Specialist dental care in Australia – What's in store?

Media item: article

Date published: 12 January 2015

Subject: dental specialties in Australia

This page records the media item. The original article is the property of its publisher and is not reproduced here.

The thirteen recognised specialties

Australia recognises thirteen dental specialties. Each requires an approved postgraduate qualification — typically three years full time — on top of a dental degree, and specialist registration with the Dental Board of Australia. The ones practising here are listed on Specialist Care and Dentists & Registered Specialists.

Every one of these titles is protected by law. A general dentist may lawfully perform work that overlaps a specialty, and many do it to a high standard, but may not use the title or imply specialist registration. It is verifiable free, in a minute, at ahpra.gov.au. See Why would I need to see a dental specialist?

The headings below use the Dental Board of Australia's own names for the specialties, which in two cases differ from the shorthand in common use. Where a website uses the shorthand, the register is what settles which specialty is actually held.

Here is what each one actually does, and when you would be referred.

Orthodontics

Moving teeth and guiding jaw development. Braces, aligners, functional appliances, retention. The specialist page is Orthodontists.

Referred for: complex crowding, skeletal discrepancies, impacted teeth needing exposure and traction, cases combined with jaw surgery, and children with developing bite problems identified at the age-7 assessment — When should I take my child to see an orthodontist? and Orthodontic treatment: general dentist vs specialist orthodontist?

Periodontics

The supporting tissues: gums and the bone holding teeth in. See Periodontists and Periodontal (gum) disease.

Referred for: advanced or rapidly progressing periodontitis, disease not responding to treatment in general practice (when do you need deeper cleaning?), gum grafting for recession, crown lengthening, and peri-implantitis. Periodontists also place implants.

Endodontics

The inside of the tooth. Root canal treatment, retreatment, apical surgery, and managing dental trauma. See Endodontists.

Referred for: molars with difficult anatomy, calcified canals, retreatment of a previous root filling, separated instruments, perforations, and persistent unexplained tooth pain — see Endodontist vs dentist for root canal and Why is the microscope so crucial in endodontic treatment?

Prosthodontics

Replacing and restoring teeth, from single crowns to full-mouth rehabilitation. See Prosthodontists.

Referred for: complex aesthetic cases, extensive tooth wear, full-arch implant work, and rebuilding a dentition after trauma or disease. This is the recognised specialty closest to complex "cosmetic" work — there is no cosmetic dentistry specialty, though there is cosmetic dentistry under specialist care.

Oral and maxillofacial surgery

Surgery of the mouth, jaws and face. In Australia this pathway commonly involves both dental and medical qualifications, making it one of the longest training routes in any profession. See Oral and Maxillofacial Surgeons and What does oral and maxillofacial surgery involve?

Referred for: difficult impacted teeth, facial trauma and jaw fractures, orthognathic (jaw) surgery, pathology requiring surgical removal, cleft surgery, and salivary gland disease.

Oral surgery

A separately recognised specialty focused on surgical procedures within the mouth.

Referred for: complex extractions, surgical exposure of teeth, implant surgery, and minor pathology — I've just had oral surgery: what can I expect during recovery?

Oral medicine

Non-surgical diagnosis and management of diseases affecting the mouth.

Referred for: persistent ulceration, lichen planus, burning mouth, dry mouth, orofacial pain, oral manifestations of systemic and autoimmune disease (diabetes and oral health), and anything suspicious that needs investigating rather than removing.

Oral and maxillofacial pathology

The laboratory specialty. Oral and maxillofacial pathologists examine biopsy tissue and make the diagnosis — including of oral cancer. “Oral pathology” is the shorthand in everyday use; the Board's own list gives the full title.

You will rarely meet one. They are the reason a biopsy result is reliable.

Paediatric dentistry

Children, including those with medical complexity and disability. See Paediatric Dentists and Children's Dentistry.

Referred for: very young children with extensive decay, severe anxiety, developmental conditions such as severe molar incisor hypomineralisation (chalky teeth) or amelogenesis imperfecta, dental trauma to permanent front teeth, and children whose medical condition complicates treatment — Should your child see a specialist paediatric dentist?

Special needs dentistry

Adults with disability, medical complexity, or conditions that make ordinary dental care difficult.

Referred for: people with significant intellectual or physical disability, complex medical histories, severe mental illness, dementia, and residents of aged care. See Oral health care for children with special needs and Visiting the dentist: caring for a child with autism.

This is one of the most under-recognised and most needed specialties in Australia, and demand substantially exceeds the number of specialists.

Dento-maxillofacial radiology

Imaging and its interpretation.

Relevant to you mostly through cone beam CT — which delivers a substantially higher dose than a conventional dental radiograph and should be justified, and which frequently reveals findings outside the area of interest that need reporting by someone trained to read them. See How safe are dental X-rays and when do they become unsafe? and Our Technology.

Forensic odontology

Identification of human remains from dental records, and the analysis of bite marks and dental evidence.

Australian forensic odontologists have been central to disaster victim identification, domestically and internationally. It is the reason dental records are retained for as long as they are.

Public health dentistry (community dentistry)

Populations rather than individuals. Water fluoridation, school programs, workforce planning, surveys of oral health, and policy. Often called dental public health; “community dentistry” is the wording in the Board's own list.

Nobody is referred to a public health dentist, and their work determines more about the nation's teeth than every other specialty combined.

What is NOT a specialty

This matters, because these terms appear in advertising:

None of these confer specialist standing. They describe an interest, which is lawful to state provided it is not presented in a way that implies specialist registration — and implying it is a specific breach of the National Law.

Practical points about referral

You generally do not need a referral to see a dental specialist in Australia — unlike medical specialists, and there is no Medicare rebate either way for adult dental treatment. A referral is still worth having, because it carries the records, the radiographs and the reason.

Specialist fees are higher. That is not a mark-up; it reflects longer training, longer appointments, and the fact that they receive the cases that are difficult — the price guide and Understanding Your Treatment set out how a plan is costed here.

A general dentist who refers is not admitting inadequacy. Knowing the limit of your own competence is a professional obligation, and failing to refer in time is itself a recognised source of harm — covered at Record payout to patient for failure of GP's duty of care to refer to a specialist. Complex dental cases: what happens when multiple specialists need to collaborate and Complex Dentistry describe the other side of it.

Ask directly: "Is this a case you would normally refer?" It is a fair question and a straight answer is a good sign.

And check the register before complex treatment. ahpra.gov.au shows division, specialist entry, and any conditions in force — free.

Related pages: Dentists & Registered Specialists, Alumni winner speech — Dr Kia Pajouhesh, Our Team, General Dentistry, and the rest of the media record.

Common questions

I was told to find “an orofacial pain specialist” for my jaw. Is that one of the thirteen?

No. Orofacial pain is not on the Dental Board's list of approved specialties, so nobody in Australia holds specialist registration in it, and the title cannot lawfully be advertised. The recognised specialty whose scope covers it is oral medicine, as set out above. That does not mean the problem is unrecognised — only that the label is not a registration.

It also does not mean you need a referral first. The RACGP describes orofacial pain as “a common presentation in the primary healthcare setting”, with temporomandibular dysfunction as “one of the major causes”, and concludes that “Conservative management involving non-pharmacological and pharmacological therapies is effective in the majority of cases.” The prognosis figures it cites are the reason to start conservatively: “Up to 40% of symptomatic patients have spontaneous resolution of their symptoms without any treatment, and 50–90% of patients have relief with conservative therapy.”

What conservative means, in its list: “patient education and reassurance, jaw rest, a soft diet, warm compress over the region of pain and passive stretching exercises”, together with behaviour changes including “improving sleep hygiene, stress reduction and elimination of parafunctional habits such as teeth clenching and grinding”. Two cautions it adds: on splints, “The use of occlusional and non-occlusional splints is controversial and evidence to support their use is inconclusive”, though they “may benefit a select group of patients who have severe bruxism and nocturnal clenching”; and on resting the joint completely, “TMJ immobilsation has no benefit and may actually worsen symptoms due to muscle contractures and fatigue.” Physiotherapy “has been shown to be effective”, particularly for range of motion, with referral worth considering in refractory cases.

On timing, the guidance is specific: absent red-flag features, “it is reasonable to trial conservative management for six to eight weeks prior to referral.” The red flags it lists are the exception, and they include persistent and worsening pain, trismus, cranial nerve abnormalities, concurrent infection, systemic illness, weight loss, asymmetrical neck or facial swelling, unilateral hearing loss, and new-onset or unilateral tinnitus. Any of those is a reason to be seen promptly rather than to wait out the eight weeks. Medicines are a matter for your prescriber; the same guidance notes several classes with little or no demonstrated benefit in this condition and advises against opioids for chronic pain of this kind because of dependency risk. See TMD and Teeth Grinding.

Is the list of thirteen the same everywhere? A relative in New Zealand was referred to a “restorative” specialist.

It is not, and that is a real example rather than a mistake. The Dental Board of Australia states that the Board and the Dental Council (New Zealand) “have 11 specialties in common”, and then lists the differences. Recognised by the Australian Board but not by the New Zealand Council:

Recognised by the New Zealand Council but not by the Australian Board:

So a New Zealand restorative specialist has no Australian equivalent title. In Australia the closest recognised specialty is prosthodontics, described above. The practical consequence for anyone moving between the two countries is that a title held in one may not be usable in the other, and the register is the place to settle it. Specialty lists are set by the relevant board and change; confirm the current list with the Dental Board of Australia rather than relying on this page.

My dentist qualified overseas. Does that change anything I can check?

The things you can check are the same; there is simply more behind the entry.

An overseas-qualified dental specialist must “apply for both general registration as a dentist and specialist registration”, and the Board notes that “Your application for general registration will be assessed first.” For twelve of the specialties — dento-maxillofacial radiology, endodontics, forensic odontology, oral medicine, oral and maxillofacial pathology, oral surgery, orthodontics, paediatric dentistry, periodontics, prosthodontics, public health dentistry (community dentistry) and special needs dentistry — there is a qualification equivalence pathway to specialist registration. Specialist registration also requires “a minimum of two years general dental practice”, which “may be achieved by experience outside Australia, subject to assessment and approval by the Board”.

A practitioner arriving from New Zealand can apply under the Trans Tasman Mutual Recognition Act if registered with the Dental Council and holding a current annual practising certificate in that specialty. Here the Board's power to limit scope becomes visible: it “may impose conditions on your registration if this is required to make your occupation equivalent to an Australian occupation” — its own example being that “the scope of practice for an occupation may be narrower in New Zealand than in Australia” — and it may also “impose conditions that are the same as those applying to your New Zealand registration”.

There is one more wrinkle worth knowing, because it looks odd on the register. The Board records that “There are a small number of specialists who, because of the previous legislative framework that existed in one jurisdiction prior to the National Registration and Accreditation Scheme, are registered only on the Board's Specialists Register”, and that “These specialists must restrict the scope of their practice to the specialty or field of specialist practice in which they hold registration and to their education, training and current competence.”

All of which reduces to one instruction: read the conditions field on the register entry, not just the specialty field. Conditions are the part that tells you what somebody may actually do.

Sedation is offered. Is that a specialty, and who is allowed to provide it?

It is not a specialty — as the list above says, “sleep dentist” is not a recognised title — but it is regulated, and by a different mechanism that is easy to miss. Alongside its registration standards for general and specialist registration, the Dental Board of Australia maintains an Endorsement for conscious sedation registration standard, with published conscious sedation competencies.

An endorsement is recorded against a practitioner's registration and is a separate thing from specialist registration — somebody holding one is not a specialist by virtue of it. What the Board publishes is the standard itself and the competencies that sit under it, so those are the documents to read rather than anyone's description of them. The practical point is that an endorsement appears in the same place on the register as everything else, which means the question “who is administering the sedation, and what is on their registration?” has a checkable answer. Note also that AHPRA's advertising guidelines treat “specialist registration in a recognised specialty or an endorsement” as the two things that permit a corresponding title in advertising — so an endorsement is real, and its wording matters.

Ask which kind of sedation is proposed, who will monitor you and with what equipment, who will be in the room, and what the recovery and escort arrangements are. See Sleep Dentistry.

Beyond holding the qualification, what does a practitioner have to keep doing to stay registered?

More than most people assume, and it is a set of published standards rather than a single one. The Dental Board of Australia maintains registration standards covering, among others:

The scope-of-practice standard is the one that matters most in the room. It “applies to all practitioners registered with the Board” and “requires dental practitioners to practise within the scope of their education, training, and competence at all times.” That is the same obligation that sits underneath the duty to refer, stated as a registration condition rather than as a legal duty — see Record payout to patient for failure of GP's duty of care to refer to a specialist.

What this page deliberately does not give you is the numbers — how many hours of professional development, or over what cycle. Those sit inside the standards themselves and are revised periodically. Read them on the Dental Board's own site rather than taking a figure from anywhere else.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. Directions are on Location; enquiries go through Contact Us.

Every practitioner's registration, division and any specialist entry can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published article and its date, with general information. The list of recognised specialties, their official names and the requirements for specialist registration are set by the Dental Board of Australia and can change; confirm current information with the Board. Statements attributed to the Dental Board of Australia, AHPRA and the RACGP are those bodies' own. This is not a diagnosis or a treatment plan, and nothing here is advice about medicines — that is a matter for your prescriber. Third-party published content is not reproduced.

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