AGD Impact
Exploring Nonclinical Career Paths
U.S. Air Force International Health Specialist Program Things I Wish I Knew Before Starting Dental School
Exploring Nonclinical Career Paths
By Carrie Pallardy
After years of dental school, new graduates are thrust into the work of practice. What are some of the nonclinical career paths in dentistry, and how can dentists who want to leave the world of chairside care explore their options?
‘Go-To Global Health Resource’: Exploring the U.S.
Air Force International Health
Specialist Program
By Maj. Michael D. Santora, USAF, DMD, MPH, and Lt. Col. Benjamin J. Pass, DDS, MPH, MA
The U.S. Air Force International Health Specialist Program plays a crucial role in extending the operational reach of the Joint Forces. These highly trained health professionals possess diverse international skills and knowledge in both military and civilian health disciplines, including dentistry. Their vision is to be the Department of Defense’s go-to global health resource.
Lt. Col. Grabowski Reflects on His IRT Experience in Lahaina, Maui
Soleil Levant
French painter Oscar-Claude Monet was the founder of impressionism painting. The term for the movement comes from his painting, “Impression, soleil levant” (“Impression, Sunrise”). His philosophy was to express one’s perception of nature. His works are exhibited in prominent museums and considered the first in a new direction in painting. Impressionists bucked the rules of academic painting at the time, using visible brush strokes to create effect instead of smooth color transitions. Monet was an innovator and excelled in something never seen before in the art world. Right now, dentistry is at a stage where innovation is exponential, and we are managing and creating intraoral and facial art in a way never before imagined.
change the direction of an entire profession, but they do not accomplish it in a vacuum. This is done with a conscious effort to take the knowledge of those before us and then incorporate, evolve and make success personal. Monet took the established framework but visualized something dramatically different. Today in dentistry, innovations are all around us, almost to the point of overwhelming our senses and ability to incorporate. Shadematching, marketing strategies, and new materials and technologies are changing the way we serve. We are at the beginning of a huge influx of resources that will benefit patients, practitioners and team members.
Editor
Timothy F. Kosinski, DDS, MAGD
Associate Editor
Bruce L. Cassis, DDS, MAGD Director, Communications
Kristin S. Gover, CAE
Executive Editor
Tiffany Nicole Slade, MFA
Managing Editor Leland Humbertson, MA
Associate Editor Caitlin Davis
Manager, Production/Design
Tim Henney
Graphic Designers
Robert Ajami Eric Grawe
As I walked through an exhibit of Monet’s works recently, I wondered why an individual would take such a drastic turn in expression of his talents. His early works were very lifelike, but the impressionistic form was so dramatically different. These paintings create more of a feeling of images, allowing the viewer to interpret nature with emotion.
The art world in Paris in the late 1800s was made up of professional societies that honored members and elevated them to high levels, but Monet did not fit the established mold and initiated his own path, and many subsequently followed. While impressionism was criticized at its outset, today it is celebrated just as much as any other form of art. There is no single way to appreciate art; it is in the eye of the beholder and can be interpreted in many ways.
Just as there are multiple ways to paint a sunrise, there are many paths in dentistry to help our patients. There may never be just one way to accomplish form and function, but the principles of excellence are always the same. The end result of patient satisfaction is most critical to successful treatment. The best approach is to gather as much information as possible and then morph that knowledge into processes that make sense and are easily integrated into individual practice methods. This is true in any environment. Dentistry is as much art as it is clinical talent.
Monet became a master of his profession, just as many of us choose to elevate therapy modalities and provide some of the most innovative treatments available. Innovators can dramatically
Monet’s life was not all peace, prosperity and water lilies. He was a refugee who needed to leave Paris during a war; he nearly drowned himself during a depressive state, which he immediately regretted; and he lost his eyesight due to cataracts. He was mocked early in his career because critics claimed his work looked unfinished or simple. However, Monet was successful during his lifetime, even though many prominent artists are not truly appreciated until after death.
The lesson here is that life is not perfect. There will be ups and downs, good times and bad, financially rewarding stretches and periods of stress and inadequacies. Being able to overcome challenges can help composure and add to professional and personal fulfillment. Sometimes we need a support mechanism. Our talents as dentists are second to none. I don’t think there is another profession that demands knowledge and experience to fulfill visual contentment as much as dentistry. We must create our own special requirements to fulfill ambitions and dreams. That creates true success — now and in the future. Certainly, dentistry is in the age of soleil levant — a rising sun, a rising profession.
Timothy F. Kosinski, DDS, MAGD Editor
Academy of General Dentistry 560 W. Lake St., Sixth Floor Chicago, IL 60661-6600
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Dental Practice Advocacy
AGD Representative Attends Dental Quality Alliance Meeting
By Ralph A. Cooley, DDS, FAGD
Earlier this year, it was my honor to represent AGD at the spring meeting of the Dental Quality Alliance (DQA). This agency, founded in 2010, continues to lead the effort to develop quality measures for dentistry, and several new achievements were unveiled at its June 14 meeting in Chicago.
Among the meeting’s most notable accomplishments was approving a new measure, “Early Childhood Oral Evaluation by a Dental Provider Following a Medical Preventive Service Visit.” This measure was developed with the intent to support system- or plan-level efforts to connect families of young children who are accessing the medical care system with dental care. The measure focuses specifically on dental visits that include either a comprehensive oral evaluation or periodic oral evaluation versus visits involving episodic or problem-based care (i.e., only addressing acute dental needs). Its goal is to boost families’ awareness of the importance and value of early comprehensive dental visits. The measure can also be used by professional dental associations, such as AGD, in their efforts to continue advocating for this care to the public and other groups, including lawmakers, federal agencies and benefit companies.
Another key accomplishment from the meeting was the comprehensive review and updating of 21 current measures that comprise the Pediatric User Guide and the Adult User Guide. This effort is of critical importance since many of the quality measures in the guides are used in various state Medicaid programs. The review and updating of all existing measures is an annual activity for the DQA. AGD and other DQA member organizations review all existing measures each year. Within AGD, that review is managed through the Dental Practice Council (DPC). This year, after completing its review, the DPC shared its recommendations with AGD President Merlin P. Ohmer, DDS, MAGD, who considered its input and conveyed AGD’s official response to the DQA. The Pediatric and Adult user guides are posted on the DQA website and will be updated to reflect changes for the 2025 versions.
Recently, a DQA workgroup has been assessing the development of validated practice- and clinician-level quality measures.
Inside General Dentistry
Look for the following article in the November/ December 2024 issue of AGD’s peer-reviewed journal, General Dentistry.
Clear aligner therapy and symptoms of temporomandibular disorders: a case report
The etiology of temporomandibular disorders (TMDs) is remarkably diverse. This case report highlights the use of clear aligners as a probable cofactor of TMD in an adult patient. A 56-year-old woman who presented with a chief concern of crowding was missing teeth in both arches and had generalized tooth wear, an indistinct history of temporomandibular joint musculoskeletal pain, and a self-reported history of clenching. Based on the patient’s preferences, clear aligner therapy (CAT) was initiated
While some third-party payers already use internal “measures” to evaluate dentists’ performance, the DQA is investigating to see if any of these tools meet the criteria of a true quality measure. By definition, a true dental quality measure must meet standards of feasibility, reliability, validity and usability. The workgroup concluded that many of the proposed practice- and clinician-level measures will not be pursued as recognized DQA measures for use in accountability programs (e.g., provider rating systems or value-based payment programs) at this time when derived from claims data sources.
Also at the meeting, the DQA approved and released for public comment two interim practice- and clinician-level claims-based measures on “Care Continuity for Children and Periodontal Maintenance for Adults with Periodontitis.” The DPC was still evaluating both reports at the time this article was submitted. Its recommendations will be shared with Ohmer, and AGD’s official comments will be submitted and incorporated into the feedback from other stakeholders. Both interim reports will be discussed at the DQA’s next meeting, Nov. 22, 2024, in Chicago.
AGD has been at the table to represent general dentists in regard to quality measures since the DQA’s inception in 2010. AGD is among the 11 members of the DQA’s Executive Committee and its 26 member organizations. More information about the DQA — including education, updates, the State Oral Healthcare Quality Dashboard, and detailed explanations about quality measurement in dentistry and how it can affect you in a positive way — can be found on the DQA website at ada.org/ resources/research/dental-quality-alliance.
Ralph A. Cooley, DDS, FAGD, is the assistant dean of admissions and student services at UTHealth Houston School of Dentistry, following 34 years of private practice. He serves on AGD’s Legislative & Governmental Affairs Council and is AGD’s liaison to the Dental Quality Alliance.
with a limited treatment goal of providing improved esthetics by reducing the overjet, expanding the arches, and aligning the anterior teeth. A few weeks into CAT, the patient developed acute masticatory facial pain. Therefore, the course of CAT was adjusted in favor of an individualized protocol to alleviate her occlusal symptoms until orthodontic treatment was completed. Dental providers must consider the potential contributory role of CAT in TMDs in patients who adapt poorly to occlusal changes and offer a patient-centered approach to manage the problem.
Read this article and more at agd.org/generaldentistry.
AGD Fact Sheets
Talking to Patients About Diabetes
AGD fact sheets provide your patients with all of the information they need to maintain their oral health. Fact sheets on more than 25 oral health topics are available for downloading online and can be customized to include your name and practice information. Download the fact sheet “Oral Health and Diabetes” at agd.org/factsheets
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Publication Title: AGD IMPACT Publication Number: 0194-729X Filing Date: 9-2424 Issue Frequency: Monthly Number of Issues Published Annually: 12 Annual
Subscription Price: $70.00 Mailing Address of Known Office of Publication: 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600, Cook County Contact Person: Leland Humbertson Telephone: 312.440.4311 Mailing Address of Headquarters or General Business Office of Publisher: Same as above Names and Mailing Addresses of Publisher, Editor and Managing Editor: Same as above Publisher: Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600 Editor: Timothy F. Kosinski, DDS, MAGD, address same as above Managing Editor: Leland Humbertson, address same as above Owner: Academy of General Dentistry, 560 W. Lake St., Sixth Floor, Chicago, IL 60661-6600 Known Bondholders, Mortgagees, and Other Security Holders: None Tax Status: Has not changed during preceding 12 months Issue Date for Circulation Data Below: October 2024
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Membership
Renew Your Membership for 2025
It’s time to renew your membership for the coming year! AGD has recently added some great new member benefits, including:
• New content in the members-only AGD Free CE Library.
• Free attendance at the Virtual Advocacy Conference, Dec. 20–21, 2024, worth 7 CE credits.
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How Engaging with AGD Can Benefit You and Your Peers
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To encourage new memberships, there’s a limited-time offer until Dec. 31, 2024, allowing new members to join AGD for 2025 and access the remainder of 2024 for free. This opportunity helps members expand their professional community while saving money.
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Publication of Statement of Ownership:
We Didn’t Learn That in Dental School
By Maggie Augustyn, DDS
The list of things we thought we would achieve upon dental school graduation is long and includes reduced stress, increased life satisfaction, mentorship, helping people, aboveaverage income and mastering overall skills. The list goes on for all the things we thought would be true, but weren’t. There were also items on that list that we could not conceive — things that we didn’t know when we considered taking the Dental Admission Test, things we didn’t discuss when we were shadowing, and things that might have changed the trajectory of our professional careers had we known them. Among them are chasing the incessant perfectionism that will never come, professional isolation, unbelievably high debt, lack of communication skills, emotional turmoil, and — somewhere at the top — physical pain and injury.
Dealing with Patients’ Hatred of the Dentist
As much as we might joke about it, as students, as new graduates and even as seasoned practitioners, we underestimate the power of hearing, “It’s not personal, but I hate the dentist.” And when our patients say, “I hate the dentist,” those messages do penetrate and reach our souls, because those who utter them are staring right at us. And you’re supposed to gently giggle and ward off the comment as banter, sarcasm or ill-positioned humor. But when you spend a career hearing the very people you’ve dedicated your life to helping say that they hate you, well, that statement comes to define you in more ways than we allow ourselves to admit. Do you protect yourself in some sort of emotional armor when you hear “I hate
you”? Studies tell us that what people say to us, going all the way back to how our teachers view us, shapes how we view ourselves.1-3 It doesn’t matter how minor on their part, or whether it’s made in jest or in malice; it shapes our perception, and it builds our reality. When we, as healers and providers, face the rough uncharted waters of clinical complications and fail to live up to the images displayed in textbooks, messages like that can bring us down even further. In fact, they might make us reconsider clinical dentistry altogether.
Two decades into my career, I no longer allow patients to feel comfortable with that kind of oversharing. I ask, kindly and gently, that they reframe the narrative. Depending on the patient’s disposition, I explain that dentistry as a profession is unforgiving, and words like that make it harder. I allow them to see me as human, someone who is just as capable of having my feelings hurt as they are. I ask them to instead say: “Coming to the dentist makes me nervous. Can you help with that?”
A Fear Realized
As dentists, we can’t outsource or find a virtual replacement for what we do. And so, one of the greatest fears we have is losing function in our dominant hand, especially when we might be the breadwinner. I, personally, have been under the care of a physical therapist since 2007, having graduated from dental school years prior. I have spent many months — yes, months — benched because my hand couldn’t hold a handpiece. It physically could not
grip the tool I trained to perform with. My initial injury occurred after a difficult day filled with root canal therapy, doing more hand-filing than my arm muscles could handle, sandwiched with piano playing. That injury, which occurred in 2007, put me in an operating room in 2012. For several months prior and many months after, I was unable to practice my craft or earn a living. I was in pain almost every day for 18 months despite having risked surgery on my “money-making” hand.
Since then, I have had to go more times to physical therapy than I’d like to admit to calm the surgically repaired arm. In addition to physical therapy, this includes oral and injectable steroids, specialized massages, dry needling, and acupuncture. But that isn’t all. I also get 200 units of Botox® every three months because of tension headaches. I have a bulging spinal disk that needs outpatient steroid injections at least once a year. My iliotibial band and hip act up from standing too long. When I applied for a spot in dental school and finally entered the doors of the University of Illinois Chicago College of Dentistry on that hot August day in 2000, I was in complete ignorance of the fact that realizing my dream would hinge on such a physical sacrifice. I didn’t know that in the prime of my career, I’d need to reduce my chair time in an attempt to live pain free.
Thank You for Leaving
I happen to be one of the lucky ones. Though I needed to cut back on my clinical hours, I didn’t need to walk away from clinical practice altogether. Holding a handpiece is my happy place. It’s an opportunity for me to not just help others, but also to live in my purpose. I know many practitioners who have had to stop their clinical practice because of injury. I know of many practitioners who have had to walk away from practice ownership because
of its emotionally unforgiving nature. In many ways, we are lucky to have had them walk away. Many have come out on the other side as recovering clinicians, teaching us how to make sense of our practice, how to not surrender to the pitfalls they themselves had fallen into. Many of them have become life coaches and consultants. Some have begun companies or invented products and services that allow our lives in practice to be less challenging. I want to take a minute to applaud them, because walking away from a career and all of the education and training could not have been easy. Walking away from the income generated must have been a tremendous risk. And yet, had they not done it, had they not broken away (even if only part time), we would not have author and speaker Katrina Sanders, RDH, BSDH, MEd, RF; entrepreneur speaker Eric J. Roman, DDS; business coach Anissa Holmes, DMD; or Productive Dentist Academy with Bruce B. Baird, DDS, and Victoria Peterson, RDH, PhD. ♦
Maggie Augustyn, DDS, is a practicing general dentist, owner of Happy Tooth, faculty member at Productive Dentist Academy, author and inspirational speaker. To comment on this article, email impact@agd.org
References
1. Brookover, Wilbur B., et al. “Pygmalion in the Classroom: Teacher Expectation and Pupils’ Intellectual Development.” American Sociological Review, vol. 34, no. 2, April 1969, p. 283.
2. Jussim, Lee, and Kent D. Harber. “Teacher Expectations and Self-Fulfilling Prophecies: Knowns and Unknowns, Resolved and Unresolved Controversies.” Personality and Social Psychology Review, vol. 9, no. 2, 2005, pp. 131–155.
3. Turner, J.C., and R.S. Onorato. “Social Identity, Personality, and the Self-Concept: A Self-Categorization Perspective.” The Psychology of the Social Self, edited by T.R. Tyler, R.M. Kramer and O.P. John. Lawrence Erlbaum, 1999, pp. 11–46.
Things I Wish I Knew Before Starting Dental School: Advice for Incoming Students
By Brooklyn Janes
As a fourth-year dental student, I’ve learned some valuable lessons that I wish I had known from the beginning. Here are some insights I think every new dental student should have.
Humility
Humility is crucial for every dental student. Many students enter dental school with prior experience as dental assistants, dental hygienists, lab technicians or other roles within the dental field — myself included (I practiced as a dental hygienist for several years before dental school). With this experience, it’s easy to become accustomed to doing things a certain way and believe there is only
one correct approach. However, if we allow pride to overshadow our learning, thinking we’ve already mastered something, we do ourselves a great disservice.
When students humble themselves and accept that they don’t know everything, they open the door to new knowledge and fresh perspectives that can significantly enhance their skills. It’s beneficial to explain your reasoning to professors or discuss your approach with attending faculty, as this creates valuable learning opportunities. However, it’s important to recognize that insisting on a particular way of doing things simply because a trusted family member or mentor does it that way can come across as disrespectful.
In the early stages of learning, we need to absorb as much as we can. It’s also important to remember that we cannot legally practice without our mentors’ supervision. Recognizing that it’s a privilege to practice dentistry and that we can only do so under the guidance of our mentors can help us appreciate their approaches. Listening to and respecting their advice is essential for our growth as future dentists.
Setting aside pride can be difficult. Despite already being a licensed dental hygienist, I’ve had to go through all the periodontal courses in dental school and am now preparing for the Commission on Dental Competency Assessments licensure exam in periodontics. There’s no “free pass” in dental school just because I hold a license — I still have to go through everything with the rest of my classmates. Sometimes, I feel humiliated when another hygienist checks my work. I have the same degree as some of my faculty members, so why do they need to sign off on my work? Shouldn’t my license speak for itself? I’ve definitely felt these frustrations.
However, when I take a step back, set aside my pride and view things from a dental student’s perspective, I realize that these periodontal experiences — both clinically and didactically — have allowed me to fine-tune my hand skills and techniques. Relearning the periodontal diagnoses taught by my hygienist professors, including the different stages and grades, has sharpened my ability to quickly assess, diagnose and treatment-plan. I can confidently say that these experiences played a significant role in my success on the written national board exam, and, for that, I’m incredibly grateful for all that my hygienist professors have taught me.
Embracing Diversity and Acceptance
Traditionally, students pursue their undergraduate degrees close to home, often opting for in-state schools where tuition is more affordable. This choice allows them to remain in familiar environments, creating a comfortable atmosphere during their studies. However, dental school often takes students beyond their home state — or even country — and introduces them to a more diverse environment. In this new setting, students are likely to find themselves surrounded by classmates from various backgrounds, cultures and perspectives.
I was fortunate to be accepted into dental school in Utah, where I’m originally from. Being close to family during this time has been a blessing, and I’m familiar with the culture and way of life. My belief in God and my lifestyle choices are generally well accepted in this environment. However, there have been moments in dental school where I’ve felt marginalized and outcast because of my religion or my decision not to drink alcohol, for example. Some encounters with my peers have brought me to tears. I never anticipated having to explain myself in my home state, but stepping into dental school made me realize that I was no longer the norm. For the first time in my life, I felt like the “weird kid” at school. My advice to those attending dental school is to truly embrace diversity. Diversity can be a beautiful thing when fully accepted, but it can also be hurtful if others don’t feel welcomed or accepted. I encourage you to learn about your classmates’ backgrounds and cultures. Be respectful of their lifestyle choices, how they dress, their religion, their language, etc. By doing so, we create an environment where everyone feels valued and supported. Who knows — you might just gain a few lifelong colleagues along the way.
Some of my very best friends from dental school come from completely different backgrounds, religions and cultures than mine. Honestly, getting to know people from all over the country has been the highlight of my dental school experience. I had the unique opportunity to be a bridesmaid at my best friend’s wedding — the first Indian wedding I’ve ever attended. I was blown away by the richness of the culture, the beautiful ceremonies, the family gatherings, the intricate beadwork and details on the dresses, and, of course, the incredible food! Because of the richness that diversity brings to a dental school class, I’ve gained friendships that mean the absolute world to me.
Learning from Failure
One of my mentors in the oral surgery clinic always says that the worst thing that could happen to you during dental school is to do everything perfectly. This resonates because there’s so much value in learning from mistakes. At my school, faculty emphasize that the same student who preps a tooth for a full-coverage crown should also seat the crown once it comes back from the lab. If another classmate seats the crown on your behalf and it doesn’t fit perfectly, you miss out on understanding how to improve your crown preps, communicate better with the lab or adjust the crown chairside to ensure a proper fit.
You don’t realize what you don’t know until you face a challenge. These challenges are what drive us to improve and become better clinicians. Dental school is undeniably difficult. Learning to drill out a cavity on the distal of a maxillary second molar — often in low light, with water spraying on your mirror and working backward off a mirror image — is extremely challenging. Seasoned dentists might laugh at this because they’ve done it so many times it’s second nature, but, for us students, it’s a tough skill to master.
Mistakes are inevitable, even on your best day. There will be times when you’re not proud of the work you’ve done. But, with practice, you’ll see growth in yourself. Some strategies that have helped me succeed include arriving at the clinic early, reviewing my patient’s chart in advance, looking ahead at my schedule, and mentally rehearsing each step of the procedure or the specific details of the appointment. Even when you’re the most prepared, new challenges will pop up. There’s a common stereotype that doctors should perform perfectly because of our title, but the truth is that we’re human and make mistakes. In my experience, if patients trust you because they know you care about them, they will be understanding when things don’t go as planned. If patients know you’re doing your absolute best and are prepared for them, it is amazing how gracious they can be.
In the end, it’s through facing and overcoming these challenges that we truly grow as dental professionals. Perfection isn’t the goal — learning and improvement are. Embracing failure as a valuable part of the learning process allows us to refine our skills, build resilience, and, ultimately, become more competent and confident practitioners. By preparing thoroughly, staying adaptable and learning from every experience, we set ourselves up for long-term success in our dental careers. ♦
Brooklyn Janes is a fourth-year dental student and AGD chapter president at Roseman University College of Dental Medicine. To comment on this article, email impact@agd.org
Practice Management
The Real Solution to Managing Insurance Reimbursements
By Roger P. Levin, DDS
Over the last 39 years, as both a dentist and CEO of a management consulting firm, I have observed patterns and trends in dental insurance. In an ideal world, dental insurance would at minimum offer increases in reimbursements to match overall inflation rates on an annual basis. However, at best, insurance companies are inconsistent at raising reimbursements and, in some cases, are actually lowering them. This has an immediate impact on dental practices since the majority today participate in at least one or more dental insurance plans.
The Effects of Stagnant Reimbursements
For the purposes of this column, let’s assume that most insurance companies do not raise reimbursements on an annual basis (or very frequently at all). Dentists fail to understand that, from a financial standpoint, a lack of insurance reimbursement increases moves the practice backward. For example, if inflation stands at 4%, but insurance reimbursements remain flat (or decline), the practice will effectively recognize a 4% (or greater) loss on the insurance revenue it receives. If inflation increases, the picture gets even worse. If there is an increase in overhead, as there was in 2022 and 2023, then that also reduces profit by the amount of the overhead increase. This erosion of practice profitability is compounded when insurance companies reduce the reimbursement rates for procedures.
Although this is not good news, and dentists are well aware of this scenario, there are solutions that are highly effective. Many practices are performing at excellent levels even while participating in dental insurance plans.
What Is the Answer?
As a dentist who practiced full time for 10 years, I understand that no dentist ever wants to hear they should increase patient volume to keep up with inflation and overhead and increase practice profitability. For most busy practices, the idea of increasing volume comes across as having to work harder and be more frenetic, which will cause increased stress and fatigue. But there is a better way to increase volume, production and profitability while actually decreasing stress.
First, understand that the solution to a lack of increase in dental insurance reimbursements is to in fact increase patient volume. You can work to reduce overhead, but that is a shortterm gain, and you can typically only reduce it by about 3%–4%. Once those reductions are made, you cannot reduce any further. But you can increase patient volume — which will lead to higher production — in a way that makes the practice more enjoyable, easier and streamlined.
Here are some strategies:
• Build the right schedule. I repeatedly see practices with schedules that have been designed to keep them exactly where they are without realizing it. I recommend mathematically analyzing your schedule in areas such as production, production per new patient and production per hour. You should then apply procedural time studies to determine the real amount of time that is necessary for each procedure. The goal is to establish key step-by-step systems that maximize efficiency. Many practices have a scheduling system that limits the practice’s ability to have enough volume to reach improved levels of practice performance and production.
• Procedural time studies. It is critical to regularly perform procedural time studies. My company recommends a minimum cycle of every three years due to advances in supplies, materials and technologies. A procedural time study is a process in which you time your most common procedures at least 10 times to develop a composite average. We find that, in most cases, practices recognize that they do not need as much time as they are currently allotting in the schedule. A savings of 10 minutes per hour per day in a four-day practice will increase the available doctor production time by the equivalent of two months per year or six years in a 36-year career. Small time savings add up immensely on an annual basis — and certainly throughout a career.
• Delegation. Once new systems are implemented, they must be taught to the dental team. One key to increasing volume is delegation. A good litmus test is to examine whether a dentist is performing procedures that are legally allowable by other staff members. Another is to determine if a dentist is consistently receiving numerous questions from staff members during the day. Both of these scenarios indicate that delegation is not at the right level and that the team is capable of handling more tasks and making more decisions, thus allowing doctors to focus more on patient care. This reduces stress and fatigue while increasing patient volume.
• Recognize the value of new patients. We find that the average production per new patient is approximately two to three times higher than that of a current active patient in the first 12 months. Although all patients should be treated with extreme respect and customer service, the new schedule you develop should block time for the right number of new patients per month to ensure that higher-level procedures and more comprehensive dentistry can be performed. ♦
Roger P. Levin, DDS, is the founder and CEO of Levin Group, a dental management consulting firm. To receive his Practice Production Tip of the Day, visit levingroup.com. To comment on this article, email impact@agd.org
Leadership in Nonclinical Pathways in Dentistry: Expanding Horizons Beyond the Chair
By Amrita Feiock, DDS, FPFA, FICD, FACD
Dentistry is often perceived as a profession centered around clinical expertise, with much of the focus on patient care and procedural skills. However, effective leadership in nonclinical pathways is equally crucial for the success and sustainability of the profession. As you navigate your career, you may find yourself drawn to positions that extend beyond direct patient care. These pathways encompass various leadership roles, including practice management, strategic planning, education, research and policy development.
Academia: One of the first career trajectories that comes to mind is academia, as there is always a need for faculty in both dental schools and residency programs. A director of dental education focuses on advancing dental education and training. This role involves developing curricula, overseeing educational programs, and ensuring that students and professionals receive high-quality education. Integral parts of this role include designing and updating educational programs to ensure they meet current standards and address emerging trends in dentistry; recruiting, training and supporting educators to ensure they deliver effective instruction; and ensuring that educational programs comply with accreditation standards and professional guidelines. By thinking innovatively about new methodologies, providing guidance and support to students and other faculty, and collaborating with industry professionals and organizations, you can emerge as a true leader in your institution.
Research: Dental researchers conduct and oversee projects aimed at advancing knowledge and innovation in dentistry by designing studies, analyzing data and disseminating their findings. This involves a fair bit of critical thinking, as you must ensure that your findings are valid and reliable, and you must collaborate with other leaders and institutions.
Advocacy: Dental policy advocates work to influence policy and healthcare regulations. This role involves engaging with policymakers, developing policy recommendations, and advocating for changes that benefit the dental profession and public health. Important leadership skills like persuasive communication, strategic networking and evidence-based advocacy are utilized in order to make the greatest impact and benefit the highest number of doctors and patients.
Consulting: As the dental industry grows and changes and new developments and technologies are implemented to optimize patient care, industry consultants provide expertise and advice to dental practices, organizations and companies. This role involves assessing business operations, offering strategic recommendations and helping clients improve their performance. By evaluating practice operations, identifying areas for improve-
ment and providing actionable recommendations, consultants can develop strategic plans to help clients achieve their goals and address challenges.
To excel in nonclinical leadership roles, dentists may benefit from additional training in areas such as business management, finance or public policy. Pursuing advanced degrees, certifications or professional development courses can enhance leadership skills and knowledge. Effective leadership also always requires strong communication and interpersonal skills. Focus on improving your ability to convey ideas clearly, listen actively, and build collaborative relationships with colleagues, staff and stakeholders. Often, you will be involved in strategic planning and decision making. Develop an organized mindset so that you can focus on long-term goals, evaluate opportunities and risks, and make informed decisions that align with organizational objectives.
Mentorship from experienced leaders and networking with peers can provide valuable insights and support. Engaging with professional organizations, attending conferences and participating in industry events can help you expand your network and gain new perspectives. Leadership in nonclinical pathways within dentistry offers dentists opportunities to make significant impacts beyond the clinical setting. By excelling in roles such as education, research, policy advocacy and consulting, you can contribute to the growth and advancement of the profession while enhancing your own career. Embracing these roles with dedication, strategic thinking and a commitment to continuous learning will pave the way for success and help shape the future of the profession. ♦
Amrita Feiock, DDS, FPFA, FICD, FACD, is in private practice with her father, endodontist Rohit Z. Patel, DDS, PC, in Westchester County, New York. To comment on this article, email impact@agd.org
Lt. Col. Grabowski Reflects on His IRT Experience in Lahaina, Maui
I
nnovative readiness training (IRT) is a two-pronged Department of Defense military training opportunity that delivers training opportunities for various branches of the uniformed services to increase deployment readiness. For servicemembers who are healthcare providers in the military, these IRTs involve providing healthcare services to American communities as a way to ensure their skillsets are adaptable and field-ready.
In 2018, AGD member Lt. Col. Douglas N. Grabowski, DMD, participated in an IRT on Maui, Hawaii, in a community that was devastated five years later by the August 2023 wildfires. He shared his experience and how it impacted him.
AGD Impact : What was your assignment in Maui, and what kinds of activities and procedures did you and your unit perform?
Grabowski: The highlight of my military service came during the summer of 2018, when I was tasked with leading a site for the 2018 Tropic Care IRT in Maui, Hawaii. I was assigned as the site director for Lahaina, Maui. The IRT program provided a benefit to both the residents of Lahaina and the 40 military members who made up our team of medical professionals. For the residents, the benefit was clear — our patients received much-needed dental care and vision exams, including prescription glasses. Additionally, we were able to offer health screenings and, in some instances, acute care. On the flipside, our military team was able to practice “readiness,” which is crucial to our ability to provide worldwide medical response at a moment’s notice. The military utilizes these humanitarian training opportunities, or IRTs, to make sure that everything ranging from deploying logistical support to providing topnotch medical care is proficient.
What challenges did you face during this experience?
Most notably, we faced two natural disaster challenges that helped ensure our deployment skills were ready to go. On the eve of our final day of care, our planners informed us that a tropical depression, which would turn into Hurricane Lane, was heading right for us. We flexed to make sure we were able to get personnel and medical equipment on earlier flights. As we successfully mitigated Mother Nature’s first challenge,
we then faced a brush fire that encroached on our site. The fire eerily foreshadowed the devastating fire that engulfed and destroyed most of Lahaina on Aug. 8, 2023. The community is still recovering from the massive losses.
How did the local population benefit from your IRT mission?
When I first learned I was going to Lahaina as a part of a medical mission, I was ignorant of the need for low-cost or voluntary healthcare in Hawaii. I associated Lahaina with a very affluent and wealthy population — the type of place people visit for a once-ina-lifetime vacation. The truth is that many of the residents on the island who support tourist activities are independent contractors, like surf instructors or small family business employees. Many locals do not have the means to seek emergent healthcare or the money to afford preventive care. In our week of care, our site alone was able to see more than 1,000 patients, complete more than 15,000 procedures and log more than 500 hours in combined personnel training.
What impact did this assignment have on you personally and professionally?
I have always been proud to serve. For more than 16 years, I have had the privilege of providing dental care to the airmen who
Lt. Col. Grabowski treats a patient during the 2018 Tropic Care IRT.
voluntarily defend our country. This opportunity provided me with the opportunity to connect my day-to-day work with the impact our Armed Forces have around the world. I was able to see firsthand the community’s excitement when they knew we were there to help.
What are some key takeaways from your experience?
The big takeaway I had from this event was that our military is incredibly capable. Forty individuals were able to get together and convert a church into a clinic. Our site was able to serve as an emergency pharmacy, a sterilization center for medical
Layout of the church that was converted to a humanitarian clinic. The kitchen was turned into a sterilization center, and the main room was the optometry clinic and pharmacy.
instruments, an optometry clinic, a dental clinic and a wellness center. Our team was composed of nearly all the military branches: Air Force, Army, Navy and Coast Guard. We gelled instantly, and many of us still keep in touch six years later.
Any favorite moments?
Meeting the locals and treating them was incredibly rewarding, but my favorite memories are of what the community did for us. They welcomed us with open arms. They hosted a luau in our honor, taught several of our team members how to surf and showed us how to cook traditional Hawaiian cuisine. Sadly, many of my local friends from this trip lost everything in the fire of August 2023. The church that served as our clinic — the historic Waiola Church, which is pictured in one of the most famous images from the fire, taken by Matthew Thayer of The Maui News — was also destroyed. I hope to go back one day with my kids and show them the Lahaina community. It was an experience I’ll never forget, and I’ll always be thankful for the opportunity. ♦
A fire just blocks from the Lahaina humanitarian site in 2018. High winds altered the travel deployment plans. Sudden timeline shifts are vital when it comes to the readiness of military medicine.
Members of the IRT team learned to cook traditional Hawaiian cuisine.
The team that made up the Lahaina Site for the 2018 Tropic Care IRT.
Newspaper article on the 2018 Tropic Care IRT.
Exploring Nonclinical Career Paths
By Carrie Pallardy
After years of dental school, new graduates are thrust into the world of practice. They have a variety of paths they can take in that clinical world: working as an associate in a private practice, working at a dental school clinic, starting their own practice, or joining a dental support organization (DSO). But some dentists, for a variety of reasons, decide to look outside of the clinical sphere.
What are some of the nonclinical career paths in dentistry, and how can dentists who want to leave the world of chairside care explore their options?
Nonclinical Career Paths
A clinical career is the goal for many dentists. “I certainly think clinical dentistry is a much bigger space than nonclinical dentistry,” said Clayton O. Pesillo, DMD, an
American Association of Dental Consultants (AADC) board member. “I think most dentists who go to dental school and graduate go with the intent of practicing dentistry. They either want to work with a practice, join a practice or open a practice.”
But there are also a lot of different ways to build a nonclinical career. Academia is one avenue. Dentists can join the faculty of a dental school and dedicate their careers to teaching.
Whatever areas dentists are interested in — whether it be specific oral diseases, dental materials, technology or any other specific subject — they can channel that passion into research. Academic roles can give dentists the opportunity to build careers in research. Military dentistry also offers a way to build a career in teaching and research.1
Dental product and technology companies hire dentists to champion their research efforts. Laura Brenner, DDS, founder and CEO of Lolabees Career Coaching, has worked with clients who have gotten research positions at Colgate, for example.
Product companies also hire dentists to serve as liaisons to their customers — the dentists buying and using their products in clinical settings. “It’s not a sales position, but it is very social. You can educate the doctors so that they know about the product,” Brenner explained.
If dentists do have an aptitude for sales, there are several ways to put those skills to work. They can work in sales positions with product and technology companies, or they can serve as practice brokers, connecting buyers and sellers.
Many nonclinical positions are available in the dental benefits space. Dentists can review claims for insurance companies, for example. Since the COVID-19 pandemic, this work can often be done remotely.
“The company sends the claims electronically. Dentists review them electronically and keep track of and get paid for
their time. In some cases, companies will pay by the claim,” said Pesillo.
This flexibility means that some dentists opt to do this work in conjunction with their clinical practice. But dentists can also work full time in administrative and executive leadership roles at dental benefits companies.
DSOs offer another option for dentists seeking nonclinical positions. Andrew De La Rosa, DMD, is vice president of clinical support at Aspen Dental. He spent the first eight years of his career in the clinical space alongside his co-owner and wife, Lauren McDonough, DMD. They became practice owners under the Aspen Dental umbrella before transitioning to nonclinical roles as part of Aspen Dental’s clinical support team. McDonough is the vice president of practice owner development, working alongside De La Rosa and eight other clinical support leaders.
“Being able to teach a younger doctor — or even a doctor who has experience — how to become successful and thrive in the dental field is what we ultimately enjoy doing,” De La Rosa said. “I get to work with a lot of our
doctors in the field to be part of building the next generation of Aspen Dental practices.”
De La Rosa pointed out that DSOs can be a solid bridge to a nonclinical position for dentists who are thinking about retiring from clinical practice.
“After working with a DSO for years, many dentists have built and fostered meaningful relationships, resulting in a strong network within the organization,” said De La Rosa. “These connections and relationships naturally help curate nonclinical opportunities. As doctors are ready to retire from clinical dentistry, many choose to pursue these nonclinical roles, and the connections they’ve made are paramount to secure them.”
Dentistry appeals to many people who have an entrepreneurial spirit. Some dentists thrive on building, operating and expanding their businesses in clinical practice. That same entrepreneurial drive can be put to work in the nonclinical space.
Some dentists find the perfect blend of desire to build and to teach in consulting roles, which can take various forms with any company that touches the field of dentistry.
Why Choose Nonclinical
The decision to leave clinical practice — or to avoid entering it at all — is made for many different reasons. For some dentists, it may be a difficult choice. For others, it may be a natural way to continue their passion for dentistry.
Brenner spent a decade working in clinical dentistry, but she knew by her third year that the fit wasn’t right. She wanted to quit dentistry.
“I talked myself out of it because we invest a lot into this career and it becomes a part of your identity,” she said.
Instead of quitting then, she tried working in different practices. But she still did not find the right fit. After that decade in the clinical space, she gave herself permission to try something else. She scaled back her time practicing dentistry and worked as a weight loss coach on the side.
Ultimately, Brenner found her fit in dentistry through career coaching. She officially launched Lolabees in 2018.
“When I was in the process of recognizing that I had chosen the wrong career, it was very isolating. It felt shameful. It was painful, and I worked with a career coach,” she said. “I really valued the work and how she helped me.” At Lolabees, she works to help dentists through the experience of transitioning to nonclinical work.
Some dentists may love what they do for years but become burnt out. Sometimes, burnout can be addressed.
“When you love your work but get burned out, I’d say the typical burnout treatments like taking breaks and getting support, going on vacation, and creating more space and balance in your life will help,” said Brenner.
Other times, burnout requires a more significant pivot. After years of clinical practice, a dentist may opt to leave the clinical space to find a position that offers a different kind of challenge. When the COVID-19 pandemic temporarily shuttered practices and then required significant precautions as patient care
began again, some dentists stopped to think about a different future.
An influx of people reached out to Brenner during the pandemic. “It made them reevaluate their careers and their lives,” she said.
However, some dentists may not have a choice about leaving clinical practice. Illness, injury and age can impact the necessary fine motor skills and ability to stand for hours.
“Dentistry is incredibly taxing on your body. We have a lot of doctors who are brilliant in the field, but, long term, they don’t know if they’ll be able to continue that route,” said De La Rosa.
Dentists in this position may opt for a nonclinical career path because they are still passionate about dentistry but unable to work in a clinical environment.
In some cases, dentists can embrace work in both the clinical and nonclinical realms. Pesillo spent 42 years as a general practitioner and 38 years as a dental director with United Concordia Dental in Pennsylvania.
Let go of the idea that your next step has to be your perfect plan B. It might paralyze you into never taking that step."
— Laura Brenner, DDS
“It was like having a two-path career,” he said.
Through his work at the AADC, Pesillo has gotten to know many dentists working in the dental benefits field. He has seen some dentists gravitate toward the administrative aspects of dentistry instead of the clinical side. Some of his colleagues opted to get MBAs.
“Some of them got MBAs right out of dental school and then took positions in dental benefits companies as administrators,” he said.
However a dentist arrives at the decision to explore a nonclinical career is personal, but the next step for most becomes figuring out which nonclinical path is the right fit.
How to Find the Right Fit
Making the shift to a nonclinical career path can be a monumental and often overwhelming choice for a dentist. What does work outside of practice look like? How do you begin to find the right fit?
Simply jumping from practicing to the first nonclinical job opportunity that comes up may not be the best decision.
Allison Norris worked as a dental hygienist for more than a decade before launching her talent recruiting agency, The Dentele Group.
“If you’re looking to leave clinical dentistry but don’t have a clear path, it’s important to not jump into the first nonclinical role you find just to escape your current situation,” Norris warned. “Without intentional planning, you could end up in a position that doesn’t truly align with your skills or longterm goals. Make sure that you explore your options and find roles where you can leverage your strengths. You will then find a position where you can truly thrive.”
Rather than taking a blind leap, a productive first step can be evaluating what you like about clinical dentistry. Brenner enjoyed the teaching, coaching and relationship-building aspects of dentistry, so career coaching was a natural fit.
Brenner worked with a client who loves to read radiographs. That interest guided her to become a director at a dental insurance company. Similarly, someone who is tech-savvy and loves to implement the latest software
and equipment in their clinical practice may find a natural fit with a 3D scanning company.
Dentists can also turn to some helpful tools to inform their decision-making process. “Taking a strengths assessment or career aptitude test can help you discover in what role you will excel. These assessments will help you explore your strengths and weaknesses, which will help you focus on roles that fit you best,” said Norris.
While making an informed decision can help dentists find the right fit, it is important to remember that a career shift can take time. “Let go of the idea that your next step has to be your perfect plan B. It might paralyze you into never taking that step,” Brenner warned.
If dentists are still able to practice, they can scale back their hours and try a few different options in the nonclinical space to work toward a smoother transition. Brenner likens it to dating.
“If you really want to find the career that you love, date your career, and give yourself that freedom,” she said.
Salary is another consideration. “Your income is going to play a role in your decision-making,” said Pesillo.
Dentists may find that they are able to earn more in a clinical role than in a nonclinical one, although that is not guaranteed.
In 2023, general dentists in private practice earned an average salary of $218,710.2 And clinical dentists can increase their earning power when they become practice owners.3
A dentist who shifts to sales can expect to see salaries for dental sales representatives ranging from $85,000 to $158,000.4 In the academic world, dentistry professors typically earn between $121,285 and $193,442.5
For some people, career satisfaction may outweigh earning power. Other dentists may decide to remain in the clinical sphere because they want to maintain their current salary. For younger dentists with higher student loan burdens, salary may be a weightier factor.
Shifting to a nonclinical role may also require a change in perspective for dentists who are accustomed to running their own practices.
“Working for a corporation is very different than working for yourself. When you work for yourself, you make decisions,” said Pesillo. “If you’re in a corporate setting, that’s not the case — unless you’re the CEO.”
Clinical autonomy is valuable to many dentists, but, in the corporate world where they are not practicing, they are likely to be working under the direction of a manager or management team.
If you feel prepared and want to make the shift to the nonclinical world, how do you actually land a job?
“It’s more about networking and building relationships than simply performing a Google search,” said Brenner. “Anytime I ever got a different job, it was through relationships. It was through a connection. It was never through a search.”
Dentists can build their networks through personal relationships and with the help of professional organizations. For example, the AADC hosts a yearly workshop for people interested in the dental benefits industry.
“Whether it’s for part-time work or for a complete career change, they can network and talk to different dentists and companies to learn how to get involved in this space,” said Pesillo.
Networking and forging a nonclinical career might be easier for someone who has an established clinical career than for someone fresh out of dental school. For example, someone who has worked for years with a DSO could consider selling their practices and shifting to an administrative role within that organization.
“To best support the doctors who join or who are already in our network, it’s important that our clinical support team has the foundational knowledge of being a chairside dentist, managing a practice and running a business. These key components give us the background needed to fully understand what doctors and dental teams need to thrive,” said De La Rosa.
That doesn’t mean new graduates or dentists earlier in their careers cannot take a nonclinical path.
“Dentists who are early in their careers and find they don’t enjoy practicing clinically still have plenty of time to explore new career opportunities,” said Norris.
The Future of the Nonclinical Space
The nonclinical space will continue to be an option for dentists who want or need a different path to leverage their skills. Demand in some areas may even grow in the coming years.
More dentists are affiliating with DSOs. In 2019, 10.4% worked with a DSO. In 2023, that number increased to 13%.6
As the DSO practice model grows, there will be more administrative job openings for dentists. “Every DSO is going to need support teams, and I think you’re going to see that trend accelerate fairly quickly,” said De La Rosa.
The technology sector is another area that could attract dentists who want to work in nonclinical roles. Digital dentistry, for example, is a significant trend today.
“Dentistry is changing quickly, and the technology is finally catching up to meet the industry’s needs. For example, digital workflows in practices are making everyday processes more efficient,” said Norris. “As these innovations continue to grow, they will transform the way dental practices provide patient care.” Dentists could find roles consulting or researching for these kinds of companies.
The artificial intelligence (AI) boom could also prove to be a growing opportunity for nonclinical careers. “Due to their specialized expertise and knowledge, many AI companies are hiring dentists to help train and refine their AI models,” said Norris.
Brenner is hopeful that the nonclinical opportunities for dentists who want them will continue to grow. “My hope is that dentists and the people hiring can see how much we have to offer and that we will be considered for these roles,” she said. ♦
Carrie Pallardy is a freelance writer and editor based in Chicago. To comment on this article, email impact@agd.org
References
1. “‘My Workday Is Not What You Would Think’: Options Abound for Military Dentists.” AGD Impact, vol. 50, no. 12, December 2022, pp. 22 z–26.
2. “U.S. Dentist Earnings and Busyness Trends.” American Dental Association, ada.org/resources/research/health-policy-institute/ dental-practice-research/2023-us-dental-practice-trends. Accessed 18 Sept. 2024.
3. Hanks, Brian. “How Much Does a Dental Practice Owner Make?” Dental Buyer Advocates, 30 Aug. 2024, dentalbuyeradvocates.com/ how-much-does-a-dental-practice-owner-make/.
4. “Salary: Dental Sales Representative in United States 2024.” Glassdoor, glassdoor.com/Salaries/dental-sales-representative-salarySRCH_KO0,27.htm. Accessed 18 Sept. 2024.
5. “Professor - Dentistry Salary in the United States.” Salary.com, salary.com/research/salary/benchmark/professor-dentistry-salary. Accessed 18 Sept. 2024.
6. Ganski, Kelly. “More Dentists Affiliating with DSOs: Newer Dentists Leading the Trend.” ADA News, 1 June 2023, adanews.ada.org/ ada-news/2023/june/more-dentists-affiliating-with-dsos/.
‘Go-To Global Health Resource’: Exploring the U.S. Air Force International Health Specialist Program
By Maj. Michael D. Santora, USAF, DMD, MPH, and Lt. Col. Benjamin J. Pass, DDS, MPH, MA
The U.S. Air Force International Health Specialist (IHS) Program, established in 2000 by former Air Force Surgeon General Lt. Gen. Paul K. Carlton Jr., plays a crucial role in extending the operational reach of the Joint Forces. These highly trained health professionals possess diverse international skills and knowledge in both military and civilian health disciplines, including dentistry. They serve as full-time advisers primarily within the Office of the Surgeon General at Combatant Commands and Air Components. The IHS Program has a clear mission: “To optimally shape conditions through health-related opportunities that align with the National Security Strategy, National Defense Strategy, and National Military Strategy as expressed in Combatant Command Campaign Plans throughout all phases of conflict.” Their vision is to be the Department of Defense’s go-to global health resource.
To achieve this mission, the IHS Program focuses on formalizing requirements and training for global health engagement. Participants professionalize roles at the strategic, operational and tactical levels, emphasizing activities such as assessment, monitoring and evaluation. By doing so, they drive sustainable, long-term global health engagement efforts and enhance the return on investment for these activities.
IHS teams collaborate closely with allied and partner nation counterparts to identify mutual medical capability and capacity-building goals. Subsequently, they develop global health engagement activities and programs aligned with the geographic Combatant Command Campaign Plan.
Over 300 Air Force medics with IHS training are stationed at military treatment facilities worldwide, ready to respond to global health engagement assignments, humanitarian assistance operations and major disasters.
Air Force Dentists in IHS Billets
The Air Force Dental Corps has two full-time IHS positions. Lt. Col. Benjamin Pass serves as an IHS embedded within the Command Surgeon’s Office at Air Combat Command, located at Joint Base Langley-Eustis, Virginia. Maj. Michael Santora holds a similar role at the Command Surgeon’s Office at Pacific Air Forces Headquarters in Joint Base Pearl Harbor-Hickam, Hawaii. Their work includes a wide range of health-focused priorities such as personnel health protection, foreign humanitarian and civic assistance activities, foreign disaster relief, bio surveillance, stability operations, veterinary health, laboratory research and
development, medical and dental readiness training exercises, multilateral interoperability exercises, and numerous healthfocused security cooperation projects.
Additionally, the Command Surgeon’s Office at Air Combat Command oversees Air Force ground medical assets, known as expeditionary or field hospital equipment. It develops training instructions for these assets.
The Command Surgeon’s Office at Pacific Air Forces Global Health Engagement office focuses on building the medical capability and capacity of allied and partner nations in the Pacific. Its goal is to achieve medical interoperability — seamless execution of capabilities. Aeromedical evacuation is a significant aspect of its portfolio due to the considerable distance between forward operation locations and military treatment facilities.
Expanding Medical Readiness Training Options
The U.S. military has a rich history of participating in medical and dental readiness training exercises abroad through humani-
tarian and civic assistance projects. In the Pacific region, Santora is currently organizing and executing his third Pacific Angel mission. Since 2007, the Pacific Angel mission has collaborated with various Pacific nations annually, bringing together military and civilian organizations to address critical needs.
In 2023, Santora served as the medical planner and lead for Pacific Angel 23-2 in Mongolia. During this mission, he established two small clinics in remote Mongolian areas, working alongside Mongolian Armed Forces medical personnel. These clinics provided medical and dental care to over 2,000 local patients, covering general medicine, radiology, pediatrics, dentistry, optometry, physical therapy and pharmacy services. Additionally, Santora facilitated subject matter expert exchanges on topics requested by the Mongolian military, including mental health, tactical combat casualty care and tropical medicine — a specialty not commonly encountered in Mongolia but relevant due to Mongolian military members’ involvement in peacekeeping operations abroad.
An after-action review discussion facilitated by Lt. Col. Pass and a Danish medical unit.
Capt. Kenneth Stuart performs dental treatment at the Pacific Angel 22-3 Timor-Leste clinic.
Capt. Nshombia Stan performs an extraction alongside Timor-Leste military dental nurse.
Lt. Col. Pass capturing medical readiness data in the field, Paraguay.
Capt. Kristina Reck working with Mongolian Armed Forces dentist and oral surgeon during Pacific Angel 23-2 Mongolia.
A Mongolian dental student serves as a translator during Pacific Angel 23-2 Mongolia while Capt. Brian Ng examines the patient.
Meanwhile, Pass has been a strong advocate for a dedicated assessing, monitoring and evaluating position responsible for validating medical readiness achieved during humanitarian and civic assistance missions. While quantitative data offers one perspective, qualitative vignettes capture how training in volatile, uncertain, complex and ambiguous conditions has led to innovative adaptations. These engagements empower medics to develop a solutions-driven mindset, preparing them for prolonged care scenarios in resource-limited environments during permissive training conditions.
These engagements strengthen partnerships — a critical imperative outlined in the National Security Strategy. By fostering collaboration and knowledge-sharing, they not only enhance dental capabilities but also contribute to global health resilience.
Military-to-Military Interoperability
At Air Combat Command, Pass consistently reviews existing medical and dental policies, seeking innovative ways to collaborate on global health engagements. He actively pursues additional education to influence policies that impact how the international military health community trains. After completing an International Military Medical Observer Trainer course, Pass partnered with North Atlantic Treaty Organization (NATO) medical units to provide real-time feedback on interand intra-team communication dynamics. This multilateral exercise involves over 50 ally and partner nations rigorously testing interoperability in critical areas such as point-of-injury
care, patient movement, patient evacuation coordination, disease outbreak response and patient administration.
At Pacific Air Forces, Santora is actively coordinating health engagements and subject matter expert exchanges, often integrating them within military exercises. While aeromedical evacuation remains a primary focus, aerospace medicine is consistently requested by partner nation air forces. Santora also facilitates exchanges in the fields of forensic odontology and digital dentistry. The U.S. Air Force is well positioned for forensic odontology exchanges, as all Air Force dental clinics maintain forensic dentistry kits and possess basic identification skills through the Comprehensive Medical Readiness Program. Santora also collaborates with forensic dentists at the Defense POW/MIA Accounting Agency, which tirelessly recovers remains of missing service members worldwide. The Philippine Air Force requested such an exchange following a C-130 crash in 2021.
Summary
Through their extensive efforts, Pass and Santora significantly contribute to global health engagements and medical readiness, ensuring that personnel are well prepared for challenges both domestically and internationally. Both maintain their dental licenses and credentials, actively practicing dentistry in Air Force clinics. Their multifaceted roles exemplify the wideranging abilities and leadership of dental officers, significantly contributing to global health resilience. ♦
Why I Joined IHS:
Lt. Col. Benjamin Pass, DDS, MPH, MA
I initially misunderstood what the IHS role in the military healthcare system entailed, thinking it was solely about delivering patient care abroad. During my dental school interviews, I shared my passion for serving vulnerable populations and expanding access to care, both at home and internationally. Motivated by this goal, I actively sought opportunities to make a difference. As a student, I worked in a mountainous region of the Dominican Republic, experiencing comprehensive dentistry while staying with generous local families. Later, as an Air Force dentist, I joined a mission to Kingston, Jamaica, with a nongovernmental organization (NGO). These experiences reinforced the principle that led me to take the Oath of Office: “Service before self.”
I had heard of global health but was unfamiliar with global health engagement — the way the Department of Defense uses health-related activities abroad to support national strategies. While this definition might sound formal, it doesn’t lessen the importance of our work compared with NGO efforts. It simply means that our dedication to “service before self” allows us to learn about different healthcare systems, share best practices and build relationships through increasingly complex engagements over time. It means our health investments with partner nations are held to account and must align with national interests, showing our activities are
What IHS Has Allowed Me to Do:
Maj. Michael Santora, DMD, MPH
My interest in global health began in dental school. I was able to join dental service trips to Peru, Haiti and Jamaica, treating patients with little to no access to dental care. I was also involved with an education exchange in Kuwait. After beginning my active-duty service, I volunteered for an overseas tour in South Korea and followed on in Germany. I continued to be interested in the global health aspect of dental care and applied for the U.S. Air Force IHS program, obtaining a master of public health with a concentration in global health from the Uniformed Services University.
I really sought to make a greater impact on the world outside of the dental clinic, and the IHS program allows me to do just that. One mission that really resonated with me was hosting a forensic dentistry lecture and lab with the Philippine Air Force, an exchange requested after a recent air disaster required forensic odontological identification. The direct request for these skills and the impact this has on the readiness of not only the military but also civilian response was exactly the type of impact I sought to make when I joined the IHS program.
I see dentistry through a different lens now. I look for ways in which dentists can be utilized on the operations side of the
in accordance with fiscal stewardship. The positive impact of these activities can range from improving access to dental care for key indigenous populations to working alongside partner nation dentists in challenging environments. Every mission, conference and exercise with our military and civilian partners is a chance to contribute to the evolving landscape of global health engagement. Incorporating a dental voice in this space is simply icing on the cake!
military, far from the comforts of the clinic. Of course, not all of my work is related to dentistry; in fact, very little of it is directly related. But this further highlights the capability dentists have as military officers to lead health engagements across the spectrum of medicine, from setting up rural medical care clinics to mass casualty and aeromedical evacuation exercises. Our dentists integrate seamlessly with the diverse medical backgrounds involved in the IHS program and contribute to improving global health and building the medical capability and capacity of our allied and partner nations.
Lt. Col. Pass observed moulage patients received by a partner nation during a mass casualty event near Budapest, Hungary.
Maj. Santora leads a forensic odontology lecture in Manila, Philippines.
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