I wanted to write this blog post after being asked a heartfelt question by a younger black female. That question was “Dentistry sounds great, but how do I deal with potentially being the only black person there?”. A demoralising deliberation that I am guessing many black students may have considered before applying. I could only think to myself that this within itself is a tangible deterrent to achieve in the environment we live in today. If I am honest, the thought did cross my mind on how I would cope in an environment where I knew I would look around and most people would not look like me. I wanted to share some realism, thoughts, and experiences on trying to overcome this mental roadblock. I wish to do this in the hope of encouraging more young black students to pursue a career in Dentistry.

Recently, the Black Lives Matter movement has been so important and educating. Some of my friends explained to me the emotional toll experienced when reliving and sharing some uncomfortable, upsetting personal experiences to help spread awareness. It also stirred up thoughts of the hard facts that you might have to work twice as hard as the people around you in conjunction with things like systemic racism existing. With all these things stacked against you, it can be daunting to want to start the journey especially when the application process alongside is so gruelling in the first place.

I myself through my experience have been subject to imposter syndrome and comments about making my hair look more professional than its natural form. However, I was also shocked by the supportive community network of strong black colleagues I have made in dentistry alongside other fantastic friends I have met on the way. I never expected any of these things and I guess the point I am trying to make is that the unknown really is the unknown. Of course, this is just one perspective of one person’s experiences. Dentistry, or the world may not be 100% multicultural. Uncomfortable situations can arise, nothing is perfect, and everyone is constantly growing. But a few things helped me to take the plunge into the unknown.

Just because the world is not perfectly ready for us does not mean we should not arrive. When I think back to all the inspirational black people that encouraged me, I am so grateful they stepped into the unknown. A recent quote by Kamala Harris springs to mind:

And on that note, I’m going to leave it here and I hope to see you in the unknown.

Here in the UK, we like to think that racism isn’t a problem. That we don’t see colour so it’s not an issue. This false equivalence of a colour-blind society to a post-racial utopia is harmful as it rejects the need for systemic change while invalidating Black, Indigenous People of Colour (BIPOC) experiences.

Dentistry doesn’t exist in a vacuum void of racism. As dental students and clinicians, we are often branded as ‘’nice’’ people. However, nice people like you and I, can still perpetuate and uphold systemic racism and anti-blackness, whether we mean to or not. We must dispel the narrative that only ‘’bad’’ people are racist. Racism is not a one-off event; it is an entire system.

I would argue that we cannot fully treat and care for patients without having an idea of their world views and experiences. To provide true holistic care, we must dismantle the systemic racism and oppression that directly impacts the general and oral health outcomes of BIPOCs. 

Before you think about making changes at home, work or university, I implore you to unpack your own implicit bias. 

This guide is by no means exhaustive nor is it intended to teach you everything about allyship. I would recommend using it as a starting point and using my PDF for further resources. 

Ask yourself how you have unconsciously upheld systems of racism, anti-blackness and perpetuated the exploitation/oppression of black people. 

This is an arduous and ongoing reflective process. Here you will need to embrace responsibility and accountability. 

Becoming conscious of your own behaviours can often lead to feelings of guilt. Channel these feelings into a productive conversation and action, whilst putting your own fragility aside. 

Our education system has starved us of the necessary substance to understand race relations in the UK. History repeats itself, so we need to learn the past to better understand the present and challenge the dynamics that persist. 

The past has left us ignorant with medical misconceptions and myths about our black patients. This has manifested itself in inaccurate diagnoses as a result of unfamiliarity of how different diseases appear in BIPOC.

By learning, we will gain a better understanding of everything from the normal appearance of gingiva of BIPOCs to accurately diagnosing dental pain in black patients. 

It is your own responsibility to self-educate. Don’t rely on BIPOC friends and family to explain the terms and events outlined above. Recalling and explaining racism can often be triggering and traumatic. Don’t put this emotional labour on your loved ones. See my PDF for more.

5. Listen more and speak less

6. Although it is OUR collective problem, you are not saving anyone

7. Reflect on how departments, academic institutions, and practices are unintentionally racist

Are they actively anti-racist rather than focused purely on diversity?

Look around, how many black folx do you see? Is this a microcosm?

8. Question whether you are a performative ally

You can’t pick and choose whenever it suits you to be an ally.

Do not claim you stand in solidarity with Black Lives if you do not:

• Continuously put in the work to unlearn your unconscious bias and behaviours
• Have difficult conversations with your loved ones, educators, colleagues, etc
• Speak up in situations of racism

9. Acknowledge you will make mistakes

Next in the Equality, Diversity & Inclusion Series, is an anonymous post from a dental student...

I have been inspired by recent events, not least the ‘Black Lives Matter’ protests, to write about my experiences as a dental student from an ethnic minority background. I am not black, and so cannot claim to share the experiences of my black peers; but I can speak about the knowledge and experiences of those close to me and my own, as British Indians working throughout the years in the dental field. 

During my first degree, I formed fantastic friendship groups of multiple races, ethnicity and personalities! Going to a university that a member of my family had been to years prior, I was aware of the previous racial attitudes, although I didn’t experience any. Towards the end of my time there, I discovered that some medical students had conducted a play, inviting many black students, and ridiculed one of the only black staff members, making him into a hellacious character. 

I was elated when I got into dental school. I was in love with the university that had given me an offer. It didn’t matter that it was far away from home. The university is based in a multicultural area, but I noticed a lack of representation of tutors from the BAME community. The majority were White, with a few Asian and one black member of staff. My friends and I agreed that there was a lack of black dental tutors that students could look up to. 

The first barrier I faced was being told by some senior students, before I went on clinic, that ‘they might not like you, because you’re a brown woman’. As startling as that was, I found my first and second years more difficult than some of my peers. I felt like I had to work harder, that I had to have better knowledge and put in systems that my colleagues didn’t have to think about. This was reinforced when my housemates voiced the supervisors were much harsher on me than my colleagues. 

Another incident which pops into mind was with a temporary BAME tutor, who I didn’t get along with. Along with the three other BAME students in my cohort, her tone left my peer with anxiety attacks. It was mentioned by a few of my non-BAME friends that it was odd because they hadn’t been targeted. Despite this, I did not want to conclude that these acts were racially motivated, or play the ‘race card’, when actually, it may have been my own short comings leaving me in that position. 

Although the university has great BAME representation from visitor speakers, I did notice a lack of engaging equality and diversity training. In situations with patients passing unsavoury comments It strikes me that I still wouldn’t know what to do. 

Coming into my fifth year as a dental student, I feel like I am as equally respected as my peers, and I work with a great team of students and tutors. However, I do feel like I had to work harder to get there. 

Situations like this are far from isolated. On talking with colleagues within the profession, I heard of incidents such as that of a dental nurse who recalls being qualified in the eighties only to earn less than a white trainee nurse at their practice and attending Christmas parties where offensive songs were sung about them, the only BAME person in the room. Even now, they’ve seen patients refuse to see dentists of colour, witnessed staff in practices disproportionately assigning complex cases to BAME dentists in lieu of white colleagues. 

In another such account, racism was witnessed even at the university a dental care professional attended. Students were given a scenario to hire someone. One group said they would refuse to hire the person in the scenario because he was black. This had no consequence from the tutor. The dental professional recalls fellow trainees, asking how they would know if their hands were clean, given how dark their skin is. Although having worked in more Cosmopolitan parts of London, they have still experienced a bullying mentality in the wider team. They have encountered handing out CV’s and being rejected almost automatically, despite their credentials and vast experience. 

Looking back at these experiences, it is easy to pick them apart and offer an argument both for and against barriers that these GDC registrants have faced. To me there are no positive experiences in the accent of being a BAME member of the dental profession, because any experience that is not negative, should be normal. 

A senior community dental officer that studied in one of the universities I attended, had experiences (that I hope) would be challenged in their midst, if they were to happen today. They were told when they were studying that they would have a hard time, and to keep their head down. They were picked-on throughout their degree, and at one point was told by a lecturer to smell a pot of eugenol, which would remind them of their ancestors. They were almost failed in a number of modules and when questioned, was told that the supervisor would lower their grades even more if he wished. They witnessed every year, only 1-2 students from BAME backgrounds, and anymore would drop out, due to a high failure rate. They were a good student but when applying for a hospital post, was told by a consultant that they would not get the job because they were black. Despite this, they thrive as a community dentist. However, recent racist remarks are still abundant within the team. It is clear from this, how far we have come as a profession, but how far we still need to go. Experiences like this can affect the mental health of dental professionals, as well as squash their potential. 

This post was difficult to write because there is such a wealth of anecdotal evidence, but little official redress. It is clear to me, that there is a problem here. One of conscious and unconscious bias, of casual discrimination affecting generations already burdened by historic and political barriers. I would advocate open discussion and regular checks to ensure that our own internal biases are not hindering our opportunities and the opportunities of those around us. As a profession, we need to come together to enable these barriers to be minimised as much as possible. 

On reflection here are some areas which could be targeted for improvement within the dental team: 

• BAME positions on student committees at all universities, who can be a figure of support for students and ensure equal representation throughout the course. 
• Training for dental students that enables them to deal with racism in practice. 
• Representative and diverse academic staff. 
• Generalised active discussion about barriers and feelings amongst the BAME community within the profession. 
• Internal bias workshops taught in healthcare university courses and in practices. 

One trend I have noticed is that of not questioning, in fear of having that opportunity taken away, or raising your concerns may amplify the barriers against you. Many of the same barriers which exist within society, exist within the dental profession, and these are the things that cannot be changed unless every member of the profession steps in to stand for change. Thus, I invite you all, to address your biases and stand for change. 

The coverage of the black lives matter marches following the death of George Floyd on May 25 2020, in Minneapolis Minnesota at the hands of white police officers has stirred strong emotions across the world and prompted many people to reflect on their life experiences of culture, race, heritage and ethnicity. There has been much more soul searching about the way we treat each other, how the police profile its citizens, the history we study, the statues we put up as well as the use of language in our everyday lives. 

Your cultural background and heritage are incredibly personal and everyone has strong views about them. 

Debates and sometimes angry discourse across social and print media and television as well as dining tables at home have raged for the past few weeks and see no sign of abating. 

Everyone has some sort of story to tell and the older you are the more graphic and painful that will be. Having a brown face in England in the 1970's and 80's attracted the pejorative epithet of "Paki", commonly with "go home". The confusion I experienced as a young boy in secondary school was obvious. I was in fact Indian and whilst I was born in Kenya, my home was definitely North West London. Trying to educate anyone about this fell on deaf ears even though I bravely tried this on the many occasions I was called it and the few occasions I was threatened and punched for it. But that is not emblematic of my relationship with England. We all have personal stories of intimidation, insult, ridicule, aggression, ill judged humour and ignorance about where we come from, no matter where you come from and whatever the colour of your skin. 

My own personal view is that England is a very different place than the place I grew up in. Unrecognisable in fact for the tolerance, assimilation and celebration of cultural diversity. there are of course still prejudices and animosity simmering beneath the surface in many communities and provably in some institutions and the black lives matter marches have stirred this along with Brexit. COVID-19 and its apparent disproportionate impact on BAME people. 

We should be cognisant also that the term BAME helps identify particular groups who may share a risk to a disease or medical condition and is used to target healthcare resources and research. It is not a lazy short cut to group vastly different people from all parts of the world with different backgrounds, ethnicity, religions and heritage into one amorphous cultural soup. It should be obvious that the "A" in BAME refers to Asians who could be from anywhere across the entire Asian land mass[1]. 

I would argue that the dental profession does not mirror that animosity. It is now, in 2020, I believe a meritocracy - you get a job, promotion, elected and selected because of your ability, skills and attitudes irrespective of the colour of your skin or racial background. There might still be patronage but I cling to the belief that if it is, it is not based on colour. 

I have faced very little racism in my older years as a dentist, either overt or subtle and I would hazard a guess that I am not unique that in London in particular. Of course I might be the only brown face in a particular place, at a particular time which I only become aware of it I consciously make the observation. Equally in London amongst a large group of dentists at an LDC meeting or group of vocational trainers, white faces may be hard to find. Harder still to find black dentists. This is obviously not the case in other parts of England. 

My hopeful belief is that younger dentists see less racism directed at them than their older colleagues or parents. Anecdotes, like mine, are not research and organisations like the BDA will doubtless address this[2], but in the meantime I would be interested through Natalie's blog to hear the stories of black, Asian and minority dentists growing up and working in the UK

I would like to introduce something a little different.... a really insightful guest blog from Shona Sawhney, a fourth year dental student at Barts & The London, describing her experiences as a dental student with chronic illness...

In my third year of dental school, I started to notice a decline in my health. Fatigue, joint pain and stiffness took a big toll on me. Not only did this affect my clinical skills at university, but also my day to day life. Goals such as doing well in exams and passing gateway tests were quickly changed to being able to cook or take a walk without assistance. 

Being told that these symptoms would not go away but would instead need to be managed was really hard for me to accept. I felt such frustration that, through no fault of my own, dentistry become a lot harder for me. I would often enter the clinic feeling very anxious and fearful that once clinics were over, I would be in a huge amount of pain. Tutors were often extremely surprised when I told them what I was experiencing, mainly because in general I didn't look sick. In fact, I looked completely healthy, yet I was suffering from an invisible illness.

Dental school is often exceptionally fast-paced, and although this can be exciting t times, it can also be incredibly stressful. For this reason, it is important to have outlets to channel that stress; for me it was music and the gym. However, as time went on any condition worsened, I struggled to maintain these hobbies. I felt like I had no way to relieve the stress I was under, not just with my education, but with the deterioration of my health.  

During this period, it became apparent to me how important accessibility is in the field of dental field, not just for our patients, but for dental professionals themselves too. Being asked by tutors "what can we do to help" it truly meant a lot to me. I felt for a long time almost an outsider to the profession, but small changes such as seeing oral surgery students exclusively in the afternoon, allowed me to rest my joints after clinic. 

It is very easy during dental school to compare yourself your peers, it can become quite a competitive environment, and when managing your condition, it is hard not to become frustrated. Learning to celebrate the small victories throughout the journey really helped me in managing my condition. An example for me would be the classic crowns gateway usually taken in 3rd year. Due to constant flare ups, I was unable to complete the exam during the last term. However, when the 4th year revalidation came, my mindset changed. Instead of belittling myself and saying "You must pass this", I started telling myself, "I am proud of you for giving it your best." This ability to be kinder to myself not only allowed me to take the exam, but pass it!

Chronic illness can fluctuate massively. Some days will be generally okay while some will be very difficult both physically and mentally. As I have learnt more about my condition, I have discovered certain coping mechanisms for my metaphorical "tool box" to manage the tough days. For me, one of them was talking to a trusted tutor about what can help me through the flare ups, which included implementing a simple card to carry to show tutors explaining my condition and what they could do to support me. I find going into the clinics on a flare up can be very nerve-racking because you're worried people won't understand. However, showing clinicians the card before patients come allows them to understand what you are going through without going into too much depth which may affect you mentally but enough for them to know the main take home message: how to support you.

I was often told with my condition that dentistry was not for me. Such statements can hugely affect a person's confidence instead of instilling it like it should be. There is a place for those with chronic illness within the dental profession. Everything is achievable with the appropriate backing and measures put in place to help you.