The United States (US) population and the dental workforce are becoming increasingly diverse. Characteristics of the April 2024 cohort of the 65 permanently named deans at Commission on Dental Accreditation-recognized US dental schools show the most diversity among deans yet. This cohort demonstrates increases in the representation of women and non-Whites, as well as substantial number of those who are internationally dental school-trained. This article explores individual and dental school characteristics for these deans through an inclusive lens. The “30% Solution” is considered as a critical mass benchmark for achieving meaningful representation of diversity and inclusivity among these deans.
Key points
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Historic data indicate the gradually increasing diversity among dental school deans, and contrast with the April 2024 cohort being the most diverse yet.
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The April 2024 Cohort of the United States Dental School deans approaches or meets the critical mass benchmark of 30% representation on several critical facets.
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Nearly a quarter of these deans have received international dental training, enhancing diversity and inclusivity reflective of the evolving dental student and general populations.
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Ongoing challenges include the persistence of underrepresentation of historically underrepresented minorities.
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Data monitoring and leadership training initiatives are essential to ensure progress in diversity and inclusion with dental school leadership.
Introduction
The composition of the United States (US) is becoming increasingly diverse from a dental perspective whether looking at the patient population, students, practitioners, or leaders. Recent trends (2000 – 2020) on selected demographics ( Fig. 1 ) show contrasts among the US population, the dentist workforce, first year dental students, , and US dental school deans. Through an inclusive lens, this article examines the status of dental school deans amidst this evolving diversity.
Diversity in the dental workforce and its translation to dental education has been discussed for decades. For some aspects, diversity and access have taken small steps for over a century ( Fig. 2 ). Becoming more diverse contrasts with a considerable history of dental deans being predominantly White males. , Data for women versus men as the deans of US dental schools have been monitored, albeit with changing emphasis on terminology concerning sex and gender. These terms are examined in an accompanying chapter in this Dental Clinics of North American (DCNA) issue. “Sex” refers to “female or male” for biologic characteristics and “gender” refers to “woman or man” for social characteristics. In this article with the focus on social characteristics, gender is used. Instead of using race/ethnicity, this article uses a modification of Culturally and Linguistically Diverse (CALD) , for a broad scope of sociocultural distinctions. Three categories of CALD are presented: (1) Non-Hispanic White/largely European American (White), (2) historically underrepresented minority (URM), concentrating on Black (African American is used in the paper when used by the original source) and Hispanic, but also would include Native American/American Indian or Alaskan Natives, and (3) other diverse groups (other CALD). Another element of observed diversity among US dental school deans is that of international dental school training (IDT).
To appreciate the historic context and advancements in diversity in US dental leadership, this article provides brief reviews of women and men, CALD, and IDT in dentistry and for dental school deans. Following those reviews, the current (April 2024) cohort of US dental school deans is assessed, and an overview of future contributions toward enhancing inclusivity is offered.
Women and Men
Lucy Beaman Hobbs Taylor, the first woman to graduate from a US dental school, completed her studies in 1866 from the Ohio College of Dental Surgery. Between 1866 and 1893, 26.0% of the 181 women who graduated from US dental schools were foreign-born. For a century, the number of women graduates remained low. However, between 1970 and 1984, the percentage of women entering dental school rose from 2% to 25%. , By 2001, women represented 40% of entering dental school classes and in 2018, women surpassed the rate of men entering US dental schools.
The first woman to be named as a dental school dean was Dr Jeanne Sinkford at Howard University in 1975, whereas the first man to be named a US dental school dean was Dr Chapin A. Harris at the Baltimore College of Dental Surgery in 1840. See Box 1 for early pathfinder women who continued the movement that Dr Sinkford started. , , , , Representation of women in dental faculty and leadership slowly grew, , , such as during 2020 to 2021, women comprised 17.6% of the 68 US dental school deans.
| Jeanne Sinkford | 1975 | Howard University | Black |
| Eugenia Mobley | 1978 | Meharry Medical College | Black |
| Mary Lynne Capilouto | 1998 | University of Alabama | White |
| Sharon Turner | 1998 | Oregon Health & Science University | White |
| Cecile A. Feldman | 2001 | University of Medicine and Dentistry of New Jersey | White |
| Yilda Rivera Nazario | 2002 | University of Puerto Rico | Hispanic |
| Martha Somerman | 2002 | University of Washington | White |
| Terri A Dolan | 2003 | University of Florida | White |
| Connie Drisko | 2003 | Medical College of Georgia | White |
| Marjorie Jeffcoat | 2003 | University of Pennsylvania | White |
Historically, evidence supported that women meet higher standards than men to attain dental leadership positions. A 2020 National Academies of Science review found ongoing challenges in the representation of women in academic leadership and recommended capturing the data to increase transparency. Understanding these challenges is important for improving women’s representation. , Leadership training directed at women in dentistry started in the 1990s. American Dental Education Association (ADEA) initiated women’s leadership development programs in 1992 with the Women Liaison Officer Group, followed by the Enid A Neidle Scholars Program in 1994, and support for the Hedwig van Ameringen Executive Leadership in Academic Medicine program at Drexel University in 1996. From 1994 to 1999, ADEA offered a summer leadership program, later replaced with the ADEA Leadership Institute. ADEA also created initiatives such as the Women in Leadership section and the Women Liaisons Officers to advance women and improve the academic environment for women on faculty.
Contrasting high representation among dental students and faculty members, women remain underrepresented as deans of US dental schools. From 2000 to 2021 ( Fig. 3 ), the proportion of women in these leadership positions rose. ,
Culturally and Linguistically Diversity
CALD group members have been a part of the US dental workforce throughout its history. Focus on CALD inclusion in dental education has been primarily on Blacks. The first dental school, the Baltimore College of Dental Surgery, was founded in 1840 when an estimated 120 Blacks practiced dentistry in the US.
Dr Robert Tanner Freeman faced rejection by two dental schools upon their recognition of his race but was admitted as one of the first six dental students to attend the Harvard University’s School of Dental Medicine in 1867, adhering to the University’s policy that it “would know no distinction of nativity or color”. Freeman graduated March 10, 1869, as the first degreed African American dentist in the US. , Harvard took over 100 years to graduate its first African American woman, Dr Dolores M Franklin, in 1974.
In 1890, Dr Ida Gray Nelson Rollins was the first African American woman to graduate from a US dental school. , She worked in the dental office of Dr Jonathan Taft who was the first dean of the Dental College at the University of Michigan, which is thought to contribute to his advocating for her to become a dentist.
Howard University and Meharry Medical College dental schools are the only dental schools of the 107 Historically Black Colleges and Universities (HBCU). Howard’s dental program was established around 1881 and Meharry’s in 1886, both originally included in their respective medical schools. The contributions of these schools to dental leadership and the proportion of the Black dentists are noteworthy. Dr Arnold Bennett Donowa, a Trinidad-born Howard graduate (Howard, 1922) became Howard’s dean in 1929 and is considered the first US African American dental school dean, serving 2 years. He was succeeded by Dr Russel Alexander Dixon (Northwestern, 1929) who served as Howard’s dean from 1931 until 1966. , Dr Dixon influenced Dr Jeanne Sinkford (Howard, 1958) who in 1975 at Howard became the first woman and the first Black woman, to be the dean of a US dental school.
By 2000, several men became first African American deans of non-HBCU dental schools. These men included Dr Theodore E Bolden (Meharry, 1947) in 1977 at the now Rutgers dental school, Dr Frank M Lapeyrolerie (Howard, 1953) in 1979 at the now Rutgers dental school, Dr Raymond Fonseca (Connecticut, 1973) in 1989 at the University of Pennsylvania dental school, Dr Ronald Johnson (Pittsburgh, 1961) in 1994 at the now University of Texas Health Science Center at Houston dental school, and Dr Lonnie Norris (Harvard, 1976) in 1995 at Tufts dental school.
In 1975, the same year that Dr Sinkford became the first woman US dental school dean, Dr Jessica Ricket graduated from the University of Michigan as the first American Indian woman dentist. Dr George Blue Spruce, who obtained his Doctor of Dental Surgery in 1956 from Creighton University School of Dentistry, is the first American Indian dentist. Approximately 50 years earlier, Dr Charles Goodall Lee and Dr Faith Sai So Leong, both of Chinese ancestry, graduated from the now University of the Pacific dental school, becoming the first Chinese American female and male dentists in the US. , The University of Pennsylvania dental school had an earlier Chinese graduate in 1899, Dr Moon-hung Chaun, although his career was in Hong Kong. Dr No-Hee Park, possibly the first Asian-American dental school dean, served as dean of the University of California, Los Angeles (UCLA) School of Dentistry from 1998 to 2016. Dr Rena D’Souza may be the first Asian/Indian woman dean when she became dean at the University of Utah in 2013.
Information on the history of Hispanic dental education was first proved challenging to find. In 1997, Dr Alberto Tossas became the first alumnus of the University of Puerto Rico School of Dental Medicine to become its dean, possibly the first Hispanic dean of a US dental school. In 2002, Dr Yilda Rivera Nazario was the first woman to take a similar path to dean.
The designation as an HBCU is one example of institutional designations and histories. Another is Hispanic Serving Institutions (HSI), which have at least 25% Hispanic enrollment. As of 2020 to 2021, 6 dental schools are at HSI designated universities. Tribal Colleges and Universities (TCUs) is another institutional designation of history like HBCU; however, none of the 35 TCUs has a dental school. Considering access as a part of inclusion, in 2001 15 dental schools began participation in a national demonstration program, which showed impact on dental student experiences and characteristics.
Dental schools and associated institutions have other aspects of interest possibly related to inclusivity and CALD. The missions and visions of schools reflect their histories and commitments. These aspects, not explored in this article, include religious salience plausibly through dental schools being at institutions with religious affiliations such as Catholic/Jesuit, Jewish, Seventh Day Adventist, and United Methodist. Another example of institutional diversity is for dental schools associated with osteopathic medicine, which may have different cultural or philosophic commitments , than those associated with allopathic medicine, and which may differ from those having no medical or other health sciences affiliation.
International Dental Training
The US has long benefited from the contributions of leaders in dentistry who had received their training abroad, although detailed records among the firsts with IDT are scant. Notable examples (see Fig. 2 ) of such deans are Reidar F. Sognnaes, LDS, PhD, DMD, who first received dental education in Norway, served as the acting dean for Harvard (1959–1960) and was the founding dean for UCLA (1960–1968) , and Rena D’Souza, BDS, DMD, PhD who received her first dental training in India and was named the first woman dean at the University of Utah dental school in 2013.
Having foreign trained dentists in the US, particularly related to US dental school faculty shortages, has been discussed for years with numerous pros and cons debated. One concern voiced is “brain-drain” from Canada if positions in the US attract Canadian deans away. Presence of IDT and general international influence can be seen in 4% of responses to a workforce survey in 1987 and for 5.7% of the 2020 to 2021 incoming US dental school dental students being from outside the US or Canada.
Internationally trained dentists navigate various pathways to practice their profession and integrate into the workforce. One of the primary pathways is through advanced standing programs associated with the ADEA Centralized Application for Advanced Placement for International Dentists , which allow IDT dentists to earn a US dental degree through an abbreviated training process. Tufts University School of Dental Medicine established one of the earliest such programs in 1956. Currently, 42 US dental schools offer advanced programs for dentists with IDT. Another pathway that IDT dentists can pursue is post-graduate training in various dental specialties, leading to eligibility for specialty licensure in the US. Some states offer faculty licenses for IDT dentists to practice within academic institutions.
Assessment of the April 2024 Dean Cohort
To assess current dean status, information is a census in April 2024 of the permanently named deans of US dental schools recognized by Commission on Dental Acceredition (CODA). The assessment uses publicly available information from dental-school websites and internet searches, as well as organized dentistry reports from the American Dental Association (ADA) and ADEA. This assessment is non-human subject research for use of publicly available information on these public figures in the context of their positions as dental school deans. The assessment was conducted similarly to other assessments to avoid questionnaire low response rates by deans. Fig. 3 provides an example of differences in estimates when using responses for deans’ profiles versus 100% representation, where the questionnaire responses show overestimates of women as deans, as women were more likely to participate. Both modalities show increasing representation of women as deans.
The deans’ personal characteristics identifiable from public use materials included basic demographics information such as photo and name recognition as woman or man; White, URM (Black or Hispanic only as none of the deans appeared to be of other recognized URM groups), or other CALD; education and training; and degrees beyond dental degrees, advanced education training, and associated board certification. Dental school characteristics where the deans hold their appointments include year of appointment, ADEA region, school funding designation (collapsed to 2 levels of public or private/private state-related), if the dean attended the school for training, and National Institute of Dental and Craniofacial Research (NIDCR) institutional grant funding ranking for 2023. Bivariate comparisons were conducted, focusing on similarities and distinctions between deans’ characteristics distributions by gender, CALD category, and IDT.
The April 2024 United States Dental School Dean Cohort
Overall
This 2024 April Cohort assessment focuses on the 65 permanently named deans at the US dental schools recognized by CODA. See Box 2 for basic dean demographics for the component groupings of dental school leading to this cohort.
| 80 Dental Schools Existing or Proposed | |||
| 77 with Named Deans | 31.2% Women | 67.5% White 14.3% URM 18.2% Other CALD |
22.1% IDT |
| 9 Interim Deans | 55.6% Women | 55.6% White 22.2% URM 22.2% Other CALD |
22.2% IDT |
| 71 Accredited Schools | 32.4% Women | 67.6% White 14.1% URM 18.3% Other CALD |
23.9% IDT |
| 65 Accredited Schools with Permanent Deans | 29.2% Women | 69.2% White 12.3% URM 18.5% Other CALD |
23.1% IDT |
Women versus men
Out of these 65 permanently named deans, the men-to-women ratio is approximately 2:1, with nearly 30% women ( Table 1 ). On individual characteristics, this cohort of deans, whether manmen or women, generally are similar. One area of distinction is that more men hold second doctoral degrees. Nearly one-third of the deans are general dentists ( Fig. 4 A), with periodontics and prosthodontics as the highest represented advanced specialty training for the total (see Fig. 4 A) and among men ( Fig. 4 B). Among the women with the specialties of dental public health, oral pathology, and oral medicine are the most frequent (see Fig. 4 B).
