“A healthy research environment should maintain strong centres of excellence”

Dr Riad, your study shows a negative correlation between oral disease burden and the number of top dental scholars. What do you see as the most actionable strategies for countries with high oral disease burden to cultivate research excellence, despite limited resources?
You are right that countries with the highest oral disease burden tend to host very few excellent dental scholars. This imbalance is neither inevitable nor irreversible. To my thinking, there are five key ways that countries can develop high-quality—not merely high-volume—dental research despite limited resources.

Firstly, they must prioritise oral health at the national level. According to the 2024 Bangkok Declaration, all UN member states committed to implementing the World Health Organization’s Global Oral Health Action Plan (2023–2030), including the development of nationally tailored oral health strategies and research agendas. When oral health is recognised as a public health priority, governments are more willing to allocate resources, strengthen surveillance systems and support local research capacity.

Secondly, there needs to be targeted capacity building instead of diffuse investment because this spreads limited resources too thin. Concentrating investment in a small number of academic or public health hubs can yield disproportionate returns. This includes providing protected research time for early-career investigators, establishing modest but reliable seed funding streams, strengthening data systems and supporting training in epidemiology, statistics, health economics and implementation science.

Thirdly, oral health research should be decolonised. A considerable portion of oral health research in high-burden regions is still shaped by external priorities rather than local needs.

“National research priorities should focus on studies that directly inform prevention, service organisation and policy development rather than maximise publication counts.”

Decolonising oral health research means ensuring equitable authorship, shared leadership on grants and mutual capacity strengthening with international partners. Low- and middle-income countries need to migrate from a data producer state to an equitable partner state. Fourthly, research agendas can be realigned towards quality, not quantity. The race to be among the top dental schools in the QS, Times Higher Education or ShanghaiRankings lists is counterproductive for institutions in low- and middle-income countries and encourages the manipulation of citation practices to artificially boost metrics. National research priorities should focus on studies that directly inform prevention, service organisation and policy development rather than maximise publication counts. When academic evaluation frameworks reward methodological rigour and policy impact, researchers are incentivised to pursue work that addresses local oral health needs.

Finally, there is a need to embrace integrity in dental research. Upholding the highest standards of research ethics and integrity is essential for safeguarding research quality, particularly in low- and middle-income countries. When researchers face resource constraints, the temptation to engage in questionable practices such as data manipulation, redundant publication or inappropriate authorship can become more difficult to resist. Therefore, promoting research integrity at the institutional level is vital for producing dental research that improves people’s health.

Your analysis suggests that gender differences diminish once academic age is accounted for. What specific institutional policies do you believe would most effectively support women’s academic longevity and advancement in dentistry?
In my analysis, once academic age was brought into the models, the apparent gender gaps in excellence metrics disappeared. In other words, part of what appears to be a gender effect is in fact an age and retention effect: women often have shorter or more interrupted academic careers. If institutions aim to support women’s academic longevity in dentistry, there are a number of measures that might be introduced.

The first would be to build family-compatible academic pathways, including more part-time appointments that still allow progression, as well as transparent tenure and promotion rules after parental leave or caregiving breaks, such as implementing the concept of “effective research years” rather than chronological years. A second measure would be to value the full spectrum of academic contributions. Women are often over-represented in teaching, mentoring and administrative duties, which are less visible in citation metrics. Promotion frameworks should formally credit educational leadership, mentoring and supervision, and contributions to clinical service redesign and community outreach. This would reduce the penalty for taking on these roles.

“Dental institutions should routinely monitor gender differences in hiring, pay, promotion rates, leadership roles and grant success.”

A third measure would be to expand women’s access to leadership and influence. Institutions could accomplish this by rotating leadership positions in departments, societies and guideline panels so that prestige and visibility are not monopolised by a small group of senior men and by ensuring women’s representation as principal investigators on major grants, not only as co-investigators. The fourth measure concerns the issue of monitoring and accountability. Dental institutions should routinely monitor gender differences in hiring, pay, promotion rates, leadership roles and grant success. Without data, inequities remain anecdotal and easy to ignore.

Given the limitations of citation-based metrics—even sophisticated ones like the composite citation indicator in the Stanford–Elsevier lists—how would you redesign the concept of research excellence if citations were only one component of a broader, more holistic evaluation?
The composite citation indicator used in the Stanford–Elsevier lists is indeed sophisticated and certainly more nuanced than a simple h-index or raw citation count. Nevertheless, it remains fundamentally citation-based, which I do not consider sufficient for capturing real scientific impact. A more holistic evaluation of excellence should advance along several trajectories. Citations from scholarly journals should not be treated as equivalent to citations originating from policy documents, patents, educational textbooks or clinical practice guidelines. A citation embedded in a government-adopted policy, for example, has far greater implications for health systems and population outcomes than a typical journal citation does. Although initiatives such as Sage Policy Profiles and Google Patents have made fragmented progress in identifying non-journal citations, my vision is to integrate all citation types into a composite framework that assigns weights based on source and influence, following principles similar to those of PageRank.

Furthermore, citations do not inherently signal positive influence; some references reflect disagreement or critique rather than endorsement. Tools such as Scite have begun distinguishing between supporting, contrasting and neutral citations, offering a more nuanced view of scholarly influence. An additional layer of analysis should examine where citations appear within new studies, such as whether they inform methodological development or merely contribute to background narrative.

It is also important to observe that mentions across social media platforms, policy commentary, public engagement outputs and online communities provide insight into the societal salience of research. While not a substitute for scholarly impact, these signals offer complementary evidence that a piece of work resonates beyond academic circles and contributes to wider public discourse.

Finally, the methodology of the composite citation indicator in the Stanford–Elsevier lists currently treats all dental publications as equivalent, but this overlooks substantial heterogeneity across national research environments, economic contexts and dental specialties. Publication intensity, journal ecosystems and opportunities for editorial participation differ markedly between orthodontics, oral surgery, public health dentistry and other fields. Developing normalised indicators for national, regional, economic and specialty levels would provide a more equitable platform that recognises excellence emerging from resource-constrained settings and diverse disciplinary traditions.