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Oral medicine specialty?

Published:August 21, 2016DOI:https://doi.org/10.1016/j.oooo.2016.07.028
      I was both interested in and concerned by Dr. Craig Miller's recent editorial regarding specialty recognition for the discipline of oral medicine.
      • Miller C.S.
      Oral medicine: the new dental specialty.
       It's true that any dental group can form a health profession academy as well as a related certifying board. Yet the Commission on Dental Accreditation (CODA) and the American Dental Association's Council on Dental Education and Licensure (CDEL) continue to serve as the gold standards for the profession by providing independent, consistent, and reliable validation of advanced dental education programs as well as fully vetted recognition of specialty status at the national level under the guidance and approval of the U.S. Department of Education.
      Among the six formal requirements for specialty recognition in dentistry adopted as amended by the American Dental Association House of Delegates in November 2013 is the following:
      • (3)
        The scope of the proposed specialty requires advanced knowledge and skills that: (a) are separate and distinct from any recognized dental specialty or combination of recognized dental specialties; and (b) cannot be accommodated through minimal modification of a recognized dental specialty or combination of recognized dental specialties.

        American Dental Association House of Delegates. Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists. November 2013. Available at: http://www.ada.org/∼/media/ADA/Education%20and%20Careers/Files/requirements.pdf?la=en. Accessed July 1, 2016.

      As with recent applications to the CDEL for specialty recognition by the American Boards of Anesthesiology, Orofacial Pain, and Oral Implantology/Implant Dentistry, past efforts by the oral medicine organization to gain specialty recognition have failed to satisfy this crucial requirement. While health care providers on both sides of the “recognized specialty” issue have strong opinions, I offer the following facts regarding one advanced education program in oral medicine.
      The University of Iowa College of Dentistry has active CODA-approved advanced education programs in all nine recognized dental specialties. Several years ago, the college hired a faculty member “certified” in oral medicine who immediately set out to establish a new advanced education program in oral medicine. The faculty member obtained the university and collegiate curriculum that the college had submitted to CODA before the most recent accreditation site visit and identified the didactic and clinical courses specific to oral and maxillofacial pathology. From this information, an application was prepared for the oral medicine board, which approved the new program.
      A review of the 2-year curriculum that had been approved by oral medicine showed that it consisted of no less than 60% of the CODA-approved 3-year oral and maxillofacial pathology program curriculum. No additional clinical or didactic curriculum had been designed for the program.
      By approving this application, the oral medicine board had shown de facto that advanced education in oral medicine could consist of nothing more than subtotal completion of an accredited oral and maxillofacial pathology advanced education program. This provided clear evidence that training for the “specialty” of oral medicine could be accommodated via the clinical and didactic educational components of an oral and maxillofacial pathology training program.
      The new oral medicine training program was in existence for about 10 years before it was discontinued due to lack of interest and qualified applicants. Not a single resident who completed the program went on to practice or teach oral medicine.
      The Texas Dental Board suit represents nothing more than a dental group, unhappy at failing to achieve specialty recognition from informed peers through a legitimate, nationally recognized due process, choosing to take their case to a less knowledgeable group with minimal appreciation of or responsibility for the integrity of the dental profession. The discipline of oral medicine contains no knowledge or skills that are separate and distinct from other recognized dental specialties. Furthermore, it fills no unmet patient care need in the profession of dentistry, a fact that was conveniently omitted in the Texas litigation.
      If sustained, the action by the Texas Dental Board could allow any dental practitioner to advertise on a state-by-state basis as a “dental specialist,” without independent verification and validation of proper educational credentials or continued competency using nationally recognized standards. This self-serving move threatens to dilute the integrity of the dental health care profession and minimize the well-earned respect afforded current diplomates of American Dental Association–recognized dental specialties, and it could jeopardize the safety of the American public.
      At a time when dentists are clamoring for reciprocity and universal recognition of their licensure, it certainly seems like a step back for specialty recognition to be determined on a state-by-state basis by individuals or committees with less knowledge or experience than currently exists.
      How could the public be at less risk with such a plan?

      References

        • Miller C.S.
        Oral medicine: the new dental specialty.
        Oral Surg Oral Med Oral Pathol. 2016; 1: 1-2
      1. American Dental Association House of Delegates. Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists. November 2013. Available at: http://www.ada.org/∼/media/ADA/Education%20and%20Careers/Files/requirements.pdf?la=en. Accessed July 1, 2016.

      Linked Article

      • Oral Medicine Specialty? Response to Dr. Vincent
        Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyVol. 122Issue 6
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          We thank Dr. Vincent for his letter to the editor. Diversity of opinion is what makes this country strong and our profession stronger. Having said this, it is important that the discussion directed at specialty recognition be viewed in full context at the historical level as well as its present status.
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      • Oral Medicine—the new dental specialty
        Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyVol. 122Issue 1
        • Preview
          In the court case American Academy of Implant Dentistry et al. vs Texas State Board of Dental Examiners et al., I was asked, under oath, by the Attorney General of the State of Texas, “What is a specialist?” I replied, “Well, that is a good question. To an extent, it depends on who is making that determination. Do you mean in dentistry? Because there are air conditioning specialists and foreign car mechanic specialists, etc.” The attorney quickly specified, “In regards to dentistry.”
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