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For Better Or Worse – Can You Tell The Difference?

October 8, 2019
by Dr. Peter Birek


Over the years our profession has managed to confuse patients by what we call ourselves. Can you tell the difference between dentists with various letters after their names? What is a bona fide (Latin for “in good face”; legal meaning “sincerely, without deception”) specialist and a generalist? Today, I am afraid, we may have confused both the public and ourselves.

Here is what I mean:

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All specialists must complete a specialty training program. Most are university-based, and often are linked to a scientific degree. Programs are of 3-5 years in duration, during which trainees are taught and repeatedly tested on their knowledge, their ability to assess and implement emerging scientific data, and on performing skills based on accepted standards of the profession. Most jurisdictions require a comprehensive final examination, so-called fellowships, before they are granted licence to practice and present themselves to patients and the public as specialists. Specialty programs are periodically accredited by educational (usually national) bodies, applying another layer of legitimacy to the specialty (fellowship) designation.

Fellowships of various kinds have grown like mushrooms in recent years, often granted to dentists by self-proclaimed and sometimes dubious organizations upon successful completion of various courses and/or web-based requirements. The resulting letters conferred after successful completion of requirements for various fellowships clearly confuse the public as they cannot “tell the difference.”

A good example for perpetuating misinformation is the very degree that is granted to many of our general practice dentists. For example in Ontario, after completion of the university based dental schools: DDS (Doctor of Dental Surgery or Dental Surgeons for short). This is confusingly close to the genuine Oral Surgeon designation, the Oral and Maxillofacial Surgeons (OMFS). While the name DDS respects historical tradition, the Dental Surgeon is far from an OMFS both in knowledge and skill. DMD, Doctor of Medicine in Dentistry may more accurately describe the graduate of a four-year university based training program for a general dentist.

The issue of “accepted specialties” adds more to the confusion. Often, they vary from Canadian province to province. For example, Dental Anesthesia is a recognized specialty only in Ontario – as if Canada wasn’t a cohesive Country for the past 152 years.

Further misinformation arises from changes that occur when the scope and very definition of a specialty changes to include treatments that were not within their scope prior to the change. Let’s take implant surgery for example. In addition to training periodontists, I personally contributed to training of residents of Prosthodontics and Endodontics in implant surgery under a well-controlled and designed university setting. Indeed many specialties, some non-surgical in nature, now include training in implant surgery. I wonder how it is perceived by the public when a well-trained endodontist or prosthodontist offers implant surgery to a patient? Or, for that matter, a periodontist offers the prosthetic phase of implant treatment?

It seems that, while on one hand it is safe to stick with historical designations, not moving ahead with change is equally condemnable. The reality is that dental schools cannot train dentists in all aspects of dentistry, and by far, there is a clear void in the toolbox of recently graduating dentists. What are they to do, as speciality programs are few, costly, and extend the already lengthy years of training? Where are they to fill in the gaps in their basic training if not with continuing education that will give them the right to “flash” those fellowship letters after their names?

The real challenge before us – as educators, regulators, dentists, and as well as new graduates – is to fill our toolboxes with knowledge and skill, not just with letters after our names.


About The Author

Peter Birek

Dr. Peter Birek, is an Associate Professor in the Department of Periodontics and a staff surgeon with the Oral Reconstruction Unit at the University of Toronto. He maintains a private practice in Periodontics and Implant Surgery in Toronto. Dr. Peter Birek is the Periodontology editor for Oral Health.


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