RESEARCH AND EDUCATION

Leadership diversity in prosthodontics: Number of women and

nonwhite individuals serving as President of selected
prosthodontic organizations in the last 20 years
Kamolphob Phasuk, DDS, MS,a Sreenivas Koka, DDS, MS, PhD, MBA,b Mathew T. Kattadiyil, BDS, MDS, MS,c and
Murat Mutluay, DDS, PhDd

The power of role models to ABSTRACT

inspire women and underrep-
resented minorities (URMs) to
pursue career advancement
and attain leadership positions
in academic medicine has been
documented.1-4 Specific to
women representation, Gang-
wani and Kolokythas5 con-
ducted a literature review and
determined that the following
factors were barriers to career
advancement to leadership
positions: the lack of appro-
priate role models and
mentorship for successful so-
cialization of female faculty;
the lack of peer support for
women’s promotion through
the academic ranks and their
selection for executive admin-
istrative roles at equal rates as
their male counterparts; and
implicit bias and negative ste-
reotypes. These findings are
similar to the barriers
impeding URMs.2,3
Statement of problem. As a measure of the leadership diversity in prosthodontics, the number and
percentage of women and nonwhite Presidents of prosthodontics organizations is unknown.
Purpose. The purpose of this observational study was to calculate and compare the number and
percentage of women and nonwhite Presidents of 10 selected prosthodontic organizations over
the past 20 years and to determine whether the number of women and nonwhite Presidents
has changed over the time frame of 2000-2019 in comparison to male and white Presidents.
Material and methods. The number of women and nonwhite Presidents of the Academy of
Prosthodontics (AP), American Academy of Fixed Prosthodontics (AAFP), American Academy
of Maxillofacial Prosthetics (AAMP), American College of Prosthodontists (ACP), American
Prosthodontic Society (APS), European Prosthodontic Association (EPA), International
Association of Dental Research - Prosthodontics group (IADR-P), International College of
Prosthodontists (ICP), Greater New York Academy of Prosthodontics (GNYAP), and Pacific
Coast Society for Prosthodontics (PCSP) was recorded. The chi-square test was used to
determine differences in the percentage of women and nonwhite Presidents over time and
between organizations.
Results. The range of women Presidents in the selected years was 20% (EPA) to 0% (APS) with a
mean of 10%. No statistically significant differences over time and between organizations were
observed. The range of nonwhite Presidents in the selected years was 25% (ICP) to 0% (AAFP,
AAMP, ACP, and GNYAP) with a mean of 7.5%. No statistically significant difference over time
was observed while a statistically significant difference between organizations was observed
(P=.015). Multiple comparisons revealed the ICP had significantly more nonwhite Presidents in
the selected years.
Conclusions. The relatively low numbers of women and nonwhite Presidents in the organizations
studied is compelling evidence that there are an insufficient number of women and nonwhite role
models in prosthodontics and that important voices representing the diversity of members of the
prosthodontic community remain unheard. Clinical Implications (J Prosthet Dent 2020;-:---)

a
Director, Predoctoral Implant Prosthodontics and Clinical Assistant Professor, Indiana University School of Dentistry, Indianapolis, Ind.
b
Clinical Professor, Advanced Prosthodontics, Loma Linda University School of Dentistry, Loma Linda, Calif; Private practice, Koka Dental Clinic, San Diego, Calif; Lecturer,
Advanced Prosthodontics, UCLA School of Dentistry, Los Angeles, Calif; CEO, Career Design in Dentistry, San Diego, Calif.
c
Professor and Director, Advanced Specialty Education in Prosthodontics, School of Dentistry, Loma Linda University, Loma Linda, Calif.
d
Clinical Professor and Chair in Prosthodontics, Institute of Dentistry, University of Eastern Finland, Kuopio, Finland; Chief Dentist, Department of Oral and Maxillofacial
Diseases, Kuopio University Hospital, Kuopio, Finland; Senior Researcher, Adhesive Dentistry Research Group, Department of Restorative Dentistry and Cariology, Institute
of Dentistry, University of Turku, Turku, Finland.

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Clinical Implications
One way to achieve leadership diversity is through
representation of underrepresented minorities in
leadership positions of influence. In this study, the
leaderships opportunity afforded to women and
nonwhite individuals through the officer position of
President of 10 different prosthodontic
organizations indicated that the representation of
women and nonwhite Presidents needs to be
improved, and, doing so, establish more diversity in
leadership positions within prosthodontics.
The Women Dentists Worldwide section of the
Federation Dentaire Internationale (FDI) noted a femi-
nization of dentistry with, for example, over 60% of
dentists in Europe being women.6 Similar trends in the
increasing number of women dentists have been re-
ported in other industrialized nations such as the USA7
and Canada8 as well as specific to prosthodontists in
the United States, where currently 25% of prosthodon-
tists are women.9 It has been proposed that increased
representation of women in leadership positions is
influenced by women role models in leadership posi-
tions.9,10 In prosthodontics, leadership positions manifest
in different forms such as officer of an organization,
board examiner, practice owner, scientific program
speaker, scientific program chair, session moderator at
scientific meetings, dental school Dean, residency or
graduate program director, division chair, and depart-
ment chair. Given the evidence that role models are an
important element in the progression of women and
URMs to leadership positions, the purpose of this
observational study was to calculate and compare the
number and percentage of women and nonwhite Presi-
dents of 10 prosthodontic organizations over the past 20
years and to determine whether the number of women
and nonwhite Presidents has changed over these 2 de-
cades. The null hypothesis was that no difference would
be found in the relative frequency of men and women
Presidents and white and nonwhite Presidents in the
organizations included in this study.
MATERIAL AND METHODS
The identity of Presidents of the Academy of Prostho-
dontics (AP), American Academy of Fixed Prosthodontics
(AAFP), American Academy of Maxillofacial Prosthetics
(AAMP), American College of Prosthodontists (ACP),
American Prosthodontic Society (APS), European Pros-
thodontic Association (EPA), International Association
for Dental Research Prosthodontics Group (IADR-P),
International College of Prosthodontists (ICP), Greater
New York Academy of Prosthodontics (GNYAP), and
THE JOURNAL OF PROSTHETIC DENTISTRY
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Table 1. Source of data for each organization
Organization Source
AP https://www.academyofprosthodontics.org/Past_Presidents.html
AAFP https://www.fixedprosthodontics.org/presidents.html
AAMP https://www.maxillofacialprosthetics.org/past-presidents.html
ACP https://www.prosthodontics.org/about-acp/acp-presidents/
APS https://www.prostho.org/about_past_presidents.html
EPA https://www.epadental.org/about/past-presidents
ICP https://icp-org.com/leadership.aspx
GNYAP President James Hudson (2019-2020)
PCSP President Mathew Kattadiyil (2019-2020)
AAFP, American Academy of Fixed Prosthodontics; AAMP, American Academy of
Maxillofacial Prosthetics; ACP, American College of Prosthodontists; AP, Academy of
Prosthodontics; APS, American Prosthodontic Society; EPA, European Prosthodontic
Association; GNYAP, Greater New York Academy of Prosthodontics; ICP, International
College of Prosthodontists; PCSP, Pacific Coast Society for Prosthodontics.
Pacific Coast Society for Prosthodontics (PCSP) for the
years 2000-2019 was collated from a variety of sources
(Table 1). These organizations were selected as they
represent either some of the larger established prostho-
dontic organizations in the USA or prosthodontic orga-
nizations with multinational profiles (EPA, ICP, and
IADR).
Male and female Presidents were recorded for each
year for each organization. President gender was iden-
tified using previous programs from the respective
annual meetings, and the number of male and female
Presidents was recorded. Gender was determined by the
President’s given name or, in the case of organizations
which included photographs of their Presidents, by the
President’s photograph. For those Presidents whose
gender could not be identified by their given name or
photograph, it was determined based upon biographical
information retrieved from an Internet search.
White and nonwhite Presidents were recorded for each
year for each organization based on their photograph.
Determination of white or nonwhite was made using the
definition of the US Census Bureau in which white is
defined as “A person having origins in any of the original
peoples of Europe, the Middle East, or North Africa.”11
Presidents who did not meet this definition of white
were classified as nonwhite. For those Presidents whose
status as white or nonwhite could not be identified by their
photograph, it was determined based upon biographical
information retrieved from an Internet search.
Overall comparisons for the significant differences
between the women and nonwhite president distribu-
tions between organizations and between years were
performed by using the chi-square test with a statistical
software program (IBM SPSS Statistics, v25; IBM Corp)
Where multiple comparisons indicated statistically sig-
nificant differences, the Bonferroni correction was
applied to prevent family-wise error rate (a=.05/
20=.0025).
Phasuk et al
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Table 2. Results of chi-square test comparing men and women Table 3. Results of chi-square test comparing white and nonwhite
Presidents of selected prosthodontic organizations by year from 2000 to Presidents of selected prosthodontic organizations by organization from
2019 2000 to 2019
Value df Asymptotic Significance (2-Sided) Value df Asymptotic Significance (2-Sided)
Pearson chi-square 28.889* 19 0.068 Pearson chi-square 6.667* 9 0.672
Likelihood ratio 31.815 19 0.033 Likelihood ratio 8.306 9 0.504
Linear-by-linear association 1.212 1 0.271 Number of valid cases 200 d d
Number of valid cases 200 d d *10 cells (50.0%) have expected count less than 5. Minimum expected count 2.00.
*20 cells (50.0%) have expected count less than 5. Minimum expected count 1.00.

Table 5. Results of chi-square test comparing white and nonwhite

Table 4. Results of chi-square test comparing white and nonwhite Presidents of selected prosthodontic organizations by organization from
Presidents of selected prosthodontic organizations by year from 2000 to 2000 to 2019
2019 Value Df Asymptotic Significance (2-Sided)
Value df Asymptotic Significance (2-Sided) Pearson chi-square 20.541* 9 0.015
Pearson chi-square 16.937* 19 0.594 Likelihood ratio 22.156 9 0.008
Likelihood ratio 21.010 19 0.336 Number of valid cases 200 d d
Linear-by-linear association 4.271 1 0.039 *20 cells (50.0%) have expected count less than 5. Minimum expected count 1.00.
Number of valid cases 200 d d
*20 cells (50.0%) have expected count less than 5. Minimum expected count 0.75.

prosthodontic organizations over the time frame of 2000-

RESULTS 2019 was accepted. However, the null hypothesis that no
difference would be found in the relative frequency of
From 2000 to 2019, the mean number of women Presi-
white and nonwhite Presidents of the reviewed pros-
dents per prosthodontic organization reviewed was 10%
thodontic organizations was rejected as the ICP was
(20 out of 200). The distribution of women Presidents
noted to have statistically significantly more nonwhite
and the percentage of women Presidents in the selected
Presidents (P=.0017).
years was 20% (EPA), 15% (ACP), 10% (AAFP, AAMP,
The results of this study, in which 10% of President
IADR-P, PCSP0, 5% (AP, GNYAP), and 0% (APS).
positions were held by women, support the findings from
Comparing years, the chi-square test yielded a P value of
previous work in prosthodontics regarding representa-
.068 indicating that the number of women Presidents did
tion of women speakers in that women are less likely to
not change over the time period of 2000-2019 (Table 2).
hold positions of prominence such as becoming Presi-
Comparing organizations, the chi-square test yielded a P
dent of a professional organization.9 It is likely that this
value of .672 demonstrating that the organizations were
situation where there are relatively few women Presi-
not different to each other with regard to the number of
dents will not change soon because becoming a President
women Presidents over the time frame of 2000-2019
usually requires serving on the Board or Executive
(Table 3).
Council of an organization first and becoming a Board or
From 2000 to 2019, the mean number of nonwhite
Executive Council member relies on having established a
Presidents across the prosthodontic organizations
national or international reputation which relies, in part,
reviewed was 7.5% (15 out of 200). The distribution of
on being a speaker. In essence, there is a positive cor-
nonwhite Presidents in the selected years was 25% (ICP),
relation on effect of being a speaker in that it amplifies
20% (IADR-P), 10% (APS, PCSP), 5% (AP, EPA), and
one’s visibility, establishes one as an expert and opens up
0% (AAFP, AAMP, ACP, and GNYAP). Comparing
new networking opportunities, all of which are helpful in
years, the chi-square test yielded a P value of .594 indi-
being invited to serve on an organization’s Board or
cating that the number of nonwhite Presidents did not
Executive Council. Implicit or explicit biases against
change over the time period of 2000-2019 (Table 4).
women also play a role in limiting speaking opportunities
Comparing organizations, the chi-square test yielded a P
and the paucity of women speakers influences the
value of .015 (Table 5). Multiple comparisons after
paucity of women Presidents because there are fewer
applying the Bonferroni correction demonstrated that the
women role models.5,10
ICP had a statistically significantly higher number of
The authors are unaware of a previous study that
nonwhite Presidents (P value of .0017).
assessed the frequency of white and nonwhite Presidents
of national and international professional dental organi-
DISCUSSION
zations. The data presented in this study showcase a
Based on the results of this study, the null hypothesis need for change as 4 organizations (AAFP, AAMP, ACP,
that no difference would be found in the relative fre- and GNYAP) had no nonwhite Presidents for the 20
quency of men and women Presidents of the reviewed consecutive years reviewed and 2 organizations (AP and

Phasuk et al THE JOURNAL OF PROSTHETIC DENTISTRY

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EPA) had only 1 nonwhite President in the same time
frame. This means that out of the 10 organizations
reviewed, between these 7 organizations, there was only
a total of 2 nonwhite Presidents between 2000 and 2019
and that there was not a single nonwhite female
President.
The issue of white and nonwhite individuals in po-
sitions of leadership is a topic fraught with nuance and
may make some uneasy. Yet, the first step in needed
change is discussing it based on evidence like the data
presented here. A second step is to implement active
programs to address the inadequacy. Clearly, it is simply
not on the radar of many organizations despite their
international memberships, such as AP and APS. It ap-
pears that international may mean white international. In
the case of the ICP, as of July 2019, the 4 countries with
the most members in the ICP were China, United States,
Japan, and Australia (personal communication, ICP co-
President). Perhaps the fact that many members of the
ICP are nonwhite is a precursor to board members and
Presidents also being nonwhite. This is important
because members of a group who cannot see their
identities reflected in the group feel a lower sense of
belonging. Humans crave conformity and it requires
special effort to include those unlike us as the majority
question the need or value of including others, especially
if things are going along well enough.
Is change really needed? Regardless of whether one
believes that an organization’s goal should be to serve
society or one takes a more closed-minded approach
that the goal of an organization is to serve its members,
the evidence from this study is that most of the orga-
nizations studied have fallen short on both measures.
The data are unequivocally explicit that if you are a
woman and/or nonwhite, you are at a significant
disadvantage based upon nothing other than your
gender and/or the color of your skin. This is not a new
problem but that does not make it less of a problem. In
fact, it makes it more of a problem that organizations
perpetuate this failure.
How might change happen? Gordon Livingstone
stated “Any relationship is under the control of the
person who cares the least”.12 It appears that organi-
zations care less about diversity of their leaders since
little progress has been observed and there is insuffi-
cient incentive to alter the historical course. Incentives
can come in 2 broad forms: Incentives (money, prestige,
more members) and punishments (fines for non-
adherence to a standard, loss of reputation, loss of
members). The data from 2000 to 2019 presented in this
paper showcase insufficient incentives and punishments
for the organizations studied to change and members
and prospective members have little leverage to realign
the status quo unless they threaten to withdraw their
THE JOURNAL OF PROSTHETIC DENTISTRY
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membership and their membership dues. Ironically,
most organizations begin because a group of people
sees a need to come together in a way that promotes a
set of common goals that is otherwise unattainable. It
may be that an organization needs to arise where one
of its core publicly stated and measured goals is di-
versity of thinking and diversity of role models where,
at a minimum, its leadership reflects its membership.
Who would join such an organization? Anyone who
believes that today’s diverse opportunities and problems
are best addressed through solutions derived from
diverse perspectives.
CONCLUSIONS
Based on the findings of this observational study, the
following conclusions were drawn:
1. Both the range of women Presidents in the selected
years (20%-0%) and the range of nonwhite Presi-
dents in the selected years (25%-0%) indicate un-
derrepresentation of women and non-white
individuals in this important role of influence within
prosthodontics.
2. The relatively low numbers of women and nonwhite
Presidents in the organizations studied is compel-
ling evidence that important voices and perspectives
representing the diversity of members of the pros-
thodontic community remain unheard and that role
models for those from these underrepresented
groups are too few in number. Organizations are
obligated to strive for a level of leadership diversity
that yields a broad range of perspectives and in-
cludes a diverse group of role models is important if
organizations are to serve prosthodontic, prostho-
dontists, and patients in the most effective way
possible.
3. Diversity and equity and inclusion are all necessary
for an organization to have maximum impact and an
organization that does not hold these values central
to its decision-making and succession planning is
less well prepared for a global society.
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