Message from the Herman Robert Fox Dean

Charles N. Bertolami, DDS, DMedSc Herman Robert Fox Dean

This issue of Global Health Nexus takes a look at the juncture we have reached in the dental profession's ongoing debate regarding access to dental care, and, in particular, whether the rapidly accelerating initiative—known as the dental therapist or midlevel provider movement—will actually expand access to care.

Not long ago, I was invited to give a talk celebrating the 200th anniversary of the Massachusetts General Hospital, and I used the midlevel provider movement in dentistry to explore the broader societal trends affecting the profession—including economics, demographics, public relations, and public policy. By tracking the trends from 1947 to the present and then overlaying them, some of the findings that emerged were rather remarkable and explained a lot, including the traction being gained by the dental therapist movement.

These findings spurred me to write the article, "What Just Happened?," which immediately follows this message. In that article, I offer both an overview of the reasons underlying state and national interest in implementing training programs for midlevel providers and a discussion of my personal concerns and skepticism about the ultimate effectiveness of this approach in expanding access to care for the people who need it most.

Mine is one of several perspectives on the debate included in this issue of Global Health Nexus, which also offers opinions from several leading advocates for, and opponents of, the dental therapist movement. They are Dr. Raymond F. Gist, president of the American Dental Association (ADA); Dr. Carter Brown, a private practice general dentist who is also a South Carolina state dental society leader; Ann Battrell, RDH, MSDH, executive director of the American Dental Hygienists' Association; and Dr. David A. Nash, William R. Willard Professor of Dental Education and professor of pediatric dentistry at the University of Kentucky College of Dentistry. Rounding out the discussion are comments by NYUCD's Dr. Ananda Dasanayake, who was commissioned by the California Dental Association to conduct a systematic review entitled "Are Dental Procedures Performed by Auxiliaries Safe and of Comparable Quality?"; and by NYUCD's national and international outreach leadership team, on "The Role of Dental Schools in Expanding Access to Oral Health Care."

The University as a Conversation

Someone once described a university as an ongoing conversation—one with hundreds of people at any given time that goes on for years, and decades, even for centuries. People join the conversation and people depart from it, but the conversation continues. At first glance, a conversation seems like a pretty flimsy foundation on which to build a major institution-but nothing could be further from the truth. The intellectual engagement fostered by dialogue and debate as well as the ideas it inspires is far stronger than bricks and mortar. The power inherent in this definition of a university is evident in the antiquity of some universities—among the oldest institutions in the world. Thirty-nine continuously operating universities were founded before 1500 and even here in the United States there are universities with buildings older than the country they are located in. NYU—and its College of Dentistry—identify strongly with that tradition. We are committed to the role of a research university as a forum for discussion and inclusion of various viewpoints; or, to put it another way, to the role of a research university as a counterforce to dogmatism. Indeed, as NYU President John Sexton has written: "The embrace of the contest of ideas and tolerance of criticism does not mean a surrender of conviction. Dialogue within the university is characterized by a commitment to engage and even invite, through reasoned discourse, the most powerful challenges to one's point of view. This requires attentiveness and mutual respect, accepting what is well founded in the criticisms offered by others, and defending one's own position, where appropriate, against them..."

It is within this context of listening to the views of others that I want to assert that the dentist is the gold standard in delivering oral health care, for it is the dentist who brings to patient care a breadth of education and knowledge that is designed to provide higher-level treatment outcomes than those who have been trained purely as technicians. However, this belief does not preclude careful attention to the points of view of others who are striving with the best intentions to fix a system in which too many people are not receiving the dental care they need.

Other articles in this issue that I believe will also engage your interest concern innovative research, much of it collaborative, that is being conducted at NYUCD in the areas of bone biology, oral cancer pain, evolution theory, gene therapy and engineering, and the links between periodontal disease and diabetes. Regarding collaboration, I especially want to turn your attention to the opening story in News from the Colleges entitled "Groundbreaking Surgery Merges Passion, Computer Technology, and Teamwork," which features a pioneering procedure using virtual surgery-performed by NYUCD alumnus, oral and maxillofacial and head and neck surgeon Dr. David Hirsch, in collaboration with NYU physician Dr. Jamie Levine and Dr. Larry Brecht, a maxillofacial prosthodontist, and also an NYUCD alumnus-to save the life of a young woman with a large tumor in her left jaw.

You will also meet other outstanding faculty, as well as students and staff, who are contributing on many levels to NYUCD's increasingly diverse and robust academic environment, as well as learn about the exciting ongoing philanthropic support and international activities that are helping us to aspire to ever-higher levels of excellence.

Also in this issue, you will read about one of the great milestones of the academic year—the annual celebratory rite of passage of graduation day. It is a day that reminds us all of our reason for being and brings us back to the theme of this issue of Global Health Nexus: Devising ways to help improve the health of our society.