NCRDSCB: 2021 Period Review of Dental Specialty Education and

NATIONAL COMMISSION ON RECOGNITION OF DENTAL

SPECIALTIES AND CERTIFYING BOARDS

2021 PERIODIC REVIEW

OF DENTAL SPECIALTY EDUCATION AND PRACTICE

April 2021

Through the Periodic Review of Dental Specialty Education and Practice, the National Commission on Recognition of

Dental Specialties and Certifying Boards hoped to gather strategic information that will be of value to the National

Commission, the recognized specialty sponsoring organizations, the recognized certifying boards, the profession and

the public. The review focuses on changes occurring within the advanced dental education programs, specialty

practice environments, board certification, disease trends, technology, and scope of practice. The review also looks

at the current environment as well as potential trends for the future and how these trends could impact the public and

the profession.

Background: In 1992, the American Dental Association (ADA) House of Delegates adopted Resolution 144H-1992

directing the Periodic Review of Dental Specialty Education and Practice be conducted every ten (10) years

beginning in 2001. In 2001 and 2011, the Council on Dental Education and Licensure conducted the review. With the

establishment of the National Commission in 2017, the Periodic Review became the responsibility of the National

Commission who adopted policy to continue the practice of conducting the review every ten (10) years.

For the 2021 Periodic Review of Dental Specialty Education and Practice, the following specialty sponsoring

organizations submitted reports: American Academy of Oral and Maxillofacial Pathology (AAOMP), American

Academy of Oral and Maxillofacial Radiology (AAOMR), American Academy of Pediatric Dentistry (AAPD), American

Academy of Periodontology (AAP), American Association of Endodontists (AAE), American Association of

Orthodontists (AAO), American Association of Public Health Dentistry (ABDPH), American College of Prosthodontists

(ACP) and American Society of Dentist Anesthesiologists (ASDA).

This summary report is divided into four sections:

I. General Information and Demographic Data of the Specialties

II. Major Research Changes and Technology Advances

III. Trends in Specialty Education

IV. Changes in Scope of Practice

I. GENERAL INFORMATION AND DEMOGRAPHIC DATA OF THE SPECIALTIES

History of Dental Specialties: As noted in Table 1, in 1947, the ADA formally recognized five (5) dental specialties,

oral and maxillofacial surgery, orthodontics (now known as orthodontics and dentofacial orthopedics), pedodontics

(now known as pediatric dentistry) periodontics and prosthodontics. Further, the ADA formally recognized oral and

maxillofacial pathology in 1949; dental public health in 1950; endodontics in 1963 and oral and maxillofacial radiology

in 1999.

The National Commission formally recognized dental anesthesiology in 2019 and oral medicine and orofacial pain in

2020 as dental specialties. Because oral medicine and orofacial pain were recognized during the year the Periodic

Review was being conducted, the organizations were exempt from participating.

Table 1. History of the Recognized Dental Specialties and Dental Specialty Certifying Boards

Year Specialty

Recognized

Year Specialty Certifying

Board Recognized

Founding Date of

Certifying Board

Dental Anesthesiology

(ASDA)

2019

2020

1994

Dental Public Health

(AADPH)

1950

1951

1950

Endodontics (AAE)

1963

1964

1956

Oral and Maxillofacial

Pathology (AAOMP)

1949

1950

1948

Oral and Maxillofacial

Radiology (AAOMR)

1999

2000

1979

Oral and Maxillofacial

Surgery (AAOMS)

1947

1946

Orthodontics and

Dentofacial Orthopedics

(AAO)

1947

1950

1929

Pediatric Dentistry

(AAPD)

1947

1948

1940

Periodontics (AAP)

1947

1948

1940

Prosthodontics (ACP)

1947

1948

1946

Compliance with the Requirements for Recognition of Dental Specialties: The National Commission requested

each of the recognized specialty sponsoring organizations to provide documentation exhibiting that the six (6)

Requirements for Recognition of Dental Specialties are being met.

American Association of Public Health Dentistry

Requirement 1

• Full membership is for dentists who have either completed a Commission on Dental Accreditation (CODA)

accredited advanced education program in dental public health, advanced training in public health (an MPH

degree) without formal dental specialty training or who have sufficiently demonstrated experience or interest

in dental public health as assessed by the AAPHD and the American Board of Dental Public Health

(ABDPH). Only full members are allowed to hold office or vote on issues related to the specialty. The

ABDPH was established in 1950 and recognized as the national certifying board in 1951.

Requirement 2

• Educational preparation for dental public health (DPH) includes successful completion of graduate-level

coursework in public health, including masters or doctoral level courses in epidemiology, biostatistics, health

care policy and management, environmental health, and behavioral sciences. These courses are generally

not included in predoctoral dental curricula.

Requirement 3

• Dental Public Health is the only specialty focused on population health. The body of knowledge and skillsets

are distinct from those involved in all other dental specialties.

Requirement 4

• A large proportion of DPH specialists are employed in academic or research institutions and are active

researchers in the field. DPH specialists were heavily represented among the editors and authors of the

upcoming 2021 Surgeon’s General Report on Oral Health. The Journal of Public Health Dentistry is among

the world’s most widely known and recognized peer-reviewed scientific journals in its field. The National Oral

Health Conference is the largest and most widely recognized scientific conference that focuses on DPH.

Requirement 5

• Dental Public Health is not a clinical specialty and advanced training does not provide training on specific

clinical procedures; however, the specialty directly benefits many aspects of clinical patient care through

research, health promotion, surveillance, and policy development. Dental Public Health specialists are

leaders in promoting oral health and providing care in underserved populations, thereby reducing the

burdens of oral disease in vulnerable populations who face challenges in accessing the oral health care

system.

Requirement 6

• Advanced education programs in Dental Public Health are accredited by CODA and are of at least two years

in length.

American Association of Endodontists

Requirement 1

• Membership is reflective of the specialty of endodontics. Voting members have completed a CODA-

accredited advanced education program in endodontics or were in good standing prior to January 1, 1985.

American Board of Endodontics (ABE) is the recognized certifying board for the specialty and has a close

working relationship with the American Association of Endodontists (AAE).

Requirement 2

•

Endodontics is the only specialty focused on diagnosis, prevention and treatment of pulpal and periradicular

diseases.

Requirement 3

• The scope of endodontics requires advanced knowledge and skills separate and distinct from other dental

specialties and cannot be accommodated through minimal modification of an existing recognized dental

specialty.

Requirement 4

• Endodontics continues to contribute to new knowledge in the field, professional education, research needs

and provision of oral health services.

Requirement 5

• The focus of endodontics is saving the natural tooth in a healthy, functional state that can be predictably

accomplished with appropriate diagnosis and treatment using all clinical approaches to endodontic care.

Requirement 6

• Currently, 56 CODA-accredited 2-3 year endodontic advanced education programs exist in the United

States and there are two (2) programs in Canada.

American Academy of Oral and Maxillofacial Pathology

Requirement 1

• Membership consists of practitioners, educators, residents, dental students, and other individuals holding a

professional or doctoral degree in a healthcare discipline or a student enrolled in a biomedical or healthcare

program. Only dentists who have completed a CODA-accredited advanced education program in oral and

maxillofacial pathology (OMP) and who have achieved Fellowship status in the American Academy of Oral

and Maxillofacial Pathology (AAOMP) either by passing the fellowship examination of the American Board of

Oral and Maxillofacial Pathology (ABOMP) certifying examination have the privilege of holding office and of

voting rights. The ABOMP and the AAOMP work in concert to ensure the continuing competency of oral

pathologists through continuing education and certification maintenance

Requirement 2

• The practice of oral and maxillofacial pathology includes research, diagnosis of diseases using clinical,

radiographic, microscopic, biochemical or other examinations, and evidence-based management of patients,

which is not included or taught at the predoctoral level.

Requirement 3

• Oral and Maxillofacial Pathology is the specialty of dentistry which deals with the nature, identification and

management of diseases affecting the oral and maxillofacial region and requires advanced knowledge and

skills that are unique, and well beyond those required of any other dental specialty. Such skills and knowledge

cannot be achieved through modification, minimal or otherwise, of any other recognized specialty.

Requirement 4

• The field of oral and maxillofacial pathology contains individuals who are recognized worldwide for their

expertise in oral and head and neck cancer diagnosis and pathogenesis, medication-related osteonecrosis

of the jaw, immune-mediated mucocutaneous diseases, and other pathologic processes and conditions,

local and systemic, with influence on the oral-maxillofacial complex. Oral pathologists (including residents)

contribute to advances in research that have implications for diagnosis and improved clinical practice.

Requirement 5

• Oral pathologists’ training and practice emphasize microscopic interpretation and diagnosis of tissue biopsy

specimens submitted by various healthcare providers in dentistry, medicine and surgical specialties. Oral

pathologists further bring their unique qualifications into the clinical setting, seeing patients referred by other

practitioners of dentistry, medicine and surgery, for diagnosis and management of local and systemic

disease processes and lesions manifesting in the oral mucosa and jawbones.

Requirement 6

• Oral and Maxillofacial Pathology has 14 CODA-accredited programs that are a minimum of three (3) years in

length.

American Academy of Oral and Maxillofacial Radiology

Requirement 1

• American Academy of Oral and Maxillofacial Radiology (AAOMR) bylaws limits voting privileges and the

ability to hold office to members who have completed a CODA-accredited Oral and Maxillofacial Radiology

(OMR) advanced education program. The AAOMR has a close working relationship with the American Board

of Oral and Maxillofacial Radiology (ABOMR) and both organizations collaborate closely on matters related to

education, certification and practice.

Requirement 2

• Oral and Maxillofacial Radiology practice requires in-depth knowledge of all imaging modalities used in

healthcare, including CT, MRI, ultrasound and nuclear medicine. It further requires knowledge of radiation

physics, biology and safety, and dento-maxillofacial disease pathogenesis that are beyond the education

provided in the predoctoral curriculum.

Requirement 3

• The depth and breadth of knowledge of imaging technology and interpretation provided by OMR programs

are well beyond that provided by other advanced education programs.

Requirement 4

• Oral and maxillofacial radiologists contribute significantly to multi-disciplinary teams and publish in diverse

areas including diagnostic imaging, radiation biology and technology development. Actively educates the

dental profession via CE, position statements and national conferences and is involved in promoting safe

and effective use of x-rays via collaborations with other organizations.

Requirement 5

• Patient care occurs through diagnostic imaging acquisition and interpretation services. With expanded use

of CBCT imaging in dentistry, demand for services has increased.

Requirement 6

• Advanced education programs accredited by CODA are a minimum of two (2) years in length.

American Association of Oral and Maxillofacial Surgeons

Requirement 1

• Governed by an 11-member Board of Trustees composed of five officers, including the president, president-

elect, vice president, treasurer and immediate past president, and six trustees, each of whom represents a

geographic membership district. Members must complete a CODA-accredited advanced education program

to be eligible for membership.

Requirement 2

• Oral and Maxillofacial Surgery (OMS) is the surgical specialty of dentistry with advanced education in

diagnosis, surgical intervention and adjunctive treatment of diseases, injuries and defects, involving

functional and esthetic aspects of hard and soft tissues of the OMS region that is beyond the education

provided in the pre-doctoral curriculum. Oral and Maxillofacial Surgeons are licensed to perform procedures

that are also performed by physicians.

Requirement 3

• Oral and maxillofacial surgeons provide a critical component of the contemporary scope of the profession

that includes: evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related

procedures) of diseased, disordered and/or conditions of the oral cavity, maxillofacial area and/or the

adjacent and associated structures and their impact on the human body. Oral and maxillofacial surgeons

treat such conditions as problem wisdom teeth (dentoalveolar surgery), facial pain (diagnosis and

management of craniofacial disorders), dentofacial/craniofacial abnormalities (correction of skeletal

deformities), severe facial injuries (trauma management and esthetic/cosmetic surgery), oral cancer

(management of malignant disease in the head and neck), and cleft lip/palate (reconstructive and

craniofacial surgery).

Requirement 4

• Through the various research conferences, committee work and research, American Association of Oral and

Maxillofacial Surgeons (AAOMS) has collaborated in the development of relationships between oral and

maxillofacial surgeons and researchers to bridge the gap between clinical and basic science. AAOMS has

researched medication-related osteonecrosis of the jaw (MRONJ) and developed a position paper to inform

practitioners, patients and other interested parties on the diagnosis, staging, and management strategies

regarding risks and benefits of medications related to osteonecrosis of the jaw. Advances in technology

have allowed certified OMSs to utilize an upper airway stimulation device for patients who suffer from

obstructive sleep apnea (OSA) and cannot tolerate positive airway pressure treatments.

Requirement 5

• Oral and maxillofacial surgeons are respected and valued members of the health care team. They maintain

active staff privileges with local and regional hospitals in their community and practice in a variety of settings

including private clinical practice, ambulatory surgical centers and hospitals. OMSs may also be found

contributing their talents in academia, military service, or in dental research and industry.

Requirement 6

• Oral and Maxillofacial Surgery advanced education programs are accredited by CODA and are a minimum

of four (4) years in length. In addition to their OMS training, whether residents are in an MD-integrated or a

single-degree-training program, all residents are required to complete the same surgical training, including

the core surgical year.

American Association of Orthodontists

Requirement 1

• Only active American Association of Orthodontists (AAO) members in good standing are eligible to seek or

hold office or other elective or appointive positions in the association, or to vote or otherwise participate in

the selection of Association officials or the establishment of policies. Membership is reflective of the

specialty who complete a CODA-accredited advanced education orthodontic program, pass the National

Dental Specialty Examination administered by The Royal College of Dentists of Canada, or successfully

complete the educational requirements established by the AAO.

Requirement 2

• The skills and knowledge acquired in an advanced dental education program include the diagnosis,

prevention, interception and correction of malocclusion, as well as neuromuscular and skeletal abnormalities

of the developing or mature orofacial structures that are beyond the education provided in the predoctoral

curriculum.

Requirement 3

• Orthodontics and Dentofacial Orthopedics is the only specialty whose definition specifically addresses the

diagnosis, prevention, interception, and correction of malocclusion as well as neuromuscular and skeletal

abnormalities of the developing or mature orofacial structures.

Requirement 4

• The AAO Foundation provides support to orthodontic education programs and orthodontic research and has

award programs for contributing new knowledge and educational research. The AAO’s Practice-Based

Research Network Committee works with the National Dental Practice-Based Research Network. The

committee conducted an Anterior Open Bite Study in 2016-2018, and from this study, three articles were

published in nationally recognized orthodontic journals. Currently, the committee is submitting three studies

for the Network’s current funding cycle: a Class II study, a cleft palate study and an aligner study.

Requirement 5

• The AAO’s Clinical Practice Guideline Review Committee maintains guidelines of clinical care.

Requirement 6

• Orthodontics and Dentofacial Orthopedics has advanced education programs accredited by CODA that are

at least 2 years in duration.

American Academy of Pediatric Dentistry

Requirement 1

• The American Academy of Pediatric Dentistry (AAPD) is made up of specialists with CODA-accredited

advanced education training and represents pediatric dentistry. Affiliate membership is specified in AAPD

Bylaws. The AAPD maintains a close working relationship with the American Board of Pediatric Dentistry

(ABPD).

Requirement 2

• Pediatric dentistry is well-defined, requiring knowledge/skills beyond those possessed by dental school

graduates.

Requirement 3

• Pediatric dentistry is an age-defined specialty that provides both primary and comprehensive preventive and

therapeutic oral care for infants, children and adolescents, including those with special health care needs

and to populations not seen by other specialists/general dentists. Like pediatricians and internists in

medicine, it provides treatment and health supervision. Application of knowledge and skills is in a

developmental, parent-engaged and socially-relevant context.

Requirement 4

• AAPD supports new knowledge and research supported through AAPD journals, the AAPD EBD process

and newly-organized IADR Pediatric Dentistry Section, AAPD Reference Manual triennial review process

and quinquennial update of the Handbook of Pediatric Dentistry. Presentations at annual sessions, support

of fellowship research and symposia support research by the specialty and profession.

Requirement 5

• Pediatric dentistry provides comprehensive surgical and primary health supervision for children including

diagnostic, preventive, surgical, restorative care and true primary prevention and developmental supervision

from age one through adolescence and for children with and without special health care needs.

Requirement 6

• Pediatric dentistry has advanced education programs accredited by the Commission on Dental Accreditation

that are at least two (2) years in length.

American Academy of Periodontology

Requirement 1

• The American Academy of Periodontology (AAP) maintains a membership that is representative of over

90% of periodontists in the United States as well as a significant number of international periodontists. The

right to vote and/or hold office is reserved to Active and Life Active members. The Bylaws define Active and

Life Active members; both membership categories require the individual to have completed an advanced

education program in periodontics that is accredited by CODA. The AAP has a close working relationship

with the American Board of Periodontology (ABP).

Requirement 2

• Periodontics is well-defined, requiring knowledge/skills beyond those possessed by dental school graduates.

Requirement 3

• The skills and knowledge required of a periodontist are specific, unique, and well established. The field of

periodontology has been advanced through rigorous, empirical research, continuing education, and

continuous evolution of training and study.

Requirement 4

• AAP supports rigorous scientific evaluation and studies that regularly contribute new knowledge to the field

and regularly supports consumer awareness about the importance of oral health and the role of the

periodontist in maintaining oral health and treating disease. The continuing education program supported by

AAP is robust and expansive.

Requirement 5

• The advanced training, study, research, education, and collaboration that the AAP engages in is focused on

advancing clinical care of patients and improving the understanding of periodontal disease.

Requirement 6

• There are 56 U.S. based CODA-accredited advanced education periodontal programs. Periodontal

postdoctoral education programs are all required to be a minimum of 30 months, with virtually all programs

now 36 months.

American College of Prosthodontists

Requirement 1

• American College of Prosthodontists (ACP) Members/Fellows are required to complete a CODA-accredited

advanced education program in prosthodontics. Members/Fellows have the privilege to hold office and vote.

Resident Members are eligible to vote, but not hold office. The ACP has a close working relationship with

the American Board of Prosthodontics (ABP).

Requirement 2

• The knowledge and skills acquired in the advanced dental education programs are related to treatment

planning, occlusion, fixed and removable prosthodontics, dental implant placement and rehabilitation,

maxillofacial prosthetics, biomaterials and patient management are beyond those possessed by dental

school graduates.

Requirement 3

• The scope of prosthodontics requires advanced knowledge and skills, separate and distinct from the other

recognized specialties in the restoration of oral/orofacial defects. Minimal modification of any other

recognized specialty would not provide the necessary advanced training to treat complex prosthodontic

patient needs.

Requirement 4

• Research designed and directed by prosthodontists positively impacts oral health services for the public.

Prosthodontic journals, such as the Journal of Prosthodontics, publish original research devoted to dental

materials, dental technology, diagnosis, advances in the design and use of dental implants and treatment of

unique patient conditions. Annual education programs showcase how technological advances in digital

dentistry aid diagnosis, prosthesis design and fabrication.

Requirement 5

• Prosthodontists provide health services, including diagnosis, treatment planning, rehabilitation and

maintenance of oral health, improved appearance and function of worn, diseased, mutilated or missing teeth

and/or orofacial structure in a variety of clinical settings for multiple patient populations.

Requirement 6

• There are currently 48 CODA-accredited prosthodontic programs in the United States and 3 CDAC-

accredited prosthodontic programs in Canada. All programs are a minimum of 33 months.

American Society of Dentist Anesthesiologists

Requirement 1

• ASDA membership has increased since 2018 when >60% of dentist anesthesiologists were ASDA

members. Active members may vote and are eligible to hold office. The American Dental Board of

Anesthesiology was recognized as the certifying board of Dental Anesthesiology in 2020.

Requirement 2

• Deep sedation and general anesthesia are beyond the scope of predoctoral training.

Requirement 3

• Dentist anesthesiologists’ advanced knowledge and skills are separate and distinct from those of other

recognized dental specialties and cannot be accommodated through minimal modification or combination of

currently recognized dental specialties.

Requirement 4

• Dentist anesthesiologists have significantly contributed to the creation and dissemination of new knowledge

related to clinical anesthesia care for dental patients including the very young and elderly, and those with

special healthcare needs, chronic pain, inability to receive local anesthesia and those undergoing invasive

procedures requiring additional anesthesia support. Patient safety and access to care for these often

underserved patient populations continue to be focal points. Dentist anesthesiologists also actively

participate in the development of guidelines and regulatory initiatives for dental office sedation and

anesthesia care.

Requirement 5

• Dentist anesthesiologists provide the full scope of pain and anxiety control for all areas of dental practice, in

offices, surgicenters, hospitals and educational institutions, increasing access to care for patients unable to

obtain medically necessary dental treatment without advanced anesthesia care.

Requirement 6

• CODA-accredited advanced education programs are three (3) years in duration.

Strategic Planning: In order to understand what each of the recognized specialties envisions as its future role in

improving and providing oral health services to the public; each of the recognized specialty sponsoring organizations

was requested to provide its organization’s mission statement, goals and strategic plan. The organizations were also

requested to include a brief summary highlighting the specific areas and efforts undertaken to promote quality in the

discipline over the last ten (10) years.

The National Commission found that not all of the recognized specialty sponsoring organizations had developed a

formal strategic plan. The recognized specialty sponsoring organizations that did have formal strategic plans provided

direction for continued growth and development.

Efforts to Promote Quality in the Discipline: The National Commission requested that each of the recognized

specialty sponsoring organizations provide information on the efforts the specialty has undertaken over the past ten

(10) years to promote quality in the discipline.

American Association of Public Health Dentistry

Over the past ten (10) years, the AAPHD has worked to improve and promote the quality of public health

dentistry by focusing on the application of knowledge and critical thinking in the Dental Public Health curriculum,

board examination and continuing education to ensure continued growth of the specialty.

• In 2015, the AAPHD and the American Board of Dental Public Health (ABPHD) convened a working

group to review the Dental Public Health competencies, which had been last updated in 1998.

• In 2017, the AAPHD began the process of updating Burt and Eklund’s Dentistry, Dental Practice, and

the Community, which is a major textbook in dental public health.

• AAPHD has provided multiple opportunities for continuing education through the annual National Oral

Health Conference, which has been jointly sponsored by AAPHD and the Association for State and

Territorial Dental Directors for over 20 years. An annual symposium is organized by ABDPH. Through a

collaboration with AIDPH, the annual colloquium which discusses cutting-edge topics in dental public

health. AAPHD also provides several online courses.

• AAPHD’s recertification program of diplomates ensures competency with the DPH standards and

current areas of dental

public health

• The Journal of Public Health Dentistry (JPHD), AAPHD’s official scientific journal, continues to be a

leading peer-reviewed journal on public health dentistry, promoting the quality of the discipline.

American Association of Endodontists

Over the past ten (10) years, AAE sought to establish and uphold a single standard of care for endodontic

treatment, with all root canals completed to the standard of the specialist.

• AAE defined competency in endodontic diagnosis, treatment planning, treatment, and prognosis and developed

treatment standards for imaging, access, disinfection, canal preparation, obturation, retreatment, restoration

• AAE developed a mobile case assessment application

• AAE biannually publishes ENDODONTICS: Colleagues for Excellence, provides education on current

clinical topics to educate dental students and general practitioners and enables assessment of

requirements for quality patient care at the standard of practice.

• AAEF provides care to underserved patients domestically and internationally, and in 2020 will surpass

a total of 7,000 patients served and 500 endodontic treatments performed.

Through the efforts of the AAE, AAEF, ABE, and College of Diplomates (COD), quality in the discipline is further

promoted via:

• Providing clinical resources: Guide to Clinical Endodontics, Glossary of Endodontic Terms, Guidelines

and Position Statements

• Being the premier resource for endodontic continuing education.

• Evaluating board certification protocol, maintaining integrity while streamlining processes,

resulting in increased certification rates and providing mentorship and courses to assist

endodontists in achieving board certification.

• Supporting endodontic educators’ professional development through grants, fellowships, CE, and

educator-specific communications and resources

• Advancing the quality of care through clinical research by standardizing a core set of desired patient-

and clinician-based outcomes that are intended to drive clinical research and establish an evidence base.

American Academy of Oral and Maxillofacial Pathology

Lifelong learning is a cornerstone of the profession of Oral and Maxillofacial Pathology, especially since a majority

of the members serve as dental faculty, actively contributing to professional education by providing foundational

and continuing education courses and performing health services as oral pathologists. AAOMP is invested in

informing dental and other health care professionals about best practices concerning diseases affecting the oral and

maxillofacial region.

The AAOMP:

• Defined the parameters of care through position papers on bisphosphonates and osteonecrosis of the

jaw, diagnostic aids used in the detection of oral cancer, policies on excised tissue, oral lichen planus,

and is currently tackling diagnostic guidelines for proliferative verrucous leukoplakia.

• Promoted quality within the discipline by surveying the needs of members related to Continuing Education (CE)

courses at its annual meetings.

• Invited a diverse array of expert pathologists and respected clinicians to present courses to the

Academy with the focus on keeping members abreast of emerging oral/general health issues,

innovative methodologies in pathology, and ensuring a broad range of both clinical and surgical

pathology.

• Through its Education Committee annually assembles a Continued Competency Assurance examination

with challenging clinical, radiographic and microscopy-based cases.

• Maintains a slide-based continued competency program. Members must participate in at least one of these

programs annually and take 40 hours of pathology-based CE every two (2) years to maintain board

certification.

American Academy of Oral and Maxillofacial Radiology

Over the last several years, AAOMR has invested considerable effort toward enriching the educational content

provided at the Annual AAOMR Session, aimed to enhance the level of OMR patient care provided in dentistry.

• Newly incorporated content areas include contemporary head and neck and maxillofacial imaging

delivered by world leaders in education and clinical care, Interdisciplinary clinical care in endodontics,

TMJ and facial pain, craniofacial imaging and biology, implant treatment planning, orthodontic evaluation

and sleep apnea workshops on the role of OMRs in implementing emerging technologies such as CAD-

CAM and 3D printing

• Parameters of care: AAOMR provided financial support for drafting of NCRP Report 177: Radiation

protection in dentistry and oral and maxillofacial imaging, as well as initiatives to develop and

update guidelines for imaging in dentistry. It published position statements on CBCT imaging in

implant dentistry, endodontics, and orthodontics, and teleradiology in dentistry, participated on ADA

committees to provide recommendations on radiologic equipment and quality control and was a voting

member of the Standards Committee on Dental Informatics, an ADA-ANSI committee that develops

standards for imaging and health informatics.

American Association of Oral and Maxillofacial Surgeons

AAOMS has developed and implemented high quality professional educational meetings and resources as well as

opportunities for lifelong learning to improve and expand the educational continuum through clinical and practice

management skills and competencies in a diverse and evolving specialty.

• Published the Parameters of Care, which provides a means for assessing the appropriateness and

quality of a selected treatment modality applied to an identified clinical condition in patients treated by

oral and maxillofacial surgeons.

• Developed the Dental Anesthesia Incident Reporting System (DAIRS)

• Established the Oral and Maxillofacial Surgery Quality Outcomes Registry (OMSQOR)

• Released a white paper on opioid prescribing recommendations during the national opioid epidemic

• Developed the National Simulation Program to create practical simulation-based training courses and

assessments that will measurably increase the safety of sedation administration in oral surgery and

dentistry and built a state of the art 2.5 million dollar education and innovation center

at its headquarters

building.

• Established the Practice Base Research Network, a resource that has allowed oral and maxillofacial

surgeons to participate in relevant clinical research projects in their offices, provide data to support the

specialty and improve patient outcomes.

• Through various standing committees, conducted literature reviews and developed guidelines

highlighting the research conducted and expressing the association’s position on various issues such as:

Head and Neck Cancer Screening Prevention; Human Papillomavirus Vaccination; Tobacco and Electronic

Cigarettes; and Evaluation and Management of Obstructive Sleep Apnea.

American Association of Orthodontists

• AAO’s Clinical Practice Guidelines are reviewed and revised every three (3) years to incorporate current

evidence-based orthodontics research.

• The AAO Library has a qualified library staff to meet the information needs of AAO members. Over

the past 10 years, the library staff has conducted over 12,600 mediated searches for

members and

sent over 22,000 journal articles to members.

• The ABO sets the standard for the highest level of patient

care, promotes excellence in orthodontics

for all of its certified orthodontists, serves to protect the orthodontic specialty and encourages

orthodontists to achieve certification.

• The AAO is a participant in ADA’s Dental Quality Alliance (DQA) that uses a collaborative approach to

advance performance measurement as a means to improve oral

health, patient care and safety

through a consensus building approach.

• The AAO offers a wide variety of educational opportunities including live webinars, recorded webinars,

and AJO-DO tests. Approximately 2,066 courses have been uploaded to our site since 2011. The

number of views has been approximately 106,495. Since January 2019, 562 courses have been

added

with 81,019 views. All CE courses meet the ADA’s CERP guidelines.

American Academy of Pediatric Dentistry

• The AAPD Reference Manual has been in existence for three decades and contains policies, guidelines

and best practices that are updated on a triennial cycle. AAPD guidelines are used by most state

Medicaid programs and are a part of Bright Futures, the national health supervision guidelines for

children. It has been listed on the national quality assurance health guideline repository.

• In 2013, the Evidence-Based Dentistry (EBD) initiative was launched to refine AAPD’s commitment to

standard setting with evidence per federal requirements. Three (3) EBD clinical practice documents

have been published and three (3) more are in development.

• The AAPD provides regular continuing education programs in person and on-line. Members can create a

vital educational passport. An annual update on pediatric dentistry assists in making practice EBD-based

and contemporary.

• The ABPD assesses continued competency and the AAPD courses and CODA accreditation standards

support board certification.

• The majority of pediatric dentists hold hospital staff positions and are required to maintain qualifications.

• AAPD has a standing committee to advance the culture of safety in care of children, most recently

creating on-line COVID-19 advice and information. AAPD has partnered with certifying organizations

AAASF and the American Academy of Pediatrics to improve sedation safety and OSAP to advance

office safety.

AAPD is working with the AAOMS on its DAIRS surveillance registry.

American Academy of Periodontology

The AAP is committed to promoting quality in the profession through a multi-faceted approach utilizing scientific

innovation, robust continuing education, collaborative efforts among periodontal organizations, and rigorous

educational standards and practices.

• The AAP regularly partners with global periodontal organizations to strengthen scientific understanding of

the disease. The AAP has held joint workshops with the European Federation of Periodontology (EFP)

and collaborates regularly with the Japanese Society of Periodontology and Japanese Academy of

Clinical Periodontology.

• AAP continues to support scientific innovation through collaborative work with US partners. The AAP

collaborated with the US Centers for Disease Control and Prevention on the NHANES Periodontal

Disease Prevalence Study, released a joint statement in 2012 with the American Heart Association and

is participating the Surgeon General’s Report on Oral Health (2020).

• The Journal of Periodontology and Clinical Advances in Periodontics (CAP) are standard-bearers for the

profession. These publications continue to innovate, including moving to a large publishing house,

evaluating editorial positions and securing CAP’s indexing in MEDLINE.

• AAP’s CE offerings remain a centerpiece of periodontal scientific advancement. CE-based meetings and

conferences highlight cutting-edge science for members. CE programming is supplemented by ongoing

scientific projects such as the 2011 statement on comprehensive periodontal therapy; position papers

and statements on lasers, peri-implant disease, and moderate sedation; and development of Best

Evidence Consensus statements that are designed to provide consensus-based guidance on clinical

scenarios that may have limited existing evidence.

• AAP maintains a multi-faceted mechanism to ensure the profession is evolving and keeping pace through

integrated work with the education community, CODA and the American Board of Periodontology.

American College of Prosthodontists

The ACP continues to host vital CE to address the specialist’s needs and provide the latest updates on

prosthodontic patient management, techniques, treatments, digital dentistry, implant surgery, private practice

management, and the

latest evidence-based practices.

• Within the past 10 years, the ACP has created new CE courses such as the Practice Management

Course and Digital Dentistry Symposium to address the additional needs of practitioners and help them

stay informed of new and emerging trends.

• ACP Position Statements helps guide prosthodontists and the public by clarifying the specialty’s

position on various topics within dentistry.

• The Prosthodontic Parameters of Care have been updated, reflecting the evolution of the specialty over

the past 10 years.

• The ACP offers research grants to prosthodontic students/residents to advance basic scientific and

applied clinical knowledge in the specialty. The Sharry Research Competition provides the opportunity

for students/residents to be recognized for their completed research during training.

• The ACP assisted with major revisions to the CODA Standards for Prosthodontics that resulted in the

addition of competency standards for implant surgery and digital technology. Curriculum and additional

resources were developed around competencies, well-defined learning objectives, and an assessment

plan with measurable outcomes to help programs effectively implement digital technology into their

curriculum and ensure the quality of education.

American Society of Dentist Anesthesiologists

• In 2015, the CODA-accredited advanced education programs increased their complexity. The

duration of the programs increased to 36 months.

• In 2018, the ASDA Parameters of Care were revised and ASA Practice Guidelines for

Procedural Moderate Sedation and Analgesia were updated. Professional and educational

relationships were created with ASA and SAMBA.

• In 2019, ASDA supported AAPD/AAP Guidelines for Monitoring and Management of

Pediatric Patients Before, During and After Sedation for Diagnostic and Therapeutic

Procedures.

• The ASDA participates in the AASA NACOR database, which is the largest national anesthesia database

• Supports the ASA Anesthesia Patient Safety Foundation and established ASDA Dental Anesthesia

Patient Safety Foundation.

• The ASDA participated on the Council for Dental Education and Licensure Committee on

Anesthesia for the development of ADA Guidelines for Sedation and Anesthesia education and

training

• ASDA provided Interim Guidance For Dentist Anesthesiologists Practicing In The Office-Based Setting

During The COVID-19 Pandemic

• The ASDA Education and Research Foundation was established.

• ASDA’s Annual Scientific Session offer high-quality CE specific to Dental Anesthesiology

• ASDA’s IMPA-Partnership with the AGD provides continuing education in sedation, anesthesia, and pain control

• The ASDA provided continuing education in sedation, anesthesia and pain control for local,

national and international organizations, including state component dental societies and

dental schools.

• The ASDA initiated model legislation reform, a collaborative effort with a goal of developing safe

and fair sedation and anesthesia regulations

• The ASDA is an affiliate sponsor and expert content contribution for the peer-reviewed journal

dedicated to pain and anxiety control in dentistry-Anesthesia Progress

Specialty Membership and Certification: The National Commission requested that the recognized specialty

sponsoring organizations provide data and overview comments related to membership trends over the past ten (10)

years. The National Commission further requested overview comments on future membership trend forecasts for the

next ten (10) years.

Table 2 reflects the recognized specialty sponsoring organization’s total membership figures over the last ten (10)

years, as reported by the organizations.

Table 2. Total Specialty Membership in All Membership Categories 2010-2019

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2010-2019

Increase/

Decrease

AAPHD

790

841

897

795

876

935

973

727

654

-17%*

AAE

7,219

7,386

7,520

7,692

7,650

7,889

8,015

8,013

8,055

8,099

+12%

AAOMP

580

563

560

573

542

545

560

569

534

531

-8%

AAOMR

291

N/A*

397

399

441

298

351

349

377

+30%

AAOMS

7,348

7,429

7,498

7,606

7,737

7,783

7,801

7,849

7,973

8,034

+9%

AAO

16,357

16,643

17,096

17,281

17,758

18,089

18,946

19,014

18,955

19,332

+18%

AAPD

7,686

8,080

8,401

9,062

9,304

9,462

9,737

10,189

10,454

10,598

+38%

AAP

7,028

7,171

7,106

7,143

7,280

7,382

7,114

7,206

7,199

7,363

+5%

ACP

3,383

3,457

3,472

3,703

3,881

3,751

3,898

3,995

4,071

4,124

+22%

ASDA

274

267

261

328

370

384

387

393

356

391

+43%

*AAOMR was unable to retrieve the data for 2011 and 2012

*AAPDH was unable to retrieve data for 2010.

The National Commission noted that while some of the recognized specialty sponsoring organizations had minor

fluctuations in total membership over the course of ten (10) years, all but two (2) organizations had an overall

increase in membership. Overall, total membership across all the recognized specialty sponsoring organizations

increased from 50,166 members in 2010 to 59,503 members in 2019.

With regard to future trends:

• AAE projected a steady and modest growth rate of 0.5% to 2% annually over the next ten (10) years. While

roughly 100 members per year transition to Life and Retired membership annually, almost 200 newly

graduated endodontists convert to Active membership. Expansion in the International membership category

is expected to show the most significant growth in the next decade.

• AAOMR has devoted considerable effort toward membership retention by providing high-quality CE

programs and increasing member benefits. It is confident that recruitment and retention efforts will

continue to increase the membership numbers.

• AAOMS anticipates continued growth in total membership over the next ten years, as the incoming

members from graduating residents will exceed inactivated members.

• AAO noted that consistent, gradual growth is attainable and expected over the next ten (10) years as

more orthodontists are entering the market than are exiting.

• AAPD estimated that with current programs training pediatric dentists, there will be 10,600 pediatric dentists in

2030. The pediatric dentist to population ratio, currently 9 FTE/100,000 children, will increase to 14FTE/100,000,

but not in all U.S. regions.

• AAP noted that as the advanced education program periodontics see an increase in the number of international

students, the diversity of younger membership segments has evolved; however, as these students/residents return

to their home countries following graduation, the potential to maintain them as International members is growing.

• ACP noted that as experienced practitioners continue to retire, the ACP is committed to engaging the

next generation of prosthodontists as members of the organization, and leaders within the dental

community.

• ASDA anticipates an increase in its membership, related to increased interest in the discipline, an

increasing number of training programs, and retention of graduates from the training programs.

Membership Based on Gender and Ethnicity 2010-2019: The National Commission requested information on the

gender and ethnicity of the membership for each of the recognized specialty sponsoring organizations. Five (5) of the

ten (10) recognized specialty sponsoring organizations provided gender information. Further, with relation to ethnicity,

one (1) recognized specialty sponsoring organization started tracking the ethnicity of its membership in 2016, one (1)

recognized specialty sponsoring organization started tracking the ethnicity of its membership in 2019 and eight (8) of

the recognized specialty sponsoring organizations did not track ethnicity. Because very little data was available

related to gender and ethnicity from the recognized specialty sponsoring organizations, the data is excluded from this

report. The National Commission strongly encourages the recognized specialty sponsoring organizations to start

routinely tracking and gender and ethnicity data.

Active Diplomates: The National Commission monitors the recognized dental specialty certifying boards’

compliance with the Requirements for Recognition of National Certifying Boards for Dental Specialists through annual

reports provided by each of the recognized certifying boards. The National Commission provided each specialty

sponsoring organization with certification trend data collected via these annual reports. The National Commission

requested that each recognized specialty sponsoring organization review the certification data in collaboration with

their respective recognized certifying board and provide comments on significant trends.

The recognized specialty certifying boards are committed to the highest standards of practice including recertification

of diplomates, which provides a mechanism to assure these standards are maintained throughout the specialist’s

career. All of the recognized certifying boards require recertification with each of them determining their process.

Table 3 reflects the number of active diplomates over the last ten (10) years, as reported by the respective certifying

boards.

Table 3. Active Diplomates 2009-2018

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2009-2018

Increase/

Decrease

AAPHD

157

160

159

158

146

151

144

164

171

+9%

AAE

815

831

846

904

959

985

1075

1131

1189

1261

+55%

AAOMP

302

306

313

323

328

332

338

344

357

367

+22%

AAOMR

106

113

124

121

131

146

156

174

181

184

+74%

AAOMS

4616

4904

4983

5186

5096

5167

5219

5305

5342

+16%

AAO

5164

5034

4858

4436

3163

3134

3266

3364

3504

3488

-32%

AAPD

2383

2726

3100

3509

4019

4323

4605

5011

5169

5880

+147%

AAP

2381

2506

2544

2648

2766

2598

2687

2782

2926

3047

+28%

ACP

1085

1141

1147

1176

1195

933

970

1011

1026

1058

-2%

ASDA*

N/A

*The National Commission did not recognize a certifying board for dental anesthesiology until 2020; therefore, no data was

available.

In general, eligibility for board certification is based on the completion of an advanced dental education program

accredited by CODA and experience in the field. To achieve diplomate status, all certifying boards require successful

completion of a written examination; all but the American Board of Oral and Maxillofacial Pathology (ABOMP) and the

American Board of Oral and Maxillofacial Radiology (ABOMR) require successful completion of an oral examination,

and five (5) of the nine (9) recognized certifying boards require either a case history presentation or clinical

examination.

While not all specialists seek board certification, overall the number of active diplomates increased for all but two (2)

of the specialties. The National Commission noted that the number of active diplomates increased from 16,405 in

2009 to 20,798 in 2018, representing a 27% increase.

The National Commission noted a 32% decrease in active diplomats for orthodontics. In March 2005, the ABO

announced a one-time offering that ended in July 2007, which allowed all practicing orthodontists who successfully

passed the ABO Written Examination to receive an ABO certificate that was valid for 5 years. Within these 5 years,

these orthodontists were required to pass the ABO Clinical Examination to remain a Board Certified Diplomate past

the 5-year expiration. Many orthodontists signed up for the offer which is why there was a dramatic increase in

diplomates from 2005-2007. Unfortunately, many did not follow through; therefore, there was a large decrease in

diplomates at the end of 2012.

The National Commission further noted a 2% decrease in active diplomates for prosthodontics. The ACP reported

several discrepancies occurred in their active diplomates category, including a philosophical and managerial shift in

2014 which resulted in only active diplomates being reported, where previously the life diplomates were included

(2009-2013).

Future trends:

• The AAPHD noted the upward trend in the number of certified, active diplomates, and applications received.

This is encouraging and speaks well for the future of the specialty. With changes in the healthcare systems

and the need for continued surveillance of oral health diseases and conditions, the types of skills and

expertise it will require suggest an increased demand for Public Health Dentists.

• The AAOMR noted the number of active diplomates has increased significantly since 2009 and the

Academy expects this trend to continue for the foreseeable future, as the number of advanced education

programs continues to increase.

• As of January 2020, the ABOMS Certification Maintenance (CM) has changed to a continuous process of

learning, self-assessment and testing that occurs over a 10-year period, during which Diplomates must fulfill

specified requirements in certain years of the cycle. It is designed to affirm a surgeon’s continued

competency after certification and contains four areas of assessment.

• The AAO

noted that the number of orthodontic specialists seeking and qualifying for board certification has

steadily increased over the cited 10-year period and this trend is expected to continue for the foreseeable

future. It is anticipated that the majority of orthodontic specialists in North America will have become board

certified within the next few years.

• The AAPD supports the ABPD examination process with test-preparation continuing education which is

monitored by the ABPD. The trends in certification in terms of numbers bode well for the availability of

pediatric dentists who can qualify for the ever-increasing demand for board-certified clinicians in hospitals

and third-party programs. The growth in certified pediatric dentists who demonstrate continued competency

bodes well for the quality of health care provided to children and persons with SHCN as well as equitable

health care to underserved communities.

Certification and Examination Data 2009-2018: The National Commission monitors the recognized dental specialty

certifying boards’ compliance with the Requirements for Recognition of National Certifying Boards for Dental

Specialists through annual reports provided by each of the recognized certifying boards. The National Commission

provided each recognized specialty sponsoring organization with certification and examination trend data collected

via these annual reports. The National Commission requested that each recognized specialty sponsoring

organization review the certification and examination data in collaboration with their respective recognized certifying

board and provide comments on significant trends.

Table 4 reflects the certification and examination trend data over the last ten (10) years, as reported by the respective

recognized certifying boards.

Table 4. Certification and Examination Data 2009-2018

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Increase/

Decrease

Dental

Anesthesiology*

Total Number

Certified By

Examination

N/A

Number of

Acceptable

Applications

N/A

DPH

Total Number

Certified By

Examination

292

297

299

306

317

325

333

345

354

+21%

Number of

Acceptable

Applications

+88%

ENDO

Total Number

Certified by

Examination

1,339

1,378

1,420

1,486

1,572

1,621

1,740

1,820

1,905

2,012

+50%

Number of

Acceptable

Applications

278

248

230

239

232

260

277

305

298

303

+9%

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Increase/

Decrease

OMP

Total Number

Certified by

Examination

433

437

449

461

471

485

499

508

526

541

+25%

Number of

Acceptable

Applications

+122%

OMR

Total Number

Certified by

Examination

105

112

123

127

137

152

162

180

187

+89%

Number of

Acceptable

Applications

+389%

OMS

Total Number

Certified by

Examination

6,811

6,983

7,340

7,496

7,678

7,869

8,086

8,293

8,472

+24%

Number of

Acceptable

Applications

530

634

485

751

730

781

949

850

780

832

+57%

ORTHO

Total Number

Certified by

Examination

6,930

7,022

7,294

7,610

7,977

7,325

7,528

7,743

7,972

8,187

+18%

Number of

Acceptable

Applications

387

373

354

397

365

362

391

390

384

-0.8%

PEDO

Total Number

Certified by

Examination

2,501

2,908

3,322

3,750

4,178

4,532

4,879

5,275

5,761

6,217

+149%

Number of

Acceptable

Applications

336

377

355

365

333

394

371

467

446

475

+41%

PERIO

Total Number

Certified by

Examination

2,705

2,864

2,951

3,112

3,279

3,448

3,609

3,766

3,935

4,809

+78%

Number of

Acceptable

Applications

383

392

311

415

377

399

385

309

420

424

+11%

PROS

Total Number

Certified by

Examination

1,644

1,693

1,728

1,778

1,831

1,896

1,957

2,062

2,097

2,160

+31%

Number of

Acceptable

Applications

208

253

294

303

298

420

443

455

334

360

+73%

*The National Commission did not recognize a certifying board for dental anesthesiology until 2020; therefore, no data was

available.

The National Commission noted that the recognized certifying boards reported some minor fluctuations in the total

number of diplomates certified by examination and the number of acceptable applications over the ten (10) period;

however, overall all of the certifying boards showed some significant increases in the total number certified and the

number of acceptable applications. The National Commission did note a 0.8% decrease for Orthodontics in the

number of acceptable applications over the period but the overall number of acceptable applications remained

relatively stable over the ten (10) year period.

Board Eligibility Requirements 2009-2018: The National Commission monitors the recognized dental specialty

certifying boards’ compliance with the Requirements for Recognition of National Certifying Boards for Dental

Specialists through annual reports provided by each of the recognized certifying boards. The National Commission

provided each recognized specialty sponsoring organization with board eligibility requirement trend data collected via

these annual reports. The National Commission requested that each recognized specialty sponsoring organization

review the board eligibility data in collaboration with their respective certifying board and provide comments on

significant trends.

Table 5 reflects the certification and examination trend data over the last ten (10) years, as reported by the respective

certifying boards.

Table 5. Board Eligibility Requirements 2009-2018

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Dental

Anesthesiology

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

N/A*

Experience-Total

Years of Specialty

Experience including

Advanced Education

N/A*

Citizenship

Requirement

N/A*

State Licensure

Requirement

N/A*

Alternate Pathways to

Certification

N/A*

Dental Public Health

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

2-3

Experience-Total

Years of Specialty

Experience including

Advanced Education

3-4

Citizenship

Requirement

Any

State Licensure

Requirement

Alternate Pathways to

Certification

Yes

Endodontics

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

2-3

Endodontics cont:

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Experience-Total

Years of Specialty

Experience including

Advanced Education

2-3

Citizenship

Requirement

Any

State Licensure

Requirement

Yes

Alternate Pathways to

Certification

Yes

Oral and

Maxillofacial

Pathology

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

Experience-Total

Years of Specialty

Experience including

Advanced Education

Citizenship

Requirement

Any

State Licensure

Requirement

Alternate Pathways to

Certification

Yes

Data

Yes

Oral and

Maxillofacial

Radiology

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

2-3

Experience-Total

Years of Specialty

Experience including

Advanced Education

2-3

Citizenship

Requirement

Any

State Licensure

Requirement

Alternate Pathways to

Certification

Oral and

Maxillofacial

Surgery

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

4-6

Experience-Total

Years of Specialty

Experience including

Advanced Education

Oral and

Maxillofacial

Surgery cont:

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Citizenship

Requirement

Any

State Licensure

Requirement

Yes

Alternate Pathways to

Certification

Yes

Orthodontics

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

2-3

Experience-Total

Years of Specialty

Experience including

Advanced Education

2-3

Citizenship

Requirement

Any

State Licensure

Requirement

N/A

Alternate Pathways to

Certification

Pediatric Dentistry

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

2-3

Experience-Total

Years of Specialty

Experience including

Advanced Education

2-3

Citizenship

Requirement

Any

State Licensure

Requirement

Yes

Alternate Pathways to

Certification

Yes

Periodontics

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

Experience-Total

Years of Specialty

Experience including

Advanced Education

Citizenship

Requirement

Any

State Licensure

Requirement

Alternative Pathways

to Certification

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Prosthodontics

Education-Years of

Advanced Education

in Addition to

DDS/DMD Degree

Experience-Total

Years of Specialty

Experience including

Advanced Education

Citizenship

Requirement

Any

N/A

State Licensure

Requirement

N/A

Alternate Pathways to

Certification

N/A

The National Commission noted that overall the board eligibility requirements have remained fairly consistent over

the past ten (10) years. The recognized specialty certifying boards are committed to increasing the number of board-

certified specialists and have created eligibility pathways to assist specialists who have practiced for many years and

internationally trained specialists who are not graduates of CODA-accredited advanced education programs to

pursue diplomate status. The following recognized certifying boards do not have alternative pathways to certification

oral and maxillofacial radiology, oral and maxillofacial surgery, periodontics and prosthodontics.

Trends:

• The ABE collaborates at least annually with other specialty certifying boards to ensure that they are on track

for an equitable application, examination and recertification process. Over the past decade, these processes

created improvements for both policies and exams and have helped them to increase our overall number of

Board-certified endodontists.

• The ABOMR continues to improve the quality of their exam items based on psychometric data analysis and

to strengthen the calibration and intra-and interrater reliability during the grading process. The exams are

updated yearly to incorporate new imaging guidelines and technology.

• The AAO’s Board Eligibility Requirements remain the same and it is expected that this condition will remain

the same over the next few years. Internationally educated specialists must still meet the specified

requirements for certification by the ABO.

• The ABPD and the AAPD work collaboratively to address issues/concerns that may be reported. Monitoring

and quality measurement ensure that changes in practice and education will continue to be evaluated in the

future. Psychometric analysis and feedback in both formal and informal channels support that the

requirements are supporting the specialty’s ability to address oral health needs of the public effectively,

using evidence-based guidelines and maximizing quality care

• Eligibility requirements for periodontists to pursue Board certification have not changed in recent years, and

no future changes are anticipated by the ABP. Although not specific to eligible candidates, beginning in

2017, the ABP implemented a new pathway for diplomates certified prior to 2003 to obtain an updated

certificate that references certification in periodontology and dental implant surgery.

• A recent change was made to the ABPROS examination eligibility criteria to increase candidate applications

by allowing students/residents to challenge two parts of the current four-part examination process upon

entering the 3rd year of the program compared to six months before graduation. The ABPROS closely

monitors the examination process and pathways to reflect current knowledge, skills and values in the

practice of prosthodontics and the approved curricula and standards for postdoctoral education.

II. MAJOR RESEARCH CHANGES AND TECHNOLOGY ADVANCES

The National Commission requested that each recognized specialty organization examine the impact of major dental

research and new technology in the specialty over the last decade. Specifically, each organization was requested to

list major research changes and technology advances over the last ten (10) years and provide an overview comment

on how these changes and advances have affected the practice of the specialty.

American Association of Public Health Dentistry

Major Areas of Research:

• Oral health disparities including social determinants of health and health inequality

• Relationships among oral health and other health conditions

• Interdisciplinary (dental-medical) workforce models to improve the oral health of the community

• Continued research in preventative and alternative approaches to prevention and care

Technology Advances:

• Teledentistry

• Mobile health in the delivery of preventative strategies and management of chronic diseases

• Informatics and data in genomics and precision oral health based on DNA

• Integration of medical and dental Electronic Health Records

Research in oral health disparities and inequities has shifted towards understanding social determinants of health as

risk factors for chronic disease and adverse oral health outcomes to gain a better understanding of the forces (such

as oral health literacy and cultural competence) at both the community and individual levels. Research and

knowledge about the relationships between oral health and other health conditions have been important in integrating

oral health and primary care, exploring workforce models incorporating interprofessional collaboration and integration

of dental care into primary care. This greater emphasis on dental-medical integration, such as integrating electronic

medical and dental records, has led to better management of health for patients and improved access to dental

services.

American Association of Endodontists

Major Areas of Research:

• Dental materials specifically bioceramics and nanoparticles

• Pain management with a focus on non-opioid approaches and head and neck pain classifications

• Endodontic microbiology

• Regenerative endodontics and revascularization

• Genetic influences, including host factors (systemic disorders, DNA polymorphisms and epigenetic events),

predisposition to pulpal and periapical disease and effect on treatment, and associations between

endodontic disease and systemic conditions.

• Dental trauma

• Diagnostic imaging techniques including cone beam CT (CBCT) and magnetic resonance imaging (MRI) for

guided surgery and endodontic access

• Vital pulp therapy

Technology Advances:

• Rotary files to facilitate safer and more predictable debridement of the root canal system, superflexible rotary

and reciprocating root canal preparation systems based on enhanced properties to improve the outcome of

non-surgical root canal therapy and retreatments with emphasis on anatomical canal preparation and dentin

preservation

• Canal obturation materials and techniques such as bioceramic sealers and single cone techniques

• Active canal irrigation using sonic energy, negative pressure and lasers

• Imaging modalities including small field CBCT and MR

• Surgical planning and guided endodontics using 3-D printing

• Computer software adapted to orient the operator during access of calcified canals or during surgery to

locate and treat the root end in a conservative and precise manner

Research has impacted the specialty by providing more predictable endodontic clinical procedures, better outcomes

for surgical and reparative procedures, better management of pain during and following treatment, improved

understanding of traumatic dental injuries, enhanced treatment options related to a better understanding of pulp

revascularization and endodontic regeneration and improved diagnostic and treatment modalities. These technological

advances have prompted the integration of state-of-the-art basic, clinical and translational research approaches to further

advance knowledge of the underlying mechanisms and treatment outcomes of endodontic disease. These integrated

approaches have the potential to contribute to the development of more effective, patient-centered treatment strategies.

American Academy of Oral and Maxillofacial Pathology

Major Areas of Research:

• Identifying molecular changes predictive of the biologic behavior of OCSCCa and its precursor lesions

• Osteonecrosis of the jaws (ONJ) related to bisphosphonate and anti-metabolic agents used in the

management of osteoporosis and certain metastatic malignant neoplasms

Technology Advances:

• Next-generation sequencing (NGS) approaches

• Advanced microscopic techniques

• Novel methods to improve analysis of hematoxylin and eosin (H&E) stained slides

• Virtual microscopy

• Application of artificial intelligence in the interpretation of biopsied tissues

Through NGS technology, new tumor types and subtypes have been identified and new genetic mutations have been

characterized that have improved not only diagnostics but also the disciplines understanding of the underlying

molecular mechanisms related to disease etiopathogenesis.

NGS approaches are now used routinely in basic

research laboratories and are likely to be used more commonly in clinical settings as they continue to become more

affordable. Advanced microscopic techniques, such as super-resolution confocal microscopy, allow for the imaging of

tissue in incredible detail

. Many technologies have led to an enhanced analysis of H&E-stained tissue biopsies. For

example, dual-mode emission and transmission microscopy (DUET) and multispectral analysis tools improve image

quality and reduce costs. Together, these improved technologies will continue to revolutionize the development of

diagnostics. A tangible example of this is the development of a “simple” device that utilizes florescence-based

technology to distinguish benign mucosa from cancerous and precancerous lesions. Virtual microscopy is the ability

to digitize glass slides and the accompanying improvements in image viewing software, data storage, and sharing of

large files

. Technologies related to slide digitization have enhanced our ability to share slides of biopsy tissues in a

virtual forum.

American Academy of Oral and Maxillofacial Radiology

Major Areas of Research:

• Clinical research using CBCT

• Developing MRI and ultrasound for dental use

Technology Advances:

• As darkrooms have phased out, newer CCD, CMOS and PSP sensors with better diagnostic capabilities are

exploiting remote, Bluetooth, or Wi-Fi technologies

• Advancement in panoramic radiography allowing better resolution, automatic selection of the ideal focal

troughs and superior extraoral bitewing radiographs

• Developing artificial intelligence to streamline the diagnosis of common dental diseases (caries, periodontal

bone loss, and periapical lesions)

• Teleradiology

In the last decade, major changes have taken place in the delivery of dental care due to progress in oral and

maxillofacial radiology. Widespread availability of CBCT units has changed the way oral and maxillofacial radiologists

interact with other practitioners and how all branches of dentistry function and deliver care. CBCT units are now

essential equipment in oral surgery, endodontics, implant dentistry and orthodontic offices. In the last decade, several

dental PACS systems were introduced to facilitate academic, armed forces, and corporate dental practices. PACS

and HIPAA compliant file transfer services have significantly reduced consultation time.

Teleradiology is now widely

practiced where a dental practitioner can quickly consult with a radiologist.

American Association of Oral and Maxillofacial Surgeons

Major Areas of Research:

• Patient Safety and Surgery Quality, Personalized and Precision Medicine in Pain Management

• Precision Medicine in Head and Neck Oncology

• Business of Innovation in Oral and Maxillofacial Surgery

• Regenerative Medicine for Dentoalveolar Reconstruction

• Medication-related osteonecrosis of the jaw

Technology Advances:

• Upper airway stimulation device for patients who suffer from obstructive sleep apnea (OSA) and for those

whom cannot tolerate positive airway pressure treatments

• National Simulation Program to create practical simulation-based training courses and assessments to

increase the safety of sedation administration in oral surgery and dentistry

Through the various research conferences, committee work and research, the AAOMS has collaborated in the development

of relationships between oral and maxillofacial surgeons and researchers to bridge the gap between clinical and basic

science. The goal is to improve the care of oral and maxillofacial surgical patients through the advancement of translational

and clinical research. TMD research will identify multidisciplinary approaches necessary to the development and

implementation of safe and effective clinical treatments for TMD, as well as strategies to advance TMD research and

education. Advances in technology have allowed certified oral and maxillofacial surgeons to utilize upper airway stimulation

devices for patients who suffer from obstructive sleep apnea (OSA) and cannot tolerate positive airway pressure treatments.

American Association of Orthodontists

Major Areas of Research:

• Improvements in study design to provide stronger evidence, including more cohort studies and

randomized

control trials (RCTs)

• Genetic influences on orthodontic tooth movement and facial growth

• Potential methods for accelerating orthodontic tooth movement, including vibration, micro-osteoperforation,

and photobiomodulation

• Sleep Disordered Breathing and the effects of orthodontic treatment on airway

Technology Advances:

• Intraoral scanning, 3-D Printing, and fabrication of In-House Aligners

• CBCT Scanners – updating norms and treatment goals using 3-dimensional imaging

• Customized appliances and treatment outcomes, including customized fixed appliances and aligners due to

the rapid developments in 3-D scanning and printing

• Teledentistry – utilizing modern technology to remotely monitor treatment and communicate with patients

• Cloud Computing and Network Security

Improved study designs have provided a higher weight of evidence validating multiple orthodontic treatment

techniques. The advent of cost-effective, efficient, and patient-friendly intra-oral scanners has revolutionized

how practices can acquire 3D data. Combined with the reduced cost of 3-D printing many practices are

moving towards customized aligner therapy and customized fixed

appliances to truly individualize care to each

patient.

American Academy of Pediatric Dentistry

Major Areas of Research:

• Moved from a largely surgical to a comprehensive care model based on research over the last decade

• Evidence-based dentistry

• Created the first pediatric-specific evidence-based clinical guidelines in areas of vital pulp therapy in primary

teeth, use of pits and fissure sealants and use of silver diamine fluoride and fluoride varnish for the

management of dental caries in children

• Prevention, care compliance, motivational interviewing, and non-surgical address of dental caries

• Integrating patient and provider safety

• Interdisciplinary research to develop standards for practice

• Offering on-line information

• Workforce research to assess the effect of future care models, provider distribution and workforce trends on

children’s oral health.

Technology Advances:

• Zirconia technology

• New generation composites

• Advanced sedation medications

• Advanced pulpal agents for primary teeth

• Telehealth

AAPD’s policies, guidelines and best practices derived from research and its translation are incorporated into most

state Medicaid periodicity schedules driving oral health for the underserved. The policies and scientific care

recommendations are incorporated into Bright Futures, national guidelines directing health supervision of all children

in the U.S. Workforce studies and translation through advocacy into public training of pediatric dentists have helped

alter the DMFT distribution positively in children under 5 years of age and encouraged the rational placement of both

pediatric dentistry practitioners and faculty. The AAPD Pediatric Oral Health Research and Policy Center is nationally

recognized with its focus on access, equity, safety and is a resource for pediatric dental providers along with general

dentists, safety-net providers, insurers, and government for pediatric oral health data and the compilation of research

and technical briefs.

American Academy of Periodontology

Major Areas of Research:

• In 2017, the AAP adopted a new classification for periodontal and peri-implant diseases and conditions

based

on new evidence to more reliably diagnose and treat patients. This classification is also expected to enable

researchers to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions

utilizing unified terminology

• Evidenced-based personalized/precision medicine as well as patient-centered therapeutic outcome assessment

using patient stratification

• The link between systemic diseases and periodontal and peri-implant diseases and conditions

• Novel anti-inflammatory therapeutics (resolvins) for the treatment of periodontal and peri-implant diseases

• Regenerative medicine and tissue engineering

Technology Advances:

• Advanced diagnostic tools (ultrasound technology, optical coherence tomography)

• Sequencing and artificial intelligence/machine learning technologies for analysis of immunology and microbiology

data

The new classification of periodontitis has been a major collective effort at the global scale to support the widespread

adoption of personalized medicine in Periodontics. Advances in microbiology and immunology have led to a better

understanding of the pathogenesis of periodontal and peri-implant diseases. This knowledge has been harnessed by

practitioners to optimize patient care in both diagnosis and therapeutic developments. Analytic technology using

computing capabilities has allowed the analysis of massive data sets. Developments in this line of research are

expected to enable a more comprehensive understanding of what causes dysbiosis and the relationships between

different systemic diseases and oral inflammatory diseases. Periodontal and peri-implant plastic reconstructive

procedures have greatly benefited from the introduction of new techniques and materials over the past decade

Tissue engineering-based applications for regenerative purposes have also advanced significantly, with the

continuous development of minimally invasive procedures; novel grafting biomaterials, scaffolds, and matrices;

molecular-based biologics; and cell-based therapy approaches.

American College of Prosthodontists

Major Areas of Research:

• Dental Materials

o FDA-approved resins for use in surgical guides and digital dentures

o Translucent zirconia

o Nanotechnology/nanoparticles to strengthen acrylic/composites resins

• Genetic and Tissue Engineering

o Tissue-engineered scaffolds for regeneration of oral tissues

o Alloplastic grafts (block bone and skin)

o Growth factors to stimulate bone formation

• Dental Implants

o Implant design and primary stability

o Influence of medications and systemic conditions on implant success

o Utility, survival rates, and complications of CAD/CAM abutments and Ti bases

o Angled screw channel abutments, loading and torqueing protocol

• Clinical Research

o Survival rates and complications of all-ceramic crowns

o Clinical behavior of monolithic zirconia full-arch restorations

o Immediate loading of implants

o Definition, etiology, and prevalence of peri-implantitis/mucositis

o Efficacy of the CAMBRA protocol

Technology Advances:

• Intraoral digital surface scans/intraoral scanners and desktop digital scanners, superimposition of digital

surface scans with CBCT facilitating implant surgical planning and placement, and scan bodies Implant

impressions

• Additive and subtractive manufacturing of dental prostheses with improved accuracy

• CAD software for virtual restoration design and implant placement

• CAD/CAM titanium bars and abutments

• In-office printing and milling prostheses, and printing frameworks for RPD’s

• Fabrication of complete dentures using additive and subtractive technologies, and fabrication of ceramic

crowns using additive technology

• Improved smile design software

New and improved dental materials, research, and major technological advances have positively influenced clinical

practice and applications in fixed, removable, implant and maxillofacial prosthodontics. Improvements in dental

materials have contributed to the longevity and esthetics of restorations. Genetics and tissue engineering research on

bone formation, and advances in implant surfaces, designs and clinical techniques, have improved surgical and

restorative outcomes. Dental implant-related research has focused on the influence of systemic conditions and

medications on implant success, improving surgical techniques/applications, restoration designs, biomechanics and

implant assessment tools. Clinical research on prevention, prostheses survival and complications has influenced

treatment decisions and improved longevity. Advances in digital technologies have had the greatest impact on the

practice of prosthodontics, enhancing diagnosis, treatment planning, presentation, workflow, execution and

techniques, interdisciplinary collaboration, patient awareness/education, and the efficient transfer of information.

American Society of Dentist Anesthesiologists

Major Areas of Research:

• New drugs, including Dexmedetomidine, for anesthesia and sedation

• Investigations into the prevalence, incidence, mechanisms and prevention of intraoral fires

• Written guidance for identifying and managing known and suspected COVID dental anesthesia patients

• Local anesthetic liposomes to improve the quality and duration of postoperative dental pain control

• The evaluation of both standard and new local anesthetic delivery systems

Technology Advances:

• Use of high-fidelity simulation training and cognitive aids to enhance the predictability and safety of office-

based anesthesia

Dental Anesthesiology is at the forefront of Office Based Anesthesia (OBA) with many of the techniques used and

described by dentist anesthesiologists having been adopted by physician anesthesiologists. Modern medications

such as dexmedetomidine, liposomal bupivacaine and remifentanil have aided in the concept of opioid-free

anesthesia and enhanced recovery after surgery (ERAS), both of which increase safety and patient satisfaction in

OBA. The improvements in high-fidelity simulation have aided in the training and the maintenance of skills and

knowledge of emergency situations.

The National Commission was impressed with the extensive, innovative and ground-breaking research the

recognized dental specialty sponsoring organizations have undertaken in the past ten (10) years. Without exception,

each recognized dental specialty is creating new knowledge and new ways to apply this knowledge, resulting in

better patient care.

III. TRENDS IN SPECIALTY EDUCATION

Number of Advanced Dental Education Programs: The National Commission requested that each recognized

specialty sponsoring organization review summary data collected over the last ten (10) years regarding the number of

advanced education programs, program enrollments and faculty and provide overview comments on past or future

education trends.

Table 6 reflects the number of advanced dental education programs, as reported by the American Dental

Association’s Health Policy Institute.

Table 6. Number of Advanced Dental Education Programs 2009-2019

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

Range

Dental

Anesthesiology

6-10

Dental Public

Health

10-15

Endodontics

54-56

Pathology

14-16

Radiology

4-9

Oral Surgery

102

103

102

101

102

101

101-103

Orthodontics

64-68

Pediatric

Dentistry

74-82

Periodontics

54-58

Prosthodontics

47-50

Total Number of

Programs

by Year

430

438

442

445

448

453

455

459

460

430-460

The National Commission noted that while there were minor fluctuations in the number of educational programs for

some of the disciplines, there was a steady increase in the number of advanced education programs across all of the

disciplines. Overall, the number of advanced education programs increased 7% between 2009-2019 from 430 to 460.

Trends:

• Dental Anesthesiology - From 2009 to 2011, the number of programs has held steady. Future growth in the

number of programs is anticipated following specialty recognition.

• Dental Public Health - In the past ten (10) years, four (4) new Dental Public Health advanced education

programs were accredited.

• Endodontics -

Numbers over the last decade indicate a healthy stabilization in the growth in the number of

programs. From 2000-2018, the number of programs increased by 17%.

• Oral and Maxillofacial Pathology - As with any specialty dominated by an academic role at dental schools,

the report shows a very slight fluctuation in the number of programs across the country.

This trend reflects

dental deans’ and dental schools’ desire for the continuation of existing programs and only minor increases

in additional training programs throughout the country.

• Oral and Maxillofacial Radiology - Since the last reporting period, the number of advanced education

programs has almost doubled.

• Orthodontics -The number of accredited advanced dental education programs in orthodontics increased by

6%.

• Pediatric Dentistry - Continues to grow to meet the demands of the oral health needs of children. Since

2008, the number of pediatric dental training programs increased 11%.

• Periodontics -

There was a 7% increase in the number of advanced dental education programs.

• Prosthodontics- The number of accredited advanced education programs increased by 6%.

Enrollment in Advanced Dental Education Programs: The National Commission requested that each recognized

specialty sponsoring organization review summary data collected over the last ten (10) years regarding enrollment in

the advanced education programs and provide overview comments on past or future education trends.

Table 7 reflects the enrollment in advanced dental education programs over the last ten (10) years, as reported by

the American Dental Association’s Health Policy Institute.

Table 7. Enrollment in Advanced Dental Education Programs 2009-2019

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

Range

Dental

Anesthesiology

25-79

Public Health

44-65

Endodontics

433

448

446

455

454

472

464

473

472

477

433-477

Pathology

40-56

Radiology

31-55

Oral Surgery

1040

1081

1118

1131

1150

1170

1195

1199

1208

1040-

1208

Orthodontics

931

949

974

991

1010

1008

1023

1043

1064

1080

931-1080

Pediatric

Dentistry

733

763

803

823

844

879

900

921

940

955

733-955

Periodontics

541

544

541

550

556

563

551

565

568

575

541-575

Prosthodontics

455

453

467

459

463

467

477

496

455-496

Total Enrollment

Per Year

4273

4380

4462

4606

4663

4754

4811

4894

4974

5043

The National Commission noted that enrollment in all of the advanced education programs increased by 18% from

4,273 to 5,043 total students/residents. Notable is the 216% increase in enrollment in dental anesthesiology

advanced education programs. The National Commission further noted a 17% decrease in enrollment in the oral and

maxillofacial pathology programs from 2013-2017.

Trends:

• Dental Anesthesiology -Total enrollment numbers have steadily increased, due in part to the increased

duration of programs from 2 to 3 years

• Dental Public Health- In the last the past ten years, four (4) new Dental Public Health advanced education

programs were accredited.

• Endodontics - Numbers over the last decade indicate a healthy stabilization in the growth in the number of

enrollments, which increased16%.

• Oral and Maxillofacial Radiology is concerned that financial restrictions at higher education institutions due

to the COVID-19 pandemic may challenge the growth in the number of programs. However, they do not

anticipate a significant negative impact on our increasing numbers of graduates.

• Orthodontics -

The total number of enrolled students/residents per year increased by 20%.

• Pediatric Dentistry found that if current graduation and retirement trends continue, the number of full-time

pediatric dentists is expected to increase from 9 to 14 per 100,000 children by 2030.

• Periodontics -

Overall, the status of advanced education in periodontics remains stable with modest growth

in the number of graduates over the last ten (10) years. This trend is projected to continue in the coming

years.

• Prosthodontics -

Enrollment increased by 10%, while the applicants per program have increased by 60%

per the 2018-19 HPI Survey of Advanced Dental Education.

Advanced Education Program Directors: The National Commission requested that each recognized specialty

sponsoring organization review summary data collected over the last ten (10) years regarding the percentage of

advanced education program directors that are full-time and the number of program directors and provide overview

comments on past or future trends regarding this information.

Table 8 reflects the percentage of full-time program directors in the advanced dental education programs over the last

ten (10) years, as reported by the American Dental Association’s Health Policy Institute.

Table 8. Percentage of Program Directors That Are Full-Time 2009-2010

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

Dental

Anesthesiology

67%

40%

50%

44%

56%

44%

67%

Public Health

100%

90%

92%

83%

85%

87%

80%

Endodontics

98%

100%

98%

100%

Pathology

100%

93%

86%

93%

Radiology

100%

89%

Oral Surgery

99%

100%

99%

100%

Orthodontics

92%

89%

88%

91%

93%

91%

Pediatric

Dentistry

89%

86%

83%

86%

87%

84%

90%

91%

89%

87%

Periodontics

98%

96%

98%

96%

98%

100%

98%

Prosthodontics

94%

96%

94%

96%

94%

96%

The National Commission is aware of concerns in the dental community related to faculty shortages and the need for

full-time program directors. Existing and projected faculty shortages have and will continue to plague all of the

advanced dental education programs. With the continued growth of new dental schools across the nation, the number

of advanced dental education programs is expected to grow, increasing the projected shortage of qualified faculty.

Trends:

• Endodontics - Challenges in recruitment and retention of qualified educators continue and the AAE has

continued to prioritize this issue by supporting legislation that incentivizes specialists to return to academia.

• Oral and Maxillofacial Radiology - The number of ABOMR-certified radiologists has increased, and it is

anticipated that the trend for an increase in the number of programs and/or enrollees will continue.

• Oral and Maxillofacial Surgery -

Over the last several years, some of the oral and maxillofacial surgery

residency programs have promoted junior faculty, who have recently obtained board certification, to the role

of the program director. AAOMS anticipates, with junior faculty acquiring leadership and administrative roles

within oral and maxillofacial surgery programs, the specialty will have a strong future of remaining compliant

with the accreditation standards that all programs be administrated by a board-certified program director.

• Orthodontics – There is a growing trend is retired private practitioners starting second careers as full-time

faculty.

• Pediatric Dentistry -

Approximately 13% of program directors are in part-time academic positions. This is

problematic as a full-time, on-site, engaged program director is essential for the adequate training of

pediatric dental students/residents. Challenges in recruiting full-time pediatric dental faculty stem from the

student-loan burden incurred by new graduates and the lower salary earned in academics versus private

practice.

• Periodontics - Potential concerns for the future of advanced education include the number of qualified

faculty, decreases in funding, increases in tuition, and the increased burden on the education system due to

expanded requirements for infection control. The COVID-19 pandemic has exposed challenges in dental

education and the practice of dentistry in general. Stricter personal protective equipment requirements,

patient concerns about the safety of care, the overall priority given to care by patients with decreased

discretionary income, and the increased workload of the faculty have the potential to impact clinical

education. A potential positive from the COVID-19 pandemic is a shift towards smaller student cohorts and

more individualized teaching. While this may not be a permanent change, it currently provides benefits for

student education.

Board-Certified Program Directors: The National Commission requested that each recognized specialty

sponsoring organization review summary data collected over the last ten (10) years regarding the percentage of

board-certified program directors and provide overview comments on past or future trends regarding this information.

Table 9 reflects the percentage of board-certified program directors in the advanced dental education programs over

the last ten (10) years, as reported by the American Dental Association’s Health Policy Institute.

Table 9. Percentage of Program Directors That Are Board-Certified 2009-2018

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

Dental

Anesthesiology

100%

90%

100%

67%

100%

Dental Public

Health

100%

93%

100%

Endodontics

91%

92%

93%

96%

98%

100%

96%

98%

Pathology

100%

Radiology

100%

Oral Surgery

100%

99%

100%

Orthodontics

98%

97%

95%

94%

92%

97%

99%

Pediatric

Dentistry

91%

92%

95%

96%

95%

96%

97%

96%

99%

Periodontics

93%

96%

98%

97%

98%

Prosthodontics

100%

98%

96%

98%

100%

The National Commission noted that overall the number of board-certified program directors in the advanced dental

education programs is close to or at 100%, which shows that the advanced education programs are attracting highly

qualified board-certified program directors. The National Commission recognizes the challenges facing the advanced

dental education programs in meeting faculty shortages.

Trends:

• Dental Public Health - All program directors, full-time and part-time, are required to be board-certified.

• Oral and Maxillofacial Radiology believes that the expanding pool of ABOMR-certified individuals will be

adequate to take on positions of program director created by the opening of new programs as well as by

attrition.

• Oral and Maxillofacial Surgery- The current Accreditation Standards for Advanced Dental Education

Programs in Oral and Maxillofacial Surgery accreditation standards require that the program must be

administered by a director who is board-certified.

• Pediatric Dentistry - The increase in board-certified program directors has been facilitated by changes in the

board-certification process, enacted in 2005, allowing a candidate to achieve certification in approximately

18 months through a written qualifying exam followed by an oral clinical exam.

• Orthodontics - An increasing number of full-time faculty are trained outside of North America who are not

eligible for board certification.

• Periodontics - The expectation for the next ten (10) years is that the number of Board-certified program

directors will continue to remain consistently close to 100%.

• Prosthodontics -

The current Accreditation Standards for Advanced Dental Education Programs in

Prosthodontics require program directors appointed after 1997 to be board-certified.

IV. CHANGES IN SCOPE OF PRACTICE

Incidence and/or Prevalence of Major Conditions Routinely Diagnosed and/or Treated by Practitioners in the

Specialty: The National Commission requested that each recognized specialty sponsoring organization highlight

recent epidemiological data or studies that establish the incidence and/or prevalence of major conditions routinely

diagnosed and/or treated by practitioners in the specialty and describe how these changes have affected the practice

of the specialty.

American Association of Public Health Dentistry

The practice of Dental Public Health (DPH) involves thorough knowledge of the epidemiology of all oral and

craniofacial diseases and conditions, their risk factors, indicators, and determinants at the individual and population

levels. The DPH specialist obtains, analyzes, and reports the epidemiologic data all other dental specialties diagnose,

prevent, and treat throughout the life course of an individual. These include dental caries, periodontal diseases, oral

cancer, and craniofacial anomalies. Despite advances in disease prevention, DPH practitioners are needed to

address disparities and social determinants of health to identify strategies, reduce gaps, and move toward oral health

equity. Dental Public Health plays essential roles in the design, implementation, and analysis of national health

surveys, such as NHANES, to advance understandings of health status, interactions between systemic health and

oral health, and access to dental care. The specialty also works with state and local health departments to implement

and improve state- and county-based oral health surveillance systems.

Epidemiological data collected and analyzed provide the basis for expanded roles for dentists, including DPH

specialists, in addressing health problems. For example, the marked increase in oropharyngeal cancer incidence has

led to expanded roles for dentists in promoting and delivering HPV vaccination for their patients. Data showing very

high expenditures for emergency department visits for non-traumatic dental conditions have led DPH practitioners to

work with payers and hospitals to reduce those visits.

American Association of Endodontists

The major conditions routinely diagnosed and/or treated by endodontists continue to be pulpal and periapical

disease. These conditions are the result of caries, dental trauma, periodontal disease, extensive restorations, tooth

fractures, or compromised host factors. Several studies indicate that the prevalence of apical lesions related to at

least one tooth in the adult population varies by country. The incidence of dental injuries has remained stable over the

past 25 years. The most recent study has estimated that up to 30% of all 18-year-old have sustained some type of

injury to their teeth. According to a recent study, one billion people have sustained a dental injury, ranking fifth on the

list of main chronic diseases and injuries, after caries, headache, anemia and hearing loss. Tooth fracture has been

described as a major problem in dentistry. For vertical root fractures in endodontically treated teeth, there is an

overall prevalence of 11%. There is a 6.8% incidence of cracked teeth in an endodontic specialty practice, Another

condition diagnosed and treated by endodontists is maxillary sinusitis of endodontic origin. Odontogenic sinusitis

causes nearly 50% of all unilateral sinus disease with maxillary sinus opacification.

American Academy of Oral and Maxillofacial Pathology

Oral cavity and oropharyngeal squamous cell carcinoma together represent a major cause of morbidity and mortality,

with an estimated 53,260 new cases and 10,750 deaths in the United States in 2020. Age-adjusted rates of new

cases and deaths continue to increase. Oral and maxillofacial pathologists have a unique understanding of the

clinical and histopathologic presentation and its precursor lesions and are responsible for educating dentists, dental

specialists and other health care professionals on the early diagnosis. Through ongoing research aimed at identifying

molecular changes predictive of the biologic behavior, oral and maxillofacial pathologists continue to lead prospective

studies that will guide treatment decisions and inform dental and medical colleagues and the public about the

strengths and limitations of oral cancer screening tools. Oral and Maxillofacial Pathologists continue to play a leading

role in understanding the risk factors, presentation and pathogenesis of osteonecrosis of the jaws (ONJ) related to

bisphosphonate and anti-metabolic agents used in the management of osteoporosis and certain metastatic malignant

neoplasms.

American Academy of Oral and Maxillofacial Radiology

The practice of oral and maxillofacial radiology has markedly changed over the last decade. Oral and Maxillofacial

Radiologists encounter a broad spectrum of diseases and conditions including jaw pathoses, odontogenic

inflammations, TMJ disorders, sleep disorders, dental and craniofacial anomalies and implant treatment planning.

Affordable high-resolution point-of-service CBCT imaging has increased almost 11% per year. The FDA’s NEXT 2017

survey estimates that there are approximately 5,500 CBCT units in the US, with more than 4 million examinations

performed annually. Dentists seek radiology consultations to opine on CBCT examinations/scans which often

encompass anatomic areas outside the dentoalveolar region (paranasal sinuses, cranium and cervical spine). The

trending increase in “digital dentistry” will also shape the scope of OMR practice, requiring expertise on the imaging

aspects of such technologies. The emerging field of artificial intelligence and machine-learning will impact the practice

of oral and maxillofacial radiology and increase efficiency and allow better use of imaging data in clinical decision

making.

American Association of Oral and Maxillofacial Surgeons

Advances in technology and virtual planning have been validated to improve patient outcomes and efficiency in the

surgical correction of dentofacial deformities and oncologic defects. Advances in hard and soft tissue regenerative

technology have led to explosive growth in the understanding and development of techniques to reconstruct

congenital and acquired defects of the oral and maxillofacial region that were previously not possible. Personalized

medicine in the era of biotechnology allows for individualized treatment specific to the genotype of both benign and

malignant diseases. Much focus is on pain management and understanding the influence of one enzyme, CYP2D6,

and its significant variability on patient response to opioids, understanding the advantages and disadvantages of

opioid use in temporomandibular joint pain and understanding the potential benefit of personalized pharmacogenetics

pain management. Initial results of a prospective study of subjects undergoing third molar removal revealed

significantly less opioid requirement for those that were extensive metabolizers compared to those that were partial

metabolizers. In addition, partial metabolizers had more adverse opioid effects. The potential to use testing to identify

genetic variations among individuals may provide the opportunity to personalize post-operative pain management to

obtain an optimal patient response and minimize adverse effects.

American Association of Orthodontists

Orthodontists principally diagnose and treat individuals with varying degrees of malocclusion and related skeletal and

structural discrepancies within the jaws. The World Health Organization estimates malocclusions as the third most

prevalent oral health problem, following dental caries and periodontal diseases. Recent surveys have demonstrated

that the prevalence of malocclusion in the general population is approximately: Class I 74%; Class II 21%; and Class

III 5%. Orthodontists have traditionally employed a variety of treatment strategies, appliances, and techniques to treat

these various types of malocclusions. While treatment strategies and techniques will continue to evolve, there is a

need for large orthodontic practice-based studies to help practitioners determine successful treatment options. For

example, in 2013 the AAO, through the National Dental Practice Based Research Network, had a practice-based

study funded on adult anterior open bite. This study highlighted how practitioners treat anterior open bite and what

treatment options were successful. Information was disseminated through journal articles, and a conference

dedicated to the topic was held in February 2020. A similar conference was convened in February 2019 on the topic

of Sleep Apnea and Orthodontics which resulted in the creation of a white paper on the topic.

American Academy of Pediatric Dentistry

Pediatric dentistry remains the specialty addressing oral health and dental caries in infants, children and adolescents.

Pediatric dental populations are skewed to younger ages, as pediatric dentists are willing to see infants and toddlers

and skilled at implementing professionally accepted early childhood oral health measures. A segment of pediatric

practice is creating a dental home, risk assessment, and well-child oral health supervision from the first year of life.

Early oral health care hasn’t been embraced by the general dental or pediatric medical community and likely will

remain a focus of pediatric dentistry. Recent U.S. caries prevalence data confirm its persistence, increase with age,

and disproportionate affliction in poor and minority populations. Early childhood caries plagues U.S. children with 1 in

10 under 5 years experiencing caries-related pain and needing advanced behavioral guidance skills of pediatric

dentists, which will likely continue through the next decade. Pediatric dentists disproportionately see Medicaid

children (>70%), manage their oral conditions and will likely continue to be the main source of care and health equity.

General anesthesia care of children has increased with penetration of caries into younger children. Most pediatric

dentists report hospital care as part of their practice. Sedation has increased due to denial of access to operating

room access; pediatric dentists provide this service by virtue of their training and ability to secure

licensure/certification. The percentage of children with special health care needs is growing with 100% of pediatric

dentists caring for children with special needs as well as many adults with special needs.

American Academy of Periodontology

It has been estimated that ~42% of the US population aged 30 to 70 years exhibit some degree of periodontitis;

34.4% of the population have mild to moderate periodontitis (Stage I and II, Grade A and B); and 7.8% have severe

periodontitis (Stage III and IV, Grade A, B, or C). Further, ~60% of adults aged 65 years and older have periodontitis.

Based on U.S. Census data from 2013-2017 these percentages translate to ~33.4 million and ~6 million people with

mild/moderate and severe periodontitis, respectively. Gingival recession is also highly prevalent in the U.S.

population. Recent investigations have indicated a thin gingival phenotype is associated with diminished thickness of

underlying bone and increased risk of recession and a thick phenotype appears more resistant to recession. Further,

the extent and severity of peri-implant diseases are influenced by different etiologic and predisposing factors. The

average prevalence of peri-implant mucositis at the patient level is ~47% and at the implant level ~38%. The

prevalence of peri-implantitis on a patient basis averages ~27% and on an implant basis ~18%. Undiagnosed,

untreated, or inappropriately treated periodontal and peri-implant diseases in the U.S. have become a significant

public health issue, particularly considering various associations of periodontitis on systemic health. There are also

concerns regarding social gradients of disease where economically disadvantaged individuals have limited access to

advanced therapies to treat these diseases. Epidemiologic studies have shown 11% of the world's population is over

60 years of age; this is projected to increase to 22% by 2050. With the aging population comes an increase in root

caries and periodontitis.

American College of Prosthodontists

Prosthodontists diagnose dental diseases, oral manifestations of systemic/autoimmune diseases, and coordinating

with medical/dental specialists to perform complex reconstructions. Edentulism remains a public health problem

worldwide. In the U.S., the number of edentulous individuals is 9 million with 25% of adults over 60 years of age

missing at least one tooth. Tooth loss may be congenital (oligodontia, ED, AI) or acquired (dental diseases, trauma,

cancer, systemic diseases with oral manifestations). Prosthodontists diagnose and plan implant prostheses, place

and restore dental implants and manage related complications. Prosthodontists treat dentate patients who exhibit root

caries secondary to xerostomia, tooth wear, TMJ/TMD, and sleep apnea. The highest prevalence of erosive tooth

wear is found in North America. Prosthodontists have in-depth knowledge in biomaterials and occlusion to diagnose,

treat, and maintain these patients. Oral cancer patient demographics are changing due to the influence of HPV-

related cancers, especially in younger patients. The prevalence is significantly reduced in vaccinated patients, but the

overall effect is modest due to low patient participation. Risk factors still include age, tobacco use, and alcohol

consumption. Prosthodontists are uniquely qualified with their training and expertise to treat the prosthetic needs of

head and neck cancer patients.

American Society of Dentist Anesthesiologists

Dental anxiety continues to be the strongest predictor of patient pain during general dental procedures. A 2018

survey of practice patterns for dentist anesthesiologists identified anesthesia for pediatric dentistry as the most

commonly-provided service, followed by anesthesia for oral surgical procedures and anesthesia for patients with

special health care needs. The provision of office-based anesthesia for pediatric dentistry and patients with special

health care needs is particularly important for increasing access to dental care for underserved populations. In

2012, the Pediatric Oral Health Research and Policy Center declared general anesthesia for the treatment of early

childhood caries an essential health benefit for United States citizens. A 2011 examination of the capacity of the

U.S. dental care system to treat children with special health care needs concluded the capacity to care for this

population is extremely limited. The demand for dentist anesthesiologists to assist dentists in meeting the needs of

these populations is well-documented, and access to care for these individuals continues to be a focus of the

specialty.

Principle Health Services Provided to the Public and Where the Services are Customarily Provided: The

National Commission requested that each specialty sponsoring organization identify the principal health services

provided to the public by individuals in the area of practice and whether this has changed in the past ten (10) years.

Further, the National Commission requested that each specialty sponsoring organization identify the setting(s) in

which these services are customarily provided and whether this has changed in the past ten (10) years.

American Association of Public Health Dentistry

The principal health services provided include research, education, health service administration, policy/program

development and quality assessment services. DPH specialists prevent oral diseases, work to reduce oral health

inequities and provide oral health expertise within the core public health activities of assessment, policy development,

and assurance. DPH specialists are involved in conducting public health surveillance for oral diseases and conditions

and disseminating the findings to policymakers and the public. Such activities result in the development and

evaluation of community-based oral health program, guidance for oral health advocacy (community water fluoridation

and workforce models) and stimulation of research on effective interventions for high-risk populations (Native

Americans, low socioeconomic status families, and nursing home residents). DPH specialists lead the creation of

population-based oral health promotion and prevention strategies that are implemented at the community level.

These include school-based oral health prevention programs (sealants and fluoride varnish); promotion of HPV

vaccine for adolescents to prevent oropharyngeal cancer; development of protocols to improve oral hygiene in long-

term care facilities; development of protocols for mobile dentistry and teledentistry; and development of materials on

the use of tobacco and e-cigarettes, opioid prescribing by dentists, and sugar consumption. DPH plays a critical role

in oral health coalitions and community partnerships to reduce the burden of oral diseases.

American Association of Endodontists

The principal health services provided to the public by endodontists continue to be non-surgical root canal treatments

and endodontic retreatments. Additionally, endodontists provide various surgical procedures, including surgical repair

of root resorption (internal and external), apexification, apicoectomies, bone grafts in conjunction with periradicular

surgeries, guided tissue regeneration, root generation, re-implantation (including splinting), auto-transplantation, root

submersion, decoronation, dental implants, hemisections and various associated procedures. With a commitment to

saving natural teeth, the last ten (10) years have seen an increased commitment to maintaining the vitality of as much

of the dental pulp as possible, with pulpotomies and other vital pulp therapies (VPT). Moreover, regenerative

endodontics, or the “idea that one can replace damaged structures and regain functionality in previously necrotic and

infected root canal systems” has seen significant advancements over the last decade. Endodontists also increasingly

provide diagnoses of cracked teeth and non-odontogenic diagnoses, for example, in the event of trigeminal neuralgia,

TMD, and myofascial conditions.

According to a 2015 report in the Journal of the American Dental Association, 13.5% of dentists worked in small

group practices and 10.2% worked in large group practices. The report further showed that 11.4% of solo

practitioners were oral surgeons, endodontists, or orthodontists. A 2019 survey of AAE members found that the most

common practice settings were private practice/solo (37%) or endodontic group practice (21%), followed by dental

school faculty (15%). Relatively few endodontists practiced in other settings: multi-specialty group practice-private

(5%); military/government practice (3%); independent contractor (2%); multi-specialty group practice-corporate (2%);

or some other setting (4%). Since the 2013 survey of AAE members, changes to practice settings of endodontists

have been small. The proportion who are solo private practice (38% in 2013) has changed only slightly, while fewer

today are in an endodontic group practice (21% in 2013) or are independent contractors (2% now, 5% in 2013), and

more are dental school faculty members (12% in 2013).

American Academy of Oral and Maxillofacial Pathology

Historically, the principal health services oral pathologists have engaged in include practicing clinical oral pathology

primarily in the dental school faculty practice setting, and participation in oral pathology biopsy services, based either

in dental or medical school laboratories, or affiliated hospital settings. However, the settings for these services have

been expanding. During the last ten (10) years, some seasoned dental faculty and some recent graduates of oral

pathology residencies who have been unwilling or unable to secure dental faculty positions have ventured into the

private practice arena either full or part-time, providing clinical oral pathology services. Some oral pathologists set up

their private biopsy services, and a few participate in private pathology laboratory services, including large

multispecialty group pathology laboratories. Increasingly, graduates of oral pathology residencies have opted for

additional training in head and neck pathology and research through fellowships based in hospital pathology

departments.

In a 2018 AAOMP Laboratory Services survey, oral pathologists reported that their services and laboratories were

based in dental schools (51.28%), hospital/medical centers (7.69%), medical schools (5.13%), or private or non-

hospital laboratories (35.90%). Notably, the percentage of pathologists practicing in private or non-hospital

laboratories as independent proprietors or affiliates with private corporations has increased significantly during the

past ten (10) years (14.3% in 2009, 35.90% in 2018). This shift towards the private sector is likely related to several

factors, including changes in insurance reimbursement and increasing constraints associated with practice in

academic and hospital venues. The AAOMP’s Fall 2019 manpower survey of the specialty revealed 73% of oral

pathologists are primarily employed as full- or part-time dental school faculty involved in teaching predoctoral

students and residents. Many also participate in and/or direct school-based biopsy services and clinical oral

pathology faculty practices. Roughly 18% have appointments as medical school faculty, and about 35% of oral

pathologists’ practices are either in hospital-associated, independent non-hospital practices or within corporate

pathology practices. A small but significant percentage of oral pathologists are based in the military (Army, 2%; Navy,

1%, Air Force, 0.35%). About 22% of oral pathologists are based in research facilities.

American Academy of Oral and Maxillofacial Radiology

The welfare of the public is a serious concern and important responsibility for the AAOMR. Ionizing radiation is the

primary tool used by oral and maxillofacial radiologists and the detrimental effects of diagnostic radiation are seen in

the population decades later. Dental offices use ionizing radiation daily, leaving a major footprint on public health. In

the past ten (10) years, OMR specialists and the AAOMR have taken multiple approaches to decrease radiation

exposure and to mitigate the effects on the public. AAOMR promotes education and research on the application of

non-invasive imaging methods, including MRI and ultrasound. Oral and Maxillofacial Radiologists are improving the

health of the public by assisting other dental practitioners with appropriate diagnoses of and management options for

complex diseases.

Patient care is provided in various settings including academic institutions, hospitals and private practices. In general,

practices offer imaging services as well as consultative radiology services, often by teleradiology. OMR services have

significantly increased in number and scope, which is in part, reflective of the expanded use of CBCT imaging,

include endodontic diagnosis and treatment planning, implant treatment planning, and TMJ imaging. The workflow

and physical configuration of radiological facilities have changed markedly in the last decade. The increasing

application of digital technologies has eliminated the need for darkrooms and chemical processing, changing the

traditional landscape of radiologic facilities. With handheld x-ray units, radiographic examinations are being done in

operating rooms in hospitals, nursing homes or in areas of disaster. Traditional imaging projections (lateral skull,

Waters’ sinus view, tomography, etc.) have been largely replaced by CBCT. The demand for OMR services has

markedly increased in recent years. For example, radiology reporting services at a leading corporate provider

increased more than 100% between 2015 and 2019.

American Association of Oral and Maxillofacial Surgeons

Oral and Maxillofacial Surgeons are competent to perform a wide variety of diagnostic and surgical procedures for the

comprehensive management of the diseases, injuries and defects involving both the functional and cosmetic aspects

of the hard and soft tissues of the oral, maxillofacial and head and neck regions. Dentoalveolar surgery has not

experienced any significant changes in technique, skills and management. It remains a steady component of oral and

maxillofacial surgery practice. Third molar management has been studied for the past 20 years in a prospective study

relative to the timing of removal. Anesthesia continues to be an important area of oral and maxillofacial surgery

practice. Oral and Maxillofacial Surgeons provide the majority of office-based dental anesthesia care in the country.

During 2018, anesthesia services were delivered to 4,048,697 individuals insured by private dental insurance in the

United States. Of all moderate and deep sedation/general anesthesia (DS/GA) cases performed in 2018 (1,764,588),

80% were delivered by oral and maxillofacial surgeons (1,423,249). Oral and Maxillofacial Surgeons place dental and

craniomaxillofacial implants in the pediatric patient, treat cleft and craniofacial anomalies conditions; provide trauma

patient rehabilitation; use irradiated bone; perform ridge augmentation with the use of absorbable pins and

membrane, place immediate implants and reconstruct severely resorbed maxilla with bone grafting and

osseointegrated implants. Early awareness and early detection reduce the risks associated with oral cancer and an

increasing number of patients are referred to oral and maxillofacial surgeons for treatment. Surgeons also treat

obstructive sleep apnea caused by craniofacial syndromes, complications of pharyngeal flap surgery and obesity.

Oral and maxillofacial surgery services continue to be provided in the inpatient and outpatient facilities. Medically

compromised patients and select OMS procedures continue to be provided in the hospital. Oral and Maxillofacial

Surgeons continue to provide a similar number of services and procedures in the ambulatory and office setting as

that reported in 2011. Technological advancements in the last ten (10) years have dramatically altered the delivery of

health care services. These services may involve several modalities, including the following: live video, store-and-

forward transmission of healthcare information, remote patient monitoring, mobile health and mail-order treatment

through the internet. With judicious application, many patients are now able to receive remote treatment from

healthcare providers, granting access to much-needed care and services previously out of reach.

American Association of Orthodontists

Orthodontists require in-depth knowledge of craniofacial growth and development to provide services to diagnose,

intercept, and correct malocclusions in the developing or mature orofacial structures. Traditionally children and

adolescents have been the focus of orthodontic care, but recently there has been an increase in the number of adults

initiating treatment because much has changed in the way orthodontic needs are identified and services are

delivered. More efficient materials enhanced through technology like 3D digital scanning and printing, aligner therapy,

computer customized lingual brackets and wires, photography, videography and social media have put an ever-

greater emphasis on the importance of facial esthetics. Adults are living longer and appreciate the quality of life

afforded by healthy teeth. Orthodontists are playing an important role in helping them maintain their dentition into their

golden years. The biomechanical predictability of certain tooth and bone movements has also improved over the past

ten (10) years. Techniques such as mini-screw aided maxillary expansion or other mini-screw and bone plate uses

have prevented the need for orthognathic surgery in cases that previously required it. Aligners have improved the

orthodontist’s ease in intruding teeth, useful in closing anterior open bites. Lastly, orthodontists have begun to play a

role in screening patients for signs of airway deficiencies and sleep-disordered breathing.

Historically, most orthodontists worked in single-doctor private practices. However, over the last ten (10) years, there

has been significant growth of large multi-specialty group practices and corporate dental service organizations (DSO).

According to the McGill Advisory, from the years 2011 to 2015, there was almost a 100% increase in the number of

offices belonging to the four largest DSOs; this number grew from 1065 to 1967. A 2010 survey of graduating

orthodontic students/residents showed only 26% were interested in working as an associate. When the same

question was asked in 2018, 68% were looking for opportunities in either a DSO or as a private practice associate.

American Academy of Pediatric Dentistry

Pediatric dentists oversee health supervision as a dental home for children and work with generalists and specialists,

like orthodontists and oral and maxillofacial surgeons, to provide comprehensive care. Scope of practice includes

most accepted dental procedures relative to and appropriate for children, provided in a developmental context in

conjunction with other specialists as indicated. Pediatric dentists are often first responders to dental trauma in

children and work with dental specialists to deal with advanced behavior needs that occur with many of these injuries.

This has resulted in better long-term management including identification of systemic co-morbidities and trauma-

preventive interventions.

Most pediatric dentistry occurs in private practices largely in urban and suburban communities. There has been a

trend in having more than one pediatric dentist in a practice, which has: (1) fostered extension of existing practices

into underserved populations; (2) permitted seamless operation of a model of primary care through specialty practice

which creates a dental home for children as well as fosters advanced behavior guidance opportunities, such as

general anesthesia and in-office sedation; (3) supported a critical economic base to allow engagement of families

depending upon governmental coverage; (4) created practices with patient populations sizable enough to support

other community specialists in dentistry; and (5) provided centers for referral in areas where pediatric specialty care

for CSHCN and children with extensive caries requiring advanced behavior guidance cannot find services. Pediatric

dentists are likely to maintain hospital staff membership and provide services in institutional settings, acting as the

oral health component of comprehensive care models for children in major health systems. Pediatric dentistry, like

general dentistry, is being engaged by larger group practices and community health centers to complete a family-

oriented, whole-patient care model which endeavors to provide a full range of services.

American Academy of Periodontology

The principal health services provided by periodontists include: (1) diagnosis, assessment for future risk and

treatment of diseases and conditions that affect the periodontium, including periodontitis, and the peri-implant tissues;

(2) correction of bone and soft tissue defects to achieve and/or enhance esthetic and functional outcomes, often in

the context of multidisciplinary care; (3) implant site development and surgical placement of dental implants to

replace missing teeth or provide anchorage for prosthetic and orthodontic purposes; and (4) promotion of stable long-

term dental, periodontal, peri-implant, and systemic health through personalized preventive maintenance care

programs.

Periodontitis is one of the most prevalent diseases in humans and is currently viewed as an oral inflammatory

disease of microbial origin with biological links to many systemic conditions including diabetes, cardiovascular

disease, adverse pregnancy outcomes, and others. Collaboration with physicians and other health care providers has

grown in the past decade and is expected to continue to increase. Such expansion has allowed periodontists to adopt

an integrated approach to personalized periodontal and peri-implant care, which translates into a direct benefit for

patients’ overall health. Advances in the diagnosis of periodontal and peri-implant diseases and patient risk

assessment have enabled clinicians to communicate efficiently with other health care professionals and patients to

establish personalized treatment plans. Improvements in the armamentarium, biomaterials, and advanced minimally

invasive surgical techniques have expanded the options available to treat patients, which has enhanced the delivery

and quality of patient care. Computer-assisted diagnosis, treatment planning, and surgical interventions have allowed

better quality care with less risk for adverse outcomes in the management of periodontal and peri-implant conditions.

Regenerative therapies have expanded to include novel bioresorbable or image-based scaffolds and materials

derived from autogenous (cell-based therapies) and exogenous sources. Such therapies have been used to treat

inflammation-derived destructive conditions affecting the tissues supporting teeth and dental implants, as well as

edentulous areas for implant site development.

Periodontists have historically provided the majority of their services in a clinical office setting. The Academy's

Practice Profile Survey, published in 2003, shows an overwhelming majority (96.5%) of the procedures performed by

members are done so in the periodontal office. The survey also showed a slight increase since 1998 (0.3% to 1.7%)

in members performing procedures in another professional setting that may be due to members moving towards

group practices or itinerant practice styles. The emergence of dental service organizations in recent years has likely

affected these patterns.

American College of Prosthodontists

The principal health services provided by prosthodontists are the diagnosis, treatment planning, rehabilitation and

maintenance of oral health and improving the appearance of worn, diseased, mutilated and/or missing teeth and

orofacial structures. Prosthodontists use a systematic diagnostic approach to determine appropriate treatment

recommendations for patients exhibiting occlusal disease, bruxism, caries, xerostomia, trauma, edentulism, cancer

and many other oral diseases. During rehabilitation, peri-implant disease assessment and CAMBRA-influenced

treatment protocols may lead to improved patient outcomes. Prosthetically-driven treatment planning often guides

interdisciplinary treatment providing esthetic smile enhancements, full mouth reconstructions, implant rehabilitations

and maxillofacial prosthetic therapies. Dramatic improvements in digital technologies, materials, and techniques have

increased the efficiency and effectiveness of treatment delivery. In-office CBCT, digital radiography and photography,

intraoral scanners, tactile force measurement and pressure mapping and CAD/CAM software have streamlined the

diagnostic and planning processes, providing seamless integration to improve treatment presentation (digital smile

design), patient awareness/education as well as improved workflows for interdisciplinary collaboration through the

internet and cloud-based services. Additive and subtractive manufacturing has greatly influenced guided implant

surgery and restoration fabrication by simplifying workflows leading to decreased time to prosthetic rehabilitation

completion. Semi-crystalline polymer esthetic and strength improvements, PEEK utilization and increased zirconia

applications have been witnessed in prosthetic rehabilitations. Zirconia implants provide an esthetic and

biocompatible alternative to titanium. CAD/CAM titanium bars/abutments have improved the accessibility and

interchangeability of components for complex implant reconstructions. Biological growth factors are used to stimulate

bone formation and decrease healing times.

Prosthodontists practice in a variety of settings including solo private practice, group private practice, hospitals,

Dental Service Organizations (DSO), DSO-Managed Group Practices (DMGP), Federal Services,

universities/academic settings and charitable outreach activities. A recent study of private practice prosthodontists

reported that 60.1% of prosthodontists were sole proprietors, 12.2% partners, 20.8% were employees, and 6.9%

independent contractors. This differs from the 2007 publication where it was reported that 75.7% were sole

proprietors, 15.3% partners, 6.3% employees, and 2.8% independent contractors.

American Society of Dentist Anesthesiologists

The principal health services provided by dentist anesthesiologists are anesthesia and sedation care, provided in

collaboration with a dentist or surgeon. Safe, efficient and accessible sedation and anesthesia services have enabled

access to dental care and improved oral health for many patients who could not receive care otherwise. This is

particularly important for the very young, patients with special needs and for patients with high fears and anxiety

related to dental and oral surgical treatment. Without access to anesthesia services, many of these patients would

continue to suffer from untreated dental disease.

Dentist anesthesiologists practice, teach and conduct research in a variety of settings, including dental offices, dental

schools, surgery centers, hospitals and major academic centers. Most dentist anesthesiologists provide office-based,

mobile anesthesia and sedation care. The anesthesiologist transports the necessary equipment and medications to

dental offices for the planned dental or oral surgical treatment. In doing so, the dentist anesthesiologist works

collaboratively with dentist colleagues to provide much-needed care for patients who may otherwise be unable to

receive dental treatment. Interest in office-based anesthesia has been growing and dental office-based

sedation/anesthesia is no exception. It is anticipated that the dental office will continue to be the primary setting for

dentist anesthesiologists.

Conclusions: In reviewing all of the information submitted by each of the recognized specialty sponsoring

organizations for the 2021 Periodic Review of Dental Specialty Education and Practice, the National Commission

concluded that each specialty is unique. However, the information submitted demonstrates that the specialties also

share common concerns.

Faculty Shortage: Unfilled faculty positions, resignations, retirements and projected retirements, and the shortage of

graduating students/residents having an interest in academia as a career poses a threat to the dental workforce in the

coming years. Faculty shortages at dental schools across the country may compromise student/resident learning at a

time when the public need for dentists continues to grow.

Faculty loan repayment is crucial to recruiting and retaining

dental faculty due to the student loan debt burden and income disparity between academic positions and private

practice.

Financial Restrictions due to COVID-19 Pandemic: Potential concerns for the future of advanced education include

the number of qualified faculty, decreased funding, increased tuition and increased burden on the education system

due to expanded requirements for infection control. The COVID-19 pandemic has exposed challenges in dental

education and the practice of dentistry in general. Stricter personal protective equipment requirements, patient

concerns about the safety of care, the overall priority given to care by patients with decreased discretionary income,

and the increased workload of the faculty have the potential to impact clinical education.

Final Comments: The National Commission wishes to acknowledge the cooperation, participation and contributions

of the recognized dental specialty sponsoring organizations and the recognized certifying boards for dental specialists

in providing critical information for the 2021 Periodic Review of Specialty Education and Practice.

The recognized dental specialty sponsoring organizations and recognized certifying boards provided valuable

information that is beneficial to the profession. The format of the 2021 Periodic Review of Specialty Education and

Practice served to facilitate each recognized dental sponsoring organization’s internal review by highlighting specific

areas of growth and accomplishments over the past decade and provided the opportunity for each organization to

note ongoing and future challenges. In broader terms, the format of the review allowed the organizations to note past

and future trends, new research and cross-cutting issues such as faculty shortages, potential membership and

program enrollment increases/decreases and efforts to increase the number of board-certified specialists.

After thoroughly reviewing all of the information submitted by the recognized dental specialty sponsoring

organizations, the National Commission believes that all of the sponsoring organizations have documented evidence

that they continue to be in a healthy and viable state. From the information provided related to each specialty’s scope

of practice, the National Commission concludes that there continues to be a need and demand by the public for the

recognized specialties’ oral health services. The National Commission believes that over the past decade, the

recognized dental specialties have demonstrated ongoing efforts to improve the quality of advanced dental education,

research, practice and oral health care services.

Recognition Status of the Recognized Dental Specialty Sponsoring Organizations

American Academy of Oral and Maxillofacial

Pathology

Recognition

American Academy of Oral and Maxillofacial

Radiology

Recognition

American Academy of Pediatric Dentistry

Recognition

American Academy of Periodontology

Recognition

American Association of Endodontists

Recognition

American Association of Oral and Maxillofacial

Surgeons

Recognition

American Association of Orthodontists

Recognition

American Association of Public Health

Dentistry

Recognition

American College of Prosthodontists

Recognition

American Society of Dentist Anesthesiologists

Recognition