Demystifying Dental Specialty Credentials

prosthodontist

Written by Paul E. Scruggs, DDS, and Alvin G. Wee, BDS, DDS, MS, MPH, PhD, for the American College of Prosthodontists

The value of advanced dental credentials is important to both the dentist and dental patients. What do these advanced dental credentials mean, and which credentials reveal that the dentist is a board-certified dental specialist? The first professional dental degree in the United States is either the Doctorate of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), or a foreign dental equivalents, e.g., Bachelors of Dental Surgery (BDS), Doctor of Medical Dentistry (DrMedDent).1 In the U.S., the first professional dental degree is a professional doctorate, similar to Doctor of Medicine (MD) or Juris Doctor (JD). With this degree, the individual has obtained basic training as a dentist and has graduated from the degree-granting university. The dentist with this degree is now eligible to practice dentistry once local and federal government licensure requirements are met.

Advanced dental credentials on the other hand reveal that the dentist has obtained either additional education or recognition beyond the basic dental qualification. These advanced dental credentials, displayed as letters after the dentist’s name, are confusing to the public and are sometimes thought by the public to be dental specialty credentials. These additional credentials can be grouped into three categories: 1.) board certification of a dental specialty, 2.) additional advanced graduate degrees such as MS or PhD, and 3.) a fellow or some other special recognition in a specific dental organization. The organizations’ bylaws and the state dental boards govern the use of these additional letters after the dentist’s name. Generally, these rules are designed to ensure the public does not perceive the additional credentials as advanced degrees from qualified institutions. Each of these three categories will be explained below.
1.) Prosthodontics is one of nine specialties recognized and approved by the American Dental Association (ADA). The other eight recognized dental specialties are: dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, and periodontics. Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation, and maintenance of the oral function, comfort, appearance, and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes.2 Prosthodontics residency programs are accredited through a very elaborate process administered by the Commission on Dental Accreditation (CODA), which closely monitors all training of dentists and specialists. To be a specialist in prosthodontics requires completion of a residency at an approved institution and results in a “Certificate of Completion.” Dentists who complete this advanced residency and are awarded the Certificate of Completion do not have additional initials to display. However, they can use the words “Specialist in Prosthodontics,” “Practice limited to Prosthodontics,” or Prosthodontist to indicate that they have completed an approved training program as stated above. State licensing boards require completion of an approved training program to use such words on all correspondence, signage, business cards, etc. Most state boards allow general dentists to advertise that they do prosthodontic procedures but cannot use any wording indicating specialist status and must state, “these services are offered by a general dentist.” Prosthodontists, upon completion of the above residency can attain board certification (Diplomate Status) by completing a comprehensive written, oral, and clinical examination administered by the American Board of Prosthodontics. If the dentist is a fellow of the organization, i.e., the American College of Prosthodontists, that represents the dental specialty (prosthodontics), then the letters (e.g., FACP) or Fellow of the American College of Prosthodontists denotes the dentist is boardcertified in prosthodontics. Use of these credentials indicating board certification from one of the nine recognized specialties is universally accepted and can be used on all correspondence.

2.) The second category listed above is an advanced dental degree awarded by a university, and is most often an MS, MSD, or PhD.3,4 The master’s degree can be course-based, researchbased, or both. These include Master of Science (MS), Master of Arts (MA), or Master of Research (MRes). Doctoral degrees are research doctorates in recognition of academic research that is publishable in peer-reviewed journals. The most well-known research degree is the Doctor of Philosophy (PhD). Use of these letters is universally accepted as it indicates to both professionals and laypersons that the individual has an advanced degree from a university.

3.) The third category of initials stated above is where it can get confusing. There are several non-recognized “specialties,” and many of these also have a process for board certification. Many of these “focus areas” are thought to be specialties by consumers. A partial list of these organizations are listed below:

• Oral Implantology/Implant dentistry

• Esthetic and Cosmetic Dentistry

• Oral Medicine

• Orofacial Pain

• Advanced Dental Anesthesiology

• Dental Sleep Medicine

• Special Needs Dentistry

• Geriatric Dentistry

Most of these “focus areas” also have continuing education standards and goals, which allow dentists to obtain a certain status in the sponsoring organization; some even have an educational requirement and comprehensive examination process in which the individual can become board-certified in the particular area and thus be a diplomate. It is important to remember that these credentials do not represent one of the nine ADA-recognized, CODAaccredited dental specialties.

The American Board of Dental Specialties5 represents and sets standards for non-CODA-recognized specialties. There are currently four member boards, which include the American Board of Oral Implantology, the American Board of Oral Medicine, the American Board of Orofacial Pain, and the

Some organizations such as the Academy of General Dentistry (AGD) set continuing education goals and honor their members with additional recognition. For example, a fellow of the AGD (FAGD) has completed 500 hours of qualified education and passed a comprehensive written examination. The organization also offers a master’s (MAGD) program, which requires 1100 hours of specific continuing education.6 Credentials such as these are very honorable and indicate a dentists’ dedication, but their use is restricted by the ADA code of ethics7 to publication and professional curriculum vitae. In general, these credentials can be used among professionals but not displayed or advertised to the general public, as they may be misconstrued as an additional university-based degree.

Discussion of the problem: As our society enters an ever-increasing environment of advertising, Internet searches, and health care marketing, it is important that consumers of these services be made aware of what their provider’s credentials actually represent. For instance, general dentists can add the words “implant dentistry” to their advertising, which would imply that the individual has at least advanced training in this area, which may not be true. This represents a potential patient safety issue, as care may be administered that is not only inappropriate but also may not be to an established standard of care. Furthermore, many organizations in dentistry have established educational goals or certifying examinations, which award the individual the title of “fellow” or “diplomate.” Again, improper use of these credentials could mislead the public as to the recognized qualifications of the provider.

Position: It is the position of the American College of Prosthodontists that only individuals who have completed an ADA-recognized specialty program in prosthodontics be allowed to declare themselves a “Prosthodontist” or “Specialist in Prosthodontics.” Dentists who perform prosthodontic procedures in their practice must clearly state that they are a general dentist or other ADA-recognized specialty if they are not a prosthodontist. Furthermore, the use of additional “letters” following the dentist’s name when presented to the public should be limited to institutional presented advanced degrees and specialty board certification in one of the nine recognized dental specialties. This is in alignment with state dental licensing boards and the ADA Professional Code of Ethics.7 Additional abbreviations, as listed in category 3 above, can only be used in publication, curriculum vitae, or among professionals to indicate professional status. These credentials should not be used when marketing to consumers who would have difficulty understanding their significance. Board certification helps ensure the public that formal training has been completed and a sufficient knowledge base in the specialty has been demonstrated.