Perio: Pros and Cons?

[bvf]

---

Members do not see this ad.

I just talked to a general dentist who has been in practice for 26 years what he would do if he were in my shoes (a DSII). He said he would specialize in Perio. From what I have heard from alot of people perio isn't that attractive and not that lucrative of a specialty compared to ortho, endo, OS, etc. He did not have an interest in perio he just said it is a lucrative specialty with implants, bone grafting, tissue grafting, etc. What is the general feeling or impression on the future of periodontics in general?

Thanks.

 

[Calidental]

I just talked to a general dentist who has been in practice for 26 years what he would do if he were in my shoes (a DSII). He said he would specialize in Perio. From what I have heard from alot of people perio isn't that attractive and not that lucrative of a specialty compared to ortho, endo, OS, etc. He did not have an interest in perio he just said it is a lucrative specialty with implants, bone grafting, tissue grafting, etc. What is the general feeling or impression on the future of periodontics in general?

Thanks.

It's an interesting specialty technology wise. If you don't mind working from other peoples offices its okay. Building your own practice is difficult. The procedures arent covered by insurance, not many ppl want "pizza burn-like" tissue grafting, bone grafting is indicated in few circumstances, sinuses most commonly and this will reduce with guided surgery. Finally unlike OS you will be a long term primary carer, the GP will be concerned about losing his pt so try to bodge what he can in house.

 

[bvf]

It's an interesting specialty technology wise. If you don't mind working from other peoples offices its okay. Building your own practice is difficult. The procedures arent covered by insurance, not many ppl want "pizza burn-like" tissue grafting, bone grafting is indicated in few circumstances, sinuses most commonly and this will reduce with guided surgery. Finally unlike OS you will be a long term primary carer, the GP will be concerned about losing his pt so try to bodge what he can in house.

Thanks for the input. I kind of get the same feeling from you that I get from everyone else. Perio just isn't that attractive. I know many GP's will try to keep as many things in house as possible so they don't lose that production and with GP's and OS doing implants it seems that perio has kind of lost it's niche in the market. He told me about a perio resident who used to moonlight in his office who is 3 years out of residency who set up a $1 million practice in AZ and just built a $3 million dollar house and rides around in a Bentley! 😱 Anyway, not that I want that it just sure made a DSII up to his eyeballs in debt start to think a little bit about doing perio. 😀

 

[charlestweed]

My wife is a periodontist in California.

Cons:
- Difficult to set up a practice from scratch. There is a decline in referrals from GPs b/c a lot of GPs have in-house periodontists.
- Lots of hard works during the 3 year residency.
- Successful tx outcomes depend on patient's cooperation (smoking, hygiene etc).
- Most patients are 50+ years old. A lot of them are not in perfect health.

Pros:
- Easy to get accepted to a perio residency.
- Very low overhead. You only need a small 2 op office with 1 or 2 assistant(s). You'll do very well if you have enough patients to do 10-15 perio surgeries and place 10-15 implants a month.
- Short working hours…2-6 hours/day. You can place 2 implants in less than an hour and walk out of the GP office with a big paycheck.
- A lot of dentists like to hire periodontists. My wife has to decline job offers from a couple of GPs b/c she has no extra days to give them. The implant overhead and profit are usually split 50:50 between the periodontist and the GP.

 

[Count Orlok]

Thanks for the input. I kind of get the same feeling from you that I get from everyone else. Perio just isn't that attractive. I know many GP's will try to keep as many things in house as possible so they don't lose that production and with GP's and OS doing implants it seems that perio has kind of lost it's niche in the market. He told me about a perio resident who used to moonlight in his office who is 3 years out of residency who set up a $1 million practice in AZ and just built a $3 million dollar house and rides around in a Bentley! 😱 Anyway, not that I want that it just sure made a DSII up to his eyeballs in debt start to think a little bit about doing perio. 😀

Talk about up to your eyeballs in debt. If this story about this perio demigod is even true just give it a month to two before all his stuff gets repossessed. bentleys are only for rappers.

 

[bvf]

Talk about up to your eyeballs in debt. If this story about this perio demigod is even true just give it a month to two before all his stuff gets repossessed. bentleys are only for rappers.

I know!! I hope that the GP wouldn't lie to me....I worked for him for 6 months before starting DS. We'll see how it all shakes out. Maybe he'll be belly up after overextending himself on an outrageous mortgage and car payment.

 

[servitup]

If you like perio, it would be fun. Money is good, better than GP on average. It really depends on whether or not gums, implants, etc. interest you. Of course more and more GPs will be doing implants but there will always be some available for competent specialists.

 

[DCRedskinsRule]

If you like perio, it would be fun. Money is good, better than GP on average. It really depends on whether or not gums, implants, etc. interest you. Of course more and more GPs will be doing implants but there will always be some available for competent specialists.

What about OMFS that do implants? I know alot of them who feel that the competition for the new implant niche is between them and perio? (Not challenging, just asking for future reference 😀 )

 

[ajmacgregor]

What about OMFS that do implants? I know alot of them who feel that the competition for the new implant niche is between them and perio? (Not challenging, just asking for future reference 😀 )

Why is it that many of today's dental students feel that perio started the implant craze and that OMFS and everyone else have been crowding them out?

Historically speaking, dental implants were invented by an orthopedic surgeon, initially placed by prosthodontists, then OMFS came along, then, in the early 90s, some periodontist decided that perio should also place them...that brings us to the present day, with endo and everyone else under the sun...

Make no mistake though, periodontists, who should be credited for advancing the state of the art, had a minimal role in the birth of implant dentistry.

 

[pietrodds]

perio has had to reinvent themselves as the implant/grafting specialty since without it the specialty is well on it's way to being dead, other than CT grafts and crown-lengthenings. For decades perio devoted their time to preserving teeth with crazy splinting and scaling/RP out the wazzo on teeth with 10% bone. Now with implants if there's perio issues like mobility/ 50% bone loss you don't mess around with loosing more bone and wasting patients' money. You take the tooth out and put an implant in bypassing the periodontist. If the periodontist is good with implants he has a referal, if not then he's left twiddling his thumbs. You can see the obvious incentive to label yourself as the implant specialist. There's definitely a teritorial war going on in the rhelm of implants... not sure how it will all play out. Perio seems to be big pushers of the CAT scans as standard of care for all implants even though for decades implants have been done without such. Even with a scan, the surgery is all contigent on the hands and skill of the practitioner not a 3 D image, although it is beneficial in some circumstances. Interestingly, in Europe, 80% of implants are placed by GPs. I'm pretty certain the specialists here will see to it that that does not become a reality in the US.

 

[54807]

Interestingly, in Europe, 80% of implants are placed by GPs. I'm pretty certain the specialists here will see to it that that does not become a reality in the US.

Is the fee for implants as high in Europe? Might make a big difference....

a simple google search didn't get me an answer and i have physio to study. But everything costs more in the US.

I have also been told that in parts of Europe, implants are the standard for dentures...whenever something is standard and not a luxury, that drives fees down, right?

 

[PFM]

perio has had to reinvent themselves as the implant/grafting specialty since without it the specialty is well on it's way to being dead, other than CT grafts and crown-lengthenings. For decades perio devoted their time to preserving teeth with crazy splinting and scaling/RP out the wazzo on teeth with 10% bone. Now with implants if there's perio issues like mobility/ 50% bone loss you don't mess around with loosing more bone and wasting patients' money. You take the tooth out and put an implant in bypassing the periodontist. If the periodontist is good with implants he has a referal, if not then he's left twiddling his thumbs. You can see the obvious incentive to label yourself as the implant specialist. There's definitely a teritorial war going on in the rhelm of implants... not sure how it will all play out. Perio seems to be big pushers of the CAT scans as standard of care for all implants even though for decades implants have been done without such. Even with a scan, the surgery is all contigent on the hands and skill of the practitioner not a 3 D image, although it is beneficial in some circumstances. Interestingly, in Europe, 80% of implants are placed by GPs. I'm pretty certain the specialists here will see to it that that does not become a reality in the US.

But see you're talking about an extreme form of periodotitis where 50% mobility and little hope of retaining the tooth should be extracted and implants placed. You're right that perio has redifined itself to include implants as standard of care for pt that are indicated for it, but thats what you do as a doctor, use current technology to best treat your pt. With that said, who would you send your cases to to treat infrabony defects, or localized recession, or attachment loss? I know many dentist don't even use a probe and ignore defects such as these and wait until perio disease gets so severe to give them an excuse to extract and place an implant. The problem is you're not doing the best thing for your pt's because keeping their own teeth is still paramount to most pts. I am nervous when GPs say they want to place all of their implants after having been to a weekend course. But, I guess money is king in this country

 

[bvf]

Thanks for all the great replies. This is a very interesting debate going on here.

 

[canthacklt]

I think there will always be specialists doing things that GPs can also do, for a couple of reasons:

1) Some GPs just aren’t comfortable doing things that they didn’t do a lot of in dental school, and they’d rather not deal with the added stress. For example, some of my classmates and even faculty I’ve spoken with didn’t get a chance to do much difficult endo in school, or had very bad experiences with it, so they just aren’t comfortable doing it out in practice. They’d rather stick to the bread and butter restorative and become very good at that aspect of dentistry.
2) It may not be financially worth it for some dentists to do certain procedures like implants, molar endo, etc, just because the added financial gain from doing these procedures is not worth their added cost. It could be real monetary cost on overhead, opportunity cost of spending time doing implants/endo while you could be doing crowns (or other things that you can do faster), or even the perceived “cost” of worrying about being sued, etc.

One of my relatives is a GP, and she doesn’t place implants because in her mind, she can spend 30 minutes restoring an implant and charge $1200, or she can place and restore the implant for more money, but with the added time, cost, and headache.

I do think that more GPSs will be placing implants in the future, but not at the expense of OS or perio, but just because implants will be a lot more commonplace.

My 2 cents.

 

[PFM]

Awesome "Alf" t-shirt!!!

 

[pietrodds]

I love when people(specialists in particular) throw around the 'standard of care' card... like everyone has 3K just sitting around for two implants on top of getting a denture. Not that I don't think that implants are a great thing but there's a lot of people that can't afford a denture let alone implants to go with. To say something is standard of care means that if you don't do it you're practicing sub-par dentistry. Telling patients that implants are available is 'good' care. Specialists other than oral surgeons(OMS is the end of the line and HAVE to see all people regardless of income when they get abscesses as a result of not going to the dentist) tend to live in la la land when it comes to understanding the various levels of care, especially when it comes to the low socioeconomic patients. The reality is people can live without teeth(not that I'd recommend it!) so to say that it's standard of care to have them replaced is misleading for young dentist/dental student.We're all in the business of to saving teeth but try not to look down at dentist who just take out teeth without doing implants as practicing below the standard of care.

 

[PFM]

I love when people(specialists in particular) throw around the 'standard of care' card... like everyone has 3K just sitting around for two implants on top of getting a denture. Not that I don't think that implants are a great thing but there's a lot of people that can't afford a denture let alone implants to go with. To say something is standard of care means that if you don't do it you're practicing sub-par dentistry. Telling patients that implants are available is 'good' care. Specialists other than oral surgeons(OMS is the end of the line and HAVE to see all people regardless of income when they get abscesses as a result of not going to the dentist) tend to live in la la land when it comes to understanding the various levels of care, especially when it comes to the low socioeconomic patients. The reality is people can live without teeth(not that I'd recommend it!) so to say that it's standard of care to have them replaced is misleading for young dentist/dental student.We're all in the business of to saving teeth but try not to look down at dentist who just take out teeth without doing implants as practicing below the standard of care.

You're missing the whole point here. I'd rather save the tooth by cutting it off at the early stages of perio disease tha extract it at the advance stage (that is my idea of standard of care). Its just that GPs for some reason seem to not care about pt's perio health so much (hence by the using no probe comment) and not referring pt's to periodontist because GPs think they can handle it (which is fine if you can). There are many ways to treat a missing tooth but I'd rather save the tooth. And since you accuse of periodontist as a graft/implant specialty, that kinda contradicts your comment "We're all in the business of saving teeth." I'm not looking down at GPs (in fact the are the life blood of the profession and are responsible of primary care). I just take offence in the fact that dentist look down at periodontist because for some reason, dentist thing periodontists' sole job is to place implant which is totally not true.

 

[NileBDS]

I love when people(specialists in particular) throw around the 'standard of care' card... like everyone has 3K just sitting around for two implants on top of getting a denture. Not that I don't think that implants are a great thing but there's a lot of people that can't afford a denture let alone implants to go with. To say something is standard of care means that if you don't do it you're practicing sub-par dentistry. Telling patients that implants are available is 'good' care. Specialists other than oral surgeons(OMS is the end of the line and HAVE to see all people regardless of income when they get abscesses as a result of not going to the dentist) tend to live in la la land when it comes to understanding the various levels of care, especially when it comes to the low socioeconomic patients. The reality is people can live without teeth(not that I'd recommend it!) so to say that it's standard of care to have them replaced is misleading for young dentist/dental student.We're all in the business of to saving teeth but try not to look down at dentist who just take out teeth without doing implants as practicing below the standard of care.

I agree with you on some things here, but I personally think it only becomes sub-par if you do not recommend it to your patient or if you never discuss the option with them, making it clear that this treatment is your professional recommendation. Whether they can afford treatment or not is really never in your hand.