Pillars of the field

Dentistry, like other medical fields, is made up of many areas of expertise. In fact, there are 12 specialties recognized by the American Dental Association, and Texas A&M School of Dentistry offers training in 10 of them, more than most dental schools in the United States.

“Each of our programs has special recognition nationally; each specialty has a strong history,” said Dean Lily T. García. “These are top-tier programs. By sheer scholarship and research, we’re distinguished. It’s the fact that each specialty program has advanced in its own right, and the alumni of each of those have their own pride in what we’re doing. I’ve been at other schools, and we are exceptional.”

Dental health is vital to overall health and well-being, but why are so many specialties needed? What do they do? Faculty leaders in the school came together to offer brief explanations of their specialties and why they matter.

Dental public health: Dental public health is a specialty that focuses on community well-being, rather than individual patients. This specialty works to control dental diseases through community efforts, such as mobile clinics, educational resources and dental research.

“It is relatively a small-sized specialty, but this doesn’t underestimate the dental public health professional’s role in preventing and controlling dental disease, as well as promoting oral health in the country to fulfill national oral health strategic plans,” said Dr. Amal Noureldin. “Our dental public health program is responsible for training competent professionals to increase the available workforce – researchers, faculty, clinicians, consultants, directors, policymakers and leaders – that is capable of leading both local and national projects, improving the community’s oral health through engagement in government and private sectors.”

Endodontics: Endodontists are responsible for taking care of dental pulp and the nerves of the tooth. From the patient’s perspective, these are the dentists who perform root canals, saving teeth, said Dr. Deborah Foyle.

“This is the branch of dentistry concerned with the form, function, injuries to, and the diseases of the dental pulp and the tissues around the root of the tooth,” Foyle explained. “Endodontics plays a key role in keeping the dentition in a physiologically functional state for the maintenance of oral and systemic health.”

Oral and maxillofacial pathology: Oral and maxillofacial pathology focuses on diseases in the head and neck region. The pathologists work to identify the causes, processes and effects of said diseases.

“Oral pathologists are engaged in three major activities: education, research and service,” said Dr. Victoria Woo. “This includes the microscopic diagnosis of pathologic processes and clinical treatment of patients with disorders of the orofacial complex. Our role is to provide the diagnostic link between dentistry and the health professions with a particular focus on bridging oral and systemic health.”

Oral and maxillofacial radiology: Oral and maxillofacial radiology also focuses on the head and neck region, with a specialty in collecting and interpreting data gathered with radiant energy (such as X-rays). Dr. Madhu Nair explained that an oral radiologist must have knowledge of normal anatomy; the causes, processes and effects of disease; and how such diseases can alter the head and neck region. They must also have extensive knowledge of the effects of radiation, magnetic fields and imaging agents, plus know how to best to use them with minimal risk to patients and themselves.

“Practice of the specialty deals with five areas,” Nair said. “Determining appropriate imaging investigations; advising on radiation protection, hygiene and safety; interpreting diagnostic imaging studies and preparing written interpretations and consultative reports; working with medical radiologists on and maxillofacial cases; and communicating effectively with colleagues and critically evaluating the scientific literature to maintain standard of care.”

Oral and maxillofacial surgery: Oral and maxillofacial surgery, as the name implies, covers the surgical aspects of treating problems in the head and neck region. This can include dental extractions, implant placement, tumor treatments, facial trauma reconstruction or corrective jaw surgery. Beyond medical well-being, OMS also plays a vital role in the quality of life of the patient and addressing functional or aesthetic concerns related to oral and facial health. This is a specialty that often involves significant collaboration with other medical fields, as the head and neck region is a complex part of the body.

“Dentally, it addresses complex dental conditions that require surgical intervention beyond the scope of general dentistry,” said Dr. Likith Reddy. “Medically, OMS is essential in managing conditions that affect the oral and facial regions. Overall, the field of oral and maxillofacial surgery serves as a critical bridge between dentistry and medicine, addressing a wide range of conditions and providing essential surgical expertise to enhance oral and facial health.”

Orofacial pain: Orofacial pain is a specialty that deals with the diagnosis, treatment and management of pain disorders in the head and neck region. These include temporomandibular muscle and joint (TMJ) disorders, problems with jaw movement, headaches, sleep disorders or neuropathic and neurovascular pain disorders.

“The specialty of orofacial pain fills the gap between dentistry and medicine in the diagnosis and management of disorders that are not well taught in dental and medical undergraduate and graduate programs,” said Dr. Steven Bender. “Many patients go from provider to provider seeking relief. It is especially important to teach our dental students about these disorders and the specialty of orofacial pain to help minimize the well-intentioned but misguided care these, often desperate, individuals receive.”

Orthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics covers the diagnosis and treatment of misalignments of the teeth and jaw. Orthodontists straighten teeth with braces or corrective appliances, and sometimes surgery. Poorly aligned teeth and jaws, or malocclusion, can lead to tooth decay, gum disease and difficult or painful chewing. Orthodontics specifically covers how to safely move teeth into proper position, while dentofacial orthopedics addresses the teeth, jaw and face.

“Orthodontics and dentofacial orthopedics is a dental specialty that includes the diagnosis, prevention, interception and correction of the malalignment of teeth and jaws,” said Dr. Larry Tadlock. “In providing orthodontic treatment for all ages, the school is providing a needed service for the community, enhancing the lives of those patients.”

Pediatric dentistry: Pediatric dentistry is a specialty that focuses on dental care for youths, typically 18 years old and younger, and for special needs patients. These specialists are essentially general dentists for children, looking for cavities, making sure teeth are growing in properly and keeping an eye out for other oral health problems. Dr. Alton McWhorter said an important part of this specialty is giving kids good experiences with dentists, so they grow up without a fear of the dentist office and will be good patients in their adult life.

“We get to do all of the things in general dentistry for the most part – fillings, extractions, that sort of thing – but the smaller patients can be trickier to work with,” McWhorter said. “It’s just an easy transition from us to a general dentist. We’ve trained them to be good patients. They’ve had good experiences prior to that, and they can go on and be a good patient for someone else.”

Periodontics: Periodontics focuses on gum diseases and the bones of the teeth. This involves treatment of gingivitis (inflammation of the gums) and periodontitis (gum and bone disease).

“These supporting tissues [of the teeth] include the gums, bone and the periodontal ligaments that keep the teeth in the bone,” Foyle said. “Periodontists are also responsible for the maintenance of the health, function and aesthetics of these structures and tissues. Without a healthy periodontium (gums), the teeth will fall out.”

Prosthodontics: Prosthodontics focuses on missing or deficient teeth, often utilizing replacements. Prosthodontists repair natural teeth when they can be restored and replace the ones that cannot. If replacement is required, dentures, crowns or permanent prosthetic devices are utilized. This specialty also involves serious collaboration with other specialties and sometimes other medical fields, depending on a patient’s needs. Patients could need a prosthodontist for a variety of reasons – genetic defects, trauma causing the loss of teeth, or treatments for other diseases causing the loss of teeth.

“Prosthodontists manage patients with complex dental needs and provide care with the use of evidence-based practice,” said Dr. Dimitrios Kontogiorgos. “To successfully manage these complex treatments, prosthodontists must effectively collaborate with all members of the dental team. This can only be achieved by adhering to strong ethics, integrity and a commitment to patient-centered care.”

Texas A&M School of Dentistry currently does not offer education in two specialties, dental anesthesiology and oral medicine. However, García said they are looking into the feasibility of adding these programs in the future.

García also added that the school offering so many specialty training programs is a benefit to all students, even those who do not specialize. By learning dentistry in an environment with so many specialties, students can better learn what each one covers and when a patient might need the care of a specialist, she explained.

“We’re one of the few schools that represent the majority of dental advanced education programs,” she said. “We’re exploring our options [to add the two other specialties]. Each new program requires an investment, and we need to be able to recruit top-quality people. I think the fact that we have 10 well-established programs with years of rich history allows us the ability to recruit faculty to these programs.”