Maxims, Mantras and Musings from My Time at ADEA

In this month’s letter, Dr. Rick Valachovic explains the meaning of RPSA and reveals nine other ideas that have guided his actions during 22 years as ADEA President and CEO.

From my seat within our Association, I’ve had a rare vantage point these past 22 years. I’ve been privileged to serve as ADEA’s Chief Executive Officer in a time of transition—from an organization primarily serving dental schools to a member-driven association representing the multiple communities within dental education. Over the years, I’ve gained insights that have guided my stewardship during this period. Here are 10 of them, captured in mantras, maxims and musings that I hope may prove useful in informing ADEA’s journey ahead.

1. Oral health is a national security issue.

Oral health is rarely the first thing that comes to mind when people think about national military readiness. But the reality is, if you can’t eat, you can’t fight—and no one in harm’s way should be distracted by dental pain.

Dental conditions, including not having enough teeth, have been among the most common medical reasons for deferment from military service since the American Civil War. In fact, the label “4-F” to denote a medical deferment originated back in the days when recruits needed (and often lacked) four front teeth with which to bite down on a gunpowder cartridge so they could tear it open with one hand.

Loading today’s weapons no longer relies on the users’ dentition, yet even in the 21st century, dental readiness remains a concern. The deployment of National Guard and Army Reserve troops to Iraq and Afghanistan revealed significant deficits in their oral health, prompting changes in military regulations aimed at improving the dental readiness of our citizen soldiers. That’s good news, but we must remain vigilant to ensure that the nation’s oral health doesn’t become a threat to its national security.

2. The mouth really is a part of the body.

Shortly after the American Civil War, medical schools made it clear that they didn’t want to have anything to do with dental education. They saw the profession as mechanical in nature, dealing mostly with pain and extracting teeth. Ironically, dentistry’s historical isolation from medicine has, in some ways, worked to our advantage. We were forced to take the lead in developing our professions.

Yet over time, something counterfactual occurred: The mouth became separated from the rest of the body, almost as though it lacked nerves, blood vessels and other connecting anatomical structures.

You may have heard me joke that the oral cavity could be defined as the anatomy between the lips and the tonsils that other health professionals rarely examine, but in truth, this separation is no laughing matter. Fortunately, 150 years later, health care educators and providers have come to recognize the oral cavity for the anatomical organ that it is and advocate for integrating dental and medical care. ADEA’s work as an equal partner with organizations representing educators in other health professions shows our commitment to a future based on interprofessional education and collaborative practice.

3. The face of dentistry is changing.

When I graduated from the University of Connecticut School of Dental Medicine, 80% of dentists were white and men. That is no longer the case, and the change has been dramatic. In 2016, for the first time, the majority of applicants to dental school were women. In 2018, for the first time, the majority of applicants to dental school were non-white. These are milestones in the dental profession and it validates the work we’ve been doing to recruit a more diverse pool of applicants.

Dentistry has always been a first profession for many families. In my youth, a lot of people like me (of Eastern European descent) were entering dentistry. Today, a quarter of dental school applicants have roots in Asian countries. Through efforts such as the Summer Health Professions Education Program, which we lead with the Association of American Medical Colleges supported by funding from the Robert Wood Johnson Foundation, we continue to strive for even greater diversity in our workforce. Having reached the current tipping point in the dental school applicant pool, we’re on course to create a dental workforce that one day will reflect America’s soon-to-be minority-majority makeup.

4. This year’s graduates will still be practicing in 2060.

I completed my pediatric dental residency at the Children’s Hospital Medical Center in Boston in 1979. Had I remained a full-time practicing pediatric dentist, what I learned then would pretty much have carried me through my entire 40-year career. Some dental materials have changed since then, but overall, I could have practiced the way I learned in my program and had a successful career. Four decades later, that’s quite remarkable.

Today’s graduates, whether from dental schools or allied dental programs, face a far different future. Changes are already on the horizon—in areas such as robotics, biomaterials, digital dentistry and artificial intelligence—that will transform dental practice in unforeseen ways. The knowledge and skills our graduates acquire in 2019 will not be enough to sustain their careers through 2060. In this context, preparing our students for lifelong learning has taken on enormous importance. We’ve made strides in transforming our curriculum from what was sometimes a hollow exercise in memorization to a meaningful way of equipping practicing professionals with the ability to acquire up-to-date knowledge and skills. That said, we have a long way to go to ensure that our graduates are prepared to keep learning throughout their careers.

5. Success or failure in dentistry is measured in tenths of millimeters.

Those of us in the dental professions have reputations for being painstakingly detailed. That may not be the most desired trait in social settings, but our patients are almost universally grateful for our perfectionism. A gap of more than a tenth of a millimeter between the margin of a tooth and a restoration can result in recurrent decay, and none of us wants to think about what happens when an implant perforates a mandibular canal.

The procedures we perform require extreme precision. We have no choice but to teach and practice to tenths of millimeters. Unfortunately, it’s not always easy for students to perform to such exacting standards. In recent years, we’ve come to publicly acknowledge the stresses inherent in preparing for our professions—and in practicing the professions as well. Recent conversations about well-being and resilience have put us on a path toward a more humanistic approach to educating students. Those discussions are a vital first step, but we must put our words into action. We must “walk the walk.”

6. In today’s world, you have to have an engaging smile.

For much of the last century, you could get a good job making steel or cars or lumber, and no employer thought twice about your teeth. Not so in today’s service-oriented economy. To get most jobs, you must have an engaging smile, and any reluctance to show off one’s pearly whites can severely affect a person’s self-esteem.

The effect is even greater in the social sphere, where a vast number of people use apps to vet the appearance of potential mates before they have a chance to compete for love on personality or other criteria. These concerns, while essentially cosmetic, have created a greater appreciation for the value of dental health. A radiant smile relies on healthy gums, strong enamel, and proper spacing of the teeth—conditions that allow for pain-free use of the oral cavity in essential activities such as eating and speaking. Access to proper dental hygiene and restorative care can assure these functions and give people a critical tool for economic and social success.

7. Dental schools need to be part of the trunk of the academic tree.

Between 1986 and 2000, seven dental schools closed and another seven almost met the same fate. What distinguished these two groups? The ones that closed thought that dental schools were different from other units of their parent institutions and positioned themselves “out on a limb” on the academic tree, making it easy for the parent institution to cut them off.

The schools that survived had made themselves part of the trunk of the academic tree. They were engaged with the main campus, their faculty served on university committees, and their strategic plans were consistent with those of their parent institutions. To thrive, all of our schools and programs must be integral to their parent institutions and serve these institutions’ missions and goals. That’s a lesson we can’t afford to ignore.

8. If you’ve seen one dental school, you’ve seen one dental school.

I often hear people make sweeping statements about dental education. While they usually contain a grain of truth, we need to stop painting with such a broad brush, especially when it comes to describing our perceived shortcomings. Each dental school has a unique blend of strengths and challenges.

While accrediting bodies in the United States and Canada ensure that all dental schools meet national standards, for the moment, at least, we’ve managed to remain flexible and innovative. In fact, most dental schools are taking astonishing steps to differentiate themselves from one another. Many are exceptionally innovative—whether in research, community-based education, integration of technology, interprofessional learning environments, or some other area. Many dental schools are now thought of as the “front porch” of their universities through their teaching clinics and their presence in federally qualified health centers and mobile vans. Unlike McDonald’s franchises, you won’t find the same things on the menu no matter where you go, and that’s one of dental education’s strengths.

9. Where you stand depends on where you sit.

Most human endeavors have a political dimension, and dental education is no different. After years of advocating for change inside the Beltway, in Chicago and elsewhere, I’ve come to realize that you can’t make progress unless you understand where those with differing views are coming from.

I mean that quite literally. Whether negotiations are occurring at the federal level, state level or within or among our academic and professional organizations, each person at the table has to go home and justify his or her actions. If you can help make a case that will satisfy your opponent’s constituents, that’s half the battle.

ADEA’s recent progress on the licensure front exemplifies the value of this approach. For years, we rubbed up against the competing interests of students, educators, practicing clinicians and those charged with protecting the public’s welfare. But over the last two years, we mentally put ourselves in each other’s shoes and quickly discovered that we shared considerable common ground. It’s a lesson worth remembering as we take on new challenges.

10. Relentlessly pursue strategic alliances.

In all our Association’s initiatives, the relentless pursuit of strategic alliances, or RPSA (I pronounce it “rip saw”), has been my mantra. Why? As the academic branch of a relatively small profession, dental education has always risked being marginalized.

When I arrived at ADEA 22 years ago, I quickly discovered that we had incredibly weak relationships with outside organizations whose concerns overlapped with our own. We had next to no interaction with most of these groups and spent little energy and few resources on fostering collaborations. But as most of you know, I soon challenged our Association to turn these potential allies into strategic partners. We forged ties with organized dentistry, with education organizations representing the other health professions, and with national associations focused on higher education. We successfully deepened our relationships with a growing number of corporate partners. And then we reached beyond our borders to pursue stronger global ties, which have blossomed in recent years. Along the way I learned that a hearty laugh and a sense of humor can make all the difference in getting others to engage.

Thanks to RPSA, we are now integral to the intraprofessional, interprofessional and globalized future that is shaping both health professions education and health care delivery. I hope you will agree that RPSA has served us well.