JACD 71-4 - American College of Dentists

hour after he got the gift, I received an
e-mail that is framed in my room. It’s a
grazie. Now he wasn’t leaving anything
to chance and leaders never do.
Art Dugoni is the inventor of the
loyalty cycle. How does it work? Dr.
Dugoni is loyal to the dental school. When
you spend your whole life somewhere,
that is how you define loyalty. And that
doesn’t go unnoticed. The faculty sees
that the leader commits to the school, so
they commit to the school. Surprise, the
students are loyal to the dental school
like no other students are, and those of
us who have been in education know
that it is very difficult to get loyal alumni.
I went to a Pacific event once when
students were coming back after two
years. You talked today about the Italian
dinner—I thought it was an Italian
wedding. The students were coming up
and putting envelopes in his pocket.
Some Unresolved Issues Facing
Dentistry
“Back to the Future” is the third movie.
After all, what does a leader do? A leader
looks at things that everyone looks at,
but he sees something different and
creates an opportunity.
Amazing as he is, Art has not solved
all of the problems facing dentistry or
dental education. As I begin to call your
attention to some of the more pressing
of these problems, I wonder where the
next generation of Art Dugoni’s is.
Caries Is Back
It may not sound very exciting or very
much like the future, but we had better
begin to pay serious attention to dental
caries. A year and a half ago, I saw a
picture in ADA News of migrant workers
being helped by Dr. Guillermo Vicuña in
Stockton, California. I enlarged the picture
to the best of my ability, and saw rampant
Journal of the American College of Dentists
caries. Yesterday, I returned to Stockton.
I went through that migrant camp and
looked at that caries. It’s there.
I am learning of the same problem
in China, Puerto Rico, New Delhi, India,
Hawaii, Eastern Europe, and Africa.
Remember when we were looking at
Scandinavia as a role model in dentistry?
I tell you I was there two weeks ago and
they have caries there, too.
In their 1993 textbook, Larry Tyback
and Phil Bowen report, “The caries
reductions may well have ceased. New
clinical data indicates a 27% DMFT
increased in a 10% caries-free decrease.”
The second International Conference on
Declining Caries noted wide discrepancies
between different regions of the country
and a noticeable worsening in the
caries experience of children in lower
socioeconomic groups. The World
Health Report said that in industrialized
countries, over 50% of children have
dental cavities, of which 20% are in the
high risk group having more than five
infected teeth. How about the Surgeon
General’s Report? It notes there are
striking disparities in dental disease by
income. Poor children suffer twice as
many caries as their more affluent peers,
and their disease is more likely to be
untreated. The ADA, in their Future of
Dentistry Report, draws our attention in
the same direction. “Poor people continue
to experience more caries than non-poor
people and are less likely to receive
treatment. By age seventeen, only 16%
of children are caries free and have
permanent dental issues.”
I have come to the conclusion that
dental caries has returned. The leadership
message is right in front of us and
the real leaders find it and then they
create opportunities. What are the other
underlying factors causing this?
Demographics certainly play a role. The
population of America increased threefold
over the last thirty to forty years.
National Leadership Symposium
It may not sound very
exciting or very much like
the future, but we had
better begin to pay serious
attention to dental caries.
And much of this increase is related to
immigration. In the changing culture,
life, and community, new dental disease
patterns are emerging in new contexts.
I believe the current global oral
health database, and the satisfaction we
justifiably derived from it at one time, is
rapidly becoming obsolete. So I make
that first leadership proposal: For the ADA
to have a leadership conference, a global
oral health data summons. Bring in the
World Health Organization, NIDCR, the
public health people, the researchers, and
FDI. Let’s meet in Chicago under the ADA
Foundation banner. Let’s set the guidelines
for how the world should collect
this data. They are not going to do it by
themselves. This is an opportunity for
the Foundation and ADA to lead.
Dental Insurance
Second leadership challenge: the emergence
of a new middle class that for the
first time in world history enjoys less of
the benefits of life than their parents did.
This new middle class is unable to afford
health insurance. The New York Times
reports that in 2004: “Eighty-two million
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