Dental students decide to organize

The year was 1969. University students across the country were staging demonstrations to protest the Vietnam War, restrictive school policies, dress codes, and more. Education and just about everything else was changing and students were demanding a more active role in the change process.

During this time, a new type of dental student emerged. Dental school admission criteria had become more selective and the competition for acceptance into dental schools increased. Students entering programs at this time had higher grade point averages than ever before. Many individuals sought higher education as a means of postponing the impending military draft. The resulting student profile was a brighter, more socially aware individual with many interests and talents outside the profession of dentistry.

As anyone who was a dental student at the time can attest, dental school was akin to boot camp. In fact, many instructors at that time were indeed retired military officers. They told students how long to wear their hair and sideburns. Some schools even had fingernail inspections. And only a handful of women and minority students could be found in the dental schools of 1969. To make matters worse, there was no system of due process, which meant students could be expelled with no available recourse for help. With a multitude of issues building, the solution presented itself—dental students needed to organize.

The Initial Step

That year the federal government offered the Student American Medical Association (SAMA) a $1 million grant to coordinate student involvement in the Appalachia Project and the American Indian Health Program. Students in all health care disciplines, including medicine, pharmacy, nursing, and dentistry, were to be recruited through their respective national associations to provide indigent health care services. When organizers attempted to invite the dental student association, they found that no such group existed. In fact, dentistry was the only professional discipline without its own national student organization. To further complicate the situation, in order to receive the grant for the project, SAMA needed dental students to organize.

At the time, the presidents of SAMA (presently known as the American Medical Student Association) and the Student American Pharmacy Association were both attending the University of California at San Francisco. They approached Dennis Spain, a junior at the university’s dental school, to start a national association for dental students. Each organization contributed $500 toward establishing the new association. To help lift the dental student group off the ground, Spain sought the assistance of the American Dental Association (ADA). Unfortunately, he found that the ADA already had a student membership category and was not interested in contributing to further organize dental students.

ADA Student Policy

In 1933, the ADA added the category of “student member” to its bylaws. This entitled students to receive the association’s journal, use the ADA library, attend scientific meetings, subscribe to a life insurance program and pay reduced dues during the first year out of dental school. While this gave students access to many of the same benefits as dentist members, student members did not have an organizational structure by which they could initiate activities, express concerns, or shape association policies. Students had neither a voice nor a vote in the ADA House of Delegates and were not able to use student membership dues to advance their own initiatives.

At a January 1970 SAMA conference that included professional students of all disciplines, Spain met David Evaskus, a senior dental student at the University of Illinois. Impressed with the scope and depth of the projects in which the other student organizations were involved, Spain and Evaskus returned to their schools and began contacting dental school deans and students across the country. They sought to recruit students with an interest in public health—at the time, a new area of interest for dental students—to an organizational meeting for an independent national dental student association.

The First National Conference of Dental Students

Students held the meeting in Chicago on Feb. 14–15, 1970, just prior to the midwinter meeting of the Chicago Dental Society. Because time was limited, they could issue formal invitations to students at only 31 of the 49 U.S. dental schools at that time.

Although records indicate that 45 students from 26 dental schools participated, more dental schools may have been unofficially represented because several students came to the meeting without the approval of their schools’ administrations. This assembly represented the new dental student, selected to attend the conference based on involvement in extracurricular activities rather than the usual assemblage of student body presidents or faculty-recognized students.

The Formation of SADA

This new brand of leaders formed the Student American Dental Association (SADA), a national organization that would recruit students to serve in federal health care projects, function as an information clearinghouse on local student issues, coordinate student lobbying efforts, and establish and promote student positions on professional issues. Until a national House of Delegates could convene, the Chicago participants adopted an interim constitution and bylaws and elected national officers. The organization divided itself into nine regions across the United States, each with one regional director. Members elected Dennis Spain, the original organizer, as board president. The newly established SADA planned to hold its first national convention and House of Delegates meeting in New York in October 1970.

SADA recruited students to serve in federal public health programs. It also participated in a $50,000 grant to study and measure health care delivery in the Head Start Program. Local chapters also initiated projects, such as mobile dental clinics and free pediatric oral screenings.

Organized Dentistry’s Reaction

In 1970, the American Association of Dental Schools decided to form a student membership section, intended to work with SADA together cooperatively. The ADA’s reaction to SADA was somewhat different. Now that students had an independent organization, the ADA acknowledged its prior lack of interest in organized student dentistry. Consider the following excerpt from a report submitted by the Council on Dental Education staff to the ADA Board of Trustees:

Although the ADA had a student membership category for many years, there has been no coordinated program for students sponsored by the Association….On several occasions, the Board of Trustees has discussed the desirability of promoting the establishment of a national student organization and, on each occasion, has concluded that the Association should not sponsor such a venture. However, in spite of the lack of Association leadership in this area, a student organization has now been formed and, based on the fact that nearly 30 institutions were represented at the organizational meeting, it appears likely that the new organization will survive.

In addition, a problem soon developed over the organization’s name. SADA touted itself as a completely independent national student dental organization, but its self-chosen name suggested an affiliation with the ADA. And, by using “American Dental Association” in the title, SADA was in violation of the ADA’s copyright and trademark. Since SADA leaders believed that autonomy was crucial to their mission, it is unlikely that there was an intentional suggestion of affiliation with the ADA.

Soon after the February organizational meeting, SADA national officers met with ADA staff to request financial support and possible summer internship opportunities at the ADA headquarters. The ADA offered legal, financial, and administrative support to the fledgling organization in exchange for a seat on the SADA board of directors, along with a constitutional requirement of simultaneous student membership in the ADA. No agreement was reached. However, the two organizations met again in May 1970 at an ADA-sponsored orientation meeting for SADA board members. The ADA offered SADA $1,000 to help defray travel expenses.

That month, the ADA Council on Dental Education unanimously adopted the following resolution:

Resolved, that the Council on Dental Education commend the establishment of the Student American Dental Association and urge cooperation with that organization.

During the ensuing months, it became apparent to SADA leaders that an independent student organization would not be able to survive without increased support from the ADA.

SADA Runs Out of Time

SADA wanted to maintain its independence but was unable to attract enough funding to support its planned national convention. Support from SAMA, two San Francisco Bay-area foundation grants, and the ADA travel subsidy could not sustain the organization. To make matters worse, support from dental suppliers was not forthcoming. The American Dental Trade Association (ADTA) had offered SADA a $10,000 grant, but the funds never came through. SADA leaders had reason to believe that ADA pressure was blocking this source of support. The ADA scheduled an October meeting with ADTA representatives to discuss “mutually acceptable guidelines for dealing with the Student American Dental Association,” according to an Oct. 16, 1970, ADA office memo.

OSA Meeting and the Formation of ASDA

In the meantime, the ADA began developing its own plans for an office of student affairs to channel student requests to the appropriate ADA departments. Approved at the 1970 ADA Annual Session, one of the office’s first activities was to help organize a dental student convention, which was later held on Feb. 8–9, 1971. The purpose of the convention was to provide information about ADA resources and to discuss possibilities for the student members of the American Dental Association. Dental school deans were asked to hold campus-wide elections for delegates to attend the ADA’s student conference. The ADA paid for the travel and lodging expenses for all delegates. In addition to touring ADA facilities and electing student officers while at the conference, the representatives were divided into three groups to attend different workshops. The internal affairs workshop dealt with issues pertinent to organization and budget; external affairs dealt with community health issues and external relationships; and the administration workshop drafted a constitution and bylaws.

The culmination of the conference was the formation of the American Student Dental Association, a new national student dental organization. Its first president and other key officers were former SADA leaders. While this new organization had the ADA’s approval and support, ASDA’s guiding principles and leaders descended directly from the original student organization, SADA.

SADA Dissolves

Shortly after the February 1971 meeting, the Student American Dental Association officially dissolved. While SADA did not achieve all of its stated goals, organizers considered the movement a success. SADA recruited approximately 13,000 members, attained limited funding, placed students in major public health programs and incorporated California. SADA’s objectives are still reflected in the constitution and bylaws of ASDA. More importantly, the original association’s efforts allowed students to open communication lines with colleagues at other schools.

ASDA’s Early Years

In its first year, ASDA accomplished a great deal and without the aid of a central office or staff. It participated in minority student recruitment, migratory worker health programs in several states, and Indian Health Service programs. In addition, the association published a monthly newsletter and held regional conferences on issues concerning public health and minority student recruitment.

One of ASDA’s earliest activities was the development of an advocacy program to respond to students’ requests for support and assistance. At the time ASDA was established, dental students had virtually no means of addressing disputes or appealing disciplinary actions at their respective schools. ASDA’s Advocacy Program helped students by either directing them to local sources of assistance, forwarding cases to the ADA Commission on Dental Accreditation, or simply shedding light on injustices through ASDA’s newsletter. Following are examples of landmark cases.

ASDA helped a student from The Ohio State University who was dismissed from school for not removing his beard. The student was reinstated but penalized one year’s academic work. It was at this point that ASDA’s assistance was requested. ASDA leaders instructed the local chapter on how to effectively engage the local student government in the issue and provided financial assistance to resurrect the dental student newspaper. It also carried several articles on this case in ASDA News. The matter was ultimately resolved to the satisfaction of the students.

In 1974, an anonymous letter from an Indiana University student indicated that the dean announced to the sophomore class midyear that certain students would be prohibited from taking Part I of the National Board Dental Examination if they finished in the bottom 20 percent of their basic science courses. To become eligible to take the boards, these students were told that they must pass a departmental pretest in the area of deficiency. The students felt that the policy, which was imposed without their prior knowledge, was discriminatory. ASDA forwarded copies of the letter to the student president and the dean and ran an editorial in the April 1974 issue of ASDA News. That May, ASDA learned that the dean reversed his decision.

In another case, a candidate for the South Carolina dental licensure exam shared his concerns over the nature of the information requested on the application form. There were questions regarding applicants’ religious preferences, practice and residency plans while in the state, and other discriminatory disclosures. In addition to covering the matter in the January and February 1975 issues of ASDA News, ASDA contacted the South Carolina Board of Dental Examiners, the American Association of Dental Examiners, as well as the ADA Commission on Licensure, requesting revisions to the application form. That spring, a Columbia, SC, newspaper contacted ASDA for background information for a story to appear in that publication. Shortly afterwards, ASDA learned that the application would be reviewed and revised.

Due Process for Dental Students a Priority

After these and other instances, it became evident that without the right to due process at each dental school, students would continue to suffer from unfair policies and disciplinary measures. So in 1975, ASDA petitioned the ADA Commission on Dental Accreditation to revise its Requirements and Guidelines for Dental Education Programs Report to include a statement requiring a uniform system of due process. This petition was denied in 1975, 1976, and 1979. Despite these setbacks, ASDA persisted and made a presentation to the AADS in 1979 titled “Procedural due process for dental students” (The New Dentist, May 1979), which provided a model for the due-process mechanism advocated by ASDA.

This report drew a great deal of attention to the issue of due process. During the summer and fall of 1979, an ad hoc committee of the AADS Council of Deans reviewed the status of due process at dental and medical schools. Shortly thereafter, a new report titled “Rights and responsibilities of students—due process for dental students in non-academic matters” was accepted by the AADS House of Delegates as a special written report.

Encouraged by this success, ASDA decided to again petition the ADA Commission on Dental Accreditation. This time, the association’s efforts paid off. In 1980, the commission added a new section titled “Students” to its Requirements and Guidelines for Dental Education Programs. However, because the due-process clause was listed under the section “Guidelines” rather than “Requirements” and therefore not mandatory for the schools, ASDA felt it necessary to continue efforts to ensure that individual institutions provided these rights for students.

In 1981, the association analyzed the due-process procedures at each of the 60 U.S. dental schools and published a comparative table in the ASDA Handbook. Subsequently, a number of schools did change their guidelines. In fact, by 1984, more than 90 percent had achieved ratings of “adequate” or “excellent” or were in the process of reviewing their due-process policy guidelines. Today, thanks to ASDA’s early and persistent efforts, the right to due process protects all dental students.

ASDA Activities Expand

ASDA started a dental student externship program as a priority project in 1977. ASDA’s current consultantships and externships are products of this initial project. These positions have given many dental students the opportunity to learn more about areas of interest and involvement in organized dentistry.

ASDA came of age in the 1980s. Several of its existing programs were initiated and benefits to members greatly expanded. In 1986, ASDA became a founding sponsor of the Post-doctoral Dental Matching Program, which included post-doctoral positions in oral and maxillofacial surgery, general practice residencies, and advanced education in general dentistry programs. Since that time, the Match has expanded to include first-year positions in orthodontics, pediatric dentistry, and prosthodontics.

Also in 1986, the ASDA Political Education Network, made up of students who coordinate legislative activities and lobbying efforts at their dental schools, was established. PEN monitored state and national legislative activities and organized students for grassroots political activities, such as letter-writing campaigns and voter registration drives. ASDA organized its political advocacy network of dental students nearly 10 years before the ADA created a grassroots network for dentists. In the fall of 2000, ASDA changed PEN’s name to the Legislative Grassroots Network to better reflect its purpose and efforts.

In response to the abuses of student rights generated by the announced closings of several dental schools in the 1980s, ASDA initiated new policies to protect students during the closure process. In 1988, ASDA elected its first female president, N. Gail McLaurin of the Medical University of South Carolina. It was not until 1995 that a second woman, Jessica Meeske of the University of Missouri–Kansas City, reached the association’s highest office.

During 1987, ASDA collaborated with the AADS-ADA Select program to promote ASDA predental membership to potential dental students. In 1989, the ASDA Select Student Network was established. The program developed into the ASDA Career Guidance Network, a program involving a three-tiered leadership structure—national, regional, and local—to recruit promising individuals for careers in the dental profession. Today the formal network is no longer maintained, but the career guidance function is encouraged as a chapter activity, and new emphasis is placed on addressing the career development needs of pre-doctoral members interested in specialty and other post-doctoral dental educational opportunities. ASDA’s consultant on career development lends support to local chapter leaders responsible for coordinating “Lunch and Learn” programs or other chapter activities focused on career development.

Adversity and Action

Prior to 1988, the ADA allowed new dentists who had been ASDA members during their junior and senior years of dental school to pay reduced ADA membership dues during their first four years out of dental school. However, in 1988, the ADA House of Delegates passed a resolution calling for a study of membership categories and dues structure. The ADA formed a dues study committee, which sought input from ASDA. ASDA submitted written testimony to the committee, stating its case for keeping the four years of reduced dues for former ASDA members intact. The testimony detailed how elimination of the program would discourage students from forming early ties to organized dentistry, ultimately resulting in lower membership percentages for ASDA and the ADA. (For the previous four years, ASDA had been capturing 81–82 percent of the pre-doctoral student market.) Still, in 1989, the ADA House followed the board’s recommendation to simplify the dues structure by offering reduced dues to all new dentists, regardless of any previous affiliation with ASDA and the ADA. ASDA felt that the action was counterproductive to its goal of encouraging lifelong membership in organized dentistry beginning with dental students.

From 1989 to 1993, ASDA’s membership market share slipped from almost 80 percent to just more than 70 percent. Membership market share for recent dental graduates during that time period hovered in the low 60 percent range. In 1993, the ADA Board of Trustees proposed a major shift in its marketing strategy for students and new dentists. This plan was presented in the form of a resolution to the ADA House of Delegates calling for two bylaws changes that would allow the ADA to establish a “direct communications link” with dental students. The ADA board proposed that the ADA bylaws be changed so that ASDA membership would no longer be a requirement for student members of the ADA. The possible implications for ASDA were sobering. Dual membership in ASDA and the ADA for pre-doctoral students was a major marketing tool for ASDA. More importantly, it symbolized a unity of purpose for the two organizations in introducing new dental professionals to lifelong involvement in organized dentistry. ASDA members and leaders nationwide mobilized to gather support from their regions’ ADA delegates against Resolution 78. Their efforts proved successful—the original version of the resolution never made it to the House floor. After hearing the overwhelmingly negative testimony presented at the Reference Committee Hearings, a substitute resolution was drafted and adopted, which focused on developing new action plans to recruit more recent graduates and pre-doctoral students for membership. This resolution invited ASDA to participate.

ASDA’s Voice Grows

ASDA gained its first vote in the ADA House of Delegates in 1982, in a surprising 313–87 vote. Students now had a voice in ADA policy decisions and could help shape the future of dentistry. However, with only a single vote, student representation was not proportionate to the number of student members.

In 1995, ASDA leaders felt the time was right to ask for increased representation in the ADA House. During ASDA’s Annual Session, the leaders drafted a resolution stating that for the welfare and promotion of student issues, dental students must have more substantive representation in the ADA House of Delegates. The following month, during the ADA’s Annual Session, ASDA achieved its quest when the ADA House of Delegates voted to grant ASDA four additional seats (for a total of five), along with five alternate delegates. The lobbying efforts of ASDA leaders coupled with the support of many ADA leaders helped pass the resolution.

ASDA Today: A Channel for Dental Student Concerns

ASDA is the only national organization dedicated solely to dental student concerns. Structured as a network of local chapters, ASDA is uniquely geared to respond to the concerns of its members at the local, regional, and national levels. Two delegates at each dental school chapter serve as voting members in the ASDA House of Delegates. Their role is to voice the concerns of their constituents to the House of Delegates for action in the form of resolutions.

As an outcome of these resolutions, ASDA publishes policy statements on dozens of issues, including dental education, the rights and fair treatment of dental students, dental research, dental student representation, and education financing, among others. ASDA notifies groups or individuals, such as dental school deans, dental associations, and state boards of dentistry and lawmakers, of its position on particular issues. As a result, ASDA has stimulated many positive changes at the local and national levels.

Opposing Unfair Student Policies

Recently, a dental school held students responsible for the unpaid bills of their patients. The students were expected to pay the outstanding balances if patients did not settle their accounts by a certain deadline. Local ASDA chapter leaders felt this was unfair and hired an attorney to represent their position when talks with the school failed. As a result, the school dropped the requirement was dropped. The ASDA House of Delegates then adopted a policy statement asserting that responsibility for collection of dental school patient accounts rests ultimately with the dental school and not with individual students and that student receipt of credit for clinic procedures should not be dependent upon the payment status of the patient’s account. Other ASDA chapters have used this foundation to protest similar policies at their schools.

At another school, nonuniform departmental grading scales made it extremely difficult for students to maintain the necessary grade point averages needed to pursue postgraduate professional training. The ASDA chapter took student concerns to the dean of student affairs, who facilitated a meeting with the school’s policy committee. ASDA leaders presented student concerns to representatives from each department. The dental school subsequently adopted a uniform 10-point grading scale.

The association has also adopted policies asserting that dental schools should distribute student grades in a manner that is fully confidential, that students must be informed of all graduation requirements upon enrollment and provided with guidelines and explanations of these requirements, and that dental schools must strive to graduate all students by the announced graduation date.

In Support of Diversity

ASDA promotes diversity within academic circles and organized dentistry. The association’s leadership consistently represent minority and female dental students, reflecting the national demographic makeup of the dental student population.

ASDA’s House of Delegates has passed a number of important resolutions that strive to create a more favorable dental school environment for women and minorities, including the following examples.

The association’s policy on sensitivity to diversity opposes sexist, discriminatory, or other similarly insensitive language and practices at dental schools. ASDA has communicated this policy to dental school deans, urging them to provide a physically and psychologically safe and humane environment for all students and members of the dental team.

ASDA’s policy on sexual harassment condemns all forms of sexual harassment of dental students and cites definitions of what actions specifically constitute sexual harassment. All dental school deans have been notified of this policy and urged to acknowledge the existence of sexual harassment and work toward its eradication.

Association leaders have also collected information about maternity policies at dental schools and urged deans of dental schools without such policies to develop them. As a result, several schools requested ASDA’s assistance in developing a formal policy on maternity accommodation for dental students. Recognizing that circumstances or opportunities may arise that demand or legitimately necessitate a temporary interruption in any dental student’s course of education and training, ASDA adopted a policy on leave of absence for dental students that would apply broadly to many personal circumstances.

The 2000 ASDA House of Delegates established a Task Force on Diversity in an effort to focus ASDA on three areas of concern: recruitment of a dental school applicant pool that represents the diversity of the U.S. population; retention of diverse dental students and new dentists in organized dentistry; and informing and educating dental students and dentists about the issues of diversity in the dental profession.

Capturing Support of Legislators

ASDA aggressively lobbies members of Congress and state legislatures about educational and funding issues, such as the tax deductibility of student loan interest, in-school interest subsidies, and maintaining Medicaid funding for dental school clinic patients. It took more than 10 years of effort, but ASDA, working collaboratively with other student and dental organizations, successfully reinstated tax deductibility of interest paid on educational loans.

With support of the American Dental Education Association, ASDA established its first ASDA–ADEA National Dental Student Lobby Day in 1999. Twenty-one students lobbied members of Congress, advocating Student Loan Interest Deduction (SLID) legislation and access to additional unsubsidized Stafford Loan funds. With nearly 130 students participating in 2001, Lobby Day has become one of ASDA’s most successful events.

Improving Dental Student Life

ASDA embraces its role as a watchdog for dental student rights and interests and stays ahead of the curve by adopting policies to encourage the improvement of student life at dental schools. Although most dental schools have fair policies regarding the treatment of students, ASDA is always prepared to intervene when warranted. The association had adopted a policy statement on faculty-student interaction, which asserts that dental schools are responsible for promoting an atmosphere of mutual professional respect among members of the administration, faculty, and student body. It states that in such an environment, criticism is offered constructively in a manner that preserves individual self-respect and that care is taken to ensure that any chairside evaluation of performance is completed in a way that supports the student-patient relationship and preserves the patient’s confidence in the student.

ASDA has also adopted position statements on the confidentiality of student health status, hepatitis B vaccinations for dental students, student representation on committees that directly affect student academic life, and the ethical conduct and professional behavior of dental students.

Dental Licensure Reform

In 1994, the ASDA House of Delegates formed the Task Force on Dental Licensure Reform to research and address the obstacles to dental licensure faced by many students. Some of the problems defined by the task force include restricted freedom of movement, exam inequities, ethical dilemmas, and examiner bias.

Today ASDA is leading the profession in initiating reforms to the process of dental licensure. ASDA’s licensure goals include the creation and acceptance of one content-uniform clinical licensure examination that is valid, reliable, anonymous, and fair; minimizing candidate stress as well as intimidation of candidates by both examiners and the examination process; creation of a more candidate-friendly examination; substitution of successful completion of the National Board Dental Examination Part II for all written examinations covering clinical topics; eliminating the use of human subjects; making state jurisprudence examinations available on the Internet in order to increase access and allow for immediate disclosure of results and decrease administrative costs; universal implementation of pregraduation clinical licensure examinations; creation of dental school-based remediation programs for candidates who fail; better education of students concerning the purpose and process of licensure examination; improve opportunities for candidates and patients to evaluate, comment, and offer suggestions concerning the examination process; and reduction and control of costs associated with dental licensure examination for all parties involved.

The 2000 ASDA delegation to the ADA House of Delegates successfully lobbied for ASDA’s resolution calling for the elimination of the use of human subjects in the clinical licensure examination process by 2005. With an 82.9 percent majority, the ADA House passed ASDA’s resolution. In the following months, state societies and boards of dental examiners in more than five states, including New York, Rhode Island, Maine, and Kentucky, passed similar resolutions that support ASDA’s licensure reform goals.

ASDA: The Future

ASDA has grown into a well-respected and influential organization. Today more than 84 percent of all pre-doctoral dental students join the association. In June 2000 ASDA implemented its predental chapter plan. More than 15 universities and colleges have established predental chapters, and ASDA has added more than 1,000 new predental members to its ranks.

As the exciting future of dentistry continues to unfold, ASDA works to meet the changing needs of dental students. Whatever lies ahead, ASDA will be ready to offer its members the support and services they need to face that future with confidence.