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The Future of Endodontics and the Endodontic Specialty—What is the Reality and What is “Our” Role?

“There will be very few jobs for life, much less security, and very little predictability. There will be an emphasis instead on being able to learn, develop, and adapt rapidly as new roles and tasks arise” — Richard Suskind 

It is sometimes difficult to move forward when the memories of the recent past are still fresh in our minds. As we move from 2022 to 2023, I give pause to contemplate and take account of my own personal tribulations and accomplishments and reconcile how I will use my experiences to guide me into a productive and meaningful future. Similarly, I look back upon the thoughtful progress our organization has made, and how it will potentially affect our future not only as an association, but as the driver of endodontic innovation, education, and patient care. I am proud of our progress, but also realize that we have more work to do, more problems to solve, and that our role as stewards of the endodontic world is never ending. And even though I am concerned for the future of our specialty, I am confident that with our bright and resolute volunteers, staff, and members we are up to the challenge. 

Each morning I begin my day by reading the AAE Connection Discussion Open Forum Digest. As a clinician I appreciate the incredible cases our members treat and aspire to do work which matches the ambitious standards which they set. As an educator I learn new techniques and philosophies which contribute to my own teaching and curriculum. But as a leader in our organization and our specialty, I gain great insight as to the opinions and concerns of our members. I see their great passion and frustration for the direction and future of endodontics as they look for guidance and intervention from our association. As a clinician, as an educator, and as a leader I too share these important and valid concerns. 

In a recent post on Connection, a member posed a rhetorical question— “Should I have done a mini-residency instead (of an advanced endodontic residency)?” Contained within the ensuing narrative was a detailed account of a “mini-residency” in endodontics which “promised that participants would leave the 4-day experience armed with the skills to treat all endodontic cases”. Acknowledging that his own endodontic residency involved two years of specialty training, and that his current level of expertise took nine and a half years of clinical experience to develop, his rhetorical yet sarcastic inquiry initiated a conversation about the appropriateness of these type of claims, how they affect our mission as endodontists and as an association, how the dental world may fuel their existence, and how the public might be impacted in the long run—certainly valid concerns. 

I believe that as endodontists we are all aware of the existence of these courses, their various claims as they pertain to clinical training, and their inability to replicate the advanced training one receives in a CODA approved endodontic residency. They are worrisome and often offensive. However, the conversation that ensued, and which attempted to verify the reasons and remedies for these types of courses, brings into question the roles and responsibilities of our association. Factors such as dental school class size, student debt, insurance reimbursement, lowering of dental school competency standards, and the emergence of corporate dentistry were all hypothesized as the potential causes. And alumni pressure on dental schools and complaints to dental boards were offered as remedies. Yet other posters offered opinions that the AAE had fallen short by its failure to enforce the Case Difficulty Form as a standard record of care, and that corporate dentistry has conspired with dental schools to increase class sizes to flood the market with cheap labor.  

Let us take a critical look at these factors. Most dental schools operate primarily on their tuition base, and private and alumni contributions, although well-meaning, account for merely a small portion of operating revenues. For this reason, changes to class size or tuition are unlikely to happen, despite the questionable need for more dentists. Any mandate to reduce the cost of dental education will undoubtedly be accomplished by reduction of overhead, which will include contraction of dental faculty units. This will affect the quality of dental education and the reduction of requirements and competencies. Dental schools will continue to push the notion of the “Super Generalist” to justify the inflated cost of dental school and to support the notion that their graduates will have the ability to make a living once graduated. Simultaneously, student debt will rise, putting extreme financial pressure on graduates and significantly affecting the ethical decisions they make once in practice. This will ultimately affect the quality of dental care in our communities. Those practitioners that are so inclined will seek instruction via “mini-residencies” which neglect the value of real specialty residencies, harp on the “ease” of the procedures we specialists do, fill the gaps left by our dental schools, and often substitute technology for knowledge and experience. This is truly a complicated, concerning, and multifactorial problem. 

So, what is our role in all of this? I am sure that we would all wish that there was an easy fix, and that we could impose mandatory standards which would be universally accepted and automatically adhered to. But that is neither possible nor realistic. As endodontists we are aware of the rigors of the programs we have attended, the science which supports what we do, the difficulties of delivering excellent endodontic care, and the deficiencies of the weekend courses which make false claims. We must shamelessly, unabashedly, and vigorously promote ourselves in this regard, in our communities, at our local dental societies, in our study clubs, and to the public. The AAE must continue to develop resources which set standards, describe the value of those standards, and avidly explore the interface between science and technology. We must grow our advocacy efforts, especially on a legislative level, and continue our public facing campaigns which extol our training, tout our expertise, and emphasize the superiority of what we do. Endodontic educators in our dental schools must be vocal and steadfast and make administrators aware of the benefits of specialty treatment, the limitations of predoctoral dental students, and the dangers and disservice of delivering substandard endodontic care. 

Rest assured, the American Association of Endodontists cares about these issues. And although in most cases we do not have the authority or power to mandate any policy, we will continue to fight for the existence of quality specialty endodontic care (performed by endodontists) and the health of patients around the world. And yes, there is great value in the education we receive and the treatment we deliver.