Doing the Right Thing

Dental school dean speaks to graduates about past discoveries and those yet to be made

R. Bruce Donoff

This is such a special day for the graduates of the Harvard School of Dental Medicine and Harvard Medical School, the Class of 2018. Congratulations to you and your loved ones who have helped you to reach this point in your lives. You are at a major milestone of a long journey of education and training designed to permit you to help people through the discovery, application and communication of knowledge, competence, compassion and caring. The development of wisdom and clinical judgment through lifelong learning and further experience represents the road ahead.

Each year I associate the graduating class with a particular event or accomplishment. Last year it was the 150th anniversary of the dental school at Harvard University, a momentous occasion recognizing the first dental school in America associated with a university and its medical school. This morning, when I presented the degree candidates to the Harvard president, she welcomed them into a demanding branch of medicine.

Read more about HMS/HSDM Commencement and Class Day here

I can remember your class as a remarkable group of DMD graduates who have published more papers than any other class. Moreover, these scholarly endeavors were on important issues from health care delivery to cutting-edge basic science. This past year, the school went through a full accreditation and received a report with no recommendations—perfect. This is also the last class that I had the pleasure to teach Patient-Doctor I to on Monday afternoons. Will those Holmes Society students please stand up to be embarrassed?

I could not let this opportunity pass without remembering two giants of the Faculty of Medicine, both of whom passed on September 6, 2017, and had an immense impact on the education of Harvard dental and medical students. Walter Guralnick and Daniel Federman will be remembered for far more than the professorships that bear their names. Primarily clinicians, they both saw the importance of the integration of oral health and medicine and worked together to forge important curricular programs. In 1971, Dr. Guralnick championed a program that added surgical training and medical education to the playing field of practice. This first program is now mimicked by almost 60 others; in fact, 11 of you are entering such programs around the country.

Implemented as a Harvard-centric program during the 1980s, it was Dr. Federman who helped permit qualified graduates of other dental schools to enter our program. It was also Dan Federman who called me one day when I was chief of OMFS (oral and maxillofacial surgery) to say that he had attended a session on teaching medical students about dentistry and oral health. So, I at the MGH, along with Steve Sonis at the Brigham, initiated sessions in the essentials of dental medicine for medical students during their clerkships.

Our Initiative to Integrate Oral Health and Medicine seeks to advance the education, clinical practice, outcomes and policy regarding comprehensive disease management and the economic imperative of good oral health. We work with the medical school’s Center for Primary Care to foster integration and hope to create an integrated medical-dental practice that will be a teaching unit for all students.

"We are privileged to take care of people. Treat them well, treat them kindly and treat them with respect."

When I had just become a professor, I had a series of patient encounters that were remarkable because of the patients involved and because each was prescient of the future of health care that you, today’s graduates, are now entering. I had a patient present for a tooth extraction; he said hello and then told me to put on gloves before examining him. Mind you, most dentists and physicians did not wear gloves for general exams at the time. He had just had a bone marrow transplant, developed graft-versus-host disease and had something called HIV infection. A disease that was a diagnosis for death is now a treatable illness. That is part of health care’s past and future and science made it possible.

I also recall a group of a dozen young women with tongue cancer; they had none of the usual risk factors and despite detailed study of them we could not identify a reason for them to have such cancers. However, just recently it was shown that these patients have a marker, PD-L1, which can be a very useful indicator for patients with a relatively well-behaved tongue cancer.

Medical treatment of surgical disease is becoming a reality for dental decay as well as cancers, and science makes this possible. We’ve come a long way since Australian physicians Barry Marshall and Robin Warren won the Nobel Prize in Physiology or Medicine in 2005 for the discovery that gastric ulcers are caused by bacteria. The discovery of Helicobacter pylori was groundbreaking and opened up the study of the human microbiome, which is so important to today’s understanding of many diseases. It will take just one of you to discover how the human immune system turns these normal inhabitants into pathogens.

So, congratulations to the 34 individuals receiving the DMD degree, the seven with honors in a special field, and the six receiving the degree with general honors, the 13 receiving the MMSc degree and the four receiving the DMSc degree. And congratulations to the residents and fellows who are receiving specialty certificates and will go on to make an impact in their chosen fields.

Always remember, we are privileged to take care of people. Treat them well, treat them kindly and treat them with respect. Above all, treat them all equally, with one high standard of care. Don’t allow missions of mercy, thousands of people lined up for free dental care once a year, to become the profession’s scar of oral health delivery for the underserved. Don’t permit our growing elderly population’s oral health needs to be excluded from Medicare.

Your achievements should make you very proud. Those who have helped you reach this day and those who have nurtured and sustained you share that pride. The entire HSDM community and I feel no small measure of joy and pride in your accomplishments. We look forward to your futures with justifiably high hopes.

Congratulations, Class of 2018. I hope your memories of HSDM and HMS will always remain a treasured part of who you are and who you become. Be the leaders you are in transforming our health care world, through science, policy and compassionate care.

Most importantly, do the right thing, especially when no one is watching.

Adapted from a speech given by R. Bruce Donoff, dean of HSDM, at Class Day on May 24, 2018.