A New Dental Specialty in Canada

The pathway leading to specialty recognition for dental anesthesiology here in North America (the US and Canada) has been long and winding. Canada was actually first to have dental anesthesiology formally recognized as a specialty, although that recognition did not extend nationally and was limited to only the province of Ontario. In 2004, the Royal College of Dental Surgeons of Ontario (RCDSO) identified dental anesthesiology as a potential specialty and circulated a proposal for recognition to various stakeholders. The RCDSO ultimately determined that recognition of dental anesthesiology was in the best interest of the public, approved the proposal, and forwarded it to the Ministry of Health and Long-Term Care. As a result, dental anesthesiology was formally recognized as a dental specialty in 2007 within the province of Ontario.More recently, efforts to expand dental anesthesiology's recognition beyond Ontario have gained significant traction. In February 2023, the Canadian Dental Regulatory Authorities Federation sent notice to the Canadian Academy of Dental Anaesthesia (CADA) that their application for specialty recognition submitted in late 2021 had been approved. This decision has paved the way for specialty recognition to expand into other provinces. Canadian provinces and their dental regulatory authorities, similar to their US state and state dental board counterparts, are now tasked with determining how to implement their newly approved dental specialty by way of provincial legislation amendments. In short, each Canadian province decides for itself how to incorporate dental anesthesiology into its provincial laws and regulatory rules. Additional ongoing steps in solidifying dental anesthesiology's place as a recognized dental specialty in Canada include formalizing accreditation standards for training programs and board certification nationwide. This will involve expansion of the Commission on Dental Accreditation of Canada to include standards for specialty training in dental anesthesiology and working with the Royal College of Dentists of Canada (RCDC) to establish a National Dental Specialty Examination in anesthesia as part of the pathway for specialty recognition licensure. Canada requires all dentists who complete specialty training to pass their respective RCDC exam prior to registering (ie, advertising) as a recognized specialist. Although there is still much work to be done, hats off to the CADA leadership and the application cochairs for their success thus far!The roots of dental anesthesiology as a specialty of dentistry in the US trace back to 1953 and the establishment of the American Dental Society of Anesthesiology (ADSA), which created a preliminary specialty application that was ultimately abandoned in the '90s because of political pressures within the organization. The American Society of Dentist Anesthesiologists (ASDA) picked up the ADSA's torch and submitted 4 specialty recognition applications to the American Dental Association (ADA), all of which passed every step along the way minus the last— approval by the ADA House of Delegates (1994, 1997, 1999, 2012).1 In response to mounting pressures, the ADA altered its specialty recognition process in 2017 by forming the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSCB) and effectively bypassing the ADA House of Delegates. The ASDA subsequently submitted a fifth application in 2018, which was evaluated by the newly formed NCRDSCB and formally approved on March 11, 2019, cementing dental anesthesiology as the 10th specialty recognized by the ADA. The American Dental Board of Anesthesiology was recognized a year later as the new specialty's official certifying board.2In the years following the ASDA's successful application, the ADA has added 2 more recognized dental specialties, orofacial pain (2020) and oral medicine (2020), along with their respective certifying boards, to bring the number of dental specialties in the US to 12. There are now a total of 10 recognized dental specialties in Canada following the recent announcement of dental anesthesiology as the newest to gain such recognition.What does the future hold for dental specialty areas? Will we continue to see the development of novel emerging dental specialties? It seems certain that dentistry will continue to grow in response to diagnostic and treatment innovations and changes in patient needs and demands. In 1963 the ADA recognized 8 dental specialties, and it took 36 years and another 20 years for it to recognize the 9th and 10th, respectively (oral and maxillofacial radiology, 1999; dental anesthesiology, 2019). In contrast, medicine had 4 recognized medical specialties in 1932, but now the American Association of Medical Colleges lists over 135 medical specialties and subspecialties.3 If dentistry continues to follow the pathway set by our medical counterparts, the development of new dental specialties and possibly even new subspecialties appears likely. Per the NCRDSCB4 website, “specialties are recognized in those areas where advanced knowledge, skills and training are greater than those taught in a predoctoral dental education program and are separate and unique from the other specialties to maintain or restore oral health.” Areas of interest with strong potential at this time could include special needs dentistry, implantology, laser dentistry, sleep dentistry, and possibly even geriatric dentistry. Looking to the future, one could even foresee dental genetics being another possibility. Prospective subspecialties for dental anesthesiology could include fellowships in simulation or chronic pain. Perhaps oral and maxillofacial surgery will end up developing another formal subspecialty such as temporomandibular joint surgery, allowing dedication to that singular area of interest.It is clear, regardless of where dentistry goes next, that the redesigned process for specialty recognition in dentistry established by the ADA and the NCRDSCB has enabled dentistry within the US to continue marching forward and help stave off stagnation. The same can be said for Canada as well as Japan and a few other countries around the world. The trend of new dental specialties may be worrying for some, especially those who feel such changes may encroach upon their practices. However, it is your editor's opinion that dentistry must continue to innovate, adapt, and respond to ever-changing internal and external pressures. Developing emerging areas of interest into formal dental specialties and subspecialties is simply a much-needed part of that critical process. Such change should be celebrated for what it is: another step forward for dentistry as a whole.

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