VIEWS THINKING OUTSIDE THE BOX With membership at just over 71 percent of eligible dentists, the ADA has earned distinction as the gold standard for ...

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THINKING OUTSIDE THE BOX With membership at just over 71 percent of eligible dentists, the ADA has earned distinction as the gold standard for national professional organizations.

With membership at just over 71 percent of eligible dentists, the

ADA has earned distinction as the gold standard for national professional organizations. Neither the American Medical Association nor the American Bar Association, with membership numbers hovering around 40 percent, can compete. This strength in numbers has served the Association well. However, a slow but continuous erosion in the percentage of those qualified to join the organization but not doing so may signal trouble ahead. Between 1993 and 1998, the ADA’s market share decreased from 74.3 percent to 71.4 percent, with a 1.2 percent loss noted in 1998. A continuation of this downward trend over the next decade could tarnish the ADA’s image as the representative of the dental profession’s interests. One hopes this will not occur, but an examination of present and future membership components should sound an alarm.



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Consider: In 1993, ADA market share of those who classified themselves as nonminority was 75.5 percent. By 1998, that percentage had dropped to 73.4 percent. The ADA’s minority market share declined even further, dropping from 61.7 percent of those eligible in 1993 to 57.6 percent last year. The 1998 market shares for those reporting themselves as minorities were 41.8 percent for African-Americans, 57.3 percent for Hispanics and 65.4 percent for Asians and Pacific Islanders. Sex differences were also noted. Less than 65 percent of women eligible for membership belonged to the ADA. These market-share percentages take on added significance when the following facts are noted: dOf the 20,000 minority dentists presently in active practice, approximately 50 percent graduated from dental school less than 10 years ago. dOf this year’s dental freshmen, 24 percent are Asian or Pacific Islander.

JADA, Vol. 131, January 2000 Copyright ©1998-2001 American Dental Association. All rights reserved.

VIEWS dFuture sex ratios will be profoundly altered as the cohort of recent dental graduates, of whom 40 percent are women, moves through the membership ranks. Minorities and women are critical to the future of the profession, but many have not responded to current membership incentives. Not that the ADA hasn’t tried. Our membership division puts forth extraordinary efforts to capture both the emerging and the older nonmember. Its creativity appears to have no limits, yet market share still falls. Perhaps what ADA membership offers is insufficient to affect commitment. Today’s dentists want to know what the organization does for them; otherwise, the feeling runs, why join? Credit cards, insurance, home mortgages and loan consolidations can be attractive membership inducements. It is right and appropriate for the Association to offer such services, but they alone will not attract and hold new members. The ADA should emphasize highly relevant, practice-directed benefits with broad appeal to all dental practitioners regardless of age, sex or racial background. A review of the ADA’s programming indicates there are at least two activities that presently fit these descriptions: continuing education and political advocacy. Both need only to be enhanced to increase their present effectiveness. To this grouping, I would add a creative program of information transfer plus the creation of a new structure within the ADA that will allow for enhanced recognition of special interest groups.

Continuing education is an ADA benefit that could affect ADA members at all stages of their careers. It could become the hook that attracts and maintains members for life. It’s not that the ADA isn’t already active in this field. Outstanding clinicians pack them in at the national meeting. With assistance from Sullivan-Schein Dental and 3M Dental Products, more than 50 half- and full-day seminars are available to individual dentists and dental organizations. The JADA continuing education program counted more than 18,000 dentist enrollments last year.

Today’s dentists want to know what the organization does for them; otherwise, the feeling runs, why join? The suggestion here is to think beyond the traditional. Expand! Expand! Expand! Make an ADA membership synonymous with continuing education. Say the words “continuing education”—think ADA. Lectures, hands-on instruction, fellowships, masterships, distance learning—even, perhaps, a virtual university that grants continuing education degrees— are potential components of an ADA education program. An initiative of this magnitude challenges the resources of the ADA. But I believe that by partnering with education, industry and the ADA’s component and constituent societies, the Association could accomplish such a venture. The ADA’s Washington advocacy program tops the list as a

membership benefit that addresses the interests of all ADA members. Consider: What member would deny that practice life is so much better now that dentists do not have to fear an unannounced visit by an Occupational Safety and Health Administration inspector? What young practitioner isn’t enjoying the enhanced student loan interest deduction? The ADA’s advocacy continues. Through its efforts, there are no ergonomic restrictions for dental offices; patients’ rights, including the patient’s right to choose his or her dentist, are being championed; and dentists can play music in the office without being taxed. Can this benefit be enhanced? Not by increasing the activity; it already operates at a high level. Perhaps the ADA’s accomplishments in advocacy could be more broadly communicated, perhaps through newsworthy inclusions in the nonmember issues of ADA News. These are accomplishments worth mentioning more than once. In a previous editorial, I suggested that the ADA serve as the search engine for members seeking up-to-date information on products and clinical treatment. This concept has unbelievable potential as a membership benefit. Imagine tens of thousands of ADA members hooked up electronically and communicating daily with the ADA’s Division of Science and with each other. Now, that’s a membership benefit! Finally, addressing the oftstated concerns that the ADA is not appropriately addressing the needs of its minority and female members requires a new initiative tailored to rec-

JADA, Vol. 131, January 2000 Copyright ©1998-2001 American Dental Association. All rights reserved.


VIEWS ognize ethnic, sex-related and cultural issues. Dentists who fall into these categories need to have the opportunity to develop special interest groups within the ADA structure. This does not mean abandoning their present external organizations. On the contrary, they could bring the thoughts of these external organizations directly to the ADA

LETTERS JADA welcomes letters from readers on topics of current interest in dentistry. The Journal reserves the right to edit all communications and requires that all letters be typed, double-spaced and signed. The views expressed are those of the letter writer and do not necessarily reflect the opinion or official policy of the Association. Brevity is appreciated.


It was with disappointment that I read the article by Peter Ngan and colleagues titled “Management of Space Problems in the Primary and Mixed Dentitions” (September JADA). During this very comprehensive analysis, the authors never present second-molar replacement as an option for severe crowding. Over the past 50 years, the successful extraction of second 14

through the special interest mechanism—thus ensuring that their voices would be heard at the highest organizational levels. This is not a radical proposal. Such organizations as the American Association for Dental Research and the American Association of Dental Schools have successfully acknowledged the special interests of their constituents, giving them both

position and voice. If strength can be measured by numbers, then today the ADA is strong. Will it remain so? Not without creative thinking and risk taking. The current catch phrase, “thinking outside the box,” takes on real meaning when applied to the critical issue of how to build the ADA’s future membership base. ■

molars, with third-molar replacement, has been well-documented in the literature.1-4 While taught extensively in European orthodontic programs, this procedure receives little support from graduate programs in the United States. A growing number of practitioners in the United States are now seeing the value of finishing orthodontic treatment with 28 functioning teeth, as opposed to the 24 found in most traditional premolar and third-molar extraction cases. The common misbelief that third molars are too unpredictable has been addressed by Quinn,5 who showed that if the second molars are extracted when the third-molar roots are immature, the maxillary thirds commonly erupt unaided into good occlusion, while the lower thirds require uprighting in about 25 percent of the cases. (Uprighting a third molar involves the same mechanics Dr. Ngan describes for uprooting any ectopically erupting molar.) While bicuspid extraction has definite indications in orthodontic treatment, I would urge the author to include the removal of

second molars in his treatment planning alternatives. Damien A. Mulvany, D.M.D. Englewood, Colo. 1. Wilson HE. Long-term observation on the extraction of second molars. Trans-Euro Orthod Soc 1974;50:215-21. 2. Smith DI. The eruption of third molars following extraction of second molars. Dent Pract 1958;8:292-4. 3. Richardson ME. The effect of lower second molar extraction on lower arch crowding. Angle Orthod 1983;53:25-8. 4. Liddle DW. Second molar extraction in orthodontic treatment. Am J Orthod 1977;72:599-616. 5. Quinn GW. Extraction of four second molars. Angle Orthod 1985;55:58-69.

Author’s response: Thanks for your interest in our article. In it, we described the prevalence of crowding, developing of the occlusion, diagnosis of crowding and treatment alternatives. These discussions were aimed at the generalist, who we believe should be aware, at a minimum, of overall treatment approaches. In planning and writing this article, we believed that the details of specific unique approaches related to extraction or nonextraction were beyond its purview. You point out that extraction of second permanent molars can offer an alternative to extraction and premolar extraction regi-

JADA, Vol. 131, January 2000 Copyright ©1998-2001 American Dental Association. All rights reserved.