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Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 4-7

Prerequisites in Behavioral Sciences and Business Revisited a Decade Later: Ongoing Opportunities for Dental Education

Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, East Campus Loop South, Lincoln, NE

Date of Submission15-Aug-2020
Date of Decision30-Aug-2020
Date of Acceptance20-Sep-2020
Date of Web Publication2-Mar-2021

Correspondence Address:
PhD David G Dunning
Professor of Practice Management, Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, East Campus Loop South Lincoln, NE 68583-0740
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/denthyp.denthyp_133_20

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Introduction: Ten years ago a study reported on the lack of prerequisites in behavioral sciences and business management for entry into dental college. The primary objective of this follow-up study was to assess the current status of similar prerequisite courses in both U.S. and Canadian dental schools. Materials and Methods: Required and recommended courses in behavioral sciences and in business in each North American dental school’s official online publication were analyzed in December 2019. Admissions requirements were readily available in sixty-five of the sixty-eight U.S. dental schools and in all ten schools in Canada; three U.S. schools were contacted by phone to collect the information. Result: Only nine (13.2%) U.S. and four (40%) Canada schools required at least one behavioral sciences course; however, thirty-nine (57.3%) U.S. and six (60%) Canada schools recommended a behavioral sciences course, most often in psychology, sociology, or communication. Zero (0%) of the total seventy-eight dental schools required a course in business; however, eighteen (26.5%) U.S. and two (20%) Canada schools recommended a business course, most often economics. Conclusion: The authors strongly encourage the dental education community to again reconsider establishment of a minimum core of behavioral sciences and business courses as prerequisites in predoctoral dental education. Doing so will provide a much needed stronger foundation upon which to build upon in the curricula of dental schools.

Keywords: Dental academic affairs, dental admissions, dental curriculum, dental education, dental matriculation, dental prerequisites, dental students

How to cite this article:
Beckler RM, Nuckolls NA, Dunning DG. Prerequisites in Behavioral Sciences and Business Revisited a Decade Later: Ongoing Opportunities for Dental Education. Dent Hypotheses 2021;12:4-7

How to cite this URL:
Beckler RM, Nuckolls NA, Dunning DG. Prerequisites in Behavioral Sciences and Business Revisited a Decade Later: Ongoing Opportunities for Dental Education. Dent Hypotheses [serial online] 2021 [cited 2023 Jun 2];12:4-7. Available from:

  Introduction Top

Martin Luther King Jr. once declared that “the function of education is to teach one to think intensively and to think critically. Intelligence plus character − that is the goal of true education”.[1] The essence of this concept of learning is seen clearly in the field of dentistry, where a dentist is found in a unique position as healthcare provider and business, patient, and staff manager. A dentist is expected to possess the knowledge required to care for the oral and systemic health of the patient, the character and social strengths to care for the emotional state of the patient, and the business acumen to manage overhead and motivate staff.[2],[3] On any given day, a dentist must juggle leading their staff, managing emotional patients, and monitoring daily business practices such as overseeing insurance claims processing and monitoring accounts receivable.[2],[3] These responsibilities are in addition to clinical procedures and required paperwork for medical consults, patient progress notes and prescriptions.[2] To meet these daily demands, dentists need to facilitate both business and behavioral science skills in addition to clinical skills and an understanding of basic sciences/medicine.[4] Millichamp and Ayers astutely claimed in 2004, “in the field of dentistry, knowledge and technical skills are not the only prerequisites for good practice. An ability to communicate effectively with patients—in particular, to use active listening skills, to gather and impart information effectively, to handle patient emotions sensitively, and to demonstrate empathy, rapport, ethical awareness, and professionalism—is crucial”.[5],[6] The benefits of exercising skills related to behavioral science are measurable, including “increased patient satisfaction, improved patient adherence to dental recommendations, decreased patient anxiety, and lower rates of formal complaints and malpractice claims”.[7] The importance of a dentist being comfortable with business concepts such as marketing, loan procurement, and accounting[2] must also be emphasized. Dental schools are burdened, now more than ever, with the responsibility of preparing the future generation of dentists with a foundational understanding of practice management and leadership skills to thrive in today’s environment.[2],[8] This assertion is supported by the Commission on Dental Accreditation Standard 2-19, which states “graduates must be competent in applying the basic principles and philosophies of practice management, models of oral health care delivery, and how to function successfully as the leader of the oral health care team”.[9] The expectation is clear, yet according to the 2016 American Dental Education Association (ADEA) publication, only 38.8% reported feeling prepared and 12% reported being better prepared for practice as a result of their practice management education in dental school.[10] More recently, students have reported improved opinions on their preparedness for practice management, most likely due to schools implementing curricular changes.[11] The less than optimal preparedness is complicated by “the fact that predoctoral dental curricula are already overloaded with coursework,”[8] an obstacle that could be overcome by “downloading some instruction in behavioral science and business to the level of prerequisites in order to maximize the limited faculty and curricular time assigned in the discipline”.[4] Ten years ago, the results showed that only 12% of the U.S. dental schools required prerequisite coursework in behavioral sciences and no school required coursework in business. However, 64% and 31% encouraged coursework in behavioral sciences and business, respectively.[4]

This research project analyzed the changes, if any, over the past 10 years in the prerequisite requirements in disciplines of behavioral science and business in U.S. dental schools, extending the scope to include dental schools in Canada. The published academic admissions requirements were examined for each dental school in the U.S. and Canada to gain an appreciation of how prepared the average predental student is in the liberally-defined domains of behavioral science and business before matriculation. Specifically, these two research questions guided the project: (1) Do dental schools encourage predental students to take behavioral science courses or business courses? and (2) Do dental schools require behavioral science courses or business courses as prerequisites and, if so, how many semester credit hours and what specific courses?

  Materials and Methods Top

The required and recommended courses in behavioral sciences and in business were collected from each school’s official online publication in December 2019. Admissions requirements were readily available in 65 of the 68 U.S. dental schools and in all 10 schools in Canada. The majority of schools provided required and recommended courses as a standalone page, roughly 25% of the recommended courses were included in supplemental pages such as frequently asked questions; three schools were contacted by phone to collect the information. For the purpose of this study, “behavioral sciences” was defined widely to encompass courses in the disciplines of psychology, sociology, communication, anthropology, and social sciences. We readily acknowledge the inherent allowance for including courses in a given discipline (e.g., introduction to speech in the discipline of communication) that may not be, strictly speaking, “behavioral sciences” courses. Similarly, a broad definition of a “business” course was established, which included courses in business communication, business law, economics, finance, marketing, accounting, business management, human resource management, leadership, and ethics. These definitions followed those in the previous study, allowing for data comparison.[4]

The authors collected the online data for all 75 schools independently and one author called the remaining three schools to collect the information seen in [Table 1]. The majority of the required and recommended credits in behavioral sciences and business were clearly listed and required no collaboration to consistently code the data. The authors agreed on 100% of the data from schools with well-defined prerequisites, which comprised approximately 95% of the coding decisions. An example of well-defined prerequisites would be a given school listing academic requirements including a three semester credit in “introduction to psychology”, with no mention of any courses fitting our definition of “business” in the list of requirements and recommendations or in the Frequently Asked Questions and other supplemental pages. Less than 5% of schools listed prerequisites that required collaboration between authors to ensure consistent coding. In one case, a requirement for three credits in “English, Communication or Speech” was coded as three credits in “behavioral science” despite the possibility that the credit will be awarded from an English course. In another case, a school requires six credits in “Social and Behavioral Sciences” then lists “Sociology, Psychology, Political Science, Economics, Anthropology, and Ethics” as options to fulfill that requirement; the authors agreed to code for 6 hours of required behavioral sciences and to code for recommended business courses. Other cases of ambiguous coding were resolved unanimously between authors. It was decided that requirements only applying to international students would not be included. For simplicity, the information regarding the number of credit hours was limited to include only semester credit hours, as not all schools published their acceptance of quarter credit hours. [Table 2] compares the most current information to data collected in 2010 to aid in a retrospective comparison with “Prerequisites from 2010”.
Table 1 Behavioral sciences and business prerequisites in U.S. and Canada dental schools (n = 78).

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Table 2 Behavioral sciences and business prerequisites in U.S. dental schools in 2010 (n = 59) and 2020 (n = 78)

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  Results Top

[Table 1] summarizes the behavioral sciences and business courses requirements and recommendations in U.S. and Canada dental schools. In the United States, 39 of 68 (57.3 %) dental schools recommended or encouraged behavioral science courses. Nine (13.2%) schools required at least one behavioral science course, eight (11.8%) requiring credit in a psychology (general, introduction to, human, and applied) course. In those schools requiring behavioral science credits, five (7.4%) schools require three credit hours, and four (5.9%) schools require six credit hours. Specific disciplines were encouraged more frequently than others; 24 (35.3%) schools recommended taking a psychology course, and eight (11.8%) schools recommended sociology and/or communication. Demonstrating a more progressive approach to prerequisites, 60% of Canadian schools recommended courses in behavioral science; 40% (four schools) required one courses in psychology, 30% requiring 6 hours in behavioral sciences, and one school (10%) requiring a solid core of 12 credit hours in behavioral sciences. Four Canadian schools uniquely recommended that its future students take a combination of courses in the humanities and social sciences.

In the U.S., 18 (26.5%) schools recommend a course in business. In Canada, two (20%) schools recommend a business course. In total, 0% of the 78 dental schools required a course in business. Of the specific discipline courses recommended in the U.S., economics was the most frequently encouraged by six (8.8%) schools, accounting and/or ethics were each encouraged by five (7.3%) schools. In Canada, economics was recommended by two (20%) schools, and business management by one school (10%).

Turning to [Table 2], 10 years later there has seen an unfortunate trend to actually weaken rather than strengthen recommendations for students to take courses in behavioral sciences and business in U.S. dental colleges. On a percentage basis, in 2019 only 57% and 27% of schools recommended taking courses in behavioral sciences and business, respectively, compared to 64% and 31% in the previous study. Required courses in behavioral sciences have remained about the same at ∼12% to 13%. Regrettably, another finding has remained exactly the same: no U.S. dental college requires coursework in business as a requirement for matriculation.

  Discussion Top

The results of this study confirm those of the study a decade ago and actually show an alarming decline in an emphasis on behavioral sciences and business courses as prerequisites for dental school. Accordingly, the authors agree with and encourage the same recommendations to change the curriculum. The vast majority of schools still do not require prerequisite courses in behavioral sciences or business, with none requiring courses in business. Meanwhile, the knowledge explosion has vastly increased our understanding in both domains. In the behavioral sciences, for example, it is estimated that ∼26% of the population suffers from some form of diagnosable mental health disorder, from mild to severe, every year.[12] In a thriving practice of 2000 active patients, that would prorate to ∼520 patients to whom a dentist should have a at least a working knowledge to understand, manage, and provide care for these special needs patients. Similarly, especially for new dentists entering private practice with future aspirations of ownership, there are now more than ever a myriad of nuanced issues to manage, ranging from COVID-19 pandemic requirements for personal protective equipment/infection control, issues of employment law—including sexual harassment, and the need to compete in the marketplace with dental service organizations.

There are multiple ways for the dental community to accomplish this. The council of students and leaders among key groups in ADEA, such as the sections on dental school admissions officers, behavioral science, academic affairs, and practice management, should open these discussions and create recommendations for updated admissions standards which have been basically unchanged for 40+ years. Additionally, faculty and administrators at dental schools should discuss this issue of a lack of requisites in behavioral sciences and business in the admissions and curriculum committees at the respective institutions.

Updating the predoctoral dental curriculum to include required courses in business and behavioral sciences would help alleviate the gap in these subjects. ADEA’s guidelines for dental schools when extending offers requires 2 years of preprofessional education that include all the prerequisites and a Dental Admissions Test or Canadian Dental Admissions Test exam score. The American Dental Association only lists biology, physics, English, general chemistry, and organic chemistry on its general required prerequisites course. Incorporating business and behavioral sciences as required prerequisites for dental school would lay a firmer foundation upon which dental faculty could build. This would also allow for a more specialized, deeper instruction in professional school, instead of being required to devote precious curriculum time to basic concepts students could have already learned. In turn, this would allow for a more focused discussion on behavioral sciences with relevant and practical applications for future practice management topics and skills.

Advisors for predental students could be educated to encourage their students to take business and behavioral science courses when choosing their electives. This would accomplish a couple of things. First, the classes would be taken and the student will be served better in dental school. Second, the importance of professional development will be advocated by advisors when encouraging students to expand their knowledge on behavioral and business topics through elective courses. Lastly, predoctoral students using their required elective credit hours for behavioral and business courses removes the need to add more courses to student schedules. In an era of alarmingly rising student debt, this would not increase tuition costs (and debt) since students in most cases have to take elective courses.

In addition to schools facilitating change, the dental community and dental social media platforms can raise discussions by voicing concerns or difficulties transitioning postgraduation.

  Conclusion Top

The data from 2010 showed that a majority of U.S. dental schools did not require sufficient prerequisites in the areas of behavioral science and basic business education. Unfortunately, this remains an ongoing weakness and an opportunity to make progressive change in an antiquated model of prerequisites for dental school. With the steady increase and ever-changing social, governmental and economic impact on the dental profession, the dental education has an opportunity to better prepare dental students for their professional education and life without further burdening students with more student loan debt. One pragmatic way to close the gap in behavioral sciences and business is to add a core set of courses from each discipline as prerequisites to matriculate into dental school.

Financial support and sponsorship


Conflicts of Interests

The authors report no conflicts of interest.

  References Top

“Martin Luther King, Jr. Quotes.” BrainyQuote, Xplore,  Back to cited text no. 1
Fontana M, González-Cabezas C, de Peralta T, Johnsen DC. Dental education required for the changing health care environment. J Dent Educ 2017;81:eS153-61.  Back to cited text no. 2
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Dunning D, Lange B, Madden R, Tacha K. Prerequisites in behavioral science and business: opportunities for dental education. J Dent Educ 2011;75:77-81.  Back to cited text no. 4
Sangappa SBe. Patient satisfaction in prosthodontic treatment: multidimensional paradigm. J Indian Prosth Soc 2011;12:21-26.  Back to cited text no. 5
Hannah A, Millichamp J, Ayers KM. A communication skills course for undergraduate dental students. J Dent Educ 2004;68:970-7.  Back to cited text no. 6
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Commission on Dental Accreditation. Accreditation standards for dental education programs. 2016. Available at:∼/media/CODA/Files/pde.pdf?la=en. Accessed September 8, 2019.  Back to cited text no. 9
Annual ADEA survey of dental school seniors: 2016 graduating class. J Dent Educ 2017;81:613-30.  Back to cited text no. 10
Roberts BS, Robert EP, Brachvogel W, Stein AB. Practice management curricular changes may lead to enhanced preparedness for practice. J Dent Educ 2020;84:887-94.  Back to cited text no. 11
The WHO World Mental Health Consortium. Prevalence, severity, and unmet needfor treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 2004 291:2581-90.  Back to cited text no. 12


  [Table 1], [Table 2]


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