picksix

2+ Year Member
Jul 23, 2016
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Pre-Dental
Hello all,

So I was wondering, what exactly do general dentists that decide to go into pedo get training for? Obvious answer to treat children, I know. But I mean more in regards to what SPECIFIC skill set do you learn/train for during your pedo residency? I know young children management is one, but I'm looking more into what "tangible/practical/hands on" things per say do you get training in that a general dentist wouldn't get training in? Coming out of pedo residency what are things you are licensed to do that a general dentist couldn't do? Well you could say "advertise as a specialist" but I mean more like for example, can a general dentist also use nitrous if he/she were to take a CE course? Do pedodontists get hospital privileges that genera dentists don't? If you can give me as many specifics as possible that'd be helpful. Thank you all for feedback. Hope you are having a great Sunday. :thumbup:

Also I read from a majority of posts here in SDN forums saying that the reason pedodontists make so much more than general dentists is because of the volume they see? But I have a hard time believing that volume is why.... (please don't bash me) but I watched a couple of youtube videos of pediatric dentists at work and it seems to take them almost an "eternity" to get the children comfortable and trusting enough to comply to let them work in their mouth. I just don't see the volume, maybe pedo just works more hours. Idk... any insight will also be helpful. Thanks again, just curious.
 
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kidsaremypassion

5+ Year Member
Jul 1, 2014
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I'll bite.
Not sure if you are a dental student currently, but if you are, and have ever tried working on an anxious 4 year old with a full mouth of cavities, and bombed out molars, then you would know exactly why pedo is a certified specialty.
Yes, general dentists can treat children, but by and large, most dental schools do not prepare graduates to treat children to the extent that a pediatric residency can. Cutting less than 5 SSCs and doing 1 pulpotomy on a generally well behaved child is not going to prepare you for the screaming/anxious child who needs 10 of them and refuses to sit still. I know, that personally, I needed a residency to hone my skills regarding behavior management, when is the Papoose appropriate/when is it not?
A general dentist can use Nitrous, even out of dental school, if the certification was offered. It was offered through a course during our 4th year. However, Nitrous is simply not enough with every child. Nitrous works best when the child is calm enough to inhale it. If the child is screaming and jumping out of the dental chair, Nitrous is not going to help you...lol.
Regarding hospital privileges, it always helps to be residency trained in order to obtain this. As you become an established pedo provider seeing GA cases in your community, unless you offer the option of in house GA in the office (where the anesthesiologist comes in and provides GA for your patients in your office), you will likely need to be affiliated with one of the neighboring hospitals to handle these cases, especially with medically complex children.
Then comes the topic of oral sedation and administering medications to children that could have some very serious consequences if one is not adequately trained. Dental school is not going to provide you with the opportunity to sedate children, even on a mild/moderate level. I feel that residency provides you with a solid background on when this mode of behavior management is appropriate, what doses are appropriate, and a large enough patient population to adequately refine these skills in a monitored, controlled environment under the guidance of expert faculty.
Now there are some GPR's that are pedo oriented, and provide relatively similar levels of training, but they are few and far between; and most Docs in those programs are typically hoping to match into Peds anyways.
Coming out of residency, you should be able to apply for your sedation license depending on the state you are looking to practice in, as well as have your "Pediatric Specialty" certificate that allows you to advertise as a specialist.

I'm still a resident, so I'll let more qualified folk comment on the money aspect.
 
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Aug 29, 2006
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Rather than get a lot of anecdotal answers ( no disrespect intended ), why don't you go on the CODA website of the ADA and look at the Standards for a Pedo residency. These are the published minimum requirements an accredited residency must provide. After reading through that, you may have some more insightful questions.
 
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Lane138

7+ Year Member
Jun 1, 2010
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I thought I wanted to do pedodontics and almost applied so I got extra exposure in dental school. However can that doesn't prepare you to handle complex cases and treatment planning for mixed dentition. Just today I did a cleaning on a wriggling and screaming two year old and I'm happy to refer out for the two pulpotomies he will need.

Furthermore, most general offices don't sto certain pediatric tools and materials (formocresol or even band and loops) so you are limited in what treatment you can provide.

As a GP, it's very rare to have hospital and OR privileges.
 
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Pedodel

2+ Year Member
Dec 26, 2015
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Behavior management is a huge part of Pedo training. Seeing difficult kids all day long for 2 years hones your skills. Having attendings and other residents to learn from helps you see and learn how to deal the worst of situations . That is step 1.

Then their is the pharmacological training ( nitrous, oral sedation, and GA.) learning when , what , how and when to employ differen't stuff. It takes years to really dial in what works and what works for you.

The clinical stuff, while actually pretty easy once you have done it a 1000 times , are actually pretty specific and tricky at first ( I know of very few GP's who do pulpotomy's and SSC's correctly, and really understand growth and development or when to do space maintainers or not,,,,, it blows me away actually how bad 90 % of the GP's do this stuff or don't understand the most basic stuff in Pedo.

As pedo specialist's were are not licensed or privileged to do anything that a GP can't do. A GP can get hospital / OR rights. Some do things pretty well. 95% no way would I let them touch my child ( especially in the OR under general anesthesia). Presently I work in with a hospital that has many pedo's and a few GP's who do GA cases with kids. They are now considering banning all GP's on bringing kids under 10 years to the OR old due to many many issues ( cases taking 2 -3 times as long,,,,, crowns falling off in post op, or medical issues that were completely ignored or misunderstood by the GP's.

In pedo , volume is a part of it. We see a ton of patients during the day. I work with another Doc. We see about 60- 80 patients a day with 1 hygenist. Yeah, I have built a very busy and successful practice ( which also takes time, skills and hard work to do ).
Yeah, we take time in situations getting to know patients , getting them numb , and getting them situated, but once the hand piece goes down, we work fast. You have to. I don't have many op apps that last longer than 1/2 an hour. Many are only 15 mins.
Check ups and hyg apps are usually 15 min ( 30 with hygenist,,, and that's long compared to many pedo offices).

Last thing,,, you asked about income and volume etc,,,, in 30 mins, We can do a pulp, crown and adjacent filling, or another crown,,,,
Or,,,,, crown, adjascent extraction, impression for space maintainer,,,,, or two quads of basic restorative,,,all in 1/2 hour ,,and make almost as much in that time as a GP doing an endo or a permanent crown ( every half hour if need be ). It takes time, training , a lot of experience, and mad skills to do that,,,,
But that is what we do,,,,, no way to get their without a solid pedo residency , and then doing
It all day every day for years. It's a very very different beast than being a GP. . GP's don't have a clue how to do it the way most of us do it ( and we have now clue how do most of the GP stuff,,, and that's ok with all of us pretty much ).
Pedo is actually pretty easy and fun most of the time( clinically at liest ) after a handful of years to dial things in.
Yeah, as a GP you can do all things Pedo. But never with the skill ,precision , speed , or expertise that a typical pedo would do things.
 
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Jan 13, 2016
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If you want my take on this here it goes....
I'm a GP. In my practice, about 1/3 of them are kids of all ages 1 year olds and up. Peds make their money in VOLUME. I am NOT a very fast dentist (unless your talking extractions) by any means, but most of the time with kids you are either 1)filling MO/DO, SSC or extracting the baby molars either one quad or half mouth and 2) sometimes you're doing pulp and baby tooth crowns C-H or D-G. Usually a quad takes me 5-10 minutes regardless of the procedure or maybe 20 or minutes if your doing the front 4-6. The procedures are easy and very very few post ops. The other GP I work with is even faster (honestly it all depends on assistants and how you use them).

I have found that Peds have several advantages.
1) Where Peds have the best advantage (in my opinion) is oral sedation. I do IV sedation (rarely oral) on teens and adults but I would never dream of doing this on a kid (not counting N2O). Oral sedation scares me, I prefer having an IV line in. All the peds I know have done hospital rotations and have privileges at hospitals and feel comfortable with PALS (at least I hope they do). Most of the dental deaths I've read about have been related to kid sedation. 2) They have a way better knowledge of medical disorders in kids and how to treat them. They work better with the oral surgeons and ortho guys than most GPs, 3) hospital privileges (GPR/AEGDs probably can do this - I can't). 4) They have to deal with the occasional pain in the butt parent that I refer to them. 5) They do pulpectomies on anterior baby teeth, for me if it can't take a pulpotomy and a crown it's getting yanked (I don't run across this too much and yes I should probably learn how to do a pulpectomy on front baby teeth but its rare that a pulpotomy and crown won't take care of it at my practice).

I will say that I rarely refer to peds but when I do 90% of the time it is because of #1 listed above, usually at the request of the parent. I will say child management and the procedures for pedo are not something that a residency is going to give you that private practice and a line of screaming kids at a GP office can't give you...sedation, anesthesia rotations, and hospital privileges are the Peds greatest advantages over the GP in my opinion....but what do I know, I'm not a Pedodont.

Hope this helps.
 
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