General Dentistry on Life Support: The Overspecialization of the Profession

ABSTRACT

Issue

General dentists are trained to identify and treat the most common oral conditions and their complications, including dental caries lesions, by restoring tooth structure and function and replacing missing teeth, as well as by treating gingival diseases. However, many senior undergraduate students and junior dentists believe they lack confidence to practice comprehensive clinical dentistry; they may avoid surgical endodontic procedures, orthodontic care, and implant‐related cases, for example. The answer, they believe, lies in the imminent need to pursue a specialization to have a successful career.

Approach

General dentists must remain the backbone of the profession if we aim to improve access to basic dental care and address inequities. This perspective explores the values of a general dentist in meeting the majority of the care needs of society at large by recognizing the importance of training students to graduate as clinically well‐rounded providers. It discusses the issues pertaining to overspecialization in dentistry, while acknowledging that specialized care is needed when general dentistry falls short.

Impact

We argue that oral health inequities may only widen if the profession focuses on specialization over general practice, as this might inadvertently take the focus off prevention and not fully address general oral health‐care needs of the population. Overspecialization, and the resulting fragmentation of responsibilities, may undermine patient's basic care needs. Training a broad‐spectrum dentist is paramount while acknowledging the value of specialization to deliver specific—and complex—clinical care that does not come at the expense of general practice.

1. The Practice of General Dentistry

Many agree that equitable access to oral health care is a human rights issue [1]. As a regulated health‐care profession, our main duty as dentists is to equitably address the priority health‐care needs of the population we serve. Dentistry can be defined and legitimized as a profession rather than a trade by considering the social contract between society and providers in exchange for their ability to alleviate pain and suffering caused by oral diseases [2]. Our responsibility is also to prevent oral diseases from developing, and when prevention fails, to treat them with technical and professional skills so that the burden to patients is minimized and the negative impact on health is avoided. Dentists should also focus on providing care to those with the greatest health needs and on decreasing oral health inequities in a socially responsible manner. General dentistry involves preventing and addressing the consequences of tooth decay and gum disease, two of the most globally prevalent chronic conditions impacting nearly everyone. As emphasized by Fontana et al. in 2017, “the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency … ethical and professional values … to [achieve] high standards for individual patients and the public at large” [3]. However, no gold standard has been established for the minimally acceptable “number” of procedures a student should have completed in order to graduate knowledgeable and technically skilled. Not surprisingly, insufficient clinical experience remains a key predictor of low confidence levels reported by practicing dentists and recent graduates [4, 5]. In turn, the scope and content of current dental curricula have been questioned given that fresh graduates may not feel they possess sufficient training in specific procedures [4, 6], even if these procedures might not be considered complicated enough for a specialist [6]. It is known that community‐based dental education involving clinical placements along side the clinical experience offered at university clinics can increase students' clinical confidence; give them opportunities to provide care that meets the need of the public at large, including more complicated cases; and expose them to an array of equity‐seeking populations; we should provide more, not less community placements [7]. However, an undergraduate curriculum can only offer so many opportunities to practice many different dental procedures when not structured to eliminate non‐clinical redundancies. Also, an undergraduate curriculum must be based on the best available evidence to address the evolving health‐care needs of a changing society. There seems to exist an unspoken assumption that specialization would perhaps bridge this gap in undergraduate dental training. But is this approach realistic?

2. Overspecialization of the Profession and Its Impact

A well‐trained general dentist can confidently deliver dental treatment to a significant portion of the population. While there is a continuum of complexity for these procedures, many experienced and older general dentists comfortably and routinely provide care at the complex end of this spectrum [8]. Such providers' confidence may develop from a combination of having been exposed to such procedures during their undergraduate education, enrolling in continuing education courses, and/or having some years of experience under the adage that “practice makes perfect.”

On the other hand, a recent graduate with none or very few years of experience may not have been exposed to the full scope of general dental procedures, neither during their training nor since. The solution, many may think, is to specialize. But the option to pursue a specialty training comes at various costs.

The financial cost to the provider is palpable; although some dental undergraduate training programs are fully or partially subsidized, the vast majority of specialized dental degrees are not. In fact, clinical tuition generated from training students, including graduate and specialty training, has been one of the main sources of revenue for many dental programs and institutions, which pass on the higher costs of operations to their trainees—increasing their educational debt [9]. Furthermore, specializing at an early career stage may leave a practitioner with limited ability to collaborate, compounded by the lack of a prior reputation which may result in an early career specialist finding it difficult to attract referrals from general dentists. Finally, there is a risk that with the training of too many specialists, the job market becomes saturated, and the oversupply of dentists with niche clinical interests leads to work becoming increasingly difficult to come by [10].

But the risks associated with early specialization and oversupply of dental specialists may not just be limited to the career and financial prospects of the practitioner themselves. There are also potential costs and risks to the public. Fees for specialized services are generally higher than those charged by general dentist to reflect the extended—and often expensive—training these providers now have. With a proportion of the population already avoiding dental care due to cost, one can theorize that higher fees may not improve much needed basic access to oral health care equitably. Lastly, overspecialized services may lead to a fragmentation of responsibilities among professionals who are no longer able to care for their patients as a whole, undermining preferences, expectations, and needs of these patients when they bounce from one specialized provider to another.

Despite these issues, the various dental specialties are widely promoted as career choices so that practicing dentists feel more clinically confident, achieve financial returns, and experience intellectual fulfilment and career satisfaction [11]. The above points are reasonable and are considered the primary reasons to build the specialist dental workforce; however, they include little to no consideration on how overspecialization may further limit access to general dental care for the public.

But, perhaps the most worrisome reason for a junior dentist to pursue specialization would be to justify the gaps in clinical training during undergraduate education. When asked, as many as one‐in‐three recent graduates would readily consider pursuing specialized postgraduate training, a consistent trend over the years [12]. However, specialization should be more limited, and aimed at addressing the complex and unique needs of a few patients and not the need for routine treatment experienced by the majority of the population. We argue that our role as dental educators must be focused on fostering the training of well‐rounded general practitioners comfortable with providing the full spectrum of care most of their patients will need. Our belief is that we should not be focusing our mentoring efforts on encouraging undergraduate students to make specialization level career choices at the expense of general practice. Specialization should be a choice, not a mandate.

3. Summary

We are not against specialization, as many of the co‐authors of this perspective have specialty qualification training. In fact, we do acknowledge that practicing dentists should pursue their career aspirations, including specialization, when desired. But such career choices should not happen at the expense of placing general practice on life support. Undergraduate dental training programs should expose their students to the various aspects of clinical dentistry, and not advocate for specialization as a must‐pursue path to fulfil the deficiencies of their clinical training programs. From our viewpoint, specialization should not compensate for these deficiencies; rather, it should be built on this much‐needed clinical training when necessary. In a global society where oral health inequities are only widening, a sole focus on specialization to address the basic needs of the majority of the population may only make these inequities worse to those most vulnerable and underserved citizens in our communities. A well‐rounded general dentist can meet the majority of care needs of the general population. For that to occur, we should increase undergraduate clinical practice by revising the dental curriculum to eliminate didactic redundancies and repetition, by increasing extracurricular placements during the academic year and the summer months, and by implementing more community‐based dental education to provide experiences not available in many dental school environments.

Author Contributions

M.B. contributed to the conception of this perspective, design and acquisition of the literature, as well as drafting and critically revising the manuscript. D.A., L.S.‐S, and M.B. contributed to editing this perspective and critically revising it. J.B. helped with formatting and coherence of the final draft. All authors are in agreement and accountable for all aspects of the work and gave their final approval for this publication.

Conflicts of Interest

The authors declare no conflicts of interest.

Brondani M., Braga M., Broadbent J., Slack‐Smith L., and Ardenghi D., “General Dentistry on Life Support: The Overspecialization of the Profession.” Journal of Dental Education 89, no. 10 (2025): 1506–1508. 10.1002/jdd.13878