Dentistry as a Career
With advances in a variety of dental techniques and with the current focus on preventive and restorative dentistry, the need for special expertise in the various branches of dentistry has significantly increased. While general practitioners have training in and frequently do work in specialty areas, there are currently about 20,000 dentists whose practice is limited exclusively to one specialty. These dentists have had from one to four years of additional training (depending on the specialty), during which time their diagnostic and operative skills were further developed to achieve a superior degree of competence.
The following eight areas of specialization are recognized by the American Dental Association. (They are listed in order of the number of practitioners in each specialty.)
This specialty has about 6,500 practitioners. It is concerned with correcting irregular and abnormal dental development. Orthodontic procedures are applicable to patients in any age group, but treatment is more easily and effectively achieved on youngsters. The goal is not only to improve appearance, but to correct the functioning of the teeth by altering the bite. Correcting a bad bite, or malocclusion, will aid in eating and speaking, and will prevent eventual loosening or even loss of teeth, in addition to having a positive cosmetic effect. A bad bite is generally the result of an incorrect relationship that developed during childhood between jaw shape and teeth size. It may also result from habits such as thumb-sucking, nail-biting, or night grinding. Since teeth are moved to improper positions by forces that are out of balance in the mouth, they can be moved back by opposing forces. This is done by the use of various fixed orthodontic appliances such as metal braces, rubber bands, or plastic brackets. Removable appliances may also be used on occasion.
There are more than 3,600 practitioners in this specialty. They use surgical procedures to deal with defects and diseases of the entire maxillofacial region—the middle and lower face. Their work encompasses the jaws, cheekbones, and other skeletal elements and their surrounding structures. In addition, the oral surgeon diagnoses and treats injuries, deformities, and growths in and around the jaw. When a tooth (or teeth) must be extracted, the procedure is usually carried out in an oral surgeon's office. Another common surgical procedure is apicoectomy, or surgical removal of a tooth's root tip. Reemplanting teeth knocked out in an accident and treating simple or compound jaw fractures are types of traumatic-injury treatments requiring an oral surgeon's skills.
This specialty has about 2,000 practitioners. It is concerned with the diagnosis and treatment of diseases affecting the periodontal tissues that support the teeth, namely the gum, periodontal membrane, and surrounding bone. These diseases are very insidious and become increasingly prevalent with age. The earlier treatment is instituted, the more likely it is that teeth loss can be prevented. Periodontal diseases are diagnosed by several procedures; probing the depth of the space around a tooth, comparing bone level as reflected in X-rays taken at two different dates, and examining for tooth mobility. Slight or somewhat moderate disease can be readily treated by scaling — the removal of plaque or tartar, or root planing — a fine smoothing of the surface of the root. More advanced cases require curettage — scraping of the tissues lining the infected tooth pocket. In severe cases, surgical intervention to expose teeth, or even bone grafting, may be necessary. Various splinting techniques that join loose teeth to firm ones are also utilized.
The specialty also has about 2,000 practitioners. It is concerned with the treatment of children, adolescents, and young adults exclusively. Pedodontists are in a sense equivalent to pediatricians. In their special facilities and in the approach they use, they strive to establish in the child a positive attitude towards dentistry and a disposition to develop good oral hygiene habits. It is essential to maintain the health of the primary (“baby”) teeth for, if decay sets in or premature loss occurs, the health and shape of the permanent teeth could be adversely affected. Also, the overall health of a child will be influenced by the condition of the primary teeth. Undetected decaying teeth can cause poor eating and chewing habits and thereby influence the overall state of a child's health.
There are about 1,000 specialists in the field. It deals with the diagnosis and treatment of diseases of the pulp (nerve) of the tooth. With the current emphasis on saving teeth and utilizing extraction only as a last resort, root canal therapy is a vitally important dental specialty. A tooth needs endodontic treatment if the nerve has been damaged by decay, infection, irritation, or trauma. In such cases, the endodontist cleans out the nerve canal(s), removing the degenerated pulp. When the tooth is asymptomatic and has stabilized, the canal(s) can be filled. The complexity of the treatment is determined by how many canals the tooth may have. Also, a live (vital) tooth is more readily treated than a dead (non-vital) tooth, especially if the latter has abscessed.
There are about 750 dentists in this field. Only several decades ago it was a common assumption that as one grew older, teeth would have to be lost, and a partial or even full set of dentures was thought to be unavoidable. While the current philosophy is that with good oral hygiene and prompt and competent treatment extraction can be minimized, there are nevertheless patients who will lose teeth and require a replacement for them. Replacement of even a single (non-wisdom) tooth is desirable, since if it is not replaced the teeth on either side of the gap may move. To replace missing or extracted teeth, a fixed or removable bridge can be attached to one or both adjacent teeth, or, in some situations, removable partial or full dentures may be required.
There are currently about 100 specialists in oral pathology. They are concerned with diseases of the mouth, studying their causes, processes, and effects. Essentially a diagnostician, an oral pathologist usually serves as a consultant to other specialists, as well as a teacher of dental students.
Dental Public Health
This field also has about 100 specialists. They are involved in promoting the oral health of communities by stimulating development of programs that aid in the prevention and control of dental diseases. Such specialists also gather and analyze data that are useful in determining the effectiveness of the oral health methods being used in a community.
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