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

Fluoride has been in the headlines — tens of thousands of headlines this past month alone. Even before President-elect Donald Trump nominated a fierce opponent of community water fluoridation to be secretary of health and human services, the popular press was busily examining the mineral’s purported benefits and harms. In September, a federal judge’s decision that community water fluoridation “poses an unreasonable risk of injury to health” appeared to confirm public fears. These were already heightened by the summer release of a monograph by the National Toxicology Program (NTP), which showed an inverse association between high levels of fluoride exposure and neurodevelopment and cognition.

These events triggered what has since become an avalanche of media coverage. Happily, much of it focused on setting the record straight. Reporters and commentators were quick to point out that, as with any medicine, dose matters. The negative effects of fluoride cited in the NTP monograph came from studies performed in regions with high levels of naturally occurring fluoride in the water supply. Fluoride exposure in these studies (all conducted overseas) was at or above 1.5 milligrams per liter — more than double the amount in U.S. fluoridated water systems.

So, should Americans be concerned that community water fluoridation is a risk to their health?

There is no evidence to suggest that community water fluoridation at 0.7 milligrams per liter — the current standard — is harmful. Quite the contrary. According to the Centers for Disease Control and Prevention (CDC), community water fluoridation safely and inexpensively reduced dental caries in children by 40%-70% and tooth loss in adults by 40%-60% between 1945 and 1999. You don’t get much more effective than that, which is why the agency listed community water fluoridation among the top 10 public health achievements of the 20th century.

That said, a lot has changed since community water fluoridation was first introduced in the United States. If those of us in the public health community want to preserve our credibility and continue to influence policy, we should consider the latest evidence on the value of community water fluoridation and talk honestly with our patients who are seeking alternative ways of protecting the health of their teeth. 

Evolving Evidence

The movement to fluoridate U.S. community water supplies was born out of an auspicious 15-year study. Following the introduction of fluoride in the Grand Rapids, Michigan, water system in 1945, scientists at the then-named National Institute of Dental Research monitored the dental health of 30,000 impacted school children. The results were dramatic. The dental caries rate among children born after the introduction of community water fluoridation was more than 60% lower than that of their older peers.

The success of community water fluoridation in preventing dental caries in Grand Rapids led other communities to adopt the practice and spurred businesses to develop new products to prevent tooth decay. Fluoridated toothpaste entered the marketplace in 1975, and mouth rinses containing fluoride were also introduced, becoming widely available on supermarket and drugstore shelves.

Given these developments, should Americans be concerned about ingesting too much fluoride?

In most cases, no, but there is one group of Americans who may have cause to avoid products containing fluoride: the 1.9 million people living in communities with naturally occurring fluoride in the water supply above the 1.5-milligrams-per-liter level considered safe by the World Health Organization. According to the CDC, these communities made up less than 1% of the U.S. population in 2020, and since they don’t live in areas with community water fluoridation, they are unlikely to be affected by any new federal policy recommendations. It will be up to local policymakers and public health officials to mitigate the health risks children in these regions may face.

As for the 72.5% of U.S. residents living in areas with community water fluoridation, the current evidence suggests that community water fluoridation is strengthening their teeth without harming their overall health. That said, 80 years after its introduction, is there still a strong case for implementing community water fluoridation?

The Cochrane Database of Systematic Reviews released a review in October that sheds light on this question. The reviewers examined 157 studies comparing dental caries in populations receiving community water fluoridation with populations consuming naturally low-fluoridated water. They found that as the use of fluoride-containing products became commonplace among consumers, the relative impact of community water fluoridation declined. Prior to 1975, the reduction in the number of decayed, missing or filled teeth resulting from community water fluoridation averaged 2.1 teeth per person. In studies conducted after 1975, the effect size had dropped to one quarter of a tooth.

Looking Ahead

So, where does the evidence leave us?

We should continue to inform policymakers and our patients about the safety and efficacy of fluoride at recommended doses, but we also need to acknowledge that community water fluoridation is not the indispensable intervention it once was and accept the fact that public sentiment may be shifting against it. If that occurs, how else can we protect the oral health of our most vulnerable populations?

Encourage good oral hygiene. Brushing with fluoridated toothpaste and flossing remain the first line of defense in preventing cavities in teeth.

Encourage the use of sealants to protect children’s teeth. Sealing molars has been shown to reduce the risk of dental caries by almost 80%. Best of all, sealants can be applied in school settings, making it possible to reach children who may not have a routine provider of dental care. 

Discuss the role of diet in maintaining oral health. As long as Americans continue to consume large amounts of sugar and other processed foods, their oral health will be at risk. Public health measures that influence people’s dietary choices can help lay a foundation for better oral and overall health.

Stay informed about alternative remineralizing agents. A growing body of evidence supports the safety and efficacy of hydroxyapatite in reducing dental caries. Since it was first tested in Japan in the late 1980s, a variety of oral care products containing the compound mineral have come on the market, but one recent survey suggests few dentists practicing in this country are familiar enough with these products to recommend them to patients.

Offer fluoride treatments. Varnishes, gels and other topical fluoride products are another effective means of preventing dental caries for those at higher risk, whether applied during a dental visit or as part of a school-based program. Dietary fluoride supplements can also benefit these patients. Even individuals who do not want to consume fluoride in their drinking water may be open to using fluoride mouth rinses to control decay.

Ironically, the public resistance to fluoride coincides with two developments that showcase the mineral’s value:

• The 2021 World Health Organization decision to update its list of essential medicines to include fluoride toothpaste for the first time.
• The growth in evidence supporting the use of silver diamine fluoride to arrest decay and prevent dental caries.

Members of the dental community should use their influence to ensure these tools remain in our collective toolbox as the debates about fluoride continue in Washington and the public square.

Americans continue to make over 2,000,000 emergency department visits each year for dental pain. The vast majority of these visits arise from untreated dental caries and their consequences. Community water fluoridation — and other proven preventive measures — can mitigate that risk, especially for the most vulnerable among us. As we reconsider the evidence on fluoride and appraise the latest research, let’s keep their well-being top of mind.

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

The health professions face an urgent challenge — a significant shortage of leaders amid an overarching shortage of health professionals — and dentistry is no exception. Anyone following demographic trends has long known this day would come. Baby boomers have been aging out of the health professions for about a decade now, and they are joining the ranks of older Americans, the heaviest consumers of health care.

These two developments amplify one another, and they have been further exacerbated by recent changes in healthcare delivery and the lasting impacts of the COVID-19 pandemic. Medicine, nursing, and dentistry have all seen an exodus of professionals from clinical roles, driven by burnout, job dissatisfaction, and a reevaluation of career paths. The result is a pressing need for leadership that can guide the professions through both immediate hardships and longer-term challenges.

Dental education is also witnessing a critical shortage of leaders. The expansion of the number of dental schools and the increase in student enrollment have created a demand for experienced deans, faculty members, and administrators. Unfortunately, the traditional pipeline for seasoned professionals has been disrupted both by baby-boomer retirements and by a slower-than-anticipated influx of new graduates stepping into leadership roles. In this context, cultivating a new generation of leaders who are prepared to navigate and address these complexities has become imperative.

Developing Tomorrow’s Leaders

These concerns propelled NYU Dentistry to establish the Center for Oral Health Policy and Management in 2021. When Dean Charles Bertolami asked me to direct the Center along with Executive Vice Dean Michael O’Connor, we decided that creating a portfolio of student leadership opportunities would be one of our highest priorities. We launched several innovative initiatives that year, and these were so successful that we soon heard from faculty and staff saying, “I want in!”

This thirst for leadership development speaks volumes. Clearly all generations within dental education are eager to step up to leadership roles and recognize the value of preparation. So how can we cultivate this latent talent? Here’s what we’re offering at NYU Dentistry.

• The NYU Dentistry Leadership Track. This twice-monthly lecture series focused on character-based leadership was initially designed exclusively for dental students. Enthusiastic demand from other members of our community led us to open these talks to faculty and staff. This initiative highlights the value of leadership training throughout the dental education ecosystem.
• Student Leadership Mock Congressional Hearing. Each spring, students are invited to apply for this competitive program, which enhances students’ public speaking and advocacy skills. Participants prepare and deliver testimony on a health policy topic before a mock congressional panel, gaining valuable experience in policy-related leadership.
• The Dental Student Leadership Institute (DDSLI). Each year, up to 35 D1 students are selected to take part in the DDSLI, an intensive leadership development experience. Over the next three years, participants are given access to seminars, workshops, internships, mentoring, and other opportunities designed to prepare them to manage the complex challenges of advancing oral health in the 21st century. The program culminates in a capstone project during their fourth year, ensuring that students can apply their leadership skills in a real-world context.
• Global Health Care Leaders: Washington, DC. Students from across the College of Dentistry, including advanced standing students and dental hygiene students, are eligible to apply for this professional development experience. Participants visit NYU’s DC campus to gain insights into policymaking and legislative processes through meetings with oral health advocates and federal lawmakers.
• Global Health Care Leaders: NYU Global Academic Centers. D4 students are eligible to apply for this international experience. Selected students travel to one of NYU’s Global Campuses each year to explore complex policy issues with overseas leaders in government and oral health advocacy. In fall 2023, the experience took place at NYU’s Villa LaPietra in Florence, Italy. This October, 25 students will travel to NYU’s Prague campus to participate in a program entitled, “From the Velvet Revolution to Health Equity: Using Dissent and Hope to Reframe Oral Health Care.”

The students in these programs are thriving. Just one example: Two of my mentees in the DDSLI — Sam Al Safarjalani and Natalie Ralston — were elected to serve on the NYU Dentistry Student Government Executive Board as president and vice president this year.

Last year, we created a second leadership development program specifically aimed at faculty. It launched this past June with twenty-five full-time faculty taking part. Over three days, they developed skills that can accelerate their ability to move into leadership roles in higher education. The experience inspired some of the participants to begin working together to recruit DDS applicants from underrepresented groups and address other compelling issues in dental education. If their efforts bear fruit, they will have shown true leadership — paying it forward as they continue to pursue their own leadership journeys.

Looking to the Future

The dental profession is encountering a host of contemporary challenges that require innovative leadership. Whether addressing disparities in access to care, integrating advanced technologies such as artificial intelligence and personalized medicine, or managing public health crises such as the opioid epidemic, leaders will be needed to drive the dental professions forward in a rapidly changing environment. By integrating leadership development into dental education, we can ensure that the profession remains resilient and capable of meeting the needs of the populations it serves.

The example set by NYU College of Dentistry provides a valuable roadmap for how dental schools can prepare their students for future leadership roles. While such initiatives could take many forms, leadership development is essential for equipping students to succeed in a complex and evolving healthcare landscape. It is imperative that dental educators commit to fostering the next generation of dental leaders. As we look to the future, let us commit to empowering and supporting the leaders of tomorrow, so that they are well-equipped to address the challenges and opportunities that lie ahead in the dental professions.

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

The age of value-based care has begun. The result will be an overhaul of how we think about, deliver, and are reimbursed for health care. These sweeping changes represent an extraordinary opportunity for dentistry—not only to define what value-based care means for oral health, but also to reshape health care to include what medicine has so often overlooked: the mouth.

Value-Based Care in a Nutshell

For anyone new to this discussion, at its core, value-based care aims to reward the quality rather than the quantity of care delivered. This prevention-focused approach incentivizes providers to improve the health of their patient populations by using personalized preventive care to ward off disease before it happens. This approach represents a sea change from the typical fee-for-service model that rewards providers for the number of procedures or treatments delivered after a patient becomes ill or experiences pain. Reimbursement models that focus on quality are person-centered and risk-based, so they inherently promote equity, target social determinants, and reduce health care disparities. The result is a healthier overall population at a reduced cost.

Value-Based Care and Oral Health Care

The value-based care movement is international, making strides in countries such as Brazil and the Netherlands, as well as in the United States. In 2022, 41% of U.S. health care payments involved alternative payment models, and another 18% of payments linked quality and value to fee-for-service reimbursements. Alternative payment models have gained the greatest traction in Medicare Advantage followed by Medicare and Medicaid—public programs which play much larger roles in medicine than in dentistry. Do our professions risk being left behind?

In 2020, the CareQuest Institute for Oral Health surveyed almost 3,000 dental providers in more than 20 states. It found 51% of respondents had never heard of alternative payment models in dentistry. Their report noted an increase in dental payments linked to alternative payment models from 27% of all Medicaid dental claims in 2013 to 33% in 2017. Additionally, some federally qualified health centers have implemented an integrated dental model emphasizing value-based care.

That represents progress but on the margins. Traditional Medicare does not cover most adult dental care, and in many states, fewer than half of dentists are enrolled as Medicaid providers and many of those are not seeing any Medicaid patients. We need to do more to push dentistry in the right direction.

Academic dentistry could help, but our commitment to value-based care also lags behind that of our medical peers. In a 2022 survey of dental school deans, 65% of respondents reported that value-based care was not currently in the didactic curriculum and only 25% said their schools were considering implementing value-based care in their clinics. Similarly, a 2022 study showed a need for more training and guidance among dental school faculty to effectively bring value-based care into didactic and clinical instruction.

An Opportunity at Our Fingertips

In addition to its potential to reduce health care spending, value-based care blazes a path for medical-dental integration. The focus on value gives oral health professionals an opportunity to demonstrate how the integration of dental and primary care can improve patient outcomes. You might say it is our chance to show that the money is where the mouth is.

Control of type 2 diabetes is one case in point. A recent study in The Journal of the American Dental Association showed that overall health care spending for Medicaid patients with the disease decreased by 14% when they regularly received periodontal treatment. A decrease of 12% occurred for similar patients with commercial insurance. Value-based care should incentivize this type of integrated care and make it the rule, rather than the exception.

In a recent article in JAMA Internal Medicine, Ira Lamster, DDS, MMSc, clinical professor, Stony Brook School of Dental Medicine, and Lisa Simon, MD, DMD, fellow in oral health and medicine integration, Harvard School of Dental Medicine, suggest some specific ways dentists could enhance primary care by seizing the opportunities latent in our unique access to patients who come in for regular dental cleanings. They note past successes with screening for tobacco use and poor diet, adding that dentists can perform services such as hypertension and depression screenings without additional infrastructure. Further, screenings for conditions such as colorectal cancer, HIV, and type 2 diabetes can occur with minimal additional resources.

The shift to value-based care in health care primes the landscape for this kind of thinking. When conversations occur about shaping value-based care, we need to be sure we are present and ready to make the case for medical-dental integration.

Barriers to Value-Based Care in Oral Health Care

Of course, implementation of value-based care in oral health care is not without its challenges. The predominance of small dental practices, compatibility issues with electronic health records, the limited use of diagnostic codes in dentistry, and the current structure of dental insurance all present barriers. Most significantly, state and federal quality and reporting programs lack standardized oral health measures that would help us define what we mean by “quality,” hindering our ability to develop uniform ways of addressing such things as compensation and accountability. But these barriers are not insurmountable—and they are not new. The rise of value-based care has simply brought them to the fore.

Embracing the Value-Based Care Paradigm

The barriers we face leave us with quite a to-do list that includes devising outcome measures, increasing our use of diagnostic codes, and developing collaborative partnerships to foster interprofessional care. But the first order of business is to increase understanding and acceptance of value-based care among those in our own community. This is where dental education can play an essential role. We must incorporate value-based care into our curricula, determining what to teach and how to teach it. If we take these steps, the next generation of dentists will be prepared to practice in a value-based care environment enhanced by medical-dental integration. The sooner we embrace this paradigm shift, the sooner we can make it a reality.

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

It’s a cliché to say that traveling opens our eyes to new ways of seeing things. That doesn’t mean it’s not true. My frequent interactions with internationally educated dentists — both overseas and here at NYU — have me thinking about how we first decided it should take eight years after high school to produce a dentist and whether we can do it more efficiently moving forward. Are there ways to shorten the total time to a dental degree and make it more affordable without compromising the quality of education and patient care? The evidence points to a resounding, “Yes!”

It is in just a few countries — the United States, Australia, New Zealand, and some Canadian provinces among them — that most dental schools require a four-year university degree for admission. Almost every other country does not. If you live in China, Japan, Brazil, or most of Europe, you can apply to dental school directly from high school. The time these students spend in dental school is a year or two longer than the time spent here, but they enter the dental workforce years in advance of their U.S. peers. 

Could the United States adopt a similar model? The four-year undergraduate degree has become such an established first step on the U.S. career ladder for all professions that it is hard to imagine an alternate path, but there are precedents. Before the 1970s, most people entered dental school after just two years in college. That was still the case for many of my dental school classmates, some of whom were veterans during the Vietnam War era. The increase in applicants resulting from the Baby Boom changed that. When the numbers of applicants competing for 6,000 first-year slots swelled to 16,000, some dental schools began requiring bachelor’s degrees for admission. 

Those dental students who lacked four years of undergraduate preparation were able to graduate and obtain licensure, and I suspect there are many students today who could also succeed in U.S. dental schools without first completing a traditional bachelor’s degree. The undergraduate classes students take in subjects not directly related to dentistry may have value in and of themselves, but they cost money—more and more each year. For some students, the return on investment of accumulating credits outside their chosen area of study may be marginal at best. 

Whatever benefit students derive, it’s difficult to see how those additional courses necessarily contribute to preparing students for dental school. Meanwhile, the cost of obtaining those credits has skyrocketed, while burgeoning student debt has prompted Americans to question the value of higher education. Might there be benefit in allowing students who can demonstrate their knowledge and skills in the prerequisite sciences, math, and English to enter dental school without a four-year undergraduate degree?

The ROI on a dental education remains strong, but some potential applicants are hesitant to take on more educational debt. Replacing a year or two of college with a year or two of earnings would certainly be a win from their vantage point. That said, I realize this line of thinking may be anathema to some. If nothing else, it flies in the face of recent trends in some of the other health professions. 

• Physical therapy moved from a two-year degree in the 1930s to a four-year degree in the 1960s. Today a six-year Doctor of Physical Therapy degree is the standard for entry into practice.
• Pharmacy has followed a similar path. In the 1990s, the six-year Doctor of Pharmacy (PharmD) degree replaced the four-year Bachelor of Science degree, which reigned throughout the preceding half century.
• Nursing has also encouraged higher levels of education. Although the profession still accepts a variety of degrees for entry into practice, many hospitals have been preferentially hiring nurses with bachelor’s degrees over those prepared at the associate-degree level, and more and more advanced practice registered nurses enter their fields with practice doctorates rather than master’s degrees. 

At the same time, a countervailing trend aims to shorten the time it takes to earn a professional degree. For instance, nursing schools now offer a host of accelerated degree programs at both the undergraduate and graduate levels to speed entry into the workforce. The Association of American Medical Colleges is working to implement a competency-based educational model, which would lay a foundation for self-paced medical education. In 2013, the Blue Ribbon Commission for the Advancement of Osteopathic Medical Education recommended the creation of a competency-based model for educating primary care physicians. These moves suggest broad agreement that the value of education is not accrued through seat-time alone.

In dentistry, many schools have replaced numerical requirements with other ways of demonstrating clinical competence and readiness for practice. And some dental schools have opted for year-round education so their students can enter the workforce in three years rather than four. At NYU, we offer early admission to undergraduates who can meet our requirements in three years of college study. These students arrive well prepared and possess the maturity needed to pursue professional studies. 

These are steps in the right direction, but could we be doing more? Is it time for all U.S. dental schools to consider alternatives to the eight-year path? The answer seems obvious to some of my internationally trained colleagues. I personally find my encounters with our seven-year students persuasive. They are thriving in dental school and will soon be treating patients outside our clinic walls. The sooner they get there, the better. 

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

Across the globe, millions of people lack oral health care. Others are going to great lengths to access it. Imagine traveling thousands of miles for a routine dental appointment, leaving the country to get an implant, or—unfathomably—extracting your own teeth! These things are happening to residents in the present-day United Kingdom, and they are not alone. Almost half of the world’s population experiences oral diseases, and health systems are struggling to keep up. Worse, the prevalence of disease is compounded by unequal oral health status and access, where issues such as poor service distribution hinder access to care for those individuals who most need it.

The United States is not immune to these global issues, so our next generation of leaders must look beyond their own backyards if they hope to bring the best and most innovative ideas to bear on the world’s oral health care challenges. Lessons from abroad can also help leaders see the pitfalls and limitations of seemingly promising approaches and avoid repeating others’ mistakes.

One Lesson From Abroad: The NHS

We saw the transformative power of a global outlook in real-time when students in NYU’s Global Health Care Leaders program traveled to Italy. Each fall, interested NYU D4 students apply to visit one of NYU’s Global Academic Centers where they can explore complex health policy issues with government leaders and oral health advocates.

In November 2023, students in this program met with European oral health leaders at the NYU campus in Florence, Italy. We provided educational sessions in which students learned about European oral health policy priorities and opportunities for advocacy. It was during these discussions that we learned about what’s happening in the UK, where the National Health Service (NHS) is in turmoil.

If you’re not familiar, the NHS is the UK’s public health care system. Established in 1948, it aimed to provide all medical care to all residents free of charge and has long been revered as a beacon for those who believe health care is a human right. But in recent years, the NHS has hit hard times. A combination of underfunding, privatization, and a failure to adequately grow the budget and maintain a provider pipeline have all led to what can only be described as a disaster.

The current NHS is beleaguered by strikes, long wait times, provider shortages, and debt, while private care options remain out of reach for many budgets. The failure to systematically invest in the workforce, in particular, has produced devastating results. It takes six to seven years to educate a dentist in the UK, so the problem cannot be fixed overnight. In the meantime, UK residents are left without health care.

 A Similar Challenge at Home: Medicaid  and Children’s Oral Health

This tragedy can serve as a cautionary tale for health care providers in the United States. Of course, the two health care systems differ significantly—and most U.S. dental care is delivered through private practice—but we have encountered a not-so-different issue with the provision of dental care to children on Medicaid, where insufficient investment has also undermined access.

In 1967, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit mandated comprehensive oral health care benefits for children enrolled in Medicaid. On paper, the program had extraordinary potential for addressing the needs of children living in poverty, but deeming children’s oral health care an essential benefit doesn’t equate to their having access to care. In 2020, the American Dental Association reported that only 50% of children aged 3 to 17 on Medicaid had a dental appointment in the past year.  Considering what we learned about the NHS while in Florence, our mid-20th-century legislative victory followed by a failure to follow through rings familiar. We’re left wondering: How did this happen here in the United States?

A number of factors appear to have contributed, among them a lack of awareness among Medicaid beneficiaries of the available benefits. Additionally, Medicaid’s low reimbursement rates and cumbersome paperwork requirements dissuade dentists from participating. With fewer than half of dentists in many states accepting Medicaid patients, there aren’t enough appointments to go around.

A Future Imperative: Adopting a Global Mindset

In its Global Oral Health Status Report (2022), which I wrote about last year, the World Health Organization (WHO) called for universal oral health coverage. This means all individuals across the globe should have access to affordable providers who can deliver the care they need wherever they are in the world.

While in Florence, our students felt the enormous impact of adopting a global mindset as exposure to European oral health leaders shifted and enhanced their perspectives. After hearing about other ways of delivering care, one of our students called the experience “mind-blowing” and “life changing.” Another put it better than I could when she said, “Being able to hear the other person and then create your own understanding based on their perspective is so important, because it’s not just us, it’s all of us.”

As we strive to remedy the barriers to universal access to dental care in the United States—such as those experienced by Medicaid beneficiaries—we can learn from the early successes and later missteps at the NHS. Over time, we may also see our overseas colleagues solve their current problems in ways we want to emulate in the future.

Likewise, our friends in the UK can learn from us. Together, we can expand our ability to envision solutions to oral health challenges and actively contribute to meeting the goals laid out by the WHO.

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

The world is changing at a breathtaking pace, yet as the first quarter of the 21^st century draws to a close, it feels as though the dental education community is still struggling to achieve consensus on what constitutes a 21^st-century dental education.

Beginning in 2005, the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI) created a framework for supporting efforts to modernize our enterprise and disseminate promising practices. Many of our colleagues launched ground-breaking initiatives, published their results, and presented at conferences. Substantial progress was made, but despite these advances, our community still faces some perennial challenges. Chief among these, we need more faculty and innovative ways to develop the skills they will need to successfully lead our institutions.

Whatever the obstacles, dental education must adapt to the current environment, but something seems to be holding us back. I’ve come to believe that the problem is not a lack of ideas but rather a reticence to act in the face of uncertainty. As academics, we are trained to approach our research methodically and to test our results through repeated experimentation. Those steps are critical for building a scientific evidence base, but it takes 17 years on average for research evidence to be implemented in clinical practice.

Where health and even lives are at stake, that level of caution is critically protective, but does it make sense in clinical education? What would happen if we adopted a “fail forward” mindset instead?

“Failing forward” is the idea of creating or implementing something before it is perfected to see how it works in practice and then iterate from there. Such an approach could help us accelerate the pace of educational change. Faculty and staff throughout our community have already conceived dozens of strategies and piloted tools that are ready for replication or adaptation. Not every one of these 21^st-century approaches will stand the test of time, but by rapidly implementing them, we would gain insight into what works, what doesn’t, and what can be refined to deliver the best dental education possible today and in the future.

As we consider where to put our energies to ensure that dental education remains strong in the years ahead, do we really need another systematic review before implementing practices that have shown promise over the last two decades? I would argue that we have more than enough evidence to justify embracing some core strategies. Here are ten that stand out to me.

1. Focus on core biomedical sciences. Technologies and treatments are constantly evolving – just think of how artificial intelligence and machine learning have evolved since IBM’s Watson debuted on Jeopardy! in 2011 – but the human body and its vulnerabilities change little over time. Strong education in anatomy, physiology, pathology, and pharmacology will remain the foundation of a dental education.
2. Teach research and critical thinking skills. Dentists must possess the skills to critically evaluate new science and practice models as they emerge. Schools can prepare students for evidence-based practice by teaching literature review techniques and encouraging participation in research.
3. Incorporate technology and innovation. Students’ clinical experiences should prepare them for real-world practice. Schools should endeavor to introduce students to telemedicine, innovative electronic health records, the use of artificial intelligence in diagnosis, robotic surgery, and the other technologies they will likely encounter in state-of-the-art health care environments.
4. Offer simulation-based learning. Simulation has proven its effectiveness as a tool for learning and practice. Schools should employ simulation to facilitate the development of various competencies and to fill gaps in students’ clinical experience, such as exposure to certain rare or complex conditions.
5. Develop soft skills. Fewer and fewer dentists are working on their own. In today’s health care environment, solid communication and teamwork skills are essential, and leadership is prized. Developing empathy is also critical for delivering culturally respectful, patient-centered care. Schools should strive to foster all these traits.
6. Engage in interprofessional education and practice. Create opportunities for learning with students from other health professions (nursing, pharmacy, etc.) to promote collaboration and foster an understanding and appreciation of each profession’s role in patient care.
7. Promote adaptability and resilience. Health professionals need the ability to adapt to change and handle stress effectively, a fact driven home by the COVID-19 pandemic. Even under the best of circumstances, it is vital that schools prepare students to adjust as procedures, guidelines, or health care systems undergo change.
8. Emphasize ethics and patient-centered care. Schools should strive to acculturate students to their future professional roles throughout their education, teaching them strategies for navigating ethical dilemmas and emphasizing their responsibilities to patients, the profession, and their communities.
9. Provide a global health perspective. Whatever the field, a global perspective is an asset in an interconnected world. Schools can find ways to expose students to health and health care beyond the local community. Knowledge of global oral health challenges and alternate models of care delivery will deepen students’ awareness of the value and duties of the dental professions.
10. Encourage lifelong learning. Time doesn’t stand still, and neither should working professionals. Because scientific discovery and technological change will continue to reshape dental practice throughout the 21^st century, schools should stress the importance of continually updating their graduates’ knowledge and skills. Beyond simple encouragement, schools can offer continuing education to alumni on preferred terms.

Throughout my career, I have always looked to see what trends were on the horizon in order to help our community prepare for whatever was coming our way. The need for leaders as my generation ages into retirement is one recurring theme. If you read last year’s ADEA report, New thinking for the new century: Preparing for the next 100 years, you saw it there as well. In addition to replacing faculty, it called out the need for leaders who can fill the shoes of today’s deans and other academic leaders.

Both these challenges are among my primary concerns, and I’ve taken steps to address them in my current role. At the NYU Dentistry Center for Oral Health Policy and Management, we have developed a portfolio of leadership programs to equip students with leadership skills and instill in them a willingness to serve their communities — whether as faculty at their alma maters or policy influencers on the global stage.

As dental educators, it is incumbent upon us to help students understand the various roles they will need to play and to help them develop the resiliency to adapt to whatever they encounter. I know my colleagues at other institutions share my concerns, and I hope we can spur one another to action. Only by taking risks — and occasionally failing — can we move dental education forward.