A TIME FOR CHANGE?

As Lynne and I look back at an other year gone by we’ve asked ourselves as others often do, how could this year and others have flown by so quickly. The most pleasant part of the past twenty or more years has been our making of long-lasting friendships with so many of you in the Academy of Prosthodontics. We cherish the friendships and want them to continue for the rest of our lives. We wish you and your loved ones a very happy and healthy new year.The purpose of this editorial is to sensitize members of the Academy of Prosthodontics of a major problem that exists in prosthodontics today and to offer a suggestion for a possible new direction for our Academy.

I hesitated to write this editorial because I knew it most likely would cause controversy. I hesitated because I am fully aware of the sacred traditions of the Academy and I fully respect those traditions. It is difficult to break tradition for the sake of change. However, as the old expression states, .no risk, no gain.. As your president, I feel it necessary to ask you to consider this editorial with an open mind and think of what is best for our Academy, the specialty and the discipline of prosthodontics. This editorial is not new. I presented a version of this message to the American College of Prosthodontists annual meeting in 1999 and was also asked to express my thoughts in the Pacific Coast Society of Prosthodontists newsletter. I ask you, the members of the Academy of Prosthodontics, to read it, think about it, and decide if it makes sense for us to be the first prosthodontic organization to candidly establish our identity in a different manner than other prosthodontic organizations in the world. I ask you to recall that we had the insight and courage to change our name in the past, and believe it is time to do so again as we cross the threshold into a new millennium.

INTRODUCTION

More than fifteen years ago this author wrote an article entitled .I’m a Prosthodontist, You’re a What?. The paper was presented at a number of specialty meetings and appeared to receive some praise for its creativity and humor. The manuscript focused on the author’s survey of the public’s knowledge of who we are and involved a small but statistically significant population in the Southern California area. Interestingly, while a significant number of the population knew what an orthodontist was, less than 5% of the population knew anything about a prosthodontist. Close to 10% surveyed thought we were associated with prostitution. The purpose of the article was to sensitize members of the specialty of the need to inform the public of our existence, to market the specialty, and to encourage students of dentistry to focus on the possibilities of a prosthodontic education and a career in prosthodontics.THE PROBLEM

In the year 2000 the specialty is in a bigger dilemma. Not only is the public still poorly informed about what a prosthodontist is but more importantly, the number of applicants and enrollees in prosthodontic programs has dropped to an all-time low. Gary Goldstein has suggested that within ten years there will be an inadequate number of prosthodontists to support the American College of Prosthodontists and justify the specialty. In his paper he confirms that in 1993-4 there were 1509 applicants for 201 prosthodontic positions in the United States. In 1997-8 there were only 1011 applicants and 150 enrollments. Recently, David Felton indicated that in 1998-99 there were 963 applicants for 145 positions. Felton further states that in the period from 1991-1999 there has been a 40.2% decrease in applications and a 31.7% decrease in enrollment in prosthodontic programs in the U.S. Of all enrolled students in prosthodontic programs, 60% are exclusively internationally trained.

The specialty of periodontics is experiencing an even larger decline. Other specialties such as oral and maxillofacial surgery, endodontics, and pediatric dentistry are thriving relative to the number of applicants. From 1991-99 pediatric dentistry has witnessed a 119.3% increase in the number of applicants. Advanced education in general dentistry programs have also shown a significant increase in the number of applicants (64.7% increase).

One of the biggest problems facing dental educators in the area of prosthodontics is the inability to teach implant dentistry to DDS students. The author is unaware of any school of dentistry who teaches students that the treatment of choice, when possible, is to replace a missing tooth or missing teeth with an implant(s). In the area of implant dentistry, most DDS programs offer a few hours of didactic instruction, a selective course, and the possibility of observing a surgical procedure.

Implant dentistry is a restorative treatment modality practiced by only a select few who treat a very small and relatively wealthy segment of the patient population. There are a multitude of reasons for this. First and foremost, third party providers do not reimburse for the placement and restoration of implants except in rare circumstances. The author’s discussions with various third-party insurance providers have led to the conclusion that the companies may consider providing partial payment for implants when they see out- comes data suggesting that dentists are using implants rather than conventional prostheses for the replacement of missing teeth. Dentists appear to be complacent replacing teeth .the good old fashioned way. and would still rather subject patients to endodontic therapy, periodontal procedures, hemisections, etc. in instances where the prognosis may be better if the teeth were extracted and replaced with implants. Equally important, our schools of dentistry do not have sufficient faculty with the expertise to educate students to understand that if patients are partially or totally edentulous the choice of treatment may be the replacement of one or more missing teeth with implants implant supported restorations. Just as the gold foil was and amalgam soon will be eliminated because of the emergence of newer materials, other antiquated procedures must be eliminated in order to provide for the most contemporary treatment for our patients. It does not appear that in the foreseeable future we will have a critical mass of educators to provide a comprehensive education to DDS students in implant dentistry.THE SOLUTION

Data indicates that there is a decline in the enrollment of students in traditional prosthodontic programs. The reality is that general practitioners and advanced general dentistry program graduates are performing conventional prosthodontic procedures routinely. As a result of their education and expertise, prosthodontists are the specialists of choice to teach students of dentistry and the profession the art and science of implant dentistry. The time is now for us to attract a large number of minimally educated U.S. and foreign trained graduates from schools of dentistry who know little about implants and enroll them in our prosthodontic specialty programs. The specialty of prosthodontics can be recognized as an innovative specialty of the 21st century with a new emphasis which concentrates its research, educational and practice experience in the area of implant dentistry. It is even conceivable that we can eventually have the numbers to provide the desperately needed educators to provide the needed expertise in implant dentistry to our DDS students in this emerging area of interest.

I urge the Academy of Prosthodontics to become the first prosthodontic organization in the world to take the needed step and become the Academy of Prosthetic and Implant Dentistry. In doing so we will establish ourselves as the organization who are the forerunners of progress and who are not only changing the name and focus of the specialty and discipline, but are looking to the needs of our students and patients in the new millennium.