Dentists with specialist interests have always been an integral component of our profession. Specialist practice was a way for practitioners to indulge their personal interests and improve their skills, giving them the range of expertise and confidence to handle some of the most complicated cases out there.
Nevertheless, specialisms take time. Endodontics now takes at least three years and, along with a house job, membership exams and the initial BDS degree, brings the number of years in training up to nine. Those nine years won’t be cheap and now the exclusivity specialists may have previously had upon completing their training has come to an end; technology, investment and training has made most treatment modalities accessible to all.
General dental practitioners are achieving excellent results in a wide variety of different fields and certainly in endodontics, with the latest NiTi files and dramatically cheaper microscopes. Indeed, dental technology has advanced to the stage where specialist skills are at risk of losing their monopoly in many cases. GDPs are now capable of achieving high levels of clinical success in fields that once would have required specialist attention – and they can do so with a fraction of the training that would been necessary a couple of decades ago.
Dentistry is becoming more generalised and it’s not immediately the case that a practitioner with a specialism can achieve better results than one who hasn’t. So, the question is: are specialisms still worth it? To provide an answer we need to look at a number of different factors. First and foremost, we have to understand that experience is key. I have seen some outstanding cases from many of my referring GPDs but often some which, in hindsight, they should never started as they did not have the range of expertise to call upon should anything have gone wrong. Indeed, many specialists are referred cases that require treatment and while this is not ideal for both the health of the patient and the reputation of the GDP who tried and failed to provide appropriate treatment, it does highlight the importance of proper training.
We must also appreciate the importance of specialists when it comes to training the next generation of professionals. Without the knowledge that our periodontists or endodontists can impart, we may encounter a dearth of expertise in the future. Indeed, it is a sobering thought that some graduates pass out of dental school without having gained any practical endodontic experience at all, completely unprepared for general practice. On top of all this we must consider how dramatic the increase in dental litigation has been in the last few years. The number of GDC hearings has gone through the roof – and, as a result, many practitioners are simply too scared of legal repercussions to perform certain treatments.
So, I believe the role of dental specialists is far from over. We remain vital to the provision of exceptional patient care, and I think we always will. We may never quite get things back to the way they were, but that is not the nature of progress and I do feel that, as a profession, we are progressing. It may seem bleak at times for us endodontosauruses, but I, for one, am not ready to go extinct just yet.