Prosth vs. Ortho Advice

[eastcoast2021]

Hi everyone,

Been very interested in ortho the past few years but I recently had dinner with my general dentist (also a prosth) who highly recommended I shift course and consider prosthodontics instead. He feels Americans aren't having kids anymore and due to DIY ortho and competition and saturation from a high number of programs, the future isn't great for them. Though everyone has their thoughts on prosthodontics, he mentioned that because boomers are getting older and most have disposable income, that would definitely be something to pursue. I do like restorative work but was wondering what anyone else thought about one vs. another.

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[nealofgrafton]

please talk to a general dentist. i refer to ortho weekly. i've referred once in the past five months to prosth...

 

[eastcoast2021]

please talk to a general dentist. i refer to ortho weekly. i've referred once in the past five months to prosth...

I moreso mean a prosth who works as a general dentist not as only a specialist

 

[mmc12]

As a prosth, you will probably dealing with really picky patients that will drive any dentist nuts with ten different try-ins, etc. If you are up for this, then go ahead.

 

[TanMan]

As a prosth, you will probably dealing with really picky patients that will drive any dentist nuts with ten different try-ins, etc. If you are up for this, then go ahead.

Exactly. You have to love prosth and crazy patients a lot. Referrals to prosth are usually major screw ups or difficult patients. They don't always have money either. Those that self-refer to a prosth are usually know-it-alls or severely demanding.

 

[ortho_mds]

I applied for Orthodontics program this year and was invited for interviews....I met 3 prosthodontist in one interview who applied for the program as they want to switch to Ortho since the work is not as rewarding in prostho.....so don't listen to a person who has specialized in a particular branch coz he/she will always say that their branch is the best one....take a general opinion from different practitioners and then come to a decision.....

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[P7898]

To the OP. I think it is how you market yourself. You can be a prosth and practice as a GP. I have seen this done and it is quite amazing. There is something to be said about being a self-sustaining restorative/implant practice. I honestly think this is better than ortho in the long run. 1) You don't have to beg for referrals - yes orthos will directly market well but so will you (you can still receive some referrals from GP's). 2) In 20 years from now there will be more people over the age of 65 than under 18 - I want to tailor my skills to this population. 3) You can always work as a GP after your residency for a corporate or private office - anyone can re-learn anterior endo and simple extractions but not everyone can understand complex restorative and implant dentistry. 4) You are the standard of care in a general practice for restorative - "mam I am the standard of care". 5) Ortho is hard to get and some of them have crazy tuition costs - prosth there are a lot that have stipends and not so wallet damaging. All in all it depends on what kind of dentistry you want to do.... Do you want to wake up at 6:30am every morning and fix teenagers gaps that want to be there or do you want to change someone's outlook on life and smile but may have to hassle with people on pricing and whatnot. It is all variable obviously but this is the information that I have gathered.

Life is too short so I recommend finding something you love to do and get good at it. We are all going to make $XXX,XXX so who really cares what the best thing is. Never have to work a day in your life - find your definition for that.

 

[mmc12]

I applied for Orthodontics program this year and was invited for interviews....I met 3 prosthodontist in one interview who applied for the program as they want to switch to Ortho since the work is not as rewarding in prostho.....so don't listen to a person who has specialized in a particular branch coz he/she will always say that their branch is the best one....take a general opinion from different practitioners and then come to a decision.....

Sent from my Nexus 5X using SDN mobile

Yeah. On my interview trail, I’ve met dentists from all specialties who apply for ortho. However, I’ve yet to meet an orthodontist who decides to pursue another specialty.

 

[TanMan]

To the OP. I think it is how you market yourself. You can be a prosth and practice as a GP. I have seen this done and it is quite amazing. There is something to be said about being a self-sustaining restorative/implant practice. I honestly think this is better than ortho in the long run. 1) You don't have to beg for referrals - yes orthos will directly market well but so will you (you can still receive some referrals from GP's). 2) In 20 years from now there will be more people over the age of 65 than under 18 - I want to tailor my skills to this population. 3) You can always work as a GP after your residency for a corporate or private office - anyone can re-learn anterior endo and simple extractions but not everyone can understand complex restorative and implant dentistry. 4) You are the standard of care in a general practice for restorative - "mam I am the standard of care". 5) Ortho is hard to get and some of them have crazy tuition costs - prosth there are a lot that have stipends and not so wallet damaging. All in all it depends on what kind of dentistry you want to do.... Do you want to wake up at 6:30am every morning and fix teenagers gaps that want to be there or do you want to change someone's outlook on life and smile but may have to hassle with people on pricing and whatnot. It is all variable obviously but this is the information that I have gathered.

Life is too short so I recommend finding something you love to do and get good at it. We are all going to make $XXX,XXX so who really cares what the best thing is. Never have to work a day in your life - find your definition for that.

This is perhaps the best pro-prosth post I've seen. Although it's pretty biased for prosth and anti-ortho, I think you highlight the good things about prosth. Choosing prosth has to be a decision based on what you mentioned above. Are you willing to sacrifice an extra 3-4 years (prosth/maxface) so that you can do more, make a bigger difference in people's lives, dealing with patients no one else wants to touch, and potentially make the same or a bit more than a GP w/o that training?

The main determining factor of going into prosth depends on the answer to the question above.

LOL about the standard of care, please don't say that **** to patients. If and when your work ever fails, those words might bit you in the ass. Then your peers will be the one to determine if you were "the standard of care".

On ortho being hard, yes, it's hard to get in and more expensive. It's the lifestyle and work environment that comes with ortho. If your focus is lifestyle and never wanting to do a crown prep/interprox ever again, do ortho. Ortho is life changing for a lot of people, especially for people who avoid smiling due to the position of their teeth. I wouldn't throw them under the bus like that because both prosth and ortho can change people's "outlook" on life (self-esteem). "Changing lives" isn't the exclusive domain of prosth. Heck, I can even say that I changed someone's life by doing an RCT and getting them out of pain.

Last thing, we are all going to make from $XXX,XXX to $X,XXX,XXX... that's a massive range. Even from 100,000 to 999,999+, that's still a huge difference.

 

[ortho_mds]

To the OP. I think it is how you market yourself. You can be a prosth and practice as a GP. I have seen this done and it is quite amazing. There is something to be said about being a self-sustaining restorative/implant practice. I honestly think this is better than ortho in the long run. 1) You don't have to beg for referrals - yes orthos will directly market well but so will you (you can still receive some referrals from GP's). 2) In 20 years from now there will be more people over the age of 65 than under 18 - I want to tailor my skills to this population. 3) You can always work as a GP after your residency for a corporate or private office - anyone can re-learn anterior endo and simple extractions but not everyone can understand complex restorative and implant dentistry. 4) You are the standard of care in a general practice for restorative - "mam I am the standard of care". 5) Ortho is hard to get and some of them have crazy tuition costs - prosth there are a lot that have stipends and not so wallet damaging. All in all it depends on what kind of dentistry you want to do.... Do you want to wake up at 6:30am every morning and fix teenagers gaps that want to be there or do you want to change someone's outlook on life and smile but may have to hassle with people on pricing and whatnot. It is all variable obviously but this is the information that I have gathered.

Life is too short so I recommend finding something you love to do and get good at it. We are all going to make $XXX,XXX so who really cares what the best thing is. Never have to work a day in your life - find your definition for that.

1) If Ortho is so difficult to get in, then definitely it offers something really good in the long run,since you know anything in life which is so difficult to achieve, has more rewards to offer. 2) According to your stats, in the next 20 years there is going to be a recession in younger generation as people might stop giving birth...right?? 3) if you perceive Ortho as only closing spaces of teenagers, then you are really naivè....it feels like you haven't heard about adult Orthodontics, surgical Orthodontics or an orthodontist who actually goes on to work on cleft cases.
I have nothing against any speciality, and I believe every speciality has a role to play, but trying to present a negative picture of Orthodontics to outshine prosthodontics is something only an amateur can do....
We are all dentist and we all do our bit to give the best oral profile to our patients.....don't spoil it by your negative feedbacks about a branch which you have neither studied, not practiced(and plss don't cal Invisalign as practicing Ortho)....

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[ortho_mds]

Yeah. On my interview trail, I’ve met dentists from all specialties who apply for ortho. However, I’ve yet to meet an orthodontist who decides to pursue another specialty.

I can guarantee you that you will never find even a single one....Ortho is the zenith.... nothing comes after that.....

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[P7898]

1) If Ortho is so difficult to get in, then definitely it offers something really good in the long run,since you know anything in life which is so difficult to achieve, has more rewards to offer. 2) According to your stats, in the next 20 years there is going to be a recession in younger generation as people might stop giving birth...right?? 3) if you perceive Ortho as only closing spaces of teenagers, then you are really naivè....it feels like you haven't heard about adult Orthodontics, surgical Orthodontics or an orthodontist who actually goes on to work on cleft cases.
I have nothing against any speciality, and I believe every speciality has a role to play, but trying to present a negative picture of Orthodontics to outshine prosthodontics is something only an amateur can do....
We are all dentist and we all do our bit to give the best oral profile to our patients.....don't spoil it by your negative feedbacks about a branch which you have neither studied, not practiced(and plss don't cal Invisalign as practicing Ortho)....

Sent from my Nexus 5X using SDN mobile

I get my stats from the gov for population: Census profile: United States

Also fixing occlusion is one aspect of ortho in teenagers just like fixing a smile is one aspect in prosth so no....I am not naive. I am just not on my high horse about one specialty I think all of them can be great. Just because something is hard to get into doesn’t mean it’s good always and just because 60 year old bob is an established ortho making $500k doesn’t mean 26 year old joe is gonna do the same - things have changed for all specialties.

But regardless I am happy that you found something in dentistry that your passionate about - I think with all the possibilities in our field this is a hard thing to do so congrats.

 

[P7898]

This is perhaps the best pro-prosth post I've seen. Although it's pretty biased for prosth and anti-ortho, I think you highlight the good things about prosth. Choosing prosth has to be a decision based on what you mentioned above. Are you willing to sacrifice an extra 3-4 years (prosth/maxface) so that you can do more, make a bigger difference in people's lives, dealing with patients no one else wants to touch, and potentially make the same or a bit more than a GP w/o that training?

The main determining factor of going into prosth depends on the answer to the question above.

LOL about the standard of care, please don't say that **** to patients. If and when your work ever fails, those words might bit you in the ass. Then your peers will be the one to determine if you were "the standard of care".

On ortho being hard, yes, it's hard to get in and more expensive. It's the lifestyle and work environment that comes with ortho. If your focus is lifestyle and never wanting to do a crown prep/interprox ever again, do ortho. Ortho is life changing for a lot of people, especially for people who avoid smiling due to the position of their teeth. I wouldn't throw them under the bus like that because both prosth and ortho can change people's "outlook" on life (self-esteem). "Changing lives" isn't the exclusive domain of prosth. Heck, I can even say that I changed someone's life by doing an RCT and getting them out of pain.

Last thing, we are all going to make from $XXX,XXX to $X,XXX,XXX... that's a massive range. Even from 100,000 to 999,999+, that's still a huge difference.

We all know specialists killing it and I did not mean to be biased towards one or the other - I just personally wouldn’t want my business to be based off of referrals that’s all.

Haha I was hoping that you’d catch the sarcasm for “Mam I am the standard of care”. Yes ortho can directly market to consumers which is why I think it’s still a wonderful profession. I didn’t mean for my comment to sound negative towards ortho it was just the business side of specialties. But I just think a restorative/implant practice that is regarded by a prosth that works like a GP is a great life too. The problem is the ones I know didn’t see benefits right away after graduating like you do with ortho, endo, pedo, omfs in terms of jobs - it took a while. Which then boils down to what you can afford to do.

 

[2TH MVR]

I am obviously biased, but I'll throw out some observations.

1. My personal dentist is a prosthodontist. It's not like I need extensive, complex treatment, but I like the dude. He's very talented, although somewhat introverted (not that there is anything wrong with introverted dentists ) . He does not advertise on his office front that he is a prosthodontist, nor do you see it spelled out anywhere in his office .... except for his brochures. I can only assume that, for him, being a prosthodontist does not necessarily drive patients into his office. As far as patients are concerned .... he is a general dentist.

2. Both orthos and prostho get to do full mouth rehabs. I do it every day. I am the quarterback for making the overall treatment plan for the patients.

3. Ortho is about treating many, many patients in a single day. I average 50-70 patients every day. Most procedures are short, simple and delegatable. Pretty sure a prostho doesn't see that many patients in a single day.

3. Orthos treat younger, healthier, less demanding patients as compared to those aging patients who want to talk all day.

Honestly ... I do not see alot of similarities between the two specialties. I did opine that ortho will be like prostho in the future. GPs and others treat all the easy stuff and orthos/prostho get to treat the hard, complex cases. I personally love to treat the hard, complex cases and there are plenty of these patients.

 

[P7898]

I am obviously biased, but I'll throw out some observations.

1. My personal dentist is a prosthodontist. It's not like I need extensive, complex treatment, but I like the dude. He's very talented, although somewhat introverted (not that there is anything wrong with introverted dentists ) . He does not advertise on his office front that he is a prosthodontist, nor do you see it spelled out anywhere in his office .... except for his brochures. I can only assume that, for him, being a prosthodontist does not necessarily drive patients into his office. As far as patients are concerned .... he is a general dentist.

2. Both orthos and prostho get to do full mouth rehabs. I do it every day. I am the quarterback for making the overall treatment plan for the patients.

3. Ortho is about treating many, many patients in a single day. I average 50-70 patients every day. Most procedures are short, simple and delegatable. Pretty sure a prostho doesn't see that many patients in a single day.

3. Orthos treat younger, healthier, less demanding patients as compared to those aging patients who want to talk all day.

Honestly ... I do not see alot of similarities between the two specialties. I did opine that ortho will be like prostho in the future. GPs and others treat all the easy stuff and orthos/prostho get to treat the hard, complex cases. I personally love to treat the hard, complex cases and there are plenty of these patients.

Great post. The newer dentist will be treating an aging population so we have to get use to the 15 minute stories

 

[mmc12]

I’d also like to add that prosth is likely much more physicially demanding than ortho. Something to keep in mind.

 

[P7898]

What is stopping a prosthodontist from starting an implant center that does the placement and restoration as well? Obviously this wouldn't be fueled by referrals but I think this is something to consider for prosthodontists out there.

 

[2TH MVR]

What is stopping a prosthodontist from starting an implant center that does the placement and restoration as well? Obviously this wouldn't be fueled by referrals but I think this is something to consider for prosthodontists out there.

In Arizona .... a company named CLEAR CHOICE has been operating for a long time. Prostho and OS work together in same office. OS places implants. Prostho restores them. Their calling card is that Specialists place and restore the implants. Now there are other copy cat companies doing the same thing. They do alot of advertising. I believe ownership was the implant company itself. I could be wrong.
Point is .... in this business arrangement ..... the OS still places all the implants.

 

[P7898]

In Arizona .... a company named CLEAR CHOICE has been operating for a long time. Prostho and OS work together in same office. OS places implants. Prostho restores them. Their calling card is that Specialists place and restore the implants. Now there are other copy cat companies doing the same thing. They do alot of advertising. I believe ownership was the implant company itself. I could be wrong.
Point is .... in this business arrangement ..... the OS still places all the implants.

What is stopping a prosthodontist from doing this by themselves?

 

[P7898]

There are a good amount of implant and denture companies some actually ran by GPs. However, I can see the use of a prosthodontist doing the same thing maybe even better.

 

[Svart Aske]

What is stopping a prosthodontist from doing this by themselves?

Many prosthodontists were not trained on implant surgery, especially the ones who did their residencies before the 2000's, and prefer to just deal with the prosthetics. Also, think about the type of people that go into prosth.... many of them don't like surgery. But there is nothing stopping them from placing implants, just like there is nothing stopping GPs from doing surgery. I know prosthos that market their practice doing mostly all-on-4's, zygoma implants etc.

 

[P7898]

Many prosthodontists were not trained on implant surgery, especially the ones who did their residencies before the 2000's, and prefer to just deal with the prosthetics. Also, think about the type of people that go into prosth.... many of them don't like surgery. But there is nothing stopping them from placing implants, just like there is nothing stopping GPs from doing surgery. I know prosthos that market their practice doing mostly all-on-4's, zygoma implants etc.

Correct and I have seen the same. They just market to the public. It is an interesting proposition though. A good number of programs have implants placement components (idk about your program) - congrats btw.

What are your thoughts?

 

[schmoob]

In Arizona .... a company named CLEAR CHOICE has been operating for a long time. Prostho and OS work together in same office. OS places implants. Prostho restores them. Their calling card is that Specialists place and restore the implants. Now there are other copy cat companies doing the same thing. They do alot of advertising. I believe ownership was the implant company itself. I could be wrong.
Point is .... in this business arrangement ..... the OS still places all the implants.

They’ve expanded nationwide. LOTS of locations

 

[laundry]

Do GP and take CE courses in pros and clear aligners. I have NEVER referred to Pros in 8 years of practice, but have taken hundreds of hours in implant-based pros (i.e. all on 3,4,6,etc). I refer to Ortho about 20% of the time, keeping 80% of ortho patients and treating them with clear aligners.
Insurance fees for Pros are the same as for GP (non-recognized specialty by Delta), and for clear aligner therapy you can charge whatever you want.

 

[AONLINE]

Insurance fees for Pros are the same as for GP (non-recognized specialty by Delta).

Interesting. I am wondering why insurance does not recognize Pros as a specialty?