Your family-practice dentist refers you to a dental specialist whenever he believes you have a problem beyond his own ability and purview as a general practitioner. As with your family doctor and a problematical medical condition, you should reassure yourself that a consultation with a specialist is absolutely necessary, since in almost all cases a specialist’s fee is higher than a general practitioner’s. That’s because, ideally speaking, the procedures require more skill and specialized knowledge—the reason, after all, for needing a specialist in the first place. The questions we recommend you ask your family doctor concerning the need for a specialist are appropriate here as well .
Now for a little background to make you a more informed consumer in any situations and decisions involving dental specialists.
According to the American Dental Association (ADA), a specialist must have certain qualifications: two years of education beyond the general degree at an accredited dental school, and/or certification by an ADA-recognized certifying organization.
What is certification? A dentist who beyond dental school has continued his or her studies in depth in a chosen field may choose to become board-certified. First, the dentist must pass a qualifying examination administered by a specialty board (national board of professionals in that specialty field). While board certification is an achievement awarded by the dentist’s colleagues and does require additional education, it is not necessarily an indicator of skill or higher-quality care. What it does indicate is a higher price tag for the services, so it’s important to know who’s who and what each does so that your money is well spent.
The American Dental Association has approved eight specialized areas of dental practice:
Endodontics. An endodontist performs root canal therapy. Although a general practitioner does too, a particularly complicated case may be referred to the specialist, whom you should reasonably expect to be more proficient and expert—and more expensive. One thing to bear in mind, however, is that with successful root canal therapy you may have avoided the expense of having the tooth extracted and a false tooth put in its place.
Oral and maxillofacial surgery. Sometimes called an exodontist, an oral and maxillofacial surgeon extracts teeth as well as performs surgery on the mouth, jaws, and related structures. While the general dentist can perform simple extractions, the specialist usually does the problem extractions—complications such as an impacted wisdom tooth (imbedded in the bone under the gum far back in the mouth) or the tip of a broken root. The “maxillofacial” designation, referring to the jaw and the face, is relatively recent, and requires some skilled surgical techniques such as those involved in cosmetic surgery and surgery on the temporomandibular joints, which connect the jawbone to the skull.
Oral pathology. The oral pathologist is involved in the diagnosis of disease through biopsy and other methods. Typically, when your general dentist is stymied by a particularly tricky problem and having difficulty identifying the cause of oral disease, then he or she consults an oral pathologist.
Orthodontics. The orthodontist corrects malocclusion (the improper position of the teeth) by wiring the teeth so that they move into the correct and most attractive positions. Although it was once true that older children and teenagers were the orthodontist’s only customers, lately more adults are getting braces. As a general rule, your family dentist will not do orthodontics and instead will refer you to the specialist. Of course, you can choose an orthodontist yourself—preferably someone whose “success stories” you have personally seen. Considering that the therapy takes around two years, on the average, it pays to find an orthodontist you can trust for that length of time, not to mention one you can afford and who is willing to make financial arrangements you can live with.
Pedodontics. The pedodontist looks after children’s teeth—not that the general practitioner cannot or does not, just that the specialist is supposed to know more about the psychological and emotional aspects of working with children. Usually children with behavioral problems, children with some disabilities, and children with unusual dental problems are referred to the pedodontist. Some pedodontists even do orthodontic work, and you may end up saving money by having both phases of your child’s dental work done by one specialist. Check into it.
Selecting such a practitioner for your child is different from choosing one for yourself, since the process often relies on understanding the child’s impressions of the practitioner—and a child’s thoughts are not always easy to discover—and on determining the practitioner’s attitude toward children, which may also require acute observation.
Periodontics. Probably known best for the treatment of gum problems, the periodontist also looks after the bones and supportive tissue that surround the teeth. Although the general dentist can treat some gum disease, only the periodontist does gum surgery, which involves various procedures, including the recontouring, tightening, or grafting of gum tissue. If your dental problems require this specialist’s services, again choose carefully because much of the treatment calls for multiple visits and an extended series of checkups.
Prosthodontics. The prosthodontist replaces missing teeth with prosthetic (artificial) ones: caps, bridges, and dentures. Most general dentists do some prosthodontic work in their practices, so the specialist is reserved for the truly difficult cases that the dentist does not want to undertake.
Dental public health. In general, the public health dentist is concerned with the dental health education of the public, with the prevention and control of dental disease on a community-wide basis, and with the administration of group dental care programs. To check the credentials of dental specialists, contact the appropriate specialty board.