Charting Progress

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic considers the evolution of ADEA’s centralized application service and where the application process stands today.

In 1972, I applied to dental school. I was one of many young people whose interest in pursuing a dental career created an unprecedented surge in the number of dental school applicants—from about 9,000 at the start of the decade to a peak of almost 16,000 in 1975, before falling back to roughly 10,000 by 1980.

In 1979, 6,301 students enrolled in dental school, the highest number on record. Today, about 12,000 individuals apply to dental school each year, and with the addition of 10 new schools and the expansion of class sizes over the last 20 years, institutional enrollments have increased about 50%. With 6,122 first-time, first-year enrollees in 2017, enrollments may soon exceed their historical peak.

1972 was also the year that ADEA, then the American Association of Dental Schools (AADS), launched its centralized application service for predoctoral programs—AADSAS®—freeing participating schools from much of the up-front work that goes into the admissions process. Centralizing the application process was a bold step, and we can be proud that dentistry was one of the first health professions to take it. Applications were printed on paper, filled out by hand and mailed to AADSAS. The service photocopied the forms and distributed them to dental schools. That process was in still in effect when I arrived at ADEA in 1997, and I knew it was time for a change.

Later in 1997, we engaged George Haddad of Liaison International, a Boston-based tech firm that is now a leader in online application services. Outsourcing some of the more cumbersome tasks streamlined operations at ADEA, but George and his team had their work cut out for them. “At first, we continued to print the applications and send them to schools every week,” George recalls. “We had stacks of paper applications.”

In the early years, we used a hybrid process that integrated floppy disks (remember those?). Applicants filled out their applications on paper and ADEA sent the information to a data entry firm to transcribe. Meanwhile, ADEA staff collected transcripts and verified coursework and credits. Because schools still wanted to read the applications on paper, Liaison International was printing and mailing reams of paper as late as the 2010–2011 application cycle.

It quickly became apparent that moving AADSAS to the web was the right solution. To accomplish this, Liaison International developed a secure platform that ultimately allowed us to move the entire application process online and into the 21st century. ADEA was the first health professions association to launch a web-based application service, a pioneering move that other associations have since emulated.

Since 2012, the pace of progress has been dizzying. Applicants submit all information online, including letters of recommendation. DAT scores are automatically reported to the service. Paper has been entirely eliminated from the process—schools now log in to the service to access applications electronically. In 2013, ADEA reached another milestone: becoming the first health professions association to boast that all of its U.S. schools participated in its predoctoral application service. Over the years, we introduced three more application services: ADEA PASS®, for advanced education programs; ADEA CAAPID®, for programs designed for dentists with degrees earned outside the United States or Canada; and ADEA DHCAS®, for dental hygiene programs.

When I spoke recently with George, he confirmed that ADEA was among the first health professions organizations to outsource the management and operations of the application process and the technology needed to run the service. Turning this function over to his firm has reduced our Association’s costs by saving space and eliminating the need to hire and train seasonal staff. Meanwhile, the most important outcome of this transformative change is that we’ve improved the experience for applicants. Applicants now have a “one-stop shop” where they can access information and complete the entire application process.

The application’s content has also been modernized. We changed how we ask about race and ethnicity, introduced socioeconomic-status variables and provided schools the opportunity to ask questions that are not part of the standard application. We’ve also encouraged the use of new interviewing techniques, such as the multiple mini interviews, which allow schools to evaluate skills such as critical thinking, ethical decision-making and effective communication.

All of this provides ample evidence that ADEA’s application services are up-to-date and have kept pace with today’s ever-changing times. In fact, we’ve been ahead of the curve, leading the way for many of our sister associations. But putting aside whatever pride we may feel in these accomplishments, it’s fair to ask, “Why does this matter? How does it advance our mission?”

I think George sums it up well when he says, “Centralized application services allow associations to market their professions as a whole, so recruitment happens on a national level, eliminating redundancy while preserving the uniqueness of each school’s admissions process. The platform gets all the schools around the table. They share best practices and create requirements for the profession.”

I couldn’t agree more, and the results are evident in the changes we’re seeing in admissions practices and the applicant pool. The widespread adoption of holistic admissions, particularly by dental schools, allows applicants to “tell their stories” and articulate why they have what it takes to be a caring, competent health care professional. While admission to dental school remains extremely competitive, we are seeing a wider range of grade point averages and DAT scores, suggesting that schools are more willing to consider a broader range of attributes when evaluating applicants.

One of the most interesting trends has been the rise in the number of re-applicants, those who apply to dental school for a second or third time. These individuals typically work hard to gain additional education and experience to achieve their goals. They now represent one-third of our applicant pool, demonstrating just how attractive a dental career remains.

The increased presence of women in our incoming classes is another striking example of how things have changed since I applied to dental school. In 1972, women accounted for 14% of the applicant pool. Mirroring other economic and social trends during this period, women now account for 51% of dental school applicants.

ADEA has also invested considerable effort in attracting underrepresented students to the profession. One important ADEA priority is the Summer Health Professions Education Program, an academic enrichment program for educationally and socioeconomically disadvantaged students seeking to enter dentistry or another health profession. In addition, to promote diversity and ensure that all students have the opportunity to present a complete picture of their qualifications during the admissions process, we are working across our membership to help train faculty and staff in the use of holistic review, consistent with federal case law. Most recently, we established an ADEA Centralized Application Service Working Group to analyze trends and give us a better sense of our applicants and enrollees. We still have a long way to go in creating a dental workforce that truly reflects our nation’s diversity, but I am optimistic that our investments will pay off.

This year, we introduced a “soft launch” of the application, which allowed applicants to prepare their applications three weeks before the site opened for submissions. More than half of anticipated applicants took advantage of this head start, and George was not surprised in the least that this student population is first out of the gate. “Dental students are among the first to apply,” he told me. “They are very diligent.”

So, what’s next? I don’t have any pronouncements to make, but rest assured, as technology advances and social norms and expectations shift, ADEA will continue to embrace change. Our operational goal is to always be able to say, “We are actively simplifying the process of applying to dental school,” with all signs appearing to indicate that our motivated pool of applicants will continue to “seize the moment.”


Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic asks tobacco-cessation educators how their work has changed with the advent of vaping and some states’ legalization of recreational marijuana use.

You may recall the title of my May letter, “A Matter of Life and Death.” I could easily have used the same title this month, but whereas deaths from pediatric sedation (last month’s topic) are extremely rare and occur in a matter of minutes, deaths related to tobacco use remain all too common and occur over the course of decades. Will the availability of new, smokeless nicotine delivery systems reduce smoking-related deaths or introduce a new generation to the tobacco habit? Will the legalization of marijuana in more and more states introduce a new contaminant to people’s mouths and lungs or simply decriminalize a hidden behavior?

The research into these questions is incomplete and contradictory, but we have several reasons to be concerned about new practices that complicate the effort to reduce tobacco use. Smoking marijuana poses similar risks to smoking tobacco and may be responsible for some additional oral health effects. As an ADA topic page points out, THC, an appetite stimulant, encourages snacking, which may explain why using marijuana is associated with higher numbers of caries.

Vaping, which delivers nicotine without the smoke, has been heralded by some as a welcome alternative to tobacco use. In fact, the United Kingdom embraces the practice in its effort to help smokers quit.

“It’s part of the National Health Service’s treatment plan for those who want to quit to incorporate e-cigarettes and vaping,” says self-described tobacco nerd Joan Davis, RDH, Ph.D., Director of Research, Special Projects & Initiatives at the A.T. Still University Missouri School of Dentistry & Oral Health. “On the other hand, the CDC is 110% against it.”

Why are scientists at the Centers for Disease Control and Prevention concerned? You can get the full CDC assessment of e-cigarettes on the agency’s website and a summary of the evidence on the public health consequences of using them in a 2018 report from the National Academy of Sciences, Engineering, and Medicine. In a nutshell, while e-cigarette vapor typically contains fewer toxins than tobacco smoke, it is far from harmless.

  • The primary ingredient, nicotine, is highly addictive and affects the developing brain.
  • Vaping liquids contain flavorings and other chemical additives, some of which are linked to cancer and other serious diseases.
  • The process of converting liquids into an inhalable vapor involves heat, which can damage cells in the mouth, potentially increasing the risk of such oral conditions as infection, inflammation and gum disease.
  • Perhaps of most concern is the popularity of vaping among young people, leading many observers to fear that the practice may induce users to start smoking and expose them to all its attendant harms. (A recent issue of The New Yorker offers a vivid portrait of the phenomenon in affluent high schools.)

As we consider these risks, our experience with tobacco may be instructive. It took decades of concerted effort with substantial government support to bring smoking rates down to the current level, roughly 15% in the United States and Canada. Nevertheless, one in five deaths is still linked to tobacco use, a habit that also contributes to tooth loss, periodontal disease and oral cancer among the living.

“Somehow this problem has not gone away,” Joan points out, “and the most addicted populations are those who are poor, have limited education or are mentally ill.”

CDC statistics corroborate this statement. Almost a third of adults with less than a high school degree smoke cigarettes, as compared with 10.4% of college-educated adults. This disparity explains why many highly educated people think smoking is no longer an issue, despite the fact that 480,000 people die from it each year.

The good news is that smoking-cessation interventions work, and dental professionals are well positioned to deliver them effectively. A 2012 Cochrane review of 14 studies found that interventions conducted by oral health professionals roughly doubled the rate of tobacco abstinence at six months or longer. Unfortunately, the treatment of tobacco dependence continues to be inconsistent in many dental practices, suggesting a growing role for dental and other health professionals who are ready and willing to talk with their patients about what they are inhaling.

Joan would like to see everyone receive a tobacco-cessation intervention at every appointment, but she acknowledges that several barriers stand in the way. She told me many dentists don’t think tobacco-cessation counseling falls within their purview. Others lack the necessary skill set, and based on their limited experience, they believe that counseling doesn’t work. Joan attributes these failures to a lack of understanding about motivational interviewing and health behavior change.

“You need to ask open-ended questions as opposed to, ‘Did you quit yet?’” she says, and work in questions about tobacco and other substance use with routine questions about brushing and flossing. Many dentists are also pressed for time.

That’s certainly true for dental educators, who, research shows, also have a mixed record when it comes to preparing new providers to help their patients kick the tobacco habit. Joan and several colleagues have surveyed U.S. and Canadian dental schools and U.S. dental hygiene and dental assisting programs about tobacco dependence education (TDE). Among the researchers’ findings:

  • As of 2016, TDE had not been consistently integrated into predoctoral education.
  • At dental schools, 90% of respondents indicated that faculty members were “confident” to “extremely confident” in teaching tobacco-related pathology, but only 49% reported the same level of confidence in teaching students how to help patients quit.
  • Three-quarters of dental hygiene programs reported expecting their graduates to be competent in a moderate-level tobacco-cessation intervention, but only one quarter reported having a formal competency that encompassed the U.S. Public Health Service’s Clinical Practice Guidelines for such an intervention.
  • Almost all dental assisting programs addressed oral and systemic diseases related to tobacco use, but less than 30% of programs covered key topics related to tobacco cessation.

All dental providers should be versed in TDE, according to Laura Romito, D.D.S., M.S., M.B.A., Associate Professor at the Indiana University School of Dentistry (IUSD), Director of its Nicotine Dependence Program, and Associate Director for Faculty Development and Curriculum at the IU Interprofessional Practice & Education Center.
“Patients may share more readily with a dental assistant or a dental hygienist than with the dentist, so we advocate for tobacco interventions to involve the entire oral health team,” she says. “It’s one of the things that makes Indiana unique.”

IUSD has been a leader in tobacco research, education and cessation since Arden Christen, D.D.S., M.S.D., M.A., started the school’s first programs in these areas in 1980. Historically, the university’s Nicotine Dependence Program has ranked among the most successful in the field. According to a 2001 paper in the Journal of Dental Education, the program’s one-month quit rate was 58% and its one-year quit rate was 33%, well above the national averages for intensive interventions.

IUSD continues to be among a handful of schools that do an exemplary job when it comes to TDE. Led by Pamela Rettig, M.S., IUSD’s dental hygiene TDE program requires all students to work on their communication skills and to develop a personalized quit plan for a friend or family member. The dental assisting program makes sure students graduate with knowledge of tobacco’s oral health effects, various tobacco products, and behavioral and pharmacological interventions, enabling graduates to advance the oral health care team’s tobacco-dependence treatment efforts.

Dental students learn to:

  • Take a social history that captures the use of tobacco, e-cigarettes and marijuana.
  • Educate patients on the oral health implications of continued use of these substances, advise them of the benefits of quitting and gauge whether they are interested in doing so.
  • Connect patients who want to reduce their tobacco use with resources, such as the state’s quitline, or providers who can prescribe pharmacotherapy for tobacco cessation.

Students may also choose to counsel patients themselves. During a clinical elective, which Laura supervises, students develop a behavioral and pharmacological treatment plan and initiate counseling. They seek to identify the triggers that influence each patient’s substance use and the barriers that discourage them from quitting. Laura then evaluates students on a range of competencies.
“Can they assess patients’ use of these substances? Can they develop a cessation treatment plan? Can they communicate effectively with the patient using the motivational interviewing techniques that they’ve been taught?” Laura asks.

In Joan Davis’s view, this assessment piece is key. If the Council on Dental Accreditation made evidence-based tobacco-cessation counseling a graded clinical competency, she believes it would be a game changer. “Schools would have to back it up with didactic education, make time in the curriculum and provide faculty with training,” she says. “A lot of schools teach students about tobacco using nongraded case studies. These don’t demonstrate students’ interpersonal skills, which are essential for tobacco cessation.”

Schools and programs that want to bolster their tobacco education will find a ready-made, open-access resource in Tobacco Free! Curriculum©, which includes learning objectives, student activities and assessments. Joan designed the curriculum while on the faculty at Southern Illinois University Carbondale well before vaping and marijuana legalization were on everyone’s radar screens, but she believes it’s premature to change the fundamentals of tobacco cessation education until more definitive research emerges about how use of these additional substances influences people’s efforts to quit.

“Honestly, I think educators and clinicians need to just keep doing what they’re doing and up their game to provide more comprehensive treatment,” she says. “If everybody at least asks if people use tobacco products and encourages them to quit and gets them to a quitline, that’s good. It would be even better if they could work on motivating them to quit.” (A quitline is a tobacco cessation service available through a toll-free telephone number. Quitlines are staffed by counselors trained specifically to help smokers quit.)

One of the challenges of addressing tobacco use in today’s more complex social environment, Laura says, is identifying the practice in the first place. People who vape, or go to a hookah bar on the weekends, don’t always think of themselves as smokers. “They need to understand why we’re asking,” she says, “and that using these products may have oral health ramifications.”

As science sheds additional light on newer nicotine delivery systems and marijuana use, the principles underlying tobacco-dependence treatment will likely remain relevant, she says. At IUSD, they are currently studying the feasibility of integrating a clinical decision support system in the electronic health record that would trigger tobacco-cessation counseling. “This should help to standardize student oral health provider’s messaging,” Laura says, “and hopefully make their interventions more effective.”

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic hears from experts in pediatric sedation about efforts to reduce adverse events in the dental office.

You’ve read the headlines or heard them on TV, and if you’re like me, the stories seem surreal. How, you wonder, could this happen again?

While deaths in the dental office are exceedingly rare, they do occur, and it’s especially troubling when a child’s life is lost. The good news is, we know a lot about why this happens, and we can do a great deal to prevent future tragedies.

I recall the bygone days when hospitalization and general anesthesia were often required to treat the youngest patients. The ability to sedate children in the dental office was a major advancement, but it is not without serious associated risks. Studies show a low but persistent rate of life-threatening respiratory events induced by sedation, and the size of children’s airways makes them especially vulnerable to complications that can end in death.

A 2013 study revealed 44 media reports of such events between 1980 and 2012. How does that compare with the number of children sedated for dental procedures during those decades or today? No one knows for sure, but observers agree that the use of pediatric sedation is on the rise.

One such observer is Stephen Wilson, D.M.D., M.A., Ph.D., Chief Dental Officer at Blue Cloud Pediatric Surgery Centers and author of the first textbook solely devoted to pediatric sedation for dental procedures. Steve also served for three years on the ADEA Board of Directors. He published a study in 2001 on the use of procedural sedation (referred to as “conscious sedation” to reflect that patients remain more responsive compared with an unresponsive state when under general anesthesia). He found an increased use of procedural sedation compared with the preceding decade, a trend that he believes continues to this day. Why? A multitude of reasons—early childhood caries are on the rise, with parents eager for treatment; many preschool-aged children are ill equipped to sit still for dental procedures; some school-aged children are paralyzed by fear and anxiety in the dental setting; and more.

“I think sedation is increasing to meet a need that’s out there, and that’s appropriate,” Steve told me. The occurrence of adverse events, he believes, boils down to inadequate training—in both sedation and rescue techniques.

“General practitioners receive very little if any didactic or clinical sedation experiences in dental schools,” Steve told me. “When they graduate and go out into practice, they’re basically using sedation for the first time on their own. They’re essentially self-taught, so they may not be aware of guidelines or procedures or even basic pharmacology, and consequently, they get into trouble.”

To make matters worse, when trouble occurs, providers may not be prepared to intervene effectively while they wait for emergency services to arrive.

“We have this model in dentistry where the person doing the surgery is also the person who is supposed to be providing the anesthesia and monitoring the patient’s safety. You really can’t do both safely,” says Paul Casamassimo, D.D.S., M.S., Professor Emeritus in the Division of Pediatric Dentistry at The Ohio State University College of Dentistry.

In recent years, Paul and Steve have been involved in developing and editing the pediatric sedation guidelines jointly issued by the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD). Paul also led the task force that revised the Accreditation Standards for Advanced Specialty Education Programs in Pediatric Dentistry about a decade ago. In 2017, the Commission on Dental Accreditation reissued those standards, which now require students and residents to complete a minimum of 50 patient encounters in which sedative agents other than nitrous oxide are used. In at least half of those cases, residents must act as the sole primary operator. Observing sedative procedures doesn’t count.

These requirements represent vastly more preparation than the typical general dentist receives in a weekend CE course on sedation, no matter how high the quality may be, and Paul feels it’s warranted.

“Someone who might be mildly sedated can go into moderate to deep sedation just because of their physiology, and dentists have to be able to handle those types of unexpected effects,” Paul told me.

He is pleased that the sedation standards for pediatric dental residents have been strengthened, and he praises the sedation training oral and maxillofacial surgeons receive. But Paul notes with concern that sedation training is not a standard feature of most general practice residencies, nor is it included in the typical predoctoral curriculum. Meanwhile, the practice standards for dentists who use sedation vary substantially from state to state.

There are exemplars, including Paul’s state of Ohio. The state’s dental board lays out stringent criteria that dentists must meet before receiving a permit to provide deep sedation or general anesthesia. Requirements include completing accredited graduate-level training and passing an onsite facility evaluation to ensure that appropriate personnel, drugs and equipment are in place to monitor and rescue patients.

States can also help ensure patient safety by requiring dental offices to become certified through the American Association for Accreditation of Ambulatory Surgery Facilities and by bolstering their Medicaid programs. Low reimbursement rates for publicly funded pediatric dental visits make it difficult for families to find willing providers, Steve says, let alone dentists who are well trained in sedation and skilled in managing young children.

This is an art in and of itself, as anyone who has worked with very young children can tell you. In Paul’s view, detailed in a 2015 article in the Journal of Dental Education, problems associated with pediatric sedation arise in part from how little exposure most dentists and dental students have to treating very young children, especially those with complex needs. “If you’re going to practice family dentistry,” Paul believes, “you’ve got to be able to take care of kids from one year of age and people with special needs, and the training needs to reflect that.”

He thinks raising the training standards for specialty programs and for dentists who want to provide sedation is probably the best avenue for improving safety. As far as predoctoral students are concerned, he’d like to see elective opportunities that meet state dental board criteria for those who want to provide sedation. Absent that training, he recommends communicating that sedation is not in the realm of general dental care and putting “the fear of God, so to speak,” in future dentists who see sedation as a simple procedure.

I appreciate Paul’s sentiments. In an ideal world, all children who need sedation would be referred to highly trained specialists, but there simply aren’t enough of those specialists to go around. And the alternative—general anesthesia in a hospital operating room—comes with its own set of problems as I learned firsthand during my pediatric residency at Children’s Hospital Medical Center in Boston. I, for one, am glad that we now have the option of sedating children who need care in outpatient settings. The question is, what more can we do to ensure that providers are well trained in sedation and in rescue techniques?

Steve has given a lot of thought to what comprehensive training might look like. On the didactic side, he would like all dental schools to give predoctoral students a common foundation by:

  • Familiarizing them with the AAP/AAPD pediatric sedation guidelines.
  • Having them review morbidity and mortality case studies to understand that almost all sedation-related cases involve the respiratory system or overdosing with local anesthetics.
  • Teaching them about physiologic monitoring devices, such as pulse oximeters and capnographs.
  • Emphasizing the need to have a person in the operatory whose only task is to monitor patients during deeper levels of sedation and intervene to rescue if problems arise.
  • Explaining the implications of the sedation routes (oral, intranasal, intravenous).
  • Offering simulation training in advanced life support and rescue.

This last item is costly and time-consuming, but has been shown to be more effective than didactic education alone, and on most of our campuses, simulation centers are already in place. At present, general practitioners and some specialists receive very minimal training in this area, sometimes as little as a basic course in CPR.

Steve acknowledges the challenge of adding to an already packed curriculum, but he points out that “Sedation is the one aspect of dentistry we do that can be life-threatening to the patient.”

Can sedation emergencies be eliminated? Probably not, but we can prepare ourselves better to deal with them when they happen. We can start by considering curricular changes such as Steve suggests, by supporting legislative and regulatory efforts that would improve safety and by reducing barriers to care that allow children’s dental problems to become acute.

Paul tells me that the AAP, AAPD and other dental and medical specialty organizations are working in concert to eliminate deaths from pediatric dental sedation. It’s time for the dental education community to seriously consider what more we can do to ensure that providers are well-trained in sedation and rescue techniques.

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic makes clear why you should plan ahead now to attend next year’s ADEA Annual Session & Exhibition.

The one complaint we hear following every ADEA Annual Session & Exhibition is a happy problem to have: There are simply too many sessions people want to attend and no way they can physically attend all of them.

While we haven’t found a magic potion that allows dental educators to be in two places at once, this year in Orlando we did introduce a media-rich environment that led attendees to experience more of the meeting than ever before. Meet ADEA TV, our latest communications venture, which debuted to rave reviews. Five monitors became hubs in the convention hall where people gathered throughout the day to view Annual Session highlights. The production team did a stellar job making the videos feel interactive. As one person I spoke with commented, it felt as though the people on screen were talking directly to you. But as the infomercials say, don’t take my word for it. Visit the website to see for yourself!

We also upped our social media game this year with the help of Western University of Health Sciences College of Dental Medicine (WU CDM) Assistant Dean for Clinical Education, Hubert worked with the ADEA Division of Communications and Membership to organize a Social Media Squad comprised of members of the ADEA Council of Students, Residents and Fellows and WU CDM students. Together, they chronicled each day’s events under the hashtag #ADEA2018, posting 500 messages that reached ADEA’s 10,000 Twitter followers and thousands more via Twitter, Facebook, Instagram and Snapchat.

The Annual Session mobile app featured something new as well: ADEA Quest. While not quite Pokémon Go, the game succeeded in sending players throughout the Exhibit Hall on a hunt that spurred conversations among attendees, exhibitors and ADEA staff. Players collected points as they went and could enter raffles to win prizes. Following many sessions, we also introduced ADEA TouchPoll™ surveys to get an instant read on how members viewed select events. Respondents were entered into a raffle, and one lucky third-year student, WU CDM’s Katie Oates, went home with the grand prize—complimentary registration and round-trip airfare to next year’s Annual Session in Chicago.

One highlight of every ADEA Annual Session & Exhibition is the ADEA Political Spotlight. It is always entertaining, but this year it also was genuinely educational, combining both substance and style. Roll Call reporters Mary C. Curtis and Patricia Murphy shared the filters they use to distinguish news from noise as they cover U.S. politics and policy. For example:

  • Hope Hicks leaving the White House?
  • Congress voting to repeal the Affordable Care Act for the 69th time?
  • Anything that happens on the Hill between now and the midterm elections?

All noise, but luckily for us, the information shared at this year’s Annual Session was most definitely news, and welcome news at that.
ADEA members are taking seriously the need to prepare for the road ahead, and in session after session, they were eager to share the myriad individual ways they are gearing up for the challenges that lie around the corner. This year’s theme, Vision 2030, amplified those efforts by putting them into a larger context and challenging ADEA members to imagine how our community can continue to thrive in a rapidly changing environment. As Leon Assael, D.M.D., now Immediate Past Chair of the ADEA Board of Directors, is fond of pointing out, 2030 is a mere 12 years away, so we have no time to lose in getting ready for the sweeping changes coming to dental education.

Three Chair of the Board symposia explored the specific challenges dental education will confront in the years ahead, while the Opening Plenary speaker, futurist Mike Walsh, offered a big-picture perspective. He issued a wake-up call for all of us to reinvent, reimagine and redesign the oral health ecosystem, urging us to “think big,” “ask dangerous questions” and consider what roles automation, artificial intelligence and algorithms can play in our teams.

The Closing Plenary speaker, Natalie Kogan, also addressed the need for a cultural shift, but reassured us that “It is okay not to feel okay about change.” Her upbeat presentation on striving for emotional health and resilience in the workplace seemed to strike a chord with an audience all too cognizant of the stresses associated with preparing for and practicing our professions. Our community cares deeply about student well-being, as evidenced by the overflow crowd at a separate session on student happiness.

A palpable feeling of calm and camaraderie permeated this year’s gathering. The Gaylord Palms Resort & Convention Center provided a tropical oasis where attendees could feel close to nature. Under a giant glass dome, hotel guests watched alligators and turtles bask in sunlit pools. The adjacent convention center was easy to navigate, with lots of nooks that encouraged people to sit and converse, and more than once, I overheard people talking about collaborating on proposals for next year’s Annual Session.

The programming also put people at ease. For the second year in a row, we hosted a Find Your Tribe event, during which first-time attendees received guidance on how to get the most out of the meeting from a volunteer Army of Connectors. Roughly 140 newcomers took part, double last year’s attendance. Over in the Exhibit Hall, a steady stream of members kept staff at the professional development booth busy explaining which of ADEA’s various educational offerings might be right for them. Meanwhile, the introduction of electronic media was seamless, with people of all generations gathering around screens and interacting comfortably as though they were digital natives.

If this year’s gathering went off without a hitch, it was no accident. Keith Mays, D.D.S., M.S., Ph.D., Associate Dean for Academic Affairs at University of Minnesota School of Dentistry, and the rest of the Annual Session Planning Committee did a phenomenal job pulling together this year’s programming, and ADEA staff members worked diligently to address member feedback from past gatherings. Under Krisa Haggins’ leadership, the ADEA Meetings, Conferences and Education Technology team stepped up to provide an exceptional experience. Members told me they felt listened to and heard.

Because we were looking to the future, it seems only right that students, residents and fellows had a strong presence this year. These young people who come through our doors are the most important part of what we do and why we do it. On Monday, we hosted the inaugural ADEA Summit for National Student Leaders, which brought representatives of seven associations supporting dental students together to form a strategic alliance in pursuit of common goals. The ADEA Student Diversity Leadership Program drew another 53 students who left with individual leadership plans and a new vision for their program’s future, one focused around reducing health disparities and promoting student well-being.

The allied dental community, including dental therapists and a record number of students, was also well-represented this year, and the entire allied community was moved to see Dr. Colleen Brickle, RDH, RF, Ed.D., Dean of Health Sciences at ‎Normandale Community College and one of Minnesota’s dental therapy pioneers, receive an ADEA Presidential Citation award.

There are so many more moments I’d love to describe:

  • The remarkably moving acceptance speeches given at this year’s William J. Gies Awards for Vision, Innovation and Achievement.
  • The meeting of the ADEA Women Liaison Officers’ Group—now 45 strong including Canadian members—and their plans to work toward becoming an ADEA Special Interest Group.
  • The presence of our colleagues from Europe and beyond, with whom we made plans for two future international conclaves.
  • Three outstanding sessions presented by our Advocacy and Government Relations staff examining Medicare funding for Graduate Medical Education, health care reform and select cases before the U.S. Supreme Court.
  • Timely presentations on licensure, prescription drug abuse and augmented reality.
  • And, of course, the 2018 ADEA GoDental Recruitment Event, which brought people from all over the country to meet face-to-face with admissions officers. One look at the rapt expressions on the faces of prospective dental students during a staged mock interview and the critique session that followed, and you were both proud of our profession and reinvigorated.

For me personally, it was a special pleasure to reconnect with a classmate of mine from my time at Harvard University, Alexia Antczak-Bouckoms, D.M.D., Sc.D., M.P.H., who spoke during the “In the Mix” Plenary. Since a 1996 spinal cord injury changed the course of her life, this dental educator has focused on raising her children and raising millions of dollars for spinal cord research.

“A person is a person,” she said, sharing her vision of inclusiveness. “It doesn’t matter what they can or can’t do. You just have to recognize the spirit of them and include them in any way that you can.” I was especially pleased to see that attending Annual Session has sparked her interest in renewing her engagement with dental education.

So what’s next for the other attendees? In March 2019 we’ll gather again—this time in Chicago to celebrate our collaborative spirit. In the meantime, I’ve no doubt we’ll be hard at work—in our Sections and SIGs, in our Councils and workgroups, in our sister associations and at individual schools—processing all that we heard and experienced in Orlando and thinking intently about how we can prepare for tomorrow. As Mike Walsh pointed out, it won’t be enough to simply invest in technology. Successful organizations also invest in their cultural “operating systems.”

“How easy is it for the next generation of leaders and professionals to share and act on their vision of the future?” he asked. “All the answers you may need are inside your organization. Question is, ‘Are you listening to these people?’”

That’s a great reminder to keep our ears—and our minds—wide open.

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic talks with dental educators at three schools that excel at meeting dentistry’s social mission.
It seems as though hardly a day goes by that I don’t read an article or an online discussion with some mention of the .

In the last several years, a growing consensus has emerged that the best way to get a handle on health care costs and improve population health is through interventions that address these social determinants—defined by Healthy People 2020 as the conditions in the places where people live, learn, work and play. Research increasingly supports the idea that these conditions can be just as influential as biomedical factors, such as a person’s birth weight or genes, when it comes to determining health status. The good news is that, unlike our fundamental biological makeup, our social circumstances are amenable to change and can be influenced by public policy.

From a dental perspective, viewing our nations’ health challenges through a public health lens-taking steps to change the conditions that are linked to disease rather than just striving for better treatmentsmakes perfect sense. Nearly all dental diseases and conditions are preventable, and while we canand dopromote prevention at the individual level, we know from experience that community-level prevention is even more powerful. Our decades-long history with community water fluoridationone of the 10 great public health achievements of the 20th centuryaptly illustrates that point.

As self-evident as all this may seem to many of us, I wonder whether we are fully conveying the importance of public health and public policy in our classrooms and clinics? Like most of today’s students, I entered dental school with every intention of becoming a private-practice dentist in my hometown, but my residency in pediatric dentistry at Boston Children’s Hospital opened my eyes to other professional pathways. At that time, the city lacked community water fluoridation, and I witnessed high levels of childhood caries as a result. I came to appreciate the impact of community factors on the health of the patients I treated and decided to enter the dental public health residency program at Harvard. That experience filled me with a strong desire to pursue a dental career that would allow me to impact populations rather than treat one patient at a time.

Not every dental student will follow in my footsteps, nor should they. Hometowns still need dentists after all. But to make major headway in improving oral health across North America, we need to make sure all our students appreciate that they are responsible to their communities as well to their individual patients.

A.T. Still University’s Arizona School of Dentistry & Oral Health (ASDOH) was founded on that proposition. Its mission is to help address our nation’s gap in access to dental care by educating “community-responsive general dentists” who are committed to providing access to care for underserved populations. Several things set ASDOH apart:

  • Students engage in service learning each year and spend at least half of their fourth year living and working in the community.
  • Public health certification is woven into the predoctoral program so that all students come to view dentistry through a public health lens.
  • Roughly 25% of dental students build on their public health certification and opt to earn a Master of Public Health degree as well.

It’s also worth mentioning that ASDOH leads in graduating American Indian dentists, the vast majority of whom return to their communities to practice.

“Social mission is built into ASDOH’s culture and curriculum,” says Dean Robert (Bob) Trombly, D.D.S., J.D., and the school’s graduates reflect this. Almost a quarter of them work in Federally Qualified Health Centers, the Indian Health Service and the military, and those who pursue private practice report a high level of involvement in community service and providing pro-bono care for underserved patients.

Bob believes that ASDOH’s strong emphasis on public health does as much to draw in students whose values align with ASDOH’s social mission as it does to instill a public health perspective.

“A.T. Still University, the National Association for Community Health Centers and our founding Dean Jack Dillenberg envisioned the dental school’s creation as a strategy to improve access to care. Community health centers continue to work with us each year to identify and recruit students,” Bob notes, which is why some individuals enter the dental school having already earned an M.P.H. degree.

ASDOH is not alone in offering a public health certificate or the opportunity to earn a dual degreean option at roughly half of our schools. Nevertheless, public health is not necessarily integral to the teaching of dentistry.

“In dental school, usually we say, if you’re interested in public health, it’s over here,” says Caswell Evans, D.D.S., M.P.H., Associate Dean for Prevention and Public Health Sciences at the University of Illinois at Chicago College of Dentistry (UIC COD). He would like to see public health’s often-peripheral status change, and he’s looking for opportunities to make dentistry’s social mission more visible in a consistent and organized way.

Like ASDOH, UIC COD places a high value on educating students in the community, where they can be exposed to the people most in need of dental services. UIC COD’s commitment to public health and community engagement is visible through 16 weeklong extramural rotations in mission-driven community-based clinics. Classes on access to care, health inequities, social justice and the ways in which delivery systems strive to address these issues are also part of the mix.

Another exemplar in this regard is the East Carolina University School of Dental Medicine (ECU SoDM), which I wrote about in January. The school’s unique model of distributing clinical education across ECU SoDM clinics in underserved regions of the state gives students an acute awareness of their patients’ circumstances. As the Dean, D. Gregory (Greg) Chadwick, D.D.S., M.S., put it when we spoke, placing students in the community to care for patients is “more than just filling and drilling and extracting. It’s appreciating how people live.”

Greg is pleased with his school’s record of placing graduates in safety-net settings, but in his view, the availability of more dental providers will not be sufficient on its own to solve North Carolina’s oral health problems. Achieving that goal will require a public health perspective. “You’re going to improve oral health with community involvement, through prevention, by having your graduates understand that they have to be leaders in the community,” he insists.

Helping students develop that public health perspective appears to be closely tied with the time they spend immersed in the community. Although the Commission on Dental Accreditation’s Accreditation Standards for Dental Education Programs require that schools make community-based experiences available, these experiences are not mandatory, and their extent varies considerably from institution to institution. Nevertheless, we’ve come a long way from the days when all clinical education occurred within the footprint of the dental school. Today, a considerable portion of clinical education happens in the community, making it easier for students to grasp the public health nature of their work.

Indeed, each year the ADEA Survey of Dental School Seniors reveals the increasing value that students place on their community-based experiences and the increased likelihood that they will expand the pool of patients they treat as a result. These developments are welcome and worth building on, but so are many other facets of what we do. As Bob put it, “Each school has its own unique mission and focus. You have to work with what’s consistent with the overall university mission.”

I agree. Even at ECU SoDM, where Greg calls social mission “part of our DNA,” other priorities also demand attention.

“We are having more and more conversations about whether it is enough to educate people who are technically skilled and kind and competent,” Margaret (Maggie) Wilson, D.D.S., M.B.A., ECU SoDM’s Vice Dean and Associate Dean for Student Affairs, told me. “I’m hearing from some colleagues that it may not be enough, but it gets down to resourcesnot just money but also your energy, your time.”

Inevitably, all dental schools must first focus on helping students gain the skills they need to provide care for individual patients. Beyond that, institutional missions will vary based on their history and tradition. For some, the emphasis will be on research and the creation of new knowledge, treatments and technologies. For others, advancing the quality of teaching and learning will take center stage.

Whatever these distinctions, our institutions must also attend to their social missions, consider how they can improve the health of the communities they serve and prepare their graduates to contribute to the public good. These goals are a natural fit for a profession rooted in prevention. Viewing what we do through a public health lens will help us achieve these aims.

Dr. Richard ValachovicIn this month’s letter, ADEA President and CEO Dr. Rick Valachovic talks with a champion of dental and primary care integration.

Michael Glick, D.M.D., has a vision for dentistry’s future. The University at Buffalo School of Dental Medicine (UB SDM) Professor sees dentistry becoming a portal to primary care.
During his tenure as Dean at UB SDM, Michael put this vision into practice. The school’s dental clinics became places where students routinely screened patients for hypertension, diabetes, and, if patients chose, HIV. The clinics also became exemplars of interprofessional care, with pharmacists, librarians and social workers on hand to help interpret patients’ medication histories, find evidence to guide treatment and connect patients to follow-up medical care and other resources.

Why introduce primary care screening into an academic dental setting? “As health care professionals, we can do much more to impact our patients’ health than we’re doing right now,” Michael told me. Most people who arrive at the dental office perceive themselves as healthy, but noncommunicable diseases take a long time to develop. By the time there are signs and symptoms, the diseases may be far advanced.

Michael considered this problem and then posed a question: “Would it be possible in a dental office to do some screening for individuals who may be at risk for developing these diseases?” His answer was, “Yes,” and several studies that he and others have conducted support this conclusion. Not only is such screening feasible, it is also accepted, even welcomed, by dentists, patients and physicians.

These findings have implications for academic dentistry. Screening for hypertension has become the norm in dental school clinics, and a number of schools are engaged in other types of primary care screening as well. (I wrote about some of these in 2013.) But the integration of primary care screening within a dental clinic setting is far from universal.

I asked Michael what would have to change for every dental school to screen for a few common health conditions in its clinics as he and his colleagues have done at Buffalo. “Not much,” he responded. “The expertise exists in every dental school to do these screenings. It’s just a matter of making it a priority.”

That said, Michael acknowledged that integrating primary care screening in nonacademic clinical practices is another matter. Many private practice offices don’t want to take on procedures that are not reimbursable by third parties. Some dentists feel uncomfortable screening for conditions that don’t manifest themselves in the oral cavity. And others have a legitimate fear that they would be courting trouble if they screen and diagnose patients but don’t provide appropriate follow-up care.

“You need a support system to ensure that the dentist knows what to do next. In a dental school, you have that support system, but you may not have that in private practice,” Michael said.

Nevertheless, Michael argued that such conditions as uncontrolled hypertension have costly consequences, and if timely screening in a dental office can mitigate those, it makes sense to integrate screening in dental practices—both for the health of patients and to reduce health care costs. As health care moves toward a value-based reimbursement system, the logic of this approach becomes all the more clear.

Michael has wrestled with some of these larger issues in his role as co-chair of the FDI World Dental Federation’s Vision 2020 think tank. In 2016, the FDI, of which ADEA is a supporting member, released a new definition of oral health, which reads: “Oral health is multi-faceted and includes the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and without pain, discomfort and disease of the craniofacial complex.”

The definition further states that oral health:

  • Is a fundamental component of health and physical and mental well-being. It exists along a continuum influenced by the values and attitudes of individuals and communities.
  • Reflects the physiological, social and psychological attributes that are essential to the quality of life.
  • Is influenced by the individual’s changing experiences, perceptions, expectations and ability to adapt to circumstances.

“This new definition moves dentistry from treating disease to treating a person with disease,” in Michael’s view. This shift in thinking aligns with his goal to graduate health care professionals “that happen to be dentists” as well as with trends in health care reimbursement. Michael told me that third-party payers have expressed a willingness to pay for oral health rather than dental procedures, especially as care moves to a context in which the patient is looked at holistically. He is now working with others at the FDI to develop a tool to measure oral health in all its dimensions—a step that could facilitate dentistry’s transition to value-based payment.

When we spoke last month, Michael laughed as he thought back to how he became a champion of dentistry’s role in primary care.

“I applied to both medical and dental school and could’ve gone to either,” he said, “but I thought, ‘I don’t want to be with sick people. I don’t want to be in a big institution,’ so I decided to go to dental school.”

As you may already know, it wasn’t long before Michael deviated from that path—entering academic dentistry and specializing in the care of individuals with complex medical issues, including people who had organ transplants and people with HIV/AIDS and other communicable diseases. He sees primary care activities as a natural extension of that work, having always viewed dentistry as a part of medicine.

Michael expects the relationship between dentistry and primary care to evolve slowly, but he is eager to see dentistry do more in this realm. As he and his co-author from Touro College of Dental Medicine at New York Medical College, Barbara Greenberg, M.Sc., Ph.D., wrote in the Journal of Dental Education last year, prevention and early intervention are effective for reducing the incidence and severity of increasingly prevalent conditions, such as cardiovascular disease, diabetes mellitus and infections from HIV and hepatitis C—all associated with significant morbidity and health care costs. Dental settings have shown themselves to be suitable for screening and referring patients with these conditions, so why not prepare dentists to engage in these activities?

Beyond screenings, Michael envisions a future in which dentists might give immunizations and perform other functions currently delegated to physician assistants and others, especially in regions where physicians are scarce. Currently, state law prevents these practices, but who knows what tomorrow may bring? In the meantime, let’s seize the opportunities before us, and begin to view the dental office as a portal to primary care.

Dr. Richard ValachovicIn this month’s letter, Dr. Rick Valachovic talks with North Carolinians to find out how a new model of dental education is bringing dental care to rural parts of the state.

What happens when you recruit students who are committed to rural practice and prepare them to be dentists in rural practice environments? Can such an investment make a measurable difference in improving access to dental care?

East Carolina University (ECU) set out to answer these questions when it opened the doors of its School of Dental Medicine (SoDM) in 2011. The plan for the school had many unique features, which I’ve described in this column before, but what most set this groundbreaking venture apart was the decision to move a substantial portion of clinical education to the community by building eight, identical 16-chair Community Service Learning Centers (CSLCs) in underserved areas across the state. Senior dental students—all of whom hail from North Carolina—spend three nine-week rotations at the CSLCs, practicing dentistry alongside ECU SoDM faculty and residents.

The first entity to partner with ECU to bring dental education to a rural corner of the state was a Federally Qualified Health Center (FQHC) in Ahoskie, a town of nearly 5,500 in eastern North Carolina. Health Center Chief Executive Officer Kim Schwartz, M.A., remembers well her first meeting with Greg Chadwick, D.D.S., M.S., ECU SoDM’s Dean. The conversation that ensued was scheduled for 45 minutes. It lasted almost three hours, and after three years of planning, development and construction, the Roanoke Chowan Community Health Center in Ahoskie became the first FQHC in the nation with a co-located dental school clinic and residency program.

Dentistry’s arrival in Ahoskie worked out well, not least for Nicole Beasley, D.M.D. She grew up in Jackson, about 30 miles away, and recalls having to drive an hour to get to a dentist when she was young. She saw a career opportunity in her community’s lack of dental care and chose to attend ECU SoDM for two reasons: She felt at ease there, and she knew its mission dovetailed with her own aspirations.

After graduation, Nicole completed an Advanced Education in General Dentistry residency at the Ahoskie CSLC, and today she practices at an FQHC in Jackson. “I had always thought I wanted to be back home, but after graduating, I was weighing my options,” she told me. “When it came down to it, I just knew that the whole reason I went to dental school was to be here in the first place. Here’s where I can do the most good.”

Maggie Wilson, D.D.S., M.B.A., Vice Dean and Associate Dean for Student Affairs at ECU SoDM, couldn’t agree more with Nicole’s assessment. “It’s only once our graduates are out there in a practice, in a rural community or an underserved area, that our mission is realized,” she told me.

Maggie and Greg put me in touch with Nicole and another graduate who exemplifies ECU SoDM’s promise. Gustavo (Gus) Gasca, D.M.D., had difficulty accessing dental care as a child because he moved from Florida to North Carolina to Michigan and back each year as his Mexican-born parents followed the harvest. Gus told me he and his siblings needed to have primary teeth extracted, and their permanent teeth came in misaligned. In his brother’s case, the problem was extreme enough to draw unwanted attention from his middle and high school classmates.

As it happened, the family’s desire to see Gus go to college led to a marked improvement in their oral health. So Gus could take advanced placement courses, the family decided to live in North Carolina year-round, a choice that made the family eligible for Medicaid. Gus’s mother was finally able to address her dental pain, and his brother got the orthodontic treatment he needed.

“Getting braces changed my brother’s self-esteem,” Gus told me, and watching that transformation eventually led Gus to pursue a career in dentistry. Today he is practicing at Pollock Advanced Dental Group in Burgaw, where he primarily treats Medicaid patients and is the only dentist in a 20-mile radius who speaks Spanish. He is delighted to be “giving back.”

Where are ECU SoDM’s other graduates?

  • The majority—83 of 148—are practicing in North Carolina.
  • Seven are practicing out of state, and two will likely return when their spouses complete residencies.
  • Another 38 graduates are in General Practice Residencies.
  • Fifteen are pursuing advanced dental specialties.
  • Two are in the military.
  • One is a faculty member at ECU SoDM.

Perhaps the better question is: Are these graduates engaged in work aligned with ECU SoDM’s mission of placing dentists in rural, underserved communities? Apparently many are.

“We’d like to track this by county,” Greg told me, “but even in doing that … you have to peel the onion back. One of our graduates is working in Mecklenburg County. That’s urban, but he’s working in two Medicaid practices and seeing 100% Medicaid patients, so his work is clearly mission aligned.”

Back in Ahoskie, Kim sees ECU SoDM’s mission in practice every day. The Ahoskie CSLC provides continuous care for an established panel of patients and prioritizes care for individuals who arrive at the FQHC with dental needs. An arrangement with the Roanoke-Chowan Foundation allows the center to provide complex procedures on a sliding fee scale for uninsured patients.

Kim calls the impact of this care “miraculous.” One patient saw her diabetes improve after receiving dentures that allowed her to get off a soft diet of applesauce and sweet potatoes. Another patient found a job after his missing front teeth were replaced. A third was able to sleep again after being treated for the condition causing her dental pain, Kim told me. “To literally have this clinic right here in Ahoskie, this little rural town in eastern North Carolina, and to be known for it. … People are very proud of that fact and proud of the association with ECU,” she says. “They finally have an option for oral health and (this is not too strong a word) hope that there’s someone looking out for their oral health needs.”

There’s no question in Kim’s mind that by providing one-stop shopping for medical and dental care at Ahoskie, ECU SoDM has improved the lives of some of the health center’s most vulnerable patients. The school’s statewide numbers are also impressive. Since that first CSLC opened in 2012, Greg told me, ECU SoDM students, residents and faculty have treated 49,720 patients at the Greenville campus clinic and the eight CSLCs distributed throughout the state. More than 15,000 of those patients were enrolled in Medicaid.

These numbers are welcome news in a state with one of the lowest dentist-to-population ratios, roughly five per 10,000. According to the Health Resources and Services Administration, North Carolina has roughly 140 Health Professional Short Areas when it comes to dental health. So why are so few dentists practicing in rural parts of the state?

When I asked Nicole if she had thought about opening her own practice in the area, she expressed doubts about her ability to make that happen. She says it’s difficult to find front-desk staff, dental assistants or a business manager. Additionally, because so few people have private insurance, it can be challenging to develop an adequate patient base. Instead, she has set her sights on one day being the Ahoskie CSLC clinic director—a goal with which no one at her alma mater will argue.

Despite the obstacles, rural practice can be financially viable. “A lot of people look at the Medicaid fee scale and say, no way can I take part in that,” Maggie observes, but that reaction is too hasty, she tells students. “You can serve Medicaid patients and still earn enough to pay off your loans, send your kids to college, buy a home, etc., but you need a well-designed vision and a practice plan.”

To equip students with the tools they need to care for underserved patients in a sustainable way, the ECU SoDM curriculum explores public policy, financial barriers to care and the sociology of poverty. The school has also hired Hillary Harrell, who serves as Student Financial Support Manager. She works with students to help them figure out how they will pay for dental school, teaches in the practice management curriculum, and assists students, residents and graduates with identifying practice opportunities that are aligned with ECU’s mission. Her support ranges from critiquing business plans to helping students arrange for loan repayment to coaching students on salary negotiation. With a number of first-generation college students among ECU SoDM’s graduates, many without a family member to guide them, Maggie says, Ms. Harrell can be a lifeline.

So, what’s next for Ahoskie? According to Kim, the CSLC could use several more dentists just to meet the routine needs of the patients at the FQHC. That may happen one day, but Greg plans to proceed cautiously.

“We have room for expansion within the facilities, but we’re trying to make the center sustainable—not just economically but also educationally. We’re not just a safety net clinic. Students need to do crowns, bridges, root canals, partials and not just provide basic care.” Greg echoes Nicole’s concerns when he adds, “In rural areas, it’s hard to recruit a mix of patients who can afford more complex treatments, and Medicaid doesn’t cover much.”

It has been clear for years that Greg and his colleagues are contributing to the transformation of dental education. Six years into ECU’s experiment, it seems irrefutable that the CSLCs are achieving their early goals and having wider impacts. By bringing dental care to rural populations, ECU SoDM students, residents, faculty and graduates are not only making a measurable dent in their state’s access-to-care challenges, they are also helping to reinvigorate communities. When CSLC practitioners eliminate pain and restore smiles, they participate in a process that can lead to employment and improved economic circumstances. Kim also reports that the presence of young dentists drawn from the community is inspiring a new generation to consider pursuing dental careers.

These are some of the good things that happen when you recruit students who are committed to rural practice and prepare them to be dentists in rural practice environments. I look forward to hearing more good news as the program grows.