Advice for a D3 - should I specialize? perio?

[dental1993]

I wasn't planning on specializing (not involved in extracurriculars, less than impressive CV, and haven't been building relationships with my professors). I've always planned on working right after graduation, mostly because I'm older and want to start saving for a family & my own practice one day. However, I am also open to specializing AFTER working for a few years if I'm still passionate about it.

Due to more recent exposure in clinic, I've found myself drawn to the idea of specializing in perio (want to do implants/all on 4s). Should I shoot my shot and just apply to perio programs considering all of this? Odds I get accepted? Other advice?

Background info: Currently a 3rd year, I don't have the best DS transcript & had to remediate a class (however I go to a P/NP school - UCSF), will be a late applicant (won't be taking boards until August), I'll graduate at 29, and no loans.

---

Members don't see this ad.

 

[charlestweed]

Do you plan to open your own office? Are you OK with going door to door to meet the general dentists to ask them to refer patients to your office? If the answers are both no, then I don’t think you should apply. Theres's no point of specialzing if you don't have patients to work on. There are not a lot of corp offices that hire in-house perio.

 

[Undecided__]

I wasn't planning on specializing (not involved in extracurriculars, less than impressive CV, and haven't been building relationships with my professors). I've always planned on working right after graduation, mostly because I'm older and want to start saving for a family & my own practice one day. However, I am also open to specializing AFTER working for a few years if I'm still passionate about it.

Due to more recent exposure in clinic, I've found myself drawn to the idea of specializing in perio (want to do implants/all on 4s). Should I shoot my shot and just apply to perio programs considering all of this? Odds I get accepted? Other advice?

Background info: Currently a 3rd year, I don't have the best DS transcript & had to remediate a class (however I go to a P/NP school - UCSF), will be a late applicant (won't be taking boards until August), I'll graduate at 29, and no loans.

How did you finish with no loans

 

[knewstance]

I was in this same boat around the same time as you. I decided against applying bc I realized that the bread and butter of perio was not implants.

If you are really that dedicated with implants, get some extra training and do them as a GP. That's my plan at this point.

 

[redchesus]

I wasn't planning on specializing (not involved in extracurriculars, less than impressive CV, and haven't been building relationships with my professors). I've always planned on working right after graduation, mostly because I'm older and want to start saving for a family & my own practice one day. However, I am also open to specializing AFTER working for a few years if I'm still passionate about it.

Due to more recent exposure in clinic, I've found myself drawn to the idea of specializing in perio (want to do implants/all on 4s). Should I shoot my shot and just apply to perio programs considering all of this? Odds I get accepted? Other advice?

Background info: Currently a 3rd year, I don't have the best DS transcript & had to remediate a class (however I go to a P/NP school - UCSF), will be a late applicant (won't be taking boards until August), I'll graduate at 29, and no loans.

Clinical considerations: Do you like soft tissue management especially for anterior cases? Do you like tissue/bone regeneration procedures? For implants, GPs will place most of the slam dunk ones (premolars/molars on fat abundant ridges), you'll get difficult anterior cases with thin ridges or posterior resorbed ridges. (If you don't know if you like these, start shadowing the post-grad perio clinic)

Personality considerations: Do you like getting to know patients over time and marketing to the public directly? Or schmoozing with other providers to get you patients?

 

[LFA20]

If you are dead set on perio then I would apply and try to get in straight out of dental school.

 

[LFA20]

Do you plan to open your own office? Are you OK with going door to door to meet the general dentists to ask them to refer patients to your office? If the answers are both no, then I don’t think you should apply. Theres's no point of specialzing if you don't have patients to work on. There are not a lot of corp offices that hire in-house perio.

What about endodontists? lol... Are there a lot of corp offices that hire them?

 

[FutureDent020]

I was in this same boat around the same time as you. I decided against applying bc I realized that the bread and butter of perio was not implants.

If you are really that dedicated with implants, get some extra training and do them as a GP. That's my plan at this point.

This is the answer. I know some groups that focus on all on 4’s but they include Prosth/ OMFS/ and maybe 1 perio. All on 4’s are being quarterbacked by prosth and GP’s. The likely hood that you as a periodontist gets involved will depend on your specific situation and if you can finagle your way into those groups.

 

[FutureDent020]

What about endodontists? lol... Are there a lot of corp offices that hire them?

It’s irrelevant because you DO NOT want to work for corp unless it’s some of these newer groups like USEndo or ENDO1. The latter are still controlled by Endodontists and seem to favor providers a good bit.

Corps thrive off of volume. Endo is not a good specialty to rely on volume. Cases are hard, patients are difficult, and sometimes it takes time to do a good job.

 

[LFA20]

It’s irrelevant because you DO NOT want to work for corp unless it’s some of these newer groups like USEndo or ENDO1. The latter are still controlled by Endodontists and seem to favor providers a good bit.

Corps thrive off of volume. Endo is not a good specialty to rely on volume. Cases are hard, patients are difficult, and sometimes it takes time to do a good job.

Good to know.. Thanks for the insight

 

[charlestweed]

I was in this same boat around the same time as you. I decided against applying bc I realized that the bread and butter of perio was not implants.

If you are really that dedicated with implants, get some extra training and do them as a GP. That's my plan at this point.

It depends on where you get your perio training at. If you attend a perio program, where you have a strong working relationship with the prosth residents and share the same classes with them, you will gain a lot of restorative experience. And when you get out, you can use this knowledge to help the referral GPs to diagnose and tx plan difficult implant cases. Many of the patients who need implants have ignored their teeth for a long time….and the cases become very difficult (multiple perio involved teeth, collapsed VDO, uneven occlusal plane etc) for the GPs to handle....and therefore, they dump these cases to the perio offices. During the peak of my wife’s career, 70% of the procedures were implant placements and other implant related procedures such as sinus lift and bone grafts.

 

[charlestweed]

What about endodontists? lol... Are there a lot of corp offices that hire them?

It’s the same for endo. For a few corp offices that hire them, they only hire them a few (1-2) days a month. To get more cases, the perios and endos have to open their own offices and have to travel to multiple GP offices to supplement their incomes.

My former dental classmate (also a roommate) got his endo certificate at 42. He was a non-traditional student. Because of his age, he didn’t want to take the risk to open his own office. Since graduation, he has worked at this endo specialty office that accepts mostly HMO insurances (that’s how the office gets a lot of patients to keep him busy 3 days/wk). It’s a busy job but he likes it a lot. He has always said nice things about endo and he's glad that he spent 2 extra years after dental school. He also travels to a few other offices….one of them is a multi-specialty practice that is owned by an orthodontist, who is our mutual friend.

 

[2TH MVR]

One other consideration regarding Corp Perio. This could also apply to private practice perio. I'm friends with a periodontist who works at the same Corp as I do. He is the ONLY periodontist employed at this Corp. He complains all the time that the GPs are not knowledgeable or trained properly to RESTORE his implants. So the success of his implant tx is heavily reliant on the GPs who restore them. So. Of course. When an implant fails due to a questionable restoration ... then it comes back to the perio who placed the implants. Who. Then is responsible for the implant redos?

Point is. I prefer an area in dentistry where my tx success is not reliant on others (GPs).

 

[dental1993]

I was in this same boat around the same time as you. I decided against applying bc I realized that the bread and butter of perio was not implants.

If you are really that dedicated with implants, get some extra training and do them as a GP. That's my plan at this point.

Yeah this was my original plan.. I might just end up doing this

 

[dental1993]

How did you finish with no loans

I was lucky enough to have my parents pay for everything

 

[schmoob]

One other consideration regarding Corp Perio. This could also apply to private practice perio. I'm friends with a periodontist who works at the same Corp as I do. He is the ONLY periodontist employed at this Corp. He complains all the time that the GPs are not knowledgeable or trained properly to RESTORE his implants. So the success of his implant tx is heavily reliant on the GPs who restore them. So. Of course. When an implant fails due to a questionable restoration ... then it comes back to the perio who placed the implants. Who. Then is responsible for the implant redos?

Point is. I prefer an area in dentistry where my tx success is not reliant on others (GPs).

Is there anything special about how this Perio places his implants that he consistently has problems with GPs restoring them?

 

[2TH MVR]

Is there anything special about how this Perio places his implants that he consistently has problems with GPs restoring them?

I see your point that maybe .... HE'S the problem. He's been doing these implants for a long time. From his point of view ...the issue is the lack of knowledge from the GPs ... both new and old.

One example he told me about. An upper denture supported anteriorly with 2 implants and posteriorly supported by palatal tissue. I don't know anything about the anterior implants type or size. Apparently ... the female patient was complaining about how much the denture covered her palate. The older dentist (who now has a teaching job at a dental school ) removed the entire center portion of the max denture (half a bagel) to make the patient happy. I guess this lessened ????? the posterior support. Caused more rocking/instability and the anterior implants failed. This happened twice with the same dentist. Again. Maybe it was the Perio's fault. I'm just going off what he was saying to me.

He got to the point that HE was restoring his own implants. Corp was fine with this ... which I thought was odd. A Periodontist doing restorative fixed and removable. But ... he doesn't like doing the restorative.

The main issue is the GP's lack of knowledge. He has offered to conduct some mini CE courses to the GPs, but last I heard ... Corp was dragging their feet on this. I've known this perio for the last 5 years. I do trust in his abilities.

The main point of my post is that certain specialties, like Perio require communication between both Perio and GPs for a successful outcome. Success for one party relies on the other party doing their treatment properly. Certain specialties requires more communication with the GPs.

Another example for all you aspiring OMFS. With an impacted palatal cuspid in braces. PLEASE. PLEASE. Place the button/chain on the LABIAL of the crown. Or as close to the labial crown as possible. Not the LINGUAL. Anything else means the tooth will come in sideways or rotated. Kind of like fishing. Hook the fish in the mouth (LABIAL of crown) and the fish comes in easily. Snag the fish in the back of the head or body .... it will be difficult to bring that fish in.

Speaking of fishing. I'll be in Alaska this summer slaying some Salmon.

See. MY success depends on how the OMFS places that button/attachment.

 

[P7898]

I thought about perio. But really I was interested in the implants and then ended up liking endo a lot more. So I decided GP and expand my endo skills.

Fact is, as GP you can be any kind of dentist that you want to. Perio is great - but job search is touch. People I know work multiple jobs but do well. If you hustle, work hard, and treat patients right you will do well financially no matter where you go. My deciding factor for GP was more job opportunities and better opportunities to hustle on earlier in life and save 3 more years for retirement instead of taking out loans for residency and missing out on income. I like everything in dentistry but it all depends on what you want out of life - this should be your first question.

I do not have to worry about where patients come from. Can do any procedure I feel comfortable doing or refer to our amazing specialist friends. I can work as much as I want or as little as I want (many GP opportunities everywhere). GP is the more flexible work life balance in my opinion - but hindsight 2020 I graduated with well above the average debt (more than half) so I had some flexibility. My significant other is a GP too and didn't have much of any debt so we live comfortably and have control of our lives. Financials play a big role in your life so I encourage to do the math and figure out what you want in life (and of course keep finances down) .