The Community of Dentistry

AMISHA SINGH, DDS

Community. When you read this word, what do you think about? Some of us imagine our families, the hands of our loved ones, the eyes of our children. Some of us think about the people in our neighborhood, the smiles of old acquaintances, the sounds of the homes we grew up in. Some of us think about our peers, the people we work with, the team that helps us grow in our professional lives. “Community is both a feeling and a set of relationships among people;”1 community is something you perceive and understand through emotion and is ultimately about the people. The person that you become is an amalgamation of the people you surround yourself with. Jim Rohn once said, “You’re the average of the five people you spend the most time with.” A related idea is “show me your friends and I will show you your future.” Ultimately the message is the same: your community shapes you in nuanced and persistent ways.

The power of relationships is pervasive, compelling and undeniable. Nicholas Christakis, a physician and social scientist, talks about this power in his TED talk entitled, The Hidden Influence of Social Networks.2 The findings of his research are astounding: “if a friend of yours becomes obese, you yourself are 45 percent more likely than chance to gain weight over the next two to four years.” More surprising, however, Christakis and Fowler found that if a friend of your friend becomes obese, your likelihood of gaining weight increases by about 20 percent—even if you don’t know that friend of a friend. The effect continues one more person out. If a friend of the friend of your friend develops obesity, you are still 10 percent more likely than random chance to gain weight as well.”3 Similar findings exist with the propensity for smoking, emotional exhaustion, depression, and even, likelihood of death. Christakis discusses three theories of why social networks tend to cluster: “induction, which is similar to contagiousness, spreading influence; homophily, where similar demographics group together; and confounding, where people with similar experiences unite.”4

The day we got the fateful and long-awaited admissions call from the dental school we ended up choosing, we were handed admittance into the community of dentistry; that is exactly what this profession is: a community, a network of people, national and perhaps even global, connected through relationships. When we see the world of dentistry as a community, we see similar patterns of social networking.

INDUCTION

Ideas spread like wildfire through our profession. For example, cone beam computed tomography (CBCT) technology was first developed in the late 1990s and now, less than 25 years later, over 86% of surveyed American Academy of Endodontics (AAE) members have a CBCT in their office. 72% of surveyed American Dental Association (ADA) members either have a CBCT in their office or have access to one in their area.5 In less than one generation of practicing dentists, we have normalized the use of technology that is transformative to patient outcomes. It is rare to see that agility in professional groups, especially ones as grounded and historic as dentistry. This is not the only pivot our profession has made: we have seen similar trends in digital radiology, scanning and milling, the use/disuse of certain dental materials and more. We are a profession that can change readily and adapt quickly, and this is, in part, due to the relationships we foster.

HOMOPHILY AND CONFOUNDING

The need for human connection is innate and universal, and this could not be truer for the dental community. As professionals who often practice in silos (although this is rapidly changing), we have found several ways to foster a sense of community and create strong professional networks. Not only have we created groups that are functional “affinity spaces” for different generations (i.e. New Dentist Committee), people with similar interests (i.e. study clubs), and people with similar passions (i.e. advocacy within organized dentistry or honor societies like ACD), a number of different sub-groups and sub-cultures have emerged as dental professionals specialize and congregate around specific interests, techniques, or areas of expertise, such as airway, orofacial pain or cosmetic dentistry. The emergence of social media has accelerated this and allows us to create even more specialized groups in which we can share our passion for dentistry with people who have very similar life experiences (i.e. Mommy Dentists in Business).

These smaller communities within the dental profession often foster a sense of camaraderie and mutual support among like-minded practitioners. Subgroups might form based on dental specialties or interests, and become a place where practitioners share advanced skills and knowledge within their niche. Additionally, sub-cultures can develop around specific treatment methodologies, schools of thought or training, dental technologies or particular patient populations, further enriching the profession's collective knowledge and fostering innovation to expand access and quality of care. Collectively, this fuels our profession forward.

THE DOUBLE-EDGED SWORD

No one will argue the value community brings to dentistry, for the individual practitioners and the collective profession alike. But it is important to note the presence of these social networks also has the potential to create unintended phenomena as well. Just as we have the ability to transmit new and productive ideas, and incubate transformation and innovation in like-minded groups, we also have the potential to transmit bias, form echo chambers, and unintentionally propagate groupthink in professional silos. For example, this is a profession where 18% of dental students indicate they plan on working in a DSO (Dental Support Organization) immediately after graduation6 , and where 20% of dentists under the age of 34 are supported currently by DSOs.7 Despite these facts, a 2017 survey indicated that 77% of the dentists surveyed believed that DSOs “had a negative effect on dentistry.”8 I do not believe any of these surveyed dentists would have intentionally undermined the ethics or practice philosophy of their colleagues, but when we subconsciously remove people from a group, we have the potential to dehumanize and lean into bias, which then becomes dangerous territory.

Psychological isolators such as “groupthink” and the formation of echo chambers can have detrimental effects on decision-making and the open exchange of ideas. In communities like these, individuals may prioritize consensus over critical thinking, leading to a stifling of alternative viewpoints and potential blind spots. Similarly, echo chambers occur when individuals surround themselves with like-minded people, reinforcing their existing beliefs and shielding them from diverse or evolving perspectives. Within the industry, this can lead to a lack of innovation, poor decision-making, the propagation of misinformation, and perhaps most dangerously, the anchoring of exclusion and a lack of belonging for certain groups of people.

So how can we, as a profession, use the power of community to push our industry forwards, while still actively promoting an open and inclusive culture that encourages diverse opinions and constructive dissent? It is imperative to build spaces where people feel safe to challenge prevailing ideas and express different viewpoints, to tell their stories and know they will be heard in an environment of openness, validation and intellectual curiosity. We must tell our stories and hear the stories of others. The communities we have created have value, but pushing for interdisciplinary collaborations and seeking input from professionals outside our immediate practice modality can also help in gaining fresh insights and avoiding insular thinking. The most essential piece of the right balance between support and growth is individually, actively engaging in self-awareness and being open to understanding our own implicit biases.

We have formed strong communities and their fabric is creating a new foundation for our profession. Using these communities, if we intentionally listen to understand, we may encourage a healthier exchange of ideas that will transform the future of dentistry.

REFERENCES

1. https://ssir.org/articles/entry/what_is_community_anyway

2. https://www.ted.com/talks/nicholas_christakis_the_hidden_influence_of_social_ networks?language=en

3. https://medium.com/the-mission/youre-not-the-average-of-the-five-people-you-surroundyourself-with-f21b817f6e69

4. https://blogs.cornell.edu/info2040/2015/09/25/the-hidden-influence-of-social-networksnicholas-christakis/

5. https://apps.dtic.mil/sti/trecms/pdf/AD1186387.pdf

6. https://www.adapracticetransitions.com/blog/to-dso-or-not-to-dso-that-is-the-question

7. https://adanews.ada.org/ada-news/2022/march/main-types-of-dsos/

8. https://www.dentalproductsreport.com/view/dentists-hold-negative-view-of-dsos-survey-shows