Dental Specialties

Definition

There are nine dental specialties approved by the Council on Dental Education and Licensure of the American Dental Association (ADA). These are:

• Dental public health: Dental public health is the dental specialty devoted to promoting public dental health and preventing and controlling dental diseases through community and public education.
• Endodontics: Endodontics is the dental specialty focused on the morphology, physiology, and pathology of the periradicular (tooth root) tissues and human dental pulp.
• Oral and maxillofacial pathology: Oral and maxillofacial pathology deals with the nature, identification, and management of diseases affecting the regions of the mouth, jaw, and adjacent parts of the face.
• Oral and maxillofacial surgery: Oral and maxillofacial surgery is the dental specialty that focuses on the diagnosis, surgical, and related treatment of diseases, injuries and deficiencies of the hard and soft tissues of the oral and maxillofacial regions. These specialists address functional and esthetic aspects of the areas treated.
• Orthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics is the specialty concerned with guiding and correcting children's and adults' dentofacial structures.
• Pediatric dentistry: Pediatric dentistry is the dental specialty that is devoted to providing primary and comprehensive preventive and therapeutic dental health care from infancy through adolescence. Pediatric dentists also provide dental care to children with special health care needs.
• Periodontics: Periodontics involves the prevention, diagnosis, and treatment of diseases affecting the tissues supporting and surrounding the teeth. The specialty also focuses on the maintenance of healthy gums and supporting dental tissues.
• Prosthodontics: Prosthodontics is the specialty concerned with the restoration of natural and replacement teeth, as well as contiguous oral and maxillofacial tissues.
• Oral and maxillofacial radiology: No definition has yet been approved by the ADA House of Delegates for this newly granted dental specialty. However, these specialists use imaging techniques to assist general dentists and other oral health specialists in the diagnostic assessment of diseases of the head and neck.

While there are overlapping responsibilities among the specialties, each focuses on an aspect of the oral cavity, maxillofacial area, or adjacent associated structures.

Description

According to the ADA, about 20% of all dentists practice a dental specialty, while the rest remain general dentists. Orthodontics and dentofacial orthopedics and oral and maxillofacial surgery make up nearly half of all specialties.

Dental public health specialists view the community, rather than the individual, as their patient. Their roles are to educate the public, using applied dental research, and initiate community-wide dental care and preventive programs.

Endodontics encompasses basic and clinical sciences of normal pulp biology and the causes, diagnosis, prevention, and treatment of diseases and injuries to the pulp and associated periradicular conditions. Endodontists specialize in root canal treatments to remove damaged tissue from inside tooth root canals. Root canal treatment, a nonsurgical endodontic treatment, treats the soft inner tissue of the tooth, called the pulp, when it becomes inflamed or infected. During a root canal, endodontists remove the damaged pulp, clean the area and fill and seal it to preserve the tooth. Surgical procedures performed by endodontists include apicoectomy, which removes infection or inflammation of the bony area surrounding the tooth's end.

Oral and maxillofacial pathologists research the causes, processes, and effects of diseases that affect the oral and maxillofacial regions, which include the head, face, mouth, teeth, gums, jaws, and neck. These specialists use clinical, radiographic, microscopic, biochemical, and other examinations to research and diagnose disease. The practice of oral and maxillofacial pathology includes research; clinical, radiographic, microscopic, biochemical or other disease diagnosis; and patient management.

Oral and maxillofacial surgeons treat patients who have problems with wisdom teeth, facial pain and misaligned jaws. They treat accident victims with facial injuries, perform reconstructive and dental implant surgery, offer treatments for tumors and cysts of the jaws, and specialize in functional and cosmetic conditions of the head, face, mouth, teeth, gums, jaws, and neck. Oral and maxillofacial surgeons also offer preventive care of the teeth, mouth, jaws, and facial structures.

These specialists offer a wide variety of surgical procedures performed in the office and hospital, including dentoalveolar surgery to treat impacted teeth and reconstructive surgery to address inadequate bone structure of the upper or lower jaws, which can result from injury, some types of surgery, and dentures. They place dental implants, which are an option for replacing missing teeth, and treat facial infections, which can develop into life-threatening conditions if not addressed. Oral and maxillofacial surgeons are often called in to treat trauma of the face, jaws, mouth, and teeth, often from injuries such as falls, as well as facial pain from such things as temporomandibular joint (TMJ) disorders. Other conditions treated by oral and maxillofacial surgeons include deformities in skeletal growth between the upper and lower jaws, which can affect chewing and swallowing, and snoring or obstructive sleep apnea, a condition that can lead to excessive daytime sleepiness. Not all procedures performed by oral and maxillofacial surgeons are covered by dental or health insurance because they also offer some cosmetic procedures of the face, mouth, and neck.

Orthodontists and dentofacial orthopedic specialists specialize in diagnosing, preventing, and treating dental and facial irregularities, known as malocclusions. Orthodontists represent about 6% of all dentists. Orthodontists treat children and adults. The American Association of Orthodontists recommend that all children have an orthodontic screening no later than age seven.

Malocclusions are often inherited but can be caused by trauma, pacifier sucking, airway obstruction, dental disease, or premature loss of primary or permanent teeth. Orthodontists most commonly treat crowding of the teeth, overbites, open bites (when upper and lower incisor teeth do not touch when biting down), spacing problems, crossbite and underbite, or lower jaw protrusion. Orthodontic treatment, often involving the placement of braces, helps not only cosmetically, but also functionally.

Pediatric dentists provide primary and specialty oral care for healthy, normal children, as well as those with special needs. Much of what the pediatric dentist does involves educating parents and children. The pediatric dentist will advise parents about thumb sucking and pacifier habits, dental decay in the early years, proper brushing habits, bottle and breastfeeding, and more. In a child's later years, they'll advise children and their parents about protecting teeth during sports and other preventive dental issues. Pediatric dentists offer techniques that can protect children's teeth, such as dental sealants, which fill the crevices on the surfaces of the teeth to protect teeth from decay.

Periodontists specialize in preventing, diagnosing, and treating periodontal disease. Periodontal diseases are bacterial infections of the tissues around the tooth, which, if untreated, can result in tooth loss. Periodontists place dental implants, which replace missing teeth and look and feel like natural teeth, and they perform periodontal surgery used to treat severe cases of periodontal disease. While simple procedures might suffice to remove the plaque and calculus below the gum line and remove bacteria, surgical procedures are often necessary if periodontal disease has caused deep pockets in the gums and loss of supporting bone structure. Cosmetic periodontal procedures include treatments to improve a gummy smile, as well as treatment to correct long teeth, or receding gums.

Prosthodontists understand dental laboratory procedures and work closely with dental technicians to create comfortable and attractive custom-made prostheses for patients. Prosthodontists offer patients options for replacing missing teeth. Sometimes this involves the placement of dentures or fixed bridges, while other patients prefer dental implants. Prosthodontists receive training in diverse dental conditions, including complex care management involving many specialties, post-oral cancer reconstruction, some children's dental problems, jaw joint conditions, traumatic injuries, and snoring and sleep disorders. Prosthodontists are also trained in some types of cosmetic dentistry, including bleaching techniques, tooth bonding, and veneers.

Oral and maxillofacial radiologists are dentists who specialize in the use of imaging and other technologies to diagnose and manage dental and associated diseases. They also advise state agencies and dental professionals about regulatory compliance in the use of and advances in radiologic technology.

Work settings

Dentists work in private practice offices, public hospitals and clinics, for the federal government, and in dental research.

Education and training

Most dentists go through three years or more of undergraduate school with an additional four years of dental school to become a general dentist. All dentists graduate from dental school with a degree in general dentistry, receiving either the DMD (Doctor of Dental Medicine) or DDS (Doctor of Dental Surgery) designation. While most schools today award DDSs, there is no difference in these degrees for general dentistry. Dental specialists must then undergo additional postgraduate training to become a dental specialist. About 17 states require dentists to achieve specialty licenses before practicing as specialists.

Dental public health specialists must successfully complete two years of academic study in a program accredited by the Commission on Dental Accreditation leading to a graduate degree in public health, or complete two or more years of dental public health advanced education by a non-U.S. institution followed by completion of an accredited U.S. residency dental public health program.

Endodontists possess advanced surgical and nonsurgical skills that allow them to treat routine and complex cases. Endodontists attend two- or three-year advanced dental school endodontic programs.

Orthodontists and dentofacial orthopedic specialists must successfully complete a two-to three-year residency program of advanced education in orthodontics after graduating from a general dentistry program accredited by the Commission on Dental Accreditation of the ADA. Through their advanced training, orthodontists acquire the skills necessary to manage tooth movements and guide facial development.

Oral and maxillofacial surgeons undergo four years or more of postdoctoral, hospital-based surgical residency training after graduating from a four-year dental school program. Their education intensity is similar to that of internal medicine physicians and general surgeons.

Pediatric dentists need two to three years of specialty training following dental school to learn about children's dental problems and how to educate parents and children about avoiding these problems. They also learn about the care of special needs children, including hospitalized, handicapped, and chronically ill children.

Periodontists receive three years of periodontal training after graduating from dental school.

Prosthodontists receive three years of specialized training in an American Dental Association (ADA) accredited graduate education program after completing dental school.

Oral and maxillofacial radiology programs are between two and three years long.

KEY TERMS

Calculus— Calcified deposits that have formed around teeth.

Dentition— The natural teeth.

Dentofacial— Relating to the dentition, or natural teeth.

Etiology— The science of disease origins and cycles.

Human dental pulp— The soft, moist, coherent solid tissue within the pulp cavity of the tooth.

Malocclusion— Bad bite.

Maxillofacial— The area of the jaws and face.

Morphology— The study of the configuration or structure.

Pathology— The study of the nature and cause of diseases and the changes produced by them.

Periradicular tissues— The tissue around the top of a tooth root.

Physiology— The science that looks at normal life processes (functions and activities) of organisms.

Temporomandibular joint (TMJ)— The joint of the lower jaw.

Advanced education and training

All dental specialists can attend continuing education courses to keep up with research, clinical procedures, and technology. They can also apply to become board certified in their dental specialties.

Future outlook

While, the dental profession is expected to experience slower than average growth through 2008 because more people are avoiding problems associated with tooth decay, the demand for specialists could rise. Baby-boomers coming into middle age will require complicated work, including bridges. The elderly will be more likely to keep their teeth into old age and also will need complex procedures. Future general dental care will focus more on prevention and education.

Resources

BOOKS

Occupational Outlook Handbook. Washington, DC: U.S. Department of Labor, Bureau of Labor Statistics, 2000. 〈http://stats.bls.gov/ocohome.htm?Lnav〉.

ORGANIZATIONS

American Academy of Oral and Maxillofacial Pathology. 710 E. Ogden Ave., Suite 600, Naperville, IL 60563-8614. (888) 552-2667. 〈http://www.aaomp.org〉.

American Academy of Oral and Maxillofacial Radiology. PO Box 55722, Jackson, MS 39296. (601) 934-6060. 〈http://www.aaomr.org〉.

American Academy of Pediatric Dentistry. 211 East Chicago Ave., Suite 700, Chicago, IL 60611-2663. (312) 337-2169. 〈http://www.aapd.org〉.

American Academy of Periodontology. 737 N. Michigan Ave., Suite 800, Chicago, IL 60611. (312) 573-3256. 〈http://www.perio.org〉.

American Association of Endodontists. 211 E. Chicago Ave., Suite 1100. Chicago, IL 60611-2691. (800) 872-3636. 〈http://www.aae.org〉.

American Association of Oral and Maxillofacial Surgeons. 9700 W. Bryn Mawr Avenue, Rosemont, Illinois 60018-5701. (847) 673-6200. 〈http://www.aaoms.org〉.

American Association of Orthodontists. 401 N. Lindbergh Blvd., St. Louis, MO 63141-7816. (314) 993-1700. 〈http://www.aaortho.org〉.

American Association of Public Health Dentistry. 1321 N.W. 47th Terrace, Gainesville, FL 32605. 〈http://pitt.edu/∼aaphd/abdph.html〉.

American College of Prosthodontists. 211 East Chicago Ave., Suite 1000, Chicago, IL 60611. (312) 573-1260. 〈http://www.prosthodontics.org〉.

American Dental Association. 211 E. Chicago Ave., Chicago, IL 60611. (312) 440-2500. 〈http://www.ada.org〉.

OTHER

American Dental Association. "Glossary of Dental Terms." 〈http://www.ada.org/public/resources/glossary.asp〉.