The demographic numbers are changing in dentistry. From a policy standpoint, dentistry looks pretty good on paper. The ADA, for example, reports a large increase of women and minorities who are entering and graduating from dental schools. In 2001, 16% of the dentists in the United States were women, and in 2019, 33.4% of US dentists were women.1 In terms of representation of the US population in dentistry, women still lag behind. Women represent only 33.4% of dentists yet make up 50.8% of the population. With the exception of Asian Americans, ethnic minorities also lag behind in representation. In the United States, 38.3% of the population are minorities, and they represent only 25.8% US dentists. Asian Americans show an overrepresentation of dentists at 15.7% as they make up only 5.3% of the US population.2
Consider leadership positions within the profession, and the number of women and ethnic minorities drops off more. In a piece in an ADA publication, the author accentuated the fact that just 13 women were state dental association presidents in one year: “Come later this year, Dr. Enos will be one of 13 women serving as presidents in their state dental association—the most in the ADA’s 160-year history.”3
That is 13 out of 55 state dental associations, which demonstrates progress as well as raises the question: Where are the rest of the women? At this leadership level, the representation drops to 23%. If we consider the ADA’s presidency role, yet another level of inclusion, the number of women drops to 4 out of the last 157 presidents—or 0.02% overall.4
By the appearance of its members, Black Americans were not generally welcomed into the ADA until the Civil Rights Act of 1964. In 2010, the first African American ADA president, Dr. Ray Gist, was quoted as saying, “Along with acknowledging past mistakes and to build a stronger, collaborative platform for future accomplishments, the ADA apologizes to dentists for not strongly enforcing non-discriminatory membership practices prior to 1965.”5
Due to laws, the ADA, along with many other professional associations, were forced to be inclusive on paper, but that did not always materialize into widespread acceptance. It wasn’t until 35 years later that a black ADA president was elected. There have been no others since.
Lack of Inclusivity in Academia
The ADA is not the only part of an exclusionary past in dentistry. Educational institutions played a role as well. One dentist finally spoke up years after “failing out” of dental school at Emory University. He researched the inequity and outed the blatantly discriminatory practices at Emory University from 1948 to 1961 against Jewish dental students. Dr. Perry Brickman’s research on his fellow Jewish classmates helped uncover these anti-Semitic prejudices, and this led to an apology from the then-president of Emory university in 2012, who said: “Institutions—universities—are as fallible as the human beings who populate them, and like individuals, universities need to remind themselves frequently of the principles they want to live by. The discrimination against Jewish students undermined the academic integrity of the dental school and ultimately of Emory. I am sorry. We are sorry.”6
There is yet another problem within our dental community when it comes to being more inclusive—individual ignorances in cultural awareness. When a dental office in North Carolina placed an ad in 2018 with its white dentists dressed in cultural costumes, the feedback was not positive. “No excuse to be clueless anymore,” one social media user wrote. “This is shameful.” The dental office later apologized: “‘In one of our recent advertisements, we attempted to focus upon something that unites us…the warmth and joy behind a smile,’ Renaissance Dental tweeted….‘We now realize it was ignorant and offensive, and we are truly sorry. We have learned a valuable lesson in this situation.’”7
By way of ignorance and exclusionary culture, dentistry, like many other professions, risks 2 very important losses when we fail to recognize exclusionary behaviors. First, on a national level, we risk losing a unified voice. Whether it be in a national association like the ADA or in state/local associations, our unified voice and actions, taken on public health issues with political influence, truly are more effective when done in unison with everyone rowing in the same direction. Membership losses in these organizations create losses in this centralized voice. Secondly, on a more personal level, dentists risk losing patients or never gaining new patients because of their ignorance of potential opportunities. They miss unique needs, offend potential patients with ads like the one mentioned earlier, or continue to market to the same group of people that no longer represents the larger market.
What Can We Do?
According to the American Dental Education Association (ADEA), we should start with dental schools and continue to educate a diverse workforce. ADEA describes cultural competency as “A person’s ability to understand and interact with people from cultures and backgrounds other than their own.”8
The ADEA’s website serves as a good resource for further understanding of the topic. “It is important to have a diverse group of students in each class to promote cultural competency. When students work closely with their colleagues from different backgrounds, they are more likely to understand them and therefore become culturally competent practitioners.”8
For me personally, this rang true as a student at the University of Michigan School of Dentistry. My rural, small town experiences were very limited (and skewed) when it came to diversity. Fortunately, I did believe in the golden rule of treating others as one would like to be treated. This helped me overcome my embarrassment when I asked ignorant questions or exhibited racist behaviors. Others were willing to teach me and dispel my under-challenged ways of thinking. I grew personally and professionally.
What Else Can We Do?
Remain open and learn to be more inclusive. It is pertinent to learn about others, but it’s also paramount to learn about ourselves. What do you know about yourself and your own biases? We all have them. To seek greater self-knowledge, take an implicit bias test, and uncover what perceptions you may unknowingly possess, and with this knowledge, be more intentional in day-to-day activities. Cantu-Pawlik9 explains the original well-known test called the Harvard Project Implicit: “Harvard’s Project Implicit developed The Implicit Association Test (IAT). The test, created 20 years ago, measures social attitudes and beliefs that people may be unwilling or unable to realize.
“The various implicit bias assessments focus on gender, race, skin color, weight, and more. There is no Hispanic/Latino-focused test, though.”9
These kinds of tests have their limitations and can vary, but simply understanding the possibility of unconscious bias is important for each of us to understand. If we remain unaware, our stereotypical thoughts lead to actions in our daily work lives—actions we may regret or feel shame for later on.
Oral surgeon Dr. Cathy Hung discusses ways to increase our cultural competency in her book Pulling Wisdom: Filling the Gaps of Cross-Cultural Communication for Healthcare Providers. She offers tools to bridge the communication gaps that exist with patients.
Although dentistry still struggles to be more inclusive, there is work being done to close this gap. Each of us plays a role in eliminating that gap, not just closing it. The future of our profession depends on us to struggle more. If we demonstrate the ways we all can work together and find the commonalities—by first understanding and respecting our differences—our patients will benefit, our professional lives and interests will thrive, and the future of a unified profession will be preserved.
References
- American Dental Association. Health Policy Institute. Supply and profile of dentists. Accessed November 9, 2020. https://www.ada.org/en/science-research/health-policy-institute/data-center/supply-and-profile-of-dentists.
- American Dental Association. Health Policy Institute. The dentist workforce—key facts. Accessed November 9, 2020. https://www.ada.org/~/media/ADA/Science and Research/HPI/Files/HPIgraphic_0716_1.pdf?la=en.
- Solana K. Changing faces: state dental associations see most women serving as presidents. ADA News. February 26. 2019. Accessed November 9, 2020. https://www.ada.org/en/publications/ada-news/2019-archive/february/changing-faces-state-dental-associations-see-most-women-serving-as-presidents.
- American Dental Association. Presidents & history of the ADA. Accessed November 9, 2020. https://www.ada.org/en/about-the-ada/ada-history-and-presidents-of-the-ada.
- Wyckoff WB. ADA apologizes for tolerating discrimination in ‘60s. NPR. November 6, 2010. Accessed November 9, 2020. https://www.npr.org/sections/health-shots/2011/02/15/131039590/dentist-group-says-it-should-have-stood-against-racial-discrimination.
- Fox K. Emory apologizes for history of anti-Semitism at dental school. November 19, 2012. ADA News. Accessed November 9, 2020. https://www.ada.org/sitecore/content/home-ada/publications/ada-news/2012-archive/november/emory-apologizes-for-history-of-anti-semitism-at-dental-school.
- Elizalde E. North Carolina dental office apologizes for ‘offensive’ ad featuring white doctors in cultural garb. Daily News. Accessed November 9, 2020. https://www.nydailynews.com/news/national/dental-office-ad-showing-white-doctors-cultural-garb-article-1.3983433.
- American Dental Education Association. Need for diversity. Accessed November 9, 2020. https://www.adea.org/GoDental/Dentistry_101/Need_for_diversity.aspx.
- Cantu-Pawlik S. You may be biased and not know it (and here’s how to check). April 3, 2019. Accessed November 9, 2020. https://salud-america.org/you-may-be-biased-and-not-know-it-and-heres-how-to-check/.
Dr. Knowles graduated from Alma College with a major in communication and a minor in biochemistry. She graduated from the University of Michigan School of Dentistry in 1998, completed a general practice residency at the Veterans Medical Center in Ann Arbor, Mich, and currently owns a private practice in East Lansing, Mich. She writes and speaks nationally and owns IntentionalDental Consulting. She can be reached at intentionaldental@gmail.com.
Disclosure: Dr. Knowles reports no disclosures.
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