The General Dentist

At 1600 hours, the plane from Germany lands at Joint Base Andrews Naval Air Facility outside Washington, D.C. Maj. Gen. Gerard Caron, D78, watches as the sick and injured emerge from the enormous belly of the slate-gray C-17 transport. Some walk on crutches; others are carried on litters. One patient is in critical condition. Buses wait on the tarmac, ready to take the Marines to the National Naval Medical Center in Bethesda, Md., the soldiers to Walter Reed Army Medical Center, the airmen to the medical center at Andrews.

Were the general to walk over, the medical personnel would undoubtedly come to attention. But Caron doesn’t want to interfere. The tall man with thoughtful blue eyes is still a little awed that this first point of return to home soil for the nation’s “wounded warriors,” some of them coming from Afghanistan and Iraq, is part of his jurisdiction.

“Taking care of these injured airmen, soldiers and Marines—there is probably nothing more important that we do,” he says. “If there was anything that I never, ever thought I would be involved with as a dentist, it’s this.”

As commander of the 79th Medical Wing, which is based at Andrews, Caron is in charge of this three-times-a-week transfer operation, as well as the nearly 1,500 employees who provide health care to 400,000 airmen, veterans and their families in the Washington area. He is also the highest-ranking dentist in the Air Force and serves as its assistant surgeon general for dental services.

This job wasn’t exactly what he was picturing when he made the decision 25 years ago to leave his small solo practice in rural Maine to join the military. Becoming a general is not a career path you can plan, he says.

But the military provides lots of opportunities for leadership. And Caron found that he not only was good at leading, he kind of liked it, too.

Earlier in the day, at 1230 hours, Caron was met with salutes as he walked through the clinic at the 579th Dental Squadron at Joint Base Anacostia-Bolling in southeast Washington. He was the commander here 10 years ago, and it’s clear that although most of his time now is devoted to overseeing the medical wing, his heart is still in dentistry.

He points out that military and civilian dentistry are similar—with a few exceptions. The emphasis here is on keeping the airmen “deployment-ready,” that is, free from cavities, gum disease, fractures or faulty restorations that are likely to need emergency treatment during the next 12 months, longer than the average deployment. At the end of 2010, almost 95 percent of uniformed Air Force personnel were deemed ready to deploy, a statistic in which Caron takes some pride.

The post-cleaning conversations in the Air Force clinic might go a little differently than they would in a typical civilian practice, with reminders to keep up dental care even during deployment. You might not be able to stand in front of a mirror every morning to floss, the military dentists advise their patients, but you can do it in your tent. You’ll find M&Ms at the end of every food line, but make sure that the comfort foods don’t linger on your teeth. Ditto for Mountain Dew.  

Caron has helped oversee a number of technological upgrades to Air Force dental services. In the clinic lab, a state-of-the-art machine can sculpt a new bridge in minutes, ensuring an airman can be on to his next assignment in just a couple of hours (rather than days). In 2010, the Air Force completed a four-year program to convert all 90 of its clinics at home and abroad to digital radiology, supported by two central archives that allow access to any digital image from any location.

But Caron says one of the biggest improvements in recent years has been the Air Force’s adoption of risk-based assessments, which help dentists and hygienists make specific cavity-prevention recommendations for each patient based on factors such as a history of cavities, visible plaque, diet, exposure to fluoride and dry mouth.

“We instituted that model across the entire system,” Caron says. “We put it on the inspection checklist. Nothing spurs a clinic director to action like knowing they are going to be inspected on something.” In the first four years after the plan was implemented, from 2000 to 2004, the percentage of Air Force patients characterized as high risk for cavities decreased by 31 percent.

Military Career Takes Off

Caron grew up in Nashua, N.H., in a family with no military or dental connections to speak of. His father was a mechanic, and he was the first in his family to go to college. But his family dentist seemed to make a good living, so he applied to Tufts Dental School.

“I really started dental school with no idea of how to pay for it,” he says. In his senior year, a National Health Service Corps Scholarship, which pays tuition in exchange for a pledge of service in an underserved community, helped soften the financial blow. After serving his year in a rural health center in Maine, he set up his own practice in the scenic town of Brooks, northwest of Belfast.

After seven years, the drawbacks of being a solo practitioner in a small town were clear. It was difficult for him to take time off, yet he and his wife, Kathy, longed to travel. And as their two children grew, they wished they had better educational opportunities. Caron knew a few dentists who had gone into the service; they didn’t seem to have those problems.

The couple hemmed and hawed about whether they should look into the military life. Then an uncanny sign arrived in the daily mail. Right at the top of the pile was a card from an Air Force recruiter. Soon after, in 1986, Caron joined the Air Force as a major.

The Carons soon got the travel they desired. Caron went on to treat patients as a general dental officer in Maine, as a chief of dental examination and diagnosis in the United Kingdom, as a resident in comprehensive dentistry in Mississippi and as a clinical dentistry flight commander in the Azores.

And with 30 days off a year—much more than his solo practice allowed him—he was able to take his family on trips throughout Europe and to the pyramids in Egypt. “I’ve probably spent more time doing things with our kids as they were growing up because of being in the Air Force than I would have otherwise,” Caron says. He also credits the experience with giving their children, now grown and living in New Jersey and Oregon, the confidence to travel on their own.

But hands-on dentistry was just part of the job. “Before you know it, you’re being offered opportunities of leadership,” he says. He was assigned as dental squadron commander and worked in the Washington, D.C., office of the Air Force surgeon general, editing a book on Air Force dental policy. In 2009, he was given his first deployment, as commander of a medical group on an air base in the Kyrgyz Republic during Operation Enduring Freedom, the military operation in Afghanistan.

But where did his ability to take charge come from? Was he class president in high school? Captain of the debate team? “No,” he says, “but I was an Eagle Scout.”

This afternoon, his wife, Kathy, joins him as he tours the Fisher House, a temporary home for families of patients receiving care at the Andrews base medical center. As the general asks the director about the house’s fiscal health (holding strong), Kathy Caron points out that her husband has long been a student of authority.

“He is always reading books on leadership,” she says, and indeed, his bookshelf has held everything from Lincoln on Leadership: Executive Strategies for Tough Times to the story of George C. Kenney, the air commander in the South Pacific during World War II, to Colin Powell’s autobiography.

But the reference he consults most often is probably How Good People Make Tough Choices, which is not a military primer or a management guide, but a book on ethics. “Choosing between right and wrong is not a difficult thing to do,” he says. “But how do you weigh two options when both are right from a certain point of view?” He says one of the most difficult parts of his job is disciplining—fairly and fittingly—someone under his command.

He has also taken cues from his own commanders. “When leaving an assignment to go to another assignment, I used to write down the things that inspired me about their leadership,” he says. His first commander oversaw a clinic with 40 people, and would go out of his way to say good morning to everyone, to know at least something about what was going on in their lives. “I saw the importance of making personal connections with people.”

He demonstrates that particular skill at a lunch with enlisted men and women, a monthly opportunity for some of the dental, pharmacy and biomedical equipment technicians in the 79th Medical Wing to talk with their commander. The smiling general joins them in the cafeteria at 1100 hours, and, over a meal of catfish, proceeds to put them at ease.

“Any of you seen Air Force One coming or going?” he asks, bringing up the most famous aircraft to use the base. “Have you gotten into the city to see the sights?”

One staff sergeant says that most of his time off is spent catering to his pregnant wife’s needs. “Where does she go for her prenatal?” Caron asks with interest, opening up a conversation about raising a family in the Air Force.

Someone brings up the Air Force’s new fitness test, which many believe is more difficult to pass than the old one. Airmen and airwomen are now tested twice a year, instead of once, among other changes. “Wishing and hoping that it’s going to change isn’t the answer; spending more time on the track probably is,” he says, with just the right mix of empathy and encouragement. (Caron learned from a previous commander—one who grumbled about a policy change—that openly criticizing higher authority causes morale to fall. “You can argue when a policy is being formulated,” Caron says. “Then the discussion is over, and it’s time to get on with it.”)

His challenge for the next couple of years will be a different kind of reducing: cost-cutting. Then-Defense Secretary Robert Gates announced the military would be making $78 billion in budget cuts. Caron is already looking to see where the Dental Corps, which performed an estimated $85 million in care last year, can begin to save money.

Not to say that Air Force dentistry won’t be moving forward. Caron is currently overseeing the design of a new dental clinic, scheduled to open at Anacostia-Bolling in 2016. By then he will most likely have finished his term as chief of dentistry, but he is used to starting projects and then handing them off to others.

In most military careers, Caron says, “you’ll be on to another assignment before your efforts will show anything.” It took 10 years to get all the approvals for a scholarship program he proposed that sends enlisted airmen and airwomen to school to become licensed dental hygienists.

“The thing is not to lose heart and not be discouraged by how long it sometimes takes to get things done,” he says. “If it’s important enough, and you keep working at it, and you get other people working with you, eventually you’ll get there.”

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

Julie Flaherty can be reached at Julie.flaherty@tufts.edu.