A Conversation with John Clarkson
A former president of the IADR talks to Inside Dentistry’ James B. Bramson, DDS about his career in international public health and preventive dentistry efforts worldwide.
John Clarkson (JC): About 20 to 30 years ago, there were major differences across Europe—for example, in Spain, Portugal, and Italy, you first got a medical degree, then you added on a year or two for dentistry. It wasn't very practical. However, that has changed—within the EU, there's a standard 5-year program. That's the minimum requirement for dentistry, and it's mandatory across Europe—although there is some minor variation among countries. For example, the Dutch have a 3-year primary degree, where you can graduate with a hygiene or auxiliary qualification, or you can go back and do another 2 years to become a dentist. That's an interesting development in that country.
In general, the big difference between Europe and the United States is that in Europe, you leave high school around 18 years of age and go straight into dentistry. You do a 5-year program: a pre-clinical and clinical program with no liberal arts degree beforehand. Therefore, the students entering dentistry are less mature in general than they would be in the United States, where you do a liberal arts degree first. That's a major difference, I think.
It's changing somewhat. Some universities are taking in mature students with science degrees now, and I think that trend will continue. I think the general content of the DDS degree in Europe is similar to the United States. Obviously, there are variations when you have a large number of individual countries in a region, compared with the United States, where there's one central organization running everything. However, dentistry is pretty well controlled by the state bodies that give the licenses in Europe, and they apply core standards for graduating dentists. Many academic institutions also use external examiners from different universities to ensure that standards are appropriate.
Postgraduate education is generally the same as in the United States. It's a 3-year program leading to the specialist degree. Again, some variations appear in Europe. The United Kingdom and Ireland have a higher training 5-year program—a type of super specialist called a "consultant."
That's just a general overview of the two systems. Broadly, the standards of the education systems are similar. For example, in the DentEd Project that ran in Europe—a lot of the US academics who came over and participated in that project as reviewers were very impressed with the standards, which they thought were very similar to the United States.
ID: Most US students come in with a bachelor's degree or at least 3 years of undergraduate collegiate education, most of it in science. Without that preparation, are the students less able to deal with the science that's typically integrated into the curriculum?
JC: Generally speaking, this is not so, because the entry requirements, similar to the U.S., are extremely high. You're getting the top 5% of students, and science is a strong part of their high school education. Therefore, the scientific education that's attained at that level is usually very high. However, it wouldn't be quite the same, obviously, as having a 2-year or a 3-year degree in a science program, so there is a bit of a disadvantage for students. However, with a 5-year training program in Europe—instead of the 4-year program most schools in the U.S. use—the first year is heavily concentrated on the preclinical sciences, which brings the students up to speed.
ID: How competitive is the admissions process?
JC: If you look at the U.K. and Ireland, for example, say the maximum number of entry points for a university used to be about 600. For medicine and dentistry, they would need 580 or 590 to gain entry. They're very, very competitive entry requirements. In general, the universities are state-supported public schools, so it's open access. You take a central examination in a state, and if you get in top 5% or whatever the grade is that particular year (it varies from year to year), you get into dentistry or medicine—or pharmacy which is also a very high requirement in the health sciences.
ID: How deep is the applicant pool?
JC: It's very strong. The science high school background has eased up a bit in some European regions, but governments have been emphasizing the importance of math and science, making it more attractive to get additional university entrance points with a higher level of these subjects. That has encouraged students to go for those particular sciences.
ID: How has the role of the dental educator—and the role of the school itself—changed in the last decade?
JC: I'm more familiar with the U.K. and Ireland, and it's a very strong science-based approach to dentistry in the preclinical program. In the first two years in the 1960's, I didn't see a patient. That's changed now, thankfully, because previously you only received three years' clinical exposure. There's a move now to more of a critical thinking process and problem-based approach for learning and training. In addition, the clinical training phase is introduced earlier in the curriculum, and there's probably more patient holistic approach to education. However, there's still a very strong emphasis on technical processes, which is understandable. I was just looking at a document on the profile of the European dentists which is part of the DentEd Project, and if you look at the list of competencies required for a dentist, they're so extensive. The range of the various sciences you need to have to practice dentistry is very broad.
ID: How about the schools themselves? Are they moving toward a different role—one that's larger than simply training individuals to practice?
JC: Most schools have a service commitment to the community, and especially to the public health system. In particular, the public health service takes advantage of the highly qualified clinicians at the schools, and refers patients for specialist care. Of course, many schools in the U.S. now have outreach programs, where dental students might take up to a year in a community public health practice and get some of their experience there. That outreach approach has occurred in Europe as well. It varies from country to country, but there's a much stronger emphasis on public service commitment and a community approach to training and service delivery.
ID: What advice would you give students graduating today, and is that advice any different from what you've given them in the past?
JC: Get some experience before you make major decisions on what you want to do with your career, and spend a few years in general practice working with an experienced practitioner. Then look at the opportunities—do you want to be in a practice, specialize, or get into research/ academics? We also encourage students to join their dental association as student members and get involved. Obviously, keeping your standards high and having an ethical approach to training is important.
I think what's probably changed over the years is that—with the advances taking place in dentistry and with the public's ability to gain knowledge of the latest developments in medicine and dentistry—continuing education is vital. That's the key point I would emphasize to all qualifying practitioners.
In addition, the changing pattern of practice, where there are now more group practices than when I qualified, is an advantage for the graduating dentist. I would advise them to take the opportunity to work in a good group practice with senior people, where they can get experience and continue their professional development.
ID: How do the continuing education requirements compare to what we typically require in the United States?
JC: In my own country, Ireland, the governing body of the dental profession, it's beginning to move in the direction of mandatory CE. I think in the next year or two it will be mandatory, and similar developments are taking place in the U.K. and in Europe.
ID: Is it more likely for graduates in Europe to practice for a period of time before they go on to an advanced or a specialty program, or do they move directly into those programs right out of dental school?
JC: Many students take a few years to make up their minds. Probably the top two or three students in a year go straight into training. The schools or universities tend to approach them and say, "We want you as part of our program," because they see potential there, and want to get them involved right away. We also have hospital training programs at junior and senior registrar levels, in the U.K. and Ireland, where postgraduate students get fantastic experience on the ground. These programs also set them up for specialist training.
ID: How did you become interested in dentistry, and what kind of role did mentors have in those formative years?
JC: Well, my decision to do dentistry was a little strange, because I was planning to do medicine. In fact, I was standing in line at the university to apply for medicine, and while I was talking to some of my friends, we were looking over the program—and I noticed dentistry in the middle of the medicine program. It was 6 months shorter, and there was a more hands-on approach. So I jumped from one line to the other. There was no real career guidance in the late 1950s. It was a bit of an accident in a way, but it worked out well.
The mentoring situation in my early years wasn't particularly good, quite honestly. However, later on, as I did my postgraduate qualifications, I had a few very excellent mentors, who really influenced my career direction. I think mentoring is extremely important. I missed out in the early days, but fortunately I did receive strong mentoring later on. When I was dean of the school at Trinity, we had a good mentoring program. Besides the fact that mentoring is an important role for an academic, there's the enjoyment you get out of seeing a student mature, graduate and move on, then come back 5 or 10 years later and say thanks for that advice or thanks for what you did for me. It's very gratifying as a teacher.
ID: In regards to your interests as a world-acclaimed expert in promoting health and disease prevention, how do you view the status of dental caries worldwide in the last 10 years—and maybe the next 10 years?
JC: There's some evidence that caries levels are increasing in the so-called developed countries, compared to the dramatic reductions from the 1970s with the use of fluorides. Across the world, in the so-called developed countries, we have this 80/20 split, where 80% of the caries are in 20% of the population. This tends to be more socio-economic issue, and that's always a problem. I think that's probably where we're seeing some of the increases.
Obviously, in the less developed countries, there have been increases in caries due to the increased availability of sugar, and the limited availability of fluorides and services. There are changes taking place, and it's hard to know which way it's going. The economic downturn certainly is affecting developed countries, and there are a lot more economically disadvantaged people, which I believe is going to influence the level of disease and general health, as well as dental caries and oral diseases, over the next 10 years or so.
ID: Do you think we're going backwards in our fight to control dental caries?
JC: I think we have a little bit. In the health promotion area, we keep talking about emphasizing this common risk factor approach to try to handle caries the same way as we do other diseases. In theory it's a very, very good idea, but in practice it's so difficult to change behavior, particularly in the lower socioeconomic groups, which we've been attempting to do. There's much research done on behavioral changes and the social determinants of disease. It's a much broader issue than just dentistry alone. We're fortunate, in a way, to have a few tools, particularly fluoride, on both a community and individual basis, which has changed dentistry dramatically. If we continue to use these tools in an appropriate fashion and ensure that water fluoridation and other sources of fluoride continue to be available, we can keep caries in particular at a relatively low level.
ID: Dental caries is probably the single most chronic disease on the planet. Why do you think it's seldom acknowledged as such, when it comes to funding and planning for education and delivery of services?
JC: I think there are probably a number of reasons. First of all, it's not seen as a life-threatening disease. The other impression, of course, is that many politicians and health administrators believe that we have already solved the problem, that caries has just disappeared off the map and is under control. Plus, we have this great fluoride tool, and we have created the impression that we don't need new resources to spend on caries prevention and treatment.
The other factor, of course, is that dentistry tends to be a little outside the loop compared to other areas of medicine, and especially when there are limited health resources. Dentistry is not necessarily high on the agenda, and therefore neither is caries. When we start talking about periodontal and systemic disease, people are interested and say, "Oh, oral health is important." However, caries isn't quite linked into that message. We need to emphasize that caries is still a major problem, and we have to be proactive in handling and preventing it.
ID: Has the freedom to move around the EU countries been problematic for any of the individual countries with the global recession?
JC: I think Americans are amazed at this; they just can't understand how graduates from one country can move to another and not have any major problems. When the EU was formed, initially it was felt that dentists in some countries would probably move to Germany, which has a very sophisticated social insurance health structure, an extensive dental program, and a potential for high incomes for dentists. That didn't happen, because people—and dentists are no different—live where they want to live, in their own countries, their own regions. The movement of dentists hasn't been a major issue at all, and it's been the same in the other professions. It has been quite interesting to observe. The standard of dental graduates across Europe is similar and there have been no major issues in free movement in that context. In Ireland, for example, which is a small country, we might have 2% or 3% of people practicing there who are from other EU countries, which is a very low number. The U.K. might be a bit different with national health care, where they're looking for dentists to come in. They're very happy to receive dentists from other countries; it hasn't been an issue. The language differences could have been an issue, but emigrating dentists learned the local language.
I think the recession has hit in Europe; in particular, governments tended to cut back on the money spent on health services, especially the lower profile ones such as dentistry. Also, the recession has hit the private care side of dentistry. Many of my colleagues in Europe would say that the number of patients is down about 30%. That's a major factor, which may influence a certain amount of movement within Europe, say, to the U.K. or Germany, but not on a major scale.
ID: You have mentioned the DentEd project, which is an initiative designed to address the variable standards of undergraduate dental education across Europe, bringing them into greater conformity. What is the progress on that project?
JC: It was a fascinating project, run out of Trinity College for 10 years and funded by the E.U. There were three stages. The first one was really looking at standards across Europe, examining and analyzing them. Then site visits were set up; individual schools did self-assessment, and visitors came in and issued reports. That was a voluntary program. Both the schools that were visited and the visitors learned a great deal. There were many US senior academics along who thoroughly enjoyed the process and learned a lot from it.The second part of the program was to develop a web-based network for dental education, which has been implemented. The third part was to create a profile of European dentists, which was an interesting exercise. A major amount of work has been done in developing competencies, curriculum structure, etc. Also, there was a major global conference in Dublin in 2007, where there were representatives from dental education all over the world.
Now the Association for Dental Education in Europe has taken over the project. Their plan is to update these profiles and competencies for European dentists every 5 years. The latest profile and competencies document was issued in 2009 and published in the European Journal of Dental Education. The Taskforce on Curriculum Structure Assessment was published in 2010. These documents outline the profile of a European dentist and the competencies necessary to qualify as a European dentist. They are very interesting, very comprehensive documents.
ID: In your opinion, what are some of the greatest challenges facing dentistry worldwide?
JC: The recession has been around for a while, and that is a major challenge. I don't know how strong its impact has been on dentistry in the US, but I know in Europe it's a major issue. The dental profession and dental associations are seriously concerned, because patients are deferring treatments, while governments and insurance companies are cutting back. Speaking of insurance companies, the impact they have on the type and quality of services is important—they have a strong influence on how services are delivered. That's a challenge as well. The other issue is that dentistry, in a way, has been pushed to the periphery. It's so important that the dental advocacy networks keep working on the profile of dentistry to ensure that we are seen to provide a quality service in an open and transparent manner; that we have a balance between a strong private base, together with an insurance-based, government-based system; that we market our services appropriately; that we broaden the role of dentistry in the health field: and that we tackle the access to care issue, which is important worldwide.
ID: Based on what you've seen, what does America do well in dentistry, compared to the rest of the world?
JC: You have a very strong dental education and research system, including the world's largest dental research center, NIDCR, and also a well resourced dental association in the ADA. Achieving that structure in the European scene would be quite a difficult exercise. A strong education/research system is important, and also the mature student entry situation I believe is an advantage.
Going back 40 years ago, your clinical training would have been regarded as ahead of most European or other countries, and people came here especially to do clinical training. I think that's changed now. The US system is still superb, but most other countries have caught up with it. There tended to be more high-end dentistry in your graduate training, compared with Europe. However, I believe that's also changed.
Your standards are high, there's a good service orientation, you market your services pretty well, and it's a respected profession in the U.S.
ID: Any lessons we can learn from the areas that we don't do as well?
JC: I think the public service commitment in the U.S. isn't as strong. I've been talking about Europe in general, but when you consider Australia and New Zealand as well, there's also a very strong public service commitment there. Access to care is somewhat of a difficulty in the U.S compared with the counties I've mentioned. The cost of obtaining care is also relatively high in the U.S. I also think there's a specific danger in that some schools that have recently opened in the U.S. don't have as strong a science base as those attached to some of the major universities. I think you need to be aware of that issue. Generally, the cost of third-level education in the U.S. is very high, compared with Europe, where a lot of it is state-supported. We're astonished at the debt students have when they graduate in the U.S. There were protests in the streets of London recently when they talked about $10,000 a year tuition fees. Costs in the U.S. are so much higher. I think the cost of care and dental education, lack of public services, along with access to care are the key issues.
ID: Do you think the cost of education here somewhat restricts the ability of dentists to go back and deliver care in certain kinds of environments, because they need to recoup the costs of their education?
JC: That is an issue, obviously. To graduate with a debt of $200,000 or $300,000—or whatever the average is now—your first objective would be to try to pay off your debt. Therefore, you go into a practice to try to recoup that. So the opportunities to do things you might want to do with less income are restricted.
ID: You've held both chief elected and chief executive positions in international dental organizations. How do these bodies work to try to improve oral health, and are they still relevant in the 21st century?
JC: Obviously, the organization I'm very familiar with is the International Association for Dental Research (IADR), which encourages, supports, and promotes research and dissemination of its findings. In addition to its major meetings and publications, networking and advocacy are its other primary roles. Also, it is formally involved with the World Health Organization (WHO), and they inform the public and the profession on major issues. The World Dental Federation (FDI) has a similar function, particularly for clinicians. Both organizations have a strong role in encouraging research, giving a higher profile to dentistry, disseminating results of research, and moving oral healthcare forward, which I think is extremely important. Getting that information out in the 21st century is different now, with new methods of communication. Access to this information, both from the profession's and the public's point of view, is now much better, and associations have to adapt to this situation.It's also important for these associations to realize we're there to assist the public and improve their oral health —not just to represent the profession or its special interests. Sometimes we forget about that, which is understandable to a certain extent. However, I think it's extremely important that international organizations and national dental associations ensure that their primary role is to improve oral health—and that in doing so they use modern communication tools.
Another issue that comes up on an international basis is the ability of associations to react quickly to issues as they develop. The FDI and IADR need to look at developing a rapid response mechanism to major issues and challenges to general health and oral health and to communicate on these to the public and to the profession.
ID: In your opinion, what effect do all these new vehicles for publishing have on the peer review process and the scientific validity of new information?
JC: I don't think it is a major issue. With electronic publication, making science available within a short period of time, there were worries that it would have an effect on the income of associations, which are very dependent on subscriptions from their publications for income. Associations have adapted well to this situation. The peer review process continues, whether it's electronic or otherwise. The references are there; the publications are peer-reviewed. Publications go through the same process as before; it just happens more quickly.
ID: Did you find there were different leadership traits that you needed to help govern an international group or work in an international environment?
JC: I think that the basic skills or qualities of leadership are the same, whether it's national or international. On an international basis, you have to think globally. Even national dental associations have to think globally now. You need to be aware of cultural differences. The world is a big place with diverse cultures, and people think differently in different regions of the world. You have to be sensitive to the needs of small and developing countries and try to involve people in these regions in your association. If they're involved, they get to know you and relationships develop both professionally and socially, and it works both ways. Also, if you're providing support to less developed regions of the world, you do it in an appropriate—not in a condescending—manner. We're all equals in this situation. People appreciate that and accept you on a one-to-one basis, and I think we get on pretty well that way.
In the dental profession, it's especially interesting. It's a relatively small community. The issues are similar worldwide, and people pull together extremely well. I have made many friends around the world working in this manner.
ID: How involved are students in dental research at dental schools? Can you suggest any strategies for increasing the awareness of the importance of dental research for our youngest students and new graduates?
JC: It's very important that there's a strong science base for dentistry. Otherwise we become a technical profession rather than a science-based profession. Incorporating science into the curriculum is extremely important, and the United States has generally been very good at this. When I came to the United States in 1990, I was very impressed with the student research group in the American Association for Dental Research. There was very strong support for students. There's a good base here that worked very well. Interestingly—and this is linked with mentoring—the strongest student research outputs came from maybe six or seven superb schools. Outside of the United States, I think support for student research hasn't been as strong, but that's changing now. The key is to get students interested and get them involved in doing projects during their early years, and they develop an interest in research and they see how it works and the outcomes from it. Providing some support and recognition to students and their research groups encourages the whole social and scientific aspect of dentistry. It gives them a mindset where they can work for the future. They can look at information in a critical manner and analyze it in the best interests of their patients.
ID: How is exposing students to research translating to careers in research? What are the numbers telling you?
JC: That's been a huge problem—encouraging individuals into academics or research is a major issue. We touched on this previously while discussing the educational debt situation. I think it is a continuing problem and can be seen from the large number of vacancies of academic positions in dental schools. Many people in dental research are not necessarily dental graduates, but PhDs coming through from the sciences, the material and biomedical sciences in particular. Then they're pulled into the dental school environment to create the research field/infrastructure, whereas the dentists move out into practice. That's a worrying trend, I think.
ID: How about the interaction with the research community and the corporate community?
JC: I don't think we take advantage of that relationship as much as we could. The corporate sector plays an important role in providing healthcare products, obviously, but also in research. If you look at any IADR meeting, the strong input of the corporate sector into the research presentations and its support for research are extremely important. There have been some programs where students gain experience in the corporate sector and see how research is carried out there. I think we should tap into that a lot more. The role of the corporate sector is essential and has been very valuable to dentistry.
ID: As a researcher and an administrator, what issues of conflicts of interest have you seen in that environment?
JC: I think most companies, certainly the major ones I've dealt with, are very aware of the need for a professional approach to any relationship. If you're carrying out a major research project for a company, there are very formal processes, and the lines are clearly outlined. I would say there have been some issues over the years, but there's now a maturity among the corporate sector and the professionals as to how these relationships are handled. My working relationship with the corporate sector has always been very positive and upfront, which they appreciate and encourage. Both sides know that if it's not handled well, they won't get the support and the recognition for any collaboration.
ID: Does the lack of access to care exist in other industrialized nations to the degree that we see it here in the United States?
JC: I think it does to a certain extent. However, if you look at the European region, the structures vary quite a bit. They have got a national health service in England. The Scandinavians have a very strong public health system. The Germans, Dutch, and French have various types of social insurance. Australia and New Zealand have similar, very strong public health programs. Although access does vary among nations, in theory the public health social insurance systems tend to take care of the issue. I think that the safety net for various groups—low-income, special needs, children, expectant mothers, etc—is included in most public programs in Europe, Australia, and New Zealand. I think that's extremely important, compared to the U.S., where you don't have that strong a public health program. These systems have worked out pretty well in providing access. Unfortunately, the lower socio-economic groups, where poor health is a major problem, in particular don't tend to avail themselves of it. I think the U.S. could learn from these approaches—maybe not through a public health system, but through some existing program. For example, you've got your Medicaid program, etc, to provide services to the less well off.
ID: Where do you see the next great research opportunities for the dental profession?
JC: There's much talk about the oral–systemic relationship and salivary diagnostics and there's huge potential in these areas. A recent seminar organized through the American Association for Dental Research in Washington this past October highlighted development in salivary diagnostics. But if dentists are going to be part of this, then they have to be part of the health team and have the ability to deliver results from areas such as salivary diagnostics, etc.
There's been great interest in these developments and they get a profile for a while, and then you move on. I do think you have to look at the competencies necessary to be a dentist in Europe and the United States; the breadth of areas that graduates have to experience is very, very broad. Introducing any changes, such as salivary diagnostics, should be incorporated into training programs. It shouldn't be a shift in nature from the way we practice or deliver care now; it should be part of it. When new developments occur, whether it's in saliva or oral–systemic relationships, they should be part of education system at all levels. I don't see the profession suddenly changing to become oral physicians. I think the profession will continue to adapt and develop, but it's up to our trainers, our educators, and our profession to use the new science appropriately, to ensure that our graduates are trained in these new developments, and to incorporate them into continuing education and in the delivery of services. Sometimes we expect dramatic changes, but it's a gradual process.
ID: Could you describe for us a key challenge or a turning point for you, and how you handled it?
JC: When I was in my late forties, I applied for a senior post in the government. I probably wasn't experienced enough, but I was a bit disappointed when I didn't get it. Like most people, when I go for something, I like to get it. In fact, it's the only job I went for that didn't I get. But as a result, I applied myself to my existing position with renewed vigor, expanded my professional interests locally and with dental associations and international organizations, and became an expert in some key fields—health promotion, caries, and fluoride. I made myself somewhat "essential" for certain programs and developments, both in the national and international areas. So, when opportunities arose—and fortunately they did—I was there. I have had some 15 years in clinical practice, 10 years in government administration, 8 years in Washington as ED of the IADR, and then back to academics as a professor and Dean for 8 years. Quite honestly, I am glad I didn't get that particular position now, as my career worked out well. If you work hard, push yourself in the right direction, and get the appropriate training, opportunities usually arise, and you move forward. As a result, I was extremely fortunate to have such a diverse career.
ID: Among all your roles—clinician, government policymaker, dean—what was your best job, and why?
JC: I think I would share it between two roles, Executive Director of the IADR and academic life. When I moved to the United States—that was just so exciting for me, because of the different approach to things in the United States. After my 8 years in the United States, when I was leaving, people asked me what my abiding memory was. I said, well, in this country if you work hard, people appreciate you. You get on with life and you move forward. And that's true.It was an exciting and rewarding time to see IADR develop, and I made a lot of friends around the world in that organization, which was important. Later I was elected president of the Association, which was a nice recognition from the members.
I also really enjoyed academic life in Trinity College in Dublin, which has a history going back to 1592 and is a great dental school. Students make you feel young, and it's great to see them advance. As a result I've known some great young people coming through in the profession.
So it's a combination of these roles. I certainly enjoyed working in the United States, and that's part of the reason I come back here every year.
ID: What has been the most significant change that you've witnessed in the profession in the last 25 years?
JC: It's difficult to say. All the advances in science, materials, and equipment—CAD/CAM, diagnostics, implants—are all part of it. Of course, infection control in practice is so important. Maybe I'm biased because of my background, but I think the reduction in caries over the last 30 to 50 years, and the public's expectations as a result of that dramatic change in caries—that's had a huge, lasting influence. Dentistry's changed so much because of that ability to provide better oral care and people's ability to retain their dentition for life. I think that's been the major, underpinning change in the last 40 or 50 years. Although advances in science and materials have been part of that, I believe that if we hadn't had fluoride and all those major reductions in oral disease, then the technology and other advances might not have had the influence they have had.
ID: In closing, what's the best piece of advice you've ever received that you'd like to share with our readers?
JC: When you see an opportunity, go for it wholeheartedly in an open, professional, positive manner, and you will get the results. I think if you do that you will be successful in your career and in your profession with your colleagues and in your family life—I think you'll enjoy life. And that's what it's all about.
About the Interviewee
John Clarkson, BDS, MA, PhD, is Professor Emeritus at Trinity College Dublin, Ireland. He was previously Dean of the Dental School and Hospital at Trinity College and Professor/Consultant in Public Dental Health and Community Services. After serving as Executive Director of the IADR/AADR from 1990 to 1998, he was elected to the Executive Committee of the Association for Dental Education in Europe in 1999. Afterwards, he served as President of the IADR from 2002–2003. Dr. Clarkson's career has been focused in public health, epidemiology, dental education, and preventive dentistry, particularly in research on fluorides.