Sox were continuing their precipitous September decline. But Thomas’ enthusiasm for leading the dental school remained undiminished.

“I think this is a very warm, friendly and inviting place,” he said. “I’m continually impressed by the people here at all levels, whether it’s staff, students, faculty or administration. I definitely get a sense of the Tufts family.”

A pediatric dentist, Thomas is also an accomplished researcher, with more than 150 articles, chapters and abstracts to his credit. His recent work examines the relationship between vitamin D deficiency and early childhood cavities, or caries, as dentists refer to them. Among his top priorities for the dental school, he says, are further integrating clinical practice and research, expanding the rubric of community service activities and developing a curriculum that embraces inter-professional education.

Thomas grew up in Wales and received his dental degree from Guy’s Hospital, University of London. He earned a certificate in pediatric dentistry from the Eastman Dental Center in Rochester, N.Y., a master’s in dental research from the University of Rochester and a Ph.D. in biomedical sciences from the University of Connecticut Health Center.

He narrowly missed an earlier opportunity to come to Tufts in 1974, when as a dental student in the U.K., he was offered a traveling scholarship to the United States, where he had the chance to spend six weeks either at Tufts or the State University of New York at Buffalo. He chose Buffalo on the recommendation of a friend who had been there the previous year.

He served on the faculty at the University of Connecticut Health Center and later headed the pediatric dentistry department at the University of Texas Health Science Center at San Antonio. In 2004, he was appointed dean of the dental school at the University of Alabama at Birmingham, where he was also a professor of pediatric dentistry.

His CV unfolds in a more personal way along the shelf beneath the expansive windows in his office: an old microscope he “inherited” during his doctoral work in Connecticut; a sculpture of an armadillo, given to him by his daughters as a reminder of their Texas days; another sculpture, titled “Agony,” of a dentist extracting a tooth in a most forceful fashion, purchased at a fair in Rochester. “It fits the sort of mindset of what dentistry used to be,” he says.

There are many photos of his daughters, Caty, an assistant district attorney, and Megan, a nurse. “We’re great friends, the three of us,” Thomas says, beaming. It was during their time in Connecticut that the father and his daughters discovered the Red Sox, and Fenway Park was among his first destinations when he moved to Boston this past summer. And, since he did grow up in the U.K., he was also looking forward to watching the 6 Nations rugby championship broadcast live on TV (“You couldn’t get that in Alabama!”).

His other pursuits outside dentistry include hiking and reading fiction (he’s currently into Scandinavian detective novels). And every few years, he re-reads his favorite, J.R.R. Tolkien’s The Hobbit. “It’s such a wonderful allegory for life,” he says. He’s also quite fond of the riddle that Bilbo Baggins poses in the book:

Thirty white horses on a red hill,
First they champ,
Then they stamp,
Then they stand still.

The answer, of course, is teeth.

We sat down with the new dean earlier this fall to talk about his path to Tufts and his aspirations for the School of Dental Medicine.

Tufts Now: What led you to dentistry, and dental research, in particular?

Huw Thomas: My father was the principal of a school for developmentally delayed children. He was a tremendous, positive influence on me, and still is. When I was at those formative years trying to decide what to do with my life, he arranged for several of his friends from Rotary to entertain me for a day. So I went to spend time with a dentist, time with a physician and a few other people. Seeing what the dentist was doing and how he was doing it, I thought, “That sounds like a good thing to do.”

What was interesting was that once I started in dentistry, I never really envisioned myself in private practice. I really enjoyed dental school, and I did have an “aha” moment when I had the opportunity to visit the Eastman Dental Center in Rochester. I just knew I wanted to go there and pursue more education. I graduated from dental school [in the U.K.] in June 1975, and moved to Rochester in August. After I completed my pediatrics training, one of my professors persuaded me to enroll in the master’s program. I think it was then that I got bitten by the research bug.

My experiences coming over here on that traveling scholarship for those six weeks—even though it was January in Buffalo!—were amazingly positive, and it’s the reason I’m here today. One of the things I’m very supportive of, and want to develop more of here at Tufts, are student-exchange programs. I’m delighted to see some established already. I think it’s a great opportunity for us.

Why did you choose pediatrics?

I had two reasons. I have a sister who is almost nine years younger than I am, so I grew up with this young kid around all the time and have always had an affinity for little kids. I think that was part of it, but it wasn’t a conscious part. The conscious part is that while I was a dental student doing a rotation in pediatric dentistry in London, we had a very unruly patient. He was shouting, screaming. And one of the faculty members on the clinic floor went up to this kid, and within two minutes had him eating out of hand. I thought that was just so fascinating to see how that happened. I remember talking to this faculty member afterward, and I found out he had undergone pediatric training in the U.S. I think that was the real flashpoint.

It’s a wonderful specialty—the whole spectrum of care that you can provide to children, and really have an influence on their lives, especially if you help them become disease-free and establish patterns that they’ll have for life.

Talk a little about your research.

My thesis work was essentially in developmental biology, looking at the development of the tooth root and the attachment mechanism to the surrounding bone. But I also got involved with a lot of national groups that were looking at health disparities, infant oral health and preventive programs for children.

In working with children who have a very severe and rampant form of dental caries, called early childhood caries, I was struck by the pattern of the expression of the disease on the tooth surface. It occurred in a very specific location. And so we went back into the lab to find out what was going on.

The caries lesion appears in the part of the tooth that forms immediately after birth. We thought that maybe there was some sort of nutritional influence on that postnatal enamel that might affect the quality of the enamel, and therefore, make it more susceptible to caries. It had been known for a long time that vitamin D and vitamin A have an impact on developing teeth. There was also data that was coming out that showed that many children—especially impoverished children, in whom this disease is prevalent—are vitamin D deficient.

We hypothesized that vitamin D deficiency is a potential mechanism to explain a poorer quality of enamel in the tooth, which may make it more susceptible to caries attack. And we discovered that was true.

Eventually, you moved into administration, as a department chair at the University of Texas and at the University of Alabama at Birmingham. What did you accomplish in those positions?

I had the opportunity to chair the department of pediatrics at San Antonio, and the good thing about that was it was a large department, with a large number of faculty positions. I was able to recruit research people to the department, as well as clinicians. And we had a general theme of craniofacial molecular biology, and all of the people we hired were part of that research. It was, in fact, a clinical department, but it reinforced for me that you can integrate research within a clinical department and make it very successful.

I took the job [as dean at the University of Alabama at Birmingham] because I felt I had accomplished what I set out to in San Antonio. We had successfully integrated research into clinical programs and successfully changed a lot of the curriculum within the department, and, I believe, improved it. So here was a chance to do that on a school level.

I think we got a lot accomplished at Birmingham, despite significant economic challenges in the last three years. That’s been a major challenge for all dental schools, but much more so at a state school. It was our state funding that was hit; we had about a 30 percent reduction in state funding over three years.

How do you see the role of dentistry in the broader health-care system?

The mouth is connected to the rest of the body, and as such—and I’ll paraphrase the Surgeon General’s report—you can’t have good general health unless you have good oral health. The two are intricately linked, and I think the dental profession needs to be very cognizant of that.

Some of the ideas that are coming out now in inter-professional education—educating dental, medical, nursing, public health, nutrition, optometry students, all in the same environment—present some tremendous opportunities for us. And I think that community-based health-care approaches are an ideal way to do that, marrying those two areas together. Where better to provide that opportunity for students than in a community setting?

I think dentists should become leaders of the health-care team. More adults in America visit a dentist than they do a physician. Seventy percent of middle-class Americans have regular dental appointments, but just 30 percent of that population have regular medical appointments. And if that is the case, I can certainly envision a situation where the dentist could be a gatekeeper into the health-care system.

There is no reason why certain tests that would be markers of systemic disease couldn’t be conducted in the dentist’s office. Diabetes and heart disease are two of the most expensive diseases that we spend money on in this country. And typically you don’t do anything about them until it’s too late.

There is a prototype now for a diagnostic tool where you can take a saliva sample, analyze it with an instrument no bigger than a cell phone and identify risks for a variety of systemic conditions. There’s no reason why a dentist couldn’t do that kind of test. I’m not suggesting that dentists should be the only gatekeepers, but certainly they can be a gatekeeper.

What are some of your goals for Tufts Dental School?

In order to have optimal clinical programs, you have to have very strong research programs. At some level, we need to be able to focus our research efforts to bring them in line with our clinical programs. The two are intimately linked. It’s not clinical or research; it’s clinical and research.

The other thing that we did in Birmingham that’s happening here is curriculum reform, from both didactic and clinical aspects. I think some of the curricular reform that has taken place at Tufts is really outstanding. Some very careful thought is being put into how to develop the optimal curriculum for our students. That’s an ongoing process, as it should be. We also have to look at the impact of science and technology on our profession. There’s something new almost every day, and we’ve got to be able to give our students the best opportunities to evaluate and use those technologies for the benefit of our patients.

The area that Tufts has always been known for is community service, and we have some phenomenal outreach programs in the city and across the state. I think there are some tremendous opportunities for us to expand on that so we not only provide service to the community, but also educate our students in a community health environment. Hopefully, by doing so, we can make our students more likely to provide care to underserved populations after graduation.

The improvements in the oral health of Americans have been significant over the last few decades. But there are certain segments of the population that don’t have good oral health: the poor, children, the elderly, those with developmental disabilities. I think that educational institutions have a responsibility to serve those populations and educate their students in the delivery of those services.

My short-term goal is to identify where we can form additional alliances so that more of these community-based programs can be developed.

Personally, I’m looking forward to a fulfilling time at Tufts. I’m excited about the opportunity to work with a lot of excellent people, and, together, meet the challenges of our profession.

This article first appeared in the Fall 2011 Tufts Dental Medicine magazine.

Helene Ragovin can be reached at helene.ragovin@tufts.edu.