Underrepresented minorities (URM) often leave their residency programs with greater negative experiences than non-URM co-residents. It is critical for program leaders to understand the experiences of all their residents during the 2-3 year residency programs. This mixed-method study aims to assess whether race in an orthodontic academic setting leads to increased stereotype threat and to understand URM orthodontic dental residents' experiences and coping mechanisms. A total of 257 orthodontic residents completed a stereotype vulnerability scale, modified for dental residents, to assess the level of threat they face. The results revealed that 67.9% of URM residents were at high risk, in contrast to the 16.9% of non-URM residents who were at high risk. Additionally, ten high-threat and ten low-threat residents were interviewed using in-depth, semi-structured interviews. These interviews highlighted contrasts in race-based experiences based on threat levels, how stereotype threat can manifest (didactically, clinically, and socially), and the consequences and coping mechanisms of residents. Furthermore, five program leaders were interviewed to understand the current measures taken to create inclusive workplaces, how they perceive the experiences of their residents, and the effectiveness of the support systems implemented by program directors and chairs.

IntroductionMinoritized providers are more likely to serve low income and underserved communities while individuals from rural or underserved areas are more likely to go back and work in these areas after medical and dental training. Currently African American/Black individuals make up only 3% of the current dental workforce though representing 14% of the nation’s population. While the overall dental workforce does not reflect the diversity of the country, pediatric dentistry is on the forefront as the most racially and gender diverse dental specialty. This is in great part due to the increase in African American/Black females pursuing pediatric dentistry. It is important to assess the factors that are leading African American/Black females selecting this career, as an exemplar for other specialties and programs to follow, and as a means to help address the nation’s health disparities in healthcare provider diversity. The purpose of this study was to determine the personal, social, and policy factors influencing African American/Black women’s choice to specialize in pediatric dentistry and serve children insured by Medicaid.

MethodsThis study is an observational mixed methods study using qualitative and quantitative data. This study consists of two components. The first component is analysis of data collected for a previous research study on minoritized dentists, as well publicly available data sources from the American Dental Association. The second component consisted of interviewing African American/Black pediatric dentists regarding their lived experiences and their decision to pursue pediatric dentistry and treat children insured by Medicaid, and analyzing the data thematically.

ResultsDentistry is still a male dominated profession overall, but in pediatric dentistry men make up only 48.7% of the specialty. African American/Blacks make up 3.6% of general dentists without postdoctoral training, 5.5% of the pediatric specialist population and only 3.4% of all other dental specialists combined. Among the African American/Black population of dentists enrolled in advanced dental education programs in the 2021-2022 academic year, 58% are female. Of all African American/Black individuals who graduated from an advanced dental education program in 2021, 70% were female. There are positive factors and negative factors that predict one to pursue pediatric dentistry. Positive predictors include being any race/ethnicity (African American/Black, Asian, Hispanic) besides White and being female. When having white females as the comparison group, African American/Black females are more likely to pursue pediatric dentistry than any other race/gender combination. In interviews, common themes were mentioned by participants regarding their pursuit of pediatric dentistry. The value of mentorship was a common theme that aided in all steps through one’s career. Racial factors and discriminatory events were all common occurrences in dental school and residency, as well as occurring at all stages in one’s career. This has led to a constant fear about “being enough” or how one will be perceived in the workforce.

ConclusionPediatric dentistry tends to bring in more diversity in regards to both race and gender, with African American/Black females more likely to pursue pediatric dentistry more than any other specialty. Factors contributing to this positive environment include attending a HRSA funded program, having a mentor who could aid and support one in the career process, exposure to underserved communities in childhood and in one’s dental education, and being able to relate to one’s patient population and minoritized communities.

INTRODUCTION: Minority populations within the US have been growing more rapidly than in the dentist population leading to the underrepresentation of African American, Hispanic and American Indian/Alaska Native dentists. This lack of diversity in the dental workforce has been linked to disproportionately inadequate delivery of dental care to minority populations in the United States. Furthermore, the current diversity-focused efforts in place primarily focus on understanding and enhancing underrepresented minority (URM) recruitment and retention within dental school. While these programs are critical, little effort has been made to track URM providers through education and practice; leaving a major gap in our knowledge of the extent to which the documented disparities worsen beyond professional school and into residencies and specialization. The purpose of this study is to assess the status of workforce diversity in the dental specialties and to understand the pipeline of URM dental specialists. Understanding the current state and pathways of URM dental specialists will inform pipeline efforts and policies to address access to specialty care.

METHODS: Our study used mixed methods to identify and assess the status of workforce diversity in the dental specialties and to understand the pipeline of URM specialist dentists. The approach includes a literature review, quantitative analysis of practice patterns, and qualitative interviews.

RESULTS: This study elucidates the challenges that URMs face in their pursuit of specialization within the dental profession. The pipeline continues to winnow with fewer URM dentists in specialty practice, indicating a small and leaky pipeline. Further, among all URM clinical dentists being first in his/her family to obtain a college degree, having a strong desire to work in his/her own cultural community or joining the NHSC due to debt load independently predicted lower odds of specialization. Alternatively, being initially foreign trained as a dentist and valuing professional training were independently predictive of higher odds of specialization. The geographic distribution of specialist dentists by race mirrors trends seen on previously published race/ethnicity dentist population maps, with African American specialist more densely populated in the South Central and Southern Atlantic regions (53.9%) and H/L specialists more populated in the Mountain, Pacific and some of the Southern Atlantic regions (58.9%). Qualitative findings reveal further details about the challenges URM dentists face along the pipeline including personal attributes (i.e first generation and rural upbringing), inadequate institutional resources (i.e. diversity within the institution and debt repayment options for specialists) and lack of access to mentoring and support.

CONCLUSION: The pipeline that prepares students for careers in health professions continues to leak, and despite individual program successes, cumulative impacts are not enough to improve the disparity that exist. This study shows despite efforts aimed to improve the pipeline of URM students into dental school, there is still a significant disparity that exist as URM dentists continue on to specialize. Further, this disparity has not changed much over time and our quantitative results show continued exacerbation of this gap. The lack of diversity within the dental specialties continues to be a critical factor in our educational system and unless, clear actions centered around this topic are initiated improving the pipeline into residency programs for URM students from beginning to end will continue to be unsuccessful.

Up until the last two decades, the LGBTQ+ population was rarely recognized as a marginalized population within dentistry. Despite the oral health disparities of this patient population, dental schools lack sufficient LGBTQ+ content and dental school leaders majoritively agree LGBTQ+ dental students do not need special academic support provided to them. While demographic information within dentistry is lacking, the United States population who openly identifies as LGBTQ+ is increasing, especially younger generations. It is imperative to both adequately prepare dentists to treat the needs of this community as well as diversify our dental workforce to include more LGBTQ+-identifying dentists. In order to better understand the training and work climate for current LGBTQ+ dental providers, nine LGBTQ+ pediatric dentists were recruited and participated in this study. Semi-structured interviews were conducted with the participants focusing on the inclusiveness of their training and work experiences, instances of harassment or negative experiences, and value of LGBT mentorship within dentistry. Compared with younger participants, older pediatric dentists all encountered negative personal or second hand experiences related to their sexual orientation. LGBTQ+ mentorship, although not a resource available to all participants, was identified as valuable. During dental school and residency, mentors serve as guides and symbols of what they can achieve; in work and early career experiences, mentors serve as outlets of community and networking. Most participants agreed that the collection of sexual orientation demographic information would be a valuable tool, allowing for more focused recruitment efforts for the profession as well as policy changes and improving dental care for LGBTQ+ patients.

During the past century the field of dental care has evolved to be stable, mature, and highly oriented to a set of institutional logics, particularly entrepreneurship and autonomy, that support the traditional organizational archetype (ideal type model) of solo private-practice dentistry. Since the 1970s, dental hygienists have been working to realign the occupational structure in oral health by challenging both the professional dominance of dentistry and the traditional organization of dental care services.

The study combines insights from the sociology of the professions on the agency of emerging occupations seeking to advance a professional project with insights from organization theory on institutional entrepreneurship to explore a case study of the development of Registered Dental Hygienists in Alternative Practice (RDHAP) in California. This mixed-method case study was developed from qualitative data, including key informant interviews, archival data, media analyses, and two quantitative surveys examining the RDHAP work force. A theoretical model for understanding the institutional agency of emerging professions was developed that provides a link between the study of professions and the study of organizations in health care.

This study explores the movement for independent hygiene practice, which entailed a politicized battle between organized dentistry and dental hygiene that played out in their respective professional associations, the legislature, the courts, the business community, and the media. This conflict led to the development of a new category of hygienists who are allowed to work independently in underserved areas and to the introduction of an alternative practice archetype that now co-exists in the field and is underpinned by a unique interpretive scheme (values and beliefs), structures, and systems. The alternative archetype is built on providing mobile preventive dental hygiene care in a collaborative manner within underserved communities and institutions. This new organizational form has not yet been fully institutionalized as it does not yet have the resources and legitimacy of the traditional model. Expansion of the specific model is hampered by a regulatory structure that inhibits the diffusion of innovation across state lines; however, similar efforts are underway in other states, contributing to the wider adoption of this general practice model.

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