Spring 2013

Revolution Afoot

21st-century challenges will transform dental schools

By Jacqueline Mitchell

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The Simulation Clinic on the fourteenth floor of Tufts School of Dental Medicine. Photo: Alonso Nichols

With major population shifts and a rapidly evolving health-care landscape, dental education is about to undergo significant changes, according to Richard Valachovic, executive director of the American Dental Education Association.

The inaugural presenter in the Dean’s Distinguished Speaker Series, which brings outside experts to the School of Dental Medicine to talk about issues in health sciences education and practice, Valachovic touched on the “drivers of change” that will affect dentistry and dental education in the next 10 years.

Overall, the future looks bright for dentistry, he said. Public perception of the profession continues to be positive, as people recognize the importance of oral health.

“With the wars in Iraq and Afghanistan, up to 35 percent of the troops from some battalions didn’t have the dental status that allowed them to be deployed to the field,” Valachovic said during his talk in November.

“The standard predoctoral curriculum as we now know it, and that we’ve been so successful at for so many years, will prove inadequate.”  — Richard Valachovic, ADEA

The fact that so many military personnel could not be deployed because of poor oral health underscores the need for more dental-care providers, said Valachovic, who serves on the dental school’s Board of Advisors. In 2000, 28 million Americans lived in federally designated dental health professional shortage areas, meaning there was less than one dentist for every 5,000 patients. By 2008, that number had climbed to 48 million Americans.

With two-thirds of the nation’s 186,000 practicing dentists age 50 or older, the dentist-to-patient ratio in the United States—already on the decline since the 1990s—is poised to dip precipitously. “I graduated in 1977. Half of my class is retired or working only part time now,” said Valachovic.

Today about 12,000 applicants vie for approximately 5,000 spots in U.S. dental schools, making this the first time it’s been harder to get into dental school than into medical school, Valachovic said. “We are getting some of the best and brightest we’ve ever had,” he said, but 5,000 new dentists a year won’t be enough to address the impending nationwide shortage of providers. The solution, he said, is to rethink the existing model for dental education.

“The standard predoctoral curriculum as we now know it, and that we’ve been so successful at for so many years, will prove inadequate,” he said. Dental education eventually will look more like medical education, he said, with an increasing emphasis on clinical training in community settings.

In fact, educating dentists alongside physicians, nurses and other health-care providers–a concept known as interprofessional education (IPE)–could prove a workable solution to solving access-to-care issues across the health professions, Valachovic said. IPE has been endorsed by the World Health Organization as a means of creating a more flexible and efficient health-care workforce. Many U.S. medical schools—including Nova Southeastern University’s College of Osteopathic Medicine, which opened a dental program in 1997—have adopted some versions of IPE.

Likewise, some new dental schools have been launched in existing academic health centers in a bid to expand the education they offer to students and the services they offer to patients. These new dental programs—tend to be located in economically stagnant regions where access-to-care issues are already acute.

In addition to being able to share resources with other health and science educators on campus, these new schools will pioneer innovative ways to deliver dental education via the Internet, Valachovic said. “Does every school really need to have every department? Or can we find ways to collaborate through massive open online courses,” known as MOOCs.

No discussion of the future of dentistry would be complete without mention of the ongoing debate about a new kind of dental health provider, sometimes called a dental therapist.

Some advocate the use of these mid-level providers as a means of broadening access to care—a model akin to the way physician assistants and nurse practitioners operate in medicine. (Minnesota became the first state to license dental therapists in 2009.) But others say the access-to-care problem can be solved more easily by expanding the scope of hygienists and dental assistants. Opponents also worry that there are yet no official standards or accreditation processes for programs of dental therapy as there are for hygienists and assistants.

The issue is likely to come to a head in the next few years, said Valachovic, as proponents in at least 15 other states are pushing their legislatures to license midlevel providers. In 2011, Oregon decided to allow the limited use of midlevel providers in a pilot program to test the viability of that care model, and legislators in Washington state are considering a measure to allow midlevel providers.

“There’s a lot of strength of conviction on both sides without really a lot of data yet,” Valachovic said. “We’re going to be hearing about it a lot more.”

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