FUTURE OFDENTISTRY
and away from individual dental specialties will be
determined in the main by economic factors, partic-
ularly supply and demand. New, officially recog-
nized dental specialties will form over time, particu-
larly in response to demonstrated service demand by
patients, and to some degree by pressure from mem-
bers of informal but aspiring specialties.
A one-year postgraduate experience (PGY-1) will
continue to be seen as an essential and widely support-
ed form of education that assists the new dental gradu-
ate to consolidate recently acquired clinical skills.
Specialty training choices will greatly impact the
future of dentistry. While certain broad profession-
al, social and economic forces affect all the dental
specialties, factors shaping individual dental special-
ties may also have considerable impact on future
trends in dental education.
Specialty-specific forces will continue to be very
important in shaping the future development of the
individual dental specialties, and in turn their con-
tributions to dental education. Moreover, it contin-
ues to be a problem to attract potentially high-earn-
ing dental specialists to a career in dental education.
Two general considerations will likely affect the
dental specialties in a more systematic fashion.
First, as the ADA 1997 Survey of Dental Practice
revealed, the net income of dental specialists is dou-
ble that of general dentists (ADA, 1998). Moreover,
in a recent economic study focusing on orthodontics
and oral and maxillofacial surgery, it was deter-
mined that there remains a strong incentive to invest
time and resources into dental specialty training
based on the usually accepted economic indices
(return-on-investment, internal-rates-of-return) for
economic evaluation of decisions.
The same methodology has not been applied
recently to evaluate the economic outcome related
to training and working in other dental specialties,
but positive returns may be expected relevant to the
majority of the dental specialties. As long as there
are positive financial incentives to specialization,
dentists will become specialists.
Recognized dental specialties represent less than
25% of the dentist workforce. Thus, dentistry is
not in imminent danger of becoming overspecial-
ized, although a slow increase to the 30% level is
quite likely. Moreover, the demand for specialized
dental services appears to be growing, while interest
in becoming a specialist has held remarkably steady,
in absolute numbers, for the past three decades.
It is reasonable to expect that the economic incen-
tives for dental professionals to specialize will con-
tinue to be present in the foreseeable future. During
a time when many aspects of dentistry are being
increasingly affected by rapid technological change,
specialization is a dental professional's rational
response to be better grounded in the delivery of
more advanced and complex clinical services for
patients.
Well-trained, scholarly dental specialists will also
be increasingly important to help the nation's dental
schools to maintain a first-class teaching faculty.
The shortage of full-time teaching faculty across the
aggregated dental schools has been commented
upon elsewhere in this chapter. While the faculty
shortage is reflected by more than just the clinical
dental specialties, it remains the case that scholarly
dental specialists should continue to form the back-
bone of the full-time teaching faculty in American
dental schools.
In the nation's dental schools a great deal of the
applied and clinical research will be carried out by
investigator teams functioning within one or other of
the dental specialties. That most of such research will
be collaborative, spanning several other dental, med-
ical and biological sciences, does not alter the tenden-
cy for most of such research to focus on specialty-
specific clinical problems. As such, teams involving
dental specialists, their graduate students and postdoc-
toral students will generate much of the growth of den-
tistry's future clinical knowledge. This scenario sug-
gests that specialists, dental and non-dental alike,
through their capacity to generate new knowledge for
dentistry, will be essential to a dynamic dental educa-
tion system, and thus will be critical to the future vital-
ity of the whole dental profession.
Monitoring of non-ADA recognized specialty train-
ing is needed. As it has recently done for oral and
maxillofacial radiology, the dental profession would
do well to continue reviewing the informal specialties
for their potential to rise to formal specialty status.
Given the rapidly changing population demographics,
it may be advisable to study the merger of GPR, hos-
pital dentistry and geriatric dentistry programs into a
specialty of geriatric/special care dentistry.LIFE-LONG LEARNING AND CONTINUING
DENTAL EDUCATIONLife-long learning is an integral element of the
dental profession, a theme first taught in the dental
school. Ample availability of high quality continuingDental Education