As with serving good scotch . . . I’m going to give it to you straight. Webster’s dictionary defines an expert as someone “having, involving, or displaying special skill or knowledge derived from training or experience.” When we graduated from our professional training programs, we were considered experts in our respective disciplines. I was an expert in general dentistry. Through training and clinical exercises, I had developed the skills to evaluate and treat the majority of routine dental maladies to a predetermined level of competency. I could do an acceptable history, examination, and treatment plan, and perform a variety of therapies to the soft and hard tissues of the oral cavity and related structures. To present myself to the general public as an expert in the dental profession, I was required to demonstrate a predetermined competency level in academic and clinical arenas. I took national boards to demonstrate my academic level of accomplishment and a regional board to demonstrate my clinical proficiency to a body of my peers. After satisfying those exercises, I was granted the right to practice. But that is not the end for practitioners who wish to emphasize or limit their practice to a specific area of dentistry. These individuals must focus on advanced education in their disciplines of choice. We call these people specialists, which Webster defines as “one who specializes in a particular occupation, practice, or branch of learning.” To become board certified in their discipline and be called specialists, they must demonstrate a predetermined level of proficiency, the substance of which is determined by specialists currently practicing in the field. These panels or peer groups determine what is contained within the written examinations and in most cases, evaluate oral case studies that demonstrate a candidate’s level of clinical proficiency. These practitioners do not make their claim to specialist status unsubstantiated. Only after demonstrating their proficiency to their peers are they so entitled. The arena of craniofacial pain has come a long way since my first introduction in the mid 1970s, and its development has not been without growing pains. In the beginning, ours was regarded as a pseudoscience with little academic support and clinical experience as the only teacher. In the ensuing years, it is astounding to see the volume of scientific evidence that has developed to support our methodologies and place our discipline alongside the other recognized areas of modern dentistry. Excellent organizations have developed to foster education and research. Journals, like CRANIO, are available with an abundance of peer reviewed information and studies. Many dental schools now embrace this discipline, with a department or sub-department dedicated to this arena, and new texts are constantly being introduced. For those already in practice, there are now a number of training programs through various institutions and organizations to supply advanced training in the area. Although attempts have been made to define specialty status for the discipline of craniofacial pain, the ADA has turned a blind eye and a deaf ear to the overwhelming evidence that specialty status is necessary. As a result, patients are left with the alternative of deciding for themselves who is an expert in their community when seeking help. When a practitioner limits or dedicates his or her practice to a particular discipline, it is all too often assumed (and logically so) that he/she is an expert and as such, he/she is frequently perceived as a specialist in the area. For better or worse, most patients are given to assume that a doctor possesses the training and experience necessary to adequately care for them, solely on the basis of the diploma on the wall. In reality, a patient has no way of determining what type or how much training the doctor has had in the discipline. It is the opinion of this editor–and I’m going to give it to you straight–that anyone who treats beyond a basic level in the area of craniofacial pain, and who is perceived to be an expert in their community, should make the effort to demonstrate his/her level of expertise to a panel of his/her peers in the area. The American Academy of Craniofacial Pain (AACP) offers a fellowship level of membership. This level requires significant post graduate studies, completion, and documentation of treated cases, an exacting written examination, and oral case presentations and defense of those cases. The Ameican Board of Craniofacial Pain requires standards beyond fellowship status for certification both in training, completed cases, and case presentations. The American Board of Orofacial Pain requires successful completion of a rigorous written examination before the status of diplomate is conferred, and the International College of Craniomandibular Orthopedics offers a fellowship and masters program to their members. What do all of these organizations and boards have in common? They all believe, profess, and require that an individual be tested to a predetermined level of competence. That level of competence demonstrates knowledge and understanding well beyond dental school education and, as such, is acknowledged by a body of peers in the discipline. In other words, if you want to be considered an expert . . . prove it! Our patients have the need and the right to know that their doctor has taken more than a weekend wonder course in TMJ when they seek treatment. Our patients need the tools necessary to make an informed decision as to the level of competency of an individual in which they will place their trust, confidence, and very health. The area of craniofacial pain and temporomandibular disorders, although young, has reached a level of maturity where it needs to start acting like a grown up. Only then, will those of us who have committed ourselves to this exacting discipline of dentistry get the respect, trust, and acknowledgement that are necessary and deserved.
Gerald J. Murphy, D.D.S.
Grand Island, NE
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