By Dan Fost
There are many triples in sports – the triple play in baseball, the triple crown in horseracing, and the triple axel in figure skating — but with sports so affected by the pandemic, take heart perhaps in Triple O, an ambitious initiative at UCSF’s School of Dentistry to address people’s oral health in new and deeply meaningful ways.
For many decades Triple O has encompassed the clinical specialties of oral medicine, oral pathology and oral radiology. Oral pathology has long been one of the most successful clinical and research enterprises at UCSF but now, three recent hires are leading Triple O’s revitalization that will boost the University’s offerings to patients, to medical research and to students.
“I have to admit, this is a dream come true,” says Caroline Shiboski, DDS, MPH, PhD, chair of the school’s Department of Orofacial Sciences, which includes Triple O.
The new hires are (below, from left) Alessandro Villa, DDS, MPH, PhD, who arrived in March from Harvard University to be Chief of the Oral Medicine service (which combines the dual role of director of the Sol Silverman Oral Medicine Clinic and of the Postgraduate Program in Oral Medicine); Rumpa Ganguly, BDS, DMD, MS, who joined UCSF from Tufts University last October to run the Oral and Maxillofacial Radiology service and educational program; and Kyle Jones, DDS, PhD, a homegrown oral pathologist who trained at UCSF and now directs the Oral Dysplasia Program.
“Each has a tremendous skill set,” says Richard Jordan, DDS, PhD, chair of Triple O. “All three are young, at the beginning of their careers, and on the right trajectory.”
While the onset of the COVID-19 pandemic has slowed the implementation of some of the programs, such as holding up the installation of a new state-of-the-art Cone Beam CT scanner for Ganguly’s radiology diagnostic service, the new team is in place and already establishing new clinics and coursework. Villa arrived in early March, shortly before shelter-in-place orders froze everyone in their tracks. It didn’t stop him from hitting the ground running.
“One of the first things I implemented, with the help and support of the department, was telemedicine,” Villa says.
Several other developments have provided even greater impetus for Triple O’s growth at UCSF. Notably, the American Dental Association in March recognized oral medicine as a dental specialty. “Oral medicine is the specialty that bridges the gap between dentistry and medicine,” Villa says. “We work a lot with our dental colleagues and we interface every day with our medical colleagues.”
Another bridge is the oral dysplasia clinic that Jones was able to establish in the dazzling new Precision Cancer Medicine Building at UCSF’s Mission Bay campus, enabling close collaboration with UCSF’s top cancer scientists and physicians.
And it all came together thanks in part to a significant anonymous donation to honor the legacy of UCSF’s pioneer in oral medicine, Sol Silverman, which enabled Villa’s hire and will allow expansion of the Oral Medicine unit over time. In 1956 Silverman created one of the country’s first oral medicine clinics at UCSF, Shiboski says. Silverman mentored Shiboski and scores of other oral health professionals and was the author of numerous books and scientific articles. “He was part of the initial group that put oral medicine on the map,” Shiboski says.
Only two months before Silverman died in 2014, he told Shiboski, who was being appointed chair of OFS, he wanted all his papers to be accessible to future generations of residents through an Oral Medicine library at UCSF. This led to the creation of the Sol Silverman Digital Library that is accessible to all residents in oral medicine programs in the US. Subsequently, an anonymous gift of $1 million enabled the naming of the UCSF Sol Silverman Oral Medicine Clinic after its founder. This gift was then supplemented by an additional $1.5 million to create the Sol Silverman Endowment that totals $2.5 million, and will support the expansion of the oral medicine educational mission and clinical enterprise at UCSF.
Suddenly, Shiboski says, an understaffed and underfunded division was ready to soar. The Silverman endowment meant Shiboski and Jordan could hire a new chief of oral medicine. Jordan had been the only oral pathologist on staff, so the time seemed right to hire another. In the meantime, Linda Angin, DDS, a dentist and longtime professor of orofacial sciences, had taught radiology thanks to her additional training; when she retired, Shiboski launched a national search for a dedicated oral and maxillofacial radiologist, a position that had been vacant for nearly 25 years.
“A year ago, we had become a very small division because of multiple faculty retiring over the years,” Shiboski says. “All of a sudden, we are now experiencing the rebirth of Triple O.”
The three specialties work well together and often complement each other. A patient may have a biopsy collected by the oral medicine specialist that will be read by an oral pathologist and need a CT scan read by a radiologist; the information will be used by the oral medicine specialist to come up with a diagnosis and a treatment plan.
Villa says the ADA’s recognition of oral medicine was “a big success for providers and patients.” Oral medicine, he says, “is the specialty that takes care of patients with oral mucosal diseases and oral pain conditions.” Oral medicine practitioners also help with the dental management of medically complex patients, he says, such as those recovering from cancer, the treatment of which increasingly causes oral complications.
Villa, a native of Italy, says UCSF has the tools to become a national leader in oral medicine. “It’s like having 10 Ferraris in a parking lot and you just drive one of them. It’s time to drive them all,” he says. By that, he means he sees potential to expand UCSF’s clinical offerings, which will then create more educational opportunities, including an expanded oral medicine residency training program.
Shiboski says Villa is just the guy to do it. “He has the drive, enthusiasm and competence to make that a much more flourishing enterprise, and is an incredible asset to the department and UCSF” she says. “Years ago, when the field was quite new, UCSF became a mecca of oral medicine,” and Silverman was instrumental in mentoring so many of the next generation of oral medicine clinician scientists. Troy Daniels, who established one of the first Sjögren’s syndrome clinics in the U.S., and many years later created with John Greenspan, and other UCSF scientists, the Sjögren’s International Collaborative Clinical Alliance (SICCA), still ongoing today under Shiboski’s leadership; Deborah Greenspan, who together with oral pathologist John Greenspan played crucial roles in learning about and treating HIV and AIDS associated oral diseases. Earlier this year, the School of Dentistry won a prestigious William J. Gies Award for Achievement in Academic Dentistry and Oral Health in recognition of the pioneering work on oral HIV led by these UCSF teams. (The ADEAGies Foundation is the philanthropic arm of the American Dental Education Association and is named for pioneering dental education William Gies.)
Ganguly had been at Tufts for 10 years and wasn’t looking to move, but saw a tremendous opportunity to build an oral radiology program at UCSF. “It’s pretty exciting to me,” she says.
An oral radiologist is a dentist who specializes in oral and maxillofacial radiology. “We are well-trained in not only just dental X-rays, but any imaging of the oral and maxillofacial region — the jaws, sinuses, most of the head except the brain,” Ganguly says.
That includes not only two-dimensional imaging, but also three-dimensional imaging, such as MRIs and CT scans. Ganguly anticipates a gradual ramping up of clinical work, particularly after social distancing measures are relaxed. Others at UCSF will be able to refer patients for cone beam CT scans once a machine that has been purchased is set up, and others in and out of the University will send their scans for her interpretations. Her "Teleradiology" set up allows for clinicians from distant locations to avail her diagnostic imaging interpretation services.
Her services represent a critical offering for the program. As an oral radiologist she works closely with dentists and dental specialists who routinely seek her expertise in treatment planning and management of their patients. Whether a patient was referred by an endodontist, a periodontist, an orthodontist or some other professional, she will review every scan for a range of possibilities. “Every scan done through my service gets a thorough reading and a report,” she says. She might tell the referring professional, “I know your patient is getting implants, but have you looked at their cervical spine? Maybe you want to refer them to an oral surgeon or a neurosurgeon to assess a suspicious finding.”
Shiboski credits Richard Jordan with leading the search for Ganguly. “We are so thrilled that we managed to recruit her,” Jordan says.
UCSF did not have to look quite so far for Jones, who earned his dental degree here in 2010 and his PhD in 2017, when he joined the faculty. Jordan doesn’t hold back any praise. “He’s one of the very best scientists among his peers,” Jordan says. “We’re looking for him to supercharge our research mission and he can do it.”
Oral pathology deals with the diagnosis, treatment and management of diseases of the oral cavity, jaws, maxilla and mandible, Jones says. The pathologist primarily reviews tissue samples and offers diagnoses, which specialists in oral surgery or oral medicine treat. The UCSF Dermatopathology & Oral Pathology Service, a joint operation with the School of Medicine, is the largest diagnostic pathology service in academia in North America. Like oral medicine, some oral pathology specialists also diagnose and treat patients in the clinic. In starting the Oral Dysplasia Clinic at UCSF’s Mission Bay cancer center — to Jones’ knowledge, the only clinic in the U.S. that focuses exclusively on patients with oral dysplasia — he partnered with the Department of Otolaryngology, Head and Neck Surgery in UCSF’s School of Medicine. With oral dysplasia — which he says are precancerous lesions that occur in the mouth — “we don’t have great tools to manage patients once they’re diagnosed,” he says.
While his first goal is to help patients in his care have better outcomes, he says his second goal lies in research, gaining “a better understanding of disease, new treatments, biomarkers — who’s at higher risk of seeing (the lesions) turn to oral cancer and who’s not?” He’s also working in the exciting new field of immunotherapy, where cutting edge cancer treatments are developing, as well as developing a tissue bank, that will help shed light on the mysteries of dysplasia over time.
“Sol Silverman put oral dysplasia on the map years ago,” Shiboski says. “He wrote books and multiple papers about it and followed a number of patients. It’s very befitting now to have Kyle start an oral dysplasia clinic at Mission Bay. I feel like that closes the loop.”
