specializing

[Pre-Dent Jeff]

I'm about to start my first year of D-School in the Fall. I was wondering what the process typically is for specializing. I am leaning towards specializing just from what I've observed, but I haven't made my mind up.

What made you decide to specialize or practice general dentistry?

What are the pros and cons of each common field of dentistry?

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[Contach]

Congrats!

I chose to specialize in OMFS mostly because of three reasons.
1) I saw a lot of general restorative work failing (crowns, fillings, etc) and didn't want to have to see my work fail. I had difficulty when I had to tell patients that their crown needed to be redone, and it overwhelmed me with regret. When you take out teeth, the teeth are gone. There are accepted complications, and sometimes that happens, but you won't ever have to take out that tooth again. Implants, have great success rates as well, 90%+ after 5 years, and generally if they last 5 years they're going to last a long time. The ADA says the average lifespan of a crown is 5 years if I remember correctly, and a filling is 1 year? Ludacris. Okay, the bigger OMFS surgeries like orthognathics can have significant relapse rates, but I think people understand that these are much more complex procedures that carry a lot of risk, and the risk of relapse.
2) I like that OMFS isn't primary care... We get referred specific problems, and we can do things to fix those problems.... often quickly and immediately. Then we send the patients on their way, back to someone else to coordinate the care for their other 15 problems in their mouth. As tertiary care, we also are the last stop for a patient's care - as a general dentist you are held to the standards of a much better trained OMFS every time you do an oral surgery procedure... I don't know about you, but that would cause me to have a lot of anxiety.
3) I appreciated the medical work-up and management of medically complex patients. I always had a lot of questions about patient's medical histories and realized in dental school that I was really interested in the pathophysiology and my dental school curriculum didn't do enough to explain it all. Medical school has been a good place to learn all this.

...I also dreamed about working 3 days a week, and OMFS seemed like the best way to do that.
... .... Also, my tinder account gets a lot more matches when I say I'm an oral and facial surgeon, and that I fix faces for a living.

 

[yappy]

I'm not a specialist, or a licensed dentist, yet but two things made me realize that a particular specialty was for me:
1. General dentistry is so incredibly broad that I doubted I could ever really master all of what I would be responsible for to the degree that I wanted.
2. The craft is just so AWESOME!!!

 

[gn4]

Congrats!



...I also dreamed about working 3 days a week, and OMFS seemed like the best way to do that.
... .... Also, my tinder account gets a lot more matches when I say I'm an oral and facial surgeon, and that I fix faces for a living.

really? is that true? I've always assumed OMFS works crazy hours everyday. You work in your practice and you probably have to take call at the local hospital to continue with hospital privileges, correct?

 

[THS]

I totally understand why some choose to specialize. For instance, being the "go-to" guy for a certain procedure carries with it some level of prestige and respect. It would be so cool for a general dentist to talk me up to the patient and say "I'm going to refer you to Dr. THS, he can do that apicoectomy with no pain, easily." Also, the low overhead in endo is very significant. If you're billing 1M per year with 45% overhead (or less), that's $500K+ take home.

However, being limited to one scope of dentistry seems frustrating to me. I suppose perio is more broad than endo or prosth (are there even any prosthodontists around anymore?), but I would still like to be able to choose which procedures to excel at and which to refer out. It kind of reminds me of those circular/pentagon charts used for football player stats (like this: http://i3.mirror.co.uk/incoming/article3184483.ece/BINARY/Sturridge_v_Zlatan_overlay.png) but instead of "non-penalty goals" and "shots", it would be "molar endo" and "RPDs".

There are obvious pros and cons to both. If you aren't sure what you want to do yet, keep your grades as high as possible and get involved with student government at your school. Otherwise, C's get degrees, y'erd me?

 

[setdoc7]

Congrats!

I chose to specialize in OMFS mostly because of three reasons.
1) I saw a lot of general restorative work failing (crowns, fillings, etc) and didn't want to have to see my work fail. I had difficulty when I had to tell patients that their crown needed to be redone, and it overwhelmed me with regret. When you take out teeth, the teeth are gone. There are accepted complications, and sometimes that happens, but you won't ever have to take out that tooth again. Implants, have great success rates as well, 90%+ after 5 years, and generally if they last 5 years they're going to last a long time. The ADA says the average lifespan of a crown is 5 years if I remember correctly, and a filling is 1 year? Ludacris. Okay, the bigger OMFS surgeries like orthognathics can have significant relapse rates, but I think people understand that these are much more complex procedures that carry a lot of risk, and the risk of relapse.
2) I like that OMFS isn't primary care... We get referred specific problems, and we can do things to fix those problems.... often quickly and immediately. Then we send the patients on their way, back to someone else to coordinate the care for their other 15 problems in their mouth. As tertiary care, we also are the last stop for a patient's care - as a general dentist you are held to the standards of a much better trained OMFS every time you do an oral surgery procedure... I don't know about you, but that would cause me to have a lot of anxiety.
3) I appreciated the medical work-up and management of medically complex patients. I always had a lot of questions about patient's medical histories and realized in dental school that I was really interested in the pathophysiology and my dental school curriculum didn't do enough to explain it all. Medical school has been a good place to learn all this.

...I also dreamed about working 3 days a week, and OMFS seemed like the best way to do that.
... .... Also, my tinder account gets a lot more matches when I say I'm an oral and facial surgeon, and that I fix faces for a living.

Where are you geting the 90% success rate for implants data from? Need a refereed journal annotation for that.
Shrugging off Orthognathic relapse? Really? A crown failing is far less of a disability than this major surgery relapsing, especially after spending many months in preorthognathic orthodontics. And the post op complications of these surgeries can be staggering, as opposed to a poorly fitting crown....talk about anxiety provoking situations.
Sorry, but finiding many of your reasons over simplifications.

 

[PointEstimate]

Setdoc7, ask and you shall receive: http://www.ncbi.nlm.nih.gov/pubmed/25964006

 

[DentalDoge]

I too am starting in the coming academic cycle, though anatomy starts in the summer, and would like to know the processes for specializing, particularly OMS.

Aka timelines for CBSE, interships, externships, ECS?, summer activities between D1 and D2, etc

Thanks!

 

[Mackchops]

are there even any prosthodontists around anymore?

hahaha - yeah, there's still a few out there

How to specialize?

Step 1 - Figure out what you want to specialize in! Remember, specializing means limiting yourself - you are excluded from practicing outside the scope of your specialty while you practice as a specialist. A popular alternative is to set up your general practice with an emphasis on certain aspects of dentistry you like, and refer out the rest! Don't like dentures? Send them to me.

Step 2 - Spend a lot of time with residents/faculty in the area of specialization you're considering. This is usually done concurrently with Step 1 as you're figuring out what you want to do, but I can't emphasize the importance of this step enough. You'll learn a lot about the specialty you're considering just by spending time with those who are in it.

Step 3 - Get some exposure outside of your school. It's amazing how uni-dimentional a dental school can be. Escape the chains and see what other people are doing in that field! Shadow at a private practice or visit another school. For some specialties this is pretty much mandatory so they know that you know what you're getting into.

Step 4 - Apply. Each specialty does this differently and you'll need to get past Step 1 to delve into the specifics here, but by the end of 3rd year you should have a solid amount of stuff you can put onto an application. Good grades, experience, letters of recommendation, research, extracurriculars, etc. You've done this before when you applied to college and dental school - this time isn't any different.

Step 5 - Enjoy long hours, tons of reading, and complete immersion in your field of choice. Hope you're passionate. They call it a residency for a reason - you live, eat, breathe it.

 

[Hannah Banana]

hahaha - yeah, there's still a few out there

How to specialize?

Step 1 - Figure out what you want to specialize in! Remember, specializing means limiting yourself - you are excluded from practicing outside the scope of your specialty while you practice as a specialist. A popular alternative is to set up your general practice with an emphasis on certain aspects of dentistry you like, and refer out the rest! Don't like dentures? Send them to me.

Step 2 - Spend a lot of time with residents/faculty in the area of specialization you're considering. This is usually done concurrently with Step 1 as you're figuring out what you want to do, but I can't emphasize the importance of this step enough. You'll learn a lot about the specialty you're considering just by spending time with those who are in it.

Step 3 - Get some exposure outside of your school. It's amazing how uni-dimentional a dental school can be. Escape the chains and see what other people are doing in that field! Shadow at a private practice or visit another school. For some specialties this is pretty much mandatory so they know that you know what you're getting into.

Step 4 - Apply. Each specialty does this differently and you'll need to get past Step 1 to delve into the specifics here, but by the end of 3rd year you should have a solid amount of stuff you can put onto an application. Good grades, experience, letters of recommendation, research, extracurriculars, etc. You've done this before when you applied to college and dental school - this time isn't any different.

Step 5 - Enjoy long hours, tons of reading, and complete immersion in your field of choice. Hope you're passionate. They call it a residency for a reason - you live, eat, breathe it.

Dr. Mackchops, I am going to start dental school this fall and have been interested in prosth since I became interested in dentistry. How is the job outlook for prosthodontists and what are the average stats to aim for during dental school? I really appreciate your time because there are not many threads about prosth.

 

[agent2362]

Congrats!

I chose to specialize in OMFS mostly because of three reasons.
1) I saw a lot of general restorative work failing (crowns, fillings, etc) and didn't want to have to see my work fail. I had difficulty when I had to tell patients that their crown needed to be redone, and it overwhelmed me with regret. When you take out teeth, the teeth are gone. There are accepted complications, and sometimes that happens, but you won't ever have to take out that tooth again. Implants, have great success rates as well, 90%+ after 5 years, and generally if they last 5 years they're going to last a long time. The ADA says the average lifespan of a crown is 5 years if I remember correctly, and a filling is 1 year? Ludacris. Okay, the bigger OMFS surgeries like orthognathics can have significant relapse rates, but I think people understand that these are much more complex procedures that carry a lot of risk, and the risk of relapse.
2) I like that OMFS isn't primary care... We get referred specific problems, and we can do things to fix those problems.... often quickly and immediately. Then we send the patients on their way, back to someone else to coordinate the care for their other 15 problems in their mouth. As tertiary care, we also are the last stop for a patient's care - as a general dentist you are held to the standards of a much better trained OMFS every time you do an oral surgery procedure... I don't know about you, but that would cause me to have a lot of anxiety.
3) I appreciated the medical work-up and management of medically complex patients. I always had a lot of questions about patient's medical histories and realized in dental school that I was really interested in the pathophysiology and my dental school curriculum didn't do enough to explain it all. Medical school has been a good place to learn all this.

...I also dreamed about working 3 days a week, and OMFS seemed like the best way to do that.
... .... Also, my tinder account gets a lot more matches when I say I'm an oral and facial surgeon, and that I fix faces for a living.

DUDE, crowns last alot longer than 5 years on average...more like 15 yrs. fillings generally last greater than 5 yrs. I won't be too hard on ya'...you're barely even a dentist anymore. Just a teeth and titanium type of guy at this point.

 

[navydentist]

Dr. Mackchops, I am going to start dental school this fall and have been interested in prosth since I became interested in dentistry. How is the job outlook for prosthodontists and what are the average stats to aim for during dental school? I really appreciate your time because there are not many threads about prosth.

Prosth is not competitive to gain entry too. They probably just want to see some kind of legit passion for it. It is not an easy residency, you will spending all your evenings in the lab.

In private practice most prosthodontists work as "super general dentists". It just does not lend itself to being referral based. There's nothing wrong with this, you can go somewhere with rich old people and do well, especially if you can place the implants.

 

[Hannah Banana]

Prosth is not competitive to gain entry too. They probably just want to see some kind of legit passion for it. It is not an easy residency, you will spending all your evenings in the lab.

In private practice most prosthodontists work as "super general dentists". It just does not lend itself to being referral based. There's nothing wrong with this, you can go somewhere with rich old people and do well, especially if you can place the implants.

Thank you for sharing the info, Doc! Are you a GP or Prosth?

 

[Greyangel6]

I'd like to do endo or perio, and like one of the above posters said, open a general practice with emphasis on certain aspects while I do the endo or perio cases. Or just be a traveling doc, with little to none overhead, I'd still be ok. And yea working 3-4 days/week is my dream job haha. But dschool is tough and I can't foresee the future (upcoming D1) so I will get back to you if I've changed my mind about specializing haha.

 

[Mackchops]

Dr. Mackchops, I am going to start dental school this fall and have been interested in prosth since I became interested in dentistry. How is the job outlook for prosthodontists and what are the average stats to aim for during dental school? I really appreciate your time because there are not many threads about prosth.

Good for you! Pros is awesome!! (And dentistry's best-kept secret). The job outlook is outstanding as materials, processes, and procedures evolve. While it's not too hard to get into a program somewhere, the best programs are quite competitive.

Prosth is not competitive to gain entry too. They probably just want to see some kind of legit passion for it. It is not an easy residency, you will spending all your evenings in the lab.

In private practice most prosthodontists work as "super general dentists". It just does not lend itself to being referral based. There's nothing wrong with this, you can go somewhere with rich old people and do well, especially if you can place the implants.

Yes. Yes. Not always. Passion and long hours are the name of the game in residency. But the "super general dentist" thing is the route only some pros guys take - just as some oral surgeons never enter an OR again after residency and spend their careers on dentoalveolar. There are plenty of prosthodontists out there with pure pros practices who rely a lot on referrals.