Question about endo

[PaliRN95]

As an endodontist, can I still practice General dentistry?

---

Members don't see this ad.

 

[AppalachianDentalBoy]

You can but you shouldn’t/won’t unless you don’t like endo that much after all.

The point of completing a residency is basically to stamp “practice limited to XYZ” on your business card and website because general dentists won’t refer patients to you elsewise. Plus you will make more money as an endodontist because you will only be doing a few procedures regularly and endo has super low overhead due to no lab fees.

 

[PaliRN95]

You can but you shouldn’t/won’t unless you don’t like endo that much after all.

The point of completing a residency is basically to stamp “practice limited to XYZ” on your business card and website because general dentists won’t refer patients to you elsewise. Plus you will make more money as an endodontist because you will only be doing a few procedures regularly and endo has super low overhead due to no lab fees.

I see, that makes sense. Thank you!

 

[BluntForceTrauma]

Also, and this is the killer:

You won't because if you do, you will never see a referral. Ever.

Specialists live and die by referrals from GP (with the exception of maybe Pedo) and so if you cut into the market of GP, none of them will ever want to give to you. Same reason why specialists don't typically have hygiene as a part of their practices.

Sent from my Pixel 3 using Tapatalk

 

[hellopeople]

As an endodontist, can I still practice General dentistry?

All the above comments are correct. You'll have trouble with referrals if you do any general dentistry.

There's no point though. General dentists are having a tougher go of things, but endodontists are not. You'll make so much more doing endo that you'd have to hate it relative to general dentistry not to limit you practice to that.

 

[Blackca3]

As an endodontist, can I still practice General dentistry?

Ask this question to actual specialist and dentist not pre dental students. It very much depends on your state. In many states you cannot practice outside the scope of your specialty. This can be a contentious point because general dentist may not be bound by the same restrictions. Practicing dentist and specialist can give you better answers.

 

[AppalachianDentalBoy]

I worked for an endodontist. Doesn’t matter if you can or cannot work as a GP because you will not be getting refferals if you chose to do so.

 

[Cold Front]

As an endodontist, can I still practice General dentistry?

The whole point of being an endodintist is that you get to do RCTs a general dentist is not willing to do. A lot of general dentists do their own root canals (including molars, like myself). A patient who needs a root canal will usually not go directly to an endodontist, 95% of the time they will go to a general dentist first. The general dentist then decides if he or she would refer the case or do the RCT on their own. If you are an endodontist and you were practicing near my office, you will not get to see many referrals from me, maybe only some of the very difficult cases. Having said that, majority of general dentists don’t do molar RCTs and that’s why endodontists are fairly doing well and getting referrals from many general dentists. The same can be said about Pediatric Dentists, some basic Orthodontics, and so on.

 

[hellopeople]

A lot of general dentists do their own root canals (including molars, like myself).

Do you feel this is profitable? I feel like a fair number of general dentists say that they have trouble making it work out well after counting increased overhead and the reduced fees you get relative to the endodontist.

 

[Cold Front]

Do you feel this is profitable? I feel like a fair number of general dentists say that they have trouble making it work out well after counting increased overhead and the reduced fees you get relative to the endodontist.

With the right rotary system and speed, Endo is profitable for general dentists. I typically do 2-3 bicuspids and 2-3 molars a day. Somedays I do 4-6 molars.

 

[011110]

With the right rotary system and speed, Endo is profitable for general dentists. I typically do 2-3 bicuspids and 2-3 molars a day. Somedays I do 4-6 molars.

What’s your molar failure rate? Sargenti paste? Hahaha

 

[Cold Front]

What’s your molar failure rate? Sargenti paste? Hahaha

2-5%, which is within the standard failure rate. Just know your tooth and access morphology well and the rest is simple after doing few dozen well irrigated and obturated RCTs. I use WaveOne rotary system and that hit the Endodontist market pretty hard when it came out 6-7 years ago. Dentsply ended up buying the company that invented WaveOne (Tulsa Dental) after seeing a spike of Endo procedures in GP offices with WaveOne rotary system.

 

[desertrat12]

2-5%, which is within the standard failure rate. Just know your tooth and access morphology well and the rest is simple after doing few dozen well irrigated and obturated RCTs. I use WaveOne rotary system and that hit the Endodontist market pretty hard when it came out 6-7 years ago. Dentsply ended up buying the company that invented WaveOne (Tulsa Dental) after seeing a spike of Endo procedures in GP offices with WaveOne rotary system.

Cold Front, seems like you have a pretty good grasp on where dentistry is heading, how do you think the future of Endodontics as a specialty looks? I’m not overly interested in endo, but since it’s on topic I’m curious what your thoughts are.

While medicine seems to get more and more specialized/subspecialized, dentistry seems to be returning more and more to the gp and tech improves.

Also, in the instances when you do have a failure, are you retreating, referring, placing implant, or something else?

 

[Cold Front]

Cold Front, seems like you have a pretty good grasp on where dentistry is heading, how do you think the future of Endodontics as a specialty looks? I’m not overly interested in endo, but since it’s on topic I’m curious what your thoughts are.

While medicine seems to get more and more specialized/subspecialized, dentistry seems to be returning more and more to the gp and tech improves.

Also, in the instances when you do have a failure, are you retreating, referring, placing implant, or something else?

When I have failed Endo cases, which has been happening less and less on me, I usually refer the patient to the local dental school Endo program, and the faculty/residents usually get on the phone with me and explain what they plan to do to help the patient. I have learned a lot from those faculty/residents over the years, and I have changed my approach to Endo cases after each failed experience. There were times I had a failed lower first molar Endo case because there was a 4th/second distal canal and I was short less than 0.1mm from the apex, and you wouldn’t be able to catch it on a 2D digital PA radiograph. So instead of referring the patient out (who had a post-op irreversible pulpitis pain for days), I simply retreated both distal canals and finished it with about >0.1mm extrusion using the dental imaging software canal measuring tools. Again, you wouldn’t be able to catch it the extrusion on a PA radiograph either, unless you had before and after re-treat PA’s to compare. Patient was fine 2 hours after the procedure and never had post-op pain since. I can think of a lot of GP’s who would have recommended EXT on that tooth before the re-treat/after the initial failure. So Endo is challenging for GP’s but not impossible to do. I don’t place implants and usually refer the rare failed cases out, with the hope of learning something from that failure.

Future of Endo will be focused on perfecting the pillars of the Endo procedure; less pain, less time, better filing/shaping and irrigation, better obturation, better restoration and so on. The more simplified those steps become with technology, the more those cases will be done in a GP office than an endodontist office. Technology will try to push the Endo scale more to the GP side in the long run, it’s a good thing for dentistry in general and better treatment outcome for patients. I didn’t do a single actual RCT in dental school, and without technology I wouldn’t have touched as many RCT cases as I did as a GP without the ever improving help from technology.

 

[charlestweed]

Do you feel this is profitable? I feel like a fair number of general dentists say that they have trouble making it work out well after counting increased overhead and the reduced fees you get relative to the endodontist.

If your office is not busy enough (either because it’s a new office or because it’s in an oversaturated area) and you don’t have to hop from chair to chair, then there is no reason to sit around doing nothing….you better spend time learning how to do molar RCT yourself. The more endo cases you treat, the more you learn. You never learn anything if you keep referring cases to specialists. Of course, there are cases that you have to refer out because you want to sleep better at night. I remember when my wife and I applied for a P/T job as a GP (I was still a GPR resident at that time), many owner GPs asked us if we could do molar RCTs and how fast we could do them.

About the fees….Specialists don’t necessarily charge higher fees than the GPs. For example, my endodontist friend works for an office that accepts HMOs. The reason he gets a lot of HMO patients is most GPs don’t want to do RCTs because HMO pay them almost nothing....so they refer cases out to endodontists. HMOs pay endodontists more than GPs but still much worse than what the cash patients and PPOs pay them. So to make money, my endo friend has to be fast and treat high patient volume. The same is true for my OS friend, who accepts medicaid….he makes $$$ by extracting teeth fast. The same is true for my office. I charge lower fee than many GPs, who do ortho in their offices. The reason I make more is I hire ortho-specific assistants, who help me treat 10+ times more patients than what the GPs can treat in a day.

 

[hellopeople]

The more endo cases you treat, the more you learn. You never learn anything if you keep referring cases to specialists.

I'll have to get more comfortable with this idea I guess. It unnerves me to practice o people if I dont feel competent.
In this particular area I suppose I can practice on extracted teeth, but in general I find it difficult to try things I dont feel I'm fully trained to do.
I've yet to do much hands on CE though...

 

[2TH MVR]

Every market (rural family dentists to urban muy saturation) demands different levels of patient treatment. I get it, but if I'm bringing my family in for specific treatment .... I want those dentists who are specialized and do this specific procedure day in and day out with years of experience. It's should be common sense that an Endodontist is going to do a better job at RCT than a GP who does this procedure part time regardless of technology. I'm not saying EVERY specialist is going to be better .... just the majority. Of course there are GPs who do fantastic specialized procedures. Technology cannot make up for a dentist's poor skills, lack of proper diagnosis and lack of experience.

To get back to the OP. No ... an Endo should not do general dentistry for the same reasons mentioned in other posts (GPs will not refer to them) and also ..... their level of dentistry is most likely not going to be as good as a seasoned GP.