What Is the Standard of Excellence Today?

  • by Kathryn Ragalis, DMD, MS
  • Mar 28, 2022
This column is a collaboration between AGD and the American College of Dentists. 

The past two years have seen unprecedented changes almost everywhere, including in the dental profession. The recent changes in dentistry have occurred in response to many factors, including the COVID-19 pandemic and advances in technologies as well as progressive changes in values, visions and goals. With all these changes within the profession, what is the standard of excellence? 

Excellence is defined as “the quality of being outstanding or extremely good” or performing at the top of one’s abilities.1 In the 1990s, a sign hung on a wall in my dental school that read: “Pursue perfection, but tolerate excellence.” Perfection may not be possible in the practice of dentistry, but what are the qualities and characteristics of one who exemplifies excellence in dentistry, and have they changed? 

The answer to these questions depends on who assesses a particular item, skill or issue for its level of excellence. I remember a time in dental school when I thought my work was excellent until the professor came, picked up an instrument and carved beautiful anatomy into an amalgam restoration and truly modified my work into a more excellent result. Excellence is viewed through very different lenses, such as those of the inexperienced student, a teacher, a colleague, a school’s administrator or a patient. The time period or era must also be considered. What may have been viewed as excellence years ago may have changed or shifted to a different outcome or to the presence of additional qualities that are valued or required. Now, although the skills of carving an amalgam may be admired, there are some who may never view an amalgam restoration as having excellence because of advancements in technology and more esthetic material options.

The mission of the American College of Dentists (ACD) includes the advancement of excellence, in addition to promoting ethics, professionalism and leadership in dentistry. An aspirational statement of the ACD core values says, “A Fellow of the ACD strives to achieve the highest level of knowledge, skill, and ability within his or her capacity.”

The American Dental Association’s “Principles of Ethics & Code of Professional Conduct” also may support excellence with the following principle of nonmaleficence: 

Principle: Nonmaleficence (“do no harm”). The dentist has a duty to refrain from harming the patient. This principle expresses the concept that professionals have a duty to protect the patient from harm. Under this principle, the dentist’s primary obligations include keeping knowledge and skills current, knowing one’s own limitations and when to refer to a specialist or other professional, and knowing when and under what circumstances delegation of patient care to auxiliaries is appropriate.3 

Each practitioner must interpret how to keep “knowledge and skills current.” One may seek a minimal level or choose to pursue these with excellence, for example, through additional continuing education or involvement in professional organizations and study clubs. There is always more current knowledge and skills to gain to achieve the highest level within one’s capacity. 


Dental patients expect their provider to perform superior work with excellent results. Anecdotally, faculty members notice that some dental students show their preclinical lab work and ask, “Will this pass?” rather than being curious for a detailed critique on how to improve their skills to be an outstanding clinician. The student may either be striving only for the lowest acceptable result, or they may feel their work is excellent if they consistently pass, while faculty members may consider their work to be at the lowest level of skill. Additionally, review sessions in some courses are designed for those who may be at risk of failing a course rather than being inclusive for all who should be encouraged and would benefit from improving and further developing their skills. 

What is the danger of students and dentists who do not pursue excellence? The danger may be a negative impact on patient care and on the reputation of the profession. 

Pursuit of Excellence 

The benchmarks of excellence may change over time, but the pursuit of it should be encouraged and continued consistently with passion and dedication from the beginning of school and throughout practice. 

The pursuit of excellence must be an expectation of oneself and all in the profession. The pursuit of excellence begins in school. Faculty members must not tolerate students who pursue the minimal level of competence by striving only for a passing grade. Students must be encouraged and reminded that the pursuit of excellence is an expectation of their colleagues, staff and patients. Excellence is a part of dentistry that isn’t achieved with a minimal level of skill; it continues to develop over a lifetime of effort and learning. 

Professional athletes do not stop practicing because their skills are adequate. Some of the greatest athletes of all time continued to rigorously practice and to be constantly coached throughout their entire careers. Their success impacted their teammates and brought the whole team up. Each member of a team makes their own personal commitments to excellence, and all must realize that each has this same expectation in others. 

Times of change and challenges can make usual activities and performing the minimum standard of care difficult. These times may be an opportunity to reflect on the pursuit of excellence. Consider your health and the goals and passions you want to pursue, then access technology, educational materials and resources available and support those around you in meeting the expectation of pursuing excellence. 

Kathryn Ragalis, DMD, MS, is an associate professor and director of ethics and professional development at the Tufts University School of Dental Medicine. To comment on this article, email impact@agd.org

1. Definition of Excellence in English. Lexico, lexico.com/en/definition/excellence. Accessed 11 Jan. 2022.
2. Ethics Handbook. American College of Dentists, acd.org/publications-2/ethics-handbook/. Accessed 11 Jan. 2022. 
3. Principles of Ethics & Code of Professional Conduct. American Dental Association, 2020, ada.org/-/media/project/ada-organization/ada/ada-org/files/about/ada_code_of_ethics.pdf. Accessed 11 Jan. 2022.