Alumna’s initiative pays off

Monday is one of Jane Cotter’s “suit” days. It’s nearly 10 a.m., and she’s leaning over her desk phone, discussing a mutual patient with one of the oncologists at the Baylor Charles A. Sammons Outpatient Cancer Center, just two blocks from the dental school.

A few minutes later she gets a call from Patterson Dental Supply, which provides supplies and equipment for the dental clinic — housed in the Oncology Outpatient Clinic and operating under the program’s budget. She’s scheduled a technician to come in for a maintenance visit, but he’s lost and needs directions.

Then there’s the knock on the door from the Baylor University Medical Center’s pharmacy staff member sent to restock chlorhexidine, a mouth rinse commonly used for patients suffering from dry mouth. It needs to be stored in the clinic’s sterilization room, which is under lock and key. Cotter strides down the hallway, unlocks the door to the rectangular room and stocks the bottles into an overhead cabinet. And right now, she doesn’t even have any patients.

Whether Cotter — the clinic’s dental hygienist — is donning a suit or her scrubs and lab coat, she fills many roles at the Oncology Outpatient Center’s dental clinic, where she also functions as the dental services coordinator. That’s OK with Cotter, who was a graduate dental hygiene student at Texas A&M Health Science Center Baylor College of Dentistry two years ago when she sought out her current position — despite the fact that it was nonexistent at the time.

Taking initiative

Cotter learned about the potential for a dental clinic at the Sammons Center from Dr. Gil Triplett, Regents Professor in oral and maxillofacial surgery, who advocated for the need for a dental component to the cancer center’s planning team. Afterward, she sought out BUMC representatives during the 2009 Great American Smokeout to find out who else she must contact. She was given a name: Sylvia Coats, director of administration for the Baylor Sammons Cancer Center.

“I went to her office and said, ‘I heard you wanted to start a dental clinic. I want to be the hygienist,’” Cotter recalls. “She said, ‘Here, you can do this,’” and slid a formidable stack of papers across the desk. Coats issued Cotter a challenge: Put together a proposal of what the dental clinic should look like — equipment, personnel, the works. Considering there were only a handful of dental clinics within the hospital setting nationwide, it was quite a task.

By then it was early 2010, and Cotter, who had finished graduate school and was working as a full-time TAMHSC-BCD faculty member, spent her precious free time creating the plan; at the time a seemingly insurmountable quest.

Cotter drew from her 24 years of experience as a dental hygienist in a private practice setting and combined it with recommendations from the thesis of Joy Parker ’06, practice administrator at the Children’s Medical Center dental clinic. Parker’s graduate research outlined how to start a dental clinic in the health care setting.

Coats must have been pleased with the outline, because by November 2010, Cotter had her job offer, mere months before the Sammons Center’s spring 2011 opening.

Job description of a different variety

Cotter’s go-getter attitude that November morning in 2009 has served her well in her daily responsibilities since her first day on the job in January 2011. She works with Dr. Kenneth Bolin, associate professor in public health sciences at TAMHSC-BCD and medical director of the cancer center’s dental clinic, and Dr. Brent Hutson ’93, TAMHSC-BCD assistant professor in restorative sciences and director of clinical fixed prosthodontics, who spend a few half-days each week seeing patients at the oncology center’s dental clinic.

“I’ve got a little bit of everything going on,” says Cotter. She handles budgets, treatment plans, patient schedules and even marketing in addition to patient care. Cotter pushes two patient pamphlets across the desk; they’re emblazoned with the BUMC insignia and directed toward cancer and transplant patients, the two main demographics served by the dental clinic. It’s no surprise Cotter wrote the content in each brochure.

She also works closely with oncology nurses, staff members and sometimes doctors to educate them on the dental issues their patients face during and after cancer treatment or transplant surgery.

“It’s mostly about education, making the treatment accessible and keeping the patient safe. Those are the big three,” says Cotter, who in addition to cleaning teeth also performs oral cancer screenings for every patient who visits the second-story wing.

“A lot of times patients just want to talk and explain what is happening. We encourage this communication because frequently they’ll tell you something that’s not on their medical history,” says Cotter. “Finding out about that background starts with listening.”

Dr. Ann McCann, professor and director of planning & assessment at TAMHSC-BCD, was Cotter’s mentor for her graduate thesis and isn’t surprised that Cotter has found her niche at the dental clinic.

“She knew exactly what she wanted to do — work at the Sammons Cancer Center — right from the start,” McCann says.

Bolin, who works with Cotter several times a week, acknowledges the unique skills Cotter has gained.

“You have to be willing to face depressing situations, terminally ill patients, and be willing to do lots more than just be a hygienist cleaning teeth,” Bolin says of Cotter’s typical days, which may include doing impressions for fluoride trays, maintaining drug and supply inventories, and dubbing as PR agent.

“One has to be multi-talented and flexible in the work there, and she does that well,” he adds.

Longstanding inspiration

Cotter was on rotation at M.D. Anderson Cancer Center as an undergraduate dental hygiene student when she saw something she wouldn’t soon forget.

“Several other girls and I were on rotation through the oncology dental clinic, and we saw a man with no lower jaw,” Cotter recalls. “It makes a big impact.” That was more than 20 years ago.

While Cotter’s desire to prevent oral cancer may have initially prompted her interest in the Sammons Center, she’s continually learning about the impact of cancer and organ transplants and their related therapies on patients’ oral health.

“Your mouth is a big part of your body, and if you can’t smile or talk to your friends, you can’t eat or enjoy your food, there goes your quality of life,” says Cotter.

She channels that mindset every day.

“As Dr. Hutson says, ‘We give patients hope,’” Cotter says. “They’re healthier as they go through therapy. Hopefully they will be healthier in survivorship.”

Side effects get the attention

Treating cancer and transplant patients’ dental needs requires more than the average biannual checkup. Cotter rattles off a laundry list of potential complications from these patients’ medical treatments. These include dry mouth, taste alteration, fungal infections and trismus, a condition in which the jaw muscles contract, drastically affecting patients’ ability to open their mouths, eat or even receive dental treatment.

“Side effects are a big part of what we handle here,” says Cotter. “Dr. Bolin, Dr. Hutson, our assistant Leslie Bone and I focus on prevention to increase the patient’s quality of life. We manage oral infections that may prevent or delay cancer or transplant treatment. These are our team’s primary goals.”