Who is an “Orthodontist”? Reprise for 2015

Abstract

In the early 1890s, it was fairly easy to become a dentist. Most of the applicants to a dental school had just completed high school, they paid “a few pennies” to attend dental school, and their studies and training only lasted about 6 months. Upon graduation, a dentist could perform any dental procedure that he wished to do in any state. This included straightening teeth with “regulating” appliances. There were really no significant laws governing dentistry, and there were no dental specialists … only general dentists.In 1892, a dentist named Edward H. Angle invented the specialty of orthodontics by declaring that he would limit his dental practice just to orthodontics. He believed that a dentist wanting to do orthodontics needed special knowledge and skills, and these could not be obtained in any regular dental school in the United States. So, in 1900, he started the first school of orthodontics with a course of study that was 8 weeks in length (Fig). In 1901, he started an organization to promote orthodontics (now called the American Association of Orthodontists). More orthodontic schools were started by other orthodontists, and in 1915 a new journal (now known as the American Journal of Orthodontics and Dentofacial Orthopedics) was published to promote the specialty and advance the practice of orthodontics.Given this level of organization and advancement, it is somewhat surprising that there were still dentists of that time who simply announced on their signs and business cards that they were orthodontists. They did so without any meaningful training, and their motivation was usually based on financial gain. They were sometimes called “the imitators.”On the other hand, in 1915, it was argued that a dentist could become an orthodontist1Dewey M. Who is an “orthodontist?”.Int J Orthod. 1915; 1: 224-225Google Scholar (1) after many years of orthodontic experience (this included dentists who learned orthodontics by trial and error, and were “grandfathered” into the specialty), (2) by studying and practicing with an experienced orthodontist (a preceptor-apprentice relationship), or (3) by attending and graduating from a recognized school of orthodontics.Time, however, is never still; 100 years ago, many things were possible that are not possible now, and many things that were impossible a century ago are quite possible now. So, from 1915 over the next 100 years until now, there have been great advancements in dentistry and its related dental specialties. Oral health care improved greatly, dental technology has advanced, access to all forms of dental care has increased, and the public has become much better informed and served. Still, questions of education, scope of practice, legal issues, and professional ethics remain problematic, even today.In 2015, students who apply for admission to a dental school usually have at least 4 years of college experience and have received a degree. They have also taken a national entrance examination in dentistry. Competition for admission into a dental school is keen; only the highest-level applicants are admitted. Approximately 5000 students are admitted into the nation's dental schools each year. Those admitted will follow a 4-year program of study that includes almost 5000 hours of scheduled instruction and training in all aspects of dentistry. The vast majority of these hours are directed toward the control of disease (dental caries and periodontitis), pathology (extractions and surgery), and restorations of teeth (fillings, crowns, bridges, dentures, veneers, dental implants, and so on). The faculty of each dental school reflects the breadth of instruction provided; many general dentists as well as dental specialists are involved.In terms of orthodontic education during dental school, few hours of instruction are provided; the national average is approximately 95 total hours of scheduled instruction (ie, less than 2% of the total hours of instruction). The time allowed for teaching orthodontics involves instruction in the classroom, working in a laboratory, and sometimes actually providing limited orthodontic treatment to 1 or 2 patients in the clinic. At some schools, as few as 11 hours of instruction in orthodontics are provided. The overall quality of dental education in all the dental schools in the United States is maintained by the Commission on Dental Accreditation of the American Dental Association. Accreditation is recognized by state and federal governments as a valid method of assessing academic quality and ensuring public accountability and safety.DefinitionDentistry: The evaluation, diagnosis, prevention, and/or treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity, the maxillofacial area, and/or the adjacent and associated structures and their impact on the human body, provided by a dentist, within the scope of his or her education, training, and experience, in accordance with the ethics of the profession and applicable law (American Dental Association).Everyone who fulfills the requirements of a dental school is granted a degree (either DDS or DMD) and is educationally qualified to be a general dentist (also sometimes referred to as a “primary care provider”). To become a licensed general dentist in any state in the United States, a graduate of a dental school must also pass the National Board Examination in Dentistry (a written examination) and a regional or state clinical examination. Once licensed, general dentists can perform any dental treatment they wish as defined by the laws of the state in which they practice general dentistry.After graduating from dental school, about 10% to 20% of the graduates seek additional education in 1 of the 9 dental specialties or advanced training in general dentistry. One dental specialty is orthodontics. Dental graduates who wish to pursue training as orthodontists must seek admission to 1 of the 73 graduate orthodontic programs in the United States and Canada. Applications number in the thousands, but only about 350 are admitted each year. Generally, those admitted are some of the most accomplished students based on their college and dental school performances.Orthodontic programs in the United States are 2 to 3 years in length; a minimum of 3700 hours of scheduled instruction are required for all 73 programs in the United States and Canada; the orthodontic program at Saint Louis University is 2½ years long and includes approximately 4000 hours of scheduled instruction. Time is spent in lectures, seminars, laboratory exercises, and clinical care of patients; all of these efforts focus directly on orthodontics. The vast majority of the time is spent in the clinic treating patients. The clinical faculty consists of accomplished and experienced orthodontists. At Saint Louis University, we have approximately 40 clinical instructors whose cumulative experience in orthodontics is nearly 1000 years. Under the direct supervision of the clinical faculty, the students participate in the treatment of hundreds of patients and observe the treatment of hundreds more. The goal of all orthodontic programs is to produce knowledgeable and skilled orthodontists who are proficient in straightening teeth, aligning jaws, and improving facial appearances. At the conclusion of the orthodontic training, the graduates are awarded a certificate of specialty training in orthodontics and often a master's degree. The quality of orthodontic education in the United States is also maintained by the Commission on Dental Accreditation of the American Dental Association; accreditation of orthodontic programs began in 1966.Upon graduation, in order to practice orthodontics, a graduate must obtain licensure as a dentist (if not done prior) and be recognized (or be licensed) as an orthodontist; the details are determined by the dental board of the state in which the orthodontist will practice.DefinitionOrthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures (American Dental Association).Both general dentists and orthodontists must renew their licenses annually and, by law, must attend continuing education courses to maintain and improve their knowledge and skills. In this regard, general dentists usually take courses related to general dentistry, and orthodontists take courses that directly relate to orthodontics. In Missouri, the requirement for continuing education is 25 hours per year. The courses taken must be approved by the Missouri Dental Board.Of course, a general dentist and an orthodontist may take additional continuing education courses. Most of these courses are short (generally 1-2 days in length, equaling 8-16 hours), but some might last a week (40 hours) or so. Typically, these courses involve lectures and sometimes laboratory exercises, but no patient care. In the end, no matter the number and length of the continuing education courses, it is unlikely that a general dentist could replicate the total educational experience of an orthodontist. This should not be taken to mean that general dentists cannot perform some types of orthodontic treatment successfully; they can. As a whole, however, a general dentist cannot achieve what an orthodontist can achieve in orthodontics. I suppose that some would disagree with this conclusion; it's just that I cannot recall ever seeing any evidence to the contrary.In practice, an orthodontist can announce that he or she is an orthodontist and can perform any method of orthodontic treatment (and there are many). In practice, a general dentist cannot announce that he or she is an orthodontist but can perform orthodontic treatments. This assumes that the general dentist has an interest in orthodontics, has some training in some aspect of orthodontics, has some experience in orthodontics, and has the ability to adequately diagnose and treat some form of orthodontic problem. In practice, over time, orthodontists gain a great deal of experience in orthodontics, since they limit their practices to orthodontics. In practice, over time, general dentists get better at general dentistry, since they do not limit their practice to any one area of dentistry. In practice, orthodontists can advertise or otherwise inform the public that they are orthodontists and can perform orthodontics. In practice, general dentists cannot advertise or otherwise inform the public that they are orthodontists, but they can state that their practices offer “orthodontics”; under this condition, some states require a disclaimer in the advertisement to indicate that the “orthodontics” is performed by a general dentist. In practice, orthodontists get better and better at orthodontics every day because orthodontics is all that they do … all day. In practice, general dentists get better and better at performing general dentistry every day. In comparing them, the differences in orthodontic knowledge and skill get wider with time.A dental specialty such as orthodontics is generally thought to be defined by its related educational processes, its clinical focus, and the tools and technology that are associated with the diagnosis and treatment of patients. It is also thought that the specialty is further defined by having a related sponsoring organization (the American Association of Orthodontists). And it is believed that a certifying board (the American Board of Orthodontics) is an important acknowledgment of a focus on continuous improvement in the quality of clinical care that orthodontists provide.This is all true, but if orthodontics is considered a craft and orthodontists are craftsmen, orthodontists are further defined by their regard for and their support and use of science. The science associated with orthodontics and orthodontists is unique to the specialty and each orthodontist; it is relevant to orthodontics, and it is not the scientific consideration of the general dentist or any other dental specialty.This appreciation of science flows from the educational program that molds an orthodontist; each student must conduct a research project to satisfy the requirements for graduation from an accredited orthodontic program. In the practice of orthodontics, problems are identified that become the subjects of research that is then subjected to the scientific method. Eventually, research produces evidence and advancement that are meant to guide and improve orthodontic treatments … thus improving human health. Because orthodontists appreciate their science, they not only conduct research but also support it by contributing to research endeavors at the universities and giving to other entities that support research (eg, the American Association of Orthodontists Foundation). In the main, new knowledge in orthodontics is produced by orthodontists; this then defines the specialty and the orthodontist. Orthodontists define their existence, their presence, and their future through their science.Items of interest•There are 320,000,000 people in the United States.•1,600,000 people graduate from college each year.•5,000 general dentists graduate from dental school each year.•350 orthodontists graduate from orthodontic programs each year.•1 person is born every 8 seconds.So, what is the public to do with all this information? First, this editorial is meant to inform about the differences between an orthodontist and a general dentist in terms of background, education, training, and practice. These differences are meaningful in terms of the knowledge, experience, and skill of the practitioner who performs orthodontic treatments. It is an overall truth that orthodontists know more about orthodontics than do general dentists. Likewise, it is an overall truth that general dentists know more about general dentistry than do orthodontists. It should also be comforting to know that there are many excellent general dentists in the United States as well as many excellent orthodontists. A second use of this editorial is to point to resources that can help to explain the differences between an orthodontist and a general dentist. If you skim back through this editorial, you will note mentions of the American Dental Association, the American Association of Orthodontists, the American Board of Orthodontics, the American Association of Orthodontists Foundation, this Journal, and the state dental boards (one in each state); they (along with local, state, and regional dental and orthodontic associations) are all great sources of information about dentistry and the dental specialties. Third, the information in this editorial can be used to formulate questions that might be asked of practitioners, whether they are a general dentist, an orthodontist, or any other dental specialist. Such questions might prove valuable for patients in terms of helping them to make decisions about the best practitioner to serve their needs. Finally, if deemed worthy, reprints of this editorial might be useful to have in a waiting room or posted on a practitioner's Web site.In the end, I must fully admit that I greatly admire general dentists because they need to know so much about so many things to be considered excellent dentists. On the other hand, orthodontists need to be really good at just one thing … but in that one thing they are excellent.Rolf G. Behrents“Dental specialties are recognized by the American Dental Association to protect the public, nurture the art and science of dentistry, and improve the quality of care. It is the Association's belief that the needs of the public are best served if the profession is oriented primarily to the general dentist. Specialties are recognized in those areas where advanced knowledge and skills are essential to maintain or restore oral health.”2American Dental Association. Requirements for recognition of dental specialties and national certifying boards for dental specialists. Adopted as Amended by the ADA House of Delegates, November 2013.Google Scholar In the early 1890s, it was fairly easy to become a dentist. Most of the applicants to a dental school had just completed high school, they paid “a few pennies” to attend dental school, and their studies and training only lasted about 6 months. Upon graduation, a dentist could perform any dental procedure that he wished to do in any state. This included straightening teeth with “regulating” appliances. There were really no significant laws governing dentistry, and there were no dental specialists … only general dentists. In 1892, a dentist named Edward H. Angle invented the specialty of orthodontics by declaring that he would limit his dental practice just to orthodontics. He believed that a dentist wanting to do orthodontics needed special knowledge and skills, and these could not be obtained in any regular dental school in the United States. So, in 1900, he started the first school of orthodontics with a course of study that was 8 weeks in length (Fig). In 1901, he started an organization to promote orthodontics (now called the American Association of Orthodontists). More orthodontic schools were started by other orthodontists, and in 1915 a new journal (now known as the American Journal of Orthodontics and Dentofacial Orthopedics) was published to promote the specialty and advance the practice of orthodontics. Given this level of organization and advancement, it is somewhat surprising that there were still dentists of that time who simply announced on their signs and business cards that they were orthodontists. They did so without any meaningful training, and their motivation was usually based on financial gain. They were sometimes called “the imitators.” On the other hand, in 1915, it was argued that a dentist could become an orthodontist1Dewey M. Who is an “orthodontist?”.Int J Orthod. 1915; 1: 224-225Google Scholar (1) after many years of orthodontic experience (this included dentists who learned orthodontics by trial and error, and were “grandfathered” into the specialty), (2) by studying and practicing with an experienced orthodontist (a preceptor-apprentice relationship), or (3) by attending and graduating from a recognized school of orthodontics. Time, however, is never still; 100 years ago, many things were possible that are not possible now, and many things that were impossible a century ago are quite possible now. So, from 1915 over the next 100 years until now, there have been great advancements in dentistry and its related dental specialties. Oral health care improved greatly, dental technology has advanced, access to all forms of dental care has increased, and the public has become much better informed and served. Still, questions of education, scope of practice, legal issues, and professional ethics remain problematic, even today. In 2015, students who apply for admission to a dental school usually have at least 4 years of college experience and have received a degree. They have also taken a national entrance examination in dentistry. Competition for admission into a dental school is keen; only the highest-level applicants are admitted. Approximately 5000 students are admitted into the nation's dental schools each year. Those admitted will follow a 4-year program of study that includes almost 5000 hours of scheduled instruction and training in all aspects of dentistry. The vast majority of these hours are directed toward the control of disease (dental caries and periodontitis), pathology (extractions and surgery), and restorations of teeth (fillings, crowns, bridges, dentures, veneers, dental implants, and so on). The faculty of each dental school reflects the breadth of instruction provided; many general dentists as well as dental specialists are involved. In terms of orthodontic education during dental school, few hours of instruction are provided; the national average is approximately 95 total hours of scheduled instruction (ie, less than 2% of the total hours of instruction). The time allowed for teaching orthodontics involves instruction in the classroom, working in a laboratory, and sometimes actually providing limited orthodontic treatment to 1 or 2 patients in the clinic. At some schools, as few as 11 hours of instruction in orthodontics are provided. The overall quality of dental education in all the dental schools in the United States is maintained by the Commission on Dental Accreditation of the American Dental Association. Accreditation is recognized by state and federal governments as a valid method of assessing academic quality and ensuring public accountability and safety. DefinitionDentistry: The evaluation, diagnosis, prevention, and/or treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity, the maxillofacial area, and/or the adjacent and associated structures and their impact on the human body, provided by a dentist, within the scope of his or her education, training, and experience, in accordance with the ethics of the profession and applicable law (American Dental Association). Dentistry: The evaluation, diagnosis, prevention, and/or treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity, the maxillofacial area, and/or the adjacent and associated structures and their impact on the human body, provided by a dentist, within the scope of his or her education, training, and experience, in accordance with the ethics of the profession and applicable law (American Dental Association). Dentistry: The evaluation, diagnosis, prevention, and/or treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity, the maxillofacial area, and/or the adjacent and associated structures and their impact on the human body, provided by a dentist, within the scope of his or her education, training, and experience, in accordance with the ethics of the profession and applicable law (American Dental Association). Everyone who fulfills the requirements of a dental school is granted a degree (either DDS or DMD) and is educationally qualified to be a general dentist (also sometimes referred to as a “primary care provider”). To become a licensed general dentist in any state in the United States, a graduate of a dental school must also pass the National Board Examination in Dentistry (a written examination) and a regional or state clinical examination. Once licensed, general dentists can perform any dental treatment they wish as defined by the laws of the state in which they practice general dentistry. After graduating from dental school, about 10% to 20% of the graduates seek additional education in 1 of the 9 dental specialties or advanced training in general dentistry. One dental specialty is orthodontics. Dental graduates who wish to pursue training as orthodontists must seek admission to 1 of the 73 graduate orthodontic programs in the United States and Canada. Applications number in the thousands, but only about 350 are admitted each year. Generally, those admitted are some of the most accomplished students based on their college and dental school performances. Orthodontic programs in the United States are 2 to 3 years in length; a minimum of 3700 hours of scheduled instruction are required for all 73 programs in the United States and Canada; the orthodontic program at Saint Louis University is 2½ years long and includes approximately 4000 hours of scheduled instruction. Time is spent in lectures, seminars, laboratory exercises, and clinical care of patients; all of these efforts focus directly on orthodontics. The vast majority of the time is spent in the clinic treating patients. The clinical faculty consists of accomplished and experienced orthodontists. At Saint Louis University, we have approximately 40 clinical instructors whose cumulative experience in orthodontics is nearly 1000 years. Under the direct supervision of the clinical faculty, the students participate in the treatment of hundreds of patients and observe the treatment of hundreds more. The goal of all orthodontic programs is to produce knowledgeable and skilled orthodontists who are proficient in straightening teeth, aligning jaws, and improving facial appearances. At the conclusion of the orthodontic training, the graduates are awarded a certificate of specialty training in orthodontics and often a master's degree. The quality of orthodontic education in the United States is also maintained by the Commission on Dental Accreditation of the American Dental Association; accreditation of orthodontic programs began in 1966. Upon graduation, in order to practice orthodontics, a graduate must obtain licensure as a dentist (if not done prior) and be recognized (or be licensed) as an orthodontist; the details are determined by the dental board of the state in which the orthodontist will practice. DefinitionOrthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures (American Dental Association). Orthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures (American Dental Association). Orthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures (American Dental Association). Both general dentists and orthodontists must renew their licenses annually and, by law, must attend continuing education courses to maintain and improve their knowledge and skills. In this regard, general dentists usually take courses related to general dentistry, and orthodontists take courses that directly relate to orthodontics. In Missouri, the requirement for continuing education is 25 hours per year. The courses taken must be approved by the Missouri Dental Board. Of course, a general dentist and an orthodontist may take additional continuing education courses. Most of these courses are short (generally 1-2 days in length, equaling 8-16 hours), but some might last a week (40 hours) or so. Typically, these courses involve lectures and sometimes laboratory exercises, but no patient care. In the end, no matter the number and length of the continuing education courses, it is unlikely that a general dentist could replicate the total educational experience of an orthodontist. This should not be taken to mean that general dentists cannot perform some types of orthodontic treatment successfully; they can. As a whole, however, a general dentist cannot achieve what an orthodontist can achieve in orthodontics. I suppose that some would disagree with this conclusion; it's just that I cannot recall ever seeing any evidence to the contrary. In practice, an orthodontist can announce that he or she is an orthodontist and can perform any method of orthodontic treatment (and there are many). In practice, a general dentist cannot announce that he or she is an orthodontist but can perform orthodontic treatments. This assumes that the general dentist has an interest in orthodontics, has some training in some aspect of orthodontics, has some experience in orthodontics, and has the ability to adequately diagnose and treat some form of orthodontic problem. In practice, over time, orthodontists gain a great deal of experience in orthodontics, since they limit their practices to orthodontics. In practice, over time, general dentists get better at general dentistry, since they do not limit their practice to any one area of dentistry. In practice, orthodontists can advertise or otherwise inform the public that they are orthodontists and can perform orthodontics. In practice, general dentists cannot advertise or otherwise inform the public that they are orthodontists, but they can state that their practices offer “orthodontics”; under this condition, some states require a disclaimer in the advertisement to indicate that the “orthodontics” is performed by a general dentist. In practice, orthodontists get better and better at orthodontics every day because orthodontics is all that they do … all day. In practice, general dentists get better and better at performing general dentistry every day. In comparing them, the differences in orthodontic knowledge and skill get wider with time. A dental specialty such as orthodontics is generally thought to be defined by its related educational processes, its clinical focus, and the tools and technology that are associated with the diagnosis and treatment of patients. It is also thought that the specialty is further defined by having a related sponsoring organization (the American Association of Orthodontists). And it is believed that a certifying board (the American Board of Orthodontics) is an important acknowledgment of a focus on continuous improvement in the quality of clinical care that orthodontists provide. This is all true, but if orthodontics is considered a craft and orthodontists are craftsmen, orthodontists are further defined by their regard for and their support and use of science. The science associated with orthodontics and orthodontists is unique to the specialty and each orthodontist; it is relevant to orthodontics, and it is not the scientific consideration of the general dentist or any other dental specialty. This appreciation of science flows from the educational program that molds an orthodontist; each student must conduct a research project to satisfy the requirements for graduation from an accredited orthodontic program. In the practice of orthodontics, problems are identified that become the subjects of research that is then subjected to the scientific method. Eventually, research produces evidence and advancement that are meant to guide and improve orthodontic treatments … thus improving human health. Because orthodontists appreciate their science, they not only conduct research but also support it by contributing to research endeavors at the universities and giving to other entities that support research (eg, the American Association of Orthodontists Foundation). In the main, new knowledge in orthodontics is produced by orthodontists; this then defines the specialty and the orthodontist. Orthodontists define their existence, their presence, and their future through their science. Items of interest•There are 320,000,000 people in the United States.•1,600,000 people graduate from college each year.•5,000 general dentists graduate from dental school each year.•350 orthodontists graduate from orthodontic programs each year.•1 person is born every 8 seconds. •There are 320,000,000 people in the United States.•1,600,000 people graduate from college each year.•5,000 general dentists graduate from dental school each year.•350 orthodontists graduate from orthodontic programs each year.•1 person is born every 8 seconds. •There are 320,000,000 people in the United States.•1,600,000 people graduate from college each year.•5,000 general dentists graduate from dental school each year.•350 orthodontists graduate from orthodontic programs each year.•1 person is born every 8 seconds. So, what is the public to do with all this information? First, this editorial is meant to inform about the differences between an orthodontist and a general dentist in terms of background, education, training, and practice. These differences are meaningful in terms of the knowledge, experience, and skill of the practitioner who performs orthodontic treatments. It is an overall truth that orthodontists know more about orthodontics than do general dentists. Likewise, it is an overall truth that general dentists know more about general dentistry than do orthodontists. It should also be comforting to know that there are many excellent general dentists in the United States as well as many excellent orthodontists. A second use of this editorial is to point to resources that can help to explain the differences between an orthodontist and a general dentist. If you skim back through this editorial, you will note mentions of the American Dental Association, the American Association of Orthodontists, the American Board of Orthodontics, the American Association of Orthodontists Foundation, this Journal, and the state dental boards (one in each state); they (along with local, state, and regional dental and orthodontic associations) are all great sources of information about dentistry and the dental specialties. Third, the information in this editorial can be used to formulate questions that might be asked of practitioners, whether they are a general dentist, an orthodontist, or any other dental specialist. Such questions might prove valuable for patients in terms of helping them to make decisions about the best practitioner to serve their needs. Finally, if deemed worthy, reprints of this editorial might be useful to have in a waiting room or posted on a practitioner's Web site. In the end, I must fully admit that I greatly admire general dentists because they need to know so much about so many things to be considered excellent dentists. On the other hand, orthodontists need to be really good at just one thing … but in that one thing they are excellent. Rolf G. Behrents“Dental specialties are recognized by the American Dental Association to protect the public, nurture the art and science of dentistry, and improve the quality of care. It is the Association's belief that the needs of the public are best served if the profession is oriented primarily to the general dentist. Specialties are recognized in those areas where advanced knowledge and skills are essential to maintain or restore oral health.”2American Dental Association. Requirements for recognition of dental specialties and national certifying boards for dental specialists. Adopted as Amended by the ADA House of Delegates, November 2013.Google Scholar