Pediatric endodontics

[BocasDelToro]

Hey y'all, current endo resident here.
I'm starting to plan for life after residency and want to get some opinions. I have always had a great interest in both endodontics and pediatric dentistry since dental school (it was a tough call on which residency I ended up pursuing.) I am interested in finding a niche centered around pediatric endodontics after completion of my program.
Does anyone have information on whether this is a viable career move/know of anyone who practices in a similar manner?

From my own observations, this seems like a viable market...a lot of pediatric dentists won't touch endodontic procedures, especially on permanent teeth, while it seems like a lot of endodontists would be happy to not deal with kids (and most don't seem to offer the option to go to the OR). This leaves kids in a tough spot when it comes to appropriate and efficient treatment.

Would love to hear your thoughts.

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[Extirpator]

I agree that it seems like a viable market if done correctly. I know of a couple dual specialty trained pedo/endo, but don’t believe they see exclusively children... just a higher percentage.

If you plan on doing OR cases and don’t have experience in that realm, or don’t have experience with kids in that realm, then I’d recommend additional training whether in the form of comprehensive CE with OR exposure and a good mentor or an additional residency (ideally pedo, but a really good GPR with with lots of OR experience might suffice). Plenty of things can go wrong once General Anesthesia is involved and you’re responsible for mitigating those risks.

 

[TanMan]

In theory, it's a viable market because not many endodontists like to see young children; therefore, the supply of endodontists willing to perform treatment on young children is pretty low. There's a reason for that though, primarily, it's OR time and billable procedures. OR time is expensive - many anesthesiologists don't like to work on medicaid patients (which seem to have a higher chance of needing endos early on), OR's don't like to book endodontists because they take too long, and parents usually don't want to pay for OR time for a single tooth (they are more amenable to it if it's done in-office or multiple treatments (lots of fills/ssc's)). However, multiple treatments can kill your referral base if you piss off a referring dentist that referred to you just for an endo and you end up doing a quadrant of fills/caries control without asking. Second, apexogenesis/apexification treatments don't pay very much from a PPO perspective and I see apexogensis often billed out as an indirect/direct pulp cap.

So... in theory, there's a demand, but I don't think the economics are there to justify unless you can do the rest of the treatment and convince your referring GP's to allow you to do the rest of the treatment. I know someone around here got burned a few years ago for doing other treatment besides the referred treatment. It could work, it's just a fine line with logistical details that need to be ironed out (such as an in-house anesthesiologist, risk management, billable procedures/hour, etc...)

 

[BocasDelToro]

In theory, it's a viable market because not many endodontists like to see young children; therefore, the supply of endodontists willing to perform treatment on young children is pretty low. There's a reason for that though, primarily, it's OR time and billable procedures. OR time is expensive - many anesthesiologists don't like to work on medicaid patients (which seem to have a higher chance of needing endos early on), OR's don't like to book endodontists because they take too long, and parents usually don't want to pay for OR time for a single tooth (they are more amenable to it if it's done in-office or multiple treatments (lots of fills/ssc's)). However, multiple treatments can kill your referral base if you piss off a referring dentist that referred to you just for an endo and you end up doing a quadrant of fills/caries control without asking. Second, apexogenesis/apexification treatments don't pay very much from a PPO perspective and I see apexogensis often billed out as an indirect/direct pulp cap.

So... in theory, there's a demand, but I don't think the economics are there to justify unless you can do the rest of the treatment and convince your referring GP's to allow you to do the rest of the treatment. I know someone around here got burned a few years ago for doing other treatment besides the referred treatment. It could work, it's just a fine line with logistical details that need to be ironed out (such as an in-house anesthesiologist, risk management, billable procedures/hour, etc...)

Great points. Granted, not every kid who needs endodontic therapy requires the treatment in the OR. I've done full blown root canals on 10 year olds who didn't even need nitrous (obviously not the norm). I am looking at it more from the perspective of an endodontist who sees a high volume of kids, which makes sense from a specialist standpoint being able to the job, generally speaking, in a quicker and more efficient manner, which is something super important for treating kids. The less chair time, the better.

 

[TanMan]

Great points. Granted, not every kid who needs endodontic therapy requires the treatment in the OR. I've done full blown root canals on 10 year olds who didn't even need nitrous (obviously not the norm). I am looking at it more from the perspective of an endodontist who sees a high volume of kids, which makes sense from a specialist standpoint being able to the job, generally speaking, in a quicker and more efficient manner, which is something super important for treating kids. The less chair time, the better.

Predictability is key for all patients. The problem with children is the predictability of the procedure/patient behavior. Sedation makes the procedure more predictable, but increases liability and add-on costs. Lets say you have 10 kids, but 1 of them was completely uncooperative. The speed/profitability obtained from the 9 kids may be negated from the time consumed from the 1 that gave you problems. From a business perspective, I'd look at it in terms of standardization (sedate everyone) or quick identification of problem patients (allow triage into sedation, different queuing). The worst thing that can happen is that the behavioral problems don't present themselves until you're midway through the procedure. You end up not being able to finish the procedure/billing for full procedure (billing out for incomplete endo), patient possibly in pain, increased stress, and unproductive appointment. Think of these aspects when you're looking to making a pediatric endo office. Need consistency, speed, and volume.

 

[Sbosu]

There would be a market for this in a major metropolitan area, as you will need to draw from a lot of general dentists. Endodontists (myself included) usually do not like treating kids, I definitely think you could set up shop in a highly populated area and get the word out you will be good to go. I will pm you the name of a guy I went to dental school with that specialized in endo, moved to a highly saturated area, and made a niche endo practice treating a lot of children, it can be done.

 

[allDAT]

There's a huge need for your focus in major metropolitan areas. You would need to choose the location of your practice carefully, but you should be able to make it work well if your office is easily accessible and you're practicing in one of the larger metropolitan areas. This list would be helpful. List of metropolitan statistical areas - Wikipedia

You probably don't want to dip too far below the 3 million mark IMO because you're patient pool (while viable), is not only limited to people who need and can also afford endodontic therapy, you're also putting in the twist to focus on a younger pt. population. You probably want to be in an affluent area where parents understand and appreciate vital pulp therapy, which may take some outreach on your part to local GPs, pediatric dentists, and even older endodontists.

You could join a large group of endodontists with an established referral base and focus exclusively on kids within the practice. Or - what I would try to do if in your position, buy into a large group practice of pediatric dentists and orthodontists. There, you would perform endo on permanent teeth while patients are awake if they can tolerate it or under sedation if they are not cooperative.

Best of luck!

 

[BocasDelToro]

There's a huge need for your focus in major metropolitan areas. You would need to choose the location of your practice carefully, but you should be able to make it work well if your office is easily accessible and you're practicing in one of the larger metropolitan areas. This list would be helpful. List of metropolitan statistical areas - Wikipedia

You probably don't want to dip too far below the 3 million mark IMO because you're patient pool (while viable), is not only limited to people who need and can also afford endodontic therapy, you're also putting in the twist to focus on a younger pt. population. You probably want to be in an affluent area where parents understand and appreciate vital pulp therapy, which may take some outreach on your part to local GPs, pediatric dentists, and even older endodontists.

You could join a large group of endodontists with an established referral base and focus exclusively on kids within the practice. Or - what I would try to do if in your position, buy into a large group practice of pediatric dentists and orthodontists. There, you would perform endo on permanent teeth while patients are awake if they can tolerate it or under sedation if they are not cooperative.

Best of luck!

Thanks for weighing in. All good points to consider. Definitely seems logical to broach the subject with pedo/ortho

 

[DrReo]

After five years as a pediatric dentist, the speciality of endo (along with omfs) interest me even more due to the dynamic combo of skill sets that each discipline in combination would benefit the patient. The ability to provide sedation (preferably IV, would be paramount for most children < 10 years of age.

 

[P7898]

Well then there comes the debate as to how old your patient population are. You do not want to be doing pulpectomies on 5 years old or younger and have to put them asleep to accomplish this. I am sure you all know about the neruo implications over time.

It think this is a sticky niche because really we are trying to avoid sedation with young children as much as possible - but then again someone has to do it when it is necessary and it can be necessary.