By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

FDA announces sweeping changes to oversight of wearables, AI-enabled device

The changes could allow unregulated generative artificial intelligence tools into clinical workflows

Utah and Doctronic Announce Groundbreaking Partnership for AI Prescription Medication Renewals

Utah becomes the first state to safely evaluate autonomous AI for prescription renewals for chronic conditions

Hospitals Are a Proving Ground for What AI Can Do, and What It Can’t

Healthcare is going all-in on artificial intelligence, from reading patient scans to fighting insurance denials

Headlines from STAT’s AI Prognosis newsletter and the Wall Street Journal (WSJ)

These are just three of the headlines that caught my eye at the start of this month, and dozens more have appeared since — in my news feeds alone! 

Less than two years have passed since I first wrote about ChatGPT, the large language model (LLM) that took the world by storm following its release in November 2022. At the time, I noted that “the pace of change is accelerating at an unprecedented rate.” Little did I know. Keeping up with everything written about LLMs and other forms of artificial intelligence (AI)  has become a Herculean task. Grasping all of the ways these technologies are transforming our lives…impossible. 

Nevertheless, we can draw some insights from the ocean of information flooding the popular press, trade publications, and professional journals. Here are a few takeaways from my reading that may prove helpful to other dental educators and health professionals as we navigate the AI-infused reality that lies ahead.

1. Pilot projects are demonstrating AI’s ability to improve diagnosis and clinical decision making, but delivery of these technologies at scale appears a long way off.

Imagine…

• An AI tool that analyzes coronary plaque in CT scans to determine a patient’s risk of heart attack or stroke without undergoing an invasive angiogram procedure.
• An AI-enabled wearable device that gently wakes patients with atopic dermatitis when they begin scratching in their sleep. 
• A new class of algorithms that could soon turn the screening mammogram into a tool for predicting an individual’s risk for cardiovascular disease as well as breast cancer.

These tools already exist, as do predictive algorithms that analyze the vital signs and charts of hospitalized patients each hour to determine their risk of deterioration. Kaiser Permanente employed this AI tool in twenty-one hospitals and reports it saved five hundred lives over the course of a single year. I also heard about an equally impressive use of AI at my old stomping grounds, Boston Children’s Hospital. Genetics researchers at the hospital’s Manton Center for Orphan Disease Research worked with OpenAI to create a bespoke ChatGPT model that had diagnosed rare diseases in 15 children as of last October. 

These cases demonstrate that clinical applications of AI have come a long way and have tremendous promise. That said, it’s notable that each example constitutes a discrete application of the technology on a single condition or treatment. None offers a solution with the (admittedly failed) ambition of IBM’s Watson supercomputer or the tricorder from Star Trek — tools that aimed to revolutionize the practice of medicine, and by extension dentistry. Such giant leaps may be far off, but intermediate steps are likely just a matter of time. The federal Advanced Research Projects Agency for Health (ARPA-H) launched an effort this month to create AI agents that would serve as “clinician extenders” capable of autonomously providing 24/7 cardiovascular care to millions of Americans.

A December 2025 report from KLAS Research affirms that most health care organizations have embraced AI but primarily for administrative, not clinical, tasks and not at scale. The reasons are manifold — patient-safety and liability concerns, a lack of governing rules, and uncertainty about their return on investment. If you have time for a deeper dive into this topic, I recommend a recent European Commission report on the deployment of AI in health care. It discusses these and other implementation barriers and proposes steps that could enable “the sustainable integration” of AI into health systems. 

2. Dental use cases are fewer, but more are surely coming. 

Dental applications of AI are fewer and less diverse, but they do exist — at least according to Google’s LLM, AI Mode, which emerged last month as the top tool for providing up-to-date information in a chatbot battle staged by The Washington Post. That query pulled up a 2025 scoping review in Bioengineering, which noted the following use cases:

• Radiographic diagnostics, including reading cone-beam computed tomography (CBCT) scans, intraoral photographs, and radiographs. And identifying periapical lesions on 2D CBCT slices.
• Optimizing restoration design and implant positioning
• Predicting the risk of caries, periodontal disease, and cancer in order to personalize care planning 

The authors’ conclusion? “AI is revolutionizing dentistry with enhanced diagnostic accuracy, predictive planning, and efficient administration automation.”

Regarding this last item, industry sources suggest that dental practices are adopting AI tools for administration and revenue cycle management, with dental service organizations leading the way. If a 2025 report on digital dentistry from the United Kingdom’s National Health Service is any guide, the integration of these tools could significantly increase efficiency. “Practices utilizing AI-powered management systems report average efficiency improvements of 27%, allowing reallocation of staff time from administrative tasks to patient care,” the report states.

3. Reducing the burden of documentation is AI’s biggest impact on health care to date. 

As you may have noticed during a recent appointment of your own, ambient scribes — AI tools that capture conversations between clinicians and patients and turn those recorded encounters into clinical notes — are becoming a fixture of many practices. Health care organizations have eagerly adopted these tools in the hope of reducing clinician burnout linked to the demands of digital documentation. 

Do the tools work as advertised? A study of clinicians in seven health systems reported a significant reduction in burnout and cognitive load after a month working with an AI scribe, suggesting their use can reduce administrative burden and improve clinicians’ wellbeing. Yet writing in STAT, Mario Aguilar and Brittany Trang report on studies that show the time actually saved by these tools varies considerably and does not necessarily align with clinicians’ perceptions. Additionally, one scoping review found that errors remain an issue even as speech recognition improves, with errors of omission being especially problematic. A separate study comparing the accuracy of five unnamed AI scribes found that all five tools regularly produced AI-generated notes with errors deemed capable of producing moderate-to-severe harm, raising significant concerns about patient safety.  

Despite these limitations, I suspect health systems will continue to invest in these tools. STAT reports that companies marketing AI scribes have begun raising capital and wooing customers on the promise that AI-assisted clinical documentation will unearth more billable conditions and increase revenue for adopters. The WSJ reports about 1,000 hospitals are already using Epic’s generative-AI tool to mine patient records and draft insurance appeals. An executive at Northwestern Medicine told the paper that staff now spend about 23% less time processing each denied claim. A similar effort is paying off at New York’s Mount Sinai, which gained $12 million in revenue by using AI to successfully overturn insurance denials. Who will pick up the extra cost to the health sector writ large remains unclear, but is it any wonder that health care organizations are purchasing commercial AI licenses at more than twice the rate of other U.S. businesses?

Next month I’ll Iook at how AI might influence health professions education and scientific research and grapple with its destructive potential. Stay tuned!

By Rick Valachovic, DMD, MPH, Clinical Professor and Director of the NYU Dentistry Center for Oral Health Policy and Management

It is with deep gratitude that I reflect on Dr. Jeanne Craig Sinkford, a trailblazer, a mentor, a colleague, and a friend whose impact on dental education and on my own life cannot be overstated. Her passing in October leaves a void in our profession, but her legacy continues to inspire all who knew her and all who will follow in her footsteps.

Dr. Sinkford often reflected on her own journey with profound wisdom. “Education is not a destination but a lifelong journey,” she would say. “I have learned that the degrees we earn are not endpoints. They are tools we must use to serve others and to transform our profession for future generations.” This philosophy guided everything she did.

Her path was remarkable by any measure. Born in Washington, D.C., in 1933, she exemplified academic excellence from an early age. She was just 16 when she graduated from Paul Laurence Dunbar Senior High School, where her leadership abilities flourished. That same year, she began her undergraduate studies at Howard University, earning her bachelor’s degree with Phi Beta Kappa honors before entering dental school.

At Howard’s College of Dentistry, she distinguished herself by leading her graduating class, an achievement that brought her national recognition. But Dr. Sinkford understood that being first carried unique responsibilities. “Being the first is both an honor and a responsibility,” she believed. “It means you must be excellent, not just for yourself, but because you are proving what is possible for all those who will follow.”

She pursued advanced training at Northwestern University and then specialized in pediatric dentistry. By the mid-1970s, she had achieved what many thought impossible: ascending to the deanship at Howard University College of Dentistry and becoming the first woman to lead a U.S. dental school. She served in that role for 16 years, transforming her institution and creating pathways for countless others.

Our Work Together at ADEA

Dr. Sinkford joined the American Dental Education Association (ADEA) in 1991 after stepping down from the deanship. When I became ADEA’s executive director in1997, she was serving as associate executive director for ADEA’s Office of Minority and Women’s Affairs. She brought a lifetime of experience, wisdom, and passion to the role, eventually expanding and transforming the office as its executive director. While her formal portfolio focused on minority and women’s issues, Dr. Sinkford was far more than an administrator in a specific area. She quickly became a key adviser to me on all the issues we faced at ADEA.

Our connection went deep and, in fact, predated our roles at the association. We shared a common mentor in Dr. Joseph Henry, a visionary leader who shaped both of our careers in profound ways. Dr. Henry had been the chair of the search committee that hired me into my first faculty appointment at Harvard School of Dental Medicine. He came to Harvard after his retirement from Howard’s dental school, where Dr. Sinkford had succeeded him as dean. Through Dr. Henry, she and I were connected by more than coincidence. We were linked by a shared commitment to excellence, inclusion, and a belief in the transformative power of education.

During my time at ADEA, Dr. Sinkford’s counsel was invaluable. Rooted in decades of leadership and informed by her experiences as both a clinician and an administrator, her advice was always guided by a commitment to equity that went far beyond surface-level changes. As she often said , “True diversity in our profession isn’t just about counting faces in the classroom. It’s about ensuring that every student, regardless of gender or background, has the support, the mentorship, and the opportunity to reach their full potential and become leaders themselves.” This conviction shaped every initiative she undertook as she built what would become ADEA’s Center for Equity and Diversity.

Her extraordinary ability to see the bigger picture while never losing sight of the individuals whose lives we were working to improve extended her impact far beyond her official duties. As a scholar and thought leader, she contributed extensively to the dental education literature throughout her career. Together, we published 20 articles during our time at ADEA;  from our 1999 examination of women’s health in the dental school curriculum to our final publication, “Growing our own: mentoring in the academic dental pipeline.” This 2019 work captured the essence of our core beliefs about developing the next generation of leaders.

We were also co-investigators on numerous grants from federal agencies and private foundations, including the W.K. Kellogg Foundation, the Josiah Macy Foundation, and the Robert Wood Johnson Foundation. These collaborations allowed us to translate our shared vision into concrete programs that opened doors for countless students and faculty.

Opening Doors for Others

Dr. Sinkford’s overriding joy was mentoring women and marginalized individuals, providing the roadmap and example that “this can be done.” Her philosophy of mentorship was both simple and profound: “My greatest joy has never been in my own achievements, but in showing others that ‘this can be done.’ When we open doors, we must not simply walk through them ourselves. We must hold them open and reach back to pull others through.”

True to her word, she didn’t just open doors. She held them open, reached back, and pulled others through with extraordinary generosity of spirit. She encouraged countless people to pursue advanced degrees and academic careers in dentistry and oral health. She also led a series of ADEA International Women’s Leadership Conferences that highlighted global opportunities for women to assume key roles in academic dentistry.

Her commitment to mentoring and documenting the achievements of minority women leaders found its fullest expression in 2021 with the publication of Undaunted Trailblazers: Minority Women Leaders for Oral Health, which she co-authored with Drs. Shelia S. Price and Marilyn P. Woolfolk. This pivotal work did more than preserve the stories of 31 African American women who broke glass ceilings in oral health; it also created a roadmap to inspire and guide future generations of women entering the profession.

A Lasting Legacy

The dental education community has honored Dr. Sinkford’s contributions in ways that ensure her legacy lives on. ADEA presents three awards each year in her name. My wife Mary Kay  Leonard and I are pleased to provide the financial support for the annual ADEA Dr. Jeanne C. Sinkford Faculty Leadership Award. In this small way, we wish to honor the enormous impact she had on our profession and on our lives.

Working alongside Dr. Sinkford at ADEA was one of the great privileges of my professional career. She brought wisdom, grace, and an unwavering moral compass to everything she did. She challenged us to be better, to think more broadly, and to never lose sight of why we were working to create opportunities for those who would come after us. Through our shared connection to Dr. Joseph Henry, I came to understand that mentorship is not simply about passing on knowledge. It’s also about passing on values, commitment, and a vision of what’s possible. Dr. Sinkford embodied this understanding in everything she did.

Carrying Forward Her Legacy

As we honor Dr. Sinkford’s memory, let us commit ourselves to carrying forward her legacy: to mentor generously, to break down barriers, to create opportunities, and to never forget that our work is about the people whose lives we can change. She showed us the way. Now it is our responsibility to keep walking the path she so courageously blazed.

Thank you, Dr. Sinkford, for everything you gave us. You will be greatly missed and never forgotten.

By Rick Valachovic, DMD, MPH, Clinical Professor and Co-Executive Director of the NYU Dentistry Center for Oral Health Policy and Management

Throughout my career, I’ve tried to look around the corner to see what’s coming around the bend and how it will impact our profession. This year, I caught sight of a new concern that may surprise you: plastics.

What’s the mercury connection? Almost four decades ago, fears about the health effects of dental amalgam obscured its real downside — the need to manage disposal of the mercury contained in amalgam waste. Today  amalgam is used far less often to restore teeth in the United States, but dentistry faces a new environmental challenge: Our clinics, and health care in general, are awash in plastics. These synthetic materials are interwoven in almost every aspect of dental practice — from our personal protective equipment to our office furniture to the materials we use in the mouth.

Take composite resin fillings, which have become the default choice for treating dental caries. Composite looks nicer than amalgam, and its placement allows dentists to preserve more natural tooth, but this material is composed of polymers — the building blocks of plastic.

“We don’t yet know what all the ill effects of this material are,” says Bapanaiah “Penny” Penugonda, BDS, MS, one of NYU Dentistry’s senior mentors/group practice directors. As the first person to receive a master’s in dental materials science at NYU, Dr. Penugonda rates composite fillings “pretty good,” but acknowledges their potential downsides. “When you’re grinding this material, when you’re polishing this material, some of these microplastics are going to come out, and where are they going to go?” he asks.

Plastics and Health

Earlier this year, popular media outlets reported that our brains contain about as much plastic as a typical plastic spoon. The image is almost comical, but the reality demands much more than a passive shrug. Plastics have become ubiquitous in our daily lives, and tiny fragments of various polymers have invaded our bodies. In fact, plastics have been found in human lungs, blood vessels, and placentas, to name just some of the organs studied, and those micro- and nanoparticles are not inert. They release harmful chemicals including endocrine disruptors that have been associated with the global rise in diabetes, declining sperm counts, and certain cancers.

The problem is so vast that in August, delegates from 183 countries met in Geneva to try and finalize a global treaty “to protect the environment and human health from plastic pollution.” This was the fifth meeting held to develop a convention to govern the design, production, and disposal of plastics world-wide. A draft and a revised proposal emerged from the talks, but the delegates adjourned before reaching consensus, leaving observers feeling “deeply disappointed.”

Dentistry’s traditional separation from medicine often places it on the fringes of discussions about human health writ large, but it’s imperative that we tune in to these signals that our environment is imperiling our health. If we are to succeed in adapting to the challenges ahead, our profession must heed these early warnings signs.

A Wake-up Call for Dentistry

Regulation and awareness might reduce the amount of plastic waste humans generate, but it won’t solve the problem of how we restore damaged teeth, correct a malocclusion, or help patients with nighttime bruxism. Since the advent of plastics, the material’s versatility has made it an obvious choice for many dental uses. It can be hard or malleable, clear or opaque, and any color of the rainbow. It’s also long-lasting and typically doesn’t biodegrade. Yet plastics are susceptible to wear, especially when heated, and as they break down, they release tiny particles and known toxins whose impact on human health is now being quantified.

Part of that work is happening here at NYU, where Dr. Penugonda is preparing to conduct research to improve how microplastics are measured in the oral environment. He also plans to investigate whether plastics are leaching into saliva, tooth structure, and soft tissue. I’ve also learned that the American Association of Orthodontists has begun monitoring research into the potential connections between microplastics and dental devices. Clear aligners have many advantages over metal braces, but aligners’ presence in the mouth, their daily wear, and their exposure to friction raise concerns that they may elevate wearers’ risk of microplastic ingestion. They also contribute untold amounts of plastic to the waste stream each year — another reason I’m happy to see orthodontists calling for more research.

In September, the Center for the Investigation of Environmental Hazards (NYU CIEH) at our sister institution NYU Langone hosted its second symposium on plastics and human health. The talks were too wide-ranging to summarize here, but a clarion call emerged that bears repeating. “This is not an us versus them problem. This is an us problem,” said Matthew Campen, PhD, MSPH, a professor in the College of Pharmacy at University of New Mexico. “It is something we all have to figure out and come to terms with.”

The Way Forward

In April, I wrote about ways to make dentistry more environmentally sustainable. Reducing our dependence on single-use plastics, avoiding plastic packaging, and finding less wasteful ways to maintain a sterile environment are effective actions we can start taking now, and more help is on the way. The CIEH symposium showcased a range of novel solutions for replacing commonly used plastics, which are already on the market or in development.

This spirit of innovation is also leading to the creation and adoption of next generation dental materials.

• Silver diamine fluoride (SDF) can be used to prevent and arrest caries, providing dentists with one inexpensive, readily available alternative to conventional “drilling and filling.”
• Here at NYU, researchers have developed zinc-based materials that have been shown in the lab to fight caries and reduce sensitivity without the cosmetic downsides of SDF. The team is now working with industry to develop a commercial product that could be a game-changing non-invasive treatment for tooth decay.
• And if experiments at King’s College London and clinical trials at Kyoto University in Japan play out as hoped, lab-grown teeth and a medicine to facilitate tooth regrowth may revolutionize dentistry in the next ten years.

In the meantime, we have access to one more plastic-free material that is inexpensive, easy to use, and widely available: dental amalgam. Despite its bad rap in the 1990s, there is still no credible scientific evidence linking amalgam fillings to the harms their detractors cite. In fact, a 2018 Canadian government report comparing composite and amalgam concluded: “The best available evidence indicates that, compared with composite resin, amalgam restorations appear to be more clinically efficacious and as safe, while also costing less.” Thanks to an earlier international treaty, the Minamata Convention on Mercury, and subsequent regulations, U.S. dental offices now use amalgam separators to capture mercury waste, reducing dentistry’s contribution to this environmental hazard.

The concerns about mercury underlying these efforts are well founded. Unfortunately, the Minamata Convention signatories went a step further this November, calling for a complete global phase-out of dental amalgam by 2034. This will eliminate one of the most affordable and versatile tools in our restorative toolbox, and it could leave patients in less developed corners of the world with insufficient options for treating dental caries.

In confronting both mercury waste and microplastics, dentistry must remember that human and environmental health are inextricably linked. I believe we can address the global burden of oral disease, practice sustainably, and reduce both the environment’s exposure to mercury and the public’s exposure to microplastics, but will we? Research into the health effects of these particles should be a wake-up call to accelerate our efforts to develop a new paradigm of dental practice. I hope our profession heeds that call. It’s time for all of us to acknowledge the harms inherent in a plastics-filled world and to take concrete steps toward remedying them.

By Rick Valachovic, DMD, MPH, Clinical Professor and Co-Executive Director of the NYU Dentistry Center for Oral Health Policy and Management

U.S. dentists wrote almost nine million opioid prescriptions in 2022. I suspect the vast majority were written with only the best intentions for patients experiencing genuine pain. But given what we’ve learned about opioids, we need to ask: Were all of these prescriptions appropriate? Were patients put at risk?

I presume anyone reading this already knows that dentists have traditionally been the main prescribers of opioids to teenagers, typically in connection with third molar extractions. Studies show that young people who fill these prescriptions are at least twice and up to 14 times more likely to misuse opioids than their peers. The magnitude of this reality triggered research into alternatives for treating dental pain more than a decade ago, and the results were encouraging. Researchers found that ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs), especially in combination with acetaminophen, were effective in treating post-operative dental pain without the adverse side effects — and risk of diversion, misuse, and overdose — associated with opioids.

Yet, data on commercially insured patients show that many dentists still routinely prescribe opioids following impacted third molar extractions, and 70% of patients fill those prescriptions. What’s going on?

A Security Blanket

“The opioid prescriptions are a security blanket,” says Cecile Feldman, DMD, professor and dean of the Rutgers University School of Dental Medicine. Even though most dentists now counsel their patients to take NSAIDs with acetaminophen first, old habits persist. “People feel more comfortable leaving with the prescription. Surgeons feel more comfortable giving them the prescription,” Cecile says. In her view, these just-in-case scripts send a subliminal message: “We don’t know if that non-opioid is going to work.” 

Cecile led a team at Rutgers that studied the effectiveness of opioid vs. non-opioid analgesics for postoperative dental pain over the course of several days. They measured a range of patient-centered outcomes including side effects, sleep quality, and patients’ ability to resume normal activities without pain interference. The results? In addition to better sleep for the first night and less pain interference over the postoperative period, participants taking ibuprofen and acetaminophen also experienced fewer adverse effects with less severity. 

Notably, the study participants taking non-opioid analgesics were half as likely as those taking an opioid with acetaminophen to need rescue medication. This finding should lay to rest a common concern that, without an opioid prescription, patients may call their dentists for pain medication at all hours of the night.

The Pace of Progress

A 2021 RAND Corporation study comparing the volume of dentist-prescribed opioid medicines dispensed by retail pharmacies in 2008-2009 with the volume dispensed in 2017-2018 found a substantial 41% drop. The researchers also found a dramatic 66% decrease in opioids dispensed to 18- to 25-year-olds. Contrast those findings with a 2013 survey of oral and maxillofacial surgeons, which found that all but two of 384 respondents routinely prescribed opioids after third molar extractions.

These declines represent meaningful progress, but the pace of that progress may have slackened. Researchers at the University of Michigan medical and dental schools analyzed the impact of the COVID-19 pandemic on U.S. dentists prescribing patterns. The researchers found that the number of opioid prescriptions rose during the first months of the pandemic, and the rate of decline subsequently slowed. As a result, the researchers calculated that 6.1 million more dental opioid prescriptions were dispensed in the 30 months ending in December 2022 than previous trends would have predicted.

“In the last 10 years, we’ve seen a decrease in prescribing narcotics postoperatively for dental pain, so we’re  moving in the right direction,” says Paul Moore, DMD, PhD, MPH, professor emeritus at the University of Pittsburgh (Pitt) School of Dental Medicine. Paul led some of the research into the effectiveness of combining NSAIDs and acetaminophen for dental pain. More recently, he chaired a panel convened by Pitt, the American Dental Association, and the Center for Integrative Global Oral Health at the University of Pennsylvania (Penn) to create evidence-based clinical practice guidelines for the pharmacologic management of acute dental pain in children and in adolescents and adults. Those guidelines state unequivocally, “Clinicians should avoid the routine use of just-in-case prescribing of opioids and should exert extreme caution when prescribing opioids to adolescents and young adults.”

When Paul and I were dental students, the best option available was Tylenol with codeine. The advent of NSAIDs, which target inflammation, changed the game, he says. “They’re just particularly effective in treating dental pain, because dental pain is inflammatory to a great extent.” So why do some dentists still routinely prescribe opioids? Paul points to an age-old challenge. “It’s remarkable how slow it is to try to change practice habits,” he says. 

Getting the Word Out

Deborah Polk, PhD, is a psychologist and visiting associate professor of dental public health in the School of Dental Medicine at Pitt. She is also co-principal investigator with Alonso Carrasco-Labra at Penn on the Food and Drug Administration grant that funded the guidelines’ development and dissemination.

Deb is leading that dissemination effort, which aims to inform dentists, emergency medical providers, and the public about the new standard of care in treating dental pain. Outreach to professional organizations and a wide array of media and social media outlets alerted millions to the new treatment guidelines. The effort yielded 430 news articles, almost 10,000 downloads of the guidelines in 2024, and a huge increase in visits to the ADA’s pain management webpages. 

These results are impressive by any measure, but as Deb is quick to emphasize, “Knowledge alone doesn’t change behavior.” Implementing the guidelines also requires skills, opportunity, and motivation. One obstacle? “We heard that dentists didn’t know how to have the conversation about pain management with their patients,” Deb told me, so the team developed a one-page, visual conversation aid that dentists can use chairside. She and Paul also created an on-demand, free continuing education course that dentists can take to learn how to engage in shared decision-making with patients. A manuscript looking at the impact of the course on prescribing behaviors is currently in review.

Spurring Behavior Change

What more will it take to change the standard of care? Deb was part of a Pitt research team that looked at dentist prescribing trajectories from 2015-2019. They found that only 3.4% of dentists consistently prescribed opioids at high rates. “We thought, ‘Oh, they’re all oral and maxillofacial surgeons.’ No, 85% of them were general dentists,” she told me, which raised obvious concerns.

“Some of it is illegal, and state boards of dentistry need to be cracking down,” she says. As for other outliers, “Perhaps they trained in a time when we really thought that this pain was better managed by opioids. They think they’re doing the right thing, but now we know better,” she says.

Cecile’s group is also looking at patient and provider behaviors, the next front in the effort to stem inappropriate prescribing in our community. The Rutgers researchers hope to better understand how the practice environment  influences what dentists prescribe. They also plan to ask, “Who goes and fills that prescription?  If they fill it, do they take it?” Cecile told me. 

I’m pleased to report that dental schools appear to be adhering to the new pain management guidelines. Paul told me that Pitt adopted a policy of no routine dispensing of opioids a decade ago. At Rutgers and here at NYU, students learn that opioids should only be dispensed as a last resort. Any dental school that needs help in updating its curriculum can turn to the Dental Education Core Competencies for the Prevention and Management of Prescription Drug Misuse prepared by the Commonwealth of Massachusetts in collaboration with the three Boston-based dental schools. Given these developments, I feel confident our graduates will prescribe non-opioid analgesics as the first-line therapy for dental pain in their practices. I hope ongoing and renewed efforts by researchers, professional associations, and regulatory bodies spur implementation of this updated standard of care by the entire practice community in the very near future.

By Rick Valachovic, DMD, MPH, Clinical Professor and Co-Executive Director of the NYU Dentistry Center for Oral Health Policy and Management

Academic dentistry faces a perfect storm. Multiple policy changes have converged simultaneously, creating a cascade of challenges that individually would be manageable, but together represent an existential threat to how dental schools have operated for decades. 

This isn’t about any single policy decision. It’s about the cumulative impact of fundamental shifts in educational financing, research funding, clinic revenue, and regulatory frameworks all happening at once.

Anatomy of the Perfect Storm

The convergence began in January with a series of federal policy changes that have created overlapping pressures across every aspect of dental school operations. 

• To start, Congress eliminated GRAD Plus loans and implemented strict borrowing caps on federally subsidized loans of $50,000 annually and $200,000 total. These changes strike at dental education’s financial foundation. Urban Institute data reveals that more than half of dental students have historically borrowed above these new limits. Some prospective students will turn to the private market, but others will be unable to secure adequate financing, creating an immediate enrollment crisis at many of our schools.
• Simultaneously, proposals to curtail research funding introduced another source of financial instability. The proposed 15% cap on indirect costs associated with National Institutes of Health (NIH) grants threatens the research infrastructure that supports faculty positions and institutional operations. The cap is currently blocked in the courts, but it signals the likely arrival of future constraints. Schools heavily dependent on federal research funding face potential budget shortfalls in the millions.
• Disruptions in clinic revenue represent the third element of this storm. Medicaid cuts nearing $1 trillion will force states to reduce benefits, with adult dental coverage—already optional in most states—facing elimination or severe restrictions. Since Medicaid patients account for roughly one-third of most dental school clinic populations, program cuts will disrupt educational case mix in addition to generating revenue loss.
• Lastly, new mandates on accreditors introduce regulatory uncertainty at exactly the moment when schools need regulatory stability to manage other challenges. The  elimination of diversity-related accreditation standards is concerning to many in our community. Meanwhile, the mandate to report student outcomes without demographic disaggregation directly contradicts existing federal reporting requirements, complicating compliance.

What makes these separate stressors a perfect storm is how they amplify each other, creating a cascade of financial pressures. Reduced student loan availability will inevitably force schools to increase scholarship spending just as research and clinic revenue decline. New accreditation requirements will complicate operations, demanding more administrative resources exactly when budget pressures require cost reduction. The simultaneous arrival of these changes will make it difficult to prioritize and sequence our responses. The likely outcome? Strategic paralysis.

Weathering the Storm

Perfect storms require comprehensive responses that address the interconnected nature and escalating complexity of multiple challenges. It’s tempting to try and fight on all fronts simultaneously, but a more effective response must unfold in phases, with each building on the previous one.

Step 1. Stabilization. 

Over the next six months, schools must take immediate action to preserve their revenue sources.  Tuition income could be bolstered by initiating emergency campaigns to raise scholarship dollars; negotiating bridge financing from banks and credit unions; establishing corporate partnerships to guarantee student loans; and restructuring tuition payment plans. On the clinic side, schools can protect revenue through aggressive marketing to expand cash-pay patient volumes and by negotiating contracts with health systems for clinical services. To hedge against the loss of research dollars, schools can accelerate the formation of industry-sponsored research partnerships while implementing cost reduction measures that don’t compromise educational quality. To retain their accreditation, schools must also document evolving regulatory requirements and develop compliance strategies.

Step 2. Adaptation.

As their immediate finances stabilize, schools must also begin developing new financial models to carry them forward with fewer traditional federal sources of support. On the tuition front, schools can consider launching income-sharing agreements in which graduates agree to pay a portion of their tuition through a percentage of future earnings; developing corporate-sponsored dental education tracks with employment guarantees; creating extended residency programs that generate clinic revenue while providing advanced training; and building continuing education programs for which practicing dentists will pay a premium. To diversify revenue streams schools could look to license intellectual property from dental research, create specialized clinical services that generate premium margins, or establish satellite clinics in underserved areas with sustainable payment models.

Step 3. Sustainability. 

Establishing substantial endowments for student financial aid and creating self-sustaining clinical networks that provide diverse training sites, will be key to sustaining dental schools that survive the current storm. Developing faculty practice plans that generate significant revenue and building alumni networks that provide ongoing financial and professional support are also essential to ensuring institutional resilience.

In the long run, schools must position themselves as the solution to demonstrable problems. Addressing workforce shortages in underserved areas, generating research with clinical applications, and streamlining the delivery of dental education will help dental schools build a foundation for long-term success.

Schools must take these steps with the urgency a perfect storm demands. A swift response  will require creating crisis management teams, developing contingency plans for multiple revenue loss scenarios, and establishing protocols for regular stakeholder communication protocols.  

Addressing the Workforce Imperative

Even amid this perfect storm, the need for a diverse dental workforce that can serve all Americans remains critical. The Sullivan Commission’s findings about healthcare disparities haven’t changed: Diverse healthcare teams produce better outcomes for underserved populations. This represents both a challenge and an opportunity that must be addressed strategically.

We know what works:  

• Pipeline programs such as the Summer Health Professions Education Program (SHPEP).
• Creating community-based clinical training sites in underserved areas. 
• Developing post-baccalaureate programs that prepare career changers for dental education.
• Establishing mentorship networks and comprehensive support systems that foster student success regardless of background.

The key is to frame these efforts as a matter of operational excellence. Schools that effectively recruit and graduate students from all backgrounds will have larger applicant pools, stronger community connections, and better positioning for future growth, giving them a competitive advantage in attracting students and strategic partnerships.

The Choice Before Us

Will we allow this perfect storm to overwhelm us or use it as the catalyst for overdue transformation? Perfect storms create windows of opportunity alongside their challenges. The current model of dental education—high-cost, federally dependent, operationally inflexible—was already under stress before the storm arrived. Will this moment of adversity spur us to confront structural issues we have long delayed addressing?

Opportunities abound. Schools could implement competency-based advancement to reduce time-to-degree, establish partnerships with community colleges for pre-dental pipeline programs, expand simulation-based training to optimize clinical efficiency, develop cost-saving hybrid online/residential programs, or create accelerated programs for career-changers. The schools that welcome change will emerge from this storm more efficient, more innovative, and more responsive to community needs. They will have diversified revenue streams, sustainable financing models, and educational approaches that prepare graduates for evolving practice realities. I suspect we will discover that crisis-driven innovation often produces better solutions than gradual evolution ever could.

As Dr. David Thomas, the former president of Morehouse College, recently said, this moment calls for being “bold in aligning mission with innovation, unapologetic in asserting our value, and vigilant in protecting our autonomy.” I agree. The institutions that act decisively, comprehensively, and boldly will not just weather this storm—they will be positioned to lead dental education’s future. 

The NYU community is grieving the loss of Michael Alfano. When we decided to launch the Center for Oral Health Policy and Management with a symposium in 2021, Mike was the first speaker I thought of. The Center’s very existence owes a debt to his legacy. Mike’s visionary leadership brought an entrepreneurial spirit and commitment to interprofessional practice and overall health to the dental school, which informs the center’s work to advance policy and practice in support of oral health. Dean Charles Bertolami wrote a moving obituary, which will tell you more about Mike’s lasting impact at NYU and beyond. If you didn’t know Mike, I hope you will take a moment to learn more. If you were fortunate enough to make his acquaintance, I hope you will take a moment to reflect on his remarkable contributions to our community.

In May, I had the honor of delivering the commencement address at the Missouri School of Dentistry and Oral Health (MSDOH). The school is part of A.T. Still University (ATSU) of Health Sciences, home to the world’s first osteopathic medical school, founded in 1892. More than a century later, ATSU established dental schools in Arizona and later Missouri. Among their many distinctions, ATSU dental schools require their students to earn a certificate of public health alongside their DMD degrees. I reminded the graduates that their university emphasized the importance of serving underserved populations and challenged them to shape the future of dentistry. “As graduates of this institution,” I told them, “you carry forward that legacy, uniquely prepared to address the inequities in dental care that persist today.” Here are additional excerpts of my remarks.

You are entering a profession that is not only respected but also dynamic and filled with opportunities. From advances in robotic implant dentistry and artificial intelligence in treatment planning to innovations in public health and access to care, dentistry is at the forefront of improving both individual lives and community well-being. But with these opportunities come challenges. Think about the world you are stepping into as professionals: a world still grappling with the effects of a global pandemic, where health inequities have been laid bare. Nearly half of the U.S. population lacks dental insurance, and rural areas like many in Missouri face critical shortages of dental care providers.

So, I pose these questions to you:

• What will you contribute to advancing oral health equity?
• How will you define success beyond clinical outcomes?
• Will it be the number of lives you touch, the innovations you bring to the field, or the way you inspire others to join our profession?

Reflecting on these questions will help you chart your course as leaders and changemakers in dentistry.

To Those Entering Clinical Practice

I want to take a moment to speak directly to those of you entering clinical careers today. When you receive your license to practice dentistry, you are granted extraordinary privileges and responsibilities—privileges that, without the context of your education and training, could be considered unthinkable, even criminal. Think about it. With your dental license, society entrusts you to perform acts that would otherwise result in severe legal consequences. Using a 12B scalpel blade to make an incision, administering medications to alleviate pain, or prescribing controlled substances—actions like these, in the absence of your expertise, might be seen as assault, battery, or even drug trafficking.

 As a dentist, you will have the privilege of being trusted with your patients’ lives and well-being. Your education, training, and commitment to ethical practice have prepared you to meet those expectations. But remember, the power of your license lies not only in the legal rights it grants but also in the moral obligations it carries. It is a symbol of the dedication, expertise, and compassion that define our profession. Respect it, cherish it, and use it to make a meaningful impact on the lives of your patients and the communities you serve.

The Role of Role Models

As practicing dentists, you will also become role models. Unfortunately, the media often portrays dentists unfairly or focuses on exaggerated caricatures. From the maniacal dentist in Little Shop of Horrors to the infamous torture scene in Marathon Man, and even more recently, the quirky and overly enthusiastic Dr. Sherman in Finding Nemo, these portrayals do little justice to the professionalism and compassion of real-life dentists. Even newer films like Horrible Bosses feature outlandish characters like a dentist portrayed by Jennifer Aniston, who veers so far into absurdity that it’s comedic—but still unrepresentative of who we are as professionals.

Let’s face it: The bar isn’t set very high. We don’t even have a dentist superhero yet. It’s up to you to change that narrative. By embodying professionalism, compassion, and ethical excellence, you can serve as the true representation of what it means to be a dentist. You have the opportunity to counter these fictional portrayals with reality: trusted caregivers who transform lives, not just smiles.

Dentistry as a Moral Community

As graduates of the Missouri School of Dentistry and Oral Health, you are not only entering a profession; you are joining a moral community—a concept that lies at the very heart of what it means to be a dental professional. At its essence, a moral community is a group of individuals bound together by shared values, ethical commitments, and a dedication to serving a greater good.

In dentistry, this means we are united by a collective responsibility to prioritize patient welfare, uphold the highest standards of care, and advocate for equitable access to oral health for all. Our work is profoundly personal. Patients come to us in vulnerable states—seeking relief from pain, treatment for disease, or simply the assurance that they are cared for. The trust they place in us is sacred, and it requires that we act with integrity, compassion, and a steadfast commitment to doing what is right, even when it is not easy.

Being part of a moral community also extends to addressing broader issues like health equity and underserved populations. It means asking tough questions about the disparities that still exist and using your skills to help close those gaps.

A Call to Action

As you cross the stage to receive your diploma, let the moment remind you of the deeply personal nature of our profession. You have worked hard for this achievement, but it is only the beginning. Commit to lifelong learning, to serving underserved communities, and to becoming leaders in the field. Be the kind of professional who makes a patient feel heard, a colleague feel supported, and a community feel valued. The world of dentistry is rapidly evolving, and you have the opportunity—and the responsibility—to shape its future.

At the graduation ceremony at MSDOH, I was honored to receive an honorary Doctor of Humane Letters degree. I am grateful for the recognition.