Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic explains why community water fluoridation—a public health intervention most of us take for granted—is under attack as never before.

It has been called one of the 10 great public health achievements of the 20th century, yet 70 years after its introduction in the United States, community water fluoridation can no longer be taken for granted. Opponents of fluoridation continue to advocate for the removal of fluoride from water supplies, and they have found some interesting allies.

Just this past summer, Israel’s Health Minister Yael German ended a decades-long government policy that mandated public water fluoridation in communities of 5,000 or more inhabitants. This occurred despite vocal opposition from the Israeli Dental Association, the academic community, public health experts and the country’s Prime Minister, Benjamin Netanyahu. German acknowledged that fluoride is beneficial in preventing dental caries but defended her actions on the grounds that she believes fluoride may be harmful to certain groups and that administering it through the water system infringes on personal rights.

I’m sure I don’t need to tell any of you of the massive amount of credible scientific evidence that has demonstrated again and again that optimally fluoridated water is safe to drink, does not cause systemic disease and provides the best protection against dental caries in both children and adults over the course of a lifetime. Dental fluorosis, a change in the appearance of tooth enamel that does not endanger health, is the only proven outcome associated with ingesting too much fluoride. Severe fluorosis rarely occurs in communities where the amount of fluoride in the water is in keeping with the standards set by the Centers for Disease Control and Prevention (CDC).

Despite this strong body of research, opponents of fluoridation assert that fluoride is linked to health problems ranging from cancer to diabetes to thyroid disease. Recently, they have touted the findings of a study published in 2012 in Environmental Health Perspectives to support their call for eliminating water fluoridation. The study is a systematic review and meta-analysis of the possible effects of fluoride on children’s neurodevelopment. The authors found that “children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas,” and concluded that these “results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.”

It’s important to note that the children in question did not reside in New York, Ontario, Jerusalem or other places where fluoride was added to the water at ratios considered optimal for improving oral health. The vast majority of the data in the reviewed studies came from China, where considerably higher levels of fluoride occur naturally in the drinking water of many communities. As the authors of the paper point out, the exposed groups in the studies they reviewed had access to drinking water with fluoride concentrations up to 11.5 milligrams per liter, so in many cases, fluoride concentrations exceeded the levels recommended in the United States for improving oral health (0.7–1.2 milligrams per liter) or allowed by the Environmental Protection Agency (4.0 milligrams per liter).

Nevertheless, anti-fluoridation activists seized on the paper as evidence against community water fluoridation, and they used the Harvard affiliation of the paper’s lead author, a research scientist in the university’s School of Public Health, to bolster the credibility of their cause. These misrepresentations of the paper’s findings led the Dean of the Harvard School of Dental Medicine, Bruce Donoff, D.M.D., M.D., and the Dean of the Faculty of Medicine at the Harvard Medical School, Jeffrey Flier, M.D., to issue a letter in 2013 expressing their support for community water fluoridation and pointing out the “numerous reputable studies” reinforcing its safety and efficacy.

Setting the record straight is essential and will require an energetic response from all of us who are in a position to make scientific evidence easy to understand for the public at large. A report in the Journal of the Massachusetts Dental Society found that opponents of community water fluoridation dominate Internet and social media discussions of the topic. Moreover, some research suggests than many Americans are inclined to believe in medical conspiracy theories in general.

In a letter to JAMA Internal Medicine published earlier this year, two political scientists from the University of Chicago reported that 12% of Americans agree with this statement: “Public water fluoridation is really just a secret way for chemical companies to dump the dangerous byproducts of phosphate mines into the environment.” Perhaps more disturbing, fewer than half of respondents disagreed with the statement, which means there is an urgent need to steer people toward reliable sources of accurate information so they can play an informed role in decision-making around this crucial aspect of the public health infrastructure.

The CDC is an excellent place to start. The agency’s Community Water Fluoridation FAQs explain how fluoride works when added to drinking water and topical products such as toothpaste, and discuss the potential adverse effects from overexposure in clear and unbiased terms. Another Department of Health and Human Services site, the Guide to Community Preventive Services, has links to a 2013 systematic review of the evidence on which it bases its support of community water fluoridation as well as a summary of the rationale for supporting the intervention. The Campaign for Dental Health, a program of the American Academy of Pediatrics, has developed guides for health professionals on fluoride safety and guides for consumers and patients as well.

These resources provide plenty of evidence to counter the misinformation circulating about fluoride, but they do little to blunt the argument that community water fluoridation deprives individuals of their freedom to decide whether or not they want to use fluoride to protect their teeth. The Fluoride Action Network (FAN), the leading advocacy group opposed to fluoridation, quotes one of its congressional supporters, Rep. Dana Rohrabacher (R-CA): “[I]n this country, we should be the ones who should be deciding what we put into our bodies one way or the other. Not the federal government or the local government putting fluoride into our water. A lot of those things come down to freedom issues. They come down to whether or not we will control our own destiny.”

This type of rhetoric is reminiscent of the culture wars that have divided Americans around other issues related to health. Last month, public television’s premier science program, NOVA, devoted an hour-long show to the shift in attitudes toward vaccination that has led to recent outbreaks of measles and pertussis—diseases that were so well controlled in North America that physicians had difficulty believing what they were seeing when the first 21st-century cases appeared.

The rise in dental disease that follows the cessation of water fluoridation is harder to spot than a sudden outbreak of highly contagious disease, but it is visible nonetheless to those who know where to look. In Calgary, Alberta, where the City Council voted to stop fluoridating the drinking water in 2011, dentists say they have already seen a noticeable increase in the severity of dental caries in their patients’ teeth.

It may take a few years before we see the impact of the recent decision by the Israeli Ministry of Health. (The new policy does not ban fluoridation despite what some headlines might suggest, just makes it optional.) Moving forward, the ministry plans to address the oral health needs of the public by instituting a number of health promotion programs. These are aimed at educating pregnant women, parents, preschool teachers, health care providers and school-age children about oral health.

These types of efforts are all to the good, but researchers have found that they are neither as effective nor as affordable as community water fluoridation when it comes to decreasing the prevalence and severity of dental caries. Importantly, community water fluoridation is also a powerful strategy for eliminating oral health disparities. As the CDC stated in hailing the practice as a public health success, “Although other fluoride-containing products are available, water fluoridation remains the most equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level.”

Last month, FAN held its first lobby day in Washington, D.C., and called on Congress to hold joint congressional hearings on water fluoridation. FAN wants Congress to stop spending taxpayer money to promote fluoridation through the CDC. FAN would also like the Food and Drug Administration to regulate ingested fluoride as a drug, and the Environmental Protection Agency to reevaluate its standard for the maximum allowable level of fluoride in drinking water.

While opponents and proponents of community water fluoridation may disagree on what constitutes the best available scientific evidence, it is worth noting that we share a mutual concern about the health of future generations and a desire to see science guide public health decision-making. It is up to those of us in the academic dental community to continue contributing to and disseminating solid research. Through our contact with patients, we also have an opportunity to educate the public at large about the overall benefits of fluoride and water fluoridation specifically. This may be at least one effective way to help put public fears to rest.

Today, three quarters of U.S. communities—with the notable exception of Portland, Oregon, whose citizens voted once again to prohibit fluoridation of the city’s drinking water in 2013—provide residents with fluoridated water, as do all major U.S. cities. About 45% of Canadians have access to fluoridated water, but regional variations are significant.

ADEA supports and encourages fluoridation of community water supplies and the use of topical fluoride. So do the American Dental Association, the International Association of Dental Research, the National Institute of Dental and Craniofacial Research and the World Health Organization.

Former U.S. Surgeon General Dr. C. Everett Koop once said, “I encourage the dental profession in communities which do not enjoy the benefits of an optimally fluoridated drinking water supply to exercise effective leadership in bringing the concentration to within an optimum level.” Today he might say that dental professionals in all communities need to lead on this issue. I know that ADEA members will be in the vanguard.

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic explains why dental schools need to take a serious look at whether they are adequately preparing students to apply genetics in clinical care.

Leave a comment at the new Charting Progress.

Ready or Not, the Era of Personalized Dentistry Is Here

30,000. That’s the estimated number of people in the United States whose genomes had been sequenced as of 2011. I am not one of them, but I have an interesting related story to tell. Five years ago, I attended the annual TedMed gathering in San Diego. There I heard a presentation from Anne Wojcicki, the founder of 23andMe, a privately held personal genomics company whose direct-to-consumer personal genome test was named Invention of the Year by Time magazine in 2008. The company offered attendees at the meeting analysis of their DNA. I accepted out of idle curiosity, and since then, I’ve gained a sneak peek into the era of personalized medicine—and personalized dentistry—that lies ahead.

In 2003, the Human Genome Project completed its map of the full sequence of genes that make up the human genome. This knowledge and subsequent discoveries have deepened our understanding of what causes diseases and given us new insights into treating diseases and avenues for preventing them prior to their onset.

Today the ready availability of genetic testing and genome sequencing, and their relative affordability, have brought genetic knowledge into the clinical arena, allowing physicians and dentists to personalize the care they provide to individual patients. It doesn’t take much imagination to envision how knowing about the gene variants that affect the function of a particular patient’s pain receptors and analgesic absorption could be useful in a dental office. Taken a step further, it is easy to see how the clinical application of genetics is on the cusp of transforming care.

Ten years ago, Francis Collins, M.D., Ph.D., then Director of the National Human Genome Research Institute, and Larry Tabak, D.D.S., Ph. D., then Director of the National Institute of Dental and Craniofacial Research, published a paper calling for increased genetics education for dental health professionals. Why? “Because education is about the future, not the past, and we are now entering the era in which genetics and genomics will play a vital role in both oral health research and dental practice,” they answered.

The Collins and Tabak paper speaks of salivary diagnostics, salivary gland gene transfer, tissue engineering and the use of stem cells as just a few of the scientific advances that need to be incorporated into dental education so that genomic research outcomes can be translated into improved clinical outcomes for patients. Since then, a decade of new discoveries related to the architecture, function and coding of human genes makes this call all the more urgent. Until recently, genetics was an area of interest for a few, but it won’t be long before all dentists will need to be versed in human genetics if they want to continue to provide high-quality care. (For more on this topic, see a recent guest editorial by Hal Slavkin, D.D.S., Professor Emeritus and Dean Emeritus at the Herman Ostrow School of Dentistry at the University of Southern California, in The Journal of the American Dental Association.)

A 2001 survey conducted by Tom Hart, D.D.S., Ph.D., and researchers at the University of Pittsburgh revealed that only eight dental schools provided a formal course in human genetics at that time, and most of the remaining schools did not have plans to create one. These institutions reported that genetics education was integrated into courses such as pathology, biochemistry and microbiology, with considerable variation in the amount of time devoted to genetics and the topics each school covered.

When I spoke to Tom earlier this month, he told me he suspects there may be even fewer stand-alone courses in human genetics at dental schools today. “Those courses often came about because of the passion of individual faculty members,” he told me, “and some of them have since retired.”

Tom, who is currently a Professor at the University of Illinois at Chicago College of Dentistry, is one of three dentists serving on the Inter-Society Coordinating Committee for Practitioner Education in Genomics, more commonly referred to as ISCC. The committee is charged with improving the genomic literacy of physicians and other healthcare providers and enhancing the effective use of individual patients’ genomic results in their clinical care. The means to this end is the development and sharing of educational competencies and resources that professional societies, specialty boards and others—including associations such as our own—can modify to support the educational needs of their members.

Karen Novak, D.D.S., M.S., Ph.D., is representing ADEA on the ISCC. Karen is Associate Dean for Professional Development and Faculty Affairs at The University of Texas School of Dentistry at Houston where a genetic counselor is working with others at the dental school to assess genetic content in the current curriculum and propose ways to better integrate the topic so it has relevance for the type of personalized clinical care graduates will soon be expected to provide.

One of ISCC’s stated goals is to collaborate with provider education groups to “standardize approaches, competencies, and knowledge base for all health workers.” While the committee’s mandate is to improve genetic literacy of the practice community, ADEA is committed to seeing that the committee’s work also benefits the education community so, as Karen put it, we’re not playing catch up. I am grateful for the way in which Karen is representing all of us on this committee.

This federal initiative is occurring none too soon. According to an article that appeared earlier this summer in the New England Journal of Medicine, several thousand physicians have already ordered clinical genome sequencing or its less expensive abridged version, exome sequencing, for their patients. The paper’s authors anticipate that about 10,000 of these tests will be ordered in 2014, and that the number will only grow as the cost continues to decrease dramatically. The consumer demand will also broaden from individuals with difficult to diagnose conditions to healthy individuals who are curious about their genetic risk factors, ushering in the use of genomic information for preventive as well as diagnostics purposes. As Tom put it, “Today, the problem is not acquiring genetic information, but what to do with it.”

Dental educators are not immune to this problem of appropriately handling genetic information. Tim Wright, D.D.S., M.S., Director of Strategic Initiatives at the University of North Carolina at Chapel Hill School of Dentistry, has a longstanding interest in genetics and represents the American Association for Dental Research on the ISCC. Tim and I both attended dental school in the 1970s, before the field of genetics came into being. While it is increasingly obvious that all health professionals who diagnose and treat disease will need a grounding in this science, Tim fears that most dental educators are disinterested in genetics and ill prepared to help their students gain competency in this area. He sees faculty development as an essential first step.

“Faculty need to know about the clinical implications of genetics, why it is important in terms of cancer predisposition, oral craniofacial anomalies, or to be a good diagnostician,” Tim told me. “Most dental schools don’t even teach how to do a good family history. That’s a key component as a foundation for genetics, and it’s going to be critical for helping our patients achieve optimal health.”

I agree. If dentists and dental educators don’t become schooled in this area, the risks could be substantial for our patients and our practices. We need to know when genetic testing does and does not have value for clinical care, and we need to understand the legal and ethical dimensions that come into play when the information revealed by testing could have health implications for an individual’s entire family. Meanwhile, professional societies representing geneticists have voiced serious concerns about the potential harms that may accrue from the commercialization of genetic testing and its marketing to healthy individuals. Not only is the quality of the testing at issue—how the results are interpreted is also a concern. If a finding shows a 50% increase in a risk factor for a specific condition, a clinician will convey that information differently depending on whether the original risk was 2% or 60%, but will a testing company do that? We will have to wait and see.

“Regulation of genetic testing is not what dentists believe it to be,” Tom Hart told me. “Tests are not necessarily clinically valid or clinically useful. That’s my greatest concern—this lack of understanding—and it won’t go away until we have comprehensive genetics education at dental schools.”

Tom is optimistic that ISCC can start to remedy this situation. He has confidence in the group’s leadership and sees dentistry’s participation as a tremendous opportunity to be at the table with a truly interprofessional group of scientists and healthcare providers whose work will help translate genetics into clinical care. He believes this inclusive approach will go a long way to circumvent problems for patients by reducing disparities in the way different clinical disciplines use genetic information.

Tim Wright is equally enthusiastic about the interprofessional makeup of the ISCC and the resources it is creating. The group is building competencies that each discipline can adapt and creating resources, including a bank of unfolding case studies that educators can use in their classrooms. But Tim cautions that the ISCC will only be part of the solution.

“There is currently no funding for it,” he points out. “It’s a voluntary effort, and if it’s all just people like myself, each putting in one scenario, it’s probably not going to be as robust a national resource as it could be.”

Tim points out that curriculum revision is not a small or insignificant task, especially when most faculty are not versed in the subject matter and the geneticists who are, are focused on research. He suggests that the Commission on Dental Accreditation standards for predoctoral dental education be used to move the ball forward. “It would be very helpful to have the word ‘genetics’ in there,” he observes. “That is what drives institutions to say, this is important and we need to do it.”

Meanwhile, ADEA stands to gain from participating in the ISCC. In addition to sharing and helping to develop resources, we are learning how the healthcare professions can collaborate to optimize health care through a shared understanding of the issues that impact health across our professions and disciplines. And we also have talent and resources of our own to bring to the table, starting with the report of the 2007 Josiah Macy Jr. Foundation study on genetics and its implications for education and practice.

So how has the advent of personalized medicine affected me? The fortunes of 23andMe changed last year, and the company currently offers only ancestry-related information derived from its DNA analysis for new customers. But for those of us who got in on the ground floor, the company continues to send regular updates on breakthroughs in genetic knowledge that might be relevant to our health. I have yet to share this knowledge with my healthcare team, but under the right circumstances I will, and those circumstances could arise at any time. New knowledge of human genetics is created every day, revolutionizing our understanding of diseases, their treatments and ourselves. It’s not too soon to prepare for this future.

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic shares the latest news on dental school application trends and other indicators confirming that the profession remains an attractive one.

Earlier this month, The New York Times published an article that asked which professional degrees represented a worthwhile investment for students. Not surprisingly, dentistry was featured—along with the tag line, “Teeth Are Back.” I might argue that they never went away, but regardless, it was good to see dental education and its recent growth spurt highlighted in the mainstream media.

As the article pointed out, the Bureau of Labor Statistics projects that the profession will grow 16% by 2022, and our new schools and expanded classes will do a good deal to facilitate that growth. First-year enrollment has risen steadily over the last decade, from 4,457 in 2004 to a projected 5,770 this year. That expansion began even earlier, with the accreditation of a single new program at Nova Southeastern University College of Dental Medicine in 1997, and really picked up steam between 2008 and 2013 when more than 700 additional first-year seats became available at U.S. dental schools, with slightly more than half of them at new institutions.

The centralized ADEA Associated American Dental Schools Application Service (ADEA AADSASSM) also gives us a bird’s-eye view of what is happening in terms of applicants and applications. While the number of dental school applicants most recently peaked in 2007, the applicant pool continues to remain strong at about 12,000 annually.

Without question, dentistry remains an extremely attractive career. U.S. News & World Report dubbed dentistry the number one job in the United States in 2013, and this year the profession ranked number three. The job of physician also ranked high on the list at number eight, but the fact that a student can earn a dental degree, become fully licensed and move directly into practice after three to four years of professional education may be what gives dentistry an edge.

The one cloud on the horizon is, of course, the issue of student debt, which I discussed last year in the September 2013 issue of Charting Progress. While this problem has not gone away and still needs our attention, the good news is that the prospect of student debt does not appear to be deterring young people from entering the dental profession and pursuing a variety of career paths. A recent analysis of ADEA data performed by researchers connected with the American Dental Association revealed some interesting patterns. (The study did not look at students’ intentions to work for dental support organizations, but we know that this career path is gaining in popularity, as I reported in June’s Charting Progress.)

Although the magnitude of students’ graduating debt did have a relationship with students’ intentions concerning where and how they would practice following graduation, it was far less predictive of students’ career choices than other variables. Among the study’s findings:

  • Women dental students were nearly 60% more likely to select careers in teaching, research or administration than were their male counterparts.
  • African-American dental students intended to choose advanced education or government service upon graduation twice as often as other dental students and were three times more likely to intend to choose public health than were their white counterparts.
  • And students whose parents were dentists expressed significantly less intention to follow any of these paths than students whose parents were not in the profession.

By comparison, the magnitude of students’ debt had a small or marginal impact on students’ intentions to enter private practice, and was not correlated at all with students’ intentions to enter public health.

These findings are encouraging and suggest that, in spite of the cost of dental education, there are measures we can take to ensure that enough of our graduates choose some of the less lucrative career options that sustain our profession and improve access to care. Federal loan forgiveness programs under Title VII of the Public Health Service Act continue to be an attractive option for many of our graduates, and ADEA is working to see that funding for these programs remains robust and grows.

We are also ramping up our game on the recruitment side. In 2012, the Association hosted its first ADEA Predental Student Virtual Fair, which brought dental school applicants and admissions officers together over the Internet to explore their educational options. We have since hosted two more of these fairs and a fourth designed for dental students considering advanced education programs. These online events continue to draw not only an eager student audience but also an enthusiastic school, program and corporate partner response. In fact, the virtual fairs have been so successful that, moving into 2015, ADEA’s corporate partners have agreed to raise their ADEA dues to support the dental student virtual fair. That new support will allow us to engage a new vendor to ensure that the fairs continue to serve attendees’ and Member Institutions’ needs as this effort expands in the future.

Just days ago, we also launched a redesigned ADEA GoDental website tailored specifically to the needs of predental and predental hygiene students. The new website is more intuitive and easier to navigate, and by focusing more clearly on its target audiences, it should improve our efforts to recruit students to the dental professions. The new website features a newsletter, makes better use of social media and contains more resources for prehealth advisors. It can also be a great source of information for everyone in the ADEA community who is helping build the profession by mentoring young people.

And on the institutional side? Dental education remains an attractive investment there as well, enough so that several universities are considering opening new dental schools in the next few years. Touro College of Dental Medicine at New York Medical College is the latest addition to the ADEA family. This provisional ADEA Institutional Member anticipates opening its doors to students in 2016. It is noteworthy that all of ADEA’s member dental schools are units of not-for-profit parent universities. Their continued investment in the future of dentistry and confidence in its continued growth is encouraging—especially during this time of fiscal challenges for higher education generally.

Dr. Richard ValachovicIn this month’s letter, ADEA President & CEO Dr. Rick Valachovic looks at how ADEA’s ongoing collaboration with our sister associations—in the form of IPEC—is not only promoting the spread of interprofessional education, but also engendering fruitful partnerships and encouraging mutual appreciation between founding organizations, all while benefiting dental education.

It’s always nice to feel that you are part of something bigger than the world you live in from day to day. That is not the main reason ADEA and some of our sister associations formed the Interprofessional Education Collaborative (IPEC) five years ago, but that feeling is decidedly one of the benefits of our membership in this group.

For those of you who are not familiar with IPEC, the group is a collaborative venture of the American Association of Colleges of Nursing (AACN), American Association of Colleges of Osteopathic Medicine (AACOM), American Association of Colleges of Pharmacy (AACP), Association of American Medical Colleges (AAMC), Association of Schools and Programs of Public Health (ASPPH) and ADEA, which came together in 2009 to support the adoption of interprofessional education (IPE). Regular readers of this column know I have devoted large amounts of time and energy to this group, with much to show for that investment.

For starters, an IPEC expert panel, with ADEA Past Presidents Drs. Sandra Andrieu and Leo Rouse representing our Association, created a set of competencies that health professions schools and programs are using as a basis for educational reform and curricular change. Since its publication, Core Competencies for Interprofessional Collaborative Practice has been widely disseminated and is guiding the development of IPE programs across the country.

I recently searched Google Scholar and found that more than 400 publications—in academic journals, books and the popular press—have cited the IPEC competencies. They have also served as a resource for licensing and accrediting bodies and have influenced changes in the accrediting standards for schools of a number of health professions.

Since that time, IPEC has engaged in a remarkable range of activities aimed at disseminating IPE resources and building support for IPE and collaborative practice.

  • IPEC has held six multiday faculty development institutes, bringing together interprofessional teams, both to hear noted experts and to develop action plans to implement IPE at the team members’ home institutions.
  • AAMC, in collaboration with IPEC, has created the iCollaborative, an interprofessional online platform where educators and learners can freely share curricular materials.
  • IPEC’s member associations are founding sponsors of the Institute of Medicine (IOM) Global Forum on Innovation in Health Professional Education, which has held three workshops focused on the connections between IPE and collaborative practice.
  • IPEC has also forged alliances with others who can advance IPE, including leaders at the IOM, the Veterans Health Administration, the Centers for Medicare & Medicaid Services and the Health Resources and Services Administration.

Of course, in addition to IPEC’s efforts, ADEA has also taken a number of steps on its own to promote IPE within our ranks. The 2011 ADEA Annual Session & Exhibition in San Diego provided members with a multiday immersion in the topic, and many of our subsequent gatherings have explored particular aspects of IPE in depth. We’ve used our member publications to share some of the interprofessional initiatives coming out of our member schools and programs. Not surprisingly, our sister associations have done the same.

Less predictable perhaps are some of the ancillary benefits that have come from this partnership. Over the course of four years of weekly meetings with my colleagues in IPEC and additional planning sessions and special events devoted to IPE, my counterparts and I have discovered that we can also support each other on additional fronts.

By now I hope you know about our partnership with AAMC to make peer-reviewed dental education materials widely available through MedEdPORTAL®. This is just one of several ways we have partnered with AAMC, including last year’s creation of the web-based AAMC/ADEA Dental Loan Organizer and Calculator to help dental students manage their educational debt.

A less visible example of the mutual support IPEC members are providing one another is the invitation I received from the AACN to sit on the national advisory committee of the Robert Wood Johnson Foundation New Careers in Nursing (NCIN) scholarship program. NCIN is a national program of the Foundation and AACN.

ADEA is also lending its expertise to the Health Professions Common Application Service Consortium , which provides technical support and guidance to associations like our own with common application services.

ADEA’s increased expertise in IPE is also a welcome resource for our own members as was demonstrated in February, when the California Dental Association asked us to cosponsor a conference in San Francisco on interprofessional education and practice.

Throughout these encounters, I have been amazed by the extent to which our colleagues in the other health professions value our involvement and appreciate the role of oral health in overall health. I don’t need to tell you that, in the past, the oral health professions have sometimes been left out of national health policy discussions. In the case of this group endeavor, we are all making significant contributions. I’ve been especially struck by our colleagues’ embrace of dental education and growing awareness about oral health when the political and market forces creating upheaval within health care and health professions education could just as easily have pushed us farther apart.

As you might have guessed, my appreciation for the other health professions is growing as we interact with each other in transformative ways. I’m impressed by medicine’s willingness to play on a more diverse team, by nursing’s effort to assume more of the responsibility for primary care, and by pharmacy’s achievement in seizing its rightful place as a clinical partner in delivering care. Meanwhile, our colleagues in public health have earned my renewed respect for their persistence in reminding the rest of us that being a health care provider is about more than treating individual patients.

Much work remains to be done before IPE becomes the norm, but we are much closer to that reality today than we were four years ago. IPEC has become a respected thought leader in the educational arena and will continue to play a major role in shaping IPE and the movement to promote and provide collaborative care.

In searching for ways to speed the adoption of IPE, many of us have observed that the commitment of top institutional leaders within health systems and academic institutions is key to creating IPE programs that can be sustained over the long haul. This awareness will drive the next phase of IPEC’s work, with ADEA bringing its expertise in leadership development to the endeavor.

Meanwhile, we can all draw lessons from considering how IPEC has managed to accomplish so much in five short years. The coalition provides a model for what can be achieved when associations unite to address their shared concerns. Those words sound a lot like “the relentless pursuit of strategic alliances”—my mantra during my years with ADEA—and IPEC’s history illustrates the progress that can happen when those alliances are nurtured over time.

The sense of community that develops when a small group of committed individuals pursues a common purpose year in and year out is extremely powerful, and the mutual appreciation engendered can be uniquely sustaining. ADEA is fortunate to have such strong ties with our sister associations, and it has been a privilege for me to witness first hand the benefits these collaborations provide. I am looking forward to our continued involvement in IPEC and to seeing where this collaboration leads us in the years ahead.

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic sheds light on a potentially “disruptive innovation”: the emergence of large-group practices, where most dentists are employees rather than owners.

From Bungalow to Big Box? How DSOs Could Change the Face of Dentistry

Beyond the hype and the inflammatory rhetoric, one fact is incontrovertible: More and more dentists are choosing to work for large group practices affiliated with what have come to be known as Dental Support Organizations or DSOs.

You’ve heard the praise—guaranteed income, regular hours, few managerial headaches and a pathway to ownership—and you’ve heard the criticism—too much pressure to produce and loss of professional autonomy, sometimes leading to overtreatment and substandard care. Depending on your perspective, you may see the rise of firms that employ dozens or even hundreds of dentists in large multisite practices as a positive development, both for people seeking access to affordable care and for highly indebted graduates who lack the means to establish practices of their own. Looked at from another angle, you may think that the introduction of business values and venture capital into the practice of dentistry may be harming the profession by undermining the dentist/patient relationship and compromising the quality of care.

In 1990, almost 93% of dentists chose to care for their patients in small private practices, according to American Dental Association (ADA) survey data. By 2009, that number had dropped to 86%, and the percentage of employed dentists had more than doubled. That trend has reversed a bit in the ensuing years but seems likely to continue in the long run. New dental school graduates are three times more likely to seek employment in a large group practice than they were a decade ago, and as the competition for dental business increases, I suspect more dentists—both young and old—will find employment in a DSO an attractive option.

A parallel shift is visible among our physician colleagues. In late 2013, the American Medical Association released new data showing that while private practice in medicine remains strong, physician employment is on the rise. As of 2012, only 18% of physicians were in solo practices, down six percentage points over the previous five years, and the portion of physicians who were practice owners had decreased eight percentage points over the same time frame. Meanwhile, nearly 30% of physicians worked either directly for a hospital or for a practice owned in whole or in part by a hospital, a major increase from an estimated 16% hospital-related employment rate in 2008.

As the Dr. Marcus Welbys of the world gradually disappear, it seems only logical to ask whether private practice dentistry will follow suit. Despite our professional differences, especially when it comes to the ways in which our patients pay for care, there seems little doubt that more dentists and physicians will find themselves employed in the decades ahead.

What does this trend mean for academic dentistry? At a minimum, we must ask ourselves these questions:

  • Are we doing enough to prepare students for the shifts occurring in the business of dentistry?
  • Should we be doing more to help our students evaluate their opportunities both as employees and as entrepreneurs?

In 2007, a group of potential employers of our future graduates formed an industry association, now known as the Association of Dental Support Organizations (ADSO), which can help us understand this new practice model. According to the ADSO website, DSOs offer assistance with nonclinical functions, such as accounting, human resources, marketing and legal tasks, so that affiliated dentists can “focus on the delivery of high-quality, cost-effective dental care to their patients.”

DSOs also take advantage of the economies of scale that come with larger offices and multiple-practice chains, and they increase revenue by creating an in-house network of specialists rather than referring patients out. As I wrote last month, reimbursement rates for dental care are declining, and dentists report that their chairs more frequently sit empty. In this climate, DSOs’ efficient business model gives them a distinct economic advantage.

DSOs may also have an advantage in the marketplace for talent. Many in the current generation just starting in practice express a preference for employment as a lifestyle choice. Like their physician peers, they are less interested on average in taking on the responsibilities of establishing and managing a practice. By handling everything from negotiating leases to billing insurers, while providing a guaranteed and typically generous salary, DSOs offer many new graduates a very attractive pathway into practice.

At the 2014 ADEA Annual Session & Exhibition in San Antonio, researchers from the Columbia University College of Dental Medicine (Columbia CDM) presented findings of a study they conducted to determine the advantages and disadvantages of working for a DSO. They gathered information from four DSOs and surveyed Columbia CDM graduates from the classes of 2000 through 2011 about their perceptions of these companies. Among the respondents, 23% were or had been employed by DSOs.

When asked which incentives they believed drew graduates to these practices, more than two-thirds of respondents selected guaranteed salary, freedom from the worries of practice management and opportunities to acquire experience and gain speed. When asked about the drawbacks of working for DSOs, graduates chose production pressure (including the use of quotas), an inability to provide patient-centered care and influence from corporate management toward more profitable procedures.
When the researchers broke down the responses between those who had and those who had not worked for DSOs, some notable differences emerged. For example, among those who had not worked for DSOs, 68% and 72% named concerns about treatment-planning autonomy and production quotas as potential drawbacks, whereas only 35% and 37% of those who had worked for DSOs expressed the same concerns.

Indeed, many of the Columbia CDM graduates had very positive things to say about their experience as employed dentists. They saw working for a DSO as a good first job that would help them gain speed and confidence and allow them to pay down loans and accumulate capital. But just over a quarter of those who had tried DSOs stayed more than two years, suggesting that employment is seen by many as a stepping-stone to joining or setting up a private practice down the line. Others who had worked for DSOs complained of high stress, profit-oriented decision-making and questionable ethical standards.

Much of the criticism lobbed at DSOs hinges on two issues:

  1. Whether these corporations truly limit their role to providing management support or whether they are in effect practicing dentistry by unduly influencing how licensed professionals treat their patients.
  2. Whether the investment of venture capital in some of these companies—and the attendant expectation of high profit margins—creates incentives to put profits before the best interests of patients.

There is no doubt that some bad apples have cast an unwelcome spotlight on this practice sector by seeking to capitalize on the expansion of dental benefits under Medicaid. An investigation of five corporate dental chains by a U.S. Senate committee found evidence that some DSOs have failed to meet quality and compliance standards, providing unnecessary and sometimes painful treatment to children, often without consent, and overbilling Medicaid for these procedures. A number of states are also investigating DSOs (and individual dentists as well) for Medicaid fraud, and a few states have introduced or passed legislation in an effort to clarify how DSOs may operate in their jurisdictions.

Despite this scrutiny, the numbers of DSOs and their share of the dental market are growing. Although currently available ADA data does not distinguish DSOs from other large group practices, it does show that the number of dental firms with more than 10 offices increased from 157 in 1992 to 3,009 in 2007, and that the number of offices in each firm grew as well.

Is it any surprise that our traditional cottage industry is gradually giving way to trends that have been shaping the business of health care more generally? Indeed, while many in my baby-boomer generation may treasure their independence and the 32-hour workweek, it is becoming increasingly difficult to make a strong economic case for the traditional solo practice, or to ignore the potential benefits large group practices could hold for consumers. The Federal Trade Commission, for example, urged the North Carolina legislature to reject a state bill that would have imposed restrictions on the business organization of dental practices on anticompetitive grounds, concluding that “When licensed dentists contract with DSOs to provide nonclinical services to their dental practices, DSOs appear to increase efficiency and support entry by new dental practices, which may lead to lower prices, expanded access to dental services, and greater choice for dental consumers.”

For the most part, associations representing practicing dentists neither encourage nor discourage dentists from signing on with practice-management firms. Our Association and our member schools have also remained largely silent on the issue, but it’s time we educated ourselves on this growing sector of our profession, as our colleagues at Columbia CDM are striving to do.

DSOs are gaining a greater share of the dental marketplace, and they have become part of the face of the profession in many regions. How DSOs will reflect on our profession in the long run remains to be seen. Our future graduates will likely have a major influence on how these large group practices evolve and on whether they fulfill the vision articulated by ADSO or find themselves further mired in controversy. Perhaps it is time we put aside our preconceived notions about DSOs and make a conscious effort to prepare our students for the full-range of practice options that await them.

Dr. Richard Valachovic
In this month’s letter, ADEA President and CEO Dr. Rick Valachovic considers recent U.S. dental workforce projections and shares the perspectives of three deans on what these national trends mean for dental education at the local level.

The dental workforce is aging. More dentists are looking to retire now that the recession is drawing to a close. And despite the increase in graduation rates from U.S. dental schools—5,199 in 2012, up from a low of 3,778 in 1994—we are still producing fewer dentists annually than the 6,300 we produced at a high point in 1978. In view of these trends, we’ve been hearing for years about a looming shortage of dentists. But, is a shortage truly on the horizon? Maybe, or maybe not.

To answer this question, we need to look at demand as well as supply and recognize that what is happening locally may differ dramatically from what is happening across the nation as a whole. What’s more, dentists do not practice in a vacuum, and the current climate for dental practice is in a state of flux. The impacts of the Affordable Care Act, which is reshaping the entire health care landscape, are just beginning to be felt. More children and seniors will be accessing dental care in the years ahead, while most adults are seeking less care. Traditional dental practice patterns are also shifting as more young dentists gravitate toward large-group practices and opportunities in the public sector. Given these developments, what do the latest workforce projections mean for our institutions as they decide how many future dentists to educate and how to recruit and retain sufficient faculty to fulfill evolving needs?

To gain perspective on these matters, I called Marko Vujicic, Ph.D., Chief Economist and Vice President of the Health Policy Institute at the American Dental Association (ADA). After hearing many in our profession express concern that retirements would soon outpace the number of new dentists entering the workforce, I was surprised to learn that only 3,600 dentists retired in 2013, well short of the 5,000 plus students who graduated from U.S. predoctoral programs last year.

“We’re not seeing retirements exceed graduations in many years at all,” Marko told me. “The preliminary projections we have so far indicate either a slightly rising or a stable dentist-to-population ratio over the long term.”

Later this year, to project the future workforce supply, the ADA will release a full report that models dentists’ behavior, but much of the data the ADA has already released elucidates why the workforce may be stabilizing. To begin with, dentists are retiring later. The average retirement age was 69.3 in 2011, up from 64.8 in 2001, a trend that began before the recession and is expected to continue. Concurrently, demand for dental services is reaching a plateau. Even with more older Americans living longer and retaining their teeth, working-age adults are using less dental care, so the ADA projects only a trickle of increased demand for adult dental services in the coming decades if current trends continue.

In short, it may be time to prepare for what the ADA is calling a “new normal.” The association’s projection of per capita dental expenditures from 2010 through 2040 raises two concerns of immediate interest to our community:

  • Total per capita dental expenditures are expected to grow in the next 30 years but at a much lower rate than during the past few decades.
  • The sluggish growth combined with an expansion of dental school enrollment could potentially lead to challenging economic conditions for practicing dentists, who already saw their incomes decline between 1992 and 2009.

A separate ADA brief reported that more than a third of dentists surveyed, including 42% of solo practitioners, said they were “not busy enough” in 2012. From an economic perspective, as Marko pointed out, these figures indicate that the system has excess capacity. It just may not be where it is needed or available to the patients who need it.

That idea resonates with Mark Latta, D.M.D., M.S., Dean of Creighton University School of Dentistry. He, too, has seen the numbers indicating that there are enough dentists to meet current demand, but from where he sits, he sees plenty of unmet need. He says the problem is particularly acute in rural areas in Nebraska and on Indian reservations in neighboring states. In other words, there may be plenty of dentists in the aggregate, but they aren’t necessarily located in areas of need.

“The facts are, 30–35% of the population still doesn’t see a dentist, and the demography of active caries is heavily skewed to this population,” Mark observed when we spoke last month. “There’s plenty of care that needs to be delivered, and we’re going to need dentists to deliver that care.”

A similar appraisal is shaping policy in Connecticut. The state, which is putting systems in place to try to fund care for its low-income residents, recently approved a decision to expand enrollments at the University of Connecticut School of Dental Medicine by 12 students per class. Dean Monty MacNeil, D.D.S., M.Dent.Sc., points out that although Connecticut may be the second wealthiest state per capita in the nation, it has four of the country’s 10 poorest cities, producing a significant disparity in oral health services within the small state.

“The state has enough dentists to treat its population, but they are maldistributed, and for us, the greatest problem is urban versus rural,” Monty told me, echoing Mark’s comments. “We believe that as a state-supported institution, we have a mission to treat those who cannot seek care elsewhere. To a certain extent, we can be the equalizer.”

But educating those additional students won’t be easy—at this school or anywhere else. The aging of the dental workforce also means that academic dentistry will soon be losing a significant portion of its faculty to retirement. Monty expressed particular concern about attracting and retaining research faculty. Across the board, faculty recruitment is a concern because competition for academic talent is rising with so many schools opening or expanding in recent years.

Mark Latta is already confronting this issue at Creighton, where 50% of the full-time faculty is over age 60 and 35% is over age 65.

“I’m going to see a massive transfer of intellectual capital,” he told me.

To manage the transition, the dental school at Creighton has put several forward-looking programs in place. First, the school has created half-time, benefit-eligible positions for retiring faculty to phase their departures. The school has also created a mentorship process to bring new faculty up to speed more quickly. To retain current faculty, Creighton has begun offering stipends and loan forgiveness to individuals who want to pursue graduate training and agree to return to teach. These approaches appear to be working, but private sector salaries still constitute a major challenge to the school’s efforts to recruit graduates to pursue academic careers. Mark estimates that Creighton will need to increase faculty salaries by 30% if the school is to continue to succeed in recruiting dentists, especially specialists, to full-time positions.

At the University of Texas Health Science Center at San Antonio Dental School, Dean Bill Dodge, D.D.S., is more relaxed about the coming faculty shortage than anyone else I’ve talked with of late, perhaps illustrating once again that numbers in the aggregate may be misleading. Conditions on the ground in San Antonio give Bill cause for optimism. To start with, the school runs a teaching honors program that has graduated more than 100 students to date, of whom 11 are currently affiliated with an academic institution, either a dental school or specialty program. The school has also received a four-year Health Resources and Services Administration grant to recruit and prepare Hispanics for successful careers in academic dentistry.

Bill is especially encouraged by alumni who have recently expressed interest in returning to their alma mater to teach. To make teaching financially attractive, Bill is exploring ways to alter the school’s faculty practice plan by increasing the time available for practice and by ensuring there are adequate incentives for productivity. If structured properly, he believes such a plan would generate revenue for the dental school and allow part-time faculty to earn salaries within striking distance of those earned in private practice.

“We have two people now who want to join the faculty who may prove to be models for the future: a midcareer individual who wants to move an active clinical practice to the school and a young person who wants the opportunity to teach while simultaneously growing her intramural practice,” he told me. “They are exactly the kind of people we need, and not just for financial reasons. They’re the best role models we have to demonstrate the faculty career as a viable option.”

Bill even sees a silver lining in the utilization of dental services data gathered by the ADA. “Visits are down, per capita expenditures are down, incomes have begun to dip. In a way, that could work to our advantage by shrinking the gap between private practice and academic salaries,” he conjectures.

Not everyone would go that far, but his point does lend support to the idea that the reality we have taken for granted these past few decades is giving way to a new reality that may have unforeseen benefits as well as costs. So do we have a shortage of dentists?

As Monty observed, we clearly needed the rebound in educational capacity following the dental school closures of the 1980s, but in light of recent developments, he suggested that we may be at the stage where we should stabilize our graduation rate. At least it might behoove us to analyze where we are.

To quote Marko Vujicic: “It’s an interesting puzzle. We have over all pretty sluggish growth in demand, except among the Medicaid population, seniors and children. So the key question for the dental education community is, are you training the ‘right’ kind of dentists? Are you training your graduates so that they can work in settings where the demand for dental care will grow?”

These are good questions, ones our community would do well to consider.

Dr. Richard Valachovic
In this month’s letter, ADEA President & CEO Dr. Rick Valachovic shares what you may have missed at this year’s ADEA Annual Session & Exhibition in San Antonio.

Right from the start, that most complex of human organs—the brain—dominated this year’s ADEA Annual Session & Exhibition with the ambitious theme: The Science of Learning.

“As far as we can tell, we’re the only species on the planet that has grown so sophisticated that we’ve thrown ourselves headlong into deciphering our own programming language.”That was the assessment of David Eagleman, Ph.D., the year’s Opening Plenary speaker, who energized a packed house with a fascinating talk on the brain—in his words, “the most complicated device we’ve found in the universe.” Dr. Eagleman argued that educators need to focus more on cultivating cognitive flexibility in their students, and he shared his ideas on how to create a “brain-compatible” classroom where students feel engaged and inspired to learn.

Three symposia programmed by the Chair of the ADEA Board of Directors, Steven Young, D.D.S., M.S., further explored the science of learning.

The first of these, Urban Legend or Brain Fact: The Truth About Learning, busted myths about the brain that have been successfully used to market a range of well-known products (Coca-Cola was one of the first!), most of which have unproven benefits, and some of which can even harm cognitive performance. What truly boosts learning and memory? Prior experience (learning is context-dependent), pictures (vision dominates the other senses) and practice (spaced learning is better than massed learning).

The second symposium, Drilling Down on LD & ADHD: Understanding and Accommodating Students with Disabilities, also dispelled a few myths while exploring the social and emotional challenges that can further hamper these students’ academic performance. This session also discussed strategies for accommodating students’ needs and the legal obligations of schools.

The last of the symposia, Engaging the Brain: Art and The Science of Dentistry, explored the value of training in art appreciation to enhance three skill sets: close observation, unbiased analysis and clear, empathetic communication. The presenters described a phenomenally successful elective course developed by The University of Texas School of Dentistry at Houston and the Museum of Fine Arts, Houston. The course capitalizes on the brain’s preference for visual learning, creates opportunities for repeat practice and takes place in the sort of enriched, “brain-compatible” environment that Dr. Eagleman described as conducive to learning. Is it any wonder that the course has a waiting list?

As you can see, brains ruled at this year’s Annual Session, but it was far from dry or academic in the less flattering understanding of that word. In addition to food for thought, the gathering provided nourishment for the senses and opportunities to connect with colleagues in a festive environment. The conference hotel and the adjacent convention center sit alongside San Antonio’s famous River Walk, a meandering system of canals and bridges flanked by grand hotels, historic structures and inviting restaurants. This year’s opening reception was held at the water’s edge, where an all-woman mariachi band serenaded the crowd. I don’t know how many of us were able to enjoy the guacamole and ceviche before heading out to dinner that night, but I can tell you that more than 2,200 ADEA members attended at least some of the conference events, making this our most highly attended meeting to date.

The next morning, it was business as usual: another dynamic plenary speaker to jump-start the day and dozens of educational sessions on topics as diverse as cultural competency, tobacco cessation, dental service organizations, the Supreme Court’s most recent ruling on college admissions and, yes, more brainy topics, including neurobiology. Some of these sessions represented unique partnerships between ADEA Sections and Special Interest Groups. This growing trend toward collaboration was evident in several joint ADEA Council meetings as well.

The one complaint I hear consistently each year is that there are so many good sessions, it is impossible to attend everything. In that sense, my annual recap is as much for those who attended as it is for those who were unable to join us. Here are a few vignettes and sound bites to give you a taste of what else you may have missed, whether or not you made it to San Antonio.

Saturday

Chair-elect of the ADEA Board of Directors Lily Garcia delivers part of her speech in Spanish at the Opening of the ADEA House of Delegates. She tells the story of her grandmother who grew up in South Texas at a time of segregation. The older woman’s love of education had a lasting legacy: Every one of her 17 grandchildren earned a university degree. Her impact on Lily is clear when she announces her primary focus for the coming year: to be a strong, positive influence on the next generation of health professionals.

Earlier in the day, college students don white coats at the ADEA GoDental Workshop and Recruitment Fair for Predental Students and Advisors. More than 250 participants take advantage of this opportunity to consult health professions advisors and admissions officers from more than 50 dental schools.

Current dental students convene for the launch of the ADEA Student Diversity Leadership Program, which will train and mentor students with an interest in academic careers.

Out-of-towners visit the University of Texas Health Science Center at San Antonio Dental School for a tour of the current facility. They also get a glimpse of the new state-of-the-art facility under construction where faculty and students will soon conduct research and clinical trials to advance innovation and patient care.

Quotes of the Day:

“All things are possible with money, software and time.”
R. Todd Watkins, Jr., D.D.S., Assistant Dean for Dental Education and Informatics at East Carolina University School of Dental Medicine, speaking during the ADEA Signature Series on disruptive innovation in health care education.

“Thank you for speaking up for us.”
Nina Godiwalla, speaker at the Evening Plenary on Gender Issues and author of Suits: A Woman on Wall Street, quoting an eye-opening remark from a reader of her book with whom she had previously thought she had little in common.

Sunday

The Exhibit Hall opens. It takes a long walk and three escalator rides to get there, but the products on display, the poster sessions, the ADEA TechExpo, the New Idea Sessions and the ever-popular free lunch make it well worth the trip.

Now you see it, now you don’t. The timer is set and each presenter has only five minutes to update the audience on a new teaching practice or instructional technology during Teaching and Learning With Emerging Technologies and Informatics: Short Talks. This rapid-fire session comes to a close at noon. Two hours later, folks are at it again. The topic this time: teaching innovations in the biomedical sciences.

Attendees pack the room to learn about the latest ADEA Trends in Dental Education and leave with three take-aways:

  • The 2014 dental school applicant pool is slightly down with the greatest decline among minority students.
  • We have a new tool to identify promising students from low socio-economic backgrounds, which should help us to recruit more of these students.
  • With many new schools established and others likely to open in the next few years, we have built the educational capacity to welcome these promising students.

Quotes of the Day:

“I wish we could come to a consensus and put everybody on an equal footing.”
Questioner during a session titled Understanding the Selection Criteria for Residency Programs in the Climate of Pass/Fail.

“The team at ADEA has taken a small insular organization concerned with maintaining dental schools to a dynamic organization that, along with our strategic partners, is creating the future of our profession.” 
Kenneth L. Kalkwarf, D.D.S., M.S., Dean Emeritus of the University of Texas Health Science Center at San Antonio Dental School, and recipient of the ADEA Distinguished Service Award.

“What will the next generation of dental hygienists look like, because they’re in your hands? What role will they play—are you preparing them for any and all roles? What skill sets will they need and how will you change your systems to provide them with those skills? Will a new curriculum be needed if we’re going to be viewed as integrated into the health care system?”
Ann Battrell, M.S.D.H., Executive Director of the American Dental Hygienists’ Association speaking at a session titled Transforming Dental Hygiene Education: Recommendations for the Future.

“When my grandfather came to this country in 1900, he was part of the 1% that came from Latin America. In 2012, 48% of immigrants came from Latin America and the Caribbean. These are the shifts that are taking place.”
Ricardo Romo, Ph.D., President of The University of Texas at San Antonio, speaking at the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI) College President’s Symposium.

Monday

An impressive turnout of (dare we hope?) future candidates listens eagerly to the advice of current leaders during a session titled Will the Next Dean Please Stand Up? The United States currently has only two dental school deans from underrepresented minority groups. Many leave this session encouraged that a more diverse group of deans may emerge in the future.

A fortunate few tour the Center for the Intrepid, a state-of-the-art U.S. Army medical facility that is providing rehabilitation to service members and others who have sustained amputations, burns or functional limb loss. The facility’s efforts to return patients to the highest levels of physical, psychological and emotional well-being leave the visitors both awed and inspired.

With the sun starting to sink in the West, elegantly clad attendees make their way to the Lone Star Ballroom for the 2014 William J. Gies Awards for Vision, Innovation and Achievement. As in previous years, the accomplishments of this year’s recipients speak volumes about the ingenuity and dedication of our community.

Quotes of the Day

“I have had the privilege of excellent mentors, who became collaborators, colleagues and friends. … At all times I keep the earliest lessons from my mentors and from ADEA in mind and heart—continuing to ask, what do our institutions and our communities need from us?”
Lisa Tedesco, Ph.D., Vice Provost for Academic Affairs – Graduate Studies and Dean of the James T. Laney School of Graduate Studies at Emory University and winner of a 2014 Gies Award for Outstanding Achievement, making her acceptance speech.

“Remember, site visitors are our friends. They’re us. You want to make their job as easy as you can.”
William Dodge, D.D.S., Dean, University of Texas Health Science Center at San Antonio Dental School, one of three schools that shared their experiences using the new Commission on Dental Accreditation standards to prepare their accreditation Self-Study Reports.

“In the midst of great geopolitical, demographic and economic changes, our country has to make a decision: Are we going to turn to each other, or on each other?”
Van Jones, cohost of CNN’s Crossfire, speaking at the Political Spotlight plenary session.

Tuesday

With their bags packed for a midday departure, many attendees make their way to the theater for the Closing Plenary. They hear from Rishi Desai, M.D., an infectious disease physician who traded in his job as an epidemiologist with the Centers for Disease Control and Prevention to be part of the revolution in online learning at the Khan Academy. In the hours that follow, some head for home while others take in one last educational session or seize the opportunity to chat with colleagues they rarely see.

In the late afternoon, members of ADEA’s governing bodies make their way to the third floor of the convention center for the Closing Session of the ADEA House of Delegates. The results of the vote for the new Chair-elect are announced (it’s Tufts’ Dental Dean Huw Thomas, B.D.S., M.S., Ph.D.), and outgoing Chair Steve Young gives his final address. His words bring to mind two people who made their presence felt in San Antonio, not through proximity, but through the power of their ideas. The first is Clayton Christensen, D.B.A., M.B.A., M.Phil. Dr. Christensen was mentioned by Steve in passing during his speech and by several other speakers earlier in the session. Dr. Christensen’s concept of disruptive innovation took center stage at this year’s ADEA Signature Series and appears to have played a role in drawing a record 200 people to San Antonio a day prior to the meeting’s official opening to explore this powerful idea in the context of health professions education.

The other individual is John Medina, Ph.D. I can’t tell you how many times I heard people mention last year’s Opening Plenary speaker and his book Brain Rules: 12 Principles for Surviving and Thriving at Work, Home, and School. Apparently those of you who bought the book also read it and were excited by the prospect of hearing this year’s speakers further explore this fascinating topic.

I could say more, but I think I’ve conveyed just how rich and rewarding the ADEA Annual Session & Exhibition can be. If I haven’t motivated you to join us in 2015 in my adopted hometown of Boston, perhaps the theme of next year’s gathering will: Igniting Minds, Unlocking Potential. Hope to see you there.

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