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

In May, I watched 400 NYU Dentistry DDS graduates walk across the stage at Madison Square Garden and couldn’t help reflecting on what awaits them out there in the “real world” beyond our teaching clinics. Today’s workplace is a far cry from the practice environment my classmates and I first encountered after graduation, and the pace of change is such that even some younger faculty members may have little first-hand experience in today’s private practices.  This got me thinking about curricular changes dental schools might want to make to ensure our graduates function well in the current environment and adapt in the decades ahead.

Those changes amount to a stronger focus on meeting three core goals:

• Today’s graduates must be comfortable with digital dentistry and open to advances powered by artificial intelligence (AI).
• They need to understand how the business of dentistry is evolving to favor more efficient and less costly models of service delivery.
• They need a strong ethical foundation and moral compass to ensure they live up to their social responsibilities as health professionals while navigating the changes ahead.

And they need to develop sophisticated communication skills, effectively engaging with patients, colleagues, staff members, third party payors, referring specialists, dental laboratories, regulatory bodies, community health organizations, and professional associations.

Digital Dentistry

Electronic health records (EHRs). Digital radiography. Intraoral scanners. These technologies are well established in U.S. dental schools, but already their use is being augmented.

• Traditional dental health records, which transformed patient record keeping in dental schools in the late 1990s, are being supplanted by EHRs that integrate patients’ dental and medical records and streamline administrative and communications functions.
• Digital radiography is being paired with artificial intelligence (AI) to better diagnose disease. AI is also being integrated into treatment planning software and ultimately may enhance clinical decision-making for entire populations through advanced data analysis and predictive analytics.
• Intraoral scanning is just the first step in a digital workflow that incorporates computer-assisted design and manufacturing (CAD/CAM). CAD/CAM renderings may still be sent to a dental lab, but with the latest in-office equipment, some practices are milling crowns and using 3D printers, allowing patients to complete treatment in a single visit.
• Robotics are also expected to play a growing role in dentistry. At NYU, we expose DDS students to this technology by giving them the chance to practice implant placement using Yomi, a dental surgery robot.

“These are must haves,” says Ken Allen, DDS, MBA, clinical professor and vice chair of the Department of General Dentistry & Comprehensive Care at NYU Dentistry. He notes that a growing percentage of graduates will be working in large group practices affiliated with dental support organizations (DSOs). “They are going to insist that their new staff dentists know these technologies now. They may not use all of them yet, but they’re going to expect dentists to be familiar with them.”

That’s adding a lot to an already packed DDS curriculum, but as Ken points out, students only need to be proficient in some of these technologies. It’s enough for them to graduate with knowledge of the most advanced tools, so they are prepared to learn how to use them proficiently on the job. Do we also need to prepare students to adapt to the latest innovations as dental practice evolves, I asked Ken. “Today’s students are digital natives,” he pointed out. “They’re used to their phones being upgraded every two years, so I think they are ready to understand that things are going to change.”

Evolving Models of Care Delivery

Alongside technological change, the structure of the workplace and the composition of the dental team are also evolving. The scope of practice for dental hygienists has expanded considerably in most states; dental therapists (DTs) are poised to expand the capacity of the dental team in coming years; and some dental care is migrating outside the dental office. Primary care physicians have begun administering fluoride varnish in response to a 2021 recommendation by the U.S. Preventive Services Task Force. Last year, the governor of New York signed a law allowing dental assistants and licensed practical nurses to do the same, and two additional bills pending in New York would extend the privilege to parents and guardians under the telehealth supervision of authorized providers. In a concerning trend, more complex dental care, such as mail-order aligners, is also occurring in the home, as new business models encourage consumers to engage in do-it-yourself dentistry.

The demographic make-up of the workforce has also changed, with women making up a majority of current DDS graduates. Female dentists have traditionally worked fewer hours than their male counterparts and are more likely to choose part-time employment. This preference may preclude solo practice for some new dentists and partially explains the rise of large group practices, which can accommodate part-time providers while still meeting their business objectives. Over 28% of recent graduates chose employment at DSO-affiliated practices in 2023, almost doubling the number of dentists in this sector to 13.8%, up from 7.4% in 2015.

Given these trends, it is incumbent upon dental schools to make sure their practice-management curricula evolve with the times. Don Gallo, DMD, retired chief clinical officer for Dental Care Alliance, a DSO, sits on NYU Dentistry’s Dean’s Strategic Advisory Council and teaches in the college’s practice management course. When I asked him what DSO-affiliated practices want their new hires to know by the time they graduate, Don had a short list of priorities at the ready. In his view, dental students should know:

1. How to engage in comprehensive treatment planning. In Don’s experience, new dentists are so focused on addressing their patient’s immediate complaints that they often miss the opportunity to evaluate the entire dentition and recommend treatments that can stave off future problems.
2. How to use visual aids to present treatment plans to patients. “People retain about 20% of what they hear. They retain 65% or 70% of what they see,” Don told me. Knowing this can help dentists communicate more effectively with patients.
3. How to engage the bur longer to increase their efficiency. “It’s not about working faster,” Don insists. “Speed comes with confidence. It’s a product of understanding and visualizing what the end looks like.”
4. That the quality of customer service is what drives business success. “There are a lot of dentists that are phenomenal technicians that just aren’t successful because they’re not good at managing people and managing their practice,” Don observed.
5. Basic facts about group practice employment.

“I think there’s this perception, even inside organized dentistry, that employed dentists somehow work for the DSOs, which they don’t,” Don told me. There is considerable variation in how state laws address DSO affiliation, but in most cases, dental practices must be owned by dentists, and DSO-affiliated group practices may offer a path to practice partnership, should a dentist choose to pursue it.

How can graduates make the best choice of where to start their careers? Don suggests that dental schools coach students in contract negotiation and provide education or assistance to graduates in understanding the offers they receive. Those sound like good ideas to me.

Social Responsibility

The rise of DSOs has been controversial at times, with some affiliated dentists and hygienists reporting they feel pressured to alter how they practice in order to meet corporate goals. The use of AI in health care also poses ethical concerns that our profession is just beginning to analyze. Threats to public health — from hostility toward community water fluoridation to a rapidly changing climate — also call on dentists to live up to their social responsibilities. For these reasons and more, our graduates need a strong ethical foundation and moral compass to help them navigate the practice landscape that awaits them.

As I wrote in March, members of the dental profession are obligated to do no harm and to act in the best interests of their patients. Dental schools must imbue their curricula with this North Star and encourage their graduates to be leaders in shaping our collective future. Given the rapid pace of change, we might also offer certificate programs to help practicing dentists stay up to speed on the latest techniques, equipment, workplace practices, and ethical and legal matters. Such robust CDE offerings could have the added benefit of ensuring that faculty are also well acquainted with the challenges their students will face in the practice environment.

As stewards of the profession, we’ve done a good job of ensuring our graduates are competent clinicians in the here and now, but a lot can happen in 40 years; they will likely still be practicing in 2065.  Given the pace of change, it’s more urgent than ever that we give them the knowledge they need to adapt as the practice of dentistry evolves.