General Dentist in a Peds Office

[bilbany12]

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[edited]

 

[pubhealthdent]

General dentists can work on kids all day, everyday. Why would you want to go to a residency, pay another $200k to do what you could as a general dentist. If you absolutely don't want to work on adults then work in a peds office. The peds office I refer to has one GP that works there that usually gets the older kids (6+) but FWIW, I work in an FQHC and about half my patient base is pedo

 

[luisfigo]

biggest difference is probably working in the OR, only post-resident docs get hospital privileges

 

[Cold Front]

I’m a GP and 70% of my patients are Pedo.



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[setdoc7]

Really? Can we all agree that a Peds residency teaches more than bread and butter dentistry for children? If it did not, what are they doing for 2 years? Let's first agree that peds training is necessary to call oneself a pediatric dentist, and that a GP who treats kids is still simply a GP. A board eligible peds dentist has a larger skill set than a GP with some CE behind them. Otherwise there would be no specialty.

 

[DrJeff]

Really? Can we all agree that a Peds residency teaches more than bread and butter dentistry for children? If it did not, what are they doing for 2 years? Let's first agree that peds training is necessary to call oneself a pediatric dentist, and that a GP who treats kids is still simply a GP. A board eligible peds dentist has a larger skill set than a GP with some CE behind them. Otherwise there would be no specialty.

Certainly a Peds residency will educate one to a deeper level than just bread and butter pediatric dentistry. No question at all about that.

Agree that one CAN'T call themselves or label their practice as a pediatric specialist/specialty practice if they are a GP who just works on kids.

That being said, a sizable portion of *most* pediatric practices is "bread and butter" pediatric dentistry for which a fair amount of what is taught in a Peds residency is above and beyond what that Peds specialist will use on a majority of their daily procedures, that's just the reality of *MOST* pediatric patients that are seen.

While maybe not the quite the 70% pedo level that Cold Front mentioned fills the chairs in his schedule on average, my own GP practice is basically 50% pedo patients, and unless a GP is in an area where retirees dominate the demographic or a GP chooses to refer out pretty much every pedo patient, most every GP has a solid 1/3rd, if not much higher, of a patient population who would be considered in the pedo demographic.

Bread and butter pedo can be fun, and I personally enjoy most of it. If we're talking some higher behavioral management issues, baby bottle caries, some space maintenance situations such as distal wedges or long term where multiple space maintainer will likely be needed due to growth, then I'm grabbing that referral slip ASAP. Otherwise bread and butter pedo, and then hopefully bread and butter adult restorative on the parents of the pedo patients is what is the major production source of the majority of GP practices out there,

 

[TanMan]

I worked in pediatric mills when I was first starting. Working as a GP in a peds mill depends on the compensation model. In my first mill, there were no pediatric dentists, just GP's working mostly on medi-kids. Patient pool was 98%+ kids. They expected SSC's for all interproximals. Second mill had the same proportion of patients, but they had a pediatric dentist come by every week. That one was mostly fills, some ssc's. You can easily make 25-30k/month in these GP-based mills. The challenges that medi-mills are facing here in Texas is lowering reimbursements and getting paid for some OR cases.

Now, my office is mostly adults (85-90%). I love not having to deal with behavior (we don't get paid on parent/behavior management) and higher paying procedures. Papoose boards have gone out of fashion and mostly taboo w/o some form of sedation.

 

[2TH MVR]

When you guys discuss "Pedo" patients .... it would help if you clarify their age groups. I had a similar discussion with a GP who quite frankly did not like to treat "Pedo" pts. In my mind ..."Pedo" pts are kids in the primary and mixed dentition (up to age 11). In his mind ... these Pedo pts included kids up to 17. For myself as an orthodontist .... treating Phase 1, interceptive tx with Pedo kids between the ages of 7-10 can be challenging. If given a choice .... I would prefer to tx age 10 and over.
I consider patients in the permanent dentition (12 and over) as young adult patients. They are still kids, but have PERMANENT dentition.
I can only imagine the expertise and patience required for a GP to treat "Pedo" kids in the PRIMARY dentition (younger than age 6).

 

[DrJeff]

When you guys discuss "Pedo" patients .... it would help if you clarify their age groups. I had a similar discussion with a GP who quite frankly did not like to treat "Pedo" pts. In my mind ..."Pedo" pts are kids in the primary and mixed dentition (up to age 11). In his mind ... these Pedo pts included kids up to 17. For myself as an orthodontist .... treating Phase 1, interceptive tx with Pedo kids between the ages of 7-10 can be challenging. If given a choice .... I would prefer to tx age 10 and over.
I can only imagine the expertise and patience required for a GP to treat "Pedo" kids in the PRIMARY dentition (younger than age 6).

In my head, I go by the pedo "definition" that 2 of my pediatrician friends use, and that's birth to the 18th birthday. A wide range for sure and a HUGE variety of dental needs across that age bracket without a doubt. In the case of one of my pediatrician friends, and we were just discussing this when he was in my office for a cleaning last week, his definition of what constitutes a pedo patient in some cases where the parent(s) are first time parents, very young parents or very immature, then while he may not be working on the parents, those parents are as much, if not even more of what he is treating for the child to provide the education to the parents so that the child can receive better care from their parents. I agree with this. We then compared our craziest "bottle stories" as unfortunately he in his pediatrician role has seem numerous baby bottle caries cases and I have unfortunately seen way too many to remember over my 20+ years as a GP. My "worst" bottle story was when the parents were putting MOUNTAIN DEW in their 12 month olds bottle and sending him to bed and wondering why the child was having a tough time sleeping!! My pediatrician friend's "worst" bottle story was one where the parents were not only sending their 14 month old to bed with a bottle with milk in it, but were also putting fruit loops cereal in the bottle before giving it to their child because the parents liked how the milk in their cereal bowl tasted after they had had some fruit loops! You seriously as a clinician at times question yourself if something you hear is child neglect or just total parental ignorance....

I my "sweet spot" across that pedo definition would be roughly age 8 and above. You have a personality to work with, some space in the mouth to work in, an attention span that is typically long enough to get most things done, and as a result of that, my stress level goes down a bit while working on most within that age group, compared to the under age 8 range where you can't let down and interject a more casual nature into the conversation.

As a subset, if aside from discussing with the parents what to expect and what not to feed their kids, if I never had a kid under age 4 in my chair to actually work on, then you'd never hear me complain.

 

[DrJeff]

In my head, I go by the pedo "definition" that 2 of my pediatrician friends use, and that's birth to the 18th birthday. A wide range for sure and a HUGE variety of dental needs across that age bracket without a doubt. In the case of one of my pediatrician friends, and we were just discussing this when he was in my office for a cleaning last week, his definition of what constitutes a pedo patient in some cases where the parent(s) are first time parents, very young parents or very immature, then while he may not be working on the parents, those parents are as much, if not even more of what he is treating for the child to provide the education to the parents so that the child can receive better care from their parents. I agree with this. We then compared our craziest "bottle stories" as unfortunately he in his pediatrician role has seem numerous baby bottle caries cases and I have unfortunately seen way too many to remember over my 20+ years as a GP. My "worst" bottle story was when the parents were putting MOUNTAIN DEW in their 12 month olds bottle and sending him to bed and wondering why the child was having a tough time sleeping!! My pediatrician friend's "worst" bottle story was one where the parents were not only sending their 14 month old to bed with a bottle with milk in it, but were also putting fruit loops cereal in the bottle before giving it to their child because the parents liked how the milk in their cereal bowl tasted after they had had some fruit loops! You seriously as a clinician at times question yourself if something you hear is child neglect or just total parental ignorance....

I my "sweet spot" across that pedo definition would be roughly age 8 and above. You have a personality to work with, some space in the mouth to work in, an attention span that is typically long enough to get most things done, and as a result of that, my stress level goes down a bit while working on most within that age group, compared to the under age 8 range where you can't let down and interject a more casual nature into the conversation.

As a subset, if aside from discussing with the parents what to expect and what not to feed their kids, if I never had a kid under age 4 in my chair to actually work on, then you'd never hear me complain.

So there are times in life (or one's practice) when you just have to laugh at the timing of things... About 3 hours after I posted this this morning, I had a new patient, who is 18 months old, who came in with his mother with a chief complaint of "my son broke his tooth" - I take a quick look, and it's quite obvious that bottle decay was the likely culprit of basically the whole incisal 1/3rd of G fracturing off, and the large carious lesion on C,D,E,F and H as well. So I inquire with the mother about bottle habits, and she tells me that her older son (now roughly 3.5 years old) had to have his baby teeth out because of being put to bed with milk in the bottle, but with this child, who "is lactose intolerant", that they don't put "milk" in his bottle when he goes to bed, "just LACTAID" This sub 25yr old mother of 2 (with a 3rd about to arrive in about 2 months), from not the greatest of socio-economic situations, honestly had no clue that lactaid isn't milk!!

This is one where I was most certainly picking up the referral slip pad from my local pedodontist and will most certainly be thrilled that those chose to take the time to receive the full spectrum of pediatric dental training, as this 18 month old is almost certainly an OR case and by the limited looks I could get intra-orally, will be having atleast D,E,F and G extracted and possibly C and H as well and some long term space maintenance management needs. That's NOT "bread and butter" pediatric dentistry in my world!

 

[setdoc7]

Pedo accounts for zero in my GP practice. Not 1/3, or any fraction less. I do not own any SSC’s, and don’t want to. Being a GP does not force you into Pedo. And bread and butter pedo is not on my fee for service list of procedures. Pediatric dentist do space maintenance, intercept ortho, caries management , and growth issues. Not my thing. They also sedate their patients and do OR cases. Not my thing. Without the full Monty, a GP is only able to do half the job. My opinion. My time is spent doing advanced restoration. No time to quell poopsy and mom. No interest either. Just me. Not everyone.