OMS resident's inclinations?

[Concepcion10]

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In general did you (OMS resident) feel a certain inclination toward the surgical aspect of dentistry? or simply liked the lifestyle the career offers? Attending dental school right now I can already tell there are some things I am more interested in doing than others. I am sure this is typical. But lets put the competition and gunning aside....If you really like surgery, anesthesia..etc should one trully go for oral surgery? The intrigue with more complicated procedures and more invasise practices than general dentistry provides...etc. I understand there is a bit of "game playing" that has to happen and a need to have all stellar stats and the right personality. But I know other class mates would striaght up hate being an oral surgeon and others would trully like it. Inlcuding myself! Any advice is greatly appreciated


Cheers!

 

[UNLV OMS GUNNABE]

I am inclined to not answer this question in the first place but I'm bored so I will try to make sense of this confusing paragraph.
question 1)yes 2)not a big factor 3) not sure what you mean about putting competition and gunning aside... but yes, if you like something I believe you should go for it 4)if you would hate being an oral surgeon then you shouldn't do it. I'm not sure what else you are looking for here.

 

[shabu2]

I couldn't stand my Perio instructors. Getting chewed out because I got the order of chronic generalized moderate perio vs generalized chronic moderate perio mixed up all the time was BS. The real solution to perio is extraction! Hence I decided OMFS.

 

[armorshell]

I read this last night and decided I couldn't understand it because I was post call. Now that I've re-read it, I still have no idea what's going on.

 

[DrReo]

I couldn't stand my Perio instructors. Getting chewed out because I got the order of chronic generalized moderate perio vs generalized chronic moderate perio mixed up all the time was BS. The real solution to perio is extraction! Hence I decided OMFS.

For those who cannot manage soft tissue, there is always a more destructive treatment.

 

[drhobie7]

For those who cannot manage soft tissue, there is always a more destructive treatment.

Yes, it is well known that oral mucosa is the least forgiving tissue in the body and has the greatest predilection for scar formation. Just because you can do a primary cleft lip repair does not mean you can lasso the gingiva to a tooth. Please stick with your skin incisions and subcuticular closures.

 

[Pedosmakebank]

IThe real solution to perio is extraction! Hence I decided OMFS.

Hahaha.... True Dat!

 

[charlestweed]

I couldn't stand my Perio instructors. Getting chewed out because I got the order of chronic generalized moderate perio vs generalized chronic moderate perio mixed up all the time was BS. The real solution to perio is extraction! Hence I decided OMFS.

Yeah, and these types of perio involved cases are usually referred to periodontists, not to OS. It is the GP or perio, who will then decide which perio involved teeth to be extracted and the number of implants to be placed.

 

[armorshell]

Yeah, and these types of perio involved cases are usually referred to periodontists, not to OS. It is the GP or perio, who will then decide which perio involved teeth to be extracted and the number of implants to be placed.

And here all this time I thought the endpoint of implant therapy was restoratively driven.

 

[charlestweed]

And here all this time I thought the endpoint of implant therapy was restoratively driven.

Then, you thought wrong. Implants are not just used to prevent the grinding of the 2 adjacent teeth (for a bridge), to eliminate the discomforts due to poorly fit RPDs, or to give the loose dentures better retention etc.

The whole point of doing perio surgery is to give the patients the 2nd chance to keep their teeth by reducing the deep pockets. Yes, this would mean that more root surfaces will be exposed but at least the patient can brush and maintain them better. The success still depends heavily on patients’ good oral hygiene and their willingness to see the periodontists every 3 month for perio maintenane. If the patients cannot do all these, then they are better off with extractions and implant placements. It is easier to clean around the implant surface than to clean around the cementum surface….. and you rarely see calculus buildup around the implants. After patients receive the implants, they can clean the implant better, there are no more periodontal breakdown, the patients no longer have to come back every 3 month for cleaning. So how do the doctors know which teeth can be saved (by doing pocket reduction surgery) and which teeth need extraction (and implant placement)? Well, that’s what the 3 year perio residency is for.

 

[armorshell]

Then, you thought wrong. Implants are not just used to prevent the grinding of the 2 adjacent teeth (for a bridge), to eliminate the discomforts due to poorly fit RPDs, or to give the loose dentures better retention etc.

The whole point of doing perio surgery is to give the patients the 2nd chance to keep their teeth by reducing the deep pockets. Yes, this would mean that more root surfaces will be exposed but at least the patient can brush and maintain them better. The success still depends heavily on patients’ good oral hygiene and their willingness to see the periodontists every 3 month for perio maintenane. If the patients cannot do all these, then they are better off with extractions and implant placements. It is easier to clean around the implant surface than to clean around the cementum surface….. and you rarely see calculus buildup around the implants. After patients receive the implants, they can clean the implant better, there are no more periodontal breakdown, the patients no longer have to come back every 3 month for cleaning. So how do the doctors know which teeth can be saved (by doing pocket reduction surgery) and which teeth need extraction (and implant placement)? Well, that’s what the 3 year perio residency is for.

Charlestweed, we're in similar situations. I understand your wife is a periodontist, so you have to stick to your guns on this one otherwise you might end up sleeping on the couch. In the same vein, my girlfriend is in prosth residency so I'm going to stick to my guns on this one and say implant therapy is restoratively driven so I have somewhere comfortable to sleep this weekend. 😀

Anyway, even if you want to imply implant placement can be maintainance driven, the point of any root form implant is to hold up a crown. Otherwise you could say the same thing about every patient who may need an extraction. Are partials and FDs periodontally driven? (It's easier for a patient to maintain an edentulous site than a periodontally comprimised tooth)?

 

[charlestweed]

Anyway, even if you want to imply implant placement can be maintainance driven, the point of any root form implant is to hold up a crown. Otherwise you could say the same thing about every patient who may need an extraction. Are partials and FDs periodontally driven? (It's easier for a patient to maintain an edentulous site than a periodontally comprimised tooth)?

Yes, they definitely are perio driven….esthetically driven, restoratively driven. If the perio disease is so severe (or if the patient had perio surgery before but still experiences more perio breakdown in a few short years), then there is no point of doing more perio surgery to save these teeth….extraction is the solution. As a periodontist, my wife puts a lot of emphasis in preserving the alveolar bone and ridge form (just like how the orthos are concerned about the anchorage loss). This is why she usually asks the GPs to let her extract the tooth so it can be done as atraumatically as possible...and the GP (not my wife) just collects the extraction fee from the patient. In her opinion, RPDs and FDs are not the first or the best tx option. She always recommends dental implants (either fixed or implant supported overdenture) as the best tx option because nothing is better at preserving the bone than dental implants. Of course, a lot of people can't afford implants but it doesn't mean that you should avoid recommending the best tx option for your patients because you don't think the patients can afford it.

 

[1992Corolla]

I read this last night and decided I couldn't understand it because I was post call. Now that I've re-read it, I still have no idea what's going on.

You get post call?

 

[1992Corolla]

For those who cannot manage soft tissue, there is always a more destructive treatment.

I hope this was sarcasm🙄

You should see our healing after flaps made with small straights and then no sutures...looks just as good as any picture out of carranza...

 

[drhobie7]

This is why she usually asks the GPs to let her extract the tooth so it can be done as atraumatically as possible...and the GP (not my wife) just collects the extraction fee from the patient.

I find it really annoying when people say things like periodontists are the soft tissue experts, or periodontists are the best at atraumatic tooth extraction. It insinuates by default that oral and maxillofacial surgeons are brutish and careless. Nothing could be further from the truth. All surgeons, regardless of specialty, are taught the necessity of minimizing tissue damage as they go about completing an operation. Careless handling of tissue (any tissue) = increased pain, swelling, risk of infection, and protracted healing. As a surgeon you don't think in terms of hard tissue & soft tissue. Tissue is tissue. You don't frag the skin and muscle so you can make the perfect osteotomy. That would be idiotic. Every step is critical.

The fact of the matter is a periodontally involved tooth can be taken out atraumatically by just about anyone, including a dental student. For a GP to permit a periodontist to extract these teeth is silly. Why would they throw away easy production like that. Furthermore, the least traumatic extraction will be performed by an oral and maxillofacial surgeon because he/she is the most experienced. Experience = less complications/tissue damage.

I have no problem with periodontists doing implants, sinus lifts, ramus grafts, chin grafts, or extractions. I also have no problem with GPs doing this stuff. However, an OMS will end up managing the complications from either one. I have friends who are periodontists. The only thing I have a problem with is when periodontists claim they are superior to oral and maxillofacial surgeons with respect to "soft tissue". That's slander.

 

[InMyCrossHairs]

I find it really annoying when people say things like periodontists are the soft tissue experts, or periodontists are the best at atraumatic tooth extraction. It insinuates by default that oral and maxillofacial surgeons are brutish and careless. Nothing could be further from the truth. All surgeons, regardless of specialty, are taught the necessity of minimizing tissue damage as they go about completing an operation. Careless handling of tissue (any tissue) = increased pain, swelling, risk of infection, and protracted healing. As a surgeon you don't think in terms of hard tissue & soft tissue. Tissue is tissue. You don't frag the skin and muscle so you can make the perfect osteotomy. That would be idiotic. Every step is critical.

The fact of the matter is a periodontally involved tooth can be taken out atraumatically by just about anyone, including a dental student. For a GP to permit a periodontist to extract these teeth is silly. Why would they throw away easy production like that. Furthermore, the least traumatic extraction will be performed by an oral and maxillofacial surgeon because he/she is the most experienced. Experience = less complications/tissue damage.

I have no problem with periodontists doing implants, sinus lifts, ramus grafts, chin grafts, or extractions. I also have no problem with GPs doing this stuff. However, an OMS will end up managing the complications from either one. I have friends who are periodontists. The only thing I have a problem with is when periodontists claim they are superior to oral and maxillofacial surgeons with respect to "soft tissue". That's slander.

You beat me to it. This is the biggest crock of ****. How many eyelid lacs do periodontists repair, how many cleft lips do they do, facial nerve dissection or dog bites on 10 month olds. Exactly, none. The above mentioned demand meticulous tissue management.

As was said above, and maybe to the extreme, but not to far off, the oral mucosa is as forgiving a tissue as there is. The End. Trust me, I was a first year OMFS resident, and I have whaled (sp?) on patients, and when they come back, they look none the worse. Now, as I have progressed, and I am more critical of my work, I am doing more implants, and working more with referring dentists I pay closer attention to details. My skills have improved, and there certainly are ways to preserve tissue and manage a better result. But to say periodontists are more capable, isn't only laughable, it is insulting. And dare I say, embarrassing to me as a dentist, that my fellow colleagues (GP's) have been bamboozled by this.

Don't believe this perio propaganda. They are certainly capable, and many are excellent implantologists. But this myth of soft tissue superiority needs to end.

 

[charlestweed]

I find it really annoying when people say things like periodontists are the soft tissue experts, or periodontists are the best at atraumatic tooth extraction. It insinuates by default that oral and maxillofacial surgeons are brutish and careless. Nothing could be further from the truth. All surgeons, regardless of specialty, are taught the necessity of minimizing tissue damage as they go about completing an operation. Careless handling of tissue (any tissue) = increased pain, swelling, risk of infection, and protracted healing. As a surgeon you don't think in terms of hard tissue & soft tissue. Tissue is tissue. You don't frag the skin and muscle so you can make the perfect osteotomy. That would be idiotic. Every step is critical.

Why turn this thread into a perio vs OS war? Nowhere on my previous posts that I mentioned perio is superior at soft tissue management than the OS. I find nothing wrong when perio say they pay special attention to soft tissues. Nothing is wrong when OS say they are good at handling complications. Nothing is wrong when the ortho say they pay attention to occlusion. Nothing is wrong when the posth say they make beautiful and functional dentures.

The fact of the matter is a periodontally involved tooth can be taken out atraumatically by just about anyone, including a dental student. For a GP to permit a periodontist to extract these teeth is silly. Why would they throw away easy production like that. Furthermore, the least traumatic extraction will be performed by an oral and maxillofacial surgeon because he/she is the most experienced. Experience = less complications/tissue damage.

I am not talking about teeth w/ perio disease. I am talking about a tooth that loses a cast post and PFM crown…only a root tip remains. If you were a patient, would you want your GP extract your root tip, bite on cotton gauge, then drive to a perio office for implant placement? Or would you want everything done at 1 place?

If you think, as a surgeon, you can extract the root tip better than your referring GP, then you should offer the same kind of service that my wife has offered to her GP. As I mentioned before, the GP collects the extraction fee, my wife simply does it for the sake of preserving bone for implant placement. The one who really benefit from this is the mutual patient.

I have no problem with periodontists doing implants, sinus lifts, ramus grafts, chin grafts, or extractions. I also have no problem with GPs doing this stuff. However, an OMS will end up managing the complications from either one.

OS and perio are both good at doing implants. The one who takes better care of his/her GPs and the patients they refer to is the one who will get more implant cases.

I have friends who are periodontists.

From the way you talk about their profession, I can tell that you are not a good friend of theirs.

 

[drhobie7]

Bottom line...there is dogma that many periodontists perpetuate. It is this: "Periodontists are superior at handling 'soft tissue'. Periodontists are superior at implant placement in the 'esthetic zone'. I'm pleasantly surprised if you haven't been exposed to this dogma. Obviously there are both periodontists and oral surgeons who are skilled at dental implants. What oral surgeons don't appreciate is being defamed in an attempt to corner the implant market. Sure it's partly financial, but mostly it's just insulting.

 

[charlestweed]

Bottom line...there is dogma that many periodontists perpetuate. It is this: "Periodontists are superior at handling 'soft tissue'. Periodontists are superior at implant placement in the 'esthetic zone'. I'm pleasantly surprised if you haven't been exposed to this dogma. Obviously there are both periodontists and oral surgeons who are skilled at dental implants. What oral surgeons don't appreciate is being defamed in an attempt to corner the implant market. Sure it's partly financial, but mostly it's just insulting.

I first heard about this dogma when I was bored at work and came across this SDN forum 3 years ago. Never heard about it before that.

My classmate (dental school roommate) is an OMFS who did his training at UCLA and his partner did an extra year of orthognathic fellowship at Kaiser (you may know who I am talking about). I trust their works so much that I’ve made my ortho patients drive 30-40 miles to see them in Orange County. My wife and these OSs’ wives are very good friends.

My wife’s boss, a GP, hires both perio (my wife) and OS to perform surgeries at his office. The OS is one of the most down to earth guys my wife and I have ever known. A few times, he didn’t mind helping my wife perform IV sedation on her patients when she worked on some big cases. He’s still single and we’ve tried to introduce a couple female friends to him….so far, no luck🙂.

 

[UNLV OMS GUNNABE]

I first heard about this dogma when I was bored at work and came across this SDN forum 3 years ago. Never heard about it before that.

My classmate (dental school roommate) is an OMFS who did his training at UCLA and his partner did an extra year of orthognathic fellowship at Kaiser (you may know who I am talking about). I trust their works so much that I’ve made my ortho patients drive 30-40 miles to see them in Orange County. My wife and these OSs’ wives are very good friends.

My wife’s boss, a GP, hires both perio (my wife) and OS to perform surgeries at his office. The OS is one of the most down to earth guys my wife and I have ever known. A few times, he didn’t mind helping my wife perform IV sedation on her patients when she worked on some big cases. He’s still single and we’ve tried to introduce a couple female friends to him….so far, no luck🙂.

I know this may be inflamatory but I have to quote Mark Levin on this one...You sir, are a *****! Your N=1 (ok, maybe I'll give you N=7,but it depends on how many "wives" and "female friends" are involved in your cute little story) experience certainly does not apply to the rest of the country. Trust me, that dogma is out there and not just on these forums. It is being actively taught in multiple dental schools around the country.

 

[charlestweed]

I know this may be inflamatory but I have to quote Mark Levin on this one...You sir, are a *****! Your N=1 (ok, maybe I'll give you N=7,but it depends on how many "wives" and "female friends" are involved in your cute little story) experience certainly does not apply to the rest of the country. Trust me, that dogma is out there and not just on these forums. It is being actively taught in multiple dental schools around the country.

And Mark Levin's good friend, Sean Hannity, often says "let not your heart be troubled." You remind me of myself when I was an ortho resident. I hope you'll grow up when you finish your residency and start practicing in the real world. You're nothing without the GPs' helps (referrals).

 

[Pedosmakebank]

I know this may be inflamatory but I have to quote Mark Levin on this one...You sir, are a *****! Your N=1 (ok, maybe I'll give you N=7,but it depends on how many "wives" and "female friends" are involved in your cute little story) experience certainly does not apply to the rest of the country. Trust me, that dogma is out there and not just on these forums. It is being actively taught in multiple dental schools around the country.

No...

Hahaha... Another cocky oms resident. Surprise, surprise...

Atleast your quoting Levin, who is a stud...

 

[UNLV OMS GUNNABE]

And Mark Levin's good friend, Sean Hannity, often says "let not your heart be troubled." You remind me of myself when I was an ortho resident. I hope you'll grow up when you finish your residency and start practicing in the real world. You're nothing without the GPs' helps (referrals).

That is the whole point. Referrals DO matter and DO make a huge difference. That is why it bothers me that this "dogma" is being circulated. It IS out there and not just on these forums.

 

[armorshell]

[YOUTUBE]http://www.youtube.com/watch?v=BRTVnGptf6E&feature=related[/YOUTUBE]

 

[armorshell]

[YOUTUBE]http://www.youtube.com/watch?v=BRTVnGptf6E&feature=related[/YOUTUBE]

[YOUTUBE]http://www.youtube.com/watch?v=SJj7_xwXCgY&feature=related[/YOUTUBE]

 

[live]

haha.. awesome armor! I know many of my classmates will love this. I just want to know if you typed this all up while taking call? ha. How's intern year going? Transition go smoothly?

 

[jk5177]

LOL to the xtranormal videos.