While I support the ADA and the VDA, there have been some egregious behaviors that have occurred in specialty recognition that few seem to have a complete understanding of.  In 2012, dentist anesthesiologists applied for specialty recognition with the ADA.  This was not the first attempt at specialty recognition. However, during this attempt, the ADA, CODA, and the Board of Trustees agreed that all specialty requirements were indeed met. Nevertheless, the final phase in approval was a vote by the ADA House of Delegates.  At that time, emotion and politics outweighed logic. A campaign was launched stating that anesthesia and sedation would no longer be allowed by anyone other than dentist anesthesiologist, insurance would not pay for sedation and anesthesia unless it was provided by a separate anesthesiologist, and that dentist anesthesiologist were unsafe in their practice of itinerant anesthesia. Websites were launched saying anesthesia was a right for all dentists, such as www.anesthesiaforall.org. AAOMS and its oral surgeons were single handedly able to prevent specialty recognition. In addition, standard meeting protocols for the House were allowed to be breached so that the oral surgeons could “have the floor” to express why the specialty should be denied.

As you are aware, there have been successful Federal lawsuits surrounding the protectionist and political nature of the above described proceeding.  Even the ADA has openly recognized the flaws of this process, even before the first lawsuit in Texas was decided. More and more State Dental Boards are changing their position or are being met with legal action. Furthermore, the American Board of Dental Specialties has emerged as an alternative to the ADA, a trade organization, being the official and sole determinant of dental specialties. 

The American Board of Dental Specialties mirrors the events that created American Board of Medical Specialties.  It was born out of a determination that a trade group, in their case the American Medical Association, could not and would not determine medical specialties without bias.  Therefore a 3rd party was created as the certifying organization.

The ADA, in an attempt to rectify their self-acknowledged bias and systematic flaws, unanimously approve House Resolution # 65 and created a new Council for Specialty Recognition.  House Resolution # 65  states, “A dentist may ethically announce as a specialist to the public in any of the dental specialties recognized by the American Dental Association including dental public health, endodontics, oral and maxillofacial pathology, oral and maxillofacial radiology, oral and maxillofacial surgery, orthodontics and dentofacial orthopedics, pediatric dentistry, periodontics, and prosthodontics, and in any other areas of dentistry for which specialty recognition has been granted under the standards required or recognized in the practitioner’s jurisdiction, provided the dentist meets the educational requirements required for recognition as a specialist adopted by the American Dental Association or accepted in the jurisdiction in which they practice. Dentists who choose to announce specialization should use “specialist in” and shall devote a sufficient portion of their practice to the announced specialty or specialties to maintain expertise in that specialty or those specialties. Dentists whose practice is devoted exclusively to an announced specialty or specialties may announce that their practice “is limited to” that specialty or those specialties. Dentists who use their eligibility to announce as specialists to make the public believe that specialty services rendered in the dental office are being rendered by qualified specialists when such is not the case are engaged in unethical conduct. The burden of responsibility is on specialists to avoid any inference that general practitioners who are associated with specialists are qualified to announce themselves as specialists.”

Although the petition brought by Dr. Mayberry is being described by others as  an attempt to circumvent the ADA and force the Virginia Dental Board to accept the American Board of Dental Specialties (ABDS), this was not what was proposed in the regulatory change. Instead § 54.1-2718 would have remained unchanged and the regulations changed such that the "specialist" must not advertise an "unsubstantiated claim."  I had proposed that the regulation be changed to reflect the House Resolution # 65 and get rid of the reference to the antiquated Ethical Code that the regulation was based on.  The Dental Board did not haphazardly adopt Dr. Mayberry’s petition or ADA House Resolution # 65.  Instead, it was well considered and thoroughly evaluated by Virginia legal counsel and announced in this fashion.  Perhaps it is more prudent to recognize both the ADA and ABDS as authorities, as there are inherent flaws that have yet to be proven rectified in the ADA's Specialty Recognition.

Having said all of the above, I also understand the voiced concerns of patient safety and the risk of dentists misleading their patients. However, it appears that many dentists are advertising as cosmetic dentists, sleep dentists, sedation dentists without much concerns. However, when someone whom the State has recognized as having true advanced training required to obtain a general anesthesia permit attempts to promote their services, it is “unethical and illegal.” In addition, barring the public from knowing what advanced training someone has, can actually be detrimental to patient safety.  Why should patients not know that they have access to dentist anesthesiologists? Why should patients have to settle for a dentist that went to a weekend sedation or anesthesia course?  Why does the public not know about anesthesia providers in dentistry? Basically, it is because of these antiquated regulations. A great example of how this protectionist mindset can backfire is the recent media storm involving Dr. Goyal in AZ, whom was able to falsify anesthesia credentials. One of the reasons this is was able to occur was because there is not official recognition by the ADA and their state components of the CODA accredited anesthesia training programs as anything more than general dental training – much like a CE course a dentist may purchase and attend.

I hope that this letter may help elucidate the complexities that surround this issue. In full disclosure of the above, I am a dentist anesthesiologist by training.  I have 5 years of post-graduate training in hospitals at CODA accredited and GME accredited residencies.  However, I am a general dentist with the requisite training for a State recognized anesthesia permit.  My own society’s parameters of care restrict us from practicing dentistry while providing deep sedation or general anesthesia, therefore I must limit my practice to anesthesia, yet I am required to say I am a general dentist and not an anesthesiologist.

Thank you,

Jonathan Wong, DMD

Diplomate, American Dental Board of Anesthesiology *

Diplomate, National Dental Board of Anesthesiology *

Fellow, American Dental Society of Anesthesiology *

*Anesthesia services provided by a general dentist