Perspectives

The following perspective was received from Dr. Simonsen, for which a corresponding

response was made by Dr. Dickerson.

DELUSIONS OF GRANDEUR, OR WHAT THE PUBLIC DOESN’T KNOW

ABOUT SHORTCUTS

There it was—a full-page adver-

tisement appearing in the ADA

News for the past few months

(September–November 2004). The

degrees were listed after a dentist’s

name: DDS, FAACD, LVIM. Twelve

letters conveying, one would expect,

many, many years of study, tears,

toil, and sweat that the dentist had

put forth, giving him the right to

place these professional accolades

after his name. Or was I mistaken?

Our dental world is changing, and

not always for the better. With the

increasing acceptance of advertising

that tests our sensibilities comes the

temptation for colleagues to make

themselves appear better than each

other, frequently in ways that some

would call unethical. Despite this

trend, the dental profession still has a

great deal of autonomy. That auto-

nomy comes from decades of earned

public trust. When that trust begins

to weaken or crumble, so will the

professional autonomy that we so

cherish. Look at the Occupational

Safety and Health Administration,

and the Health Insurance Portability

and Accountability Act, just two re-

cent examples of legislated rules and

regulations that can be said to have

come, at least in part, from dimin-

ishing public trust in the belief that

the health care professions are ca-

pable of policing themselves in a man-

ner that protects the public interest.

The American Dental Association

Principles of Ethics and Code of

Professional Conduct states, ‘‘Gen-

erally, unearned or nonhealth

degrees and fellowships that desig-

nate association, rather than attain-

ment, should be limited to scientific

papers and curriculum vitae.’’1 You

can find it under Section V, titled

‘‘Veracity.’’ And it explains further

that ‘‘an unearned academic degree

is one which is awarded by an edu-

cational institution not accredited by

a generally recognized accrediting

body or is an honorary degree.’’

So what is this DDS, FAACD, LVIM

all about, I wondered?

DDS: Well that’s straightforward

enough. That’s the DDS degree, an

earned doctorate in dentistry—the

equivalent of the DMD degree.

All dentists who graduate from an

accredited US dental school earn

either the DDS or the DMD degree.

It comes after four years (or, as in

the case of just one outstanding US

dental school, three years) of full-

time hard labor.

FAACD: Well, for sure, that’s not an

earned degree. It is a fellowship in

an organization that markets cos-

metic dentistry. The letters FAACD,

‘‘designate association, rather than

attainment’’ and, as such, ‘‘should

be limited to scientific papers and

curriculum vitae.’’ Frequently, how-

ever, dentists who wish to infer that

they are superior to colleagues with

just a DDS or a DMD degree will

flaunt letters representing unearned

degrees or associations in many

arenas beyond those accepted by the

Principles of Ethics.

LVIM: Now, what is that? I was

really stumped on this one and had

to do some legwork to find out

more about this unearned ‘‘degree.’’

LVI gave me a clue, but surely an

unaccredited institute could not be

awarding degrees? Of course, I am

sure most of us get a couple of

e-mails a month offering degrees for

sale, but in an honorable health

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care profession, in which the public

trust rewards us all with a great

degree of autonomy, we surely

could not be selling degrees like

mail-order charlatans?

According to the Las Vegas Institute

(LVI) Web site, LVIM is apparently a

credential in ‘‘Aesthetic Neuro-

muscular Mastership.’’ So perhaps

using LVIM instead of ANM for this

‘‘mastership’’ is part of the master

branding strategy for LVI? Using

the letter M, usually reserved for a

master’s postgraduate degree, is

likely to mislead, inasmuch as at-

taining a legitimate master’s degree

usually requires 2 to 4 years of full-

time study at an accredited institu-

tion of higher learning. While the

profession accepts that certain strin-

gent requirements for attainment of

postgraduate education certificates

(such as the MAGD) are legitimate,

it is hard for me to believe that the

profession as a whole will accept that

an unaccredited, self-proclaimed

‘‘academic’’ institute can start to give

out ‘‘master’s degrees’’ for atten-

dance at a few courses taught by

‘‘faculty’’ who have not earned any

legitimate postgraduate degrees

(although, of course, they have con-

ferred the LVIM on some of their

‘‘faculty’’). It’s like general dentists

comprising the complete faculty of

a dental school graduate program.

Here’s what the Las Vegas Institute

Web site says about LVIM:

Due to the extensive marketing

campaigns by LVI, we have also

begun to create public awareness

of this fact [that their ‘‘gradu-

ates’’ are superior]. It won’t be

long until ‘‘LVIM’’ after the

name of a doctor will indicate

superior training and skills to

the public. As our efforts to

educate the public about neuro-

muscular dentistry continues

[sic], so will their demand for

competent restorative neuro-

muscular dentists.2

Well, LVI’s branding and marketing

strategy may well lead to confusion

of what constitutes ‘‘superior train-

ing and skills’’ by the lay public, but

to me it indicates a shortcut into the

realm of the dental specialist, the

prosthodontist. Although LVI may

not claim that LVIM is a degree, it

sure promotes that LVIM be placed

after the earned dental degree—to

look like a dental master’s graduate

degree. In my opinion, this is part

of an attempt to justify marginally

necessary, or even unnecessary,

treatment of the public by in-

adequately trained colleagues with

unaccredited qualifications.

I guess there are only six people in

the world with the LVIM ‘‘degree,’’

unless LVI has ‘‘graduated’’ some

‘‘classes’’ since listing ‘‘faculty’’ on

their Web site. The LVI Web site

shows six of their instructors with

LVIM letters after their names who

apparently feel ready to promote

their superiority to the public.

Again, from the LVI Web site: ‘‘LVI

also has embarked on a North

American PR campaign to educate

the public about the life-changing

benefits of neuromuscular dentistry.

Our goal is to educate the public . . .’’

Rather than education, it seems to

me that obfuscation and co-option

may be the goals. In the section on

the Web site for consumers, an

FAQ about how to pay for the full-

mouth reconstruction notes that

‘‘Most LVI dentists . . . will make

the payment fit comfortably into

your monthly budget. (Like a new

car except that it will last longer!)’’

Is that the payments or the recon-

struction that will last longer? What

they don’t say is that frequently

charges for a full-mouth recon-

struction are much more than most

people pay for a new car, and

there is no evidence that their par-

ticular treatment will last longer

than a car.

It is interesting that in the full list of

their ‘‘faculty’’ the LVI does not list

even one individual (out of 29) with

a bona fide advanced degree (eg, MS,

MPH, MEd, PhD) after the dental

degree.2 I guess if you don’t have a

legitimate postdoctoral degree, you

just invent one, or pile on all the

fellowships you have, to massage

feelings of inadequacy.

We are in the clutches of a monster—

progressive lunacy we could call it.

Anunaccredited ‘‘institute’’ claiming to

be the ‘‘world’s premier postgraduate

center for cosmetic dentistry’’ is so-

liciting dentists to take continuing-

education courses that are wrapped

in hard-earned university diction

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70 J O U R N A L O F E S T H E T I C A N D R E S T O R A T I V E D E N T I S T R Y

(they have ‘‘faculty’’ who participate

in the ‘‘LVI Faculty Practice,’’ and

they have ‘‘graduates’’ and ‘‘gradua-

tion ceremonies,’’ and they have

‘‘alumni’’). All of these terms are le-

gitimately the purview of accredited

universities and dental schools. This

institute has now embarked on a

master plan of selling the public with

prime-time advertising (on programs

such as Extreme Makeover, and I

have seen commercials during Larry

King Live and Wolf Blitzer Reports)

to convince the public to contact

its ‘‘alumni.’’ And so the circle is

complete—sell the courses that sell

the dentists to sell the public who see

the commercials to see the dentists

who bought the courses.

If we in the profession cannot con-

trol our own standards of ethical

behavior, others will come in and

do it for us. If a group within the

profession is seen as misleading

the public, and recommending mas-

sive irreversible treatments such as

full-mouth reconstruction for in-

adequately informed patients based

on pseudoscientific evidence per-

formed by general dentists lacking

specialty training in prosthodontics,

it is time for the profession to react

before Big Brother does.

To potential LVIM wannabees, I

say, if you want an advanced degree,

spend 2 or 3 years to get a legitimate

degree from an accredited univer-

sity. If you want to do the work of a

prosthodontist, get the training from

a program at an accredited institu-

tion where, by the way, you will find

that your teachers are mostly spe-

cialists with multiple degrees.

Taking a shortcut to expertise can

only result in disaster for the indi-

vidual and the profession that

permits it. Let’s hope the LVIM

‘‘degree’’ will disappear as quickly

as it has reared its ugly head.

REFERENCES

1. American Dental Association. Availableat: http://www.ada.org/prof/prac/law/code/principles_rep5f3.asp (accessedDecember 8, 2004).

2. Las Vegas Institute. Available at: http://www.lvilive.com/mastership.html (accessedDecember 8, 2004).

Associate dean and professor of RestorativeDentistry, Arizona School of Dentistry &Oral Health, Mesa, AZ, USA; e-mail:rsimonsen@atsu.edu

RESPONSE TO PERSPECTIVES

Thank you for giving me the

opportunity to explain what it

takes to obtain the LVIM. It is not

surprising that people would not

know what we are all about if they

had never visited the five-acre,

60,000-square-foot, state-of-the-art

campus or called me or anyone at

LVI to explain their ‘‘concerns.’’ The

LVI curriculum involves more than

just esthetics as we have over

35 courses spanning the range of

esthetics, occlusion, endodontics,

periodontics, orthodontics, manage-

ment, hygiene, implants, removable

prosthodontics, emergency medi-

cine, and others. After 10 years of

offering dentists superior post-

graduate education, LVI decided to

validate those who have had exten-

sive training in the area of compre-

hensive restorative esthetics and

occlusion. Instead of just having the

course requirements, as for the AGD,

those achieving their LVI mastership

are required to demonstrate their

skills by completing live-patient

treatment programs, presenting

cases, and taking a comprehensive

test to prove clinical expertise.

Many members of our profession

accept that postgraduate certifi-

cates such as the MAGD are legiti-

mate and endorse their designation.

The requirements for MAGD are

as follows. First, candidates must

achieve fellowship by completing

500 hours of approved continuing

education, with at least 350 of those

hours earned in participation course

Richard J. Simonsen, DDS, MS

(a general dentist)

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71V O L UM E 1 7 , N UM B E R 2 , 2 0 0 5

attendance. After completing the re-

quired number of hours, applicants

must pass a 400-question examina-

tion. Once the fellowship has been

awarded, these candidates can apply

for mastership after completing

600 hours of approved continuing

education, 400 of which are in parti-

cipation credits. These are the only

requirements for mastership; no test

or demonstration of clinical ability

is required.

The MAGD requires candidates to

obtain credits in 16 different cate-

gories, with only 184 required in

restorative dentistry, fixed prostho-

dontics, occlusion, and esthetics.

Of the total 184 required, only

120 hours of participation credits

are necessary.

The Las Vegas Institute for Ad-

vanced Dental Studies is an AGD-

approved national sponsor. Our

programs offer participation credits

that meet the requirements for AGD

fellowship and mastership. In fact,

I can guarantee you that many of

our graduates have received their

hours for MAGD at LVI.

To qualify for an application to

become an LVIM, candidates must

complete three live-patient pro-

grams, with participation credits

totaling 197 in the area of restor-

ative dentistry, occlusion, and

esthetics. They also must complete

three occlusion programs, with the

participation credits totaling 72. To

summarize, candidates for LVIM

must complete 269 hours of parti-

cipation credits in occlusion, restor-

ative dentistry, and esthetics, versus

only 120 participation credits in the

same disciplines for the MAGD. The

truth is that most of our LVIM

presenters have taken far more than

the required programs and have

more than 350 hours of participa-

tion credits from LVI.

Unlike the MAGD, candidates for

LVIM must submit three completed

comprehensive restorative cases (at

least two full-mouth reconstruction

cases). These are to be cases done at

the applicant’s office, not at LVI as

part of a course. Cases must be sub-

mitted in an intensive printed report

that includes all requirements listed

in this application. If a case is rejected

or does not meet the criteria men-

tioned in this application, a replace-

ment case must be submitted. This is

valuable learning process as an ex-

planation of nonacceptancewould be

given to provide the applicant with

the ability and knowledge to assist

with the next case submission. Ac-

ceptance would provide the applicant

with the confidence that he or she

understands the principles of restor-

ative and neuromuscular dentistry.

The reports include all required

write-ups, photographs, images,

radiographs, scans (if electromyo-

graphic equipment was used), and

so on, presented in a printed for-

mat. The following information

is included:

1. Biographical information

2. Patient history, signs, symptoms

3. Treatment plan

4. Diagnostic photographs

5. Treatment photographs

6. Final restorative photographs

7. Before and after models

8. Summary of results

9. Patient testimonials and/or

comments

For those who are unaware, some of

our faculty members have their cer-

tificates in prosthodontics. Dr. Roy

Hurst, for example, received his

certificate from USC, having under-

gone what was then a 2-year pro-

gram under Howard Landesman,

then president of the college. Dr. Roy

Hurst has provided me with a re-

sponse to those who are unfamiliar

with our training:

Whereas the training in a 2-year

program is much more literature

intense and has more classes in-

volving peripheral courses such as

statistics, LVI’s courses are totally

state of the art. The courses at LVI

are not just ‘‘weekend and out’’

courses. Each builds on the pre-

vious courses. On average, it does

take 2 to 3 years to go through

them and master the knowledge

from the courses. I can’t expect

anyone who has not been to LVI

to have a clue about the science

behind its teachings.

The LVIM and FAACD are not

degrees. They are titles of achieve-

ment. They are both well earned

and not just handed out by taking

courses. The dentists who get

these titles have spent years and

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72 J O U R N A L O F E S T H E T I C A N D R E S T O R A T I V E D E N T I S T R Y

usually hundreds of hours in

continuing education plus much

time honing skills in their offices

at great cost to them in time

and money.

The faculty at LVI are dentists

who have the clinical skills to be

considered experts as well as

management skills to run a suc-

cessful practice. The support

through the LVI forum and per-

sonal communications after our

training gives the graduates life-

long access to answers, as if

practicing in the best group

practice with a mastermind at

work. I think I was just an

average prosthodontist before;

now I feel I deliver far superior

work to what I did before my

training at LVI.

As an example of the quality of

our senior faculty in residence,

Dr. Norman Thomas is not only a

DDS but an MD and has a PhD in

Physiology. Norman was awarded a

Nuffield Fellowship (Oxford) to com-

plete an honors degree in medical

sciences in 1960. Between 1960

and 1974, he pursued residency and

research programs at the Bristol

Royal Infirmary, the Royal College

of Surgeons of England, the Medical

College of Virginia in the United

States, and the University of Alberta,

where he is now professor emeritus.

From 1970 to 2002, Norman served

on the Medical Research Council of

Canada, the USNational Institutes of

Health, and the Canadian Dental

Association, gaining a Certificate of

Merit from the latter and several

fellowships in medical sciences and

dentistry. He is a life member of the

Alberta Dental Association and re-

tired from clinical practice in 2002.

In 1988 Norman was appointed

chancellor of the International Col-

lege of Head and Neck Orthopedics,

and in that capacity he has lectured in

the United States, Europe, Australia,

and Asia.

Norm is just one example of the

faculty members at LVI. I’m proud

of every LVI faculty member. I’m

proud of all those who have even

attempted to gain their LVIM, and

would put their knowledge and skill

against anyone in the area of esthetic

reconstructive dentistry. I am also

proud that LVI has for 10 years led

the field of continuing education to

become the leader in postgraduate

continuing education. Judging by the

number of programs, course atten-

dance, graduates, and, most impor-

tantly, participant enthusiasm for

what we are doing to help them be

the best dentists they can possibly be,

LVI leads the profession in post-

graduate dental education. I was told

a long time ago bywiser men thanme

to just let our success be the response

to our detractors. ‘‘When you find

yourself the target of other people’s

bitterness, ignorance, smallness, and

insecurities, remember, things could

be worse. . .you could be them.’’

Again, thank you for giving me the

opportunity to respond to these un-

informed and unsubstantiated asser-

tions. I would like to personally

encourage readers to find out the

truth about LVI for themselves and

come and learn. They just may be

surprised. In fact, I know they will

be. As Omer Reed would say, our

detractors ‘‘don’t know what they

don’t know!’’

William G. Dickerson, DDS

(Founder of LVI)

The opinions expressed in this feature arethose of the authors and do not necessarilyreflect those of BC Decker Inc.

n2005 BC Decker Inc

P E R S P E C T I V E S

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