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A Conversation with Alice DeForest
The Executive Director of the American Academy of Periodontology recalls the changes she’s seen in the specialty during her 26-year tenure.
INSIDE DENTISTRY (ID): In your esteemed and lengthy career, what was it that brought you into the world of dentistry and oral health, and then into periodontology?
ALICE DEFOREST (AD): I have an undergraduate degree in political science and a master’s degree in sociology. After completing my MA, I took what was supposed to be a short-term job at the American Dental Association due to my interest in the relationship between the academic and the practicing medical communities. That was my gateway into dentistry, which led to a 10-year stint as Director of Advanced Dental Education at the ADA Council on Dental Education and Commission on Dental Accreditation.
However, I took the position at the AAP specifically due to my fascination with periodontics. I was always something of a science junkie and found the specialty of periodontics particularly interesting because it exists at the interface of medicine and dentistry and requires a mix of two different skill sets. While diagnosis, nonsurgical management, and an understanding of the disease management are essential, so are exquisite surgical skills. Unlike most surgeons, periodontists generally have long-term relationships with their patients while helping them manage a chronic disease. I find that mix just fascinating. To paraphrase singer-songwriter Paul Simon, I’m still crazy about periodontists after all these years.
ID: In your extensive career at the center of organized dentistry, what do you consider the two or three most important events in dentistry and periodontology?
AD: There are three remarkable advances that have shaped periodontics during my quarter of a century with the Academy: osseointegrated implants; soft- and hard-tissue regeneration; and the perio–systemic interface.
When I arrived at the AAP in 1986, implants were just being introduced. The science of osseointegration was something that was of great interest to periodontists, both from a research and clinical perspective. They embraced implantology and surgical placement of implants immediately because it offered them a solution for patients with teeth with poor prognoses. And, they had the surgical skills to excel in implant placement. There have also been enormous gains in regeneration and tissue engineering. Given that regeneration of hard/soft tissue was really no more than a gleam in periodontists’ eyes when I came into the field, it is amazing to see how it has been integrated into most periodontal practices today, often paired with implants in terms of clinical integration. But I think that the promise for the future is tissue engineering. Periodontists are beautifully positioned to bring that forward. I’ve also been able to see the blossoming of science in support of the perio–systemic interface.
Each one of these advances really came alive during my time and fundamentally altered the specialty in a lot of ways. The science and commerce associated with each has been compelling and transformative.
ID: How has organized dentistry changed over your career?
AD: Much has changed since the days when people took the time to compose a letter that was thoughtful and well written and reflective of a highly individualized approach. I wrote and received many such letters early in my career in organized dentistry. However, in more recent years, technology has abbreviated and accelerated communication and at the same time has created an incredible amount of information to absorb. Everyone and every field has experienced this change.
In this environment, I have observed two major trends that may seem to be contradictory—there is both increased collaboration and greater competition in organized dentistry.
On many levels, I see a lot more collaboration and efforts toward collaboration between and among national dental organizations, which is a very positive trend. I have represented the Academy as one of seven organizations on the executive committee of the Healthy Mouths, Healthy Lives Partnership. The Partnership is comprised of 30 different organizations who are collaborating with the Ad Council on a major national advertising and marketing campaign to improve children’s oral health. The campaign addresses a simple but critical oral health problem—how to get kids to brush twice a day for 2 minutes each time. The passion and cooperation that underlies that collaboration has been wonderful.
In addition, a few years ago, the American Dental Association initiated a National Roundtable for Dental Collaboration that is really owned by all of the involved organizations. The Roundtable includes about 20 national dental organizations that meet once a year and have quarterly conference calls. This is an excellent venue for strategic conversations among dental organizations that really didn’t exist before. The Healthy Mouths, Healthy Lives Partnership grew out of conversations at the Roundtable.
However, the environment in organized dentistry is also much more competitive than it was 36 years ago. I see more competition among specialties and between general dentists and specialists. Part of this is the result of our recent down economy but some of it seems to be based on a sometime misguided or false confidence that every dentist can do everything equally well. I don’t believe that. Specialists have greater expertise and experience in their respective fields and should be recognized and utilized more frequently to benefit patients. This takes nothing away from the remarkable fact that, in the United States, most general dentists can meet most of the needs of their patients most of the time. Specialists provide added expertise in those areas where it is needed.
Although I believe organized dentistry is more sophisticated in how it considers and discusses issues now than it was previously, these issues are much more complex. To some extent, I think that the governance and the machinery of organized dentistry is too antiquated to deal with current issues. I think this is a characteristic of nearly all associations. It seems that when people with a common interest get together, there is a desire for a strong and simple solution, and, in reality, very few problems are subject to strong and simple solutions.
ID: When and why did the Academy begin to focus on the public at large? How successful have these efforts been?
AD: The Academy and its members have long had an interest in public education and awareness of the importance of periodontal health. Our current efforts date back to the early 1990s. At that time, reports of studies associating periodontitis with various systemic diseases, including cardiovascular disease, diabetes, and some other disease entities, began to be published in the periodontal literature. Then, in 1996, a story by prominent New York Times health writer Jane Brody linking periodontal disease and preterm low birthweight in particular sent shockwaves when it was published and picked up by consumer, health, and medical journals. This has been followed by tremendous coverage of emerging research in perio–systemic research since that time and has fundamentally altered the public’s understanding of periodontal disease and its impact. While it should not have been a surprise to anyone that infections or inflammation in the oral cavity might have impact on the rest of the body, it seems to surprise people still, perhaps because medicine and dentistry are so segregated in this country. That really was the beginning of our extremely successful media outreach. Disseminating the perio–systemic message has been incredibly important in the Academy’s ability to improve public awareness of the importance of periodontal health.
The effort I am most excited about right now is disseminating the results of the Academy’s collaboration with the US Centers for Disease Control to determine the true prevalence of periodontal disease in the US adult population. The product of this 10-year joint effort was the release this past summer of the 2009–2010 National Health and Nutrition Examination and Survey (NHANES) results, which indicated that 47% of adults have periodontitis. That percentage is much higher—more than twice as high—as previously thought. I think that was a major achievement and a terrific example of a private/public collaboration that was entirely nonpolitical. Public dissemination of this information should be a wake-up call to the profession and the public regarding this prevalent and important disease. I hope that it will ignite more interest in periodontal disease from dental practitioners and educators as well as the public.
About Ms. Deforest
Alice DeForest has devoted over 35 years to directing dental associations in the United States. For the past 26 years, she served as Executive Director of the American Academy of Periodontology, where she directed the Academy’s Central Office in Chicago, oversaw all Academy publications and programs, supervised a staff of 40, and managed a $12 million budget. Ms. DeForest retired in October 2012, was named Executive Director Emeritus of the AAP and, that same month, was awarded Honorary Membership by the American Dental Association.