Periodic Review Cover · Conference in 2001, Enhancing Esthetics with Periodontal Plastic and Reconstructive Surgery Specialty Conference in 2002, co-sponsorship of the Academy of

COUNCIL ON DENTAL EDUCATION AND LICENSURE 2011 PERIODIC REVIEW

OF DENTAL SPECIALTY EDUCATION AND PRACTICE

PERIODONTICS

AMERICAN DENTAL ASSOCIATION Chicago, Illinois

Periodontics – Page 2

NAME OF RECOGNIZED DENTAL SPECIALTY:

PERIODONTICS

NAME OF SPONSORING DENTAL SPECIALTY ORGANIZATION: American Academy of Periodontology

NAME OF RECOGNIZED CERTIFYING BOARD: American Board of Periodontology Information submitted by: Name: Samuel B. Low Title: President Address: 737 N Michigan Ave, Suite 800, Chicago, Illinois 60611 Email address: [email protected] Phone number: 352.273.6580 Fax: 352.273.6578

3/18/10 _____________________________________________________________ (Signature – Organization’s President) Date of Submission


Purpose of the Review

In 1992, the ADA House of Delegates adopted Resolution 144H-1992 which directed the periodic (every 10 years) review of dental specialty education and practice beginning in 2001. In 2001, the Council on Dental Education and Licensure forwarded its recommendations from this review to the House of Delegates for its consideration. The 2001 House accepted the report and adopted the following resolutions:

20H-2001 Resolved, that the appropriate Association agency continue to conduct a periodic review of dental specialty education and practice at ten-year intervals, and be it further Resolved, that the next periodic review of dental specialty education and practice be presented to the 2011 ADA House of Delegates.

21H-2001 Resolved, that the sponsoring dental specialty organizations and ADA recognized dental specialty certifying boards be urged to continue to monitor the number of specialists who are board certified and identify ways to increase the percentage of specialists who see and achieve board certification in light of dental specialty faculty shortages and the Commission on Dental Accreditation’s standard requiring that program directors of advanced dental specialty education programs be board certified.

In carrying out the House directive for such periodic reviews, the Council hopes to gather strategic information that will be of value to the Association, the specialty organizations, the profession and the pubic. The review should clearly focus on changes occurring within the specialty education and practice environments, e.g., disease trends, technology, scope of practice, program enrollments, and demographics. It should address the current environment as well as potential trends for the future and how these will impact the public and the profession. The Council believes that the input and self-assessment of each of the specialty organizations is essential in providing an accurate report to the House of Delegates. Instructions to the Specialty Organizations: Each specialty organization is being provided with all information and data available from ADA agencies relevant to the review. A copy of the organization’s 2001 submission is also provided for reference. Where existing data is available, specialty organizations are asked to analyze the data and comment on trends that have and/or may impact the specialty and the profession. The Council seeks succinct but thoughtful responses to study items to provide a broad assessment of key issues. Each item includes a suggested length for a response. However, the length and nature of responses may vary according to the unique characteristics of the specialty. The current environment as well as potential trends for the future and how these may impact the public, the profession and practice should be addressed.


American Academy of Periodontology

2011 Periodic Review of Dental Specialty Education & Practice

General Information

1. Provide a copy of the sponsoring organization’s strategic plan. Provide a brief summary highlighting specific areas of the strategic plan that the specialty wishes to call to the Council’s attention as it relates to this review. Briefly comment on efforts the specialty has undertaken to promote quality in the discipline over the past 10 years (e.g., continuing competence, parameters of care, continuing education). (suggested response - up to one page)

The past 10 years have resulted in exciting new developments for periodontics. New understandings and advancements in science and technology have expanded the discipline’s knowledge-base and enhanced how the Academy communicates that knowledge to periodontists, dentists, physicians, and other health care providers. The Academy continues to take a leadership role in disseminating current scientific and clinical information, sponsoring continuing education, and promoting the public’s awareness of the relationship between periodontal health and overall health.

The mission of the Academy is to provide members the expertise and resources to enhance the evaluation and diagnosis of oral conditions; assessment of risk for future disease; and delivery of specialty periodontal non-surgical, surgical, and medical care for their patients. The Academy fulfills this mission through leadership, advocacy, education, awareness, and research. A copy of the Academy's strategic plan supporting this mission is appended. Of particular relevance to this review are activities in the areas of science, clinical advancement, and continuing education.

The Academy continues to be the authoritative source for identifying, analyzing, interpreting, summarizing, and publishing scientific and clinical advances related to periodontics. This is accomplished through publication of the Journal of Periodontology and its supplements, development of statements and position papers on timely scientific and clinical topics, and hosting conferences and workshops. As a scientific leader, the Academy hosts workshops/symposium on scientific and clinical topics involving world-renowned experts in periodontics and related disciplines. Conferences include the Periodontal-Systemic Connection State-of-the-Science Symposium co-sponsored with National Institute of Dental and Craniofacial Research (NIDCR) in 2001, the Workshop on Contemporary Science in Clinical Periodontics in 2003, and the Inflammation Workshop - Inflammation and Periodontal Diseases: A Reappraisal in 2008, all of which resulted in publication of proceedings. The Inflammation Workshop led to the Journal of Periodontology/American Journal of Cardiology Consensus Meeting and publication of the consensus paper and clinical recommendations on periodontitis and atherosclerotic cardiovascular disease in 2009.


The Academy is the preeminent source for continuing education in the field of periodontics. The Annual Meeting provides in-depth and comprehensive continuing education courses on periodontal topics. In addition, the Academy offers specialty conferences on focused topics and co-sponsors conferences supporting interdisciplinary care. Collaborative conferences and topics addressed include the Periodontal Medicine: Clinical Practice and Practical Implications conference in 2000, the Interdisciplinary Care Conference in 2001, Enhancing Esthetics with Periodontal Plastic and Reconstructive Surgery Specialty Conference in 2002, co-sponsorship of the Academy of Osseointegration Annual Meeting in 2003 and 2008, the Optimizing Clinical Outcomes: The Perio-Ortho Relationship conference in 2006, co-sponsorship of the 8th and 9th International Symposium on Periodontics and Restorative Dentistry in 2004 and 2007, and the AAP/AAO Midwinter Conference: 2 Specialties, 1 Goal in 2009. Webinars have been offered on clinical and practice topics including dental implants in the esthetic zone, bisphosphonate therapy, and third party issues.

By providing quality continuing education opportunities, publishing scientific and treatment-based materials, maintaining a resource-filled Web site, and distributing fact sheets and patient education brochures, the Academy ensures that periodontists, dental colleagues, and consumers have the information necessary to make thoughtful, educated decisions regarding periodontal therapy. Landmark publications on etiology and disease modifiers such as genetically determined host responses, microbiologic influences, non-surgical therapy, surgical options including tissue regeneration, dental implants, and multi-disciplinary aspects of patient care have led to enhanced training guidelines and a robust continuing education effort.

Periodontics is poised to start the next decade of this century and the Academy looks forward to continuing its leadership role by tackling initiatives best accomplished by the specialty including publishing a periodontal disease risk assessment standard and definitive information on the comprehensive periodontal examination and re-evaluation, updating the Periodontal Literature Review document and creating an online glossary (2010), convening a workgroup to develop a consensus paper on periodontal disease and diabetes (2011), co-sponsoring the 10th International Symposium on Periodontics and Restorative Dentistry (2010), offering a specialty conference on the unique team approach to care between restorative dentists and periodontists (2011), collaborating on a conference with the American Association of Orthodontists (2012), and continuing collaboration with the Centers for Disease Control (CDC) on a surveillance system to determine the incidence and prevalence of periodontal disease.


2. Complete the tables below and provide overview comments on past and future membership trends forecast for the next 10 years. Comment on how changes in membership will impact public and the profession. (suggested response – up to two pages including the table)

MEMBERSHIP CATEGORIES

Periodontics

YEAR ACTIVE ASSOCIATE INTERNATIONAL LIFE-ACTIVE

STUDENT LIFE

NONACTIVE

2000 3884 327 1051 546

(voting) 988 174 (non-

voting)

2001 3938 322 1259 549

(voting) 1035 187 (non-

voting)

2002 3917 304 1328 552 1051 190

2003 3859 310 1676 561 1021 192

2004 3872 317 1687 597 1019 199

2005 3867 327 1733 660 998 219

2006 3849 321 1769 707 959 251

2007 3825 328 1869 769 972 251

2008 3768 311 1936 872 947 251

2009 3719 300 1968 918 929 264

The Academy does not collect data on member ethnicity. Gender counts, broken down by whether gender is known or unknown, are identified below.

MEMBERSHIP/Gender/Periodontics


STUDENT LIFE

NONACTIVE

M F M F M F M F M F M F

2000 3305 520 279 27 855 196 528 10 603 273 167 4

2001 3346 538 278 28 909 209 531 10 634 278 177 6

2002 3316 546 265 24 924 231 534 10 635 294 180 6

2003 3248 561 275 28 1171 294 543 10 641 280 182 6

2004 3224 589 277 30 1192 282 578 10 633 295 189 6

2005 3187 624 287 29 1233 285 639 12 606 302 209 6

2006 3146 643 275 35 1274 294 685 12 572 318 241 6

2007 3085 672 277 42 1354 308 745 13 584 339 242 5

2008 2980 710 261 41 1415 315 843 18 593 329 242 5

2009 2924 711 251 41 1447 328 886 20 565 345 254 6


MEMBERSHIP/Gender Counts Unknown


STUDENT LIFE

NONACTIVE

2000 59 21 0 8 112 3

2001 54 16 141 8 123 4

2002 55 15 173 8 122 4

2003 50 7 211 8 100 4

2004 59 10 213 9 91 4

2005 56 11 215 9 90 4

2006 60 10 201 10 69 4

2007 68 9 207 11 49 4

2008 78 9 206 11 25 4

2009 84 8 193 12 19 4

Membership Trends 2000 – 2009:

Over the past 10 years, the Academy’s membership numbers have remained constant with the exception of the Life Active, Life Nonactive, and International membership categories. The Academy has experienced substantial growth in the Life member category, reflecting the growth of periodontics as a specialty during the 1960s. Both the Active and Student member categories have trended slightly downward over the past 10 years.

The Active category showed a decrease from 2002 to 2003 as a result of the change in the membership status of Canadian periodontists. The Canadian Academy of Periodontology (CAP) formally requested on behalf of its members a change in membership status in the American Academy of Periodontology from Active to International due to the monetary exchange rate making dues payments more expensive for Canadians than American members. In 2002, the Academy’s voting members approved this proposal. Periodontists and dentists who reside in Canada are now classified as International members. However, Canadians in accredited periodontal programs are still eligible for AAP Student membership (for up to two years following completion of residency) and are then transferred to the International member category.

From 2000 to 2009, the International member category grew by 87%. This category continues to be the fastest growing member category. Today, International members make up 23% of the current membership compared to 17% in 2000. Residencies have attracted more international students over the past 10 years with many returning to their country of origin and retaining ties to the AAP. This is a result of the Academy's reputation as the international leader in continuing education in periodontics, the excellence of the Journal of Periodontology, and the Academy's ongoing efforts to conduct symposia and workshops of international interest.


Membership Trend Forecast 2010 – 2020:

Periodontics has experienced many exciting scientific developments related to inflammation and systemic health. Research printed in the Academy’s Journal of Periodontology demonstrated that inflammation may link periodontal diseases to other chronic conditions (e.g., heart disease, diabetes). In addition, periodontal research continues to make great strides in the development of innovative hard and soft tissue reconstruction techniques and products. The Academy expects these exciting developments will continue to attract dentists to periodontal specialty training.

As the baby boomers continue to reach retirement age, the Academy expects to see increased growth in the Life and Retired member categories and a slight decline in the Active member category. From 2002 to2009, the Life member categories have grown from 720 members to 1,182. The Academy anticipates that the number of Student members transferring to the Active category will not keep pace with the number of baby boomers reaching retirement. Based on current statistics, the Academy expects the International member category will continue to grow over the next 10 years.

Impact on the Public and the Profession:

The bulk of mild to moderate periodontitis is treated by general dentists. Periodontists continue to be integral in the treatment of individuals with severe periodontitis, those with significant medical considerations and any level of periodontitis, and the reconstruction of oral hard and soft tissues. The Academy does not anticipate any change in referral patterns over the next 10 years. Based on the anticipated retirement of babyboomer over the next decade, the Academy has some concern about the number of new periodontists who will be available to replace practitioners who retire. General dentists provide a variety of preventive and non-surgical periodontal therapies for much of the early to moderate periodontal diseases. Periodontists continue to be an integral member of the treatment team for those patients of high risk regardless of the level of disease and those patients with severe periodontal diseases. In addition, periodontists continue to bring clinical advancements in reconstruction of oral hard and soft tissue as well as continued development of dental implants to the profession.


3. Review the following summary of certification and examination data from the CDEL’s Annual Reports of the ADA-Recognized Dental Specialty Certifying Boards, 2000-2008. In collaboration with the recognized certifying board, provide overview comments on significant trends for the future. (suggested response - up to one page including the table)

CERTIFICATION AND EXAMINATION DATA: 2000-2008*

Periodontics 2000 2001 2002 2003 2004 2005 2006 2007 2008

Number Certified By Examination Through 2000-2008 1568 1629 1692 1769 1935

1935

2378

2550

2705

Number of Active Diplomates 2000-08

1384 1432 1492 1569 1710 1915 2111 2267 2381

Number of Acceptable Applications Received 2000-08

143 129 141 365 358 368 426 363 383

*Note: Above 2004 and 2005 are the same total Number Certified By Examination = 1935. In 2005 the total number certified by examination through 12/31/05 was 206. The 206 was not recorded in the CDEL report in the column labeled “Number Certified by Examination” through 12/31/05, however, it was recorded in all other areas of the report. The error was not realized until the following year’s report. In 2006 we recorded the 206 along with the newly certified by examination through 12/31/2006 of 199. We also made an adjustment and increased the total number certified an additional 38 to bring the Board’s records (number of certificates issued) and the reporting records in agreement to the total of 2378.

The number of periodontists certified by the American Board of Periodontology (ABP) has increased significantly over the past two decades. Two major changes in the board certification process have accounted for these increases. In the early 90s the ABP voted to allow cases submitted by candidates to have been completed in residency programs. Annual certifications increased from approximately 45 per year to 65 per year as many more candidates progressed beyond the Qualifying Exam to the Oral Exam, where submitted cases were a section of that exam. An even larger increase occurred in 2004 when cases submitted by the candidate were discontinued and protocols were utilized for the Oral Exam. Numbers of periodontists certified increased from 65 per year to close to 200 per year.

Initially, this large increase included many individuals in private practice who had not pursued board certification following completion of their training programs under the previous guidelines. Because of not being required to submit cases, higher numbers of recent graduates also pursued board certification immediately following completion of their programs.


At present, the ABP feels that applications to take the Qualifying Exam and, subsequently, the Oral Exam have leveled off and should remain fairly constant over the next several years. The large number of established practitioners who decided to pursue certification has dropped off and the ABP doesn’t anticipate large numbers taking the exam in the future. The ABP notes that the great majority of recent graduates apply to begin the process and that should remain constant in the future. The positive emphasis that the Academy has placed on board certification, peer pressure, and credentialing requirements of hospitals and state dental boards is expected to maintain the present application and certification statistics. At present, over 50% of Active and Life members of the Academy are board certified compared to 13% in 1990 and 30% in 1999.

4. In collaboration with the recognized certifying board, provide overview comments on the board eligibility requirements from the CDEL’s Annual Reports of the ADA-Recognized Dental Specialty Certifying Boards, 2000-2008. Please note or any changes and the impact on the specialty. If an eligibility pathway for internationally trained specialists is available, explain the process. (suggested response – up to two pages)

BOARD ELIGIBILITY REQUIREMENTS

Periodontics

Professional 2000 2001 2002 2003 2004 2005 2006 2007 2008

ADA or NDA Membership No No No No No No No No No

Specialty Society Membership

No No No No No No No No No

Education

Years of Advanced Education in Addition to DDS or DMD Degree

3 3 3 3 3 3 3 3 3

Experience

Total Years of Specialty Experience Including Advanced Education

3 3 3 3 3 3 3 3 3

Other

Citizenship Any Any Any Any Any Any Any Any Any

State Licensure No No No No No No No No No

Alternate Pathway to Certification (New Question beginning 2008)

No


The ABP eliminated the term “Board Eligible” for candidates passing the Qualifying Exam in 2009. The requirements for a periodontist to apply and take the Qualifying Exam have not changed over the past several years and it is anticipated that this will remain constant for the near future. As of 2010, the ABP will hold the Oral Exam once per calendar year. Presently there are two Oral Exam sessions per year. Adding additional examiners will accommodate the larger number of candidates at the one exam session. The ABP does not anticipate any changes to the number of applicants pursuing board certification because of this change. Additionally, the ABP has no plans to allow internationally trained periodontists to pursue board certification.

Of the professional requirements listed in CDEL’s Annual Reports of the ADA-Recognized Dental Specialty Certifying Boards 2000-2008, no changes in the eligibility requirements for periodontists to pursue board certification are anticipated by the ABP.

Beginning in 2008 the ABP instituted new requirements for recertification. In addition to continuing education credits and points for other scholarly activities, the ABP initiated the Self Study Recertification Program (SSRP), to be taken during the year that the Diplomate was required to recertify. This change introduced an active element to the recertification process. The SSRP is administered online and is convenient for the recertifying Diplomate. The recertification interval was expanded from three years to six years to accommodate the increase in CE points and credits and the new SSRP requirement. Although this process is not addressed in the CDEL report, it is an important aspect of becoming a Diplomate and in maintaining competence in the specialty and is therefore mentioned here. In addition, the plans for this new process were mentioned in the 2001 report for the Periodic Review of Periodontics Specialty Education and Practice.

5. List areas of major research changes and major technology advances over the last 10 years. Provide an overview comment on how these changes and advances have affected the practice of the specialty.

As periodontics is the branch of dentistry that studies the supporting structures of teeth, and diseases and conditions that affect them and their tooth replacements in the form of dental implants, several major advances in both research and technology have affected the practice of the specialty. Most notably, research has demonstrated that there exists a more significant relationship between the periodontal diseases and many systemic conditions than was ever conceived of previously. Importantly, this relationship has been shown to be bidirectional in that not only do systemic conditions influence the periodontium as had been known, but now it is known that periodontal disease significantly influences systemic health.

Secondly, research advances in bone metabolism (particularly osteoclastogensis) and in the immunological/inflammatory fields and the recognition of their relationship (osteoimmunology) has led to a paradigm shift in the pathogenesis of the periodontal diseases. While it had been appreciated that bacterial plaque initiate an infective process in the periodontium, it is now evident that it is the host response to that


infection that is just as or more important for the pathogenesis of the periodontal diseases. Thus, the initiation of the inflammatory reaction and how the host uses this natural physiological response to initiate connective tissue loss and bone loss around the teeth and implants pathologically have revolutionized considerations of therapeutic approaches to the periodontal diseases and their influence systemically.

The important implication of this research for clinical practice is that a new emphasis has been placed on establishing and maintaining periodontal health in patients. Significantly, these findings further support traditional mechanical biofilm removal with or without supporting adjunctive techniques. Thus, mechanical plaque and calculus removal non-surgically and surgically remain the bedrock of periodontal therapy and are further supported by the significant research advancements.

Another area of significant research and technological advancement has occurred in tissue regeneration. This area includes the development of protein-directed technologies (e.g., growth and differentiation agents, angiogenic molecules), molecular biological approaches involving gene and recombinant technologies, carrier and matrix development, cell therapy (e.g., mesenchymal and undifferentiated stem cells), and tissue engineering incorporating living cells and skin equivalents.

Another area that has involved major research and technological advancement is in the area of tooth replacement with root form endosseous dental implants. Significant advancements in the design, composition, surface characteristics, and understanding of diagnostics, collaborative treatment planning, placement, and restoration (in regards to materials, timing, and occlusion) all have directly influenced patient treatment and quality of life for patients suffering periodontal disease and tooth loss.

Lastly, the development of research reporting of bias has also significantly impacted the specialty in that research in general is being evaluated based on a hierarchy of potential bias such that randomized masked prospective controlled human clinical trials are viewed as the least biased research reporting. Systematic reviews and meta-analyses are all encompassed in this evidence-based approach, which has been adopted over the last decade. These advancements allow for more confidence in the evaluation of new techniques and devices used in periodontal practice.

This overview provides broad areas that have included major research and technological advancements in the field of periodontics that have or will directly impact patient care. More specifics of some of these areas are enumerated below:

Periodontal-Systemic Relationship

Evidence is accumulating that periodontal disease can be viewed as one of many chronic diseases of aging that share inflammation as a common denominator. For example, periodontal disease and rheumatoid arthritis have many features in common. Importantly, studies suggest that untreated periodontitis can be a significant risk factor for myocardial infarction, adverse pregnancy outcomes, stroke, and poor metabolic control of diabetes mellitus. Associations have also been found between periodontal disease and respiratory diseases, osteoporosis, chronic kidney disease, and as


mentioned, rheumatoid arthritis. As examples, periodontal pathogenic bacteria can be cultivated from cardiovascular atherosclerotic plaque and the resolution of periodontal inflammation has been shown to lower serum high sensitivity c-reactive protein levels, to improve vascular endothelial function, and to lower hemoglobin A1c levels in diabetic patients. These and many other findings emphasize the importance of resolving periodontal inflammation and the profound benefits that periodontal health has for overall patient health.

Osteoimmunology

Inflammation and bone loss are hallmarks of periodontal disease. Evidence over the last 10 years in the interdisciplinary field of osteoimmunology, which integrates the disciplines of immunology and bone biology, has served as a useful framework for improving our understanding of periodontal disease. These major advances have catalyzed advances of specific cytokines and other mediators’ arrays that are involved in the propagation of the inflammatory response in periodontitis. For example, bacterially derived factors and antigens stimulate a local inflammatory reaction and activate the innate immune system involving proinflammatory molecules and cytokine networks. Antigen-stimulated lymphocytes and the adaptive immune system plays a critical role, and eventually a cascade of events leads to osteoclastogenesis and subsequent bone loss via the receptor activator of nuclear factor-kappa B (RANK), its ligand (RANKL) and osteoprotegerin (OPG), its decoy receptor. Studies demonstrate that interference with the RANK-RANKL-OPG axis has a protective effect on periodontal disease bone loss. This research is significant in that interference of this axis will form the basis of rational therapeutic approaches such as targeted drug devices for periodontal disease in the future.

Tissue Regeneration

This broadly encompassing area includes major new advances with immediate and direct application to periodontal and dental implant therapy. For example, growth promoting proteins are now approved and used to significantly stimulate and enhance tissue regeneration, either alone or in combination with bone grafts, resorbable and non-resorbable physical barriers, extracellular matrices, and a number of carrier materials. As an example, both proliferative and differentiation protein products (e.g., platelet-derived growth factor and enamel matrix derivative), now approved for patient care by the Food and Drug Administration, have been shown conclusively to stimulate formation of new cementum, periodontal ligament, and bone at the histological level in both animals and humans. Furthermore, an osteoblast differentiation factor (recombinant human bone morphogenic protein-2) now is used as an alternative to autogenous bone graft for sinus augmentation and anterior alveolar ridge augmentation for more esthetic tooth replacement and/or endosseous dental implant placement. Additionally, ongoing clinical trials are investigating the use of living cells as graft and modulating materials for tissue growth around teeth. Thus, tissue engineering is expanding therapeutic options for the patient with periodontal disease and simultaneously provides more predictable and efficient periodontal tissue regeneration.


Endosseous Dental Implants

The last 10 years have also seen major advancement in research related to tooth replacement in patients, which in turn has further led to major changes in technology for endosseous dental implants. For example, the recognition that a roughened titanium surface is more osteoconductive than a machined surface has led to almost exclusive use of implants with some type of roughened surface. Furthermore, the recognition that butt-joint interfaces between implant components result in significant localized inflammation has led to the use of implants that either extend beyond the alveolar crestal bone area or have incorporated internally connected components with reduced diameters in comparison to the implant diameter. These and other advances have been of such magnitude that patients now can have their tooth replacement utilizing endosseous dental implants either immediately or within a very short healing time. Also important to note are the advancements in radiographic diagnosis and treatment planning with the prefabrication of surgical guides, temporary and even final prostheses based on radiographic findings (such as reformatted cone beam computer tomography); modification of the chemistry of the implant surface; changes in implant composition; computer guided navigation surgery, CAD-CAM fabrication of prostheses, etc. All of these advances have led to significant enhancement in tooth replacement both functionally and esthetically.

Evidence-based Medicine and Dentistry

Therapeutic approaches and technologies have been significantly influenced by the advances in scientific reporting. An awareness of well-designed and controlled scientific investigation has occurred over the last decade such that the influence of potential bias can be evaluated. The results of scientific investigation are now evaluated in manuscripts and in presentations at meetings and symposia using hierarchal criteria related to how much potential bias exists in the study design. Furthermore, attempts to combine findings from various investigations through the use of systematic reviews and meta-analyses have influenced the determination of how useful evidence exists for patient care. Such efforts help the individual periodontist better decide on what therapeutic options are most appropriate for the periodontal patient.

In summary, major advances in both research and technology have occurred in the specialty of periodontics over the last decade. These very significant developments have created paradigm shifts in the field, but at the same time reinforced the uniqueness of periodontists (who they are and what they do) and periodontology. Lastly, these advancements have directly impacted patients and emphasize the necessity to achieve periodontal health not only for the benefit of the natural dentition and for tooth replacement, but most importantly for the overall health of the patient.


Trends in Education

6. Review the summary data collected from the ADA Survey Center’s Survey of Advanced Dental Education Annual Reports over the past 10 years regarding the number of programs and program enrollments. Provide overview comments on past or future trends regarding this information.

Periodontics Number of Programs Total Enrollment

2000-01 52 476

2001-02 52 496

2002-03 52 507

2003-04 52 497

2004-05 53 509

2005-06 53 514

2006-07 53 512

2007-08 54 517

This summation will consider only trends over an eight-year period as data were not provided for the year 2008-09 and not yet available for the year 2009-10. As noted in the attached table, the number of postdoctoral periodontal programs remained relatively stable between the years 2000 and 2008, although there was a trend towards a slight increase in the number of programs, i.e., 52 programs in the year 2000-01, 53 programs in the year 2004-05, and 54 programs in the year 2007-08.

The enrollment of students in postdoctoral periodontal programs also remained stable with a trend towards a slightly greater number over the eight-year period. The increase in students from 476 in the year 2000-01 to 517 in the year 2007-08 represents an 8% expansion in enrollment. This expansion likely results from a slight increase in enrollment in a small number of established programs and the initiation of two additional programs between the years 2005 and 2008. Data are not available to allow a determination of the number of periodontal specialists lost over this same time period due to death, retirement, non-renewal of specialty license, etc. Thus, it is not possible to determine if the current number of graduates from periodontal postdoctoral programs is sufficient to replace the annual loss of periodontal clinicians, academicians, and/or researchers.

However, the persistent and generalized shortage of full-time periodontal faculty is likely to have a multifaceted impact on the specialty. Persistent faculty shortages, regardless of the reason, will eventually impact the number of postdoctoral periodontal programs and, therefore, student enrollment. Postdoctoral programs may be forced to accept fewer students to ensure that an adequate faculty-to-student ratio is maintained. Adequate faculty-student ratios may ultimately depend on volunteer part-time faculty comprised of private practice clinicians from the local community. Further, if a critical mass of full-time faculty cannot be maintained, clinical and basic oral research programs will suffer as will undergraduate dental and graduate level academic programs. Indeed, without adequate periodontal faculty, didactic and clinical teaching of undergraduate dental students will suffer a crisis of quality in depth and breadth of the knowledge base necessary for optimal patient care in the 21st century.


7. Review the summary data collected from the ADA Survey Center’s Survey of Advanced Dental Education Annual Reports over the past ten years regarding the number of full-time and board certified program directors. Provide overview comments on past or future trends regarding this information. (suggested response - one page)

Periodontics Director is Full-Time Director is Board Certified

Yes No Yes % Certified

2000-01 48 4 45 87

2001-02 46 5 47 92

2002-03 46 6 49 94

2003-04 46 6 48 92

2004-05 48 5 45 85

2005-06 47 4 47 89

2006-07 49 4 50 94

2007-08 51 3 51 94

Similar to question 6, data were not provided for the year 2008-09 and not yet available for year 2009-10. Thus, this summation will consider only trends over an eight- year period. The number of postdoctoral periodontal program directors who are full-time has remained stable, with a fluctuation between 87% in 2002-2004 period and 94% in 2007-08. Part of the increase is the result of two new training programs over the eight- year span. Similarly, the number of board-certified program directors has remained relatively stable over the years.

The persistent and generalized shortage of full-time faculty may eventually have a negative effect on the number of full-time periodontal program directors. Recruitment of program directors comes from faculty ranks and with the potential for an increasing number of part-time faculty the pool of qualified faculty may shrink and force programs to employ a part-time program director. However, this a remote possibility given the Accreditation Standards require programs to employ a full-time program director.

In the coming years it is expected that board certification rates will remain constant given the significant increases over the past two decades that were noted in Question 3.


8. Review the summary information attached as Appendix 1 and 2. This information has been provided by the Commission on Dental Accreditation regarding general changes in the language common to all advanced specialty education standards and changes in the specialty’s discipline-specific accreditation standards. Please provide an overview comment on future trends regarding this information. (suggested response - up to one page)

Several substantive changes in Accreditation Standards for Advanced Specialty Education Programs in Periodontics have been implemented since 2000 with the most recent changes occurring in 2009. These substantive changes reflect the changing nature and enhanced scope of the specialty and include:

(1) the deletion of “case type” from the student/resident clinical experiences and its substitution with a universal and more comprehensive statement on clinical training to the level of proficiency from diagnosis to maintenance of patients with the various periodontal diseases.

(2) the consolidation of resective surgical procedures into a single standard and the inclusion of periodontal medicine (i.e., periodontal systemic interrelationships) as a specific component of the oral medicine standard with clinical training to the level of competency are of significance to the contemporary practice of periodontics.

(3) the expanded role of implant therapy in periodontics has resulted in an independent implant didactic instruction and clinical training standard. This is manifested by the requirement that students/residents be trained to the level of proficiency in implant site development, surgical placement, and management of implants with an exposure to implant prosthetics.

It is anticipated that additional enhancements and clarification of the sedation standard will be forthcoming to reflect current ADA sedation guidelines based on levels of sedation rather than methods to achieve sedation.

Major changes in boilerplate language and standards have been adopted, implemented, and proposed. For example, these include clarification of terms, the addition of a standard on professionalism and ethical conduct, and training in evidence-based dentistry. Most importantly, the Commission has reviewed how proficiency and competency are measured in advanced specialty education programs and recognized that the current definitions are not being used uniformly, are outdated, and are no longer appropriate. The Commission has proposed with potential adoption in 2010 that the terminology – proficient, familiarity, and exposed – be eliminated and “competent” and “competencies” be redefined for specialty disciplines. The Commission is also proposing a boilerplate standard on student/resident assessment that will include formative and summative measurements. The Academy is in strong support of these proposed boilerplate changes and further believes that formative feedback that encourages self-assessment reinforces good clinical skills and establishes a pattern for lifelong learning and the delivery of high-quality periodontal care. The Academy is in the planning stages for the revision of the standards for advanced specialty education


programs in periodontics in anticipation of the Commission’s adoption of these major changes in boilerplate definitions and standards.

Changes in Scope of Practice

9. Highlight recent epidemiological data or studies that establish the incidence and/or prevalence of major conditions routinely diagnosed and/or treated by practitioners of the specialty. Please provide overview comments on how these changes have affected the practice of the specialty.

Chronic Periodontitis

Four recent reports have suggested that the prevalence of periodontitis in the USA may be in decline.1-4 However, an accurate assessment of the prevalence of periodontitis is complicated by multiple factors such as different operational definitions of clinical periodontitis,3, 4 characteristics of study populations,4 measurement of clinical parameters, and choice of partial vs. whole mouth examination.4 Indeed, there is general consensus that partial-mouth examinations significantly underestimate the prevalence, extent, and severity of disease.4-9

The most recent U.S. surveys to determine the prevalence of periodontal diseases were conducted in 1988-94 (NHANES III), followed by NHANES III data collection cycles in 1999-2000 and 2002-2004.3 Even among these national surveys, there is some inconsistency in methodology, operational definition of periodontitis, and selection of disease parameters for measurement. Paradoxically, the continued evolution of the case definition compromises accurate comparison of data obtained over time. Three in-depth reviews have been recently published that chronicle the histories of national surveillance efforts for periodontal disease in the United States, the evolution of case definitions for periodontitis, and prevalence estimates from the various surveys.3, 4, 9

Prevalence of Periodontitis

In an effort to determine the incidence and prevalence of periodontal disease in the U.S. population, the Academy has partnered with the CDC to develop a surveillance system to determine the incidence and prevalence of periodontal disease in the U.S. population. A workgroup has identified and validated self-report questions for use in conducting surveillance of periodontal disease. The questions and a full-mouth periodontal exam have been integrated into the 2009-2010 NHANES, which represents the first and only opportunity for the field of periodontology (and dentistry overall) to accurately measure the prevalence of periodontal disease in a large, U.S. based sample population. Results of a pre-pilot suggested that prevalence of periodontal disease as measured with a full-mouth exam may be 2-3 times higher than previous estimates. Collecting this information on the NHANES survey in 2009-2010 provides a breadth of data to inform future research, develop future public health programs, insurance benefits, as well as programs targeted for at-risk populations. Existing studies are currently funded to validate and use the surveillance questions in diabetes and pregnancy populations,


which when coupled with the NHANES data would further provide an opportunity to educate the medical community about possible perio-systemic links, and translate the implications into clinical practice.

The most dramatic findings regarding periodontitis prevalence are presented in the 1988-94, 1999-00, and 2002-04 NHANES III reports. When viewed collectively, findings from the three NHANES III reports show a progressive decrease in the prevalence of periodontitis between the years 1988-2004. For example, the first of these three data collecting cycles reported a prevalence rate of 35% for individuals aged 30-90 years. Based on U.S. Census data for the years 1988-94,10 this translates to roughly 49 million U.S. individuals afflicted with periodontitis. The second and third data collecting cycles reported prevalence rates of 7.3% and 4.2%, respectively, for individuals >18 years – translating to 15,313,247 and 9,255,104 people with periodontitis, respectively.

Possible Caveat: Prevalence of Periodontitis in Military Populations

All large epidemiologic studies of periodontal disease in the U.S. population have employed partial-mouth examinations. As noted previously, the partial-mouth examination is likely to underestimate disease prevalence.4-9 Thus, consideration of several surveys on military populations that used full-mouth circumferential probing combined with radiographic evaluation of alveolar bone levels offer interesting comparisons.

In 1990, Horning et al.11 examined 1,984 active duty and retired military personnel with a mean age of 30.3 years. The authors reported a prevalence rate for periodontitis of 63%. A prevalence rate of 63% is slightly less than twice that reported, for the same time period, by the 1988-94 NHANES III survey (35%).12 More recent surveys of smaller groups of active duty military personnel (ranging from n = 500 to 1,107) report a 17.6%, and 23.8% prevalence rates of periodontitis, respectively.13, 14 Again, the prevalence rates reported in the latter two studies are considerably greater than those reported for the same time period in the NHANES III 1999-00 and 2003-04 data collection cycles, i.e., 7.3%, and 4.2%, respectively. Collectively, these comparative results appear to justify some degree of skepticism concerning the reliability of partial-mouth examination vs. full-mouth circumferential probing combined with radiographic evaluation of bone loss. In fact, Eaton et al.5 reported that the prevalence of clinical attachment loss (CAL) >2 mm and >3 mm when using partial-mouth vs. full-mouth examination was underestimated by 22% and 36%, respectively.

Age and Prevalence of Periodontitis

Past interpretations of epidemiologic data have led to the assumption that age of and by itself was a risk factor for developing periodontitis. However, the relationship between age and periodontitis is deceiving. Age appears to have minimal impact on probing depth (PD) and increasing CAL with age may occur without significant loss of function in affected teeth.15, 16 Further, good oral hygiene and periodontal health equate to long-term tooth retention, regardless of age. Lastly, it appears that periodontitis may begin in adolescence and/or early adulthood.17 This suggests that susceptibility to periodontal disease may be more important than age.12, 18 Consequently, current paradigms view


increasing CAL as resulting from a lifetime of disease exposure rather than an age-specific disease.

Race/Ethnicity and Prevalence of Periodontitis

The 1988-94 NHANES III reported a higher prevalence of periodontitis in Non-Hispanic blacks and Mexican-Americans compared to Non-Hispanic whites.12 Comparison of PD, CAL, and furcation involvement showed the prevalence rates of adverse clinical parameters to be consistently greater for Non-Hispanic blacks and Mexican-Americans than for Non-Hispanic whites. The pattern of Non-Hispanic blacks (African-Americans) exhibiting a higher prevalence of periodontitis followed by Mexican-Americans and Non-Hispanic whites appears consistent, regardless of case definition.13, 19

The relationship of race/ethnicity with the prevalence of periodontitis comes with several caveats. Race and ethnicity are social constructs that can strongly influence socioeconomic status, access to health care, educational levels, and frequency of dental visits.20, 21 Kaufman et al.22 and Borrell et al.23 maintain the importance of recognizing the interaction of socioeconomic status and health status as a function of social, political, and historical consequences. For example, Borrell et al.23 reported that high-income African-Americans exhibit a higher prevalence of periodontitis than do low-income African-Americans or high-income Caucasians. Indeed, it may be that periodontal disease status has little association with the use of dental services among low-income patients as those exhibiting the greatest incidence of CAL may be those least likely to seek dental care.24

Effect of Current Trends on the Practice of the Specialty

Hujoel et al.1 estimated a 31% decrease in the prevalence of periodontitis between the years 1955 and 2000. Further, these authors estimate an additional 8% decrease by the year 2020, a decrease they attributed to changes in tobacco smoking habits. There is a well established and documented relationship between smoking and development and/or severity of periodontitis.

In spite of actual and projected decreases in smoking habits, a better understanding of pathogenesis, and more refined and goal directed therapies, there is still evidence that dentistry is not consistently achieving timely diagnosis and treatment of existing periodontitis.25, 26 The use of a PD for diagnosis and recording of periodontal status in treatment records has yet to achieve the level of a routine and consistent habit.27-29 At least one study has reported a disconnect between dentists’ perception of treatment rendered and actual treatment as recorded in patient records.30

Cobb et al.25 compared the pattern of referral of periodontitis patients in 1980 vs. 2000 using patient treatment record data from three geographically diverse private periodontal practices. Results revealed the following trends occurring over the 20- year time span: decreased use of tobacco; increase in the percentage of cases exhibiting advanced chronic periodontitis with a concomitant decrease in the percentage of mild-moderate disease cases; increase in the average number of missing teeth per patient; and increase in the average number of teeth scheduled for extraction per patient.


Docktor et al.26 used data from patient records from three private periodontal practices located within a major metropolitan area to determine the level of care delivered in the general practice office prior to referral. Conclusions from this study support those reported by Cobb et al.25 Further, the authors reported that 74% of referred cases were advanced periodontitis, of which 30% were treatment planned for extraction of two or more teeth. Additionally, periodontal treatment provided by the general dental office did not vary because of disease severity. Lastly, the average number of periodontal maintenance visits/patient/year in the general dental office was less than the standard of care according to severity of disease, e.g., 68% of advanced periodontitis cases reported between 0 and 2 periodontal maintenance visits per year rather than the recommended every 3 months. This latter point is rather poignant as Lanning et al.28 reported that 86% of general dentists surveyed reported providing periodontal maintenance in their practices.

In light of the extensive body of evidence reporting an association between the inflammation of chronic periodontal disease and a steadily increasing list of systemic diseases, early diagnosis and appropriate treatment of the inflammatory periodontal diseases assume greater importance. As noted by McGuire:31 clinicians must “err on the side of aggressive control of periodontal inflammation, since, until proven otherwise, the consequences of undertreatment could be more than the loss of a few teeth.”

If, as has been suggested, the prevalence of periodontitis in the USA is in decline,2-4 such a hypothesis would have significant public health implications. For example, a significant decrease in prevalence of the most common of the destructive periodontal diseases might impact allocation of financial resources, personnel, treatment emphasis, and public health policy. Additionally, if true, such a hypothesis could have implications for dental education curricula as regards to course content emphasis, allocation of instructional time and faculty budget lines in departments of periodontics and dental hygiene, and need for and size of residency programs. However, such conjecture is premature as the hypothesis may be based on a significant underestimate of prevalence.

5-9

The assessment of periodontal status in epidemiologic studies requires a clinical examination of the periodontal tissues which in turn is time consuming, involves considerable numbers of calibrated clinicians and finances. In this regard, it should be noted, that in an attempt to collection more reliable data without the inherent problems of manpower and financing, the AAP and CDC are currently engaged in development and validation of a “self-reported diagnosis” to determine prevalence of periodontitis as part of the 2009-10 NHANES III data collection cycle. Lastly, the specialty of periodontics needs to place increasing emphasis on early diagnosis, early and appropriate treatment of periodontitis, and education of the profession and public regarding potential associations between chronic oral inflammation and systemic complications.


References

1. Hujoel PP, Bergstrom J, del Aguila MA, DeRouen TA. A hidden periodontitis epidemic during the 20th century? Community Dent Oral Epidemiol 2003;31:1-6.

2. Borrell LN, Burt BA, Taylor GW. Prevalence and trends in periodontitis in the USA: The NHANES, 1988 to 2000. J Dent Res 2005;84:924-930.

3. Page RC, Eke PI. Case definition for use in population-based surveillance of periodontitis. J Periodontol 2007;78:1387-1399.

4. Cobb CM, Williams KB, Gerkovitch MM. Is the prevalence of chronic periodontitis in the USA in decline? Periodontol 2000 2009;50:13-26.

5. Eaton KA, Duffy S, Griffiths GS, Gilthorpe MS, Johnson NW. The influence of partial and full-mouth recordings on estimates of prevalence and extent of lifetime cumulative attachment loss: A study in a population of young male military recruits. J Periodontol 2001;72:140-145.

6. Kingman A, Albandar JM. Methodological aspects of epidemiological studies of periodontal diseases. Periodontol 2000 2002;29:11-30.

7. Slade GD, Beck JD. Plausibility of periodontal disease estimates from NHANES III. J Public Health Dent 1999;59:67-72.

8. Beck JD, Caplan DJ, Preisser JS, Moss K. Reducing the bias of probing depth and attachment level estimates using random partial-mouth recording. Comm Dent Oral Epidemiol 2006;34:1-10.

9. Dye BA, Thornton-Evans G. A brief history of national surveillance efforts for periodontal disease in the United States. J Periodontol 2007;78:1373-1379.

10. Statistical Abstract of the United States, 1999, 119th Annual Edition. U. S. Department of Commerce, Social and Economic Statistics Administration, Bureau of the Census. Table No. 14. Resident Population, by Age and Sex: 1980 to 1998. 1999; p. 15.

11. Horning GM, Hatch CL, Lutskus J. The prevalence of periodontitis in a military treatment population. J Am Dent Assoc 1990;121:616-622.

12. Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-94. J Periodontol 1999;70:13-29.


13. Covington LL, Breault LG, Hokett SD. The application of Periodontal Screening and RecordingJ (PSR) on a military population. J Contemp Dent Pract 2003 August;4:24-39.

14. Diefenderfer KE, Ahif RL, Simecek JW, Levine ME. Periodontal health status in a cohort of young U S Naval personnel. J Public Health Dent 2007;67:49-54.

15. Albandar JM. Global risk factors and risk indicators for periodontal diseases. Periodontol 2000 2002;29:177-206.

16. Fox CH, Jette AM, McGuire SM, Feldman HA, Douglass CW. Periodontal disease among New England elders. J Periodontol 1994;65:676-684.

17. Burt BA. Periodontitis and aging: Reviewing recent evidence. J Am Dent Assoc 1994;125:273-279.

18. Burt B. Position paper: Epidemiology of periodontal diseases. J Periodontol 2005;76:1406-1419.

19. Borrell LN, Lynch J, Neighbors H, Burt BA, Gillespie BW. Is there homogeneity in periodontal health between African Americans and Mexican Americans? Ethn Dis 2002;12:97-110.

20. Williams DR. Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann New York Acad Sci 1999;896:173-188.

21. Borrell LN, Papapanou PN. Analytical epidemiology of periodontitis. J Clin Periodontol 2005; 32(Suppl. 6):132-158.

22. Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiol 1997;8:621-628.

23. Borrell LN, Burt BA, Neighbors HW, Taylor GW. Social factors and periodontitis in an older population. Am J Public Health 2004;94:748-754.

24. Tomar SL. Public health perspectives on surveillance for periodontal disease. J Periodontol 2007;78:1380-1386.

25. Cobb CM, Carrara A, El-Annan E, et al. Periodontal referral patterns, 1980 versus 2000: A preliminary study. J Periodontol 2003:74:1470-1474.

26. Dockter KM, Williams KB, Bray KS, Cobb CM. Relationship between pre-referral periodontal care and periodontal status at time of referral. J Periodontol 2006:77:1708-1716.


27. Cury PR, Martins MT, Bonecker M, De Araujo NS. Incidence of periodontal diagnosis in private dental practice. Am J Dent 2006;19:163-165.

28. Lanning SK, Best AM, Hunt RJ. Periodontal services rendered by general practitioners. J Periodontol 2007:78:823-832.

29. Tugnait A, Clerehugh V, Hirschmann PN. Use of the basic periodontal examination and radiographs in the assessment of periodontal diseases in general dental practice. J Dent 2004;32:17-25.

30. Helminen SE, Vehkalahti M, Murtomaa H. Dentists’ perception of their treatment practices versus documented evidence. Int Dent J 2002;52:71-74.

31. McGuire MK. Should our focus on inflammation change the way we practice? J Periodontol 2008;79:2016-2020.

10. According to the 2007 Survey of Dental Practice, responding specialists (includes all specialties) reported that general practitioners provided most of their referrals (57.5%), followed by their patients (25.3%). Describe referral patterns and who normally refers patients to practitioners in this specialty and how this might have changed in the past ten years.

As part of the Academy's Practice Profile Survey conducted in 2003, members indicate they are seeing an average of 35.7 new patients each month which is a slight increase from previous year’s (28.6 in 1998 and 34.6 in 2000). This trend is consistent with the findings of research the Academy conducted in 2007 with general dentists that showed 70% of general dentists feel that their percentage of referrals to a periodontist (18%) has stayed consistent with what they have reported in the past while 23% feel that it was slightly higher.

The 2003 Academy’s Practice Profile Survey also shows that nearly 3.9% of new patients are self referrals (i.e., visit the periodontist on their own without any other referral). This segment of referral, in addition to the number of patient-to-patient referrals, is also expected to increase. This presumption is made based on two basic factors: the heightened awareness of periodontal disease and its impact on overall health (2006 research with consumers shows that 81% of respondents are aware that periodontal disease increases the risk of other health problems); and the increased demand for cosmetic restoration of missing teeth by baby boomers.

The Academy will continue to monitor these trends into the future by surveying its members on an ongoing basis.


11. Identify the principal health services provided to the public by individuals in this area of practice and whether this has changed in the past ten years. If this has changed, what has been the impact on profession and public?

The principal health services provided to the public by periodontists include evaluation and diagnosis of oral conditions and assessment of risk for future disease; non-surgical treatment and the management of periodontal diseases, oral mucosal diseases, and periodontal inflammation associated with systemic conditions; surgical care to correct oral hard and soft tissue defects; and surgical placement/management of dental implants.

Recently, the field has undergone a paradigm shift in how it thinks about periodontal disease. It is now viewed as a critical inflammatory disease in the body and the links between periodontal diseases and systemic conditions have been strengthened by research of other inflammatory conditions such as diabetes and cardiovascular disease. This paradigm shift is creating opportunities for collaboration with the medical community which has expanded the understanding of the inflammatory connection and surfaced implications for clinical practice by dental and medical professionals. As a result, care is more comprehensive and benefits the patients’ oral and overall health.

Technologies to diagnose and treat periodontitis including risk assessment, local drug delivery as an adjunct to periodontal therapy, regenerative therapies, and laser technology have expanded the armamentarium available to periodontists to treat patients and enhanced the delivery and quality of patient care.

The advancements in implant therapy, in conjunction with expanded regenerative options, have provided periodontists with a predictable option for restoring patients’ periodontal and dental health, contributing to their overall health. Increased consumer awareness of periodontal disease and treatment options has increased patients’ expectations regarding the availability of implant, regenerative and esthetic services.

12. Identify the setting(s) in which these services are customarily provided and whether this has changed in the past ten years. If this has changed, what has been the impact on profession and public?

Periodontists have historically provided the majority of their services in the clinical office setting. The Academy's Practice Profile Survey, published in 2003 indicates that 40.5% of Academy members have hospital privileges. According to this same survey, however, only .5% of the procedures performed by periodontists are provided in the hospital setting. An overwhelming majority (96.5%) of the procedures performed by Academy members is done so in the periodontal office. The 2003 survey also showed a slight increase since 1998 (.3% to 1.7%) in members performing procedures in another professional setting which may be due to Academy members moving towards group practices or itinerant practice styles.


This information was virtually the same in 1998 and 2000 and the Academy does not expect the ratio of settings to change significantly or at all within the next ten years.

13. Provide any other information that the specialty believes may be relevant to the study of the specialty area of practice. (suggested response – one page)


AAP Strategic Overview 2009-2010

Vision Periodontists will be recognized as an indispensable part of healthcare for optimal health and quality of life.

Mission The AAP provides members the expertise and resources to enhance the evaluation and diagnosis of oral conditions, assessment of risk for future disease and delivery of specialty periodontal non-surgical, surgical* and medical** care for our patients. We will accomplish this through leadership, advocacy, education, awareness, and research. *Periodontal Surgery includes but is not limited to correction of oral hard and soft tissue defects and surgical placement/management of dental implants. **Periodontal Medicine includes but is not limited to non-surgical treatment and management of periodontal diseases, oral mucosal diseases, and periodontal inflammation associated with systemic conditions.

Goals: 2009-2010 • Awareness

Strategic audiences will have a greater awareness of the essential role of periodontists in achieving overall health and well-being.

• Scientific and Clinical Advancement

The Academy will be the authoritative source for identifying, analyzing, interpreting, summarizing, and publishing scientific and clinical advances related to periodontics.

• Membership

AAP will provide services that will enhance member value. • Influence and Advocacy

The Academy will optimize its influence to achieve our Goals.

• Education To ensure that periodontics is an integral part of the education of all health professionals throughout their careers so as to optimize patient care including appropriate referral.

• Governance

Assure that the Academy's governance structure complies with its Constitution and Bylaws, and supports implementation of the Strategic Plan.

• Resources Assure adequate resources to implement Strategic Plan and meet member needs.

AAP Strategic Plan: 2009-2010


Goal: Awareness - Strategic audiences will have a greater awareness of the essential role of periodontists in achieving overall health and well-being.

Goal: Scientific and Clinical Advancement - The Academy will be the authoritative source for identifying, analyzing, interpreting, summarizing, and publishing scientific and clinical advances related to periodontics.

How to Achieve Goal- Educate key audiences on the role of inflammation in periodontal disease.

• Action - Promote to key audiences in dentistry and medicine messages resulting from the workshop on inflammation regarding the relationship between periodontal disease and inflammation that address implications for clinical practice.

• Action - Promote to key audiences in dentistry and medicine messages resulting from the JOP-AJC collaboration regarding the relationship between cardiovascular disease, periodontal disease and inflammation.

• Action - Promote to key audiences in dentistry and medicine messages resulting from the consensus statement on diabetes regarding the relationship between diabetes, periodontal disease and inflammation.

How to Achieve Goal- Promote research published in the JOP.

• Action - Disseminate to key audiences in dentistry and medicine the consensus statement on diabetes developed by JOP in 2009.

How to Achieve Goal- Promote the periodontist and the dental specialty of Periodontology.

• Action - Promote Academy messages to public and professional media.

• Action - Disseminate resources to public and medical communities defining the periodontist and the dental specialty of Periodontology.

• Action - Promote to key audiences in dentistry messages based on the statement regarding the role of the comprehensive periodontal evaluation and re-evaluation in treating periodontal disease and inflammation.

• Action - Advocate for implementation of a pilot project on diabetes screenings in periodontal practices.

• Action - Conduct spokesperson training.

• Action - Collaborate with corporates as feasible to promote Academy messages.

• Action - Manage 1-800 # call center and respond to patient requests for information.

• Action - Manage content for the consumer section of the Academy Web site and enhance consumer access and use of the site.

How to Achieve Goal- Strengthen the one-on-one relationship between periodontists and general dentists.

• Action - Implement GP awareness program developed with PR consultant to change GPs perceptions of periodontists.

• Action - Disseminate resources developed in 2009 that support members’ one-to-one relationships with GPs.

How to Achieve Goal- Advance research related to periodontics.

• Action - Monitor the research agenda developed in 2009 which outlines clinical and scientific advancements of greatest strategic interest to the Academy.

• Action - Conduct Orban and research poster competition.

• Action - Participate in IADR/AADR and sponsor AADR fellowship in Periodontics.

How to Achieve Goal- Support clinical practice.

• Action - Develop a statement on the role of the comprehensive periodontal evaluation and re-evaluation in treating periodontal disease and inflammation that defines what it is, when it is performed, and how it relates to risk assessment and referral.

• Action - Develop a risk assessment standard for use in dental practice.

• Action - Monitor NHANES which includes comprehensive perio exam and questions.

• Action - Liaison with ADA Council on Scientific Affairs.

• Action - Monitor FDA panel and testify as appropriate.

• Action - Respond to inquires on periodontal products and therapies.

• Action - Take action on misleading advertising and marketing claims including contacting companies and FDA, developing fact sheets or statements.

How to Achieve Goal- Publish articles relevant to the science and practice of periodontics.

• Action - Manage JOP editorial, subscription, advertising, and production processes.

• Action - Review and evaluate whether to publish review articles in the JOP.



Goal: Membership - AAP will provide services that will enhance member value.

Goal: Influence and Advocacy - The Academy will optimize its influence to achieve our Goals.

How to Achieve Goal– Promote and manage membership.

• Action – Recruit and maintain members.

• Action – Collect dues and maintain membership database.

How to Achieve Goal- Support member-Academy and member-to-member communication.

• Action – Educate staff and BOT on opportunities to apply social-networking and new media opportunities across the Academy.

• Action – Update and publish Membership Directory.

• Action – Publish AAP News.

• Action – Evaluate the redesigned Web site as relates to ease of use, clarity, navigability, etc., and develop recommendations for additional evaluation and possible enhancements.

How to Achieve Goal– Provide educational, scientific, and practice related products and services.

• Action – Manage Academy products including marketing and sales, inventory and online shopper, and AAP Center at annual meeting.

• Action – Manage member section of Web site, Member Service Center, and email aliasing and logo use programs.

• Action – Respond to member inquires on practice management and marketing.

• Action – Develop patient pages.

• Action – Provide third party assistance and conduct insurance workshops.

• Action – Negotiate hotel and convention space, and market and implement CE, exhibition, social events at annual meeting.

• Action – Review and evaluation student event at annual meeting.

• Action – Support collaborative meetings/specialty conferences.

How to Achieve Goal– Advance relations with dental organizations.

• Action – Collaborate with AAO to develop a screening protocol including risk assessment to help orthodontists determine when a patient should be referred for a comprehensive periodontal evaluation prior to the initiation of orthodontic therapy.

• Action – Liaison with dental specialty organizations, dental specialty group (DSG), AO, AGD, and international dental organizations.

How to Achieve Goal– Advance relations with the ADA.

• Action – Participate in ADA Annual Session, Lobbyist Conference, and Washington Leadership Conference.

• Action – Strengthen relationships with periodontists serving on ADA councils, commissions and committees and as delegates and alternates to the ADA House of Delegates, ADA Board members and officers and constituent society leaders.

• Action – Manage listserve and meet with ADA councils, commissions and committees, delegates and alternates to the ADA House of Delegates, ADA Board members and officers and constituent society leaders.

• Action – Network with ADA staff. How to Achieve Goal– Advocate within the third party arena.

• Action – Propose codes through ADA Code Review Committee.

• Action – Participate in American Association of Dental Consultants (AADC) and National Dental Electronic Data Interchange Council (NDEDIC).

How to Achieve Goal– Connect with members at the state and regional levels.

• Action – Conduct the State/Regional Assembly and evaluate if it is accomplishing its purpose based on measures of success identified by the Assembly Coordinating Committee in 2009.

• Action – Monitor the number of periodontists on state boards and regulatory-licensing groups.

• Action – Provide expert resources and assistance to state societies to impact relevant state boards, regulatory groups, and related organizations.



Goal: Education - Ensure that periodontics is an integral part of the education of all health professionals throughout their careers so as to optimize patient care including appropriate referral.

Goal: Governance - Assure that the Academy's governance structure complies with its Constitution and Bylaws, and supports implementation of the Strategic Plan.

How to Achieve Goal– Support postdoctoral periodontal education.

• Action – Monitor CODA.

• Action – Convene Postdoctoral Program Directors Organization (PD2) and conduct workshop.

• Action – Develop and offer In-Service Examination. How to Achieve Goal– Influence the periodontal component of predoctoral education.

• Action – Participate in ADEA and meet with periodontist deans.

• Action – Convene Predoctoral Directors Organization (PDO) and conduct workshop.

• Action – Manage web-based educational resources portal.

• Action – Manage Lunch and Learn program and Mentoring Toolbox.

• Action – Monitor licensing examination process. How to Achieve Goal– Promote and offer continuing education in Periodontics.

• Action – Plan future annual meetings.

• Action – Conduct dental hygiene symposium at annual meeting.

• Action – pursue collaboration with AAO for a joint conference in 2012.

• Action – Manage AAP Speaker Recommendation List.

• Action – Develop and deliver Web-based continuing education programs.

How to Achieve Goal– Develop and orient the leadership.

• Action – Charge Leadership Development and Qualifications Committee (LDQC) to explore developing an ongoing leadership development program for current and future Academy leaders using electronic and face-to-face opportunities.

• Action – Conduct an orientation with committee chairs and Board liaisons to communicate strategic direction and clarify roles using electronic and face-to-face opportunities.

How to Achieve Goal– Implement governance processes.

• Action – Conduct appointments, nominations and elections, and awards processes.

• Action – Conduct BOT orientation, provide parliamentary training, and convene the BOT.

• Action – Manage online BOT resources and maintain records of BOT and committees.

• Action – Convene District Forums and General Assembly.

• Action – Conduct strategic planning.

Goal: Resources - Assure adequate resources to implement Strategic Plan and meet member needs.

How to Achieve Goal– Monitor and manage resources.

• Action – Manage finances, monitor investments, develop and implement budget, conduct audit, and pay taxes.

• Action – Hire, manage, develop and assess staff.

• Action – Maintain facility and equipment, and online and Web site technology.

Periodic Review Cover · Conference in 2001, Enhancing Esthetics with Periodontal Plastic and Reconstructive Surgery Specialty Conference in 2002, co-sponsorship of the Academy of

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