From John Tomes in 1880 through to Russ Ladwa in 2020, the BDA has a rich history of Presidents who have held the role for their term. Yet when in 1993 Dame Margaret Seward took the role, she probably would have been surprised to know it would be another 25 years before another female president was elected.

And yet, 2021 will see the installation of the third female president in four terms. I spoke to Past President and Dental Protection Dentolegal Consultant, Susie Sanderson, Immediate Past President, chair of the Honours and Awards Committee and mental health campaigner Roz McMullan, and President Elect and editor of Evidence Based Dentistry Elizabeth Kay to discuss what the honour means to them.

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Susie Sanderson

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Roz McMullan

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Elizabeth Kay

SS It was of its time. You have to say the three before me are pretty special though! The profession was overwhelmingly male when I was an undergraduate. Oddly - and perhaps naively - it never occurred to me that dentistry was perceived as a male profession. Not seeing why I can't has been a powerful benefit for me throughout my life. In fact, until relatively recently, I always found it a little odd when comments were made about 'the first woman to…' be something or to do something.

Maybe it's more about selfishness. If you want something badly enough, you work at it and go and get it. The profession is no longer overwhelmingly male. There are powerful women and powerful men. And men and women who lack confidence or prefer a life that doesn't involve representational work or leadership positions. I have always been sure though - if you don't like what is going on, you can only influence it by being involved.

RM I look at it as a reflection of the profession 20 years ago. The very nature of being president reflects your achievements, and for many that recognition comes towards the end of your career. Obviously that doesn't apply to Liz!

If you look at the past as you say, I'd argue that it will be completely different going forward. It was commonplace in the 80s for many of my female colleagues to work in the NHS, take time to start a family and come back to work part time. If you go further back than that, society dictated it wasn't the role of women to make a career. The fact we've had Susie and me as presidents, with Liz to come, is indicative of the huge societal change and achievements of women in dentistry over the last 30 years, of which there have been many.

I think it's also reflective of the type of personalities we have. It takes a certain type of person to make an impression, irrespective of race or gender, for example. I remember when I was doing my registrar training, I was offered my consultant post in the north west of Northern Ireland, when I really wanted a post closer to home. I had no connections or ties with the area, and there was much soul-searching and many tears before deciding to accept the position. My family and friends couldn't really understand my hesitancy - I wasn't uprooting a whole family, I could build the life I wanted, and there was a general perception it would be easier for me as I didn't have these concerns. It happened to be the best decision I've ever made.

LK Like Roz, I see similarities in the way the presidential role reflects BDS intake. My year was one of the first with a 50/50 split in gender. Up until then there had always been more men qualifying as dentists, so the odds suggested it was far more likely that a male president would be nominated than a female one - that's logical. This is all changing - dental schools are now seeing more women than men coming through - so I'd expect this to be reflected moving forwards.

LK I can. The call came from Mick Armstrong, and I was so surprised and genuinely honoured and humbled to have even been put forward, let alone chosen. It hasn't always been the case that the committee chooses a nominee who they know will do things very differently to what's gone before and bring some radical ideas to the table! I have terrible imposter syndrome and feel like I don't really deserve it!

RM Like it was yesterday! I was aware my branch and section had nominated me, but there was nothing in me that thought I'd be successful. The meeting to decide who would be announced as president elect was on the same day some friends of mine were over from Australia, and true to form it was a cold and wet day, so I took them to the Bushmills Distillery for a tour and some tasting. It's a grand old building and you have to turn off your phone because you might set light to the 'angel's share'. At the end of our tour, I noticed had a missed phone call from Philip Henderson and said to my friends I better return the call.

Needless to say when I did and got the news, I was numb. One of the staff members even asked me if I was OK because I'd turned pale! My friends had to tell him what had happened, which resulted in us getting a second nip to taste. After the news sinking in, I remember a man in a suit making his way towards me. He was carrying an 18-year-old bottle with a personalised label congratulating me on being nominated as BDA President. I'll never forget it.

SS Yes, I can too - I was overwhelmed and humbled with the honour of it. And the best of it was how thrilled my mum and my kids were. And then immediately following that, I was immensely grateful to everyone I have ever worked with in the BDA over many years. Nothing I ever achieved happened without considerable teamwork and the phenomenal efforts of many tireless, skilled and talented people. Silent leadership is, by definition, not seen; those actually doing the work while others receive the glory. The OBE is often said to be the acronym for 'other buggers' efforts'. My OBE without doubt reflects the support, advice and assistance I received from many others. I saw the presidency in the same way. The president is the front for the real grafters behind the scenes but has the fantastic opportunity to be out and about representing the BDA nationally and internationally.

RM Dame Margaret Seward. She was part of the original women in dentistry movement and had a huge role in changing the maternity rights female GDPs had.

Besides the many anecdotes she had - including the famous Concorde and Robert Redford tale - she had the political will, skill, desire, determination and personality to make headway in a male-orientated world. What makes her special to me is her gift of being able to bring people together to work towards a common goal. Her legacy will have an impact for generations of dentists coming through the system. She gave me the confidence to think 'I can be the person I am while working collaboratively and doing what's right'. That's the type of personality I have, and hopefully the type of president I was.

' It would be good that presidential nominations are viewed and recommendations made to the membership based on what the individual will bring to the role and responsibility of president. It's a job that needs energy, professionalism, wisdom, experience, insight and humility. Those traits aren't gender specific.

SS If I were being flippant - it would be The West Wing's President Jed Bartlet. Or perhaps Aaron Sorkin whose words Jed Bartlet and the rest of the cast deliver so beautifully in the earlier seasons of The West Wing. There is a seminal episode, Hartsfield's Landing, in which the president plays chess with his senior staff while he manages tensions in the China seas with wily brinksmanship. He's a powerful but empathetic man who teaches his team how important it is to 'see the whole board' when making decisions or taking a view. This way you strengthen and protect your best pieces throughout - in the chess game, in a negotiation, in your career - by taking the time and effort carefully to appreciate everyone else's positions.

In truth I've had so many role models - and the three female presidents from 1993 to me are very powerfully among them. But, for the avoidance of doubt, my role models have been a mixture of men and women and their gender has not affected my admiration of them. And I am so grateful to them all. I hope those who have also proactively mentored me appreciate that. I'm fascinated by talent, skill and cleverness and I have watched my role models using their talents, skills and cleverness in a proactive, courteous, generous and empowering way. I hope that I have learned to behave in the same style.

LK It's a terrible cliché, but I have to say my mum. She was very determined, a leader and a hoot! They're good qualities to have. She was head of a girls grammar school and inspired so many young women. I think that's maybe where I got my passion for trying to identify and develop talented people.

Like Roz, I'd also have to point to Dame Margaret Seward. She's so knowledgeable and wise, brilliant with people and especially good at bringing though women with potential. It's not a stretch of the imagination to say there wouldn't be anywhere near as many women in senior leadership roles in dentistry had it not been for her. She's a real pioneer for women in our profession.

SS I would like to think that it means that we have reached the stage where the BDA members do not consider gender when they have before them a good pool of candidates, all of whom have a proven track record of successfully holding significant leadership positions. But I don't think everyone is there yet. It would be good that presidential nominations are viewed and recommendations made to the membership based on what the individual will bring to the role and responsibility of president. It's a job that needs energy, professionalism, wisdom, experience, insight and humility. Those traits aren't gender specific.

There is no doubt in my mind that, as Liz has mentioned, there is an element of imposter syndrome for many women during early and middle career years. I also think that it doesn't sit easily with women to enter into a back scratching exercise to gain mutual advancement and most will either miss the signs of it being offered or reject it as distasteful. In my experience - and I understand it is backed up by research - a man will have no difficulty selling himself in any sort of selection process whether or not the bragging is justified. I think that the three female presidents in this four-term period have individually been attractive candidates in their own right, bringing their own demonstrated strengths and commitment to integrity and professionalism. I also think that those charged with making the recommendations for the president's role to the membership are insightful, without any element of bias and have the best interests of the BDA in mind.

RM I'm not sure it says anything if it ends with Liz and things don't continue to change over the next 20 years. It's a great start, but complacency cannot set in. you learn in Northern Ireland that things can go backwards mighty quickly - that must not happen in this environment.

What it also tells me is how important it is for women to get involved at branch and section level. People perhaps don't realise it isn't the BDA's decision who to nominate - that's something done by your peers. If someone can look at you and think 'wow, this person has contributed so much', then progress will continue.

There are conferences I have attended that really do make me despair - the same faces and therefore the same voices. It might be uncomfortable for some, but a new voice that makes an impact does get noticed.

LK I think it shows there has been progress. I was right on the cusp of when BDS intake was equal, and that change takes time to manifest - it's organic and doesn't happen overnight.

It also shows the membership and those involved at branch and section level have become more used to the idea of a female president. The numbers don't paint a pretty picture historically. However, it's worth remembering that the only constant is change, and with the benefit of time, I think we will see that it's going in the right direction.

LK Yes, it was. I am profoundly against quotas and positive discrimination - roles should be based on talent and the best people for the roles available. Any sort of preferment can provoke resentment and in my mind weakens the position and influence of the person appointed. I would hate for anyone to think 'she's only in the role because she's female'.

Where there is room for development is the process. Are all candidates considered equally? For example, even the wording of an advert can bias the type of applicants received. I've read a number of job adverts that I - and other female colleagues - think 'that's not aimed at me'. The real change is in hearts and minds. How we do that remains high on the agenda, and can only be achieved with collaboration.

RM Of course, I was delighted to be nominated on merit, and it certainly motivated me to be the best I could have been, but my own relationship with the notion of protected seats is an interesting one. I, like Liz, was a firm believer in the same process - being nominated on merit - but last November I changed my view. There's a strong argument to suggest we cannot rely on the electoral process to continue delivering change and equal representation.

What it also shows is how important it is for any chair at LDC or GDPC level to listen. It sounds simplistic to the point of ignorance, but holding a position where you represent your peers and profession means you need to listen to different arguments in a different way.

SS I have held several elected senior positions, and still hold the elected position of Speaker of the FDI General Assembly. On every occasion I have felt deeply honoured and proud to be chosen by my peers in an open election.

I suppose what is meant by a 'balanced' dental board is the key question. The electorate has a duty, in my view, to consider the context in which the Board functions and its duties and responsibilities. For the BDA, is it important to have a board that represents the characteristics of its members or represents the characteristics of the profession? Or is it more critical to have a board made up of people who have the demonstrated non-executive director skills necessary for a successful oversight of a multi-million-pound company? Or is it a mixture of all of this and more? Either way, the members of the BDA hold the key.

There is regularly now a good and diverse field of candidates standing for the BDA's board - the PEC. The members should see the whole board - not simply vote for the name they have heard of, the person who looks like them or the noisiest with a populist single agenda approach on social media. At the same time, those putting themselves forwards need to do their homework, prepare themselves if they need to gain skills, understand what 'balance' means in the context of the BDA and, if successful, be prepared in due course to make way for the next good candidates at the appropriate time.

RM If you lined up all of the photos of the next 26, I think we will see a group more representative of the membership and profession than the previous 26. Whether that happens or not is open to debate, but it's in our power to do something about it. If it doesn't happen, it isn't the profession's nor the membership's fault, it will be ours, and when I say that I refer to the BDA and those who are charged with nominating their peers. We need to listen to and recognise the immense contribution of all dentists who are making a difference. I hope Susie, Liz and I can inspire others to follow our paths.

SS I hope that we will see 26 first class presidents with diverse backgrounds: dentists from all corners of the profession who have made a difference and are appreciated for that either by their peers or by their patients. I really hope that recommendations for the presidency won't be made on the grounds of gender but that, within a short time, a genuinely meritocratic process will lead in any case to a gender balance that reflects the profession of dentists. I hope that some of those might be people that I have encouraged to take the next step.

LK Well I like to think that what I hope for, will actually happen. My hope echoes what Susie mentioned earlier - that any incoming president is chosen regardless of gender and based on their suitability. I also want to see people who are cheerleaders for the membership and the profession they represent. In my eyes, we don't have enough people who champion just how profoundly important dentistry is to the population. We're an amazing group who do amazing things, so why aren't we getting that message out there?

To me, the president cares for and about the future of the profession. That's evident in all of those who have held the position. It pains me to see the uncertainty surrounding dental students caused by the pandemic, but my message would be that we're infinitely more resilient than we know, and things will be OK. It might not be today or tomorrow, but they will be. Perhaps it's what I've seen in my role as editor of EBD that makes me so optimistic. There are enthusiastic and extremely clever young dentists beating a path to my door to offer help in analysing published research. This can only augur well for the future of the profession because among them are probably our leaders of tomorrow.