Leadership in Dentistry: Guiding the Future and Honoring the Past
A publication advancing ethics, professionalism, leadership, and excellence in dentistry.
The Journal of the American College of Dentists (ISSN 0002-7979) is published by the American College of Dentists, Inc.
103 North Adams Street Rockville, Maryland 20850. Copyright 2025 by the American College of Dentists.
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For bibliographic references, the Journal is abbreviated J Am Col Dent and should be followed by the year, volume, number, and page. The reference for this issue is J Am Col Dent 2025; 91 (2): 1-52.
Communication Policy
It is the communication policy of the American College of Dentists to identify and place before the Fellows, the profession, and other parties of interest those issues that affect dentistry and oral health.
The goal is to stimulate this community to remain informed, inquire actively, and participate in the formation of public policy and personal leadership to advance the purpose and objectives of the College.
The College is not a political organization and does not intentionally promote specific views at the expense of others. The positions and opinions expressed in College publications do not necessarily represent those of the American College of Dentists or its Fellows.
Objectives of the American College of Dentists
THE AMERICAN COLLEGE OF DENTISTS, in order to promote the highest ideals in health care, advance the standards and efficiency of dentistry, develop good human relations and understanding, and extend the benefits of dental health to the greatest number, declares and adopts the following principles and ideals as ways and means for the attainment of these goals,
A. To urge the extension and improvement of measures for the control and prevention of oral disorders;
B. To encourage qualified persons to consider a career in dentistry so that dental health services will be available to all and to urge broad preparation for such a career at all educational levels;
C. To encourage graduate studies and continuing educational efforts by dentists and auxiliaries;
D. To encourage, stimulate, and promote research;
E. To improve the public understanding and appreciation of oral health service and its importance to the optimum health of the patient;
F. To encourage the free exchange of ideas and experiences in the interest of better service to the patient;
G. To cooperate with other groups for the advancement of interprofessional relationships in the interest of the public;
H. To make visible to professional persons the extent of their responsibilities to the community as well as to the field of health service and to urge the acceptance of them;
I. To encourage individuals to further these objectives and to recognize meritorious achievements and the potential for contributions to dental science, art, education, literature, human relations, or other areas which contribute to human welfare—by conferring Fellowship in the College on those persons properly selected for such honor.
Executive Director
Michael A. Graham
Editor
Toni M. Roucka, RN, DDS, MA, FACD
Program Director
Suzan Pitman
Publication Manager, JACD
Communications Director
Matthew Sheriff, BA, MS
Editorial Board
Albert Abena, DDS, JD, FACD
Odette Aguirre, DDS, MS, MPH, FACD
Joshua Bussard, DDS, FACD
Michael Maihofer, DDS, FACD
Ethan Pansick, DDS, MS, FACD
Vishruti Patel, DDS, FACD
Catherine Frankl Sarkis, JD, MBA
Earl Sewell, MFA
Carlos Smith, DDS, MDiv, FACD
Kristi Soileau, DDS, MEd, MSHCE, FACD
Pamela Zarkowski, JD, MPH, FACD
Officers
Robert A. Faiella, President
Terry L. Norris, President Elect
Peter H. Guevara Vice President
Joseph P. Crowley, Treasurer
Teresa A. Dolan, ACD Foundation President
Regents
Julie A. Connolly, Regency 1
Sean C. Meehan, Regency 2
Robert G. Plage, Regency 3
Brenda Thompson, Regency 4
Nancy Y. Larson, Regency 5
Kristi M. Soileau, Regency 6
Ned L. Nix, Regency 7
Robin Henderson, Regency 8
Krista Jones, At Large Regent
Toni Roucka, At Large Regent
Pamela Alston, At Large Regent
Sreenivas Koka, At Large Regent
Pamela Zarkowski, ASDE Liaison
Daniel Carney, SPEA Liaison
Joshua Bussard, Regent Intern
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Letters from Readers
The Journal of the American College of Dentists (JACD) welcomes letters to the editor. The opinions and views expressed in letters to the editor submitted to the JACD are those of the individual authors and do not necessarily reflect the opinions, positions, or policies of the JACD, its editorial board, or the American College of Dentists. The JACD reserves the right to edit submitted letters for clarity, length, and adherence to our editorial guidelines. The publication of a letter does not imply endorsement by the JACD or its affiliates. Readers are encouraged to critically evaluate the content of each letter and to consider it within the broader context of scientific and professional literature. Submit letters to editor@acd.org.
4 The Ethical Imperative of Leadership in Dentistry
Michael A. Graham, Executive Director; Toni M. Roucka, RN, DDS, MA, FACD
12 Who Are the Future Leaders in Dental Education?
Marsha A. Pyle, D.D.S., M.Ed.; Karen P. West, D.M.D., M.P.H.
19 The Dark Side of Leadership: Finding Where You Belong
Bo Yu, DDS, PhD; Steven Milgazo, BA, MS; Elizabeth O. Carr, DHA, FACD (Hon); Sreenivas Koka, DDS, MS, PhD, MBA, MAS, FACD
24 Forging the Future: Cultivating Leaders for the Evolving Dental Profession at New York University
Richard W, Valachovic, DMD, MPH, FACD
30 Young Dentist Leadership: The Future of Oral Health Care
Joshua D. Bussard, DDS, FACD, FPFA
33 Navigating the Meaning of the Social Contract in Dentistry as a Former Dental Staff and Current Dental Student
Sophia Kim, HBSc
42 From the Archives: Leadership and the Professional Ethic
Govenor Winfield C. Dunn
The Ethical Imperative of Leadership in Dentistry
Michael A. Graham, Executive Director; Toni M. Roucka, Editor JACD
Leadership is one of the four pillars of the American College of Dentists, taking its place alongside excellence, ethics, and professionalism. Leadership in dentistry carries an inherent ethical responsibility to uphold the trust and well-being of those who depend on us—our patients, our teams, and the community. When leaders in our field exercise their influence, they wield significant power over patient outcomes, industry standards, and public health policy. With this influence comes an imperative to act ethically, to ensure that decisions are guided by a commitment to care, integrity, and the best interests of those we serve. At the heart of leadership in dentistry lies a truth well-illustrated by the adage: “With great power comes great responsibility.” As leaders, dental professionals are not only in positions of authority but are entrusted with the welfare of patients, the growth of the profession, and the ethical standards that define our community.
“ With great power comes great responsibility.”
Our duty is to remember that the individuals who sit in our chairs or rely on us for professional self-regulation place their trust—and their health—in our hands.
In dentistry, the power entrusted to leaders is both technical and moral. Dental leaders often make decisions that directly impact patient health and safety, from shaping care standards and teaching the next generation to implementing new technologies and providing direct care at the chairside. Each of these decisions holds the potential to improve lives but also carries risks. The ethical imperative here is clear: Leaders must not only consider what is possible but what is prudent, prioritizing patient welfare above profit, efficiency, or prestige. Our duty is to remember that the individuals who sit in our chairs or rely on us for professional self-regulation place their trust—and their health—in our hands.
Furthermore, the expanding recognition of oral health as a crucial component of systemic health underscores the broader responsibility of dental leaders within the healthcare system. This integrated role amplifies our ethical duty to advocate for policies and practices that promote health equity, accessible care, and collaboration across disciplines. As stewards of our profession, dental leaders must ensure that our field’s voice is a force for positive change, one that respects patient dignity and acknowledges the interconnectedness of health.
Ethical leadership in dentistry also involves cultivating a culture of transparency and accountability. Patients rely on us to make honest, evidence-based recommendations and to com-
municate openly about risks, benefits, and alternatives. This commitment to transparency extends beyond patient interactions to influence how we lead within our teams and broader communities. Leaders are responsible for setting a standard of ethical integrity that permeates the workplace, fostering an environment where ethical dilemmas are discussed openly and where team members feel supported to prioritize patient-centered care.
Finally, those in positions of power tasked with preparing the next generation of practitioners must demand that we invest in mentorship and create opportunities for emerging professionals to understand their own responsibilities within the field. In doing so, we are not only imparting clinical skills but instilling values that will guide future leaders to use their influence with a sense of duty, humility, and accountability.
Ultimately, the ethical responsibility of dental leadership goes beyond the individual; it is a collective duty to safeguard the trust placed in our profession. The power we hold is a privilege, one that must be exercised with unwavering dedication to ethical principles, compassion, and a steadfast commitment to the health and dignity of those we serve. As leaders, we must hold ourselves to the highest standards, remembering that our legacy lies not in the authority we wield but in the care and respect we show to the people who depend on us.
Defining Leadership
Kathleen O’Loughlin, DMD, MPH
At one time or another, it is likely that we have all worked for or reported to leaders who were great, mediocre, or just plain awful. Have you ever wondered why there exists such a wide range of “I am in charge” talent, or lack thereof, in the real world? How does one define “leadership,” and how do individuals become “leaders”?
I have thought about these questions a lot, given my experience in practicing dentistry in both a hospital-based and private practice, as a class officer, as a faculty member, as the CEO of a dental benefit company, and most recently as the executive director of the American Dental Association for over a decade. I have met hundreds of “leaders” by title or behavior—good, bad, and ugly.
Many great leaders I have known did not possess the charismatic personality traits that are often associated with “natural” leadership. More often, humility and curiosity are the most powerful traits a leader can possess.
DEFINING LEADERSHIP
Much research on leadership has been published in the realm of leadership in business. What makes an effective leader? What traits do they possess? How do great leaders make decisions? What shared experiences do they possess? The Harvard Business Review is a great source for many relevant articles. Can leadership be defined? My personal definition is “a person who is able to influence or inspire others to achieve a common goal or purpose through joint action in a manner consistent with the vision and core values of the leader.” It is not “one who commands and controls others.”
Notice that my definition does not include traits, personality styles, gender, ethnicity, experience, or age. You can be a leader simply by convincing others to follow you to achieve a shared goal. What differentiates a great leader from a terrible one are core values.
THE CRITICAL NATURE OF CORE VALUES
Core values can be positive (builders) or negative (destroyers). The leaders I admire most possess positive core values such as integrity, selflessness, humility, gratitude, curiosity, authenticity, empathy, trustworthiness, and passion for a cause bigger than themselves. I have also worked with or for those who possessed negative core values: hubris, arrogance, selfishness, narcissism, paranoia, a lack of respect for others, no accountability, and a lack of empathy for others. I was once interviewed for an executive position, and during the interview, the interviewer spoke only of himself and his accomplishments. I was not asked any relevant questions about my experience or capacity to perform the job. I chose not to work for that person. That person was ultimately replaced after a few years, but it cost the company both personnel and profits. He possessed negative core values.
If “builder” core values are in place, one can learn the traits and skills necessary for effective leadership. If “destroyer” core values are in place, one may lead through fear and intimidation, but the long-term success and legacy of that leader will be limited. History contains many examples of those who were considered great leaders, but in the end, they destroyed value for their companies, communities, or countries. Negative core values create unsafe conditions for those involved with that leader whose followers are driven to comply because of the fear of humiliation and intimidation through retribution. The act of screaming obscenities at an airport gate agent due to a delayed flight is driven by negative core values.
LEADERSHIP IS LEARNED
I believe that leadership can be learned. Leadership academies are proliferating within the dental community to answer the urgent need for future leaders. These learning environments offer dentists the opportunity to acquire the skills necessary for effective team leadership. Many great leaders I have known did not possess the charismatic personality traits that are often associated with “natural” leadership. More often, humility and curiosity are the most powerful traits a leader can possess.
I once had the honor to share a conversation with a person I regard as a great leader, Malala Yousafzai, who won the Nobel Peace Prize at age 17 for promoting the education of young girls in Pakistan. She appeared to me humble, curious, a great listener, and cared deeply about her cause. She could also laugh at herself in the most endearing way! Ruth Bader Ginsburg is another one of my “heroic” leaders. I greatly admire several business leaders as well. Warren Buffet, Indra Nooyi, Meg Whitman, and Mary Barra are a few who appear to possess “builder” core values.
Defining Leadership
Kathleen O’Loughlin, DMD, MPH
Most of us can name at least a few toxic leaders— Joseph Stalin, Adolf Hitler, and Pol Pot, for example. The more remarkable toxic business leaders seem to always be around causing chaos for their employees and shareholders—e.g., Jeffrey Skilling, Steve Wynn, and Elizabeth Holmes. Most recently, the CEO of Steward Health Care, Dr. Ralph de la Torre, appears to have enriched himself on the backs of patients at several bankrupt hospitals across the country, including one that employed me, St. Elizabeth’s in Brighton, Massachusetts. These individuals appear to have had strong “destroyer” core values of greed and narcissism.
RESOURCES FOR LEADERSHIP SKILL BUILDING
Credible leaders have written many books on leadership skills that can be developed through self-awareness and practice.
My favorite leadership books include the following:
• Leaders Eat Last by Simon Sinek
• Start with Why by Simon Sinek
• Good to Great: Why Some Companies Make the Leap…And Others Don’t by Jim Collins
• True North by Bill George
• The Power of a Graceful Leader by Alexsys Thompson
• The 21 Irrefutable Laws of Leadership by John C. Maxwell
• Tipping Point: How Little Things Can Make a Big Difference by Malcolm Gladwell
I have read all these books more than once and have tried to emulate the principles contained in each book. It is a journey that will never end. Like all skill building, it requires time and practice. One must be self-aware and have the ability to self-evaluate along the way. None of us are perfect! We make mistakes. I can vividly remember when I let my leadership skills lapse—I did not listen, I
did not hold myself accountable, I communicated poorly, and I failed to show compassion. The list is long. By being mindful of how I measured up to the high standards discussed in my favorite leadership books, I found motivation to continue aspiring to be a great leader and “builder” of people. I am still “a work in progress.”
Bill George focuses on “authentic leadership”— leading with purpose, values, and principles, leading with heart, cultivating long-term relationships, and demonstrating excellence through self-discipline.
Jim Collins describes “level 5 leadership” in Good to Great: Why Some Companies Make the Leap… And Others Don’t as the apex of great leaders.
Level 1: be a highly capable individual— be able to get the job done.
Level 2: be a contributing team member— give credit where credit is due.
Level 3: be a competent manager—be fair and kind while expecting results.
Level 4: be an effective leader—inspire those around you to achieve great results.
Level 5: build an enduring greatness through a paradoxical blend of personal humility and professional will.
Leadership, which is based on positive core values, requires strong communication skills, both written and oral. Preparation is key, along with asking others for input on what you are trying to communicate with presence. Humility is required to accept help with tasks—no one is an expert in everything. I was fortunate in my career to have excellent coaches (primarily people who reported to me) who helped me write coherent paragraphs and speak with energy and passion. As John Maxwell outlines in his book, secure leaders empower others, and as a leader, you are defined by whom you surround yourself with. One must touch the heart
Every leader must be able to manage conflict positively, whether in their personal or professional lives. How we handle conflict among team members really matters. Great teams require a strong coach who can step in when necessary to help team members work through the inevitable conflicts that arise when stakes are high and people care deeply.
before the hand. Great leaders build trust within and outside the organization. Leaders must keep the promises made.
Experience has shown me that trust is built over time. One of the best books on building trust is by Stephen M.R. Covey, The Speed of Trust: The One Thing That Changes Everything. It’s hard work to build trust, and it is extremely easy to lose it. One misstep, one lie, one deception, one failure to act when the stakes are high, one failure to recognize the team when the credit for success is theirs, one failure to communicate, one instance of spinning the truth, one failure to acknowledge mistakes can all lead to mistrust.
As Covey explains in his book, trust is the key to everything. There are four pillars of credibility described in his book: integrity, intent, capability, and results. Integrity implies telling the truth, demonstrating respect, creating transparency, righting wrongs, and showing loyalty. Listen first, talk less, keep commitments, and extend trust to others. Deliver results, focus on getting better, confront reality, clarify expectations, and commit to accountability. These are demanding challenges that require focused energy and discipline. I have loved working with others, whether it was in a
dental practice, in a university, in business, or in an association. I am grateful for others who demonstrate commitment to a common purpose. It makes going to work every day a joy! High trust makes the task easier and enables longer-lasting results— results that the team is proud of leading to a great legacy. High-trust environments create the stage for solving any problem or conflict.
LEADER AS CONFLICT MANAGER AND COACH
Every leader must be able to manage conflict positively, whether in their personal or professional lives. How we handle conflict among team members really matters. Great teams require a strong coach who can step in when necessary to help team members work through the inevitable conflicts that arise when stakes are high and people care deeply.
One of my favorite TV shows is Ted Lasso, which includes many leadership lessons in each script. “Believe in yourself. Doing the right thing is never the wrong thing. All people are different people. See good in others. Courage is about being willing to try. Vulnerability is a strength, not a weakness. Tell the truth. Winning is an attitude.” Sound familiar?
Defining Leadership
Kathleen O’Loughlin, DMD, MPH
In the show, Ted focuses not on the game but on making each player the best person they can be on and off the field. Is that not what all great leaders should aspire to? To help individuals be the best they can be, leaders must be able to assist them with effective conflict management. I was one of seven children and a middle child. As a child, I avoided conflict or simply gave in. This is not conflict management.
One of the best team development programs that I have ever participated in was “Crucial Conversations: Tools for Talking When the Stakes Are High,” based on the book by Kerry Patterson, Joseph Grenny, Ron McMillan, and Al Switzler. This workshop provided great techniques for managing conflict that hinders a team’s achievement. This resource builds on the emotional intelligence skills that great leaders must possess. Unresolved conflict erodes team trust and confidence. There are five conflict resolution strategies that most people use: avoiding, competing, accommodating, compromising, and collaborating. In my experience, the most effective management technique is the Crucial Conversation technique. These carefully constructed conversations are needed when the stakes are high, the differing views are broad, and strong emotions are involved. The techniques are sometimes difficult to master, but with practice, effective leaders can intercept conflict before it destroys a team. The following are steps in this process:
Step one: Know your heart and stay focused on the common goal, the ultimate objective for both parties. No judging allowed.
Step two: Make the environment safe for both parties by using safe speech, safe body language, and safe voice volume.
Step three: Make the content safe. Is there a mutual purpose within the conflict, and is there mutual respect?
Step four: Control emotions and actively listen to both parties —rethink the story and see the other side by sharing stories. Encourage others to share their facts and ask, “What am I missing here?” or say, “Help me understand the issues at stake here.” Listen first and respond carefully.
Step five: Explore others’ perspectives and path forward. Agree to build and compare options.
Step six: Move from conversation to resolving the conflict and agreeing to solutions that can be monitored over time. Make assignments and follow through—hold each party accountable.
I have found that using this technique resolves conflict most of the time. Leaders must have the courage to address conflicts as soon as they appear and have these sometimes difficult conversations calmly and with high emotional intelligence. Procrastination is the enemy when a serious conflict arises. Using these techniques, over time, team members learn to solve conflicts independently before they become significant problems.
SUMMARY
Great leaders possess positive core values that extend trust and inspire people to follow and achieve common goals. Leadership skills can be learned, and it is a lifelong process for most people. Communicate carefully, be self-aware, be kind, admit mistakes, self-assess, be emotionally intelligent, accept help, learn from the best, and do not fear conflict. Leaders can manage it!
RESOURCES
1. Patterson K, Grenny J, McMillan R, Switzler A. Crucial Conversations: Tools for Talking When Stakes Are High. 3rd Edition. McGraw-Hill Contemporary; 2002.
2. Collins, J. Good to Great: Why Some Companies Make the Leap…And Others Don’t. Harper Collins N.Y.; 2001.
3. George, B., Sims PE. True North: Discover Your Authentic Leadership. John Wiley & Sons; 2007.
4. Gladwell, M. The Tipping Point: How Little Things Can Make a Difference. Little, Brown; 2000.
5. Maxwell, JC. The 21 Irrefutable Laws of Leadership, 25th Anniversary Edition Harper Collins; 2022.
6. Sinek, S. Start With Why: How Great Leaders Inspire Everyone to Take Action. Penguin Random House; 2009.
7. Sinek, S. Leaders Eat Last: Why Some Teams Pull Together and Others Don’t. Penguin Random House; 2017.
8. Thompson, A. The Power of a Graceful Leader. Lioncrest Publishing; 2021.
9. Covey, SMR. The Speed of Trust. Simon & Schuster; 2008.
Who Are the Future Leaders in Dental Education?
Marsha A. Pyle, D.D.S., M.Ed.
Senior Chief, Knowledge, Engagement, and Development
Senior Scholar in Residence American Dental Education Association
Karen P. West, D.M.D., M.P.H. President and CEO, American Dental Education Association
The leaders of tomorrow need to be developed across traditional and new-age leadership characteristics. Current leaders can influence the future by cultivating strong development programs and succession planning to meet the evolving needs within and across the oral health education landscape.
ABSTRACT
Future leaders in oral health education will need a refined traditional skillset characterized by virtues, core competencies, and emotional intelligence. However, the lingering impact of the COVID-19 era and its influence on workforce development and talent retention have altered approaches to leadership training and succession planning in business and education sectors. In addition to adaptability and flexibility, future leaders require dynamic strategic skills to navigate the rapid pace of change plus the exponential advancements in technologies affecting equipment, software, and decision-making processes. The leaders of tomorrow need to be developed across traditional and new-age leadership characteristics. Current leaders can influence the future by cultivating strong development programs and succession planning to meet the evolving needs within and across the oral health education landscape.
INTRODUCTION
Looking to the future leadership needs, characteristics, and human capital in oral health education requires a fresh perspective in the post-pandemic era. The past five years have provided valuable insights into global crisis management, shaping predictions about the leadership skills and competencies essential for succeeding in a rapidly changing world. Critical to the conversation is the development of highly skilled leaders who possess the long-held core competencies of leadership, who have mastery of emotional intelligence skills, and who can anticipate an evolving, technologically laden environment of change and uncertainty.
Prior to 2020, there were emerging indications of the need for new approaches to leadership in oral health education, like in many other healthcare fields. At the highest levels, oral health education
began seeing a generation of deans retire from their roles while universities were also experiencing higher turnover in the roles of provost, university presidents, and chancellors.1 In the wake of the pandemic, the turnover accelerated. The American Dental Education Association (ADEA) has periodically tracked trends among U.S. dental deanships.2,3,4 In the most recent survey from 2021, the tenure of dental deanships fell from 7.9 years in 2014 to 6.6 years. Since 2020, an astounding 65% of U.S. dental deanships have turned over; some have turned over several times. Gaps in readiness of the pool of qualified candidates for leadership led to identified needs for succession planning and new and fast-tracked leadership development programs to prepare the next generation of leaders for success in oral health education.
Recently, the tenure of deanships has continued to decline, with several notable short tenures ranging from six months to three years, with abrupt transitions to interim leadership plus prolonged searches after failures to identify suitable candidates.5 More frequent leadership turnover lends itself to the potential for slowed growth and progress or destabilization of programs and schools. At a minimum, it often leads to a hiatus of progress toward programs’ strategic objectives.
Transition from a stable number of U.S. dental schools across several decades at 64 to a growing number of start-up schools has also added pressure to the need for leaders equipped with the requisite skills and experience to lead the current 77 accredited—and provisionally accredited—U.S. dental schools. Building on these observations about the evolving demands of leadership, it is crucial to examine the increasing turnover and shorter tenures in key leadership roles within oral health education.
Who Are the Future Leaders in Dental Education?
Marsha A. Pyle, D.D.S., M.Ed.; Karen P. West, D.M.D., M.P.H.
WHY THE SHORTENED TENURE IN KEY LEADERSHIP ROLES?
There is little disagreement that the role of leading a dynamic, diverse oral health education organization in today’s environment is more challenging than ever, requiring broad, well-developed leadership skillsets and experience in the multiple roles of academic dentistry. Few individuals today have the traditional accomplishment of what was previously termed “the triple threat” leader—significant accomplishment as a researcher, teacher, and clinician—plus agile leadership. Each of the above pressures has likely contributed to turnover, shortened tenures, and preparedness gaps among current and future leaders. Additionally, the external pressures of new practice models, workforce challenges, costs of education and practice, global initiatives to improve oral health
Leadership Skill Domains
Virtues
Core Competencies
Social Skills
and integrate oral health into general health, and the exploding impact of technology and artificial intelligence (AI) on education have added to the complex nature of leading. 6-9 Highly politicized issues, particularly in public institutions, have fostered divisive debates and created challenging institutional cultures for leadership.
While enormous challenges exist, developing the next generation of leaders is a critical need. What are those critical skills required for leadership success in the very complex world of today? The characteristics necessary are both basic and nuanced for today and represent three primary domains. To address the challenges posed by shortened leadership tenures and preparedness gaps, it is essential to identify the foundational qualities that define effective leadership, starting with virtues.
Skill Examples
Integrity
Honesty
Ethical
Compass
Trustworthiness
Humility
Servant Leadership
Visioning
Strategic Thinking
Critical Thinking
Organizational Skills
Decision-Making in Uncertainty
Project Management
Flexibility/Adaptability
Nimbleness/Agility
Communication Skills
Collaborative Mindset
Empathy
Intuition
Compassion
Kindness
Ability to Read the Room
Positive Perspective
Table 1. Requisite Leadership Skills for 2024 and Beyond 10-13
VIRTUES
Future leadership skills required for oral health education have in common the virtues and skills required of any high-functioning leader. Virtues are where the qualities of an excellent leader begin in alignment with the American College of Dentists’ ethical principles. 13 How does a leader act when no one is watching? These attributes are where the leadership journey commences. Ethical behavior, integrity, and servant leadership are foundational building blocks of leadership practiced daily. 14 Individuals either possess them or don’t long before leadership opportunities emerge in their careers. Leaders without the visibility of these essential virtues may find their colleagues and followers attributing minimal trust to their leadership and decision-making. These virtues serve as foundational requirements; leaders lacking them struggle to achieve high-functioning leadership or risk derailment at key points in their careers. Organizations may require a specific set of basic skills, including virtues, in executive leadership personnel for new hires to fit in with the sector and organizational climate and culture. While virtues lay the ethical foundation for leadership, core competencies equip leaders with the strategic and operational skills necessary to navigate complex organizational challenges.
CORE COMPETENCIES
The Harvard Business Review (HBR) has a long history of research and publication on leadership topics. A 2013 article on essential leadership skills notes that core competencies can be learned and developed across time if an individual is motivated. 15 Table 2 lists essential core leadership competencies. Therefore, it is crucial for current leaders to prioritize succession planning within their organizations. In today’s changing environment, the development of new talent guided by an organization’s strategic framework is essential. Opportunities for emerging leaders to gain essential skills through training and experience in initial leadership roles help them develop their readiness for next-level roles.
These core skills can facilitate strategic thinking to find paths in resolving the unpredictable and unprecedented issues evident today. The approach also suggests that having an appropriately skilled team working together can help leaders anticipate, see, and react to emerging trends. A study of global leaders identified highly valued leadership competencies that emphasize skills complementary to the team approach and the development of the next generation of leaders. Matching values with behaviors creates trust and a safe environment. The ability to empower others drives motivation and satisfaction. Those who cultivate connected networks within their organizations develop a sense of community. They support a learning environment and are open to change. Finally, they develop others.16 In addition to strategic capabilities, effective leadership requires a mastery of social skills that foster collaboration, empathy, and emotional intelligence, enabling leaders to build strong relationships.
SOCIAL SKILLS
In the third domain (Social Skills), emotional intelligence (EI) relates to a person’s ability to understand and monitor their emotions and understand those of others. Individuals with high levels of self-awareness, self-regulation, compassion, and empathy interact well with others, demonstrating high levels of social skills. These individuals often form relationships and collaborations more easily, demonstrate motivation, and achieve their goals. Research indicates that individuals with highly developed EI often excel in leadership roles.12
Table 2. HBR Strategic Leadership Skills15
Who Are the Future Leaders in Dental Education?
Marsha A. Pyle, D.D.S., M.Ed.; Karen P. West, D.M.D., M.P.H.
ADEA’s Council of Deans Fellowship was developed out of the realization of the impending need to identify and prepare the next generation of oral health education leaders. Implemented in 2023, this small, year-long hybrid program is patterned after an Association of American Medical Colleges (AMC) program which intensely trains emerging leaders.
Historical experiential activities viewed as preparation for oral health education leadership included both training and experiences. Training often includes leadership development, such as the ADEA Leadership Institute, the newly implemented ADEA Council of Deans Fellowship (CDF), and external partner programs, such as the Academy for Advancing Leadership (AAL) programs; the Executive Leadership in Academic Medicine (ELAM), which helps prepare mid-career academic women for senior leadership roles; and the Bell Institute Leadership programs, among numerous individual university and civic development programs.
ADEA’s CDF was developed out of the realization of the impending need to identify and prepare the next generation of oral health education leaders. Implemented in 2023, this small, year-long hybrid program is patterned after an Association of American Medical Colleges (AMC) program which intensely trains emerging leaders. The ADEA CDF program provides two week-long experiences at dental institutions other than the participants’ own, giving the fellows unprecedented access to school and university leaders, data, and insights from the deans of the schools. The goal is to give emerging
leaders a jumpstart on success as they anticipate beginning a first-time deanship. Responsive programs such as this should help build a pool of well-qualified candidates for the future. Additionally, ADEA works in partnership with philanthropists to provide opportunities for newly appointed deans within three years of their appointment to access leadership programming, engage in curated monthly conversations among their peers, and access workshops tailored to their needs.
Many current deans have risen to their roles through years of academic experience, which may have included positions such as Associate Dean for Academic Affairs or Clinical Affairs, Department or Division Chair, or Associate Dean for Research. These roles provide access to learn broader school functions, such as accreditation preparation, chairing critical school committees, and access to university-level committee roles and leadership. By integrating virtues, core competencies, and social skills, future leaders can navigate the complexities of oral health education; however, preparing them for these roles requires thoughtful recruitment, development, and innovation.
CONCLUSION
Although traditional leadership roles’ preparation remains relevant, other pathways may provide insight into and preparation for future leaders. In addition to the foundational virtues, skills, and competencies, plus EI, dental educational leaders of tomorrow will need to be prepared for leading with dynamic strategy.17 The last five years have required leaders to change direction and solve enormous problems, nearly instantaneously creating process solutions that were nonexistent six years ago. This nimbleness and digital literacy will likely remain relevant to leadership skills as the oral health professional workforce’s challenges remain and the technological developments in equipment, hardware, and software modify how the profession develops and delivers care and educational programming.18 It is difficult turning direction in academic programs that have traditionally been resistant to change and slow to adopt new ways of thinking and planning. A well-honed ability to make quick decisions under significant uncertainty will be a hallmark of effective future leaders. Pre-
REFERENCES
paring pathways for capable leaders will require enhanced recruitment and development of future faculty from among students, practitioners, and current academic dentistry faculty.
In a post-pandemic world, skill development in crisis management, crisis communication, emerging technology, and digital workflows will define dental education in the future. In a rapidly changing profession, leaders who can create efficient and responsive operations may have a greater trajectory toward success. A culture of tolerance to new ideas and approaches would help give motivated faculty permission to fail but be responsible for pivots to correct projects that do not meet the expected outcomes. Of importance is a perceptive leader who can see the relevance of applying business models, new ways to solve existing problems, and the use of AI to create efficiency in workflows and who has the fortitude to tolerate ambiguity. It is only through change and trial and error that new leaders can grow and new ways of approaching long-standing problems can emerge.
1. American Council on Education. The American College President: 2023 Edition. Accessed October 27, 2024 https://www.acenet.edu/Documents/American-College-President-IX-2023.pdf
2. Weinstein GJ, Haden NK, Stewart DC, Pyle MA, Albino AW, West KP. A profile of dental deans. J Dent Educ 2021; 86(10):1304-1316. https://doi.org/10.1002/jdd.12933
3. Haden NK, Ditmyer MM, Rodriguez T, Mobley C, Beck L, Valachovic RW. A profile of dental school deans, 2014 J Dent Educ 2015;79(10):1243-1250. https://doi.org/10.1002/j.0022-0337.2015.79.10. tb06018.x
4. Chmar JE, Weaver RW, Ranney RR, Haden NK, Valachovic RW. A profile of dental school deans, 2002. J Dent Educ 2002;86(4):475-487. https://doi.org/10.1002/j.0022-0337.2004.68.4.tb03766.x
5. American Dental Education Association. Unpublished data. Office of Knowledge, Engagement and Development, 2024. Accessed October 27, 2024.
6. Ganski K. American Dental Association. Health Policy Institute. More dentists affiliating with DSOs. June 1, 2023. Accessed October 27, 2024. https://adanews.ada.org/ada-news/2023/june/more-dentists-affiliating-with-dsos/?_gl=1*ll5mfz*_gcl_au*NzMxNDcwNjE0LjE3Mjg5MzczOTA.*_ga*MTAyMzQyMTE2LjE3Mjg5MzczOTA.*_ga_X8X57NRJ4D*MTczMDA1NjQzNi4yLjEuMTczMDA1NjQ4MS4wLjAuMA
Who Are the Future Leaders in Dental Education?
Marsha A. Pyle, D.D.S., M.Ed.; Karen P. West, D.M.D., M.P.H.
7. American Dental Association. Health Policy Institute Podcast. Dental Workforce Shortages: Data to Navigate Today’s Labor Market. Vujicic M, Fosse C, Alberti H, Gurenlian J, Aronovich H. October 2022. Accessed October 27, 2024. https://www.ada.org/resources/research/health-policy-institute/dental-practice-research/dental-workforce-shortages
8. Fernandez CSP, Taylor MM, Corbie G, et al. Institute for Educational & Social Equity. Improving the equity landscape at US academic institutions: 10 strategies to lead change. Equity Edu Soc December 2023;3:1. https://doi.org/10.1177/27526461231215084
9. Global strategy and action plan on oral health 2023-2030. Geneva: World Health Organization; 2024. License: CC BY-NC-SA 3.0 IGO. Accessed November 12, 2024. https://www.who.int/publications/i/ item/9789240090538
10. Newstead TP, Riggio RE, eds. Leadership and Virtues. Understanding and Practicing Good Leadership. Routledge Taylor & Francis New York and London. 2023. Accessed October 27, 2024 doi: 10.4324/9781003212874.
11. Van Diggele C, Burgess A, Roberts C, Mellis C. Leadership in healthcare education. BMC Med Educ 2020;20(suppl 2):456. https://doi.org/10.1186/s12909-020-02288-x
12. Dulewicz C, Young M, Dulewicz V, et al. The relevance of emotional intelligence for leadership performance. J Gen Management 2005;30(3). https://doi.org/10.1177/030630700503000305
13. American College of Dentists. Mission Statement. Accessed November 2, 2024. https://www.acd.org/
14. Haden NK, Jenkins R. The 9 Virtues of Exceptional Leaders. Unlocking Your Leadership Potential Academy for Advancing Leadership; 2016.
15. Schoemaker PJH, Krupp S, Howland S. Strategic leadership: The essential skills. Harvard Business Review January-February 2013. Reprint. R13OTL:1-5. Accessed October 22, 2024. https://hbr.org/2013/01/strategic-leadership-the-esssential-skills?autocomplete=true
16. Giles S. The most important leadership competencies, according to leaders around the world. Harvard Business Review. March 15, 2016. Reprint HO2PDE:1-8. Accessed November 2, 2024. https://hbr.org/2016/03/the-most-important-leadership-competencies-according-to-leaders-around-the-world?autocomplete=true
17. Haridy R, Abdalla MA, Kaisarly D, El Gezawi M. A cross-sectional multicenter survey on the future of dental education in the era of COVID-19: alternatives and implications. J Dent Educ 2021;85(4):4 83-493. doi:10.1002/jdd.12498
18. Matveeva S. Coding isn’t a necessary leadership skill – but digital literacy is. Harvard Business Review July 26, 2022. Reprint HO75J4:1-8. Accessed November 2, 2024. https://hbr.org/2022/07/coding-isnt-a-necessary-leadership-skill-but-digital-literacy-is?autocomplete=true
The Dark Side of Leadership: Finding Where You Belong
Bo Yu, DDS, PhD
Co-Founder, Executive Leadership Enterprises
Steven Milgazo, BA, MS
Deputy Director, U.S. Navy
Former Director of Strategic Planning, U.S. Navy SEALs
Elizabeth O. Carr, DHA, FACD (Hon)
Chair, Department of Dental Hygiene, Director, Mississippi Population Oral Health Collaborative University of Mississippi Medical Center School of Dentistry
Sreenivas Koka, DDS, MS, PhD, MBA, MAS, FACD
Past Chair, MIT Sloan School of Management Alumni Board
Former Dean, University of Mississippi Medical Center School of Dentistry
Past Chair, Department of Dental Specialties, Mayo Clinic
Conflicts of interest:
Steven Milgazo is the founder of Optimal Path Coaching and Consulting.
Bo Yu and Sreenivas Koka are co-founders of Executive Leadership Enterprises, LLC.
Sreenivas Koka is the founder of Career Design in Dentistry.
Sreenivas Koka received one or more speaker honoraria from Nobel Biocare, Neoss, and Glidewell Laboratories in the past 12 months.
Elizabeth Carr received a speaker honorarium from Glidewell Laboratories in the past 12 months.
The Dark Side of Leadership: Finding Where You Belong
Bo Yu, Steven Milgazo, Elizabeth O. Carr, and Sreenivas Koka
Leadership—whether as a parent, healthcare provider, soldier, or business executive—requires intentional effort to master its art and science. Just as we would not expect a physician or a soldier to learn their craft entirely “on the job,” we should not expect leaders to develop their leadership skills the same way. Society demands years of preparation for physicians and soldiers before they assume their professional responsibilities. However, when it comes to leadership, we often accept that individuals take on leadership roles with neither formal leadership training nor the “education of experience,” despite the profound and life-changing consequences of good and bad leadership.
Stephen Covey aptly notes that leaders are not simply born—they choose to lead.1 This choice is made through study, experimentation, reflection, and continuous iteration. To be a leader, therefore, is to be a lifelong learner who is always experimenting and adapting through the application of new strategies and tactics to become wiser. An established leader, in turn, takes on the obligation to mentor those seeking this wisdom, which they have earned through experience.
It is imperative for anyone aspiring to assume a leadership role to embrace the reality that effective leadership is a capability that is unto itself. It resides in its world, and its craft is founded on science. For example, a good marksman, teacher, clinician, and a good firefighter are not, by extension, good leaders. Nevertheless, it is all too common for individuals to be promoted into leadership roles based on their technical expertise, even though they have received negligible preparation to become leaders. When leadership preparation does occur, the focus is often on business management topics, such as strategy, finance, marketing, organizational behavior, operations management, decision-making, and team building.
The positive aspects of successful leadership are discussed regularly. However, leadership can be extremely challenging for various reasons, including cultural, personnel, and budgetary issues, to name three common reasons. Leadership can also
be a lonely undertaking because it means being responsible for everything necessary to achieve the mission, as well as for all the people in the team or organization that one is leading. These responsibilities are daunting when taken seriously and can lead to a great deal of soul-searching. Leadership is an extremely challenging responsibility.2 Team members and leaders may or may not be aligned with the mission of the organization. The resultant conflicts have undermined many talented leaders. Unsurprisingly, many leaders feel stressed and overwhelmed but do not feel they can show their vulnerability. This critical aspect of leadership, which we call the “dark side of leadership,” is frequently overlooked in formal leadership education. The “dark side of leadership” is invariably a consequence of the dark side of humanity. At the risk of oversimplification, the dark side of leadership manifests through the most tragic facet of humanity: malevolence. Malevolence is often fueled by insecurity, ambition, or a desire for power, which can overshadow and obliterate the virtues that leaders are expected to uphold. Unchecked malevolence sows discord, erodes ethical standards, and corrodes trust—all in one fell swoop.
In this paper, we present a hallmark of the dark side of leadership to help current and aspiring leaders avoid the many pitfalls we have experienced. We ask you to carefully consider the following question: “Do I truly belong where I work?”
VALUE ALIGNMENT: THE HEART OF LEADERSHIP
How does one know they belong? At our core, we each hold values that motivate us and define our purpose. “Do I belong?” It is one of the most important questions that anyone can ask. Whether we belong in an organization boils down to whether our core values align with the organization’s (Figure 1). Yet, the question takes on much greater significance for leaders because they bring not only their own values but must also embody those of the values and culture of the organization. Leadership
• Successful pursuit of the mission is always more important than loyalty to an individual
• Value mismatches lead to burnout
• Teams with aligned values thrive
• Leaving the organization may be the best solution
• True engagement needs shared purpose
lives in the space between what the organization demands and what the team members expect, and a lack of value alignment leads to a lack of strategic alignment.3
As a leader, you may have some degree of control over who is on your team. However, as you rise within an organization, your perspective may shift. What was important to you in your early career may no longer hold the same weight. With experience comes wisdom and often a reordering of priorities (Figure 1). This evolving perspective can cause tension between you and team members when junior colleagues have not yet learned to appreciate what you value and why it is valued. It can be especially challenging to navigate this tension if you were promoted internally—the proverbial “buddy to boss” transition. Nevertheless, even if you inherit a team not replete with members who share your values, you can work toward alignment over time. However, you have little to no control over to whom you report—your direct report (DR)—your boss.
Assessing the values of your DR is a critical step in evaluating whether you can be a successful leader from an organization’s perspective. If there is
Purpose-led Life
• Live a purpose-driven life
• Avoid success in meaningless pursuits
• Align values for true fulfillment
• Seek work that matches your values
• Courage prevents settling for less
good agreement between your values and those of your DR, you can move forward with confidence, knowing that you will be supported through inevitable challenges that occur. In contrast, if there is a mismatch in values, the resulting emotional conflict undermines one’s ability to lead decisively and confidently (Figure 1). Consequently, you either do not make decisions at all for fear of upsetting your boss, or you make decisions courageously but under a great deal of stress because you risk being seen as an ineffective leader or, worse yet, as a troublemaker.
The argument is that learning to manage value mismatches and position yourself accordingly to maintain leadership positions is a hallmark of an effective leader. “Congratulations on keeping your job all these years with a jerk for a boss!” However, we believe that this argument is an argument of convenience and that it perpetuates mediocrity. This question must be called because value mismatches promulgate inaction, and inaction, in turn, is the bedrock of the status quo. Value mismatches should not be endured but embraced as opportunities for self-reflection. If your core values conflict with those of your DR, it is essential to reflect hon-
The Dark Side of Leadership: Finding Where You Belong
Bo Yu,
Steven Milgazo,
Elizabeth O. Carr, and Sreenivas Koka
The mission is tied to our values and why we get up in the morning. You must permit yourself to continue looking for a place where you, the team you lead, and the boss to whom you report have the same values and overarching mission. In such an environment, work does not feel like work; instead, it becomes a shared goal that drives everyone forward.
estly on whether staying in your position is in your best interest. Failing to address this mismatch is a disservice to yourself and the team you lead.
LOYALTY TO THE MISSION OVER ORGANIZATION: A COURAGEOUS CHOICE
Another layer to the question of whether or not one belongs relates to productivity and effort. A sense of not belonging leads to disengagement and lack of motivation. When work feels meaningless, one can easily drift through the day out of obligation rather than genuinely committing to an organization’s mission. Going to work every day and finding little meaning in the work is a nonstop ticket to burnout. However, some individuals continue to push themselves to work hard despite a value mismatch. In these cases, two outcomes are possible. First, your team can meet the metrics you have established for them based on your values. Then, your team is fulfilled and engaged. Second, if your DR’s values contradict your own, your team’s success may be perceived as a threat. As hard as it is to accept, the team’s success becomes your failure. In staying true to your values, you continue to honor them and embrace the consequences of falling out of favor with your boss—losing your leadership position or your job altogether. It would appear that with a value mismatch, a leader is
trapped with a Hobson’s choice, leading to either burnout or resentment. Yet, all is not lost.
There are other really good choices if you are willing to make them. Too often, loyalty to an organization supersedes loyalty to its mission (Figure 1). The mission is tied to our values and why we get up in the morning. You must permit yourself to continue looking for a place where you, the team you lead, and the boss to whom you report have the same values and overarching mission. In such an environment, work does not feel like work; instead, it becomes a shared goal that drives everyone forward. In a small business environment like a dental office where you are the leader, you have the privilege, responsibility, and burden to clearly state a mission grounded in your values. The mission guides building a team that shares your vision and facilitates an environment in which everyone can work toward that common purpose. In larger organizations where you are an employee, it can feel like you have little or no control. Yet, you do have the power to choose because you only lose control when you do not give yourself permission to leave. There will be voices in your head that tell you, “It’s not so bad,” “There’s no guarantee it’s better anywhere else,” “It’s a steady paycheck,” “What will people think of me if I leave?” or, “I have worked hard to get to where I am in the organization, and I don’t want that to go to waste.”
Admittedly, these do sound like rational reasons to stay. However, in staying, you continue to live out the scenario that perpetuates the status quo because you are tolerating your workplace, and it is tolerating you. You are unlikely to invest much discretionary effort because you will work for the wrong reasons. As a leader, your team requires that you be fully engaged. Therefore, by staying, you think you are doing your team a favor, but perhaps the reality is that you are letting your team down.
LEADING A LIFE OF PURPOSE
At the end of the day, you will want to look back on your career and know that you have lived a life that brought you and others joy, love, and fulfillment. You get one chance to make a difference in your life, and you don’t get it back with each day that passes. You do not want to be filled with regret for wasting your life or with envy toward those who made the choices you were unwilling to make. These feelings are all indescribable in written words; these feelings, like joy, love, fulfillment, regret, and envy, do not fit conveniently into a box of rational thinking. These feelings come from
REFERENCES:
decisions made by the heart, not by the analytical frontal cortex.
William Carey said, “I am not afraid of failure. I am afraid of succeeding at the things that don’t matter.”4 As a leader, you cannot succeed fully if your values are out of alignment with those of your boss. If you succumb to your boss’s values, any success that you appear to have will be predominantly on things that don’t matter to you. Driving toward a goal that is not authentically yours, an inner voice of discontent will only grow over time.
We hope that with our words, we have given you pause to reflect on whether you belong where you work, whether your leadership values align with those around you, and especially with your boss. If they do, we are excited for you to have the perfect setting and team. If not, we hope we have given you three things to consider: (1) permission to seek a better fit, knowing that it may take time or several tries; (2) courage, despite all the voices in your head telling you otherwise, to not settle for mediocrity; and (3) a path toward a life of joy, love, and fulfillment, free of regret.
1. Covey S. The 8th Habit: From Effectiveness to Greatness NY: Free Press; 2004:62.
2. Quinn R, Crane B, Thompson T, Quinn RE. Why real-time leadership is so hard. Harvard Business Review. January/February 2024. Accessed on December 15, 2024. https://hbr.org/2024/01/why-real-time-leadership-is-so-hard
3. Ates NY, Tarakci M, Porck JP, van Knippenberg D, Groenen PJF. The dark side of visionary leadership in strategy implementation. Strategic alignment, strategic consensus, and commitment. J Manage. 2020;46(5):615-636.
4. Carey W., Goodreads quotes. Accessed on October 31, 2024. https://www.goodreads.com/quotes/9271899-i-m-not-afraid-of-failure-i-m-afraid-of-succeeding-at
Forging the Future: Cultivating Leaders for the Evolving Dental Profession at New York University
Richard
W, Valachovic,
DMD, MPH, FACD Clinical Professor and Executive Director Center for Oral Health Policy and Management
New York University College of Dentistry
The dental students who graduated in 2024 began their professional careers with the expectation that they will likely practice for the next 40 years, extending their careers through 2064. Based on what we know today, can we imagine the changes that will occur during this time?
INTRODUCTION
The dental students who graduated in 2024 began their professional careers with the expectation that they will likely practice for the next 40 years, extending their careers through 2064. Based on what we know today, can we imagine the changes that will occur during this time? In just the past few years, we have witnessed significant advancements in digital dentistry, the introduction of artificial intelligence and robotics, the rise of private equity and corporate dentistry, remarkable demographic shifts, and increasing societal demands on the provision of health care. In my opinion, these changes will continue to evolve with increasing speed and breadth. Most will require careful consideration of the American College of Dentists’ key pillars: ethics, professionalism, leadership, and excellence. These timeless principles serve as a compass for charting the evolving dental landscape.
The updated ACD Ethics Handbook for Dentistry offers essential resources to support ethical decision-making for future leaders.1 A key question we must address is who will provide the leadership to ensure the dental profession continues to uphold the ACD’s pillars as these changes unfold throughout their careers. I believe the most pressing issue facing our profession is the development of new leaders who are committed to these pillars and equipped with the skills, training, and experiences necessary to meet the challenges of an evolving and yet-to-be-discovered future.
Having served in various leadership roles, I have observed and learned from others in our profession who have been successful and those who have struggled. My goal in this article is to provide a roadmap to prepare dental students and early-career dentists to meet the needs of our profession’s future.
THE SHIFTING LANDSCAPE OF DENTISTRY
Leaders are essential across all facets of the dental profession. There are currently 75 fully accredited predoctoral dental programs in the United States, up from 53 in 1996. Additionally, five more universities are in the advanced stages of planning and are expected to open dental schools within the next three years. This expansion will increase the demand for experienced leaders to serve academic dentistry as deans, department chairs, and program directors.
In parallel, the U.S. military, with over 2.5 million personnel worldwide, will continue to require dental officers to lead at all levels, from individual bases to top command structures. The growth of more than 1,000 dental support organizations and sizeable corporate group practices has created a pressing need for leadership throughout their organizational frameworks. Nonprofit dental associations and organizations in the U.S. also depend on capable leaders to address their unique challenges effectively.
Forging the Future: Cultivating Leaders for the Evolving Dental Profession at NYU
Richard W, Valachovic, DMD, MPH, FACD
However, the environment facing future leaders will be dramatically different from that of our predecessors. As a result, we must prepare them with the new skills required to address the challenges ahead.
ESSENTIAL SKILLS FOR FUTURE LEADERS
Dentistry has been fortunate to have had visionary leaders in the past who have guided the profession through complex and transformative times. Let me offer some examples. G.V. Black played a leading role in moving dentistry from a trade to a profession. William J. Gies helped lay the scientific foundation for dentistry. Arthur A. Dugoni emphasized the human dimension of the profession and built relationships among key constituencies. These leaders shared an expansive vision of dentistry that transcended the confusion of the times and provided the energy and personal skills to enlist the cooperation of diverse groups in achieving these larger views. Each leader demonstrated exemplary skills tailored to the specific challenges of their time.
However, the environment facing future leaders will be dramatically different from that of our predecessors. As a result, we must prepare them with the new skills required to address the challenges ahead.
• Adaptability and Resilience: Leaders must embrace rapid changes in the profession and recover quickly from disruptions.
• Interprofessional Collaboration: Dentistry cannot remain isolated from other healthcare professions. Future leaders must advocate for the role of oral health in overall well-being and explore pathways for interprofessional cooperation.2,3
• Cultural Competency: The demographics of the United States are changing, and future leaders will need to respect the diverse communities we serve as a profession.4
• Ethics and Integrity: Embracing the longstanding pillars of the ACD—ethics, professionalism, leadership, and excellence— will be even more important as we move into the future. Leaders will need to have these pillars as a foundation for their decisionmaking and actions.
• Vision and Strategic Thinking: I have often referred to this skill as the ability to “look around the corners.” Future leaders will need to anticipate and respond to long-term challenges before they manifest themselves.
• Advocacy: Future leaders will need to be grounded in the skills required to navigate their careers in an increasingly politicized society. All leaders need to understand the role that evidence plays in making decisions.
• Lifelong Learning: As new knowledge is rapidly created, leaders must sift through vast information and identify credible, evidencebased sources, including emerging social media platforms.
• Alliances: I have long followed a motto: the “Relentless Pursuit of Strategic Alliances.” Leaders must collaborate, even amidst disagreements, to achieve shared goals.
Forging the Future: Cultivating Leaders for the Evolving Dental Profession at NYU
Richard W, Valachovic, DMD, MPH, FACD
PREPARING DENTAL STUDENTS AND EARLY-CAREER DENTISTS
The imperative for those of us in current leadership roles is to prepare the next generation of leaders who will succeed us. This effort must begin with a renewed focus on leadership programming for current dental students and early-career dentists by integrating leadership into the curriculum. Here at the New York University College of Dentistry, we have developed a portfolio of unique leadership opportunities for our students and faculty to develop them into future leaders.
The approach to leadership development in this portfolio stands apart from most other experiences in dental education. It emphasizes leadership as an art. It is a creative and experiential journey rather than a purely scientific one. A different kind of education is essential to cultivate leaders who will secure a healthy future for dentistry. Our portfolio’s motto encapsulates this vision: “Learning it, living it.”
We believe that it is essential to introduce these concepts to students throughout the dental curriculum and to faculty in their early careers to attract and develop individuals for future leadership roles. We encourage those who have participated in these programs to seek out opportunities to utilize their skills by leading in activities such as local and national dental organizations, clubs, faculty, and student governance or volunteering in their communities.
At the NYU College of Dentistry, this leadership education portfolio includes the following:
• Dental Student Leadership Institute
Up to 35 first-year dental students are selected each year to participate in this three-year elective curricular program. The Institute engages students through seminars, workshops, internships, mentoring, and other opportunities designed to prepare them to tackle the complex challenges of advancing oral health in the 21st century.
• Faculty Leadership Institute
This three-day program, offered twice annually for full-time faculty members, provides practical strategies for career advancement. Participants gain tools to navigate internal and external leadership opportunities with confidence. The program focuses on developing effective communication and relationship-building expertise, fostering strong connections and collaborations essential for successful leadership.
• Global Health Care Leaders: Washington, DC
Students from all NYU Dentistry academic programs are eligible to apply for this professional development experience, held annually at NYU’s Academic Center in Washington, DC. Participants engage in leadership, advocacy, and public speaking workshops and meet with federal lawmakers to advocate for oral health issues such as access to care and research funding.
• Global Health Care Leaders: NYU Global Academic Centers
This program is open to fourth-year dental students interested in an international perspective on oral health care. Selected students travel to one of NYU’s 10 Global Academic Centers annually, where they meet with dental educators and regulators worldwide to explore and compare dentistry practices, education systems, and professional regulations. Current programs have been held at NYU campuses in Florence, Italy, and Prague, Czech Republic, with plans to expand to Accra, Ghana.
• Student Mock Congressional Hearing
This competitive program trains students in leadership, advocacy, and public speaking. Participants prepare and deliver testimony on a health policy topic before a simulated congressional panel, honing their skills in public policy engagement.
• Leadership Workshop Track
This year-round virtual program, open to the entire NYU dental community, features a twicemonthly lecture series centered on characterbased leadership.5
Through these innovative programs, we engage nearly one-third of our student body and full-time faculty, nurturing a robust pipeline of future leaders in dentistry and beyond.
THE ROLE OF THE FELLOWS OF THE AMERICAN COLLEGE OF DENTISTS
The Fellows of the American College of Dentists are uniquely positioned to participate in developing future leaders.
• Mentoring: Providing guidance to young dentists and identifying potential candidates for ACD Fellowship.6,7
• Advocacy: Supporting leadership programs for students, residents, and early-career dentists.
• Ethical Stewardship: Serving as champions of ethics and professionalism and guiding peers in addressing evolving leadership challenges.
REFERENCES
• Program Sponsorship: Funding and spearheading initiatives, such as scholarships for leadership programs.
CONCLUSION: LEADING THE YET-TO-BE-DISCOVERED FUTURE
The future of the dental profession depends on our ability to cultivate leaders who are prepared to negotiate an ever-changing landscape while remaining committed to ethics, professionalism, leadership, and excellence. The programs and initiatives highlighted in this article demonstrate that leadership is not merely a skill but a practice that must be fostered intentionally and continuously throughout one’s career. As we look to 2064 and beyond, we should embrace our role as stewards of the profession, ensuring that the next generation of leaders is equipped to meet challenges yet to be discovered and to advance oral health in ways we can only begin to imagine. Through this approach, we are not just preparing for the future; we are forging it by prioritizing leadership development today. The responsibility lies with all of us to inspire, mentor, and empower those who will carry the torch of our profession into the future.
1. Roucka TM, Bussard J, Elster N, Zarkowski P, Sarkis CF. American College of Dentists Ethics Handbook for Dentistry 2024.
2. Valachovic RW. Integrating oral and overall health care: building a foundation for interprofessional education and collaborative practice. J Dent Educ. 2019;83(2 Suppl):S19-S22. doi:10.21815/ JDE.019.038. PMID: 30709935.
3. Cole JR 2nd, Dodge WW, Findley JS, et al. Interprofessional collaborative practice: how could dentistry participate? J Dent Educ. 2018;82(5):441-445. doi:10.21815/JDE.018.048. PMID: 29717066.
4. Lopez N, Shingler K, Real C, Nirkhiwale A, Quick K. Cultural competency in dental education: developing a tool for assessment and inclusion. J Dent Educ 2024;88(5):587-595. doi:10.1002/jdd.13466.
5. Haden K. The character of a profession. J Am Coll Dent 2021;88(1):14-25.
6. Al-Jewair T, Herbert AK, Leggitt VL, et al. Evaluation of faculty mentoring practices in seven U.S. dental schools. J Dent Educ. 2019;83(12):1392-1401. doi:10.21815/JDE.019.136.
7. Horvath Z, Wilder RS, Guthmiller JM. The power of coaching: developing leaders and beyond. J Dent Educ 2024;88 Suppl 1:671-677. doi:10.1002/jdd.13535.
Young Dentist Leadership: The Future of Oral Health Care
PERSPECTIVE OF A RECENT DENTAL GRADUATE
Joshua D. Bussard, DDS, FACD, FPFA
Dentistry continues to evolve rapidly, and leadership is essential among recent dental graduates. A majority of newly graduated dentists are thrust into the workforce and expected to be experts in all aspects of patient care, including staff, patients, technology, dental equipment, and more.1,2 Additionally, they generally manage full patient schedules and conceal the respective stresses. Young oral healthcare providers face many challenges and often lack leadership training to effectively balance their many roles and responsibilities.1,2 This article introduces the characteristics of effective young dentist leaders, the challenges facing recent graduates, and strategies for leadership development.
Communication is fundamental in all aspects of dentistry, and developing this skill is crucial when sharing information with people of different backgrounds. Oral health professionals can navigate challenging situations and facilitate positive interactions when communication is properly mastered.
The characteristics of effective leaders are multifactorial, and exceptional leaders can discern when a method is beneficial and use it accordingly. Values and characteristics of leadership include but are not limited to communication skills, competence, leading by example, adaptability, collaboration, continuous learning, empathy, stewardship, and reflection.3 A leader’s ability to develop and combine these skills prepares them to consider and approach the ethical dimensions of each situation.
Communication is fundamental in all aspects of dentistry, and developing this skill is crucial when sharing information with people of different backgrounds. Oral health professionals can navigate challenging situations and facilitate positive interactions when communication is properly mastered. However, effective communication is difficult in regard to understanding the various types of communication paired with identifying the best type for each encounter.4,5 Dentists are subconsciously tasked with learning communication preferences for their team, colleagues, technicians, dental supply company representatives, patients, and others. Effective communication requires understanding and respect for the preferences of each individual or entity. Individuals tend to respond best and communication is most effective when their preferred communication style—verbal, nonverbal, visual, written, or a combination—is recognized and used.3,4,5 For example, some people prefer a text message over an email, whereas others prefer a phone call.
Recent dental graduates assuming new leadership roles should have phenomenal communication skills to motivate and build confidence among their
team members. Additionally, young leaders who are capable and adaptable tend to inspire those around them. Team members who witness providers leading by example and taking exceptional care of their patients are instilled with the desire for them to provide an excellent patient experience as well.1 However, establishing rapport with team members is not always simple.
Young dental professionals face many challenges when they begin their careers. Some notable challenges include finding a dental home, navigating change, establishing authority, managing debt, attaining work-life balance, and inexperience.6 After graduation, many young dentists undergo multiple job transitions before finding a long-term dental home. This could be attributed to a lack of planning and preparation during their training, but it could also be due to a different generational mindset of recent graduates—preferring a more transient lifestyle. However, it may be a combination of both.
Dental programs must cover an extensive curriculum within a limited time frame, leaving students to navigate after-graduation employment and the business side of dentistry independently. As a result, students often lack the knowledge required to identify a dental work environment that suits their individual needs, potentially leading to higher rates of job turnover. Conversely, recent dental graduates may experience a negative work environment because of their considerable educational debt. This may negatively impact their overall wellness and derail their work-life balance.6 Many young dentists also work nontraditional hours and maintain multiple positions to pay down their educational loans to support themselves as well as their
Young Dentist Leadership: The Future of Oral Health Care
Joshua D. Bussard, DDS, FACD, FPFA
dependents.6 This leaves little time for them to participate in activities that they enjoy without feeling exhausted. Ultimately, it is difficult for young leaders to balance the responsibilities of dental practice with personal life, leading to decreased wellness and early burnout.7
Early burnout in dentistry highlights the importance of developing leadership training opportunities for recently graduated dentists. Ideally, preparation before graduation is effective; however, quality leadership requires continuous nourishment and necessitates continued training after graduation. Strategies to develop future leaders require organizational support. Encouraging young dentists’ involvement in professional organizations facilitates leadership training and networking opportunities as well as mentorship programs.
The American College of Dentists (ACD) recognizes the importance of leadership and maintains leadership as one of the four pillars of its mission in dentistry. As such, the ACD provides leadership opportunities, such as supporting fellows in the Kellogg Scholarship for Dental Leaders and providing additional leadership training recently through
REFERENCES
the Shaping the Future of Dentistry initiative. Additionally, ACD fellows are encouraged to identify young leaders for fellowship who have contributed to the dental profession early in their careers and can make continued exceptional contributions to the dental profession. The encouragement of young leadership supported by the ACD showcases how professional organizations can develop future leaders in dentistry and highlights the importance of maintaining involvement with professional organizations. Through professional organizations, the dental profession can support young leaders and actively promote self-governance.
Young oral health providers are the future of dentistry. The ability for dentistry to continue self-regulation is dependent on connecting with and developing the younger generation. Dentistry will thrive by implementing early strategies to prepare students for life after graduation, providing solutions to challenges facing recent graduates, and supporting educational leadership opportunities after graduation. Furthermore, increasing efforts to support leadership development will ultimately enhance the dental team and patient experiences and improve the quality of care for all.
1. Mohan M, Sundari Ravindran TK. Conceptual framework explaining “preparedness for practice” of dental graduates: a systematic review. J Dent Educ. 2018;82(11):1194-1202. doi:10.21815/JDE.018.124.
2. Manakil J, Rihani S, George R. Preparedness and practice management skills of graduating dental students entering the workforce. Educ Res Int. 2015;2015(1):976124. doi:10.1155/2015/976124.
3. Roucka TM, Bussard J, Elster N, Zarkowski P, Sarkis CF. American College of Dentists Ethics Handbook for Dentistry 2024.
4. Moore R. Maximizing student clinical communication skills in dental education—a narrative review. Dent J. 2022;10(4):57. doi:10.3390/dj10040057.
5. Hanke S. Communication styles: what is your impact on others? Prof Saf. 2009;54(5):22-25. Accessed December 23, 2024. https://www.proquest.com/scholarly-journals/communication-styles/ docview/200342699/se-2
6. Nicholson S, Vujicic M, Wanchek T, Ziebert A, Menezes A. The effect of educational debt on dentists’ career decisions. J Am Dent Assoc. 2015;146(11):800-807. doi:10.1016/j.adaj.2015.05.015.
7. da Silva Moro J, Soares JP, Massignan C, et al. Burnout syndrome among dentists: a systematic review and meta-analysis. J Evid Based Dent Pract. 2022;22(3):101724. doi:10.1016/j.jebdp.2022.101724.
Navigating
the Meaning of the Social Contract in Dentistry as a Former Dental Staff and Current Dental Student
Sophia Kim, HBSc
Navigating the Meaning of the Social Contract in Dentistry
Sophia Kim, HBSc
PERSONAL NARRATIVE
Like many of my dental school colleagues, becoming a dentist was and remains my dream job. Growing up, I idealized the profession as I saw dentists succeed. I was strongly motivated by the potential in this career path to make a significant difference to a large group of people, gain respect for my contributions to the community, and attain prestige for my achievements. Dentists are able to restore oral health and transform the lives of their patients, control their career trajectory, maintain a flexible lifestyle, shape the future of oral health care, exercise creativity, and be respected members of their communities (American Dental Education Association (ADEA) n.d.). Indeed, I romanticized dentistry as the perfect profession, putting dentists on a pedestal as compassionate, altruistic, reputable, and prosperous healthcare professionals. Through working in the dental field as a dental assistant and receptionist for several years and now having attended dental school for the past 2 years, I have gained additional insight into dentistry’s impact on the health of the individual and the public in general and have been introduced to the notion of dentistry’s commitment to the social contract.
My work experience as a dental assistant and office receptionist opened my eyes to issues I was too naive to understand when I first developed my interest in dentistry. Working in dental clinics, it became routine for me to anticipate the oral health challenges of specific patient populations. It became easy to stereotype those with government-funded health plans, who often faced extensive dental issues and were hindered by financial constraints and poor oral health. Conversely, patients with robust private insurance, typically obtained through their employment, exhibited better overall oral hygiene and fewer treatment needs. Unintentionally, I developed a bias in favour of patients with good insurance, appreciating their punctuality, respectfulness, and absence of payment issues. Patients from disadvantaged populations, however, often presented challenges to the dental office, including frequent no-shows,
last-minute cancellations, payment complications, and unreliability. These were frustrating issues that affected the flow of the practice, and I noticed that this bias was shared amongst staff. Indeed, I had to be removed from the environment to fully be able to reflect and realize that the way dental office staff and dentists view vulnerable populations as a hindrance is quite problematic and goes against the core of what dentistry should aim to address: improving oral health at both the individual and the community levels. It turns out that this bias, as subtle as it may be, leaves many members of these populations feeling stigmatized in the private dental office setting (Northridge et al., 2020; Bedos et al., 2013). This awareness shattered the rose-coloured lens through which I had initially viewed dentists, realizing that although many dentists are altruistic caregivers who work for the good of their patients and society, it is often easy to lose focus of a core goal of dentistry: to be of service. It is, in fact, extremely difficult for an appropriate professional identity to thrive when it is mismatched with the work demands of the job, especially if the profession’s goals are not firmly embedded into the dentist from the outset, for example, during dental school. Studies have shown that new dentists are likely to shed idealized expectations of the profession and adopt more pragmatic goals driven by the commercialization of dentistry upon graduation (DiBenigno, 2022). It is easy to lose sight of ethical principles upon entering private practice, and thus, I believe even more that this issue should be addressed.
The concept of being of service became more meaningful to me as I began my dental education. I am learning in dental school about the stark realities of the oral health disparities persisting between the able and vulnerable populations and the issues the dental profession faces in the challenges of the private-public divide. Upon reflection, I felt conflicted as a former dental staff member who shared the very prejudices I was being taught in school that I should be avoiding but have yet to be taught how to avoid. Although I do not
have the complete answer to this internal conflict, I believe taking the initiative to understand how the disparities in oral health along the socioeconomic gradient came to exist is a crucial first step.
SOCIAL DETERMINANTS OF HEALTH AND SOCIAL RESPONSIBILITY
The social determinants of health are non-medical factors that influence health outcomes, including the circumstances of birth, growth, work, living conditions, and aging, shaped by economic, social, and political systems (World Health Organization (WHO)). The social determinants of health have a significant influence on health inequities and unfair and avoidable differences in health status. Inevitably, the lower the socioeconomic position, the worse a person’s health is likely to be (WHO). The discrepancies seen in oral health along the socioeconomic gradient are notable, even in North America, and highlight how the social determinants of health affect the population of even economically prosperous countries. Oral health is a key component in the physical, mental, social, and economic well-being of individuals and populations and should not be overlooked (Peres et al., 2019). Lower socioeconomic status is linked to a higher prevalence of dental caries and periodontal disease due to barriers to accessing dental care and preventative services (Moeller & Quiñonez, 2016; Fang et al., 2021). The incidence of oral disease shows a social pattern, with the highest burden observed among children living in poverty, racial and ethnic minorities, the elderly, and other socially marginalized groups, including immigrant populations (Li et al., 2018). Moreover, the financial burdens also contribute to poor nutrition, unhealthy dietary habits, and neglecting visits to the dentist until the condition is severe (Azzolino et al., 2019). Unfortunately, the poor oral health of lower socioeconomic classes has typically been attributed to the individual, as we have historically used the model of personal responsibility when it came to oral health (Northridge et al., 2020). Brushing your teeth and making sure you didn’t get cavities
was an individual’s responsibility and was initially thought to be unaffected by society. However, it is now apparent that oral health is a social issue, not just a personal one. Society has contributed to the poor oral health of these vulnerable, lower socioeconomic groups by enforcing social barriers to access to oral health care (Northridge et al., 2020). Therefore, it is important for dentists and other healthcare professionals to come to terms with the problems they have contributed to and start to look after the problems that society has helped create. Our current society has been sanctioned for creating this problem, and it is important for dentists to live up to the social contract and start looking at dentistry as less a commercial enterprise and more as a healthcare profession. By understanding the role society had and has in creating this problem and taking ownership of it, it may be more feasible for dentists to align their ethical values to those of the professional principles society expects. It is important that we move away from a model of individual blame and shame towards a model of care and understanding. We can start this by increasing access to care, providing oral hygiene instruction, focusing on pediatrics, reinforcing good oral hygiene from a young age for all social classes, and embracing patients with lower socioeconomic statuses without judgment.
THE SOCIAL CONTRACT
Professions are different from other occupations in that they require specific knowledge and techniques that the untrained do not possess (Morris & Sherlock, 1971). This creates an imbalance in power, and the professional is expected to act in the best interest of the patient, given their heightened knowledge and responsibility (Morris & Sherlock, 1971). In addition, the professional must maintain high standards of excellence, uphold ideals of altruism, service, and sacrifice, and behave in a way that protects the profession and the benefits that come along with it (Morris & Sherlock, 1971). Such is true of the dental profession, where the dental professional is expected to act as a
Navigating the Meaning of the Social Contract in Dentistry
Sophia Kim, HBSc
fiduciary for their patients and protect the profession. An implicit contract exists called “the social contract.” Like medicine, the social contract in dentistry involves understood agreements between the profession and society, outlined in legislation, codes of ethics, and licensing mandates (Moeller & Quiñonez, 2020). Society expects the profession to care for its vulnerable populations in return for the privileges afforded to dentists, such as self-regulation of the profession, high esteem, and favourable incomes and lifestyles. Indeed, society allows dentists to be quite successful professionals and self-regulate as long as dentists are contributing back to the well-being of society. Historically, professionalism in dentistry was linked to societal expectations, trust, and privileges granted to the dental profession (Taibah, 2018). However, the focus on dentistry’s social contract has been relatively limited compared to that of medicine and has faced increased challenges, especially with the rise of commercialism and cosmetic dentistry (Moeller & Quiñonez, 2020). The current model prioritizing profit and competition risks neglecting the oral health needs of vulnerable populations and undermines the principles of professionalism. It pushes dental professionals to align more with the demands of the market rather than upholding the profession’s ethical value of altruism, which might not have been entrenched during dental school, where procedures are often inadvertently prioritized over principles. Moreover, the especially competitive first few years after graduation may direct a young dentist’s efforts towards production over care, with demands of finding a job, establishing a career, and paying off debts overriding the altruistic mindset (DiBenigno, 2022). This measure of performance and production makes it hard to allocate time to disadvantaged patients who will not aid in meeting monetary quotas, due to missed appointments, lateness, or low financial compensation from government programs. The social responsibility and moral duty that dentists must help improve the oral health of vulnerable populations can be neglected in such situations, so it is important to change how dental education is taught and
maintained to shape the future of the profession of dentistry. This is especially important in the early years of the dentist’s work life, as professional ethics can easily be forgotten when faced with the demands of work and educational debt. Therefore, it is paramount that an enhanced understanding of inclusion, moral community, and empathy be reinforced in school. In addition, the impact of the social determinants of health, with an emphasis on social justice and dentistry’s social contract, are also a few of the key topics that should be addressed continuously throughout dental education.
CURRENT CANADIAN MODEL FOR DENTAL CARE
The gap in oral health care between different socioeconomic classes that I witnessed during my time working is not a new issue and has deep historical roots. Oral health is recognized as a basic human right, yet issues regarding accessibility and availability persist, reflecting the complex interplay of economic, social, and policy factors (Levy et al., 2023). Oral health in Canada has been predominantly influenced by the fee-for-service model, where patients pay for dental services out of pocket or through private insurance (Levy et al., 2023). While the Canadian model currently works for most of the population, the absence of universal dental coverage has contributed to significant disparities in access to oral health care, with affordability emerging as a primary barrier for many Canadians (Levy et al., 2023). This was found to be especially true for those of lower socioeconomic classes, resulting in a higher prevalence of preventable oral health issues in this population (Levy et al., 2023). Historically, the government-funded dental programs in Canada have primarily targeted specific vulnerable populations, such as children, low-income individuals, or seniors, leaving a substantial portion of the working-age population without adequate coverage and uncovered by the dental safety net. Indeed, it was reported that income-related inequalities in poor oral health were still prevalent and getting worse among
The gap in oral health care between different socioeconomic classes that I witnessed during my time working is not a new issue and has deep historical roots. Oral health is recognized as a basic human right, yet issues regarding accessibility and availability persist, reflecting the complex interplay of economic, social, and policy factors.
Navigating the Meaning of the Social Contract in Dentistry
Sophia Kim, HBSc
middle-aged adults (Fang et al., 2021). Although targeting vulnerable populations, in theory, sounds like the correct model to implement aid, this selective approach has instead exacerbated disparities, leaving a large population—the working poor— uncovered. The disproportionate socioeconomic gradient in oral health care is further underscored by the fact that dental insurance coverage often correlates with employment status (National Institutes of Health (NIH), 2021). Individuals with stable employment and comprehensive benefits packages are more likely to have access to regular dental care, preventive services, and timely interventions (Northridge et al., 2020). On the other hand, those in precarious employment or lacking comprehensive benefits face challenges in maintaining optimal oral health, which is a prime example of how the social determinants of health affect the poor in an unfair manner, continuing the cycle of disparity (Northridge et al., 2020).
While various provinces in Canada have initiated community-based programs and targeted interventions to address specific population needs, the overall lack of comprehensive, universal dental coverage has perpetuated disparities. It is also alarming that Ontario, the most populated province in Canada with over 15 million people, has arguably the worst provincial government dental health plan, despite having the greatest number of dental care providers (Statistics Canada, 2023). Additionally, geographic variations in the availability of oral health services contribute to unequal access, with rural and remote communities often facing limited resources and care (Northridge et al., 2020). Such issues continue to be areas that need to be addressed by multiple levels, including the profession and government policymakers.
Acknowledgment of these disparities has prompted discussions about the need for policy reforms to create a more equitable oral healthcare system. Efforts have been made to expand public dental programs very recently by the federal government,
especially for vulnerable populations. The Canadian Dental Care Plan (CDCP), a comprehensive federal solution to bridge the socioeconomic gap in oral health care, remains a work in progress and is currently generating significant controversy within the profession. The historical context of oral healthcare disparities in Canada emphasizes the importance of addressing systemic issues to ensure that all Canadians, regardless of socioeconomic status, have equitable access to essential dental services and that new government programs need to be adjusted so that individuals do not fall outside of the dental safety net. The success of the CDCP rests on expanding dentistry’s focus beyond interventions at clinical and community levels to repairing the profession’s understanding of its social contract, modernizing the culture of dentistry to serve the public, being cognizant of the effects of the social determinants of health, and providing curricula that reinforce the social contract. Such curricula should instill a sense of service into the dental students that will continue into their professional lives.
MOVING FORWARD IN DENTISTRY AND DENTAL EDUCATION
As mentioned previously, with the commercialization of dentistry, the oral health needs of disadvantaged populations have been ignored while the profession pursues business-oriented goals. Part of the problem is the lack of consideration for ethics and social justice in the dental curriculum. A recent study indicated that many Canadian dental students perceive poverty and, possibly by extension, the oral health care of disadvantaged populations as a “distant issue” (Reis et al., 2014). They consider this a government responsibility, while often assigning blame for poor oral health to the individual (Reis et al., 2014). This perception of poverty has been shown to persist in the dentist’s mindset as they continue into their professional lives, with many adopting an “individualistic-deficit perspective” on the causes of poverty, assigning much
of the blame to the individual while ignoring the contributions of the social determinants of health (Loignan et al, 2012).
The social contract is a pivotal part of the dental profession that unfortunately, does not receive the emphasis that it should in dental school. Future dentists cannot properly be trained to be vital stewards of oral health if the dental school curriculum is only focused on the technical aspects of clinical dentistry (Schwartz, 2009). While dental school is a rigorous program to teach the clinical requirements of the profession and the didactic knowledge behind what we do, the curriculum should always be supported with an explanation of WHY we are learning—to be of service to society. Professionalism and ethics of care are fundamental components of providing optimal patient care and should be integrated into all aspects of a healthcare profession’s curriculum. However, studies have found that the average amount of ethics instruction in the North American dental curriculum only accounts for 0.5% of the mean clock hours of instruction for dental education programs (Lantz et al., 2011). In addition, it was also found that as dental students progressed throughout dental school, their level of ethical responses declined, and their level of cynicism rose (Morris & Sherlock, 1971). This is alarming to me as a dental student who realizes that this is contradictory to what should be happening, especially as upper-year dental students become more involved in clinical practice and interact with patients. I, as a member of society, would have hoped that the level of ethical responses of future healthcare professionals would positively correlate with progression throughout dental school.
To follow up with this insight and my found concern, I interviewed the Vice Dean and Director of Schulich Dentistry, Dr. Carlos Quiñonez. When asked if more emphasis should be put on ethics in the dental school curriculum, he agreed, but with “nuance,” as one cannot necessarily “teach someone to be ethical,” but one can “give them skills in
ethical reasoning.” He also mentioned that “ethical thinking and behavior is just like any skill or muscle” which “needs repetition to become stronger.” This was an enlightening response, as I had not previously considered ethical reasoning to be like a skill I can work on to improve, but rather, a fixed level of understanding. Moreover, Dr. Quiñonez highlighted the importance of educating dental students about the social determinants of health but also reaching beyond that and “consider[ing] the commercial and political determinants of health.” Again, I found this new mindset eye-opening, as I had not pointedly considered commercial and political determinants of health previously and experienced firsthand how knowledge can cause a shift in attitude. An attitude shift is precisely what is necessary in not just the government but in society as well to help break the cycle of disparity influenced by multiple determinants of health. Lastly, Dr. Quiñonez mentioned that dental education is “challenged in helping students achieve technical competence—there are simply not enough hours in the curriculum—that many other things cannot be addressed in the time that we are given,” which I can value the truth in. He believes that “establishing a culture of professionalism” in school is a better approach to transmit the values of ethics rather than “simply adding curriculum hours,” but also agrees that increased ethics in the curriculum would also be beneficial, despite the crunched context. His response made me reflect on my own dental education and how much professionalism was reinforced at my school, begining on the first day of orientation, and I felt relief that we were moving in the right direction.
I strongly believe that if ethics is more deeply engrained in all aspects of the dental school curriculum and the virtues of professionalism cultivated, it will be much easier for dental students to retain this mindset once they begin their careers, and understand their responsibility of service to society, including the economically disadvantaged. If all dentists start to value the social contract, the
Navigating the Meaning of the Social Contract in Dentistry
Sophia Kim, HBSc
focus will shift away from competition and back to a collective good. As in my personal journey to overcome my internal conflict, this process should begin by understanding why these issues of bias and inequity exist so that we can understand that we have contributed to the problem and, therefore, have a responsibility to try and repair it. Ethics and professionalism should not just be more fully integrated into the dental curriculum but also carried over into professional practice. In school, it is often easy to slip and start seeing patients as clinical criteria and treatment plans, but dental students must be reminded that they need to see them as patients and as people, for whom we have a responsibility to look after. I believe that
the future of dentistry and all dentists alike can strongly benefit from trying to understand patients who have been marginalized by their financial status and possibly by looking beyond that at other factors. It is important for healthcare professionals to be constantly reminded of the common goal: to better society through service to our patients.
Overall, I am grateful that my experiences have shaped me to realize the conflict that exists in dentistry and remain hopeful that, with better integration of ethics and professionalism in dental school and beyond, the dental profession in Canada can more fully embrace its commitment to the social contract.
REFERENCES
American Dental Education Association. (n.d.) Why be a dentist? ADEA GoDental. Retrieved from https:// www.adea.org/godental/dentistry_101/why_be_a_dentist_.aspx
Azzolino, D., Passarelli, P. C., De Angelis, P., Piccirillo, G. B., D’Addona, A., & Cesari, M. (2019). Poor oral health as a determinant of malnutrition and sarcopenia. Nutrients, 11(12), 2898. https://doi.org/10.3390/ nu11122898
Bedos, C., Loignon, C., Landry, A., Allison, P. J., & Richard, L. (2013). How health professionals perceive and experience treating people on social assistance: A qualitative study among dentists in Montreal, Canada. BMC Health Services Research, 13(1). https://doi.org/10.1186/1472-6963-13-464
DiBenigno, J. (2022). How idealized professional identities can persist through client interactions. Administrative Science Quarterly, 67(3), 865–912. https://doi.org/10.1177/00018392221098954
Fang, C., Aldossri, M., Farmer, J., Gomaa, N., Quiñonez, C., & Ravaghi, V. (2021). Changes in income-related inequalities in oral health status in Ontario, Canada. Community dentistry and oral epidemiology, 49(2), 110–118. https://doi.org/10.1111/cdoe.12582
Lantz, M. S., Bebeau, M. J., & Zarkowski, P. (2011). The status of ethics teaching and learning in U.S. dental schools. Journal of Dental Education, 75(10), 1295–1309. https://doi.org/10.1002 /j.0022-0337.2011.75.10.tb05174.x
Levy, B. B., Goodman, J., & Eskander, A. (2023). Oral healthcare disparities in Canada: filling in the gaps. Canadian journal of public health = Revue canadienne de sante publique, 114(1), 139–145. https://doi. org/10.17269/s41997-022-00692-y
Li, K. Y., Okunseri, C. E., McGrath, C., & Wong, M. C. M. (2018). Trends in self-reported oral health of US adults: National Health and Nutrition Examination Survey 1999-2014. Community dentistry and oral epidemiology, 46(2), 203–211. https://doi.org/10.1111/cdoe.12355
Loignon, C., Landry, A., Allison, P., Richard, L., & Bedos, C. (2012). How do dentists perceive poverty and people on social assistance? A qualitative study conducted in Montreal, Canada. Journal of dental education, 76(5), 545–552.
Moeller, J., & Quiñonez, C. (2016). The Association Between Income Inequality and Oral Health in Canada: A Cross-Sectional Study. International journal of health services: planning, administration, evaluation, 46(4), 790–809. https://doi.org/10.1177/0020731416635078
Moeller, J., & Quiñonez, C. R. (2020). Dentistry’s social contract is at risk. Journal of the American Dental Association (1939), 151(5), 334–339. https://doi.org/10.1016/j.adaj.2020.01.022
Morris, R. T., & Sherlock, B. J. (1971). Decline of Ethics and the Rise of Cynicism in Dental School. Journal of Health and Social Behavior, 12(4), 290–299. https://doi.org/10.2307/2137072
National Institutes of Health. (2021). Oral Health in America: Advances and Challenges. Bethesda, MD: US Department of Health and Human Services, National Institutes of Health, National Institute of Dental and Craniofacial Research.
Northridge, M. E., Kumar, A., & Kaur, R. (2020). Disparities in access to oral health care. Annual Review of Public Health, 41(1), 513–535. https://doi.org/10.1146/annurev-publhealth-040119-094318
Peres, M. A., Macpherson, L. M. D., Weyant, R. J., Daly, B., Venturelli, R., Mathur, M. R., Listl, S., Celeste, R. K., Guarnizo-Herreño, C. C., Kearns, C., Benzian, H., Allison, P., & Watt,
R. G. (2019). Oral diseases: a global public health challenge. Lancet (London, England), 394(10194), 249–260. https://doi.org/10.1016/S0140-6736(19)31146-8
Reis, C. M., Rodriguez, C., Macaulay, A. C., & Bedos, C. (2014). Dental students’ perceptions of and attitudes about poverty: a Canadian participatory case study. Journal of dental education, 78(12), 1604–1614.
Schwartz, B. (2009). An innovative approach to teaching ethics and professionalism. Journal (Canadian Dental Association), 75(5), 338–340.
Statistics Canada. (2023). More than one-third of Canadians reported they had not visited a dental professional in the previous 12 months, 2022. https://www150.statcan.gc.ca/n1/daily-quotidien/231106/ dq231106a-eng.htm#shr-pg0
Taibah SM. Dental professionalism and influencing factors: patients’ perception. Patient Prefer Adherence. 2018;12:1649-1658 https://doi.org/10.2147/PPA.S172788
World Health Organization. (n.d.). Social determinants of health. WHO. Retrieved from https://www.who.int/ health-topics/social-determinants-of-health#tab=tab_1
FROM THE ARCHIVES
FROM THE ARCHIVES
FROM THE ARCHIVES
Submitting Manuscripts for Potential Publication in JACD
The communication policy of the College is to “identify and place before the Fellows, the profession, and other parties of interest those issues that affect the dental profession and oral health. The goal is to stimulate this community to remain informed, inquire actively, and participate in the formation of public policy and personal leadership to advance the purpose and objectives of the College.
Manuscripts for potential publication in the Journal of the American College of Dentists should be sent as attachments via e-mail to editor@acd.org. In the submission cover letter, please confirm that the manuscript or substantial portions of it or prior analyses of the data upon which it is based have not been previously published and that the manuscript is not currently under review by any other journal.
Submissions must include:
1. The full name of each author;
2. E-mail address, mailing address, fax number, and phone number for each author;
3. Degrees and institutional affiliation (if appropriate) of each author; and
4. Statement of responsibility from each author indicating what they have contributed to the document.
Submissions should:
1. Be between 1500 and 3000 words in length.
2. Use inclusive language, including genderneutral pronouns, unless referring to specific persons;
3. Sufficiently de-identify any descriptions of patients and/or clinical encounters;
4. Include disclosure of any conflicts of interest;
5. Designate a corresponding author;
6. Follow the most recent edition of the American Medical Association Manual of Style; and
7. Ensure all published references are cited in the text and numbered consecutively. No references should be cited in the abstract. Each reference should be cited only once; the original number should be used in subsequent citations.
Review Process:
Unless a solicited article, review by the editor (or, in some instances, a “guest editor”) will occur within 21 days of receiving a manuscript to determine whether it suits the general content and quality criteria for publication in the JACD. All manuscripts that are suitable for publication will undergo single-blinded peer review. Usually there are two anonymous reviewers comprised of subject matter experts and board members of the College and/or the JACD editorial board. Because all peer reviewers are volunteers, review may take between 4 and 6 weeks. Once reviewer comments are received by the editor, a decision will be made to accept, accept with minor revisions, accept with major revisions, or reject. JACD reserves the right to edit manuscripts to ensure conciseness, clarity, and stylistic consistency.
