In 1926, William Gies published “Dental Education in the United States and Canada,” which established a scientific basis for the profession and its training. Yet new issues challenge today’s schools—such as financial difficulties, limited research activity, and a lack of coordination with other health professionals—prompting the need for “Advancing Dental Education: Gies in the 21st Century,” launched and led by Howard Bailit, DMD, PhD, and Allan Formicola, DDS, MS.
“We’re very much involved in dental health policy, and it became apparent to us that there are some major structural changes taking place in education and its delivery system and that dental schools are going to have to adapt to these new realities,” said Bailit. “And we decided to put together a project to investigate this.”
Based at the University of Connecticut School of Medicine, the 3-phase nationwide project will critically assess the current state of oral health education and practice. It also seeks to identify trends that will shape future dental education, develop strategies for restructuring dental education to address long-range challenges, and prepare a long-term strategic plan to implement the necessary changes.
In the first phase, which has been completed, a team of experts prepared 38 background papers published in the August and September issues of the Journal of Dental Education on 6 critical issues related to the future of dental education:
- What’s the current status of dental education?
- How many dentists are going to be needed in 2025?
- What are dentists going to do in 2025?
- What is the dental care delivery system going to look like in 2025?
- What is the role of allied health professions in this change?
- What is the role of research in dental education?
For example, Bailit sees significant problems in the way schools are now financed and how today’s students must make up the differences in funding.
“There has been a huge loss of state support and public support for dental education,” Bailit said. “Their only recourse is to increase tuition and fees and expand class size to generate revenues to operate. The problem is that the average student is now graduating with close to $300,000 in debt. At the same time, dentists’ incomes are static or declining, making it very difficult to pay back that debt.”
Even with schools relying on their students to provide that revenue, research budgets aren’t keeping up with demand. As a result, innovation and competition are both beginning to suffer as schools lack the resources to recruit and support faculties with the scientific training to compete for research grants, Bailit said. And the number of schools doing research is declining.
“Dental schools have reduced their investment in the basic sciences by 50% in the last 10 to 15 years. They’ve added all these new students, and there’s been no increase in the number of full-time clinical faculty. What impact that has on quality, it seems to me, is obvious,” Bailit said.
“So what we see in dental education is a relatively few schools dominate the research area, and the majority get very little research,” said Bailit. “If you want to stay a learned profession, you’ve got to be based in a research facility, and you’ve got to do research.”
Next, a National Advisory Committee will be appointed to review the papers, participate in public hearings, and develop recommendations. The third phase will see a new initiative to further disseminate the results and undertake demonstration projects that will help schools implement the committee’s recommendations.
The AADR’s Role
The American Association for Dental Research (AADR) has responded to the completion of the first phase with recommendations published alongside other articles related to the project in the Journal of Dental Education. For example, the AADR agrees with the need for dental schools to participate in research and foster the integration of multidisciplinary research teams.
The AADR also encourages cross-collaboration between dental schools and other departments on campus or with a neighboring academic health center, medical school, or health science institute so dental researchers could see themselves as part of the larger research community and for the larger research community to recognize the contributions of dental researchers.
“Another big issue is the isolation of dental schools from the rest of the academic medical center,” said Bailit. “And they’re too small to develop the critical mass of people that are needed to do research in this competitive world. So, they’ve got to be integrated more closely with the research taking place in the academic center. That’s a big organizational issue.”
The AADR further says that dental schools must engage dental students in research as they bring more PhD students into the dental, oral, and craniofacial research enterprise while leading efforts to improve the quality of training for dual degree students. Meanwhile, the AADR adds, dental schools should maintain flexible dental curricula to allow students to take advantage of research opportunities at their home institutions and at outside facilities.
And as the scarcity of financial resources continues to challenge the dental research community and the broader biomedical research enterprise, the AADR urges dental schools to compete for funding from the National Institute of Dental and Craniofacial Research—which only awards half of its funding to dental schools, Bailit says—and expand their portfolios to the other institutes and centers of the National Institutes of Health, other federal agencies, private foundations, and industry.
“Every dental school has a role to play,” said AADR president Raul Garcia. “Dental schools are the primary source for producing clinician scientists in dental, oral, and craniofacial research. William Gies emphasized that dentistry is both a learned profession and a specialized area of medicine, and his insights remain relevant today. We are excited to see how this project builds on Gies’ vision and validates the foundational role that research and scholarship play in the profession.”
The AADR aims to support these goals by advocating for the inclusion of oral health in large research initiatives, facilitating the involvement of its members in these projects, and raising the profile of dental research in the larger research community. According to the organization, it will continue to provide networking and mentorship opportunities for trainees and early career scientists through meetings and programming.
Also, the AADR will continue to advocate for adequate, sustainable, and predictable federal funding for dental research and training. To help further meet the financial challenges of training and research, AADR award and fellowship programs offer students opportunities to pursue their research interests. Plus, the AADR Committee on Diversity and Inclusion will continue to develop strategies to increase diversity in the dental, oral, and craniofacial research community.
Finally, the AADR calls for the Commission on Dental Accreditation (CODA) research standard to be strengthened and given greater attention during site visits. The AADR reports that it will continue to work with the ADA and the American Dental Education Association to strengthen CODA Standard 6 on research.
“I think it’s an important project, and we hope that it has an impact,” Bailit said.
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