Dentistry in the United States

From Wikinfo

In the United States dentistry is generally practiced by dentists who have completed a post-graduate course of professional education. With exception of rural Alaska, Dental therapists, technicians without medical training, are not permitted to practice in the United States. Use of dental therapists or dental hygienists to perform routine fillings or cleaning is strongly opposed by the American Dental Association, (the A.D.A.), the dentists' professional association. This has resulted in excellent but high-priced treatment which fails to delivers services at a reasonable price to lower social classes. With only a few exceptions neither government sponsored heath care programs such as Medicare or Medicaid nor private medical insurance cover routine dental treatment. As a result large sections of the population do without.^[1] The worst conditions are in Kentucky and West Virginia.^[2]

Rates for dental services have been rising rapidly, outpacing the rate of inflation. Incomes for dentists have surpassed those of medical doctors. After falling for many years the percentage of both adults and children began to rise in 2000 as did the percentage of adults with no teeth. Increasingly, people with adequate income to pay the inflated prices are forgoing treatment.^[1]

Outside the United States, more than 50 countries allow technicians called dental therapists to drill and fill cavities, usually in children. In the U.S., state boards of dentistry have blocked dental therapists and dental hygienists from working independently, arguing that only dentists should be allowed to drill teeth, because it is an “irreversible surgical procedure” and "can lead to serious complications like infections or nerve damage".^[1]

Dental Education in the United States

There are limited opportunities for dental education in the United States with only 4,440 graduating in 2003, down from 5,750 in 1982. There is little or no movement on the part of the American Dental Association, the ADA, or the states to expand dental education. Due to the hands-on training required, dental education is expensive and is not subsidized by the federal government.^[1]

In the United States, dentists earn either a D.D.S. (Doctor of Dental Surgery) or D.M.D.(Doctor of Dental Medicine) degree. There is no difference in the training for either degree. The degrees are equivalent, and recognized equally by all state boards of dentistry. The most common degree awarded by dental schools is the D.D.S. degree with only a few East Coast schools offering the D.M.D. degree. There are 56 Accredited Dental schools in the United States requiring 4 years of post graduate study (except for one unique 3 year program at the University of the Pacific)[1]. Most applicants to dental school have attained at least a B.S. or B.A. degree, however, a small percentage are admitted after only fulfilling specific prerequisite courses. So unlike many other countries, it can take more than 8 years to become a dentist. (List of dental schools in the United States) The difference relates to the history involved in the division of medicine and surgery in medical practice. There has been a recent movement to include a 5th year of education that focuses on purely practical training in the clinical setting. In at least one state, New York, a state dental license can be received without taking the licensing exam (State Board Exam) upon completing this additional year of training.

Licensure is organized on three levels in most areas. All dentists must pass National Boards, Regional Boards, and then take a jurisprudence exam accepted by their state to fulfil their requirements to get a state license. Although a state license is only valid in the issuing state, because of the regional boards a dentist may be able to apply for licensure in any other state within the jurisdiction of their regional board. There are many cooperative agreements between states that allow recognition of another state's license so as to procure a license either via "licensure by credentials" or "licensure by reciprocity." Although a national licensure exam has yet to be made, the American Dental Association (ADA) has worked with education and examining groups to form such an exam.[2]

A dentist may go on for further training in a dental specialty which require an additional 1 to 7 years of post-doctoral training. There are 9 recognized dental specialties. They are Endodontics (root canal treatment), Oral and Maxillofacial Pathology, Oral and Maxillofacial Radiology, Pediatric Dentistry, Periodontics (gums), Prosthodontics (complicated dental reconstruction), Orthodontics (moving teeth), Oral and Maxillofacial Surgery (tooth removal and surgery of the oral and related structures), and Dental Public Health. There is no specialty in esthetic dentistry or implantology, and no additional training is required for a dentist to make the claim of being an esthetic or cosmetic dentist. Dentists are forbidden to claim that they are specialists in areas of practice in which there is no recognized specialty. They may limit their practices to a single area of dentistry, and claim that their practice is limited to that area.

Any general dentist may perform those procedures designated within the enumerated specialties if they deem themselves competent. Many general dentists train in certain aspects of the above specialties such as the placement and restoration of dental implants, advanced prosthodontics and endodontics, and have limited or heavily focused their practices to these areas. When a general dentist performs any procedure that falls within the realm of a specialty, they are expected to perform with the same level of expertise as a certified specialist and are legally held to such standards with respect to any issues of malpractice.