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I Knew Beforehand What I Was Getting Into

What has been anemic in moving practicing dentists and their organizations to embrace medical- dental integration is leadership – not knowledge or evidence - there's plenty of that. After much consideration, I knowingly stepped into the ring as a leader in this struggle.

As anticipated, my motives have been deemed suspicious, my abilities questioned, my intentions distrusted. Even ageism now plays a part. But given my declared life's purpose, it was the only thing I could do. The purpose of life is a life with purpose.

And, I have long known that leadership is never given; it is always taken. No one invites you to be a leader.

Leadership is about change, but what to do as a leader when faced with nearly widespread resistance to change throughout the dentist/dental practice space? Resistance to change manifests itself in many ways, from foot-dragging and inertia to petty sabotage to outright rebellion – all of which I am encountering. Gossip is the language of resistance, and there's plenty of that.

It certainly was no surprise stepping into leadership. I anticipated encountering opposition for medical-dental integration by the majority of stakeholders of dental practices. I was also not surprised by some who have spent decades researching and uncovering evidence of the oral- systemic linkages, who have given their time, money, and years would consider me an interloper, an invader, a raider. I understood I'd be stepping into the discomfort of distrust.

I knew I'd be crashing the party, but I knew what had to get done. I knew I needed to be an agent of change. And, I was very clear what accompanies change efforts, having led a few before, what I would encounter.

Loss of control. Change interferes with autonomy and can make dentists and their entities feel that they have lost control over their territory. It's not just political, as in who has the power. The dentist's sense of self-determination is the first thing threatened when faced with this potential change now approaching. Integrating primary care in dental practice appears as a direct threat.


Excess uncertainty. If change feels like walking off a cliff blindfolded, then people will reject it. Dentists prefer to remain mired in misery than to head toward an unknown. To overcome inertia requires leadership to provide a sense of safety and an inspiring vision. A vision of what it will look like when primary care is integrated into dental practice – and how the dentist needs to think and operate.


Surprise! Decisions imposed on people suddenly, with no time to get used to the idea or prepare for the consequences, are generally resisted. It's always easier to say "no" than to say "yes."


Everything seems different. Change brings something different, but how different? Dentists are creatures of habit. Routines become automatic, but change jolts them into consciousness, sometimes in uncomfortable ways. Too many differences can be distracting or confusing. Minimizing the number of unrelated differences introduced by significant change is required for change to happen. Keep things familiar. Keep people focused on the essential things.


Loss of face. By definition, change is a departure from the past. Those people associated with the last version — the ones that did the work, the ones that have thoughts of being superseded — are likely to be defensive. When change involves a significant shift of strategic direction, such as integrating primary care in dental practice, the people responsible for the previous order dread the perception they are not adequate for the tasks required.


Concerns about competence. Can I do it? Resistance to change occurs when it makes people feel inadequate or unable. Down deep, they are worried that their skills will be obsolete. The solution is to over-invest in structural reassurance, provide considerable information, education, training, mentorship, and support systems.


More work. Here is a universal challenge. Change is indeed more work. Those closest to the change are often overloaded and overloaded because of the inevitable unanticipated

glitches in the middle of change, which have to get handled.


Once dentists realize their work prevents heart attacks, strokes, crushes the cycle of prediabetes to clinical diabetes to life-threatening complications; once dentists understand when they get their job done, they will significantly reduce arterial damage to every organ systems, including the brain and gut; once dentists realize they are essential and critical players for the healthcare system to optimally work, they will be open to change.


And that's why this conference, and that's why I decided to lead.

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