Following the murder of George Floyd at the end of May, communities across the world have come together to fight back against racism.
Over the last few weeks, thousands have taken to the streets to push for justice as part of the Black Lives Matter movement.
But is racism felt in dentistry?
We’ve spoken to three dental professionals about their experiences within the profession.
Olumide Ojo
Dr Olumide Ojo – better known as Mide – is the owner and principal dentist at Refresh Dental in Twickenham, London.
Things in the USA have clearly been going wrong for some time, for example with Breonna Taylor and Ahmaud Arbery. But when I saw the George Floyd video, I felt sick. This was the clearest sense of injustice – a man asking to save his life while there were five officers watching him die. All of them would have heard him say he can’t breathe but they either didn’t believe him or didn’t care – and I think it’s the latter.
Overall, I have got slightly more positive views to some other people. I have had experiences in the past but I wouldn’t say they’ve been mainly negative. Despite that, I feel enough is enough.
This time, we need to stand up together and not just black people. I mean white people, Asian people, people of any origin. I feel very positive that there’s actually been a movement and I feel like this is an opportunity that we can’t let pass. That’s why I feel so strongly and that’s why I’ve shared so much on social media.
Dearth of positive black role models
Dentistry isn’t any different to any other part of society. It reflects what society is. When I was in dental school, I was one of very few black people in the school and that may or may not be representative of society. In my dental school, out of around 500 or 600 students there were about three or four black people.
That might be within the norm, but what I can say all positions of authority – such as deans, associates and lecturers – consisted of a very small number of black people. I believe there is a dearth of positive black role models for many of us to aspire towards in the industry.
Would I say that dentistry is inclusive? I’d say that certain aspects are very inclusive. I’ve never felt any discrimination in terms of any jobs or positions I have got. However, when I was applying for certain jobs I’d say there were situations where if your face doesn’t fit, people won’t give you a job or even an interview. It can be subtle but it is still there and is a big issue for many people of colour.
I see it from a business point of view – some people might work in an area with a certain demographic of patients. Subconsciously they might think: ‘Will this young black guy fit in in my area where they’re all 40 – 60-year-old white people?’
I wouldn’t call that overt racism. I say that’s people stereotyping and trying to make a subconscious decision. What I would call overt racism is when somebody stops you from getting an opportunity purely because of the colour of your skin. When they think you’re less able or less talented.
Reassurance and confidence
I don’t think I’ve had any experiences of direct racial discrimination from colleagues; I can think of some indirect scenarios but I would rather not mention those now. There have been incidences with patients, especially when I was younger and first starting out. You lack experience and you lack confidence as well and some patients can pick up on that.
Given the fact that they are uncomfortable anyway and then they think you’re lacking confidence – the two things play together. I think age and experience can teach you to manage all different types of people.
I think it can vary depending on what part of the country you’re working in. When I was in the north east working in a remote mining town, I think some patients might have been a bit more shocked when they saw a young black dentist, as opposed to south west London where I have worked for the last seven years.
But to be honest, most people give you an opportunity to make an impression despite any initial preconceived opinions. I’m confident and confident in my own ability. I’m able to reassure the majority of people that I’m here to help and dispel any initial resistance.
Examples of disparities
There are a few incidences that I would like to share, although subtle and not overt.
Cases of a mistaken identity grate a bit. When I was younger, one of the other dental students sent an email from my account to the whole of the dental school. When they found out about it, they threw the book at me and threatened me with expulsion and all sorts of things. It was a pretty fierce response. When I told them that somebody had hacked my account and sent the email, they were obviously apologetic initially.
But the person who actually did it – and who wasn’t black – got a very, very minor slap on the wrist. The difference was stark! On reflection, this was quite a big thing. I’m not going to put everything to race. I’m going to let other people make their own decisions. But there are some examples of disparities.
Mistaken identities
The second circumstance was when I had been in dental school for five years. I had a colleague – I’m from Nigeria and he’s from Sierra Leone. We were at the same dental school. I was very good at attending lectures and I was always on time. My friend was not so good at keeping time and he was late on quite a few occasions. On one occasion I had been in the clinic for about half an hour doing my thing – but then the consultant came over and started shouting at me.
He said he was sick and tired of me being late all the time. I told him I had been there for half an hour and that I think he was referring to my friend. He was absolutely mortified! It was an embarrassing situation but one that the whole year group saw and one that featured in our end of year school book as a topic of debate. I would be interested to hear what my non-black friends think of this now.
When I had been applying for private dentistry jobs for around three years, I didn’t get one single interview or shortlist. I believe my CV and my clinical skills were strong. In the end, I met another black dentist at a prestigious conference who was incredibly successful in dentistry. His name is Martin Wanendeya.
I explained my situation and he offered to mentor me in terms of getting my CV up to scratch. I went to see him and after seeing it, he told me my CV was brilliant. He told me where I needed to strengthen and offered me a position in his practice.
Importance of black mentors
That’s how I got my break in private dentistry. It was really inspirational to be mentored by both him and Nik Sisodia at Ten Dental. I think at the end of the day, you often gravitate towards people who you have similarities with. It was very inspiring to see a black man be so successful in practice. I worked with them for six invaluable years and had a fantastic time.
And it was off the back of that I had the confidence to open my own practice – Refresh Dental Practice in Twickenham. I’ve been very fortunate in that I have mentored quite a few young black dental students. I believe everyone needs a helping hand so if I can do what Martin and Nik did for me, I can also give opportunities to the upcoming generations.
I do feel strongly about this; I’ve recently mentored two young black dental students through their final exams and vivas. There aren’t that many of us out there but I want to show them we can succeed and be a proper role model.
Colour shouldn’t be an issue
I can count on one hand the number of well known black dentists there are – and I know that I’m one of them. I would say I’m one of four or five who are well known in the UK. Black people can be just as good as anyone else.
It is worth noting the lack of black dentists in the Top 50 influential dentists awards each year – I feel there may be an oversight here. Colour shouldn’t be an issue. We shouldn’t settle for being a mediocre dentist – they should want to be the best and can be the best. We are just as capable as anybody else. It all comes down to hard work.
I feel I am very privileged to have achieved what I have so far. I have set up Refresh Dental practice and I am a business partner in a start-up dental company called Smilefast. Additionally, I have set up a Facebook group with over 1,000 young dentists where I mentor them in practice ownership and self development. I’ve worked really hard to get where I am but I fear I would not have had this opportunity if it wasn’t for someone of colour taking a chance on me.
Young black dentists should stand proud. There’s a community here that’s helping – like the African & Caribbean Dental Association – to level the playing field a bit and give us equal opportunities.
Chinwe Akuonu
Chinwe Akuonu is a dental hygienist and final year student at King’s College London. She has worked in both the UK and Italy.
Ever since the murder of George Floyd, I have felt a multitude of negative emotions. This episode of cruelty has not only stirred up anxiety, rage, pain and sadness, but has also caused past, bad and suppressed memories to resurface.
I am normally an optimistic person. But the past few weeks have been terribly unpleasant and hurtful. I cannot comprehend how human beings are capable of such hatred.
As I have watched prominent faces of the black community speak up on various social media platforms, I have felt the need to talk about personal and professional episodes of discrimination I have encountered. My friends and followers on Instagram have already noticed a change in my posts and content as I have conveyed my frustration over multiple racist scenarios and episodes.
As a dental professional, I have been asked to share my opinion on racism within the dental profession. Dentistry, like healthcare professions, has struggled with the historical legacy of being conceptualised as a ‘white’ profession (Adams, 1998).
I personally think whether we like it or not, and as difficult as it may be to accept, prejudice and racial bias is omnipresent. No single profession is exempt.
Treatment refusals
Discrimination in dentistry exists, both towards black patients and black dental professionals. I am a witness to this as a registered dental hygienist who has worked in two different European countries – Italy and the UK.
In Italy, where the dental profession is a monotonous niche, with rarely any kind of diversity, I have had patients use racial slurs against me and refuse treatment by me. I once had a mum who made her innocent six-year-old daughter get off the chair when she realised I was the one going to place the fissure sealant on her daughter’s teeth.
In the UK, I currently live in London, which obviously offers a more diverse scenery than Italy. However, that does not mean things are perfect because covert discrimination is still very much present. Current statistics confirm the lack of ethnic diversity in UK dentistry. This is a problem for the profession from an equality and diversity perspective, especially for those from a black British background.
Persistent numbness
I have had those days where I felt that cold chill down my spine, reminding me that some patients or even dental staff were uncomfortable around me. Whenever I cover a shift in a new practice, I am numb to that occasional comment of: ‘Sorry, I’m not used to seeing another hygienist’. On its own, this is not considered an offensive statement. Dental practices normally inform patients they will be seeing a different hygienist beforehand.
The only difference is that the receptionist probably forgot to specify I was black. As a result, the patient had to deal with the shock on the spot by making up an excuse and refusing treatment.
I am numb to those comments of: ‘Oh, I wasn’t expecting you to be so brilliant’. Because, of course, a black person’s intelligence and capabilities are always underestimated and it’s a miracle if I am excellent at what I do.
The saddest part, as I mentioned above, is the persistent numbness to all of this.
Oppressed mindset
I am ashamed to say that sometimes I have even felt grateful that, at least, no racial slurs were used and that the situation didn’t escalate. As I write these words, I cannot stress enough how no one should ever have to feel grateful for being partially discriminated, rather than fully humiliated.
That thought is the result of an oppressed mindset. Unfortunately, this is what racism does to us people of colour. We adopt coping mechanisms that are detrimental to our emotional and mental health. We try to find a bit of positivity even where there isn’t.
In regard to black patients, Patel et al studies (2019) have shown that unconscious racial bias may affect dentists’ clinical decisions on tooth restorability. This results in a greater likelihood of extractions, rather than root canal treatments for black patients presenting with a broken-down tooth or with symptoms of irreversible pulpitis.
Discriminatory acts also persist at administrative levels. Until today, I cannot comprehend why each time I need to fill an application form that may benefit me in one way or another, there always seems to be an administrative error that occurs.
It frustrates me that, unlike my peers, I have to beg for something that is rightfully mine. The worst part of this is when you think it is all in your head. The only time I get results is when I begin to raise attention to the fact that I am being discriminated, which I think is absolutely pathetic.
More diverse but still a minority
Another point to draw to your attention is the lack of black voices as experts in the profession. Most dental advertisements I am aware of include white and Asian faces but no black faces. Could this be because black dentists constitute a minority in the profession? Or could it be that a black face may appear less appealing to the audience?
Although there is evidence the profession is becoming more diverse, black people are still a minority. I also speak as a current final year dental student at King’s College London and I can confirm that black British students are seriously underrepresented in UK dental schools (2%).
In my cohort, only 6% of the students are black. If we are already a minority at a training level, we definitely will be at a professional level. Indeed, according to Berryman’s 1983 ‘pipeline’ model, the success of minority groups in certain disciplines or professions is dependent on their ability to move through three key phases. First, gaining access into the profession; second, their successful participation in and completion of professional education and third, how they progress into and develop their career (Cronin and Roger, 1999).
Celebrate successes
I personally think it’s at these three same levels that the problem may be tackled. Examples of what needs to be done within the wider profession to improve inclusiveness and reduce discrimination include:
- More visibility should be given to black dental role models. The positive impact that role models play in shaping peoples’ dental career has been identified in research (Mohamed Osama and Gallagher, 2017). This may result in young black children considering dentistry as a profession and increasing the number of applications to dental school. In addition, barriers and challenges preventing black students from aspiring to dentistry need to be investigated and monitored
- During professional education – it is important for black students to receive support rather than be excluded and forgotten. Their integration with the rest of the community should be monitored
- During our career life, our successes should be celebrated as much as others. We should be encouraged to speak up about racism, be courageous and point things out so change can occur.
Finally, I am grateful for the opportunity to publicly voice my opinion in this article. This gives me hope that people in the dental profession are willing to educate themselves and raise awareness of the presence of discrimination, rather than turn a blind eye and depend on quantitative data to justify and support the presence of ethnic diversity.
I sincerely pray for the beginning of a new era. A lot of work will be required, but as we all know, every step of the journey counts. This is just one out of the many more to come.
References:
Adams TL (1998) Combining Gender, Class, and Race: Structuring Relations in the Ontario Dental Profession. Gender & Society 12(5): 578-7
Berryman S (1983) Who will do science? Trends, and their causes in minority and female representation among holders of advanced degrees in science and mathematics New York, NY: Rockefeller Foundation.
Cronin C and Roger A (1999) Theorizing progress: women in science, engineering and technology in higher education. Journal of Research in Science Teaching 36(6): 639-61
Mohamed Osama O and Gallagher JE (2017) Role models and professional development in dentistry: an important resource. The views of early career stage dentists at one academic health science centre in England. European Journal of Dental Education 1-7
Patel N, Patel S, Cotti E, Bardini G, Mannocci F (2019) Unconscious racial bias may affect dentists’ clinical decisions on tooth restorability: A randomized clinical trial. JDR Clinical & Translational Research 4 (1): 19-28
Yewande Oduwole
Dr Yewande Oduwole recently graduated from Peninsula Dental School. She is the winner of the FGDP (UK) Dental Student of the Year Award.
It has been an extremely difficult time not only for members of the black community but for everyone that understands that inequality, police brutality, injustice, and racism still exist today. George Floyd was murdered for something that did not deserve death. This has been a common trend for black people, seen in the cases of Rashan Charles, Sheku Bayoh, Sarah Reed, Trayvon Martin, Tamir Rice, and countless others.
The one thing they all have in common is the colour of their skin. The only difference with the death of George Floyd is that it was caught on camera. The entire world was forced to watch. He constantly repeated the sentence ‘I can’t breathe’. As healthcare professionals, these three words would immediately incite worry and evoke a natural instinct to help. A life is at risk of being lost. Despite this, his outcries were ignored.
The police officer continued to place excessive force on his neck for a total of eight minutes and 46 seconds. This tragedy led to global outrage and protests to stop this once and for all.
Empower generations
Black Lives Matter is a great movement that has ignited a real opportunity to raise awareness about the imperative need to improve police relationships, economic movement, and education. I hope this movement will empower not only this generation, but future generations to come.
It is a shame that some do not understand the movement and focus on the few that have disengaged in peaceful protests. I have also observed people responding in defence with the often well-intentioned problematic statement: ‘All Lives Matter’. This is true – all lives should be treated equally. However, this phrase contradicts itself – if all lives mattered why are black people facing racism and inequality?
The issue here is that it essentially dismisses and overlooks the racism towards black people and the danger they face. Imagine you had a tooth that was causing you pain. Imagine it constantly kept you up at night and started to have a negative effect on your life.
But when you went to the dentist for support, the dentist did nothing to help. Instead, they respond with ‘All Teeth Matter’. That would be ridiculous, right? Well, that is what saying all lives matter sounds like, as it completely dismisses the main issue at hand.
Beginning of a call for change
‘When you’re accustomed to privilege, equality feels like oppression’ – Unknown
I feel like the murder of George Floyd is the beginning of a widespread call for change. It has raised awareness and highlighted the fact that racism and inequality still exist in today’s societies. It has sparked global change and given me hope for future generations.
My experience in dental school has been positive overall, although I have experienced instances where colleagues would speak to me differently than they would to their white counterparts. They would deliberately try to use colloquial ‘slang’ terms or generally make stereotypical statements which did get irritating at times. However, this is something I often looked over.
The majority of my patients have been lovely, and I have had no issues – although something small that constantly serves as a reminder that I am different is my name. There were patients that I saw every week but unless I said my name numerous times, no effort was taken to remember it or learn how to pronounce it properly.
It’s an unfamiliar name to them and this did get frustrating at times. But again, it’s something I typically brushed over as sometimes these issues are due to ignorance as opposed to racism.
‘I’ve never seen a dentist like you before’
James Nwaduba a fifth year dental student shared his personal experience with me: ‘Being a black student with very basic educational opportunities and being the first generation born in the country from a migrant family, I have found that the odds of getting into dental school have been heavily stacked against me.
‘Furthermore, after arriving in dental school it felt very apparent that I had a very different upbringing from my peers. This certainly made it harder to fit in. Over time everybody grew older and wiser and learnt to accept each other. But in the early days, it was very apparent that people of a certain “type” would come together making me feel somewhat left out.’
I spoke to a few more black dental students to find out more about their experiences. It was interesting to discover some of the things they have been through. This included feeling like they have to work harder or keep a low profile as they will be the first to be circled out or being labelled as ‘aggressive or intimidating’ due to inherently negative attitudes about black people.
They also voiced being mistaken for another black student despite looking nothing alike. There were reports of fellow colleagues casually using the ‘n-word’, people randomly touching their hair and supervisors displaying micro-aggressions towards them. They have experienced patients refusing to shake hands and displaying a clear change in demeanour, or making statements like: ‘I did not expect you to be the dentist. I’ve never seen a dentist like you before’.
Casual racism almost expected
As you can imagine, it is easy to develop imposter syndrome having to go through this experience and being hyperaware of your race whilst completing a demanding degree. This can eventually begin to take a toll on one’s mental health. Sadly, casual racism has become the norm for black students and is almost expected to happen at some point.
As a whole UK dental schools endeavour to be inclusive and non-discriminatory. It was refreshing for me to see during my time at Peninsula Dental School that students’ individual needs were catered to. People received authorised absence for religious holidays namely Diwali and Eid. There was also an understanding approach to religious jewellery, turbans and hijabs in addition to providing spaces for prayer on all of its sites.
Students from BAME background could also get an opportunity at least once a month to sit on an equality and diversity committee. This included some of the heads of the school where discussions would take place on how to make the school more inclusive to all ethnicities and religions.
As of recent, many universities have released their own Black Lives Matter statement, which is very reassuring. However, there are still some issues to touch on in regard to equality and race in dental schools.
Disparities in black representation
A review of the 2016/17 Higher Education Statistics Agency (HESA 2017) data on the ethnicity of medical and dental students indicates a majority ‘white’ composition (63.5%), followed by Asians (24.1%) and Black (3.7%) groups. ‘Others’ were recorded at 7.15% and 1.5% were ‘unknown’. It is clear there is huge disparity in the number of black students represented in dental schools.
The reasoning behind this cannot be explained simply as it has many contributing factors. The questions that need to be asked here is are there enough black students applying to dental school in the first place. If so, why are so few being admitted? Is it because their applications are weaker or is there some form of underlying racial bias?
Between 2010-2014 an average of 44.4% of British-Asians applied for dentistry. Of those who applied, 37% were accepted. This compares with 41.6% of white students applying to dentistry, with 52.2% of these being accepted over the same time period. Only 2% were black British students. In 2014, specifically 135 black students applied and 25 were admitted. When compared with university admissions overall, it would suggest that Asians are twice as likely to be represented in medicine and three to four times as likely in dentistry (Gallagher et al, 2017).
It has been found through research that pressure from Asian families for their children to pursue reputable and high-status professions, like dentistry, has been put forward to explain the representation of British-Asians that apply to dentistry. The positive impact role models play in shaping people’s dental career has also been identified in the research (Mohamed Osama and Gallagher, 2017).
Difference in opportunities
I feel that socio-economic background has a huge part to play. The majority of dental students often fall into two categories; either someone in their family is a dentist or doctor, or the student has come from a more privileged background likely paired with private or grammar school education. Then you have the few who don’t fall into either of these categories.
With no family figures to look to for help and no network of professionals to turn to, disadvantaged students walk into the application process completely blind. They can easily take the wrong approach and ultimately lose motivation.
It is clear that there is a difference in the opportunities. The question is should we continue to let these socio-economically programmed disadvantages continue or look to see tomorrow’s health professionals represent the population that they will be treating.
It is great to see such organisations such as the African and Caribbean Dental Association UK (ACDA-UK) and Melanin Medics working hard to bridge the gap in order for the narrative to be changed.
Dentistry is a compassionate profession in which racism, inequality and discrimination should play no part – but unfortunately, they do. The demographic composition of the dental workforce should be ethnically representative of the public, and we must ensure that dentistry is an equal opportunities profession.
Importance of multicultural health force
It is rare to see a black dentist in a position of leadership in the dental profession. It is not a case that they are not applying for the roles, but in the majority of instances these roles are not widely advertised, and nepotism occurs. For the past three years, out of those listed in the Dentistry Top 50 only one person was black.
It is not the case that successful black dentists don’t exist – they certainly do. But they may not be given a seat at the table or equal opportunities. This sends out the wrong message to aspiring young black dentists if they see no one in positions of power who look like them.
Figures show that fewer than 1% of the professors employed at UK universities are black. Few British universities employ more than one or two black professors, which again shows a huge disparity. Earlier this year, the dean of the Faculty of General Dental Practice FGDP (UK), Ian Mills, called for the leaderships of dental organisations to better reflect the diversity of the profession. This is something that definitely needs to happen in the future. It is widely acknowledged there are many social benefits to having a multicultural health force.
Everyone has a role to play
Additionally, for change to occur dentists need to examine their own unconscious racial bias. Patel et al (2019) conducted a randomised controlled clinical trial and found that dentists’ decision making was affected by the race of the patient. This resulted in a greater likelihood of extractions (less RCT) for black patients presenting with a broken-down tooth and symptoms of irreversible pulpitis. This demonstrates the effect that unconscious implicit racial bias may have on treatment planning decisions.
Overall, I feel that everyone has a role to play in ensuring that equality and diversity continues to improve in the dental field. Ijeoma Oluo put it perfectly by saying: ‘Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And that’s the only way forward.’
I believe that one day we will be able to reach a point where diversity in every field thrives. Each person will be able to fulfil their maximum potential and receive fair treatment, irrespective of the colour of their skin.
References
Neville P (2018) Exploring the ethnic diversity of UK dentistry. MedEdPublish 7(1): 55
Gallagher JE, Calvert A, Niven V and Cabot L (2017) Do high tuition fees make a difference? Characteristics of applicants to UK medical and dental schools before and after the introduction of high tuition fees in 2012. British Dental Journal 222(3): 181-90
Mohamed Osama O and Gallagher JE (2018) Role models and professional development in dentistry: an important resource. Eur J Dent Educ 22: e81–7
Patel N, Patel S, Cotti E, Bardini G and Mannocci F (2018) Unconscious Racial Bias May Affect Dentists’ Clinical Decisions on Tooth Restorability: A Randomized Clinical Trial. JDR Clinical & Translational Research
