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

Trust is the foundation of effective health care, yet dentistry faces unprecedented challenges to its professional reputation. When headlines spotlight a child’s death during dental sedation, a practitioner charged with Medicaid fraud, or contentious scope-of-practice disputes that limit access to care, these isolated incidents cast shadows across the entire profession. The damage extends beyond the individuals involved in that it erodes the collective trust that dentists have cultivated through years of dedicated patient care and professional integrity.

Today bad news travels quickly, and Americans’ views of professionals are declining. According to Gallup’s 2024 Honesty and Ethics poll, nurses, who have long topped the poll as the most trusted professionals, earned a positive rating from only 76% of respondents — 9 points lower than in 2019. Positive ratings of physicians fell nine points over the same period to a meager 56%, and at 59%, dentists did not fare much better. Public perceptions of the health professions rose during the COVID-19 pandemic but have since declined to all-time lows, especially among non-college graduates.

To withstand these trends, dentists must possess more than clinical expertise and managerial competencies. We need leadership grounded in the recognition that dentistry must operate as a moral community, where ethical principles, patient advocacy, and social responsibility form the foundation of professional practice.

Defining Our Moral Community

A moral community is a group of individuals bound by a shared commitment to ethical standards and a collective sense of responsibility toward the welfare of others. Through shared values and mutual accountability, this community has the capacity to influence members’ actions. In health care, those fundamental values include a commitment to providing our patients with patient-centered care, but they don’t stop there. The American College of Dentists (ACD) has historically emphasized that dentists have a social responsibility to address access and equity challenges for vulnerable populations as well. Those of us who are dental educators must also ensure that these values inform how we mentor future generations, engage with our communities, and shape the future of the profession.

Persistent and Emerging Challenges

As members of the dental profession, we are obligated to do no harm, to act in the best interests of the patient, and to respect the autonomy and dignity of each individual. Today a host of contemporary challenges undermine our ability to meet those obligations.

• The longstanding tension between the primacy of our ethical obligations to patients and the pressures of self-interest in the marketplace is being exacerbated by the growing influence of private equity in dentistry. According to a study by the American Dental Association Health Policy Institute, the portion of U.S. dentists affiliated with private equity increased from 6.6% in 2015 to 12.8% in 2021, and the number of private equity transactions rose five-fold over the same period. How these acquisitions will affect the quality of patient care has yet to be documented, but dentists will need to keep their ethical obligations in front of mind as the economic pressures on them increase.
• Advances in technology also require that we adopt an ethical lens in evaluating whether the latest procedure or test is appropriate for our patients. The use of high-dose radiographs with children, dental implants when alternative treatments are available, or crowns on healthy teeth to accommodate the quest for a perfect smile all entail a risk of harm and pose moral questions for practicing dentists.
• Persistent disparities in access to dental care and oral health outcomes present another significant moral challenge, calling us to address the larger systemic issues that affect patient care. Public health measures such as community water fluoridation may no longer be an available tool for improving the oral health of those who lack regular access to dental care. Changes in how immigration laws are enforced are also raising troubling patient-advocacy questions for dentists and their colleagues in the other health professions, whose places of works have traditionally been protected from interference by immigration enforcement personnel.
• Concurrently, programs established to dismantle the barriers that prevent underrepresented groups from entering the health professions may see their government funding eliminated. Given what we know about the value of culturally concordant care to the health and well-being of our patients, our community has a moral responsibility to devise alternative strategies for continuing this urgent work.

The updated ACD Ethics Handbook for Dentistry provides essential resources to support ethical decision-making in the face of these and other challenges. While not addressing the issues above directly, the handbook’s guidelines are useful in navigating them. For example, the section on informed consent advises us to go beyond what is legally required to include “[u]nbiased presentation of all reasonable alternatives and consequences, including costs and the probability of outcomes” and to communicate with patients “on a level assuring comprehension.” Such guidance gets to the heart of how we can act in the best interests of our patients.

The Role of Dental Educators

As members of a moral community, all members of our profession should commit to lifelong learning, humility, and service, but those of us in dental education have an additional obligation: to inculcate future dentists with the values that define dentistry as a moral community. In so doing, dental educators fulfill their fundamental role as stewards—ensuring that the profession remains true to its ethical commitments and moral foundation.

Mentoring is a vital part of this stewardship, as it enables educators to impart the ethical values and responsibilities of the profession to the next generation. So are leadership development programs such as the NYU Dentistry Leadership Portfolio, which not only teaches the technical and managerial aspects of leadership but also emphasizes the importance of character, ethics, and moral responsibility. Such efforts can foster a more empathetic and socially responsible workforce dedicated to providing equitable care for all.

Leadership as a Moral Imperative

Addressing the challenges facing our profession and our patients will require leadership — not just from academic dentists but from everyone in our profession who is committed to improving oral health and shaping the next generation of dental professionals. As stewards of the profession, we must ensure that dentistry remains a moral community—one that is grounded in ethical principles and dedicated to serving the needs of our patients and society at large. By upholding the pillars of the ACD—ethics, professionalism, leadership, and excellence—we can bolster, and where needed, rebuild the public’s trust in our profession and ensure that it continues to thrive, not only as a clinical discipline but as a community of care committed to the well-being of all.

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

Muscle atrophy. Trouble breathing. Paralysis. Death.

To members of my parents’ generation, these manifestations of polio were familiar and terrifying. By the time I came of age, few Americans gave them any thought. My generation was the first to receive the polio vaccine developed by Jonas Salk. Licensed in 1955, it reduced annual U.S. cases of polio from 58,000 to 5,600 in just two years. By 1961, only 161 U.S. cases remained.

But now we are facing a new challenge to the value of vaccines.  Even before the COVID-19 pandemic, vaccine hesitancy had become so prevalent that the World Health Organization added it to its list of global health threats. As with any medicine, vaccines are not without risks, but most of these are minor — a sore arm, fatigue, a low-grade fever. Serious side effects can and do occur, but they are very rare. Nevertheless, fear of these risks — and a belief that they are worse than the risks of contracting the diseases they prevent — has led to a steady decline in U.S. and worldwide vaccination rates, with devastating consequences.

• In 2022 — 28 years after the Americas were declared polio free — polio reappeared in an unvaccinated U.S. adult.
• In 2023, Europe had 42,200 measles cases — 42 times as many as it had in 2022.
• In 2024, England experienced a measles outbreak after vaccination rates fell to 85% nationwide and dropped to 73% in London.
• The U.S. eliminated measles in 2000, only to see outbreaks return at Disneyland in 2014 and in under-vaccinated communities in New York in 2019.
• During the COVID-19 pandemic, misinformation and fear led many Americans to refuse vaccination against the novel disease. The Peterson-KFF Health System Tracker Project estimates that 234,000 U.S. deaths could have been prevented between June 2021 and April 2022 if more people had chosen to be vaccinated.

Last fall, Scott Gottlieb, MD, who headed the Food and Drug Administration during Trump’s first term as president, told CNBC that he doesn’t think the president wants to see a resurgence of measles, whooping cough, or “God forbid, cases of polio in this country.” I hope Gottlieb is right, and that the new administration will recognize the value of vaccination in preventing such eventualities.

Social media is rife with misinformation, and the recent decision by Meta to stop fact-checking content on Facebook, Threads, and Instagram suggests the problem will only get worse. Interestingly, a U.S./UK-based nonprofit that tracked anti-vaccine content on Facebook and Twitter in the first year of the COVID-19 pandemic found that 65% of it originated with just 12 individuals and their advocacy groups. Banning these misinformation “super-spreaders” from popular platforms could go a long way to counter their influence, but it’s not clear where pressure to do so would originate.  

Of particular interest to our community, five lawsuits have been filed against Gardasil, the vaccine that protects against the human papillomavirus (HPV). In addition to nearly all cervical cancers, HPV is thought to cause 70% of oropharyngeal cancers (OPCs). While these cancers are rare, they are extraordinarily painful and often deadly — two excellent reasons to get this particular vaccine.

Sharing information of this type more widely is essential in countering misinformation, but as we’ve learned in the past few years, facts alone are not necessarily persuasive. Often, the relationship the listener has with the person who delivers the facts is more influential than the facts themselves. A just published KFF poll found a significant drop in trust in public health agencies and vaccines since 2023. Restoring trust in health authorities will be key to increasing vaccination rates.

What the Dental Community Can Do

One bright spot in the KFF poll: 85% of respondents have either a great deal or a fair amount of trust in their doctors. Given this finding, health professionals may need to take the lead in informing the public about the value of vaccines. Here are some steps dental professionals can take to build trust in vaccines and make them available to people who might not seek them out.

1. Talk to our patients. Let them know about the benefits of vaccination for themselves and their children. Research shows that anticipatory guidance from a trusted health professional is effective in encouraging vaccination, even among parents who have initially declinedit for their children.
2. Talk to parents about HPV. They might be more inclined to vaccinate their children against HPV if they knew the vaccine existed and understood how deadly OPCs can be.
3. Speak to our communities. An op-ed in the local paper or a Q&A with a local PTA — even private conversations with friends and neighbors — help to inform the public, counter misinformation circulating online and build trust in our profession’s commitment to serving the public.
4. Volunteer at vaccination clinics. Dental professionals are skilled at giving injections. They can put those skills to use and serve their communities by heeding the call to volunteer during public health emergencies, as they did during the COVID-19 pandemic.
5. Don’t get distracted. There is talk of a renewed federal focus on processed food consumption and chronic diseases. That’s all to the good, but we mustn’t lose sight of the potentially deadly threat posed by preventable infectious diseases.

As former US surgeon general Jerome Adams, MD, MPH, FASA, posted on social media, “Cardiovascular disease and cancer are now the top killers in our country. But that’s only because vaccine-preventable diseases and infections stopped being top killers long ago.” Let’s keep it that way.

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

It is a suspenseful time for anyone concerned about public health. In a matter of days or weeks, new leaders will arrive in Washington and Atlanta to lead the nation’s three-letter health agencies. Within the FDA, CDC, CMS, and NIH, people are bracing for change, while nongovernmental stakeholders publicly speculate about how the likely new secretary of health and human services — an attorney known for his unorthodox views on public health — might reshape the research and regulatory environment over the next four years.

Those seeking inspiration or guidance on navigating a changing federal landscape might want to read Anthony Fauci’s 2024 memoir “On Call.” In addition to his widely reported observations on the federal government’s handling of the COVID-19 pandemic, the book describes the forces that shaped this exceptionally talented physician and researcher, including his earlier years in medicine, research, and public health.

Fauci began his professional journey at the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), which he was tapped to direct in 1984. Over the course of a multi-decade career, he responded to a series of public health challenges, including HIV/AIDS, bird flu, Ebola, Zika, and the post-9/11 anthrax scare. In the process, he became an adept influencer of U.S. health policy under seven U.S. presidents, starting with Ronald Reagan.

Both praised and vilified during his time in the spotlight, Fauci remained in public service until the age of eighty-two, concluding a professional journey that offers lessons in leadership we can use today. Here are a few from his early career that resonated with me and offer guidance as we prepare for whatever comes next.

Lesson 1: Build connections with individuals who have the influence to drive change.

Fauci made the fateful decision early in his career to focus his research on the care of patients with HIV/AIDS. At the time, the disease was poorly understood, highly stigmatized, and almost universally fatal. As gay men started dying of AIDS in large numbers, an activist movement arose to pressure the NIH to devote more resources to studying the disease.

The movement’s strident criticism of the government’s response drew widespread attention, elevating Fauci’s public profile and immersing him in controversy. He rose to the challenge, cultivating relationships with both vocal gay rights activists and the powerful government officials they criticized. He proved skilled at helping these adversaries appreciate each other’s perspectives and at communicating with political leaders in ways that would eventually spur action. “I addressed public policy only when it related to my scientific expertise, and I left politics to others, a practice I tried hard to adhere to for the rest of my career,” he wrote. “[I]t was crucial to be truthful and consistent in providing information based purely on scientific evidence and best judgment, and nothing else.” This approach won him the respect of George H.W. Bush and each of the presidents who followed.

In my own work, I have also found that successful advocacy requires what I call “RiP SAw” — shorthand for “the relentless pursuit of strategic alliances.” While I was at the American Dental Education Association (ADEA), we forged strong ties both inter- and intra-professionally; across education, practice, and research; with dental professionals on other continents; and with lawmakers in the executive branch and on Capitol Hill. These relationships were integral to our ability to achieve changes in dental licensure, the formation of the Interprofessional Education Collaborative, the sharing of evidence-based curricula throughout the globe, and policy advancements such as the inclusion of a children’s dental benefit in Medicaid and the Children’s Health Insurance Program.

One of our earliest successes dates to the period when Fauci was focused on increasing federal funding for HIV/AIDS research. ADEA partnered with others to secure the inclusion of dental and dental hygiene services in the Ryan White CARE Act, which reimburses providers for uncompensated care of people living with HIV and AIDS.

Lesson 2: Always be looking around the corner.

In the mid-1980s, people with HIV were dying at an alarming rate and trying all sorts of untested remedies on their own in hopes of suppressing the virus. Fauci responded by accelerating NIAID’s work to discover drugs that could be effective in treating HIV/AIDS. He established the Division of AIDS within NIAID and facilitated partnerships between academic institutions and pharmaceutical companies to spur drug development.

“Not everyone at the NIH or in research institutions throughout the country was excited about spending the money to create such a network, especially when we did not have any drugs yet to test in these units. Some scientists were even saying that we were ‘throwing money away,'” Fauci writes. Despite the criticism, he stayed the course, and the network soon proved its value.

This commitment to “looking around the corner,” as I like to say, is an essential leadership skill. The political and institutional pressures to prioritize immediate needs can be overwhelming. Leaders who can also cast their gaze outward, gauge future needs, and invest their resources for the long term are essential to achieving the kind of progress that yields significant impact down the line.

Lesson 3:  Health care is an art as well as a science.

Despite his strong interest in research, Fauci learned this lesson early on. “I was dealing with a human being who needed care, compassion, and comfort in addition to the correct description of her heart murmurs,” he writes of a woman he treated while a medical student. “Right from the get-go I felt the importance of this combination of the art and the science of medicine.”

This realization served Fauci well while caring for patients with HIV/AIDS at NIAID. A particularly poignant event occurred one evening as he made rounds. A favorite patient, with whom he chatted daily, was unable to recognize him. In the intervening hours, an opportunistic infection had rendered him blind. “It was as if someone had stuck a spike in my chest,” Fauci recalls.

I also retain vivid memories of some of my early experiences treating people with HIV/AIDS. They regularly came through our doors when I was dean for clinical affairs at the Harvard School of Dental Medicine in the late 1980s. At the time, few private practice dentists were willing to treat these patients, and dental schools stepped up to provide access to care. In Boston, we became known as a place that welcomed these patients.

One day I was called on to consult on the oral complications of a patient with AIDS at the Brigham and Women’s Hospital. The 25-year-old man was unable to eat or drink because of fungal infections in his mouth. He was in an isolation room, and when I entered — fully gloved and gowned with a mask and a face shield — he began to weep. My attire telegraphed the gravity of his health situation, which he had not disclosed to his parents. He told me they did not even know he was gay.

The encounter taught me a lesson in empathy and was instrumental in shaping my future interactions with patients with HIV/AIDS. I found ways to interject humor in patient encounters and, most importantly, looked for ways to give them hope.

Final Reflection: The enduring power of hope.

Providing hope is woven throughout “On Call.” It is easy to look around at everything that is wrong in the world and get discouraged, but the book reminds us that behind the scenes, people of goodwill are making progress every day. The pace of change may be incremental, but the small gains of clinicians, researchers, and others can accrue in ways that change the lives of millions, especially when changes occur at the policy level. Health scientists willing to serve as honest brokers and do the hard work of informing politicians and the public are urgently needed today. Dr. Fauci led through six decades of often dark and frightening times—we can and will step in as he steps back. Let us hope the qualities that Fauci exemplifies continue to have currency in the years ahead.

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 Executive Director of the NYU Dentistry Center for Oral Health Policy and Management

Each Veterans Day, many dental schools and some private dental offices open their doors to veterans and honor their service by providing free dental care. These acts of generosity are welcome and impactful, but they point to a shameful reality: For too many veterans, access to dental care is often a matter of charity and chance.

Roughly 15% of veterans are eligible for dental benefits through the Veterans Administration (VA), and many of the ineligible veterans can’t afford to pay for care on their own. This gap in care has persisted for decades, despite the fact that veterans have higher rates of dental caries (56% versus 37%) and periodontal disease (42% versus 27%) than their civilian counterparts.

“They sacrifice. Their families sacrifice. They shouldn’t have to struggle to get dental care,” says Gabriela Gonzalez, MPA, director of the VOCARE (Veterans Oral Care Access Resource) program at NYU Dentistry. The VOCARE initiative provides free dental care to U.S. military veterans from the five boroughs of New York City who are registered with the VA and are not eligible for dental benefits through the VA. Enrollment in VOCARE is based on referrals received from providers at the VA New York Harbor Healthcare System, the VA Bronx Health Care, and the Leukemia & Lymphoma Society.

Since its inception in 2021, VOCARE has made a significant dent in the access to dental care problem for veterans living in our region. Between July 1, 2021, and June 30, 2024, 3,253 veterans received care in our clinics. Over the course of 29,473 visits, 58,040 procedures were performed. The program currently gets about 20 to 25 referrals each day.

“VOCARE is having an impact in New York City and New York State,” says Michael O’Connor, EdD, MPA, who serves as executive vice dean and oversees the VOCARE program. He says the NYC VA directors are “thrilled” that they now have a place to refer their patients for free dental care. So are VA leaders in Washington. During a visit to NYU earlier this year, U.S. Secretary of Veterans Affairs Denis McDonough presented Gabriela with a military challenge coin in recognition of the VOCARE program.

On the Policy Front

As we celebrate VOCARE’s success, we are acutely aware that beyond our immediate region, millions of veterans still struggle to receive dental care. According to a June article in Military Times, only 1.8 million of the nation’s 9 million veterans were eligible for dental care through the VA in 2023. To qualify, veterans must demonstrate their oral health needs are either connected to their military service or medically necessary to prepare the veteran for a covered hospital admission. Routine dental care is not a covered benefit.

The VA also provides dental care for veterans who are considered 100% disabled as a result of service injuries. The 2022 PACT Act, which created health benefits for veterans exposed to burn pit smoke and other toxins, has made it easier to qualify for the 100% rating. This should increase the number of veterans eligible for dental benefits, but shouldn’t all veterans have access to dental care, whether or not they have a service-related disability?

Some in Congress think so, and they have introduced legislation that would expand access to dental care for millions of veterans. The Dental Care for Veterans Act, introduced in 2023, has garnered 68 co-sponsors. It would eliminate the current eligibility restrictions for VA dental care. A separate bill introduced the same year would provide dental care to veterans diagnosed with diabetes and ischemic heart disease. With only 14 cosponsors, its chances of immediate passage are less promising.

Nevertheless, Michael believes momentum in favor of expanding veterans’ oral health benefits is building. “Will it be full oral health care? Not this round,” he says. “But will there be some enhancement to current plans? I think so. One idea is to have a voucher system in which each living veteran receives $1,000 to $2,000 a year to spend on dental care, and they decide how best to spend it,” he suggests.

Each spring, we take 20-25 students to Washington, D.C., in conjunction with our Global Health Care Leaders program. As part of this leadership experience, our students have been able to speak on behalf of pending legislation related to oral health priorities in meetings at our Congressional representatives’ offices on Capitol Hill. During one such encounter, a member of the New Jersey delegation asked one of our students, Anthony Allison, DDS (a 2024 NYU Dentistry grad), if he would serve as an advisor on veterans’ oral health policy. As an active-duty member of the U.S. Army, Anthony was only too happy to oblige. With such committed and knowledgeable advocates, the momentum Michael has observed can only grow.

A Role for the Private Sector

The success of VOCARE would not be possible without NYU Dentistry’s in-kind contributions and additional donations to cover the cost of care. A generous donation from the United Concordia Dental Charitable Fund helped us launch the program, and the Leukemia & Lymphoma Society, which underwrites dental care for veterans with blood cancers, soon followed suit. Subsequently, support arrived from the New York State Assembly, the New York State Senate, and the New York City Council.

Faculty, students, and alumni at NYU Dentistry have also been moved to contribute. Of special note is a $1 million donation announced earlier this week, from NYU dental alumni Dr. Nazish Jafri and Dr. Noel Liu. Their gift will sustain the program and allow us to expand the dental services the college provides to deserving veterans. The Chicago-based couple are talking with other area alumni about ways to support veterans’ oral health, and we hope their example will spur alumni all over the country to think about serving veterans in their locales.

So does Dianne Sefo, RDH, MEd, who chairs our Dental Hygiene & Dental Assisting Department. Dianne is also the daughter of a veteran and a VOCARE donor. She introduced everyone to the Wounded Veterans Relief Fund, which provides financial assistance and dental care to wounded veterans in Florida. A burgeoning relationship has formed.

“My hope is that the relationship will raise more awareness and get more Florida alumni involved, whether it’s volunteering their work or providing monetary support,” she says. As she points out, NYU graduates 10% of all dentists in the country, so the impact our alumni could have in this one area is vast.

Of course, dentists do not need to be NYU Dentistry graduates to join in providing veterans with free or reduced cost dental care. Michael is particularly eager to see how the American Dental Association (ADA) Foundation’s Give Veterans A Smile program, launched last month, impacts veterans’ care. “As advocates for veterans to get more oral health care, they have the capacity and the influence to make a major difference across the country,” he believes. I hope the organization will use that clout with their members and with lawmakers.

As someone who has worked with the Veterans Administration Outpatient Clinic in Boston and served as a technical expert to the VA on veterans’ oral health care, I’m heartened to see policy moving in the right direction. Veterans and their families sacrifice a lot to serve this country. We shouldn’t be leaving their dental care to chance.

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.