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Linda Centore: Crafting Sensitive Dentistry for Those Most in Need

SAN FRANCISCO, California – "This patient was threatening suicide over a bad tooth that the dentists told him had to come out. It was really a cry for help; he was between therapists. While the dentists are trained to keep patients healthy, the patients get to decide when they want to let go of a body part, and sometimes we need to give them time to digest bad news. Part of my role is to negotiate, based on patients' emotional health and their values, and find something that will work for them."

In her work at the UCSF Dental Center at Parnassus, Linda Centore is a Renaissance woman. A PhD psychologist, board-certified primary care NP and experienced psychiatric RN, Centore has also conducted research on the links between pain and patients' oral health. Today, she splits her time among clinical and mentoring work at the Dental Center, designing curricula and teaching classes, and serving on a variety of UCSF committees and services aimed at improving treatment of the city's underserved.

Finding a Fit

Centore became a psychiatric nurse in 1973 and spent much of the next 13 years working on locked units with patients experiencing psychiatric emergencies. During those years, she went to school part-time at San Francisco State to get her bachelor's degree in psychology. When she decided she wanted to see her own patients, she returned to school again, to earn her PhD from the California School of Professional Psychology.

While still working on her dissertation, she landed a position with Charles McNeill, an internationally known orofacial pain specialist at UCSF School of Dentistry, who wanted a psychologist on his team to help his patients cope with persistent pain.

It was a perfect fit. Centore had long been interested in the intersection of pain and psychology; in fact, it was the subject of her dissertation. Once she earned her doctorate, Centore took a faculty position in the School of Dentistry. Within a few years, she leaped at the opportunity to spearhead an effort to help all dental students better understand their patients' fears and concerns about treatment.

"Dentistry is a surgical specialty – there's often local anesthesia that involves an injection and an invasive intrusion into an orifice – and many of our patients have concurrent physical and mental health conditions," says Centore. "I believed that I could translate ideas from psychology and nursing to help students better understand the patient's point of view."

That effort eventually became the path to her current role, where she spends half her time in the dental clinic, modeling for students how to gain that understanding of patients, as well as serving as a patient advocate. The other half of her time is as a classroom educator and chair of the Division of Behavioral Sciences and Community Dental Education. She is responsible for three separate areas of the curriculum: behavioral science; ethics and professionalism; and cultural competence, awareness and humility. In addition, at the time of this writing, Centore is interim program director for service learning, in charge of 14 externship sites.

She is also collaborating with faculty members from both dentistry and nursing to help patients with severe mental illness access dental care. "I'm the liaison in the dental clinic who assesses patients for their ability to handle dentistry under local anesthesia versus more sedation, and I am helping to educate the student and faculty teams about how best to manage and deliver safe patient care for individuals with schizophrenia and bipolar disorder," she says.

Becoming an NP

Though her role in the School of Dentistry was long established, Centore returned to the School of Nursing to earn her NP credential in primary care in 2008.

"I felt I needed more medicine background," she says. "I'm an eternal student, and I wanted to be a better hybrid.… It was hard to go to school and do an 80 percent job, but I loved everything I learned, and I continue to maintain two licenses, as a board-certified NP and a psychologist."

She says that her NP training has deepened her role in the clinic, where she tests students on their ability to do a proper medical risk assessment and to communicate effectively with patients. This can be particularly important with the underserved patients who make up much of the patient population at the UCSF clinic. As noted above, many have limited access to care, are physically and/or mentally disabled and may have had bad dental experiences in their pasts.

"These people require extra time and energy," says Centore.

Thus, in the clinic, she takes a psychologically informed approach to history taking and uses her nursing and NP training to piece together what are often complex health histories. Both disciplines help her develop the necessary therapeutic relationships and, in turn, help her know where and how to connect these patients to other pieces of the health care system.

"My background as a nurse and a psychologist makes me so much more valuable in this regard," she says. "If we can get a sense of the patients' core values, health beliefs and personal preferences, we can create a bridge that makes therapeutic relationships work."

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