Hello everyone, I am currently a D2 with an interest in periodontics. As my school does not currently have a periodontist I figured I would post here. Anyways, perio surgeries and implants are fascinating to me. I definitely am interested in a surgical field but am uninterested in 4-6 years of 80+ hour work weeks and also am not interested in operating extraorally so I am leaning towards perio. I am curious to hear from any current periodontists or anyone who knows any first hand, how is the market for this specialty? If you wanted to be a travelling specialist at either a corp or at various private practices how easy would it be to fill your schedule? If you wanted to be aggressive with the loans could you work 6 days the first year or two (ie could you find this much work and could your body reasonably handle these hours? Assuming that I were to enter a stipend residency and graduate D-school with around 340K in loans is this a good career option? Thank you all in advance!
Periodontics as a Profession
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schmoob
Your school doesn’t have a single periodontist?
Also, getting into a program with a stipend is very difficult, there are only a few of them.
Also, getting into a program with a stipend is very difficult, there are only a few of them.
Yeah, we currently do not have a periodontist (and haven't since I started here). I looked through the AAP website and you're correct there really arent many. Not to digress too far from the original thread but would you say top 10% in the class with research (perio related or not) along with other volunteer/leadership positions should constitute as competitive for a stipend program?
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In hindsight, I think perio is looking awesome since it's like OS, but only the bread and butter (3rds/implants/IV sedation/osseous) in half the time.
I have heard that perio demand is geographically variable. In some locations you will be in demand and in others you will not. Also, I think perio had the greatest # of people dropping the specialty to practice general dentistry per ADA
Therefore, I think if you do perio you should be geographically flexible and comfortable scrambling more than other specialists to fill you schedule.
The actual specialty seems really cool. Don't rely on what people say online, you should shadow nearby perio, and before applying, visit/extern at paid residency programs.
Therefore, I think if you do perio you should be geographically flexible and comfortable scrambling more than other specialists to fill you schedule.
The actual specialty seems really cool. Don't rely on what people say online, you should shadow nearby perio, and before applying, visit/extern at paid residency programs.
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In what world does Perio do 3rds and IV sedation? Actually curious because I've been hearing about perio doing their own IV sedations. Do they have limitations in the kind of drugs they are allowed to use ?
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You do 3rds when you travel. It makes it much easier to fill your schedule. Probably just cases with moderate difficulty.
Thank you for your reply! I am interested in practicing in the West but I do not mind if it's in a small/rural community. Definitely not much of a city person so no SF/LA for me. And I definitely do plan on getting into contact with some local private practice docs to get a little more exposure. I am genuinely curious what would drive someone to drop their specialty though, that is pretty interesting to me.
It looks like a lot of the residency programs teach IV sedation but not GA. Someone please correct me if I am wrong. If the patient can be managed via IV sedation then it doesn't seem too outlandish for me for a perio to extract thirds but I would love to hear from others with more real world experience!
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Depends on state boards and licensure requirements. If the residency program has IV training and meets state requirements, then you can do IV sedation (depending on whether it's moderate, deep, or GA). I don't hear perio doing GA, but IV moderate/deep is typically sufficient for 3rds.
I find it to be a smart business move for periodontists. They can capture the bread and butter of oral surgeons, especially if they have more availability than the oral surgeons. I'm not a periodontist, but I have no problem referring 3rds/implants to perio.
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Hmm... interesting. Brave move to be doing deep sedations without anesthesia training or ever intubating a patient. Not sure if that is even legal. I would say it is generally smart to not attempt procedures for which you don't have the skill set to manage the complications. Perio routinely doing 3rds sounds like more lingual nerve and IAN repairs to go around for OMFS residents 🙄
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Sounds like a turf war issue to me. I gave up my sedation license because it wasn't profitable for me and a regulatory headache. I'm not a perio and I think it's unfair to paint periodontists with such a broad brush stroke, but the perio I send cases to knows which cases to take and which to punt. Every specialist has their own risk tolerances and you seem to imply that all omfs can repair lingual/IA nerve damage. I think that lingual nerve/IA nerve damage can happen to anyone and not everyone (few) can actively manage those morbidities.
You might ask why I send them to the periodontist? Because most patients don't want to wait 2-3 weeks to see an OS (sometimes not even for treatment, just for a consult) when they are in a lot of pain. Unfortunately, we have quite a bit of oral surgeons here, but they aren't very available to take emergencies. If they are licensed by the state to perform IV sedations, who am I to question the state? If they've consistently gotten great results with little to no postop issues, why should I stop sending 3rds to them, especially if their practice philosophy aligns with mine.
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I am in no way questioning your decision on who to refer to as that is your clinical judgment. I was just unaware of the fact that periodontists are attempting wizzies under IV sedation these days when you and I both know that their residency training provides them minimal to no experience in these kinds of cases. I would be especially shocked to find out that periodontists get IV sedation licenses to perform deep sedation with drugs like propofol. I do think periodontists do some excellent work managing soft and hard tissues and esthetics related to dental implants. Not sure why they would stray outside their expertise and take on risks they are ill-equipped to manage.
In my opinion Periodontics has trended upward in the last decade. When I worked in the corps, I saw things that aligned with TanMans experience.
The real world is pretty different from school and residency. Specialty lines often blur. Not every periodontist can or wants to pull 3rds, but there are opportunities out there for periodontists or even general dentists who choose to build their skills in that area.
The real world is pretty different from school and residency. Specialty lines often blur. Not every periodontist can or wants to pull 3rds, but there are opportunities out there for periodontists or even general dentists who choose to build their skills in that area.
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You can get a IV moderate conscious sedation certificate in a 4 weekends CE course as a general dentist, where you can push drugs like fentanyl and versed. These weekend courses are like 10-15k, with 60 hours of coursework, along with performing it on 20 patients. So it's not surprising a periodontist would be able to do IV moderate conscious sedation if it was incorporated into their training. To be certified doing deep sedation and pushing propofol, ketamine.. where you can really get the patient apneic, you would need to know how to bag mask and intubate if there was an airway emergency.
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First year perio resident here. We IV sedate and take out thirds. We place approx. 90% of referred implants and extractions, while OMFS here is more focused on hospital stuff. I chose perio and cant imagine going back to being a GP. DM me if you want to know more.
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Not willingly/consistently and I don't really want to keep strongarming then into taking the patient in the same day. My expectations align with patient's expectations. If they are in a lot of pain, they want to get out of pain and want something done about it, usually the same day. Not wait weeks or get a useless consult to be rescheduled another day for procedures.
There are some surgeons I don't refer to due to IC issues, ****-talking me or the patient when they think the patient is "sedated" or dangerous sedation practices. I could call them up, but I would prefer not to. My criterias for people that I refer to are pretty simple, they gotta be nice, good at what they do, and available.
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I may be sheltered by my residency, but we do IV sedation routinely...
we also do plenty of 3rds
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I hope it is moderate sedation and doesn't involve propofol or ketamine. I guess some perio programs are expanding scope to do thirds nowadays. I personally don't see an issue with that as long as periodontists are aware of their limitations and practice appropriate case/patient selection.
We do IV MODERATE sedation here as well and are not using ketamine or propofol. We are taught how to recover patients from deep sedation, if things go south. Also do 3rds. It all comes down to comfort level and knowing when to refer. All about proper case selection and being able to manage post op complications.
A three year perio residency should easily be able to accommodate doing iv sedation and impacted thirds, GPR's and other post grad programs do both all the time in just a year's time, along with weekend CE's for gen dentists. It's always case selection ultimately, even with OMS. As far as the question for OP, there are a ton of avenues to do advanced procedures without doing perio residency, even some corporate chains like DDS Dentures and Implants will train new grads in house.
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