Another body to validate dental specialties: The American Board of Dental Specialties

The field of medicine has several means to recognize its specialties, including the American Board of Medical Specialties (ABMS). The ABMS was formed in 1933 in part to more objectively validate specialties outside of the politically based American Medical Association (AMA) trade organization.¹

With the 501(c) (6) incorporation of the American Board of Dental Specialties (ABDS) in 2013, specialist dentists can now opt to be evaluated and recognized by the criteria based ABDS, rather than dentistry’s own trade organization, the politically based House of Delegates (HOD) of the American Dental Association (ADA).

In 1929, The American Board of Orthodontics was the first specialty board formed. The ADA recognized Orthodontics as a specialty in 1950. However, in 1948 the first specialties to be recognized by the ADA included Oral and Maxillofacial Surgery (OMS), Pediatric Dentistry, Periodontology, and Prosthodontics, all with specialty boards established more than 10 years after Orthodontics’.² Since 1948, the ADA HOD has recognized five more dental specialties; less than one per decade. Evidently, the ADA HOD feels dentists are adequately prepared to comprehensively treat patients in areas such as anesthesiology, craniofacial pain, and oral medicine, relying upon training gained in three to four years of undergraduate instruction.

Certainly not all of dentistry, or its patients, have agreed with the ADA HOD’s political specialty determinations.³ As but one example, in 1999, residency-trained dentist anesthesiologists were not deemed worthy, by a handful of votes, of specialty status on only one of the five existing criteria the HOD was asked to evaluate: “need and demand.” Inexplicably, the HOD determined there was no need and demand for other than traditional anesthesia options being taught in dental schools, essentially local anesthesia and nitrous oxide in oxygen. But, the very next year, the profession saw the beginnings of the still expanding advanced pain control entrepreneurial groups, such as the Dental Organization of Conscious Sedation (DOCS), which now has over 2,000 graduates who have administered millions of doses of DOCS’ protocol anxiolysis. So much for the ADA HOD’s finding of “no need or demand.”

Historically, the ADA has not always been the sole arbiter bestowing specialty status in dentistry. For instance, prior to the ADA's first approval of specialties in 1948, states approved specialty status, such as for OMS in Illinois, Michigan, Oklahoma, and Tennessee.⁴ Currently, states still bestow specialty status. Further, states have been put on notice that to defer to trade organizations, such as the ADA and AMA, in matters related to evaluation of health professionals, is inappropriate on several levels.⁵,⁶,⁷

For instance, in Ducoin vs. Viamonte Ros, the Second Judicial Circuit in Florida concluded: “Of great interest to the Court is that the challenged statute delegates to the ADA the sole discretion to designate what specialties or specialty credentialing organizations will be recognized by the Florida Board of Dentistry and enforced under the law of this state. The ADA refuses to recognize the AGD, AACD, AAID, and the ABOI as certifying boards, and consequently advertising those credentials without the disclaimer violates Florida law. In fact, under Florida law, the legislature may not delegate unguided and uncontrolled authority to a private organization to determine prospectively the lawfulness or unlawfulness of commercial speech. This is precisely what the State did by the implementation of (the statute at issue). The Courts have rejected an ambulatory construction that would allow a private organization unbridled, prospective discretion to determine the lawfulness of certain specifications. (case citations)… Clearly, the Legislature cannot delegate lawmaking authority to the ADA. This makes the statute unconstitutional on its own. The Court finds that the statutory scheme has effectively granted the ADA the power to regulate a citizen’s right to free speech and this cannot stand. …The ADA is given the authority, final and unchecked, to determine the limits of lawful dental advertising and is free from procedures consistent with due process…The ADA does not have to give a dentist notice or an opportunity to be heard as it determines the legality of dental advertising…There is no right to appeal any decisions made by the ADA…The challenged statute compels dentists to abide by the lawmaking determination of the ADA. In this respect, the ADA effectively serves as a regulatory body of the state and its determinations constitute state action.”⁸

Although many will welcome the new ABDS option, only time will tell if it is any more effective than the ADA’s current flawed process, criticized by the ADA’s own study. Specifically The ADA HOD commissioned a task force to study its specialty process and, as reported to the ADA in 2001, recommendations were made to the ADA that included no longer assuming responsibility for dental specialty recognition and transferring such authority to an outside entity. The ADA determined to not relinquish specialty recognition power in spite of the task force’s recommendations, documented conflicts of interest, documented political legerdemain, and yet to be determined potential state or federal illegality.

With regard to contemporary ABMS issues, the ABMS has been criticized for losing its original vision and morphing to an inbred primarily economic entity. As an example, the ABMS now promotes and lobbies for mandatory continuing maintenance of board certified (MOC) status, which generates significant profits for the ABMS and its executives, whom are often paid in excess of $700,000·00 annually.⁹ The combined revenue from 24 specialty boards in 2011 was $320,000,000·00,¹⁰ and the process arguably had nothing to do with patient safety,¹¹ and in fact is demonstrably harmful to patients.¹² Further, the ABMS has also lobbied for mandatory MOC to be linked to hospital privileges, state licensure, and the like.

The new ABDS is well-positioned to learn from the history of the ADA, ABMS, and individual states with regard to establishing and continuing a truly valid certification process that actually benefits dentists and their patients.

In the future, it appears specialist dentists will be able to gain recognition from the politically based ADA, the criterion based ABDS, individual state boards charged with fiduciary responsibility to the public, and/or even the federal government, which may lend its imprimatur to dental specialty recognition as the possible singular player in health care.

*Dr. Orr is President of the American Association of Dental Editors and Journalists, which granted permission to reprint this editorial from the Summer 2014 issue of the Editors’ Newsletter. Dr. Orr is Professor and Director of OMS and Dental Anesthesiology at UNLV SDM and is certified by the American Board of OMS, the American Dental Board of Anesthesiology, and the American Board of Legal Medicine.