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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

Dental Education at the Crossroads

Challenges and Change

Committee on the Future of Dental Education

Marilyn J. Field, Ph.D., Editor

Division of Health Care Services

Institute of Medicine

National Academy Press
Washington, D.C.
1995

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

National Academy Press
2101 Constitution Avenue, N.W. Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

Support for this project was provided by the Robert Wood Johnson Foundation under Grant No. 19634, the American Fund for Dental Health, the National Institute of Dental Research under Contract No. NO1-DE-22594, the Health Resources Services Administration under Contract No. 240-91-0051, the Department of Veterans Affairs, the Department of Defense, the American Association of Retired Persons, and CIGNA Dental Health, Inc. The views presented are those of the Institute of Medicine Committee on the Future of Dental Education and are not necessarily those of the funding organizations.

Library of Congress Cataloging-in-Publication Data

Dental education at the crossroads : challenges and change / Committee on the Future of Dental Education, Division of Health Care Services, Institute of Medicine ; Marilyn J. Field, editor.

p. cm.

Includes bibliographical references and index.

ISBN 0-309-05195-9

1. Dentistry—Study and teaching—United States. 2. Dental policy—United States. I. Field, Marilyn J. (Marilyn Jane). II. Institute of Medicine (U.S.). Committee on the Future of Dental Education.

RK91.D39 1995 94-41301

617.6′0071′173—dc20 CIP

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

Copyright 1995 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

Committee On The Future Of Dental Education

JOHN P. HOWE III (Chair), President,

The University of Texas Health Science. Center at San Antonio, San Antonio, Texas

MYRON ALLUKIAN, Jr.,* Assistant Deputy Commissioner and Director,

Personal Health Services and Community Dental Programs, Department of Health and Hospitals, City of Boston, Boston, Massachusetts

HOWARD L. BAILIT,* Senior Vice President,

Health Services Research, Aetna Life and Casualty, Hartford, Connecticut

EVA C. DAHL, Practice of Endodontics and Oral Pathology,

Department of Dental Specialists, Gundersen Clinic, Ltd., La Crosse, Wisconsin

CHESTER DOUGLASS, Professor and Chairman,

Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, and

Professor of Epidemiology,

Harvard School of Public Health, Boston, Massachusetts

RASHI FEIN,* Professor of the Economics of Medicine,

Department of Social Medicine, Harvard Medical School, Boston, Massachusetts

JOEL F. GLOVER, Private Practice,

Reno, Nevada

JOSEPH L. HENRY,* Associate Dean, Professor, and Chair,

Department of Oral Diagnosis and Oral Radiology, Harvard School of Dental Medicine, Boston, Massachusetts

CARLOS MANUEL INTERIAN, JR., Private Practice,

Miami, Florida

JAMES D. ISBISTER, President,

Pharmavene, Inc., Gaithersburg, Maryland

MARJORIE K. JEFFCOAT, Rosen Professor and Chairman,

Department of Periodontics, School of Dentistry, University of Alabama, Birmingham, Alabama

TERRELL E. JONES, Oral Surgery Resident,

The University of Tennessee, College of Dentistry, Memphis, Tennessee

LINDA G. KRAEMER, Senior Associate Dean,

College of Allied Health Services, Thomas Jefferson University, Philadelphia, Pennsylvania

J. BERNARD MACHEN, Dean,

School of Dentistry, University of Michigan, Ann Arbor, Michigan

ELIZABETH F. NEUFELD,* Professor and Chairman,

Department of Biological Chemistry, School of Medicine, University of California, Los Angeles, California

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

J. DENNIS O'CONNOR, Chancellor,

University of Pittsburgh, Pittsburgh, Pennsylvania

NEAL A. VANSELOW,* Chancellor,

Tulane University Medical Center, New Orleans, Louisiana

THERESA VARNER, Director,

Public Policy Institute, American Association of Retired Persons, Washington, D.C.

Study Staff

LISA M. CHIMENTO, Program Officer (through June 1994)

MARILYN J. FIELD, Study Director

KATHLEEN N. LOHR, Director,

Division of Health Care Services (from September 1993)

NINA SPRUILL, Financial Officer

DONNA D. THOMPSON, Administrative Assistant

KARL D. YORDY, Director,

Division of Health Care Services (through September 1993)

*  

Institute of Medicine member

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

Preface

Early in 1990, a group of leaders in dental education asked whether the Institute of Medicine (IOM) would undertake an independent assessment of dental education. After the governing bodies of the IOM approved a preliminary proposal for such a project, the IOM convened a planning meeting in June 1990 that recommended a study to identify measures to strengthen dental education in the United States and stabilize its position within the university. The next step involved discussions with other leaders in dentistry to determine their interest in and receptivity to an IOM study. The study was not conceived as a follow-on project to any previous study but as an independent examination of dental education. It was overseen by an 18-member committee of experts in dental practice and education, oral health and health services research, other areas of health professions and higher education, health care delivery and financing, and public policy.

During its work, the committee faced a number of questions about the nature of the IOM. The IOM is part of the National Academy of Sciences, a private nonprofit organization Chartered by Congress in 1863 to provide advice on scientific matters. IOM members include physicians, dentists, nurses, biomedical and health services researchers, and others. Despite its name, one-quarter of the Institute's members must by charter come from outside the health field. Funding for studies comes from both public and private organizations.

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

The work of the IOM has covered a broad range Of health issues since its founding nearly 25 years ago. In recent years, it has issued reports on such disparate issues as the future of public health, measuring access to health care (including oral health services), the effects of mustard gas, preventing mental illness, career paths for clinical research (including dentistry), food and nutrition, employment and health benefits, health care data systems, and health care reform. Past or planned reports on health professions education and supply include studies of the allied health services (including dental hygiene), education for primary care, nursing education, health professions education and minorities, geriatric care in physician training, physician staffing for veterans' hospitals, and nurse staffing in community hospitals. In 1980, the IOM issued a report on financing dental care, and a 1994 report on career paths for clinical researchers includes oral health research. Elsewhere in the National Academy of Sciences, the Office of Scientific and Engineering Personnel issues periodic reports on national needs for such personnel. Its 1985 and 1994 reports cover oral health research workers. By way of historical note, within the National Academy of Sciences, the first committee to consider issues in dental science was formed in 1919 by the Division of Medical Sciences. This group later considered priorities for research grants awarded by the American Dental Association.

Charge To The Committee

The charge to the Committee on the Future of Dental Education, as revised by the committee, is as follows. The IOM committee will assess dental education in the United States and make recommendations regarding its future. It will

  • examine the current status of dental education and oral health in the United States and consider future scientific, demographic, economic, organizational, and other developments that may affect oral health status and the system for educating dentists and other dental personnel;
  • develop a statement of how, over the next 25 years, oral health and oral health services should be improved in the United States, and identify the short-term and long-term implications of this statement for dental education and public policy;
  • describe strategies that will help dental education, research, and practice improve oral health by responding effectively to current problems and future developments in both science and society; and
Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×
  • consider ways in which each dental school can better relate to the mission of its university and to the community at large.

Committee Approach

The committee engaged in a very broad-ranging effort to collect information and perspectives on dental education in the context of the broader systems of health professions education and health care delivery. Members made site visits to 11 of the 54 U.S. dental schools and in the process visited with approximately 600 faculty, students, administrators, alumni, and dental society leaders. (The committee chair and the study director participated in every site visit.) The committee also undertook a mail survey of all deans of dental schools (in cooperation with the American Association of Dental Schools) and a telephone survey of two dozen university presidents, chancellors, and other senior officials. A public hearing in September 1993 generated oral testimony from 25 groups and written testimony from nearly 30 more (out of more than 80 groups invited). In addition, the committee established and met with three liaison panels representing regional dental society leadership, specialty societies, and dental school faculty.

Members of the committee met with leaders of major dental organizations including the American Association for Dental Research, the American Association of Dental Schools, the American College of Dentists, the American Dental Association, the American Dental Assistants' Association, and the American Dental Hygienists' Association. Committee members and staff also discussed the project at annual meetings and other sessions organized by a number of dental groups.

To inform its analyses and provide additional background for this report, the committee commissioned, seven papers that are being published separately by the Journal of Dental Education. In addition, committee and staff reviewed a wide variety. of published and unpublished literature on topics related to the committee's charge. The committee also consulted the literature on medical education and sometimes cites it as a reference point but not necessarily a standard or ideal. The committee report was reviewed under the procedures of the National Research Council. This document constitutes the committee's final statement.

Page viii Cite
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
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Acknowledgments

Many individuals and groups assisted the study committee and staff in the development of this report. Initial direction for this project was provided by a planning committee that met in June 1990. That meeting was chaired by John C. Greene, and the participants were Howard Bailit; Ben Barker; James Beck; Jack Brown; Teresa Dolan; Chester Douglass; Robert Ferris; Allan Formicola; James Gaines; Robert Genco; Robert Gerlach; Jay Gershen; Joel Glover; Albert Guay; Robert Heaney; Garland Hershey, Jr.; George Keller; Linda Kraemer; Warren Lesmeister; James Lipton; Preston Littleton; Kent Nash; Howard Oaks; Richard Ranney; Paul Schwab; Jeanne Sinkford; Paul Van Ostenberg; Neal Vanselow; and Richard Weaver. Many of those involved in this meeting continued to play a role in the study either as committee members or as sources of advice and information. Michael Millman, who was senior staff officer for the study before leaving for the Department of Health and Human Services, developed the project proposal and fund-raising strategy over a 2-year period. He left a valuable legacy to the committee and staff who came later. Karl Yordy, who was director of the Division of Health Care Services from the point at which this study was first discussed through September 1993, continued to take an active role in the study even after his departure from Washington, D.C. Samuel Thier, former president of the Institute, took a particular interest in launching this project.

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

The members of three liaison panels that met with committee members are listed in Appendix A. Members of these panels also assisted by reviewing background materials developed by the committee and by answering a variety of questions. Appendix B lists the organizations that prepared written testimony for the committee's public meeting in the fall of 1993.

The committee commissioned seven papers that provided useful background and insights for this report, as did two other papers drafted by committee members. These papers, which are being published in the January 1995 issue of the Journal of Dental Education, are listed with their authors in Appendix C. In addition to preparing background papers, James Bader, Eli Capilouto, William Clark, Lisa Tedesco, and Alex White contributed more generally to the study through their ideas and comments. During one of the committee meetings, Eli and Mary Lynne Capilouto also participated in a panel discussion of dental work force issues that also included James Bader, Gloria Bronstein, Norman Clark, Steven Eklund, Kent Nash, and Eric Solomon. Joseph Consani and Lindsay Hunt helped in sorting out the complexities of dental school financing by meeting with the committee and reviewing background materials.

The American Association of Dental Schools (AADS) and the American Dental Association (ADA) have been unfailingly helpful in providing information, answering our many questions, and giving us the opportunity to discuss the report during their annual meetings and board meetings and at other sessions. At the AADS, we particularly appreciate the assistance of Thomas Freeland, Carolyn Gray, Martha Liggett, and Preston Littleton. Without their help, the survey of dental school deans would not have been feasible. Of course, without the constructive responses received from all 54 deans, the survey also would not have been useful. Linda DeVore and Arthur Dugoni, while each was president of the AADS, also supported the committee's work in a variety of ways. The ADA provided extensive assistance including a wealth of statistical information on dental education, licensure, accreditation, and practice as well as help in sorting out the limits of the information's use. The committee particularly appreciates the perspectives and information provided by Thomas Berger, Tommi Cole, Clifford Miller, and John Zapp and by ADA Presidents James Gaines and Jack Harris.

The AADS also contributed to the American Fund for Dental Health, which helped fund this study; other major contributors to the Fund were Colgate-Palmolive and Warner-Lambert.

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

The committee and staff also met with representatives of the American Association for Dental Research (John Clarkson and Harold Slavkin), the American College of Dentists (Juliann Bluitt and Sherry Keramidas), the American Dental Assistants' Association (Judith Andrews and Kathy Zweig), the American Dental Hygienists' Association (Kathleen Alvarez, Gail Bemis, Elizabeth Brutvan, and Sarah Turner) to discuss issues of concern to the organizations and their members. John Clarkson, Jane Kendall, Karen Sealander, and Kathy Zweig also answered questions and provided information to the committee on a number of issues. In addition, staff and members of the American Board of Dental Examiners, American College of Dentists, American Academy of Oral Pathology, American Academy of Pediatric Dentistry, American Academy of Periodontology, American Association of Endodontists, American Association of Oral and Maxillofacial Surgeons, American Association of Orthodontists, American Board of Dental Public Health, American College of Prosthodontists, and the Academy of General Dentistry patiently answered our questions.

Many staff of the National Institute of Dental Research helped the committee in a variety of ways. James Corrigan, the project officer for this study, was an invaluable resource. Harold Löe and Dushanka Kleinman met with the committee to discuss research issues and directions and were supportive throughout the project. At the Department of Defense, Robert Augsburger, the project officer, helped answer a number of questions about dental issues for the military.

Although we agreed not to identify them individually, the chancellors and other senior officials of over 22 universities and academic health centers took time from their busy schedules to participate in telephone interviews or personal interviews with committee members and staff. Others provided time during the committee's site visits to 11 dental schools. The deans, faculty, and administrative staff at each of these schools made every effort to broaden and deepen our understanding of dental education and its environment, as evidenced by the meetings they arranged with some 800 people including students, faculty from inside and outside the dental schools, community practitioners, dental society leaders, and alumni. The committee particularly acknowledges the substantial effort required to arrange the site visits and thanks: Allen Formicola and Zoila Noguerole at Columbia University; Robert Knight and Ethel Newman at Howard University; Edward Kaufman and Joan Pano at New York University; Michael Heurer at Northwestern University; Arthur Dugoni and Edward Hayashida at the

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

University of the Pacific; Henry Cherrick, Jay Gershen, and Christy Kemp at the University of California, Los Angeles; Allen Anderson and Michael Valadez at the University of Illinois at Chicago; John Stature at the University of North Carolina; John Greene and Anne Buchanan at the University of California at San Francisco; Howard Landesman and Janice Balin at the University of Southern California; and Kenneth Kalkwarf and Karen Fuller at the University of Texas at San Antonio. (In addition, the study director, whose dental emergency provided an unplanned opportunity to learn about an advanced general dentistry clinic, thanks John Greene, Terry Chin, and Ed Hayashida for their advice and assistance).

Among the many others who contributed substantively to the committee's understanding of dental education and its environment were Brownell Anderson, Roger Bulger, Charles Cartwright, Kenneth Chance, Skip Collins, Stephen Corbin, Dominick De Paola, David Denton, Linda DeVore, Arthur Dugoni, Patrick Ferillo, Jay Gershen, James Kennedy, Sherry Keramidas, Rowland Hutchinson, Peter Lockhardt, Lawrence Meskin, Linda Niessen, David Nash, Spencer Redding, Henry Sazima, Aidan Stephens, and Barry Wogelman.

At the University of Texas Health Science Center at San Antonio, Sylvia Cantu helped coordinate work with the committee chairman. Frances Poillon was our most helpful copy editor, and Sally Stanfield at the National Academy Press was supportive, as always. Nina Spruill helped us keep our somewhat complicated financial accounts straight, and Claudia Carl managed the logistics of an extensive report review process. Although she participated in all aspects of the study, Lisa Chimento made particular contributions in literature review, data collection and analysis, and planning and analysis of the public meeting and site visits. During the final stages of report preparation, Helen Rogers provided assistance with references and fact checking, especially in the regulatory area. With her superb computer and logistical skills and unflappable good humor, Donna Thompson handled smoothly the preparation of the committee report, the revising of the commissioned papers, and the arrangements for an extensive array of meetings and other activities. The committee also benefited from the work of other committees and staff of the Institute of Medicine or the National Research Council that produced the reports noted in the reference list, in particular, the reports on national needs for biomedical and behavioral science researchers, careers in clinical research, and racial and ethnic diversity in the health professions.

Page xiii Cite
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
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Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
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Tables And Figures

Tables

1.1

 

Number of U.S. Dental Schools, 1970-1993

 

22

2.1

 

Time Line of Selected Dates in Dentistry and Dental Education,

 

36

2.2

 

Conclusions of the Gies Report on Dental Education, 1926

 

44

Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
×

3.1

 

Mean Number and Percentage Component of Decayed, Missing, and Filled Permanent Teeth (DMFT) Among Children by Age Group and Race, United States 1963-1987

 

65

4.1

 

Variability in Curriculum Requirements—Basic Sciences, Clinical Sciences, and Behavioral Sciences

 

93

4.2

 

First-Year Enrollment in Advanced General and Specialty Education Programs

 

113

4.3

 

Survey of Deans' Priorities for Dental School Faculty Development over the Next 15 Years

 

126

5.1

 

Research Standards for Accreditation

 

146

5.2

 

Dental School Expenditures (dollars) for Research, 1993

 

151

5.3

 

Dental School Revenues (dollars) from Research, 1993

 

151

5.4

 

NIDR Research Centers Support: Number of Projects and Number of Subprojects by Type of Center and Institution, FY 1993

 

154

5.5

 

Total NIDR Appropriations FY 1970-1993 in Current and Constant Dollars

 

160

5.6

 

Research Grant Activity (FY 1985-1992) of Physician (K11) and Dentist (K15, K16) Scientists

 

164

6.1

 

Standard 6—Patient Care and Clinic Management

 

187

7.1

 

Sources of Dental School Revenue as Percentage of Total Revenue

 

205

7.2

 

Dental School Expenditures and Revenues per Student, 1977-1991 (in dollars)

 

206

7.3

 

Sources of Income and Revenue for Dental Schools and Medical Schools, 1990-1991 (in $millions)

 

208

7.4

 

Number of Dental Schools Subjected to Intensive Review over the Last Five Years

 

223

7.5

 

Deans' Perceived Sources of Support for Changes in Educational Programs

 

224

8.1

 

Number of Programs Accredited by Commission on Dental Accreditation

 

230

8.2

 

States Participating in Regional Dental Testing Agencies, January 1994

 

239

9.1

 

Deans' Responses to Supply Questions in Institute of Medicine and American Association of Dental Schools Survey

 

256

9.2

 

Projection of Active U.S. Dentists by Year of Published Prediction

 

266

10.1

 

Recapitulation of Guiding Principles

 

282

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 1995. Dental Education at the Crossroads: Challenges and Change. Washington, DC: The National Academies Press. doi: 10.17226/4925.
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Figures

1.1

 

Trends in age distribution of U.S. population aged 65 and over, 1990-2030

 

25

1.2

 

Trends in the supply of dentists

 

27

3.1

 

Age-adjusted mortality rates for oral and pharyngeal cancers by race, gender, and year of death, 1973-1987

 

66

4.1

 

Alternative configurations of basic and clinical science education

 

96

4.2

 

Survey of dental school seniors: Ratings of curriculum emphasis

 

101

4.3

 

Trends in number of full-time and part-time clinical faculty

 

124

4.4

 

Dental schools, by size of enrollment

 

133

4.5

 

Average resident tuition and fees in constant dollars by school type

 

136

4.6

 

Student debt in constant dollars

 

137

5.1

 

Percentage distribution of National Institute of Dental Research (NIDR) extramural obligations, FY 1993

 

152

5.2

 

Distribution of total FY 1993 National Institute of Dental Research (NIDR) extramural funds by research areas ($thousands)

 

153

6.1

 

Trends in dental school enrollments and total patient visits, 1984-1992

 

179

8.1

 

Overall failure rate on Northeast Regional Examination Boards by school

 

243

9.1

 

Trends in supply of dentists, 1990-2020

 

258-259

9.2

 

Enrollment trends in allied dental programs

 

264-265

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Six dental schools have closed in the last decade and others are in jeopardy. Facing this uncertainty about the status of dental education and the continued tension between educators and practitioners, leaders in the profession have recognized the need for purpose and direction.

This comprehensive volume--the first to cover the education, research, and patient care missions of dental schools--offers specific recommendations on oral health assessment, access to dental care, dental school curricula, financing for education, research priorities, examinations and licensing, workforce planning, and other key areas.

Well organized and accessible, the book

  • Recaps the evolution of dental practice and education.
  • Reviews key indicators of oral health status, outlines oral health goals, and discusses implications for education.
  • Addresses major curriculum concerns.
  • Examines health services that dental schools provide to patients and communities.
  • Looks at faculty and student involvement in research.
  • Explores the relationship of dental education to the university, the dental profession, and society at large.

Accreditation, the dental workforce, and other critical policy issues are highlighted as well.

Of greatest interest to deans, faculty, administrators, and students at dental schools, as well as to academic health centers and universities, this book also will be informative for health policymakers, dental professionals, and dental researchers.

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