By Terryl A. Propper, D.D.S., M.S.
I am at the end. the end of my year as president of the AAE.
It has been a challenging year, but a rewarding one. My mantra has been “onward and upward,” a battle cry adopted as we transitioned from an exiting executive director to our acting executive director, Ms. Trina R. Andresen Coe. I have called on our staff and Board of Directors to move forward with focused determination, pride and strength. And soon, we will do so under a new executive director, Mr. Kenneth J. Widelka, who will bring energy and leadership to the AAE.
Over the past year, the Board has made fearless and courageous decisions in the best interests of our members and this Association. Our focus and direction have been clear, and our actions have been expedient, unified and thoughtful.
We have many challenges ahead of us and threats that continue to dominate our discussions about the future of endodontics. These are a few issues that I believe need our attention.
Competency of graduating dental students to diagnose and successfully treat a tooth requiring endodontic treatment
The Special Committee on Predoctoral Endodontic Education has been charged with investigating the current educational requirements for performing endodontic diagnosis, treatment planning and treatment, and establishing minimum competencies for predoctoral students to be considered by all educational institutions.
Is it possible to expect a dental student who has performed a minimal requirement, often on an acrylic tooth, to be able to perform acceptable treatment on a live patient? Do the current competencies for predoctoral endodontic education deem a graduating dentist competent? Do predoctoral students have the abilities to properly select cases appropriate to their levels of knowledge, experience and expertise? Are the AAE case selection criteria being used to train predoctoral students to assess which teeth are within their skill sets? This is not a condemnation of our predoctoral curricula or teaching standards—it is a call to action to re-examine curricula and CODA standards in need of revision.
Dr. Linda G. Levin, AAE president-elect and former chair of endodontics at the University of North Carolina at Chapel Hill, is a passionate advocate for teaching predoctoral students at the same level as graduate students, not to a lesser standard. If predoctoral students are not taught to “see” with microscopes, then they cannot be expected to know what they have missed. This is an issue that Dr. Levin will continue to pursue during her year as president.
Lack of mortality studies for teeth lost to inadequate diagnosis or treatment
We have no hard evidence showing the outcomes of teeth treated by general dentists versus those treated by endodontists. These “outcome” studies are crucial to making the case for the need to refer to a specialist.
There are no consequences for dentists who consistently perform poor-quality endodontics. The tooth is replaced with an implant and that is the end of the story. This must change. Extracting teeth that could—and should—be referred to an endodontist for a second opinion is now the norm, to the detriment of the unsuspecting patient.
The AAE Board has been discussing approaches to change this “new norm,” and we continue to investigate the best actions to take to protect the public.
The New Jersey Association of Endodontists has taken action on this issue by notifying the New Jersey State Board of Dentistry that their lack of oversight and lack of consequences for inadequate endodontic treatment is without conscience. In a letter to the Board, the NJAE urges them to fulfill their obligation to protect the public by holding general dentists accountable when their treatments fail. I applaud NJAE President Dr. Manuel Gonzalez, NJAE Immediate Past President Dr. Lawrence J. Sheer, AAE Past President Dr. Marc Balson and the NJAE Board of Directors for taking the initiative to change the current system.
Minimal surgical training in many postgraduate endodontic residency programs
Many graduate programs are sending residents to private surgery courses to gain needed surgical training and skills. Surgery is one of the skill sets that distinguish endodontists as experts in our field, and lack of surgical training in postgraduate programs weakens our stance as specialists.
Increased student debt
Student debt has a massive effect on career choices for graduating residents, both in choosing a practice model and in selecting cases to treat. The need for immediate income drives career choices. The lack of opportunities for associateships and practices for sale, as well as the high cost of opening a private practice, have resulted in students seeking alternative practice models. Dental service organizations and group practice models are gaining popularity, and it appears that this trend will continue for the foreseeable future.
Last May, the AAE unveiled a state-of-the-art online career center, which, in addition to allowing quick and easy job searches, includes all-new career resources to help residents and endodontists as they consider employment opportunities. We provide the questions you should be asking when determining if a practice setting or job offer fits with the way you want to practice endodontics.
Increased need for clinical research
With the advent of exciting new developments in basic science, regeneration and tissue engineering, there will be a renewed focus on funding for clinical research and resultant outcomes. The AAE Board will be discussing this topic further at its upcoming meeting in San Francisco and will be considering ways to strengthen research and produce valuable outcomes data.
With threats and challenges, however, come hope and renewal. The AAE Board has made great strides in several areas over the past year to address concerns in our specialty and in our Association.
Environmental scanning is essential to understanding the landscape of practice for our members and to anticipate and prepare for ongoing change. Dr. Robert S. Roda, AAE immediate past president, was instrumental in bringing environmental scanning into the mainstream of the AAE thought process. In November, a collaboration of AAE standing committees provided the Board with a comprehensive scan of the dental insurance market as well as the impact of student debt and new practice models on our members. Next month, Dr. Levin, Dr. Ali Behnia and I will be bringing concerns of the AAE to the table in a meeting with dental directors of the largest health insurance plans.
Young member involvement
The AAE Board identified Board composition as a priority through its self-evaluation process in 2014 and 2015, noting that there were gaps in the demographic makeup of the Board, as compared to the AAE membership. Identifying pathways to leadership for younger members quickly became a primary focus for the Board. When I was installed as president in 2015, I emphasized my desire to integrate young members into leadership positions.
Nearly every standing committee of the AAE has a resident or new practitioner member. In 2015, the AAE welcomed the chair of the Resident and New Practitioner Committee, Dr. Melissa Marchesan, to a seat at the Board table, and the Foundation for Endodontics has nominated Dr. Marchesan as their New Practitioner Trustee for a second term beginning in 2016. This opportunity to observe and participate in governance at work allows our younger members insight into how AAE policy is set and how initiatives are moved forward.
The Foundation has established REACH, the Resident Expert Advisory Council, which is made up of 10 endodontic residents selected through an application process. These residents act in an advisory role to the Foundation for Endodontics and offer suggestions to aid the Foundation in connecting with residents and educating them about the organization’s valuable contributions to endodontic education and research.
REACH suggested that the Foundation look into sponsoring an access to care trip that would give residents the opportunity to visit underserved areas and perform root canal treatment on teeth that would otherwise be extracted. The Foundation pursued this idea and recently sent two residents, Drs. Victoria Ball (Medical University of South Carolina) and Ryan McMahan (University of Michigan), on the pilot trip to Treasure Beach, Jamaica, along with Foundation Trustee Dr. Daniella Peinado as their mentor. The merits and success of this program will be evaluated by the Foundation Board of Trustees going forward.
I am also excited to announce that the AAE will be holding a new leadership development program in 2017, focusing on AAE members in practice 10 years or less. Two representatives from each AAE district will be selected to participate through an online application process that opens May 1. More details on this dynamic, interactive program will be available soon.
When I was president-elect, I was approached by a resident who expressed the desire for opportunities to discuss cases, present clinical challenges and network with colleagues online. Similarly, our Resident and New Practitioner Committee, as well as the Foundation’s REACH committee, have expressed that online networking and resources are high priorities for endodontists. When Mr. David Reid joined the AAE staff as the assistant executive director for information technology, he began the process of researching and developing an online communities platform that will provide resources for all of our members to enjoy.
The AAE will be expanding its IT staff to allow us to develop and manage the technical aspects of an online communities platform, as well as redesign our website and ensure its continued performance.
While the AAE and the specialty have made great transformations over the years, the AAE logo has changed very little. The Board approved a rebranding initiative to develop a contemporary and professional identity for the AAE. With the electronic age moving at warp speed and an increasing number of members—and patients—accessing AAE information on mobile devices, it is more important than ever that the AAE has a brand that is current and can be used in many applications. The new AAE brand will be launched at AAE16… you will just have to attend to be part of the excitement as we reveal the AAE’s new look!
As I approach the end of my presidency, I recognize that the AAE is fortunate to have leadership with purpose and a clear vision for the future. I leave the AAE in capable hands, with people who love our Association and our specialty and put the needs of our members first.