WHAT IS A DENTAL SPECIALIST? A CRISIS IN CONFIDENCE THE AMERICAN DENTAL ASSOCIATION (ADA) MUST ADDRESS.

There is a crisis occurring in dentistry that may change the structure of dental specialty practice. The American Dental Association has protected the public and represented dentists through thru it principles of ethics and standards.

Disgruntled groups seeking specialty status are attempting to bypass the American Dental Association and create new specialties that to not meet the criteria of the ADA. Several groups are now working to create their own unregulated board to receive specialty. These groups include Dental Implantologists, Dental Anaesthesiologists and finally Orofacial Pain. The allure of specialty is being able to charge higher fees both to patients and to lawyers for expert testimony sure to increase the cost of health care.

This issue came to a head when on March 5, 2014 a federal lawsuit was filed against the Texas State Board of Dental Examiners alleging it is unconstitutional for a state regulatory agency to defer to a private “trade organization” ( i.e. The American Dental Association) the ability to decide who can advertise as a specialist. This case may serve to destroy the current structure of specialties in dentistry and open the door to a flood of pseudo-specialties.

Special concern is given by this author concerning the specialty of orofacial pain. The American Board of OroFacial Pain has joined with the American Board of CranioFacial Pain to seek specialty. Each group agrees that their diplomats will have automatic specialty status. These groups both deal with TMJ disorders or TMD issues. There are numerous other groups that are also involved in the treatment of TMD both within current specialties and among general dentists. The American Alliance of TMD organizations (TMD ALLIANCE) represents most of the important dental groups representing Dentists who treat TMD and helping protect their patients. The members of these groups are the front line of TMD practitioners.

The TMD Alliance and its member organizations have taken a stance against specialty status for Orofacial pain. The Alliance website http://www.tmdalliance.org states "Founded in 1995 on behalf of patients’ well-being, the Alliance of TMD Organizations’ mission is to support and protect the right and freedom of clinicians to practice in the field of TMD within the scope of their care, skill, judgment, and scientific information. The Alliance of TMD Organizations has been created to represent the broad interests of professional organizations and their member practitioners who understand the importance of effective diagnosis and treatment of cranio-oro-facial disorders."
The TMD Alliance also states ten guiding principles on their website:

1. The Alliance of TMD Organizations supports ethical and professional patient centered care.

2. Treatment should be based upon individual patient needs.

3. TMD and associated facial pain disorders/diseases may encompass physical, functional, cognitive, and psycho-social factors all of which may contribute to patient’s symptoms and complaints. Dental occlusion may have a significant role in TMD; as a cause, precipitating, and/or perpetuating factor. Any or all aspects may be taken into consideration when developing diagnoses and treatments accepting that TMD and associated co-morbidities including other pain disorders may be multi-factorial in nature.

4. Diagnoses and treatments should be based upon scientific information in conjunction with the skill, knowledge, and judgment of the providing clinician within the scope of their care.

5. Patient care should progress from initially minimally invasive treatment with gradations of increased intervention weighing risk versus benefit within reasonable standards of care.

6. The diagnosis and treatment of TMD should be considered an emerging science accepting that approaches for diagnoses and treatments may change based upon scientific evidence, clinical evidence. Reasonable standards of care should always be considered in the differential diagnosis of all head, neck and facial pain.

7. Efforts should be made to allow for continuity of care between multi-disciplinary health care providers.

8. Although not gender specific, TMD symptoms and associated pain disorders are gender biased and found to be reported predominately in females.

9. Since TMD and associated pain disorders are by nature gender biased affecting a significant portion of the female population, they should also be considered a women’s health issue.

10. Third party payers should not discriminate based upon gender, body part, location of symptoms, specific dysfunction, or professional degree of the licensed health care provider.

These 10 basic principles were developed by the majority of the representatives of TMD Alliance members.
The following organizations are currently in the Alliance:
AMERICAN ACADEMY OF CRANIOFACIAL PAIN
THE AMERICAN ACADEMY OF PAIN MANAGEMENT
THE AMERICAN EQUILIBRATION SOCIETY
THE INTERNATIONAL ASSOCIATION OF COMPREHENSIVE AESTHETICS
THE INTERNATIONAL COLLEGE OF CRANIO-MANDIBULAR ORTHOPEDICS
THE INTERNATIONAL ASSOCIATION FOR ORTHODONTISTS
THE SACRO OCCIPITAL TECHNIQUE ORGANIZATION
TENNESSEE CRANIO

The ADA published in May 2014 the "Report of the ADA-Recognized Dental Specialty Certifying Boards" The ADA currently recognizes nine specialties. Over the years many groups have attempted to acquire specialty status but have been denied for not meeting the ADA standards.

THE ADA-RECOGNIZED DENTAL SPECIALTY CERTIFYING BOARDS are as follows:
• American Board of Dental Public Health (DPH)
• American Board of Endodontics (Endo)
• American Board of Oral and Maxillofacial Pathology (OMP)
• American Board of Oral and Maxillofacial Radiology (OMR)
• American Board of Oral and Maxillofacial Surgery (OMS)
• The American Board of Orthodontics (Ortho)
• American Board of Pediatric Dentistry (PD)
• American Board of Periodontology (Perio)
• American Board of Prosthodontics (Pros)

The ADA has very specific guidelines for what organizations must do to complete and qualify for specialty status. It is extremely important to separate quality of care from specialty status. Dentistry, unlike medicine is a profession dominated by Generalists not specialists. Specialty fragmentation in my opinion is adverse to best interests of the general public and the dental profession.