Best way to learn difficult extractions, third molars, and implants for a GP

[ButlerCard]

I am currently a third year student and have decided that I no longer wish to pursue surgery because I decided it wasn't the kind of life that I wanted. There are some aspects I would like to take into my future practice however, such as pulling thirds, surgical extractions, and being able to place some of the more difficult implants that many people would likely refer out. What is the best option for learning how to do these? Should be be considering a GPR? Will CE courses cut it? Just try to find a dentist who already does those things and be an associate under him? Just curious if any current dentists had any input on this. Thanks

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[DaleDoback]

I am currently a third year student and have decided that I no longer wish to pursue surgery because I decided it wasn't the kind of life that I wanted. There are some aspects I would like to take into my future practice however, such as pulling thirds, surgical extractions, and being able to place some of the more difficult implants that many people would likely refer out. What is the best option for learning how to do these? Should be be considering a GPR? Will CE courses cut it? Just try to find a dentist who already does those things and be an associate under him? Just curious if any current dentists had any input on this. Thanks

Maybe you should do a surgery residency to do more advanced surgery.

 

[Miley Cyrus.]

Depends on how many lawyers are in the area you are practicing in.

 

[Mackchops]

I am currently a third year student and have decided that I no longer wish to pursue surgery because I decided it wasn't the kind of life that I wanted. There are some aspects I would like to take into my future practice however, such as pulling thirds, surgical extractions, and being able to place some of the more difficult implants that many people would likely refer out. What is the best option for learning how to do these? Should be be considering a GPR? Will CE courses cut it? Just try to find a dentist who already does those things and be an associate under him? Just curious if any current dentists had any input on this. Thanks

I would suggest doing a good GPR or even an internship year in oral surgery. You'll learn how to become a good exodontist, sure, but more importantly you'll learn perioperative management - medical/surgical complications, pain management, sedation, etc. This stuff is important if you want to develop a surgically-heavy practice as a GP.

 

[DaleDoback]

I would suggest doing a good GPR or even an internship year in oral surgery. You'll learn how to become a good exodontist, sure, but more importantly you'll learn perioperative management - medical/surgical complications, pain management, sedation, etc. This stuff is important if you want to develop a surgically-heavy practice as a GP.

Here's my issue with this whole idea. It's strictly financial based. He/She specifically said that he doesn't want to "have that kind of life" as a surgeon, but they will provide patients a surgical option with little to no surgical training. Who wins? The patient? No, the patient doesn't have the best option for their surgical care. The GP? Yes, they get paid. It's 100% financial based.

Now the GP says, well, I really enjoy doing those more difficult surgical procedures. Fair enough. I did a plastics rotation in residency. I REALLY enjoyed doing breast augmentations on 20-35 year old females. Can I go do some CE and implement that? No, I need a residency specific for that kind of surgery. It would be financially rewarding and really fun for me, but in no way, would it be best for the patient.

 

[psiyung]

Dale, everytime you reply with a comment you come across as really mad...this guy is still a student man cut him a little slack ..to the OP, i take out the majority of third molars at my practice...some of the deeper impactions i refer out or keep on watch...you need to start out with basic flap design and keep it to partial bony extractions for atleast the first 100 wisdom teeth you take out...once youre more comfortable, you can start tackling more difficult cases...stay friends with your local OS and learn from him as much as you can

 

[DaleDoback]

Dale, everytime you reply with a comment you come across as really mad...this guy is still a student man cut him a little slack ..to the OP, i take out the majority of third molars at my practice...some of the deeper impactions i refer out or keep on watch...you need to start out with basic flap design and keep it to partial bony extractions for atleast the first 100 wisdom teeth you take out...once youre more comfortable, you can start tackling more difficult cases...stay friends with your local OS and learn from him as much as you can

The advice you just gave him......ask yourself. Do you think that is truly what is best for his patients? If your daughter/son was his first patient, you're totally ok with that? You would submit yourself to being his first patient?

I'm in the ER and OR taking care of these complications. That's why I'm angry.

 

[Toronto77]

The advice you just gave him......ask yourself. Do you think that is truly what is best for his patients? If your daughter/son was his first patient, you're totally ok with that? You would submit yourself to being his first patient?

I'm in the ER and OR taking care of these complications. That's why I'm angry.

Yep, we are the dumping grounds of the entire dental field. I love when people send referrals promising sedation by ME, for ASA 3/4 pts with BMI >60, MP 4, etc. Multiple ED pts this week and pts sent directly from their clinics after they jack somebody up for a few hours. Know your limits, treat infections properly, these are people not dollar signs......

 

[psiyung]

The advice you just gave him......ask yourself. Do you think that is truly what is best for his patients? If your daughter/son was his first patient, you're totally ok with that? You would submit yourself to being his first patient?

I'm in the ER and OR taking care of these complications. That's why I'm angry.

non sequitur...we are all here to learn...as you well know some wisdom teeth are easier to remove than placing a DO composites on certain teeth...i think with proper knowledge and smart general dentists knowing their limitations, dentists can safely remove wisdom teeth. I understand where you are coming from with cowboy dentists trying to perform procedures they know they shouldnt or cant perform. I was an oral surgery intern for a year and cleaned up a lot of the messes that GPs were making all across the NY area. But these messes will continue until we educate these doctors on proper technique and knowing their limitations.

I could take your argument and say "hey this is this persons first extraction, is this really what's best for this patient?" Of course it isnt. And i know exactly what goes on during your residencies when you guys are fresh out of school. If your hope is for GPs to stop making these mistakes, then we have to so a better job in educating them. But i have a funny feeling this is more of a turf war and financially motivated by both sides.

 

[FlyingSky]

I would suggest doing a good GPR or even an internship year in oral surgery. You'll learn how to become a good exodontist, sure, but more importantly you'll learn perioperative management - medical/surgical complications, pain management, sedation, etc. This stuff is important if you want to develop a surgically-heavy practice as a GP.

hey mackchops when you say a good GPR what do you mean? and do most schools offer an internship year in oral surgery? thats something that would really interest me but I never heard of this before, is it hard to get in?

 

[DaleDoback]

Most oral surgery internships are for people who want to do an OMS residency, but failed to match or wanted to see if it was for them. I wouldn't advise doing an OMS internship just to try to get experience to take out teeth. You spend 80-100 hours a week working while in the ER, clinic, and doing a majority of the scut work.

Interested to hear the comments of Psi on this one in regards to the value and purpose of his intern year.

 

[DaleDoback]

non sequitur...we are all here to learn...as you well know some wisdom teeth are easier to remove than placing a DO composites on certain teeth...i think with proper knowledge and smart general dentists knowing their limitations, dentists can safely remove wisdom teeth. I understand where you are coming from with cowboy dentists trying to perform procedures they know they shouldnt or cant perform. I was an oral surgery intern for a year and cleaned up a lot of the messes that GPs were making all across the NY area. But these messes will continue until we educate these doctors on proper technique and knowing their limitations.

I could take your argument and say "hey this is this persons first extraction, is this really what's best for this patient?" Of course it isnt. And i know exactly what goes on during your residencies when you guys are fresh out of school. If your hope is for GPs to stop making these mistakes, then we have to so a better job in educating them. But i have a funny feeling this is more of a turf war and financially motivated by both sides.

Haha. People who come to a resident clinic are similar to the people who come to a dental school. They know what they are getting in advance.

I agree 100% that better education of case selection is absolutely key. I'm not arguing that every surgery needs an OMS. Trust me, I don't want to take out a bunch of teeth under local. GP just needs to know when and what to refer. Getting into a case that one should have referred is never good for the patient or the dentist. Unfortunately, we don't always know that until the end of the case. My concern is when "super dentists" tell dental students they can do anything. That's the world that scares me.

Appreciate your opinions. Good discussion.

 

[Mackchops]

hey mackchops when you say a good GPR what do you mean?

One that will train you in what you want to learn. Some programs do a lot of surgery, some don't.

My concern is when "super dentists" tell dental students they can do anything. That's the world that scares me.

Amen, brother...

 

[psiyung]

Most oral surgery internships are for people who want to do an OMS residency, but failed to match or wanted to see if it was for them. I wouldn't advise doing an OMS internship just to try to get experience to take out teeth. You spend 80-100 hours a week working while in the ER, clinic, and doing a majority of the scut work.

Interested to hear the comments of Psi on this one in regards to the value and purpose of his intern year.

Just to extract teeth, it's not a smart move. I did the internship right after dental school because I did not know exactly what Oral Surgery entailed in its totality. But for those like me who did it and decided not to pursue OMFS, it will make them a more well-informed and intelligent dentist regarding numerous aspects of medical histories, note taking, simple dentoalveolar procedures, and intravenous sedation. Not to mention other small intricate aspects such as being able to read a CT scan, knowing when to refer, and greater appreciating what your local OMFS had to go through to reach his or her position.

 

[FlyingSky]

Just to extract teeth, it's not a smart move. I did the internship right after dental school because I did not know exactly what Oral Surgery entailed in its totality. But for those like me who did it and decided not to pursue OMFS, it will make them a more well-informed and intelligent dentist regarding numerous aspects of medical histories, note taking, simple dentoalveolar procedures, and intravenous sedation. Not to mention other small intricate aspects such as being able to read a CT scan, knowing when to refer, and greater appreciating what your local OMFS had to go through to reach his or her position.

Interesting thanks for sharing your experience, Im working with an OMFS right now and his work is inspiring, I dont really see myself as an OMFS but I am really developping more interest in OS, hes helping and teaching me tons about just everything

 

[psiyung]

I hate GPs like this. It makes us look bad and it makes patient trust a lot more difficult to gain.

 

[DaleDoback]

I hate GPs like this. It makes us look bad and it makes patient trust a lot more difficult to gain.

Geez. Those teeth were absolutely fine to be taken out by a GP. I have no issues with that and it seems like it went without major issues. Probably think that his time would have been spent better doing other procedures instead of fighting this guy's anesthesia for an undisclosed amount of time.

Why in the world would you ever allow someone to video the surgery? And having no assistant throughout the process as well. Very poor judgment and I agree 100%, it doesn't help perception in our world.

 

[GBP12]

I will say that I was shadowing an associate a while ago who had just recently graduated dental school like 5-6 months ago and the owner does everything from wisdom teeth to implants to root canals. So he started getting her into doing those, and I was shadowing her doing wisdom teeth extractions on someone and she couldn't take one of them out so she just told the patient to come back when the owner is here and he will do it.

If I was the patient, I would be furious, that not only did she not take it out, but she made the incision to go take it out and just left everything as is and that I would have to go through the whole experience all over again.

 

[mstanley614]

Each practitioner will be different. 5months after Graduation there will be some kids that are flying through reasonably easy 3rd molar cases. The opposite is also true ^ as we see above. I agree to start with basic flap design and stay well within your comfort level. Refer more than you might want to and be in touch with your OS guy in the area. He'll tell you after a relationship is there what he thinks you could be doing and may be willing to work together on certain cases. You can provide Incredible tx to a pt if the OS and GP work in tandem. Remember, The OS folks don't want to "waste" their time doing way too simple of procedures. Also, they really hate getting dumped on with a cleanup task. Although, signing up for OMFS, you are taking that burden on purpose to a certain degree. I can't imagine not doing another RCT or Anterior case. I love seeing the smiles with stellar looking crowns/veneers. I like the technical aspect of Endo. Same as you… my opinion… Surgery is cool. Treat your skill level with surgery the same way you will with your practice… don't expand too rapidly. That way you keep Dale happy and your pts get great tx. To that point. I wouldn't want to be the first OMFS residents fully impacted 3rds case either. In fact, I'd rather a 15 yr practitioner GP take them out if he's comfortable with it. How do you get to the point where your pt management, peri-operative assessment skills are up to the quality… Practice…

 

[DaleDoback]

Each practitioner will be different. 5months after Graduation there will be some kids that are flying through reasonably easy 3rd molar cases. The opposite is also true ^ as we see above. I agree to start with basic flap design and stay well within your comfort level. Refer more than you might want to and be in touch with your OS guy in the area. He'll tell you after a relationship is there what he thinks you could be doing and may be willing to work together on certain cases. You can provide Incredible tx to a pt if the OS and GP work in tandem. Remember, The OS folks don't want to "waste" their time doing way too simple of procedures. Also, they really hate getting dumped on with a cleanup task. Although, signing up for OMFS, you are taking that burden on purpose to a certain degree. I can't imagine not doing another RCT or Anterior case. I love seeing the smiles with stellar looking crowns/veneers. I like the technical aspect of Endo. Same as you… my opinion… Surgery is cool. Treat your skill level with surgery the same way you will with your practice… don't expand too rapidly. That way you keep Dale happy and your pts get great tx. To that point. I wouldn't want to be the first OMFS residents fully impacted 3rds case either. In fact, I'd rather a 15 yr practitioner GP take them out if he's comfortable with it. How do you get to the point where your pt management, peri-operative assessment skills are up to the quality… Practice…

Great advice.

 

[vellnueve]

Like everything else in dentistry it is up to you to judge your competence to perform any particular procedure. I am currently a GP although headed to OMFS residency in the not so distant future - I won't blink an eye at taking out pretty much anything but the deepest full bony impactions, but at the same time I haven't touched a compete denture or implant surgery in years. Which service do you think I'm more willing to provide?