Dear Ms. Reen and Members of the Virginia Board of Dentistry,

These comments are sent on behalf of the American Association of Orthodontists (“AAO”) and its Virginia members to provide comments regarding the substantive changes being proposed to 18VAC60-21 (hereinafter referred to as “specialty laws”).  We appreciate this opportunity.

Revising Virginia’s Specialty Laws At This Time May Be Unnecessary

The AAO presumes the parties requesting revisions to Virginia’s specialty laws take issue with the current laws recognizing only the ADA specialties, and the fact that the ADA’s House of Delegates has had a say on what specialties are recognized.  As you likely know, however, the National Commission on Recognition of Dental Specialties and Certifying Boards (“Commission”) has recently been created.  Our understanding is that the Commission alone will be deciding whether a new specialty should be recognized or not, without requiring final approval from the ADA’s House of Delegates.  This new Commission may very well address the issues identified by those requesting revisions to Virginia’s current laws.  As such, the AAO requests that the Virginia Board of Dentistry (“Board”) delay any revisions to Virginia’s specialty laws until the Commission is able to get fully up and running.    

The AAO Supports Specialty Laws That Require CODA Accreditation

To the extent the Board does not want to delay this issue, the AAO supports Virginia’s regulations that require those who are advertising as “specialists” to have successfully completed a post-doctoral advanced dental educational program of at least two full-time years and which program is accredited by the Commission on Dental Accreditation (CODA).   

A CODA accreditation standard assures Virginia citizens that an individual who truthfully holds himself or herself out as a specialist has met high standards for education and training.  If a dentist was able to advertise as a “specialist” without completing a multi-year CODA accredited program, it would dilute Virginia’s “specialty” laws and allow providers, who do not have years of supervised clinical and didactic training and/or who have not satisfied extensive criterion, to advertise on par with those providers who have long-term, comprehensive education and training through CODA accredited programs.  Such dilution could threaten the health and safety of Virginia patients by obscuring important distinctions between dental professionals as far as their respective educational and training backgrounds.  It is important to remember that out of the 13 groups most involved with this issue (the 9 ADA recognized specialties and 4 from the American Board of Dental Specialties (“ABDS”)), 12 have CODA accredited programs and would have members able to satisfy a CODA accreditation requirement.  The only group whose members cannot currently satisfy a CODA accreditation standard are the implantologists.  Removing a provision solely to accommodate the implantologists, and allow dentists who have graduated from non-CODA accredited programs to advertise on par with those who have graduated from CODA accredited programs, does not seem in the best interests of Virginia patients.

Given the foregoing, the AAO is opposed to the suggested removal of the provision prohibiting “(i) advertising a claim of a dental specialty unless it is approved by the National Certifying Boards for Dental Specialists of the American Dental Association,” to the extent it would no longer require those advertising as specialists to have successfully completed a post-doctoral advanced dental educational program of at least two full-time years and which is accredited by CODA.

AAO’s Response To The Proposed Removal of the Dental Disclaimer

The AAO is also opposed to the removal of the provision prohibiting “(ii) representation by a dentist who does not hold specialty certification that his practice is limited to providing services in such specialty area without disclosing that he is a general dentist.”  Virginia law currently requires a “general dentist who limits his practice to a dental specialty or describes his practice by types of treatment shall state in conjunction with his name that he is a general dentist providing certain services (e.g., orthodontic services).”  18VAC 60-21-80.  If the proposed removal took place, the “general dentist” disclosure under 18VAC 60-21-80 would no longer be required. 

Given the current language, a general dentist advertising that his or her practices is limited to orthodontic services has to state something along the lines of "John Doe, general dentist, practice limited to orthodontics." Given that requirement, Virginia patients now know exactly what education and degree the advertising dentist has – i.e. whether they are a general dentist or an orthodontic specialist.  On the other hand, the proposed removal would have the unintended consequence of no longer requiring that general dentist disclosure, so the same advertisement could read "John Doe, practice limited to orthodontics."  If that is all the advertisement said, it is easy to foresee how Virginia consumers might conclude (albeit incorrectly) that John Doe is a specialist in orthodontics or even an orthodontist, rather than a general dentist practicing orthodontics.  And as you can imagine, Virginia consumers who relied on such advertisements to choose dental services, would not be pleased if they were injured and found out after the fact that the dental provider they thought was a specialist or orthodontist, was rather a general dentist.  The cause for concern is also not just limited to Virginia patients seeking orthodontic care, but any patient seeking care from a dental specialist (e.g. pediatric dentists, endodontists, periodontists, oral surgeons, etc.). 

Conclusion

In closing, if Virginia adopts regulatory revisions that dilute the meaning of a specialist, it would seem to allow the situation in which a graduate from a non-CODA accredited, specialty program could advertise as a “specialist” or not use a general dentist disclaimer, a patient could rely upon that advertisement when choosing that provider, the patient might suffer an injury, and then the patient might claim he was not protected under Virginia’s laws because they allowed his doctor to advertise in the same manner as a doctor who completed a multi-year, CODA accredited program.  That regrettable scenario should not be given the opportunity to play out, especially if it comes at a cost to Virginia patients.  The AAO strongly believes that those dentists who identify and advertise as “specialists” or advertise that their practice is limited to specialty treatment, should have an advanced level of training and education, and any changes to Virginia’s specialty laws should clearly recognize that.  With that in mind, Virginia may wish to follow the lead of Louisiana, which made changes to its specialty laws that can be found at 46 LA ADC Pt XXXIII, § 122.

The AAO respectfully requests that the Virginia Board of Dentistry consider these comments during its review.  If the Board needs any further information or has questions for the AAO, please feel free to contact me.

Thank you for your time and attention to this matter.

Sincerely,

Sean Murphy

Attorney for the American Association