1 00:00:00,960 --> 00:00:03,379 Hello. This is Cameron Cortejano with the Becker's 2 00:00:03,600 --> 00:00:05,620 Dental and DSO review podcast. 3 00:00:06,080 --> 00:00:07,839 I'm thrilled to be joined today by doctor 4 00:00:07,839 --> 00:00:08,580 Rick Valakovic, 5 00:00:08,960 --> 00:00:12,160 clinical professor and executive director of the NYU 6 00:00:12,160 --> 00:00:15,139 Dentistry Center for Oral Health Policy and Management. 7 00:00:15,914 --> 00:00:17,914 Doctor Valakovic, thank you so much for being 8 00:00:17,914 --> 00:00:18,574 here today. 9 00:00:19,114 --> 00:00:20,734 Thanks, Cameron, for having me. 10 00:00:21,755 --> 00:00:24,175 To start us off, can you introduce yourself 11 00:00:24,234 --> 00:00:25,835 and tell us a little bit about your 12 00:00:25,835 --> 00:00:26,335 background? 13 00:00:26,954 --> 00:00:27,454 Sure. 14 00:00:28,050 --> 00:00:30,609 I'm a pediatric dentist by training and began 15 00:00:30,609 --> 00:00:32,530 my career on the faculty at the Harvard 16 00:00:32,530 --> 00:00:34,629 School of Dental Medicine in in Boston. 17 00:00:35,329 --> 00:00:37,329 I was then recruited to be president and 18 00:00:37,329 --> 00:00:40,229 CEO of the American Dental Education Association, 19 00:00:41,175 --> 00:00:43,034 where I served for twenty two years. 20 00:00:44,054 --> 00:00:47,094 The American Dental Education Association or ADEA is 21 00:00:47,094 --> 00:00:48,954 the the national organization, 22 00:00:49,495 --> 00:00:52,454 representing all of the academic dental institutions in 23 00:00:52,454 --> 00:00:53,995 The United States and Canada. 24 00:00:55,340 --> 00:00:57,979 And, I stepped down from that position in 25 00:00:57,979 --> 00:01:00,640 2019 and joined the faculty here at NYU 26 00:01:00,700 --> 00:01:01,979 at that time, and I've been, 27 00:01:02,380 --> 00:01:03,359 been here since. 28 00:01:04,540 --> 00:01:05,920 Great. Thank you so much. 29 00:01:06,540 --> 00:01:08,219 And what what are some of the biggest 30 00:01:08,219 --> 00:01:11,084 issues that you're following in the dental industry 31 00:01:11,084 --> 00:01:11,825 this year? 32 00:01:12,765 --> 00:01:14,444 So I think there's a number of them 33 00:01:14,444 --> 00:01:15,105 that that 34 00:01:15,805 --> 00:01:16,625 that we're following. 35 00:01:17,484 --> 00:01:20,385 The first one really is is well, evolving 36 00:01:20,685 --> 00:01:21,665 workforce dynamics. 37 00:01:22,444 --> 00:01:25,265 We have shortages of professionals in in 38 00:01:25,659 --> 00:01:28,560 in dental practice at all levels, including dentists, 39 00:01:28,620 --> 00:01:29,519 dental assistants, 40 00:01:30,140 --> 00:01:32,239 dental hygienists, front desk staff. 41 00:01:32,700 --> 00:01:33,760 If you talk to 42 00:01:34,219 --> 00:01:36,560 most dentists now who are in private practice, 43 00:01:36,859 --> 00:01:38,724 they'll tell you that the major, 44 00:01:39,125 --> 00:01:41,305 obstacle to being more productive, 45 00:01:42,405 --> 00:01:45,064 is that they don't they can't find the 46 00:01:45,284 --> 00:01:45,604 the, 47 00:01:46,084 --> 00:01:48,564 the support staff that they need, to to 48 00:01:48,564 --> 00:01:49,064 to 49 00:01:49,444 --> 00:01:50,905 to really fill their schedules. 50 00:01:52,159 --> 00:01:53,299 So, you know, 51 00:01:53,920 --> 00:01:56,180 as part of this whole dynamics as well, 52 00:01:57,120 --> 00:01:59,680 there's been a very significant change over the 53 00:01:59,680 --> 00:02:01,459 the past decade in particular 54 00:02:02,000 --> 00:02:05,760 in that, more than 50% of dental graduates 55 00:02:05,760 --> 00:02:06,659 are now women. 56 00:02:07,174 --> 00:02:08,375 Many schools like, 57 00:02:08,775 --> 00:02:09,275 NYU, 58 00:02:09,974 --> 00:02:12,074 that number is about 65%. 59 00:02:12,135 --> 00:02:12,635 So, 60 00:02:13,094 --> 00:02:14,555 we have more diversity, 61 00:02:15,574 --> 00:02:16,715 in terms of 62 00:02:17,175 --> 00:02:19,735 men and women and coming out of, our 63 00:02:19,735 --> 00:02:21,275 dental schools, but more diversity 64 00:02:21,735 --> 00:02:22,474 in general. 65 00:02:23,229 --> 00:02:25,550 I think that we have a retirement wave 66 00:02:25,550 --> 00:02:27,490 that's gonna come over the next decade. 67 00:02:28,830 --> 00:02:30,449 The average age of of 68 00:02:30,750 --> 00:02:33,310 of retirement for dentists is now in mid 69 00:02:33,310 --> 00:02:34,830 sixties, and and, 70 00:02:35,629 --> 00:02:38,715 that cohort that came through, you know, finishing 71 00:02:38,715 --> 00:02:41,215 up in the late seventies and early eighties, 72 00:02:41,914 --> 00:02:44,314 we're gonna be seeing a a a wave 73 00:02:44,314 --> 00:02:46,474 of retirements that are gonna really impact, 74 00:02:47,354 --> 00:02:49,455 the the number of dentists that are available 75 00:02:49,594 --> 00:02:50,974 to to care for patients. 76 00:02:52,340 --> 00:02:55,139 This next generation of of dental students who 77 00:02:55,139 --> 00:02:56,040 are now graduating, 78 00:02:56,819 --> 00:02:59,860 have a much more focus on work life 79 00:02:59,860 --> 00:03:02,500 balance that I think is gonna be changing 80 00:03:02,500 --> 00:03:03,479 things as well. 81 00:03:04,260 --> 00:03:06,520 We'll talk in a moment about how 82 00:03:07,025 --> 00:03:08,485 dental practice is changing, 83 00:03:09,344 --> 00:03:11,525 but this expectation of of these, 84 00:03:12,145 --> 00:03:13,685 graduating students to 85 00:03:14,064 --> 00:03:16,784 to find ways to to have a a 86 00:03:16,784 --> 00:03:19,264 better balance in their life is is, is 87 00:03:19,264 --> 00:03:19,764 gonna, 88 00:03:20,305 --> 00:03:21,205 have an impact. 89 00:03:22,419 --> 00:03:23,319 Dental education, 90 00:03:24,340 --> 00:03:26,819 went through a significant transformation in the '8 91 00:03:26,979 --> 00:03:28,599 nineteen eighties and nineteen nineties 92 00:03:28,979 --> 00:03:31,139 with the closure of seven dental schools and 93 00:03:31,139 --> 00:03:33,400 the reduction in class size and many others. 94 00:03:33,955 --> 00:03:35,955 You know, we went from 6,300 95 00:03:35,955 --> 00:03:36,455 graduates 96 00:03:36,834 --> 00:03:37,974 in 1980. 97 00:03:39,395 --> 00:03:41,735 With the closure of dental schools and 98 00:03:42,435 --> 00:03:44,834 reduction in class size and others, we went 99 00:03:44,834 --> 00:03:46,854 down to less than 4,000 100 00:03:47,155 --> 00:03:48,534 just ten years later. 101 00:03:49,319 --> 00:03:49,819 So, 102 00:03:50,599 --> 00:03:52,060 what we've seen a resurgence 103 00:03:52,439 --> 00:03:55,340 in universities interested in dental school, so 104 00:03:55,639 --> 00:03:57,719 20 new dental schools have opened in the 105 00:03:57,719 --> 00:03:58,860 past thirty years, 106 00:03:59,240 --> 00:04:00,460 but here's the rub. 107 00:04:01,639 --> 00:04:02,780 It we were graduating 108 00:04:03,834 --> 00:04:04,955 6,300 109 00:04:04,955 --> 00:04:08,235 dentists in, in 1980 when the population in 110 00:04:08,235 --> 00:04:10,895 United States was about 245,000,000. 111 00:04:13,114 --> 00:04:15,275 We're just back now even with the the 112 00:04:15,275 --> 00:04:17,595 opening of all these new dental schools, we're 113 00:04:17,595 --> 00:04:18,095 only 114 00:04:18,539 --> 00:04:19,759 back up to about 115 00:04:20,139 --> 00:04:21,360 7,000 graduates, 116 00:04:22,379 --> 00:04:24,779 only really a 10% increase in in the 117 00:04:24,779 --> 00:04:25,599 number of, 118 00:04:26,060 --> 00:04:28,860 of graduates, but yet we know that the 119 00:04:28,860 --> 00:04:30,860 population of The United States has gone from 120 00:04:30,860 --> 00:04:32,459 245,000,000 121 00:04:32,459 --> 00:04:34,079 in in 1980, 122 00:04:34,504 --> 00:04:36,425 to nearly 340,000,000, 123 00:04:36,745 --> 00:04:37,245 today. 124 00:04:38,024 --> 00:04:41,625 So the issues around workforce dynamics are something 125 00:04:41,625 --> 00:04:43,324 that we're really focused on. 126 00:04:43,865 --> 00:04:46,204 The second is is the business landscape. 127 00:04:47,649 --> 00:04:49,029 You know, I I think 128 00:04:49,490 --> 00:04:51,990 that many folks will will think of dentistry 129 00:04:52,370 --> 00:04:53,669 as as it 130 00:04:53,970 --> 00:04:55,189 as it was historically, 131 00:04:56,289 --> 00:04:58,310 until very recently, which was 132 00:04:59,545 --> 00:05:00,425 92% 133 00:05:00,425 --> 00:05:02,504 of dentists were in one or two person 134 00:05:02,504 --> 00:05:03,404 private practices. 135 00:05:03,944 --> 00:05:05,884 So that boutique small practice. 136 00:05:07,064 --> 00:05:09,645 But there's been a major change, 137 00:05:10,345 --> 00:05:13,290 over the past, ten years or so. And 138 00:05:13,290 --> 00:05:15,769 and, you know, dentistry has always been about 139 00:05:15,769 --> 00:05:16,990 ten years behind 140 00:05:17,529 --> 00:05:18,029 medicine, 141 00:05:18,889 --> 00:05:20,350 in in significant 142 00:05:20,730 --> 00:05:23,069 changes that were occurring within the industry. 143 00:05:23,769 --> 00:05:26,569 So now we're seeing the the private equity 144 00:05:26,569 --> 00:05:28,185 coming in, the corporatization 145 00:05:28,485 --> 00:05:30,024 of dentistry, the development 146 00:05:30,725 --> 00:05:31,384 of DSOs, 147 00:05:32,165 --> 00:05:33,865 and large group practices, 148 00:05:34,485 --> 00:05:36,485 that are putting pressure on on the smaller 149 00:05:36,485 --> 00:05:36,985 practices. 150 00:05:39,605 --> 00:05:41,785 Third thing is persistent disparities 151 00:05:42,199 --> 00:05:45,240 in access to care. We all know that, 152 00:05:45,639 --> 00:05:48,600 nearly a third of Americans lack, access to 153 00:05:48,600 --> 00:05:50,060 any form of dental insurance. 154 00:05:50,519 --> 00:05:53,339 Medicaid dental coverage for adults vary significantly 155 00:05:53,720 --> 00:05:54,779 state by state. 156 00:05:55,240 --> 00:05:57,180 There's no dental benefits in Medicare. 157 00:05:58,894 --> 00:05:59,714 We know 158 00:06:00,014 --> 00:06:01,394 from an evidentiary 159 00:06:01,774 --> 00:06:02,274 perspective, 160 00:06:02,975 --> 00:06:04,115 in 2019, 161 00:06:04,894 --> 00:06:07,795 there were two million emergency room visits, 162 00:06:08,334 --> 00:06:10,915 with a discharge diagnosis of dental pain. 163 00:06:11,300 --> 00:06:13,000 And each one of those on average 164 00:06:13,459 --> 00:06:14,279 costs about, 165 00:06:14,740 --> 00:06:16,600 a thousand dollars per visit. 166 00:06:17,779 --> 00:06:20,839 Dental education is going through a thoughtful evolution. 167 00:06:21,300 --> 00:06:22,759 How are we going to, 168 00:06:23,220 --> 00:06:24,439 implement all these, 169 00:06:25,294 --> 00:06:28,754 technological changes that are occurring? Digital dentistry, CADCAM, 170 00:06:28,894 --> 00:06:29,794 three d printing, 171 00:06:30,974 --> 00:06:33,235 AI assistant, assisted diagnosis. 172 00:06:35,214 --> 00:06:37,615 You know, what what we expect that students 173 00:06:37,615 --> 00:06:38,594 are gonna be, 174 00:06:39,520 --> 00:06:43,199 learning in just four years is has increased 175 00:06:43,199 --> 00:06:43,939 so dramatically, 176 00:06:44,639 --> 00:06:46,980 but yet we still have to put out, 177 00:06:48,560 --> 00:06:51,060 dental graduates who are ready for unsupervised 178 00:06:51,439 --> 00:06:54,000 practice at the end of of their dental 179 00:06:54,000 --> 00:06:54,500 education. 180 00:06:56,055 --> 00:06:58,935 So that certainly is is gonna continue to 181 00:06:58,935 --> 00:06:59,975 to be an issue. 182 00:07:00,455 --> 00:07:02,694 How are we gonna implement all of these 183 00:07:02,694 --> 00:07:04,935 changes within the four year period? And at 184 00:07:04,935 --> 00:07:05,835 the same time, 185 00:07:06,214 --> 00:07:07,675 the cost of dental education, 186 00:07:08,980 --> 00:07:11,540 you know, the students are graduating with with 187 00:07:11,540 --> 00:07:12,740 $300,000 188 00:07:12,740 --> 00:07:14,259 in debt and then trying to set up 189 00:07:14,259 --> 00:07:15,560 a practice as well. 190 00:07:15,939 --> 00:07:18,199 And, of course, the scientific foundation 191 00:07:18,980 --> 00:07:19,959 of of dentistry 192 00:07:20,514 --> 00:07:22,354 is really something that we need to be 193 00:07:22,354 --> 00:07:23,814 concerned about and ensuring 194 00:07:24,435 --> 00:07:25,254 that we 195 00:07:25,794 --> 00:07:28,995 continue to be a learned profession with with 196 00:07:28,995 --> 00:07:32,035 evidence based dentistry as the source of our 197 00:07:32,035 --> 00:07:32,535 practice. 198 00:07:32,995 --> 00:07:34,514 So those are the those are the things 199 00:07:34,514 --> 00:07:35,735 that I'm following now. 200 00:07:36,569 --> 00:07:39,470 Yeah. Definitely. Those are all all interesting trends. 201 00:07:40,089 --> 00:07:41,790 What do you think has maybe caused 202 00:07:42,410 --> 00:07:44,350 the, I guess, lack of growth, 203 00:07:45,209 --> 00:07:47,069 in the number of dental graduates? 204 00:07:48,169 --> 00:07:50,490 You said it's only increased about 10% over 205 00:07:50,490 --> 00:07:51,790 the last couple of decades. 206 00:07:52,345 --> 00:07:54,305 Do you think it's maybe the the rising 207 00:07:54,305 --> 00:07:55,285 cost of education 208 00:07:55,665 --> 00:07:58,464 or or maybe something else? Or what what 209 00:07:58,464 --> 00:08:00,004 do you think is kinda behind that? 210 00:08:00,625 --> 00:08:01,925 I think that that 211 00:08:02,865 --> 00:08:03,365 the 212 00:08:03,745 --> 00:08:07,105 dental schools are the most expensive unit of 213 00:08:07,105 --> 00:08:07,685 a university 214 00:08:08,600 --> 00:08:10,060 because we have to have, 215 00:08:11,639 --> 00:08:14,279 the classrooms for basic sciences. Then we have 216 00:08:14,279 --> 00:08:15,899 to have simulation labs, 217 00:08:16,520 --> 00:08:19,080 for students to to learn how to do 218 00:08:19,080 --> 00:08:19,580 procedures, 219 00:08:20,439 --> 00:08:21,259 in a simulation 220 00:08:22,595 --> 00:08:24,134 way, and then we have to have 221 00:08:25,074 --> 00:08:26,775 a clinic. Right? So 222 00:08:27,395 --> 00:08:28,775 that's very expensive. 223 00:08:29,235 --> 00:08:31,895 If you compare it to even medical schools, 224 00:08:32,674 --> 00:08:33,335 they need 225 00:08:35,480 --> 00:08:38,360 classrooms and maybe some anatomy labs and so 226 00:08:38,360 --> 00:08:40,120 on and so forth, but then they send 227 00:08:40,120 --> 00:08:43,319 their students out to the hospitals and and 228 00:08:43,319 --> 00:08:44,139 other practices, 229 00:08:44,839 --> 00:08:47,019 for their the clinical tied to their education. 230 00:08:47,605 --> 00:08:50,105 So we're we're having to to, 231 00:08:51,285 --> 00:08:52,904 use our clinical operations, 232 00:08:54,085 --> 00:08:55,705 to to educate students, 233 00:08:57,524 --> 00:08:59,625 and and at reduced prices. So 234 00:08:59,940 --> 00:09:00,840 for the patients, 235 00:09:01,620 --> 00:09:02,120 basically, 236 00:09:02,580 --> 00:09:04,519 most dental schools charge about half. 237 00:09:04,980 --> 00:09:07,059 So the it's just the cost of dental 238 00:09:07,059 --> 00:09:08,679 education is so high. 239 00:09:10,100 --> 00:09:12,360 Universities are are are skeptical 240 00:09:12,660 --> 00:09:14,600 about either starting at one, 241 00:09:15,284 --> 00:09:15,784 or, 242 00:09:16,404 --> 00:09:18,404 expanding the class size of what those that 243 00:09:18,404 --> 00:09:19,065 do exist. 244 00:09:20,004 --> 00:09:21,625 Got it. That makes a lot of sense. 245 00:09:23,044 --> 00:09:25,524 Something that I'm curious to get your thoughts 246 00:09:25,524 --> 00:09:27,764 on are what are some things that you're 247 00:09:27,764 --> 00:09:29,945 most excited about when it comes to dentistry 248 00:09:30,370 --> 00:09:32,210 right now, and what are some things that 249 00:09:32,210 --> 00:09:33,970 are making a little bit nervous about the 250 00:09:33,970 --> 00:09:34,470 industry? 251 00:09:35,649 --> 00:09:37,990 I'm most excited about the technology revolution. 252 00:09:38,370 --> 00:09:40,389 It's transforming our profession 253 00:09:40,850 --> 00:09:42,950 as I as I just spoke about. 254 00:09:44,125 --> 00:09:46,125 And and so, I mean, if we just 255 00:09:46,125 --> 00:09:48,205 think about what happened in the last couple 256 00:09:48,205 --> 00:09:51,565 years around AI and the the introduction of 257 00:09:51,565 --> 00:09:52,065 AI, 258 00:09:52,684 --> 00:09:55,105 into into into dentistry, you know, we 259 00:09:55,589 --> 00:09:57,690 recent you know, we've the we've undergone 260 00:09:58,069 --> 00:10:00,549 a transformation to over the past, 261 00:10:01,269 --> 00:10:03,769 five to ten years in terms of introducing 262 00:10:03,909 --> 00:10:05,449 digital dentistry. So 263 00:10:05,909 --> 00:10:06,409 all 264 00:10:07,190 --> 00:10:08,490 all forms of 265 00:10:08,965 --> 00:10:12,504 of, diagnosis and and, treatment planning, 266 00:10:13,125 --> 00:10:15,304 have become digitized. And, 267 00:10:16,245 --> 00:10:18,904 so, you know, just impression scanning, 268 00:10:19,284 --> 00:10:20,264 three d printing, 269 00:10:20,804 --> 00:10:21,304 CADCAM, 270 00:10:22,860 --> 00:10:23,680 the the way 271 00:10:24,139 --> 00:10:24,639 robotics, 272 00:10:25,340 --> 00:10:27,360 for implant placement and so on. 273 00:10:28,700 --> 00:10:31,259 Just if you think about the changes that 274 00:10:31,259 --> 00:10:32,220 have occurred, that's re 275 00:10:33,100 --> 00:10:34,720 how is that going to be, 276 00:10:35,125 --> 00:10:37,605 implemented? That that excites me a lot because 277 00:10:37,605 --> 00:10:39,144 I think that there's an opportunity, 278 00:10:40,245 --> 00:10:41,144 to really use 279 00:10:42,084 --> 00:10:42,904 this technology, 280 00:10:43,764 --> 00:10:44,264 revolution, 281 00:10:45,204 --> 00:10:46,105 to to 282 00:10:46,644 --> 00:10:48,184 to provide more access, 283 00:10:49,160 --> 00:10:51,639 hair for those who have been having trouble 284 00:10:51,639 --> 00:10:52,299 getting it. 285 00:10:52,840 --> 00:10:55,799 Second thing that excites me is this growing 286 00:10:55,799 --> 00:10:59,179 recognition of oral health and its relate its 287 00:10:59,480 --> 00:11:01,179 relationship to overall health. 288 00:11:01,944 --> 00:11:02,764 You know, people 289 00:11:03,065 --> 00:11:05,944 always you know, often think about dentistry. They 290 00:11:05,944 --> 00:11:07,784 might think about pain or they might think 291 00:11:07,784 --> 00:11:08,845 about some aesthetics. 292 00:11:09,384 --> 00:11:11,304 But, you know, the mouth is the beginning 293 00:11:11,304 --> 00:11:12,684 of the digestive tract. 294 00:11:13,865 --> 00:11:16,024 Not only do do the teeth, 295 00:11:16,899 --> 00:11:19,399 prepare food for digestion by through 296 00:11:19,860 --> 00:11:21,240 mastication and chewing, 297 00:11:21,860 --> 00:11:23,399 but also enzymes 298 00:11:23,700 --> 00:11:25,860 that are in saliva that start to help 299 00:11:25,860 --> 00:11:27,159 to to break it down. 300 00:11:27,700 --> 00:11:29,959 You need a smile for social interaction. 301 00:11:30,414 --> 00:11:32,575 You you you just it doesn't have to 302 00:11:32,575 --> 00:11:33,794 be extreme makeover, 303 00:11:34,335 --> 00:11:36,014 but you do need a smile. You need 304 00:11:36,014 --> 00:11:37,554 a smile to get a job. 305 00:11:38,414 --> 00:11:40,095 You know, and when we think about the 306 00:11:40,095 --> 00:11:40,595 relationship 307 00:11:41,054 --> 00:11:41,554 physically, 308 00:11:42,095 --> 00:11:42,595 between, 309 00:11:43,529 --> 00:11:45,449 the oral cavity and and the rest of 310 00:11:45,449 --> 00:11:46,190 the body, 311 00:11:46,649 --> 00:11:47,149 inflammation 312 00:11:47,529 --> 00:11:48,269 is inflammation. 313 00:11:48,970 --> 00:11:51,289 And so inflammation in the mouth, be it 314 00:11:51,289 --> 00:11:51,789 periodontal, 315 00:11:52,169 --> 00:11:54,350 be it, endodontic, whatever, 316 00:11:55,049 --> 00:11:57,789 they're clear although maybe not a 317 00:11:58,235 --> 00:11:59,375 a cause and effect, 318 00:11:59,675 --> 00:12:00,075 but, 319 00:12:00,555 --> 00:12:01,935 relationship, but certainly, 320 00:12:03,115 --> 00:12:06,075 a a relationship between inflammation in the mouth 321 00:12:06,075 --> 00:12:08,415 part and cardiovascular disease, diabetes, 322 00:12:08,955 --> 00:12:10,175 low birth weight infants. 323 00:12:11,279 --> 00:12:13,519 We and we just it's not just being 324 00:12:13,519 --> 00:12:15,299 free from dental pain. Although 325 00:12:16,000 --> 00:12:17,139 concerns I have 326 00:12:17,600 --> 00:12:19,759 are, you know, expanding on what I've already 327 00:12:19,759 --> 00:12:21,919 said in terms of growing disparities in oral 328 00:12:21,919 --> 00:12:22,659 health care. 329 00:12:23,384 --> 00:12:24,764 Do we have enough dentists 330 00:12:25,144 --> 00:12:25,644 graduating? 331 00:12:26,185 --> 00:12:29,065 Yes. We have enough dentists graduating to treat 332 00:12:29,065 --> 00:12:31,004 those who can afford dental care, 333 00:12:31,865 --> 00:12:34,045 who have the oral health literacy, 334 00:12:34,825 --> 00:12:36,985 to be able to understand the role that 335 00:12:36,985 --> 00:12:38,605 that, dental care, 336 00:12:39,100 --> 00:12:40,320 plays in their lives. 337 00:12:40,860 --> 00:12:42,480 But I think in this regard, 338 00:12:42,860 --> 00:12:45,600 my biggest concern is this, 339 00:12:46,700 --> 00:12:49,100 changes in the way that that the public 340 00:12:49,100 --> 00:12:50,240 is looking at fluoride 341 00:12:50,620 --> 00:12:51,519 and the skepticism. 342 00:12:51,899 --> 00:12:53,840 You know, for seventy five years, 343 00:12:54,855 --> 00:12:57,735 we have had community water fluoridation without very 344 00:12:57,735 --> 00:13:00,375 much of a of a put back, and 345 00:13:00,375 --> 00:13:01,414 75% 346 00:13:01,414 --> 00:13:02,075 of Americans, 347 00:13:02,934 --> 00:13:03,995 enjoy the benefits, 348 00:13:04,455 --> 00:13:05,914 of community water fluoridation. 349 00:13:07,389 --> 00:13:09,629 The the levels that are are, 350 00:13:10,110 --> 00:13:10,610 implemented 351 00:13:11,629 --> 00:13:13,090 in community water supplies 352 00:13:13,549 --> 00:13:15,009 at point seven PPM, 353 00:13:16,029 --> 00:13:18,269 have not been shown at all to to 354 00:13:18,269 --> 00:13:19,090 have any 355 00:13:19,835 --> 00:13:21,055 impact on cognitive 356 00:13:21,754 --> 00:13:23,115 abilities or or, 357 00:13:23,754 --> 00:13:24,254 neurotoxicity. 358 00:13:25,274 --> 00:13:27,514 Those kinds of things happen at much higher 359 00:13:27,514 --> 00:13:29,774 levels at four PPM and above. 360 00:13:30,475 --> 00:13:30,975 So 361 00:13:31,355 --> 00:13:32,095 if we 362 00:13:32,610 --> 00:13:33,350 take fluoride 363 00:13:33,889 --> 00:13:36,129 out of the water and we know what's 364 00:13:36,129 --> 00:13:37,750 happening in in Florida, 365 00:13:39,169 --> 00:13:41,970 now the there's a a bill on the 366 00:13:41,970 --> 00:13:43,909 governor's desk in in Utah 367 00:13:44,289 --> 00:13:47,845 to ban community water fluoride fluoridation throughout the 368 00:13:47,845 --> 00:13:48,745 state of Utah. 369 00:13:49,204 --> 00:13:49,865 If we 370 00:13:50,565 --> 00:13:51,065 eliminate 371 00:13:52,164 --> 00:13:53,464 community water fluoridation, 372 00:13:54,164 --> 00:13:56,424 we're gonna go back to a time when, 373 00:13:56,725 --> 00:13:58,565 you know, as I did early in my 374 00:13:58,565 --> 00:13:59,065 career, 375 00:13:59,649 --> 00:14:02,610 working in in Boston as a pediatric dentist 376 00:14:02,610 --> 00:14:04,789 before there was water fluoridation, 377 00:14:05,250 --> 00:14:08,070 I was doing quadrant dentistry all day long, 378 00:14:08,529 --> 00:14:10,690 on those, patients that came in from the 379 00:14:10,690 --> 00:14:11,590 local community. 380 00:14:12,605 --> 00:14:14,304 So I think that that 381 00:14:15,324 --> 00:14:17,804 pulling fluoride out of the water is going 382 00:14:17,804 --> 00:14:20,144 to dramatically impact the 383 00:14:20,605 --> 00:14:21,904 the level 384 00:14:22,524 --> 00:14:25,904 of caries and then the sequelae of of, 385 00:14:26,809 --> 00:14:30,009 either restoration or extraction or or whatever that 386 00:14:30,009 --> 00:14:33,149 may be. Another concern is the economic sustainability 387 00:14:33,370 --> 00:14:35,629 of dental practice and dental education. 388 00:14:36,250 --> 00:14:38,090 You know, we we know that the there's 389 00:14:38,090 --> 00:14:41,389 high debt on, as as students leave, 390 00:14:42,014 --> 00:14:44,095 and the start up costs are are are 391 00:14:44,095 --> 00:14:44,595 high. 392 00:14:46,414 --> 00:14:48,914 Another concern is the pace of change. 393 00:14:49,454 --> 00:14:51,454 You know, just think about it. The students 394 00:14:51,454 --> 00:14:52,194 who graduate 395 00:14:52,495 --> 00:14:54,995 this year in 2025 are gonna be practicing 396 00:14:55,054 --> 00:14:56,674 till 2065, 397 00:14:56,960 --> 00:14:58,820 a forty year professional career. 398 00:14:59,200 --> 00:15:02,639 What how are are we preparing those students 399 00:15:02,639 --> 00:15:03,779 for for what, 400 00:15:05,600 --> 00:15:07,759 is going to happen over the next forty 401 00:15:07,759 --> 00:15:10,399 years given what we've just seen in terms 402 00:15:10,399 --> 00:15:12,019 of particularly this technology, 403 00:15:12,985 --> 00:15:13,485 revolution. 404 00:15:13,945 --> 00:15:15,725 And certainly, one of the most 405 00:15:16,665 --> 00:15:19,225 compelling issues for us to face is the 406 00:15:19,225 --> 00:15:21,165 whole issue of professional burnout. 407 00:15:22,105 --> 00:15:23,384 I think that that, 408 00:15:24,665 --> 00:15:26,684 as as I've gone around to meetings, 409 00:15:27,449 --> 00:15:30,089 I'm hearing as as people at dental meetings 410 00:15:30,089 --> 00:15:31,769 are asking, what do you wanna have on 411 00:15:31,769 --> 00:15:33,929 the on on the agenda for next year 412 00:15:33,929 --> 00:15:35,629 that we had don't have now? 413 00:15:35,929 --> 00:15:38,009 And I'm hearing about we need to have 414 00:15:38,009 --> 00:15:40,110 courses on well-being, on meditation, 415 00:15:41,294 --> 00:15:44,575 on yoga. It's part of the these dental 416 00:15:44,575 --> 00:15:45,075 meetings, 417 00:15:45,855 --> 00:15:47,554 because people are really concerned, 418 00:15:48,014 --> 00:15:48,914 about burnout, 419 00:15:49,615 --> 00:15:50,575 and and, 420 00:15:51,215 --> 00:15:53,634 and well-being. So those are the issues that 421 00:15:53,759 --> 00:15:55,759 I'm excited about and those that I'm that 422 00:15:55,759 --> 00:15:56,980 I'm concerned about. 423 00:15:58,960 --> 00:15:59,940 Yeah. That last, 424 00:16:00,399 --> 00:16:02,639 point that you make about, like, even at 425 00:16:02,639 --> 00:16:05,440 these dental meetings and making it a big 426 00:16:05,440 --> 00:16:06,980 big point to kinda combat, 427 00:16:08,455 --> 00:16:11,095 burnout. I think it just goes back, like 428 00:16:11,095 --> 00:16:12,855 like you were saying before, which is the 429 00:16:12,855 --> 00:16:15,595 lack of staff at at every level Yeah. 430 00:16:16,134 --> 00:16:18,455 Of the industry and and kinda that is 431 00:16:18,455 --> 00:16:20,475 also a big reason why 432 00:16:20,809 --> 00:16:22,730 we're seeing a lot of burnout, which is 433 00:16:22,730 --> 00:16:23,789 just exasperating 434 00:16:24,330 --> 00:16:26,750 the the workforce problems that we currently have. 435 00:16:27,690 --> 00:16:29,709 Great. And just the last question 436 00:16:30,089 --> 00:16:30,589 today. 437 00:16:31,850 --> 00:16:34,490 What will the most effective health care leaders 438 00:16:34,490 --> 00:16:36,985 need, in your opinion, in order to be 439 00:16:36,985 --> 00:16:37,485 successful, 440 00:16:38,345 --> 00:16:40,125 within the next two to three years? 441 00:16:41,465 --> 00:16:42,524 You know, as I, 442 00:16:42,985 --> 00:16:43,865 as I left, 443 00:16:44,345 --> 00:16:46,445 my position at the American Dental 444 00:16:46,904 --> 00:16:47,404 Education 445 00:16:47,945 --> 00:16:50,605 Association in, in 2019, 446 00:16:51,919 --> 00:16:54,100 I left with with an appreciation 447 00:16:54,559 --> 00:16:55,779 that the biggest, 448 00:16:56,559 --> 00:16:57,620 issue facing 449 00:16:58,320 --> 00:16:59,059 the profession, 450 00:17:00,000 --> 00:17:00,500 including 451 00:17:01,279 --> 00:17:03,700 dental education, practice, and so on, 452 00:17:04,694 --> 00:17:06,315 is the future of leadership. 453 00:17:06,775 --> 00:17:09,095 Who's going to be the next leaders? We 454 00:17:09,095 --> 00:17:09,595 just, 455 00:17:11,174 --> 00:17:14,134 there isn't the ladder of people who coming 456 00:17:14,134 --> 00:17:16,714 into leadership positions that there used to be. 457 00:17:16,769 --> 00:17:18,609 And, you know, we need leaders at at 458 00:17:18,609 --> 00:17:20,710 every level, and and that includes 459 00:17:21,809 --> 00:17:22,789 organized dentistry, 460 00:17:24,049 --> 00:17:24,869 dental education, 461 00:17:25,570 --> 00:17:26,309 the military, 462 00:17:27,009 --> 00:17:27,750 in particular, 463 00:17:28,690 --> 00:17:31,815 who's going to provide leadership in in DSOs 464 00:17:31,955 --> 00:17:33,255 and large group practices. 465 00:17:33,875 --> 00:17:36,835 So as I look and we we've created 466 00:17:36,835 --> 00:17:38,775 an a a a whole portfolio 467 00:17:39,715 --> 00:17:42,455 of leadership experiences for our students and faculty 468 00:17:42,515 --> 00:17:43,495 here at NYU. 469 00:17:44,809 --> 00:17:47,130 But I think that what we're seeing is 470 00:17:47,130 --> 00:17:48,190 that adaptability 471 00:17:48,970 --> 00:17:50,269 is going to be paramount. 472 00:17:50,890 --> 00:17:53,789 Data literacy will become increasingly crucial. 473 00:17:54,329 --> 00:17:57,210 We're generating more clinical and operational data than 474 00:17:57,210 --> 00:17:57,950 ever before, 475 00:17:58,444 --> 00:18:00,545 but data alone doesn't create value. 476 00:18:01,404 --> 00:18:03,644 We need to have leaders who understand how 477 00:18:03,644 --> 00:18:06,224 to translate data into actionable insights. 478 00:18:07,325 --> 00:18:08,464 Collaborative leadership, 479 00:18:09,005 --> 00:18:11,904 you know, there's an appreciation of the relationship 480 00:18:12,285 --> 00:18:12,785 between 481 00:18:13,159 --> 00:18:15,099 the oral cavity, oral health, 482 00:18:15,480 --> 00:18:18,440 and, and overall health as we we talked 483 00:18:18,440 --> 00:18:18,940 about. 484 00:18:19,799 --> 00:18:22,440 And so we we need to to have 485 00:18:22,440 --> 00:18:24,059 people in leadership roles 486 00:18:24,359 --> 00:18:25,339 who can collaborate 487 00:18:25,994 --> 00:18:28,894 across the professions and not just within dentistry. 488 00:18:29,674 --> 00:18:30,414 We need 489 00:18:30,875 --> 00:18:32,894 leaders who have financial acumen. 490 00:18:33,914 --> 00:18:36,954 Reimbursement models, we know, are are continuing to 491 00:18:36,954 --> 00:18:37,454 evolve. 492 00:18:37,880 --> 00:18:40,200 They need to leaders will need to understand 493 00:18:40,200 --> 00:18:42,299 how to maintain financial sustainability. 494 00:18:44,039 --> 00:18:47,500 You know, emotional intelligence will always be critical, 495 00:18:48,039 --> 00:18:48,779 for leaders. 496 00:18:49,240 --> 00:18:50,200 And I think that, 497 00:18:50,865 --> 00:18:54,005 technology integration skills like the data literacy, 498 00:18:55,025 --> 00:18:55,265 will 499 00:18:56,065 --> 00:18:56,565 the 500 00:18:56,865 --> 00:18:59,444 the ability of of leaders to understand, 501 00:19:00,625 --> 00:19:02,964 how to integrate technology will separate 502 00:19:04,210 --> 00:19:06,609 those forward thinking leaders, in my opinion, from 503 00:19:06,609 --> 00:19:07,829 those who fall behind. 504 00:19:08,289 --> 00:19:09,809 So those are the kinds of things that 505 00:19:09,809 --> 00:19:12,130 I think that the leaders need to be 506 00:19:12,130 --> 00:19:14,450 concerned about and be successful in the next 507 00:19:14,450 --> 00:19:15,509 two or three years. 508 00:19:16,445 --> 00:19:17,345 Yeah. Absolutely. 509 00:19:17,805 --> 00:19:19,964 I totally agree with with all those those 510 00:19:19,964 --> 00:19:22,605 points. Good. Especially with the data literacy and 511 00:19:22,605 --> 00:19:23,984 and the technology implementation. 512 00:19:24,845 --> 00:19:25,345 Yeah. 513 00:19:25,644 --> 00:19:27,884 It it just seems like tech techs obviously 514 00:19:27,884 --> 00:19:28,384 becoming 515 00:19:28,909 --> 00:19:30,049 more and more important, 516 00:19:30,349 --> 00:19:33,089 in dentistry and in dental practices. 517 00:19:33,789 --> 00:19:34,289 Yep. 518 00:19:35,549 --> 00:19:38,049 Awesome. Well, thank you for joining us today, 519 00:19:38,190 --> 00:19:39,089 doctor Balakovic, 520 00:19:39,470 --> 00:19:41,409 and and sharing your valuable expertise 521 00:19:41,944 --> 00:19:44,345 and insights in the dental industry and in 522 00:19:44,345 --> 00:19:46,045 dental practice and dental education. 523 00:19:46,585 --> 00:19:48,664 It's been a pleasure speaking with you, and 524 00:19:48,664 --> 00:19:50,585 I look forward to connecting with you again 525 00:19:50,585 --> 00:19:51,325 in the future. 526 00:19:51,865 --> 00:19:54,204 Alright. Thanks very much for having me, Cameron. 527 00:19:54,664 --> 00:19:56,924 No problem. Have a good one. You too.