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Prosthodontics or Orthodontics

allDAT

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Ortho.
In most popular markets, prosth are not getting referrals. When they do get a referral, they are total PITA patients. This results in prosth basically marketing themselves as “super GDs” and heavy in all on ‘x’. The best prosths seem to partner with OS (within the same practice - think clear choice) to restore their cases but there’s not much room for these types of practices.
 
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mmc12

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If you guys had an option between prosthodontics and orthodontics, which one would you accept or apply to? And why?
Like pay wise, job outlooks and...

Thank you

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Why are you comparing these two?
For me, ortho. Both specialties are heavily dependent on diagnosis/tx planning, but ortho is a lot easier on the body. I can’t imagine doing full mouth crowns and how tiring that must be...

Theres a reason why ortho is a lot more competitive to match into
 

Mboy

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The reason I'm asking is because I like both and I have the opportunity to apply to both of them (although I don't know which one will I get in yet). So I was looking to see what is the job outlooks for each of them especially now that there are many places that they do invisialign without ortho knowledge.
Why are you comparing these two?
For me, ortho. Both specialties are heavily dependent on diagnosis/tx planning, but ortho is a lot easier on the body. I can’t imagine doing full mouth crowns and how tiring that must be...

Theres a reason why ortho is a lot more competitive to match into

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Two different fields. Patient pool is vastly different. I have the utmost respect for pros, but it just seems to be a niche specialty. My personal dentist is a Pros, but he doesn't even advertise it on his door. Many patients are not that familiar with the title "Prosthodontist". Orthodontist is a household term. Orthos see mostly young, healthy patients. Most appts are not stressful. Lots of procedures can be delegated.

Aligners have changed the economics of being an orthodontist forever. At one time (my Hey Day) orthodontists treated EVERYONE. Kids, teenagers, and adults. A monopoly of sorts. Now the aligner tech has allowed more GPs and DIYs to treat the simpler cases. But trust me. There are plenty of complex orthodontic cases that aligners cannot touch. Another thing about aligners is that they have added an additional LAB cost that orthos never had before. I personally get no satisfaction with treating a patient with aligners. I mean ... seriously. Where's the talent in using aligners? Not much. To date .... I have yet to see an aligner treated case in my office that is better than a traditional (wires,brackets) case. Oops. Got sidetracked on lovely aligners.

As always. Choose the profession that you will enjoy for a long career. Don't do it for the money.
 
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averageasian

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Two different fields. Patient pool is vastly different. I have the utmost respect for pros, but it just seems to be a niche specialty. My personal dentist is a Pros, but he doesn't even advertise it on his door. Many patients are not that familiar with the title "Prosthodontist". Orthodontist is a household term. Orthos see mostly young, healthy patients. Most appts are not stressful. Lots of procedures can be delegated.

Aligners have changed the economics of being an orthodontist forever. At one time (my Hey Day) orthodontists treated EVERYONE. Kids, teenagers, and adults. A monopoly of sorts. Now the aligner tech has allowed more GPs and DIYs to treat the simpler cases. But trust me. There are plenty of complex orthodontic cases that aligners cannot touch. Another thing about aligners is that they have added an additional LAB cost that orthos never had before. I personally get no satisfaction with treating a patient with aligners. I mean ... seriously. Where's the talent in using aligners? Not much. To date .... I have yet to see an aligner treated case in my office that is better than a traditional (wires,brackets) case. Oops. Got sidetracked on lovely aligners.

As always. Choose the profession that you will enjoy for a long career. Don't do it for the money.

I had the option to get invisalign in dental school. Way more expensive than regular races obviously. Mind you, i already had braces for 6 years previously. I chose the metal braces for cost even tho tx. time was longer. Got them off a few months ago and my teeth are now at their best. I would choose metal over Invisalign 24/7.

OP Im in dental school currently and both fields appeal to me. I won't be applying till after i get out of the military but Ortho seems like the field I want to pursue. DO what you makes you happy. I know the ortho market will be tough but, im confident that it will all work out.
 

Svart Aske

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Ortho is better lifestyle-wise and an easier specialty to make $$$. That said I chose prostho because I find it more interesting. Just because there’s a lot of prostho in academia doesn’t mean you can’t be financially successful in private practice.
 

Mboy

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So you think the job outlooks is almost the same?
Ortho is better lifestyle-wise and an easier specialty to make $$$. That said I chose prostho because I find it more interesting. Just because there’s a lot of prostho in academia doesn’t mean you can’t be financially successful in private practice.

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vk223

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I'd choose Ortho even if I reborn for 100 times..Prosth is way too much work and I used to see some residents in our school working on lab works till 12 am. Ultimately it comes down to whether you like full mouth rehab/more hands on work or braces/better lifestyle.
 
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teefturnsmeon

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Depends on the current situation you're in. How much debt do you own? What are your stats? Remember no one here should choose for you. You are the caption of your ship, don't let anyone steer your destiny. Shadow both specialties and do the one you enjoy more. Different folks, different stolks.
 
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endoaccess

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Only consider prostho if you enjoy dealing with pain in the @$$ patients that GPs don't want to deal with themselves. I don't see any other reason for referring patients to prostho

This is a myth. Specialist have no obligation to take referrals from GP's that only send their junk. Many prosth don't have referral based practices. They can be a GP that does high end dentistry. In fact, this is probably the better way to go. They will also need to be a salesman and marketer so they can sell the big cases. A prosth that can't market and sell big cases will not thrive in private practice.

That said... 3 years unpaid residency is insanity.
 
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This is a myth. Specialist have no obligation to take referrals from GP's that only send their junk. Many prosth don't have referral based practices. They can be a GP that does high end dentistry. In fact, this is probably the better way to go. They will also need to be a salesman and marketer so they can sell the big cases. A prosth that can't market and sell big cases will not thrive in private practice.

That said... 3 years unpaid residency is insanity.

I might add a small correction, an established specialist has no obligation, but a new specialist has a lot more incentive, especially if they are trying to penetrate the market. I see endo a little more vulnerable because the easier alternative is an ext/graft/implant. During market contractions, I see some gps who would ext and implant if try couldn't perform the endo just for the sake of keeping it in house. Sad but unfortunate reality.
 
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I might add a small correction, an established specialist has no obligation, but a new specialist has a lot more incentive, especially if they are trying to penetrate the market. I see endo a little more vulnerable because the easier alternative is an ext/graft/implant. During market contractions, I see some gps who would ext and implant if try couldn't perform the endo just for the sake of keeping it in house. Sad but unfortunate reality.

Agreed. When you're hungry for referrals ... you'll accept any patient for the opportunity to develop a new referral source. When I was younger .... I always viewed a "junk" referral as an opportunity. For most specialists .... and most GPs .... new patients are the lifeblood of a practice. Now of course .... as you get a little more established and older you naturally do not work as hard for those "junk" referrals. I will warn older specialists that just because you are established does not mean that the gravy train continues.

To bring this back to the OP. Pros will only get the really tough "junk" referrals. In reality ... ortho is headed in a similar direction. GPs are doing all the easy stuff with the hard stuff (class 2, 3, extraction cases, growth modification, orthognathic, etc) being referred to the ortho. I'm fine with this since I like the challenge of correcting difficult cases.

I've mentioned this before that my personal dentist is a pros. He's a little introverted, but I like his work. He does not advertise anywhere on the front of his practice that he is a pros specialist. As far as the public knows .... he is a GP. I asked him about this and he told me that the average patient is not really aware of what a pros is or what they do. He did not want to limit his practice by referring to himself as a pros. Of course once in his practice ... his credentials are displayed.
 

Jab1113

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If you guys had an option between prosthodontics and orthodontics, which one would you accept or apply to? And why?
Like pay wise, job outlooks and...

Thank you

Sent from my SM-N975U using SDN mobile


First - Mboy ,This is a great thread - thank you. I haven't posted on here since 2013 back when I was taking my DAT so I will keep this as simple as possible for those struggling to decide.

Personally, I was deciding this back when I was a D3 dental student. I spoke with a lot of specialists, did hours of shadowing in both prosth and ortho departments at UMich, spent time with the residents, spoke with faculty members, researched, attended CE courses during dental school and attended dental study clubs. Here is my take:

1. Referral game is gone. Nobody refers unless its a difficult case whether you choose prosth or ortho.
2. Do something that you love and something that pays well. Pay is important (especially with school debt), but enjoying what you do is as important.
3. Find a program that fits what YOU are looking for. Not all programs are the same.

This is the viewpoint I had while shadowing:

Ortho - great specialty, great $$, assistants do most of you work, you spend most of your time planning the treatment, walking around with a cup of coffee in a polo and khaki pants, 4 days a week, great lifestyle

Prosth - great specialty, great $$, team is everything, in house laboratory is a must, education is top notch, literally the navy seals of dentistry, full mouth everyday - crowns, implants, all on X hybrid restorations - need to love being in the laboratory - a lot of work, the patients reactions at the end of treatment with their new smile are priceless

Personally, I couldn't give up the opportunity to restore and being in the lab so I chose Prosth. I also chose a prosth program that was surgical based (dental implant training). I finished my residency earlier this year and even with COVID, I was able to land a position in a denture and implant center. Couldn't be happier with my decision. At the end, do what PAYS well and something you LOVE doing. For those thinking prosth, I wouldn't worry much about "advertising as a prosthodontist" and listening to dentists who say "people dont know what a prosthodontist is" - its all word of mouth anyways, your patients do all your advertising for you. Do good work, if you wouldn't put it in your mouth, don't deliver it. Put the patient first, you'll have a very successful career.
 
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DMD-DOC

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First - Mboy ,This is a great thread - thank you. I haven't posted on here since 2013 back when I was taking my DAT so I will keep this as simple as possible for those struggling to decide.

Personally, I was deciding this back when I was a D3 dental student. I spoke with a lot of specialists, did hours of shadowing in both prosth and ortho departments at UMich, spent time with the residents, spoke with faculty members, researched, attended CE courses during dental school and attended dental study clubs. Here is my take:

1. Referral game is gone. Nobody refers unless its a difficult case whether you choose prosth or ortho.
2. Do something that you love and something that pays well. Pay is important (especially with school debt), but enjoying what you do is as important.
3. Find a program that fits what YOU are looking for. Not all programs are the same.

This is the viewpoint I had while shadowing:

Ortho - great specialty, great $$, assistants do most of you work, you spend most of your time planning the treatment, walking around with a cup of coffee in a polo and khaki pants, 4 days a week, great lifestyle

Prosth - great specialty, great $$, team is everything, in house laboratory is a must, education is top notch, literally the navy seals of dentistry, full mouth everyday - crowns, implants, all on X hybrid restorations - need to love being in the laboratory - a lot of work, the patients reactions at the end of treatment with their new smile are priceless

Personally, I couldn't give up the opportunity to restore and being in the lab so I chose Prosth. I also chose a prosth program that was surgical based (dental implant training). I finished my residency earlier this year and even with COVID, I was able to land a position in a denture and implant center. Couldn't be happier with my decision. At the end, do what PAYS well and something you LOVE doing. For those thinking prosth, I wouldn't worry much about "advertising as a prosthodontist" and listening to dentists who say "people dont know what a prosthodontist is" - its all word of mouth anyways, your patients do all your advertising for you. Do good work, if you wouldn't put it in your mouth, don't deliver it. Put the patient first, you'll have a very successful career.
Congrats on finishing Residency and landing that Job!!! What prosth residency did you attend?
 

Likkriue

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Ortho is terrifyingly hard to match into and very expensive. They definitely have far less stress than almost every other specialty. They definitely aren’t what they were in the early 2000s but 200k Starting as an associate isn’t bad.

Pros will train you to do more Complex Procedures and you will come out a beast in anything pros related. However definitely more stress and PITA patients.

The young GPs with enormous loans however will always start doing more and more stuff in-house and taking on more difficult cases. So in reality, neither specialty financially. Start as a Gp and get 2-3 years head start. Take some Advanced courses and do things yourself.
 
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cu4fun2

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First - Mboy ,This is a great thread - thank you. I haven't posted on here since 2013 back when I was taking my DAT so I will keep this as simple as possible for those struggling to decide.

Personally, I was deciding this back when I was a D3 dental student. I spoke with a lot of specialists, did hours of shadowing in both prosth and ortho departments at UMich, spent time with the residents, spoke with faculty members, researched, attended CE courses during dental school and attended dental study clubs. Here is my take:

1. Referral game is gone. Nobody refers unless its a difficult case whether you choose prosth or ortho.
2. Do something that you love and something that pays well. Pay is important (especially with school debt), but enjoying what you do is as important.
3. Find a program that fits what YOU are looking for. Not all programs are the same.

This is the viewpoint I had while shadowing:

Ortho - great specialty, great $$, assistants do most of you work, you spend most of your time planning the treatment, walking around with a cup of coffee in a polo and khaki pants, 4 days a week, great lifestyle

Prosth - great specialty, great $$, team is everything, in house laboratory is a must, education is top notch, literally the navy seals of dentistry, full mouth everyday - crowns, implants, all on X hybrid restorations - need to love being in the laboratory - a lot of work, the patients reactions at the end of treatment with their new smile are priceless

Personally, I couldn't give up the opportunity to restore and being in the lab so I chose Prosth. I also chose a prosth program that was surgical based (dental implant training). I finished my residency earlier this year and even with COVID, I was able to land a position in a denture and implant center. Couldn't be happier with my decision. At the end, do what PAYS well and something you LOVE doing. For those thinking prosth, I wouldn't worry much about "advertising as a prosthodontist" and listening to dentists who say "people dont know what a prosthodontist is" - its all word of mouth anyways, your patients do all your advertising for you. Do good work, if you wouldn't put it in your mouth, don't deliver it. Put the patient first, you'll have a very successful career.
Have you also spoken with endo specialists and what is your opinion of where that specialty is headed, and if its worth specializing in that field anymore? Like you said- do what you love, that PAYS well also.
 
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Not sure if this has been brought up, but the chances of getting sued in ortho is probably less than pros. I was sued ONCE 15-20 yrs ago. A frivolous suit that settled instread of going to court. It settled because ..... that's the way the system works right or wrong. Of course I was innocent. A TMJ case. I didn't even have the opportunity to complete the pt's tx and yet ... I was still sued lol. Just prior to myself ... she had sued her hairdresser for allegedly burning her hair with a curling iron. She then sued the OMFS (partly responsible for my lawsuit) who talked her into doing TMJ surgery :rolleyes:

Point is. In ortho .... we deal with typically healthy, non PIA patients. Oh. We get our fair share of PIA patients, but ..... we have TIME to correct a patient's concern or to improve a deteriorating patient relationship. Ortho is reversible in most of the situations. Patients can see all the changes in real time and make comments. A good ortho will listen to the patient and do whatever is needed to make that pt happy, and to avoid a possible board complaint or worse ... a lawsuit.
 
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Faux

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First - Mboy ,This is a great thread - thank you. I haven't posted on here since 2013 back when I was taking my DAT so I will keep this as simple as possible for those struggling to decide.

Personally, I was deciding this back when I was a D3 dental student. I spoke with a lot of specialists, did hours of shadowing in both prosth and ortho departments at UMich, spent time with the residents, spoke with faculty members, researched, attended CE courses during dental school and attended dental study clubs. Here is my take:

1. Referral game is gone. Nobody refers unless its a difficult case whether you choose prosth or ortho.
2. Do something that you love and something that pays well. Pay is important (especially with school debt), but enjoying what you do is as important.
3. Find a program that fits what YOU are looking for. Not all programs are the same.

This is the viewpoint I had while shadowing:

Ortho - great specialty, great $$, assistants do most of you work, you spend most of your time planning the treatment, walking around with a cup of coffee in a polo and khaki pants, 4 days a week, great lifestyle

Prosth - great specialty, great $$, team is everything, in house laboratory is a must, education is top notch, literally the navy seals of dentistry, full mouth everyday - crowns, implants, all on X hybrid restorations - need to love being in the laboratory - a lot of work, the patients reactions at the end of treatment with their new smile are priceless

Personally, I couldn't give up the opportunity to restore and being in the lab so I chose Prosth. I also chose a prosth program that was surgical based (dental implant training). I finished my residency earlier this year and even with COVID, I was able to land a position in a denture and implant center. Couldn't be happier with my decision. At the end, do what PAYS well and something you LOVE doing. For those thinking prosth, I wouldn't worry much about "advertising as a prosthodontist" and listening to dentists who say "people dont know what a prosthodontist is" - its all word of mouth anyways, your patients do all your advertising for you. Do good work, if you wouldn't put it in your mouth, don't deliver it. Put the patient first, you'll have a very successful career.


Can you commit on you expected salary for the year as prostho?
 

endoaccess

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You’re ability to make money has less to do with the specialty and more to do with you and the opportunities you pursue. You shouldn’t consider a “salary”. This is not a salary job. And I wouldn’t worry about what people here say they make. We don’t even know who these people are.

I can give anecdotes of dentists I know crushing it in every specialty, and some not so much. The range is huge. The highest earning solo guy my age (mid 30s) that I know is a GP working out of just 4 ops. You think he cares he’s not a specialist? Should that make you stay GP? Well you don’t know him and why he’s successful, so it’s irrelevant.

Its all about you and the opportunities you find and take. If you like pros go for it. Money is not the reason to do any of these. Residency is hard work.
 
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gryffindor

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The biggest difference IMO is that you have to give a ton of local anesthesia daily in prostho versus we don't even load up the syringes with needles and lidocaine on a daily basis in my ortho office. That was one of the biggest factors that made me and many others I met along the way want to go to ortho - no more needles. I like moving teeth around. I don't like putting missing teeth back in, the thought of ever going back to that gives me anxiety. We have a few patients with pontics that we are managing during their ortho treatment and I shudder to see their names on the schedule. That said, there are plenty of messed up cases around to earn a living in both specialties. I see lots of adults come into my ortho office screwed up by some GP with a great advertising budget who slid some implants in all over the place or threw on some veneers because he/she is the #1 google result when patients search "I want veneers." I have to break the news to them that to fix things the way they are envisioning, they need to find a specialist called a "prosthodontist."
 
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Molar Whisperer

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I noticed Ortho is the favored specialty over Prosth. I like to root for the underdog so I'll side with Prosth. I had the luxury to feel like a Prosth for one case. A VP of a fortune 500 company sought me from recommendations. I just did a few anterior crowns on him but it felt so satisfying. After the case completion, the Hispanic VP told me there is a word for me in Spanish, "El Maestro" (Master). I was so flattered that whenever I have a bad day, I think of his complement. The pros of Prosth is, you don't see nearly as many pts as ortho (granted a lot is hands on vs DA delegated). I don't know how the orthodontist can sign and remember 40-70 charts. Guys like Frank Spear and John Kois have "lifestyles so rich and famous Robin Leach will get jealous." In terms of getting PITA pts, once you get established, you can price them out or punt them to the jerk dentist down the street. If so desired, you don't have to go to residency. Just go to John Kois institute and learn high end dentistry for similar price and still keep your day job...win, win, win.
 
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Alpha Centauri

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Prosthodontics is the closest thing to "true" dentistry. Full mouth rehabilitations, cases in tango with OMFS treatment to save cancer/trauma/radiation damaged patients, reconstructing occlusion and alleviating TMJ from the ground up. Not only do you design aesthetic cases, you also address the etiologies.

Amazing field, just not for me
 
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Prosthodontics is the closest thing to "true" dentistry. Full mouth rehabilitations, cases in tango with OMFS treatment to save cancer/trauma/radiation damaged patients, reconstructing occlusion and alleviating TMJ from the ground up. Not only do you design aesthetic cases, you also address the etiologies.

Amazing field, just not for me
It is, indeed, an amazing field. I have a lot respect for the prosthodontists. They have to deal with difficult cases (cases that most GPs don’t want to touch) every day. It’s not for me either. I am lazy. I just want to have an easy job that doesn’t require a lot of thinking and planning and has very low chance of getting sued.
 
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It is, indeed, an amazing field. I have a lot respect for the prosthodontists. They have to deal with difficult cases (cases that most GPs don’t want to touch) every day. It’s not for me either. I am lazy. I just want to have an easy job that doesn’t require a lot of thinking and planning and has very low chance of getting sued.

Hahaha, join the club. Lazy AF here and no thought required single tooth dentistry is the best for me. Prosths are undercompensated for what they do and if there was a hell for me, it would be doing prosth for an eternity.
 
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Molar Whisperer

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It is, indeed, an amazing field. I have a lot respect for the prosthodontists. They have to deal with difficult cases (cases that most GPs don’t want to touch) every day. It’s not for me either. I am lazy. I just want to have an easy job that doesn’t require a lot of thinking and planning and has very low chance of getting sued.
Hahaha, join the club. Lazy AF here and no thought required single tooth dentistry is the best for me. Prosths are undercompensated for what they do and if there was a hell for me, it would be doing prosth for an eternity.

I didn't know lazy dentists could run multiple chairs and rake in the big bucks like you studs. I like to be more "lazy" and keep up.
 
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ThirdMolarz

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Man, I love dentistry. So many vastly different options.

Appreciate all the dentists chiming in. May I throw in perio and dental anesthesia to the mix? Really curious if there are any dental anesthesia people out there that can talk about what their work life is like
 

gryffindor

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I had a guy walk in today. He had some discussion with his current dentist about replacing a crown at #10 and I guess the patient commented that it's time to fix everything and he was tired of patchwork. The following is what I just wrote in his chart just before midnight when I can no longer add day-of notes to my digital charts - "Clincal exam reveals worn, collapsed, decayed dentition with heavy restorations." I haven't wrote a note like that in ortho in a long time. He's going to need a lot of tooth movement to correct the underlying torque issues and crowding that is contributing to the collapse. I told him to come back to review the Invisalign Clinchek with me because he was really excited to see a "projection" and said he had to set up a consult with the local prosthodontist in the meantime.
 
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I had a guy walk in today. He had some discussion with his current dentist about replacing a crown at #10 and I guess the patient commented that it's time to fix everything and he was tired of patchwork. The following is what I just wrote in his chart just before midnight when I can no longer add day-of notes to my digital charts - "Clincal exam reveals worn, collapsed, decayed dentition with heavy restorations." I haven't wrote a note like that in ortho in a long time. He's going to need a lot of tooth movement to correct the underlying torque issues and crowding that is contributing to the collapse. I told him to come back to review the Invisalign Clinchek with me because he was really excited to see a "projection" and said he had to set up a consult with the local prosthodontist in the meantime.

Do you get a sense that the patient may have unrealistic expectations (either cost or results)? I get that a lot from those that are tired from patchwork... like we have a magic wand to make everything perfect instantly.

Must be nice to be "lazy" and produce bank. Lazy will be my new inspiration.

Maybe lazy isn't the right term. What's a good term for not wanting to work more hours?
 

gryffindor

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Do you get a sense that the patient may have unrealistic expectations (either cost or results)? I get that a lot from those that are tired from patchwork... like we have a magic wand to make everything perfect instantly.

Sometimes but I also don't have too many patchwork dental rehab cases where I'm doing the ortho. I won't know for sure on this one until he pays the consult fee and/or downpayment at the next meeting and also gets that prostho consult. He's already been punted from the dentist to a specialist otherwise he could have just stayed with the dentist and replaced the #10 crown. Most of my difficult cases are the "mutilated dentition" kind where they are in their 20s - 40s and have some fillings/RCT/crowns here and there, but they also had random teeth pulled along the way (often when they were kids) and now everything is all shifted and collapsed and it finally bothers them.
 
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Jul 21, 2004
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Being rich enough (although not a term).

I wish. The interesting part is that I cut my hours (used to be 34), but I make more now than when I was working more hours.

perfunctory

Fancy word, lol. I had to lookup the word. It may not necessarily be the right word in the strictest definition. Maybe the spirit of the word. I care about/express interest in efficiency, execution, and productivity.

Sometimes but I also don't have too many patchwork dental rehab cases where I'm doing the ortho. I won't know for sure on this one until he pays the consult fee and/or downpayment at the next meeting and also gets that prostho consult. He's already been punted from the dentist to a specialist otherwise he could have just stayed with the dentist and replaced the #10 crown. Most of my difficult cases are the "mutilated dentition" kind where they are in their 20s - 40s and have some fillings/RCT/crowns here and there, but they also had random teeth pulled along the way (often when they were kids) and now everything is all shifted and collapsed and it finally bothers them.

Interesting that you mentioned this today, I had a patient today that I've referred several times (after treating their emergencies) to no avail until today. I told him we're putting out one fire but several more are present every time they come back. I can keep patching them up with rcts/crowns, but ultimately, without a more definitive extreme solution, they'll all have to come out (which I think he'll need a hybrid or all on x). Finances almost always seem to be an issue. I wish I had the patience for full mouth rehab cases and dentures. Just doesn't fit my personality.
 
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  1. Dentist
Interesting that you mentioned this today, I had a patient today that I've referred several times (after treating their emergencies) to no avail until today. I told him we're putting out one fire but several more are present every time they come back. I can keep patching them up with rcts/crowns, but ultimately, without a more definitive extreme solution, they'll all have to come out (which I think he'll need a hybrid or all on x). Finances almost always seem to be an issue. I wish I had the patience for full mouth rehab cases and dentures. Just doesn't fit my personality.

So. You are new dentist with tons of DS and practice debt. Young adult adult pt walks into your office with a CC of "Front teeth look like crap and my lower front teeth are chipping". Patient presents with a Class 2 Division 2 deep OB malocclusion with resultant incisal wear on the lower incisors and some TMJ issues with the restricted mandible.

Do you?

A. Send patient to the orthodontist to correct the malocclusion and LOSE that patient for 12-18 months and LOSE all that immediate production or ....
B. show them some pretty pics of veneers/crowns on all the front teeth that can be done IMMEDIATELY.
C. Tell them you are Invisalign certified, offer invisalign and cosmetic restorations to keep ALL the production in house. Hint. Aligners won't correct the excessive OJ from uprighting (torquing) the upper incisors, but odds are .... you won't know this.
 
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Molar Whisperer

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  1. Dentist
Sometimes but I also don't have too many patchwork dental rehab cases where I'm doing the ortho......... He's already been punted from the dentist to a specialist otherwise he could have just stayed with the dentist and replaced the #10 crown. Most of my difficult cases are the "mutilated dentition" kind where they are in their 20s - 40s and have some fillings/RCT/crowns here and there, but they also had random teeth pulled along the way (often when they were kids) and now everything is all shifted and collapsed and it finally bothers them.
Interesting that you mentioned this today, I had a patient today that I've referred several times (after treating their emergencies) to no avail until today. I told him we're putting out one fire but several more are present every time they come back. I can keep patching them up with rcts/crowns, but ultimately, without a more definitive extreme solution, they'll all have to come out (which I think he'll need a hybrid or all on x). Finances almost always seem to be an issue. I wish I had the patience for full mouth rehab cases and dentures. Just doesn't fit my personality.

Sounds similar to my Meth lady that sued me. 22 y/o super nice gal that sweet talks complements you. I suspected she had used Meth but I didn't set her straight. It was one failed emergency pain and swelling patchwork dumpster fire after another. She was a nightmare in that she was so phobic with the needle. I keep kicking myself each time I think back because I could have put my foot down and refer her for FM dentures. Her suit went from $995k down to settled $35k after I looked up her 2 Meth related arrests, one during our time of tx. Also they named my DMO in the suit although I will be forever in the Provider database.
 
Jul 21, 2004
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So. You are new dentist with tons of DS and practice debt. Young adult adult pt walks into your office with a CC of "Front teeth look like crap and my lower front teeth are chipping". Patient presents with a Class 2 Division 2 deep OB malocclusion with resultant incisal wear on the lower incisors and some TMJ issues with the restricted mandible.

Do you?

A. Send patient to the orthodontist to correct the malocclusion and LOSE that patient for 12-18 months and LOSE all that immediate production or ....
B. show them some pretty pics of veneers/crowns on all the front teeth that can be done IMMEDIATELY.
C. Tell them you are Invisalign certified, offer invisalign and cosmetic restorations to keep ALL the production in house. Hint. Aligners won't correct the excessive OJ from uprighting (torquing) the upper incisors, but odds are .... you won't know this.

Refer to another GP/prosth. TMJ is a chronic management problem that although the procedures will pay dividends immediately, the frequent visits/adjustments/future liabilities will erode at your profit margin relatively quickly.

Sounds similar to my Meth lady that sued me. 22 y/o super nice gal that sweet talks complements you. I suspected she had used Meth but I didn't set her straight. It was one failed emergency pain and swelling patchwork dumpster fire after another. She was a nightmare in that she was so phobic with the needle. I keep kicking myself each time I think back because I could have put my foot down and refer her for FM dentures. Her suit went from $995k down to settled $35k after I looked up her 2 Meth related arrests, one during our time of tx. Also they named my DMO in the suit although I will be forever in the Provider database.

One of the ways that we get around that is just see them for emergencies. Document emergencies. That way, they aren't established patients of record. Once they do a comprehensive exam, that's when the patchwork stops.
 
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