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Executive Director’s Report

Lately I have been thinking a lot about pendulums, and it took me a while to figure out what it was about these devices that had such symbolic force. It’s certainly true that dental education has experienced broad swings in emphasis and funding over the years, but that wasn’t what I was after. Nor was it a matter of pendulum-like swings in the mission of ADEA, because that mission has been unwavering.

Finally it came to me: a pendulum is a storehouse of energy, and energy is carrying us into new territory to deal with the challenges of our time. I see an energy surge dating back to the year 2000, when ADEA broadened its base to represent the entire dental, allied dental, and advanced dental education communities and the academic dental institutions in which they do their work.

Through this energy surge, ADEA’s momentum has grown. You could hardly find a better example of momentum than our groundbreaking Open Membership initiative, which began January 2, 2006. ADEA now offers free membership to every faculty and staff member and every student of an ADEA member institution of any kind. The technology behind this Open . . . Wider . . . Campaign dictated that our standing membership be zeroed out, so technically we started 2006 with no members at all. Four weeks later there were 10,000, more than four times last year’s total number. Zero to 10,000 in four weeks—not bad momentum, wouldn’t you say?—and it continues to build force at the rate of a person a minute, moving toward our ultimate goal of 60,000. Why is this goal so important? Engaging more members in the work of the Association will bring new ideas, greater understanding, and more political clout—all crucial to our success.

The academic dental institutions in our community are having no trouble attracting applicants. Interest in allied dental careers and advanced dental education has increased. And again this year, as last, applications to dental schools are up more than 15 percent. As dentistry becomes a more attractive career, the ADEA Commission on Change and Innovation in Dental Education (CCI), appointed by Eric Hovland as a presidential initiative, is wrestling with the issues of preparing practitioners who will still be caring for patients in the year 2050. How will these students best learn? How can we provide dental education for life for them in just four years? It is a massive task of anticipation. But the CCI, under the capable leadership of President-elect Ken Kalkwarf and with representation from the allied and advanced dental education communities, has made remarkable progress in the short time that its members have been together this year.

Anticipation is our business at the Association. We are constantly anticipating—gauging what will happen at the point in our pendulum swings when potential energy becomes kinetic energy. We work to predict the logical futures of our community and to come up with quick and useful responses to its needs.

Thus we now work to anticipate major changes in allied dental education. What form will these changes take? There is great and determined energy here, and it is focused on unleashing the potential of allied dental professionals so that they can contribute fully to the care of our patients. New practice workforce models are being developed by other organizations, such as the American Dental Association and the American Dental Hygienists’ Association. We don’t know which models will prevail, but we do know that providing oral health care is not just the dentist’s job. In this context we restate what has long been ADEA policy: we endorse formal education of allied dental professions through accredited academic programs. Chairside, on-the-job training is not good enough. If new workforce models are adopted by states through statute or regulation, the allied dental curriculum must change. Anticipating and preparing for these changes are our responsibility.

Anticipation is powerful, but no amount of it could have predicted the devastation that Hurricane Katrina brought to our member institutions along the Gulf Coast and, most forcefully, to the School of Dentistry at Louisiana State University. When National Guard members escorted Dean—and ADEA President—Eric Hovland and his colleagues to view the damage at LSU, they saw ruins: a physical site, supplies, and equipment beyond repair. In Washington, a quickly mounted ADEAAssist staff team in Central Office received and coordinated countless offers of help. Just a few weeks later, thanks to the courage and tireless efforts of the dean, faculty, and staff at LSU, all dental, allied dental, and advanced dental classes and clinics resumed at a temporary location in Baton Rouge.

With this inspiring example before us, we turn our energies to the critical challenges facing our community. Here is the heart of the matter: we are challenged by changing demographics, by shifting finances, and by an explosion of knowledge.

	The Challenge of the Changing Demographics of Our Community

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Let me share with you a student’s-eye view of the shortage of dental education faculty: "The faculty support I had since my freshman year has decreased. . . . Simple daily tasks, such as critiques of preclinical restorations and patient start checks, are taking longer to perform. A preclinical lab that was covered by six professors my freshman year is now covered by four."

So there’s one piece of our demographic challenge: unfilled faculty vacancies and more on the way. More than half of dental faculty members are fifty and older; almost a quarter are sixty or older. At least 30 percent will retire over the next decade, and the situation with allied dental faculty is similar. Our student reporter has a very good handle on the effect of these shortages. He says, "When faculty positions go unfilled or are reduced, the learning capabilities of the students and the effectiveness of the school are decreased."

We have a brand-new response to the faculty shortage. Beginning this year, an innovative faculty recruitment program will encourage and prepare students to enter academic dentistry. The new Academic Dental Careers Fellowship is a joint project of ADEA and the American Association of Dental Research (AADR) and is being established with $100,000 of support from the ADA Foundation. It will do two things. First, it will offer seminars on the benefits of an academic career to the more than 800 dental students who attend the ADEA and AADR Annual Sessions. Second, it will give a year-long learning and networking experience (and a $2,000 stipend) to ten students during their third-year experience.

Also new in the past year is a fresh approach to another piece of the demographic challenge: increasing the enrollment of underrepresented minorities. The new ADEA/AAMC Summer Medical and Dental Education Program (SMDEP) gives qualifying college freshmen and sophomores six weeks of free enrichment programs focused on increasing their chances of being accepted into medical or dental school. SMDEP is a national program funded by $20 million from The Robert Wood Johnson Foundation and with direction and technical assistance from the Association of American Medical Colleges and ADEA.

Many efforts at many levels have brought the enrollment of underrepresented minorities in dental schools to about 12 percent of all students. This is progress, but not enough. More diversity is fundamental to the well-being of the profession. Why is this so? Dental professionals in the making who are educated not in isolation but who learn amidst diversity learn how to evaluate, communicate with, care for, and follow through with patients of many racial and ethnic backgrounds. And, increasingly, that is a description of our population.

This changing demographic profile is of keen interest to ADEA. All three of our member communities—dental education, allied dental education, and advanced dental education—are factoring the needs of multicultural, aging, and underserved populations into landmark deliberations that are going on right now. Meanwhile, more than 43 million people live in underserved areas, ranging from inner cities to rural locations, and the number of those locations has increased. In a recent year, 25 percent of children, 40 percent of adults aged eighteen to sixty-four, and half of all seniors did not see a dentist.

If we needed a reminder that a sizable portion of our population has difficulty receiving needed or wanted oral health care, it came with the first call-up of troops to Iraq. Poor oral health sidelined many reservists. As reported by the New York Times, the Government Accountability Office found that almost a quarter of the reservists in seven early-deploying units could need emergency dental treatment within a year. The head of the Reserve Officers Association told Congress that some reservists chose to have their teeth extracted so that they could be sent to Iraq. He was quoted in the Times as saying, "Their reward for their loyalty and patriotism will be dentures."

	The Financial Challenges to Sustaining the Traditional Model of Dental Education

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The threat is real. Last year Congress and the Bush Administration presided over a budget process that resulted in the elimination of a few programs important to the academic dental community, deep cuts for many, and level funding for still others. Fiscal year 2006 funding for the National Institute of Dental and Craniofacial Research translates to a 0.9 percent decrease from the comparable FY 2005 level. National Institutes of Health appropriations increased by only 0.7 percent, the smallest percentage increase in thirty-six years and 2.5 percent short of what the NIH estimates will be needed to keep up with rising research costs.

In another important development, both the Senate and the House of Representatives approved the conference report of a bill that may have great impact on children’s dental care under Medicaid. The bill’s language is ambiguous as to whether states will be required to provide Early Periodic Screening Diagnostic and Treatment (EPSDT) services, the only current federal guarantee for comprehensive dental care to children on Medicaid. Medicaid savings are achieved at the cost of cutting services and taking more money out of the pockets of low-income beneficiaries. While ADEA and other national organizations sought changes in the bill to mitigate its harsh impact, it narrowly passed and is now law.

At this difficult time, ADEA has sought strength in coalition by joining with AADR to create a joint committee that will be responsible for all future advocacy efforts. The new National Oral Health Advocacy Committee (NOHAC) has adopted a two-part strategy to fight for the survival and adequate funding of the Title VII Health Professions programs, which come up for reauthorization this year.

In the short term, our organizations will advocate strongly for the establishment of a new title within the Public Health Services Act Health Professions Training Programs that focuses solely on dental education and training programs. The new title also would authorize three existing primary care programs for which academic dental institutions are currently ineligible to receive grants. These programs are Academic Administrative Units in Primary Care, Faculty Development in Primary Care, and Pre-doctoral Training Programs in Primary Care.

In the long term, our organizations will lay the foundation in Congress for an initiative that would coordinate existing Health Resources and Services Administration dental programs under one department, expand funding to states and communities to better provide prevention and early intervention services, and educate a dental workforce. This strategy is predicated on the hope that the pendulum will swing back and the next presidential administration will adopt a more positive policy toward health care in general and the Title VII Health Professions programs in particular.

Given the current political environment, NOHAC urges the dental community to seek help from our corporate partners and the broader business community in advocating for adequate funding for oral health services, dental education, and research. The committee endorses an advocacy message that emphasizes the economic impact of oral disease on corporations, workforces, insurance companies, taxpayers, and the health infrastructure and its debilitating effect on military readiness.

CORPORATE MEMBERS: A Force in Professional Development We have witnessed continued growth in the size of the Corporate Council and the significance of our corporate members’ contributions to ADEA’s programs, which are essential means for delivering knowledge to our members. Our corporate membership grew to sixty companies during the past year, and their financial contributions for our educational programs rose to a record of $1.5 million. For the fourth consecutive year, all of our corporate members shared collectively in the sponsorship of the Opening Session at our Annual Session. In addition, several corporations made special commitments to sponsor major ADEA educational activities. Some of the highlights from this past year include a generous commitment by Zimmer Dental to support programs over the next five years; Sunstar Butler’s commitment to fund the ADEA/Sunstar Butler/Harry J. Bruce Legislative Fellowship for five more years; GSK’s endowment in the ADEAGies Foundation for the Section on Prosthodontics and its grant to support curricular development in geriatric dentistry; Procter & Gamble’s continued funding of our efforts to increase access and diversity in dental education; and OraPharma’s support for summits for both allied and advanced dental education. ADEA corporate members continue to be important forces in our efforts to maintain the storehouse of energy in dental, allied dental, and advanced dental education.

 

ADEAGies FOUNDATION: Energy to Meet Our Challenges This year will see a major obligation fulfilled and a new source of support introduced. The ADEAGies Foundation will successfully complete a $1.5 million match. This match was required of ADEA under the five-year Memorandum of Understanding signed with the William J. Gies Foundation Board of Trustees in January 2001. Moving forward, on February 1, 2006, ADEA, Oral Health America, and the ADEAGies Foundation reached an agreement that transfers more than $200,000 from Oral Health America to the ADEAGies Foundation. These funds will support dental, allied dental, and advanced dental education leadership development activities. This arrangement would not have been possible without the able stewardship of the chair of the ADEAGies Foundation Board of Trustees, Pamela Zarkowski.

 

In addition to Title VII, the National Institutes of Health, the Higher Education Act, and the Ryan White CARE Act are scheduled for reauthorization this year. The challenges surrounding all three reauthorizations promise to require frequent and effective grassroots advocacy. Working toward a more organized and effective advocacy effort, we are fortunate to have a new network of fifty-six advocacy volunteers, one designated by the dean of each dental school. On February 20 at the University of Pittsburgh we held our first advocacy workshop out in the field.

	The Challenge of the Knowledge Explosion

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This is a wonderful challenge to have. It is particularly gratifying to see the connections between oral health and systemic health more clearly drawn with every passing year. As former Surgeon General C. Everett Koop said, "You’re not healthy without good oral health," and the evidence to back that statement is mounting. We know now that if you have periodontal disease, you are at greater risk for cardiovascular disease. If you are a pregnant woman with periodontal disease, you have significantly increased your chances of delivering a preterm, low-birth-weight infant, less than five and a half pounds. We know that saliva is a diagnostic tool as useful as blood or urine; researchers have even reported early success using saliva to detect oral cancer.

When we organized for the future this past year, knowledge was very much on our minds. We responded by creating an entirely new division in the ADEA Central Office to deal with the vast proliferation of data and information in our profession. The newly established ADEA Division of Knowledge Management will organize, catalogue, and disseminate the rich content and intellectual property that are generated at ADEA and elsewhere. This new effort has been called a "Library of the 21st Century," and it will be that and more. What we have heard from the new members who have responded to our Open Membership Campaign is that they want to join a community that shares their special interests. New educators, to take just one example, want their own group with their own online presence, their own links, and opportunities to share in person as well as online. They want this resource to help them be more successful as educators. We have heard them and we are designing this resource for them.

Meanwhile, the ADEA Commission on Change and Innovation (CCI) is taking a broad look at dental education, in part because the Council of Deans has been increasingly concerned about placing the wealth of new information related to oral health care into their schools’ curricula. At the same time, the members of the Council of Allied Dental Program Directors were thinking along similar lines, and their efforts are leading up to an Allied Dental Education Summit in June 2006. The challenges facing allied dental education are a direct parallel to those facing dental education.

CCI, for its part, will oversee the Council of Sections’ updating of the Competencies for the New General Dentist, originally adopted in 1997. This process also includes defining foundation knowledge—the basic scientific knowledge that new dentists must have to be competent. This is not an easy task. With the curriculum overloaded, can some of the basic sciences be moved to prerequisite status to clear more time for genetics and human genome studies, implants, cosmetic dentistry, and serving underserved populations? Maybe not. Senior dental students weigh in with a list of what they feel least prepared for: implants, orthodontics, geriatrics, practice management, and pharmacology. And there is this mandate: when we determine the knowledge base, we must be sure it includes the scientific knowledge that defines us as a learned profession.

This is where the Association stands—dealing with the challenges of demographics, funding, and knowledge. These challenges are critical. Powerfully effective outcomes are critical to the dental, allied dental, and advanced dental education community that we serve.

Ending on a personal note, I want to thank our Board of Directors—Eric Hovland, Ken Kalkwarf, Frank Catalanotto, Sandra Andrieu, Chris Arena, Larry Goldblatt, John Killip, Sheila Koh, Trish Nunn, and Candy Ross—for their remarkable stewardship as leaders of the Association during this year. I also thank all of the volunteers who serve in leadership positions on our councils, committees, and commissions and as our representatives to other associations and organizations. Those of you who have worked with our professional staff in the Central Office appreciate the strength of talent that we are proud to have.

I have to note a special sense of gratitude for the magnificent leadership shown by Eric Hovland, Sandra Andrieu, and their colleagues at LSU during this unbelievable year of unexpected experiences following the impact of Hurricane Katrina. Not only did these leaders move the LSU dental community to Baton Rouge from New Orleans; they did so as a community devastated by the loss of homes and family businesses, the uprooting of their families and neighborhoods, and an uncertain future. There are many lessons to be learned from their journey, and I am proud to have them as my friends and colleagues. We wish them a speedy ride on the pendulum from misfortune to good fortune, so that once again we can join in the popular New Orleans refrain: Laissez les bons temps rouler! Let the good times roll!

	Footnotes

 
This report by the Executive Director of the American Dental Education Association was distributed to members and others attending the 2006 Annual Session.

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