Specialized dentistry – Free Course
Esther K. Andrews
INTRODUCTION
This three-part continuing education course will provide information on general dentistry, dental specialties and dental disciplines. The requirements for dental practice in each subject area may be determined by general and specialty dental political entities or by groups, associations, academies or societies that ultimately must conform to the law of the land. Because many dental procedures are complicated or unique, advanced learning in the subject area better qualifies the practitioner to treat the patient. A general practitioner increases his or her legal liability by practicing beyond the normal realm of general practice, unless additional coursework is completed or educational requirements are met.
COURSE OBJECTIVES
Upon completion of this course, the participant will be able to:
* Recognize terminology used in dentistry.
* Determine when general dentistry and specialty dentistry are performed.
* Access dental organization web sites.
* Differentiate between dental disciplines and dental specialties.
* Recognize selected procedures, techniques and practice settings found in dentistry.
OUTLINE
I. Introduction
II. Course Objectives
III. Outline
IV. General Dentistry
V. Dental Specialties
VI. Dental Disciplines
VII. Summary
VIII. References
IX. Test Questions
GENERAL DENTISTRY
General dentists practice dentistry by using skills in oral diagnosis, disease prevention and rehabilitation. They diagnose and treat disorders of the mouth through patient assessment, treatment planning, patient education, disease prevention, operative dentistry and/or surgery. The general dentist renders complete dental service and refers complicated and unusual cases to dental specialists. About 80% of all dentists practice general dentistry while an estimated 20% practice a particular dental specialty. (1)
Educational Requirements
Most general practitioners earn the degree of Doctor of Dental Surgery (D.D.S.), with the degree of Doctor of Medical Dentistry (D.M.D.) earned by the rest. The type of degree earned depends on the school attended. There is no difference in the educational background they receive. In order to practice dentistry in a state, the dentist must become licensed within that state. Licensure requirements vary from state to state and in the U.S. territories. Those practitioners enlisted in military service must have a valid dental license from any state in the U.S. After becoming licensed to practice, dentists must complete continuing dental education credits or units (CDE or CEU) according to the requirements of the individual state licensing board. Beyond continuing education, additional advanced study can be pursued in a dental specialty or discipline.
Academy of General Dentistry
The Academy of General Dentistry (AGD) is a nonprofit organization that provides CDE to the dental profession and resource information to the consumer public. Members of the AGD must complete 75 hours of continuing education in a continuous three-year period. AGD requirements are for personal advancement and achievement.
The AGD bestows two awards, the Fellowship award and the Mastership award. A general dentist earns the Fellowship award by maintaining membership for five continuous years, completing 500 hours of CDE, and passing a comprehensive exam. The Mastership award is presented after completion of the Fellowship award criteria and 1,100 hours of CDE that includes 400 hours of hands-on course work.
The AGD recognizes 16 disciplines of dentistry in which a Fellow must study. They are: Aesthetics, Basic Sciences, Endodontics, Electives, Fixed and Removable Prosthodontics, Implants, Occlusion, Operative Dentistry, Oral Diagnosis and Oral Medicine, Oral Surgery, Orthodontics, Pediatric Dentistry, Periodontics, Practice Management, Self-Improvement, and Special Patient Care. (2) The completion of these Academy requirements earns the individual the right to be called a Fellow or Master of the Academy of General Dentistry (FAGD or MAGD).
The American Board of General Dentistry
A dental specialty must establish a national board for certifying Diplomats. Diplomats of the Board are individuals who have progressed to the highest educational reaches in a particular area of dentistry. The national board for certifying general dentistry Diplomats is the American Board of General Dentistry (ABGD). After a general dentist has completed the Fellowship and Mastership programs of the AGD, he or she then becomes eligible to join the ABGD and to complete the additional requirements to become a Diplomat. (3)
DENTAL SPECIALTIES
When general dentists encounter a complicated or an unusual patient case beyond their ability to manage, state laws require them to refer the patient to an individual better qualified to treat that condition. Usually, the patient is referred to a dental specialist or a dentist with advanced learning in a concentrated subject area. These subject matter experts may have their own private practice or business, work in a group practice, share space with another dentist, work in a teaching institution or be hired by another dentist.
The dental specialist has completed a general dentistry degree and postgraduate training in an accredited American Dental Association (ADA)-recognized dental specialty program of study. The ADA document, “Requirements for Recognition of Dental Specialists,” outlines the process for specialty status recognition. The ADA House of Delegates votes to establish a dental specialty when that specialty has demonstrated the advancement of the profession in education, practice and research in order to protect the public at large. (1)
Currently, there are nine ADA-recognized dental specialties (Figure 1). As new disciplines of dentistry become organized they can petition the ADA for official specialty status.
Figure 1: ADA-Recognized
Dental Specialties
Dental Public Health
Endodontics
Oral and Maxillofacial Pathology
Oral and Maxillofacial Radiology
Oral and Maxillofacial Surgery
Orthodontics and Dentofacial
Orthopedics
Pediatric Dentistry
Prosthodontics
Educational Requirements
The ADA Commission on Dental Accreditation oversees dental specialty education. The additional education requirements vary from specialty to specialty. Generally, there are two to seven years of postgraduate education after dental school and a special certification board examination. Once their education is complete, specialists add the credential Master of Science (M.S.) after the credential D.D.S. or D.M.D. For example, an orthodontist’s name may be written as Michele Smith, D.D.S., M.S., which signifies the completion of an advanced degree beyond the doctorate of dental science or doctorate of medical dentistry.
Upon completion of the educational requirements of the program, dental specialists must limit their practice to that one area of dentistry. General dentists who receive advanced knowledge in a subject area but who do not specialize are still able to practice in all the areas of dentistry in which they are qualified. As is true in general dentistry, completion of an advanced degree does not allow specialists to stop the learning process. Academies and boards related to each specialty and discipline promote and support further academic and clinical achievement.
Further information on each dental specialty can be obtained by visiting the websites noted in the References.
Dental Public Health
Dental Public Health deals with public preventive education, community treatment programs and applied dental research. It is funded by federal, state and local government agencies, grant-funded programs, private companies and nonprofit private sources such as religious charities or professional associations. The public health dentist has a master’s degree in Public and/or Community Health and specializes in working for public and/or private community public health programs. With the oral health of the U.S. and other countries being deficient due to access to care issues, public health personnel are needed to promote oral health, disease prevention and education.
Federally funded public dental health programs originate in the Cabinet of Health and Human Services (HHS), Office of the Secretary, Administration for Children and Families, Administration on Aging, Agency for Health Care Policy and Research, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Food and Drug Administration, Center for Medicare Services, Health Resources and Services Administration, Indian Health Service, National Institutes of Health, Program Support Center and Substance Abuse and Mental Health Services Administration. (4) Other federally funded public health programs originate in the Cabinet Department of Defense, Cabinet Department of Veterans Affairs (hospitals) and the Cabinet Department of Justice (Bureau of Prisons).
The American Association of Public Health Dentistry (AAPHD) is the nonprofit organization that provides CDE to the dental profession and resource information for the consumer public. (5) The American Board of Dental Public Health certifies the Diplomats in public health.
Endodontics
Endodontics deals with the morphology, physiology, pathology, etiology, diagnosis, prevention and treatment of diseases of the pulpal and periapical tissues. The American Association of Endodontists (AAE) promotes the specialty of endodontics with research, highest standard of care and providing continuing education courses. (6) The AAE sponsors the American Board of Endodontics (ABE) to certify members as Diplomats. An ABE Diplomat has demonstrated skill and passed an examination administered by a panel of peers.
Oral and Maxillofacial Pathology
Oral and maxillofacial pathology deals with the etiology, diagnosis, management and research of diseases that affect the maxillofacial structures. The oral pathologist may serve the public, military, dental and medical professions, hospitals, and dental and medical schools. Oral pathologists support oral surgeons, ear, nose and throat physicians and military ships. Additionally, there is a forensic side to oral pathology. There are two main divisions in pathology–clinical pathology and anatomic pathology. Clinical pathology is the analysis of body fluids. Anatomic pathology is the analysis of tissues.
The American Academy of Oral & Maxillofacial Pathology represents the specialty and maintains a list of Diplomats of the American Board of Oral & Maxillofacial Pathology (ABOMP). (7) A Diplomat has completed the requirements for certification.
Oral and Maxillofacial Radiology
Oral and maxillofacial radiology deals with the production and interpretation of images created by radiant energy to diagnose and manage diseases that affect the maxillofacial region. The American Academy of Oral & Maxillofacial Radiology (AAOMR) promotes radiology in dentistry by conducting annual scientific meetings, sponsoring a scientific journal, publishing a newsletter, and issuing position statements. (8) The American Board of Oral and Maxillofacial Radiology (ABOMR) certifies Diplomats and audits compliance with continuing education recertification.
Oral and Maxillofacial Surgery
Oral and maxillofacial surgery deals with the diagnosis, surgical repair of injuries, defects and diseases of the maxillofacial region. Oral surgeons treat patients in hospitals, outpatient facilities, surgery centers and in private dental offices. The American Association of Oral and Maxillofacial Surgeons (AAOMS) is the nonprofit professional association for oral surgeons whose mission is to provide the standards of the specialty. (9) The American Board of Oral and Maxillofacial Surgery (ABOMS) is the specialty board responsible for the oral and maxillofacial surgery certification process. A Board-certified oral and maxillofacial surgeon has completed a residency program.
Orthodontics and Dentofacial Orthopedics
Orthodontics and dentofacial orthopedics is the area of dental practice that corrects malaligned teeth and jaws. The American Association of Orthodontists (AAO) is the nonprofit organization representing this specialty. (10) The American Board of Orthodontists (ABO) is responsible for certifying orthodontists with the title Diplomat.
Pediatric Dentistry
Pediatric dentistry deals with the treatment of children. Pediatric dentists practice an advanced level of care for children in private offices, clinics, and hospital settings after completing two to three years postgraduate study in child psychology, growth and development. They are qualified to care for patients of any age with special needs such as medical, physical, or mental disabilities. The American Academy of Pediatric Dentistry (AAPD) represents this specialty. (11) The American Board of Pediatric Dentistry (ABPD) certifies the Diplomats.
Periodontics
Periodontics deals with prevention, diagnosis, treatment and maintenance of the supporting structures of the teeth using preventive, surgical and nonsurgical techniques. The American Academy of Periodontology (AAP) represents this specialty. (12) The American Board of Periodontology (ABP) certifies the Diplomats.
Prosthodontics
Prosthodontics is the area of dental practice that replaces lost maxillofacial structures with fixed or removable prosthetic devices. The American College of Prosthodontists (ACP) is the ADA-recognized organization for prosthodontics. (13) The American Board of Prosthodontics certifies the knowledge, skills and attributes of Diplomats.
DENTAL DISCIPLINES
There are other disciplines of dentistry where additional knowledge can be sought to add more scope and dimension to dental practice (Figure 2). Currently, these areas of dentistry may not be officially recognized as a viable dental treatment or as a dental specialty but are recognized as requiring additional training and education. In the future, once requirements of ADA’s “Recognition of Dental Specialists” are met, they may be added to the list of recognized dental specialties. The general practitioner can gain advanced information in the disciplines to use when treating a particular type of patient, such as the physically challenged or sensory impaired.
Figure 2: Dental Disciplines
Complementary and Alternative
Dentistry
Cosmetic Dentistry
Forensic Dentistry
High Tech Dentistry
Implants
Oral Anesthesiology
Oral Medicine
Sports Dentistry
Temporomandibular Joint
Disorder
Alternative and Complementary Dentistry
Complementary and alternative therapy is the discipline of dentistry in which nontraditional practices and methods are used to treat chronic health problems. Allopathy is the system of using antagonists to cause a reaction that produces a different biological condition. A simple example of this is to cure fever by cooling the patient. Naturopathy is the system of using health restoration to allow the natural healing process. Homeopathy is the system of using repeated single or daily doses of plant extract or mineral that produce similar symptoms of the disease in order to stimulate the body’s defense mechanisms. The Holistic Dental Association (HDA) is available on the Internet for information on complementary and alternative therapy in dentistry. (14) (Ed. Note: For a thorough discussion of “Alternative Medicine in Dentistry” see ADAA Course #0112, Coyright [c] 2001, also authored by Esther K. Andrews.)
Cosmetic Dentistry
Cosmetic dentistry deals with the aesthetics of dental treatment. The American Academy of Esthetic Dentistry (AAED) is linked with prosthodontics. (15)
Forensic Dentistry
There is an adage in forensics: “Teeth are the first to go in life, the last to go in death.” Forensic odontology is the application of dental science to identify postmortem human remains for legal purposes. Most cadavers are easily identified. Most postmortem identifications are done by:
1. Visual inspection.
2. Dental comparisons.
3. Fingerprint matching.
4. DNA testing.
The American Society of Forensic Odontology (ASFO) is the organization of forensic dentistry that is open to all individuals and serves as a liaison with other forensic disciplines. (16) The American Academy of Forensic Sciences (AAFS) represents 10 areas of forensic specialties and is dedicated to the application of forensic science to the law. To become certified by the American Academy of Forensic Sciences (AAFS), the dentist must meet its many requirements. (17)
The American Board of Forensic Odontology (ABFO) is comprised of forensic experts and certifies the Diplomats. (18)
Geriatric Dentistry
Geriatric dentists treat the elderly. Information on geriatrics is available from the U. S. Department of Health and Human Services. (4)
High Tech Dentistry
High tech dentists use the latest technological advances in dentistry. Lasers, air abrasion units, enhanced computer programs and digital radiography are examples of current technologies used in dental practices today. The American Academy of Laser Dentistry is an international organization dedicated to laser dentistry training, use and research in the safe use of all laser wavelengths. (19)
Implants
Implantodontics deals with the prosthetic and surgical aspects of implant dentistry. The American Academy of Implant Dentistry (MID) strives to advance the practice of implant dentistry through education, credentialing and advocacy for consumers and practitioners. (20) AAID members primarily insert root-form implants, but may provide all implant modalities.
Oral Anesthesiology
Oral anesthesiology is the area of dental practice that controls pain and anxiety. The American Dental Society of Anesthesiology (ADSA) represents dentists with an interest in local anesthesia for pain management and sedative medications for anxiety control to help make dental care more pleasant. (21)
The American Society of Dental Anesthesiologists (ASDA) represents a group of dentists who have completed two years of advanced training in anesthesiology in hospital operating room and ambulatory anesthesia to assist the planning, implementation and management of anesthesia. (22)
Oral Medicine
Oral medicine deals with the oral health care of medically compromised patients. This includes both diagnosing and treating the oral manifestations of systemic disease. The Academy of Oral Medicine strives to promote education, research and patient care to improve the quality of life of patients with medical disorders and with oral and maxillofacial disorders. (23) The Academy sponsors the American Board of Oral Medicine (ABOM), which certifies candidates who have completed the educational requirements.
Sports Dentistry
Sports dentistry deals with the prevention and management of oral and maxillofacial sport injuries. Since 13%-39% of sports injuries are dental related, protection of orofacial structures is important. Accidents, unintentional injury and intentional injury to the head and neck can damage the body as a result of exposure to thermal, electrical, mechanical or chemical energy or from the absence of oxygen. The Academy of Sports Dentistry represents this discipline. (24)
Temporomandibular Joint Disorder
Temporomandibular joint (TMJ) dysfunction is the improper functioning of the jaw joint where the mandible attaches to the temporal bone of the skull. The American Academy of Orofacial Pain seeks to improve the treatment of orofacial pain and temporomandibular joint disorders by promoting the exchange of scientific information. (25)
SUMMARY
Knowledge of the disciplines of dentistry is needed for the dental assistant to properly communicate with the patient, insurance companies, labs and medical offices. It also helps the dental assistant identify workplace settings. It is the responsibility of the dental assistant to become familiar with these subject areas in order to better communicate with patients about their treatment. While it is nearly impossible to know the details of all of the thousands of dental procedures performed on patients, knowledge of the common topic areas helps the dental assistant to provide additional information to the patient.
REFERENCES
(1.) American Dental Association: www.ada.org
(2.) Academy of General Dentistry: www.agd.org
(3.) American Board of General Dentistry: www.abgd.org
(4.) U.S. Dept of HHS: www.hhs.gov
(5.) American Academy of Public Health Dentistry: www.aaphd.org
(6.) American Academy of Endodontics: www.aae.org
(7.) American Academy of Oral and Maxillofacial Pathology: www.aaomp.org
(8.) American Academy of Oral and Maxillofacial Radiology: www.aaomr.org
(9.) American Association of Oral and Maxillofacial Surgeons: www.aaoms.org
(10.) American Association of Orthodontists: www.aaortho.org
(11.) American Academy of Pediatric Dentistry: www.aapd.org
(12.) American Academy of Periodontology: www.perio.org
(13.) American College of Prosthodontists: www.prosthodontics.org
(14.) Holistic Dental Association: www.simwell.com/hda
(15.) American Academy of Esthetic Dentistry: www.estheticacademy.org
(16.) American Society of Forensic Odontology: www.abfo.org
(17.) American Academy of Forensic Science: www.aafs.org
(18.) American Board of Forensic Odontology: www.abfo.org
(19.) American Academy of Laser Dentistry: www.laserdentistry.org
(20.) American Academy of Implant Dentistry: www.aaid-implant.org
(21.) American Dental Society of Anesthesiology: www.adsahome.org
(22.) American Society of Dental Anesthesiologists: www.asdahq.org
(23.) American Academy of Oral Medicine: www.aaom.com
(24.) Academy of Sports Dentistry: www.acadsportsdent.org
(25.) American Academy of Orofacial Pain: www.aaop.org
Test Questions: Specialized Dentistry
Please note: There is an administrative fee of $8 to cover a portion of grading and publication costs. This fee MUST accompany the test when it is submitted for grading. Use answer sheet opposite. APPROVED FOR TWO CONTINUING EDUCATION CREDITS–ADAA Members Only
1. When does the general dentist refer a patient to a dental specialist?
A. When the patient requests a referral
B. When the patient’s case is complicated or unusual
C. When the insurance company refuses to pay for general dentistry
D. When the dentist has earned a Fellowship
E. When the dentist is a member of the Academy of General Dentistry
2. What is the purpose of the Academy of General Dentistry?
A. To administer and control general dentistry membership in professional associations
B. To provide an alternative choice for association membership
C. To legislate general dentistry
D. To provide continuing education
E. To regulate alternative therapy extracts and serums
3. All of the following are alternative therapy systems EXCEPT one. Which of the following is the EXCEPTION?
A. Neuropathy
B. Homeopathy
C. Allopathy
D. Naturopathy
4. The Fellowship award of the AGD is the minimum requirement for membership. The Mastership award is the highest level of achievement for a general dentist.
A. The first statement is true, and the second statement false.
B. The first statement is false, and the second statement is true.
C. Both statements are true.
D. Both statements are false.
5. The ADA document “Requirements for Recognition of Dental Specialists” describes the process for specialty status recognition. This allows specialty dental procedures to become the standard of care.
A. Both the statement and reason are correct and related.
B. Both the statement and reason are correct but not related.
C. The statement is correct but the reason is not.
D. The statement is not correct but the reason is accurate.
E. Neither the statement nor reason is correct.
6. All of the following are practice settings for public health dentistry EXCEPT one. Which of the following is the EXCEPTION?
A. Federal prisons
B. Veterans’ hospitals
C. Indian Health Service clinics
D. Military bases
E. Private dental practices
7. What is the difference between an oral pathologist and an oral medicine specialist?
A. Oral pathologists study body fluids or tissue samples. Oral medicine specialists are concerned with treating the oral manifestations of systemic disease.
B. Oral medicine specialists study body fluids or tissue samples. Oral pathologists are concerned with treating the oral manifestations of systemic disease.
8. How are public and community health programs funded?
A. Federal, state, local taxes
B. Nonprofit organization donations
C. Private donations
D. Religious affiliation donations
E. All of the above
9. Which of the following defines oral and maxillofacial radiology?
A. Using nontraditional practices
B. Identifying postmortem remains for legal purposes
C. Interpreting radiant energy images
D. Analyzing body fluids
10. Which of the following disciplines is linked with the American College of Prosthodontics?
A. Oral medicine
B. Cosmetic dentistry
C. Forensics
D. Anesthesiology
11. All of the following forensic practices are used for postmortem identification EXCEPT one. Which of the following is the EXCEPTION?
A. DNA sampling
B. Location of human remains
C. Dental records
D. Fingerprint matching
12. Oral anesthesiology concerns the control of pain and anxiety. The dental anesthesiologist must complete at least two years of advanced training.
A. The first statement is true, and the second statement false.
B. The first statement is false, and the second statement is true.
C. Both statements are true.
D. Both statements are false.
13. All of the following are high tech dental practices EXCEPT one. Which of the following is the EXCEPTION?
A. Computerized dental accounting
B. Lasers
C. Air abrasion
D. Digital radiography
14. Which of the following is NOT recognized as a dental specialty by the ADA?
A. Oral and Maxillofacial Pathology
B. Oral and Maxillofacial Radiology
C. Oral and Maxillofacial Medicine
D. Oral and Maxillofacial Surgery
15. To which recognized specialty would you refer a patient who needed to have a mandibular molar uprighted before a fixed bridge could be placed?
A. Oral and Maxillofacial Surgery
B. Orthodontics and Dentofacial Orthopedics
C. Cosmetic Dentistry
D. High Tech Dentistry
ADAA Test Answer Sheet
Specialized Dentistry
Approved for TWO continuing education credits.
Only current ADAA members are eligible to take this course for continuing education credit. Tests submitted by nonmembers will not be graded or returned. Tests not accompanied by a payment of $8 and a self-addressed stamped envelope will not be graded or returned.
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“DANB Approval” indicates that a continuing education course appears to meet certain specifications as described in the DANB Recertification Guidelines. DANB does not, however, endorse or recommend any particular continuing education course and is not responsible for the quality of any course content.
Esther K. Andrews holds a Master of Arts from Michigan State University and a Bachelor of Science, and Associate of Applied Science, from Ferris State University, Big Rapids, MI. Currently she is adjunct professor, Periodontics Department, University of Illinois-Chicago, lecturer of Dental Hygiene at Kennedy King College, Chicago, and practices dental hygiene. Her international experience includes establishing the German Summer Institute, Old Dominion University, Norfolk, VA, and developing the dental auxiliary curriculum for the Kingdom of Saudi Arabia, University of Kentucky.
COPYRIGHT 2003 American Dental Assistants Association
COPYRIGHT 2003 Gale Group
