Penn Dental on Cedar bridges medicine and dentistry, lightens ER demands

When Shivani Iyer, a fourth-year student in the School of Dental Medicine, examined a patient’s blood pressure this spring as part of a routine exam, she assessed that it was, she says, “through the roof.” Typically, she would refer them to their primary care provider. At Penn Dental Medicine at PHMC on Cedar, she walked them upstairs.

“I think a lot of times you can say something to a patient, and then it doesn’t end up happening because there are so many things that slip through the cracks for various reasons, or determinants that are preventing that patient from getting the care they need,” says Iyer. “So being able to actually take a patient for medical evaluation when they need it [is so helpful].”

This system of dental-medical integration is by design. Penn Dental on Cedar—the School’s newest community care site that opened for patient care in January 2024—is part of the PHMC Public Health Campus on Cedar, located at 54th Street and Cedar Avenue at what was formerly the Mercy Hospital Building. The Campus also includes the PHMC Health Center on Cedar, a federally qualified health center, and HUP (Hospital of the University of Pennsylvania) Cedar, which provides emergency, inpatient, and behavioral health services. Additionally, Children’s Hospital of Philadelphia offers a crisis response center for pediatric mental and behavioral emergencies. Penn Dental on Cedar completed 8,350 dental procedures at the site in its first year.

“Maintaining optimal oral health is essential to overall well-being,” says Penn Dental Medicine’s Morton Amsterdam Dean Mark S. Wolff. “Integrating dental care within a collaborative-care center, such as Cedar, where patients have access to comprehensive health care services, supports improved health outcomes.”

At its core, the Cedar care center serves as a bridge between Penn Dental Medicine and the West and Southwest Philadelphia community—and also between types of care.

A bridge between dental and medical

While connecting dentistry and medicine for overall health care is an integral part of Penn Dental Medicine’s care model, medical-dental integration at the Cedar site is the most holistic of the School’s community programs, being situated on a campus that offers behavioral health services, prenatal and postnatal care, emergency care, and more. And, perhaps most importantly when it comes to supporting “whole” health care, the dental and medical electronic health records of Cedar patients are also integrated. The health records integration, along with video resources to increase the knowledge and skills of medical and dental faculty and staff on medical-dental integration, were made possible through support from the Benjamin & Mary Siddons Measey Foundation.

“Having that relationship between medical and dental really opens up and encourages the idea that dentistry is part of overall health, and allows for people who might otherwise not have access to a dentist to find dental care here,” says Cassandra Gafford, an assistant professor of clinical community oral health and director of the Community Oral Health Clinics at Penn Dental Medicine, part of the Division of Community Oral Health.

Penn Dental at Cedar is staffed with a combination of rotating third- and fourth-year Penn Dental Medicine students, residents in the School’s Advanced Education in General Dentistry program, and Penn Dental Medicine faculty and hygienists. Students and hygienists at Cedar also conduct free, optional screenings on select days of the week as part of physical exams at Cedar.

“A lot of people who don’t have regular access to dental care, only go in for ‘episodic’ care— when something is wrong,” says Gafford. “So, to lower that barrier here at Cedar, if during a medical appointment they say, ‘I haven’t seen a dentist in a while,’ they can simply be directed downstairs to our center to make an appointment.”  

Another benefit of the co-location of medical and dental services is that the upstairs emergency department can redirect patients with dental emergencies to the Penn Dental Medicine care center, freeing up emergency resources. Gafford says this sometimes can happen several times per day. In addition, patients benefit as well given emergency departments do not always have the X-ray equipment to diagnose a dental issue and physicians do not have the level of expertise in oral care that a dentist has. There are also moments like Iyer’s, too, where a patient may present as hypertensive or gum health may indicate signs of diabetes, allowing Penn Dental providers to directly refer to a medical provider upstairs.

Since the arrival of Dean Wolff in 2018, Penn Dental Medicine’s community sites have also broadened the level of restorative care and range of treatments provided. Today, most procedures can be conducted directly at Penn Dental on Cedar with more complex cases referred to the dental School for specialty care as needed.

Serving the Philadelphia community

Shelley Henderson, an assistant professor of clinical family medicine and community health, has served as a provider at PHMC on Cedar since 2022. She’s long been committed to seeing patients in a community health center.

“I love my patients, and I love that they can walk from across the street where many of them live,” says Henderson.

The collaboration with Penn Dental Medicine, she says, has “changed the game for us,” being able to send patients for an optional dental examination during a visit for a physical. Patients have also been offered examinations while waiting, she says, on occasions when there is a longer than usual wait to be seen by a doctor.

“There can be a lot of trauma around dental care. For one reason or another, people can put that off,” says Henderson. “Diabetics with terrible infections—whatever the issue. And so, we try to hold them over until they can get a dental appointment, or follow up, and it’s drastically different to say, ‘Well, I can actually have them take a look at it right now.’”

Jackie Cuccurullo, a fourth-year student at Penn Dental Medicine, came to Penn specifically to have the opportunity to work in community sites like Penn Dental on Cedar, as part of a dental curriculum that requires rotations in Penn Dental Medicine’s community care centers. She’s rotated in and out of Cedar for the past year and says the experience has helped her learn how to make patients who may not have a history with dentists that much more comfortable.

“I think being within the community is really helpful for gaining perspective, because not everyone is going to come in and things are stable, where they’ve been coming for regular care,” she says. “One person came in and it was their first dentist appointment ever.”

It’s a contrast, she says, to have Penn Dental Medicine come to the neighborhood, rather than the other way around.

“We’re there to serve the community,” says Gafford. “This is one of the ways Penn pursues its goal of being a good citizen and a good neighbor to West Philadelphia.”

Gafford adds that care centers like the one at Cedar showcase to students that community dentistry is a viable alternative to private practices.

“This is an exciting opportunity for [us] to be part of inspiring students to go out and treat everybody with dignity and respect and understand that this is a real career path,” says Gafford, "a way to do good work in the communities they serve.”

“This is a mission-driven department, clinic, and site.”