Neil J. Gajjar, DDS, MAGD, was installed as president of the Academy of General Dentistry (AGD) on Sunday, November 4, 2018. The following are excerpts from his speech to the AGD House of Delegates.

Good Morning!

Officers, delegates, dignitaries, guests and friends, it is a great honor to be here today, and a tremendous privilege to serve as president of the Academy of General Dentistry. I have been active in the Academy since I graduated from dental school in 1999. I love what this organization stands for, what it does for the profession, how it allows us to connect with our colleagues, do more for our patients, and continually support dentistry. I know all of you here today share this enthusiasm, and I am excited to be working with you.

This is a very exciting moment for me, and I thank you for your support in electing me as your president of this esteemed organization we call the Academy of General Dentistry, the world’s largest organization made of general dentists, formed by general dentists, for general dentists and our patients.

It is a very proud moment for me to be up here as very few Canadians have made it this far and I appreciate your confidence in me.

-------

My goal is to cover three areas today: where we were, where we are and where we are going. With that said let’s get started.

For those that have not had the opportunity to meet Max, let me assure you that the AGD is in good hands for many years to come. In the last 10 months, Max has experienced all the AGD has to offer and he always looks at the positive. With experience in dentistry, marketing and business, coupled with his calm and analytic personality, he has proven to guide us down the best path for the AGD while managing the various personalities and opinions that come with every decision we make. I am not only lucky but fortunate that the honeymoon period comes to an end as I start my presidency and look forward to working with him, the rest of our leaders, and staff to propel the AGD into the future, giving members what they want and giving non-members a reason to join.

One thing that I have learned serving at the AGD is that people genuinely mean well and want a good outcome for the AGD. That has been the core of our success, our people. We must think big, take a chance and give it all we got. Only then, if the concept fails, we at least know that we did our best. We have learned to take chances with and trust each other, and sometimes those results have surprised us all.

Thankfully, we are in a better position than most organizations. However, we all share some of the same concerns, mainly a decrease in membership numbers and revenue. The main reason for this is due to relevance. We must answer why we started, why we exist, and what we can offer our members. At some point in history, we took our eye off the ball.

Let’s go back 66 years to 1952 when the AGD first started. We started as a continuing education group offering our colleagues the best in continuing education so that they could provide patients with the best possible care. We also became an organization that tracked continuing education so that every member knew what they had studied and could focus on other areas they needed to grow. We acted as the blueprint or checklist where dentists could ensure that they took education in all disciplines making them the best well-rounded general dentist. Finally, as a group of dentists, we fought to protect the services we could offer our patients, ensuring that they always had access and could afford the best possible treatment by general dentists.

So, what happened? We got caught up in the numbers. My Dad always said, do what you do well, and the numbers will come. Do something for the numbers, and you are destined to fail. We diversified and tried to be something to everyone ending up being nothing to all.

Dentists became members and engaged in the AGD to learn from each other. They learn clinical tips and tricks to make life easier for themselves and their patients, they learn practice management tips, sharpen their clinical skills and have the ability to teach others what they have learned advising what has worked and what has not. Small things that no one ever taught me at school, I’ve learned from my outstanding colleagues at the Academy of General Dentistry. This is the core of the AGD membership.

First, we need to re-visit the idea of market-share. Our organization started as the AGD dentist being a dentist dedicated to continuing education and being on the cutting edge of providing care. If we have 100 percent of market share, we now become a taxing body, and there is no difference among general dentists, they all are AGD dentists. I want to ensure that an AGD dentist maintains the prestige associated with their membership, a special and unique group, and I believe our maximum market share must be less than 50 percent, and we must determine our membership fees on that number. Not that we will grow into a number that goes against our very existence.

Secondly, continuing education has exploded around us. There is so much competition in an already super-saturated market. And sadly, it has just turned into a business for most. So how do we stay relevant and ensure we are presenting the most wanted CE?

We do it by looking at new and novel methods of delivering continuing education and appeal to the new ways of learning and teaching that most of our competition has not and will not adopt. Webinars were a start, but even that is now passé. The way learning is taking place now is through interactive apps that show procedures, explain procedures and ask interactive questions throughout the modules. We have seen gaming become a big part of learning, something we were the first to introduce with FAGD and MAGD. Get points in different categories and get rewarded for completing the mission. The latest and greatest concepts revolve around the learning through play process. Make learning fun, and you are guaranteed to fill electronic or physical seats, increasing revenue while making the AGD the leader in CE.

Thirdly, we started as the pioneers of tracking CE, but our systems have been slow to keep up with advances in modern technology. We need an electronic platform where people can register for courses electronically, select meal choices and dietary restrictions, obtain CE certificates electronically and store receipts and travel expenses for IRS/CRA purposes. The process should be as easy as locating and registering courses from your phone, scanning certificates (AGD and others) with a camera from your device, uploading, tallying that data toward the category and credits where they should be applied. I can tell you that no one has done this and not because it can’t be done. It can and must.

If we want to grow, we need to advocate more for our members. We understand there are two categories of members, those that are employed and those that are self-employed. We need to tailor our plan to advocate for both groups and protect our members, the general dentists. But more so, we need to protect the public from the bogus argument that access to dental care is access to dental care regardless of who provides it. We want to ensure that every individual is protected to ensure our patients receive the best possible care: that offered by an AGD dentist. We also need to keep that care affordable by preventing delivery from those providing substandard care who lack the training of a general dentist.

Finally, we need to make the public aware of who we are: that AGD dentists are an elite dentist dedicated to continuing education and delivering the best care possible for their patients and the public. We need to be engaged at all levels of traditional media, social media and outreach so that people see that we truly make a difference in their lives through our dedication of providing optimum care.

The old philosophy that if it is not broken, don’t fix it, will eventually kill you. It’s a problem most fortune 500 companies are experiencing as the old guard aims to get a few more years out until they retire. Sadly, these corporations will be pushed into early retirement if they do not keep up and stay ahead of the next big thing that will wipe them out because it's better and cheaper. We need to dream, and if we believe we can be there, the reality will be that we are there. We need to be willing to take risks. Not all outcomes may be favorable, but what other choice do you have but to keep trying for that one big game changer that no one knows will be.

As we head into the future, we will see technology play an even more significant role in our field. Technology is getting better. With new smartphones, when was the last time you bought a camera? I remember growing up and making my dad buy an SLR, which I still have. I was forced to carry it and learned to hate it quickly during trips. Especially when you had to check it in for rides that took away precious time from having fun. Now we have that technology in our phone, far better than the SLR I had growing up.

With tele-dentistry, patients can take photos of their teeth and smile to have diagnosis and treatment planning performed in other countries where labour is cheaper or even by computers deploying artificial intelligence. We may also see the incorporation of infrared and other short-wave photography built into smartphones allowing people to look inside their teeth enabling diagnosis via downloadable apps. Who will monitor these practices in the future and protect the public from harming themselves?

Let’s look at CAD/CAM. We have the technology today that we can deliver four crowns in one hour if appropriately managed. Technically, we can charge $250/crown, so will the cost of dentistry decrease?

As we move forward, we will be able to take a picture of the prep with a smartphone and send it to a digital printer for an instant crown. Thus, reducing time, costs and solving access to care.

But there also lurks the dangers. What if a patient goes to Walmart for a laser-thin ceramic like veneer from a photo lab type setup? What will this mean for dentistry? I guarantee that you will see it in optometry where you have the smartphone take a picture of your retina and Amazon will bring you your glasses/contacts, but laser may even eliminate this need altogether.

Too far fetched?

We have already seen the ability of a person going to a department store to have their teeth scanned and had aligners delivered to their door to align their teeth without any dentist supervision. Will this be a good thing or bad thing for general dentists? We thought that home whitening kits in department stores would mean a hit on our production, but what happened was an increase in consumer awareness and an increased demand for services provided by dentists. It won’t be long before you see kiosks in malls where you have spa technicians polish teeth for our population of narcissistic individuals.

I watched the movie Downsizing on the flight from FDI and realized it was a movie shot at our friends’ home in Toronto. The movie is about reducing the size of people to a scale of 1:15, putting less strain on resources and providing more things cheaper. What caught my attention was that they were not able to scale down the dental restorations and so had full sized dentists remove all the restorations and mini dentists replace them after the downsizing procedure. It made me happy that there will be more demand for our profession. But, later in the movie, one person's head exploded and died as a result of the dentist not removing all of the restorations. At first, I laughed and then realized that it made our profession look bad, that we are incompetent. These are the things we need to scan for and ensure that we protect the image of our members. We are in the top five of the most trusted people based on our profession, even higher than clergy.

Changes are happening all around the world that are radical, and I believe its time to make some radical changes at the AGD. In India, they eliminated ₹500/₹1000 notes and in doing so eliminated corruption and tax evasion. In, Toronto, they cut the city council in half to make them nimble and expedite decisions. Only time will tell if these changes were productive and good for the public, but if we don't make changes, people will continue suffering, and society may continue in a backward manner.

We cannot operate the same way we did 40 years ago when members came by horse and carriage from all over the country to make policies, to make the profession better and deliver better care for our patients. We have planes, emails, smartphones, video conferencing and have to start deploying this and newer technology to deliver quicker and better results.

Finally, as we move forward, we will be tasked with new ethical issues. Plan to see designer babies where malalignment and caries susceptible teeth along with wisdom teeth are wiped out of the code. Plan to see implants replaced by seeds being placed at sites to grow new teeth. Where are we heading, no one knows, but change is the constant. How will we be involved in these ethical debates and how will they affect our profession?

Infection control will also come full circle. We started with sterilizing surgical stainless steel, which slowly got replaced with disposables, adding costs and adding more to our landfills. Now with many restaurants and governments eliminating plastic straws, it is only a matter of time before someone sees the dentists as the big bad wolf, contributing to our environmental problems.

This is going to be a major image issue for us, and we need to get in front of it. Do we start by advocating the elimination of plastic/disposable three-way syringe tips? Again, tough decisions that we need to tackle for our profession, our patients and the public.

Technological changes, coupled with generational differences, expectations and entitlement. In a generation where we have seen stores like Sears and Kmart become too big allowing someone with lower costs and better products takes over their empire. When we expose ourselves to so many things that will come up that we can’t even predict, we need to prepare for not only what we know but be ready to handle what we least expect. We must be able to change course or chart a new course quickly and efficiently to stay relevant for our members. We must all work together to develop such systems and continue to move forward ensuring the AGD not only remains relevant but also an association where everyone aspires to join as a member and become a leader.

Remember, we all studied Darwin. It is not the survival of the fittest, but the survival of those that are quick to adapt to change.

As AGD leaders, I now turn to you and ask that you raise your level of commitment to the organization too. I want you to know that we want and need your constructive feedback and input on how AGD can do more for general dentists. What tools, what benefits, what enhancements increase the value of membership? What education do you need? What resources can help you in your practice? And how should we advocate for you for your patients? No one knows better than our leaders. Your challenges are our challenges. Please know that we do listen to you and take your comments seriously, so don’t ever hesitate to let us know how we can help you and improve AGD. Don’t ever hesitate to let us know how we can prepare for the future. What may seem like a silly idea, may be the next big game changer. We need to be open and engaged, and we need to do it together.

I look forward to working with you all. Thank you for your support, guidance, and dedication for the AGD. I’m Neil Gajjar, serving you as your AGD president.