Stuck between periodontist and Oral Surgery and job security

[Big Time Hoosier]

If this excites you, you have your answer. 😉

Big Hoss

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[Flashes23]

FYI I don't think that its because your views are more impartial because it's not about respect. Most ENT and Plastics do not do trauma in the real world. In fact, at a lot of smaller ENT/plastics programs, the trauma call can also be pretty weak. Realistically, these guys don't want to take trauma call when they're focusing on their private practices. That's why there is such a deficit and need for people to take facial trauma call. California apparently is especially hurting right now for people to take facial trauma call. It's a field where OMFS really shines and does a much better job than plastics and ENT. As such, anesthesia sees the speed and results that OMFS does over ENT and plastics in trauma.

Head and neck is similar. Most ENTs do not do head and neck. They have to do a fellowship to do it. If you look at the number of ENTs going into it, there is a waxing and waning of ENTs wanting head and neck due to the lifestyle and lack of pay. You could just do tubes and tonsils and live a very lavish life. That's why there is a slowly increasing number of OMFS programs doing head and neck and increasing numbers of fellowships. There are more prorgams than ever that do head and neck and I constantly hear about programs looking to expand into head and neck. Keep in mind this field is relatively young for OMFS so there is a lot of room for expansion.

The point of my post was and still is, go into OMFS for the right reasons. Which I think we can all agree on. This whole "top dog" mentality, just doesn't occur in medicine. Again, at least not in my institution.

In terms of trauma it's is also very hospital dependent, because there are numerous hospitals in my area with no OMFS program or residents and they get by with only ENT, Plastics. We occasionally get patients that have jaw surgery with screws placed through the lower anterior teeth. **** that happens when you don't have a OMFS program.

 

[dentmass]

IF it was a medical specialty yes it would be one of the most competitive. You are right, unfortunately it is not. When you get to the real world you will learn that everything is a turf war in medicine. Physicians will not look at "all your hard work" and commemorate you. When it comes to treating a pan fracture on trauma call on Christmas Eve no one cares about OMS operating, when it comes to free flaps, head/neck cancer, or god forbid esthetics then other surgeons will ostracize you. There are probably some exceptions but this has been my experience in my hospital, not just idyllic fantasies of a yet to be D1.

This is exactly the type of person I am warning against going into OMS, if it's purely an ego play you will likely be disappointed.

FYI I don't think you understand how it works in reality. There is the opposite of a turf war in real life for trauma. Most ENT and Plastics do not do trauma in the real world and private practice would not even entertain the idea of doing it.. In fact, at a lot of smaller ENT/plastics programs, the trauma call can also be pretty weak. Realistically, these guys don't want to take trauma call when they're focusing on their private practices. That's why there is such a deficit and need for people to take facial trauma call. California apparently is especially hurting right now for people to take facial trauma call. It's a field where OMFS really shines and does a much better job than plastics and ENT. As such, anesthesia sees the speed and results that OMFS does over ENT and plastics in trauma. Lots of respect there.

Head and neck is similar. Most ENTs do not do head and neck. They have to do a fellowship to do it. If you look at the number of ENTs going into it, there is a waxing and waning of ENTs wanting head and neck due to the lifestyle and lack of pay. Doing the recon for free flaps sucks. Every senior ENT attending mostly just wants to do ablative the older they get and have someone else do their recon. You can go home at noon as opposed to 7pm. And above all, most ENT just do tubes and tonsils and live a very lavish life. That's why there is a slowly increasing number of OMFS programs doing head and neck and increasing numbers of fellowships. There are more OMFS progams than ever that do head and neck and I constantly hear about programs looking to expand into head and neck. Keep in mind this field is relatively young for OMFS so there is a lot of room for expansion.

Esthetics is also becoming a free for all. There are dentists, orthodontists, OMFS, PAs, nurses doing botox and fillers. Sure, a rhinoplasty will belong to cosmetic fellowship plastic surgeons for the most part because this is an ideal, well paying private practice procedure but trauma and head and neck are not.

 

[dentmass]

The point of my post was and still is, go into OMFS for the right reasons. Which I think we can all agree on. This whole "top dog" mentality, just doesn't occur in medicine. Again, at least not in my institution.

In terms of trauma it's is also very hospital dependent, because there are numerous hospitals in my area with no OMFS program or residents and they get by with only ENT, Plastics. We occasionally get patients that have jaw surgery with screws placed through the lower anterior teeth. **** that happens when you don't have a OMFS program.

Top dog does occur. Surgeons constantly **** on non-surgeons. The amount of times I've heard a surgical resident think an ED resident is dumb or why internal medicine can't manage the diabetes. You have to have friends who are in surgical fields and work with them constantly to hear this.

 

[Flashes23]

Top dog does occur. Surgeons constantly **** on non-surgeons. The amount of times I've heard a surgical resident think an ED resident is dumb or why internal medicine can't manage the diabetes. You have to have friends who are in surgical fields and work with them constantly to hear this.

Same way non-surgeons like Hematologists, look at surgeons as *****s who have limited ability to diagnose/treat complex disease and just cut and sew.

 

[dentmass]

Same way non-surgeons like Hematologists, look at surgeons as *****s who have limited ability to diagnose/treat complex disease and just cut and sew.

Yes, but the surgical subspecialties require the highest step 1/2 scores, potentially even a full year of research and many pubs on top of clerkship honors and AOA to get in so the extremely high price of admission creates a top dog mentality and an unconscious feeling of inferiority among other medical specialities.

In med school, the kids that said they were doing plastics, ENT and derm etc def got praise from the medical residents because they knew how difficult it was to get in. There's a lot of respect for that.

 

[Flashes23]

Yes, but the surgical subspecialties require the highest step 1/2 scores, potentially even a full year of research and many pubs on top of clerkship honors and AOA to get in so the extremely high price of admission creates a top dog mentality and an unconscious feeling of inferiority among other medical specialities.

In med school, the kids that said they were doing plastics, ENT and derm etc def got praise from the medical residents because they knew how difficult it was to get in. There's a lot of respect for that.

Interventional radiology, radiation oncology, dermatology, all require extremely high test scores as well.

Its funny, now that I think about it the one "top dog" of my hospital and the one my wife works at (where I get my medical care) is neuro surg.

 

[Masterus]

Trauma is something noone wants to do including some OMFS so there is a huge lack of care in that regard.

Neurosurgery tends to be a very "dickish" mentality but rightfully so. 100+ hours of work even as an attending on call weeks.

One thing people have ignored is that perio is making a revival as a specialty. It's becoming heavily the favorite for implant referrals in dental schools. There's been a shift in the last 10+ years. I think this will be reflected in referrals in private practice as well. If implants are what you want to do, then by all means do perio. There are some absolute powerhouse perio programs like San Antonio and UAB. These programs train you to do all on Xs, direct/indirect sinus lifts, different types of grafting, PRFs with some exposure to IV sedation etc. UAB perio residents place more implants than the majority of graduating OMFS residents in the country- they're placing more implants than OR heavy OMFS programs like jacksonville, michigan, parkland, etc.. They place upwards of 150+ implants by graduation. Absolutely unheard of but if you can get yourself into one of these programs and are just interested in dentoalveolar, I think you would be very happy with being a periodontist. But keep in the mind the quality of perio programs is also super variable. There are still some that barely do any implant surgeries and definitely no sinus lifts, etc and stick to classic perio procedures.

If you want even less training and are more cowboy, there are also GPR programs placing 75-100 implants in a year per resident. They are also teaching sinus lifts, and even sedation. The famous ones for this are San Antonio VA and the Foundry in Birmingham (No idea why San Antonio and Birmingham are such dentoalveolar hubs - their OMFS programs also do a lot).

I don't think anyone outside of OMFS should sedate but that's another topic so if that's something you want to do, please do OMFS or get yourself an actual anesthetist whether its a DA, CRNA or MD.

IF you want to operate and do bigger surgeries like double jaws, etc. I think that's a great reason to go into OMFS. Going into OMFS to just place implants makes no sense. You could do that by doing perio and do it in 3 years without having to suffer the hours and general surgery.

 

[ShortShortsDad]

View attachment 346792
If this excites you, you have your answer. 😉

Big Hoss

I am offended that someone took the time to photograph that mess before ripping them out of that dudes skull…

But really, I’ve never met another OMS who gives a **** about what anyone thinks about them, especially some opinionated periodontist who thinks they know **** from working in a hospital before.

Is the point of this thread now if you’re sensitive and constantly worry about what others think of you then you gotta go gum gardening?

 

[LFA20]

Hey brother, no intention of dumbing down your field. Once you are out in private practice, you will get a better idea of what your day in and day out routine is. You will find out what the 75% is and then you can come back and share with us.

People reading this post, you can do well in any field of dentistry. Minimize your debt, minimize the number of years you are sucked into training i.e. 4 vs. 6, take all your extra money and stuff it into the S&P500 And good real estate investments.

Everything else is gravy. All the egos quickly rush away once reality hits.

LOL I find it really funny that OS get offended when we say that the bulk of the procedures they do are implants and wizzies under Iv's.

 

[Big Time Hoosier]

All this talk about hierarchy in the hospital has me thinking that as a pediatric dental resident I was cock of the walk. I mean the relief on the medical team’s face when I would come in to handle that dental trauma on the screaming 4 year old at 2 am. Ain’t no one else want to touch that! I was always handsomely rewarded with all the pudding and string cheese I wanted from the ED fridge.

Big Hoss strutting into the ED be like...

Big Hoss

 

[DomDom3790]

So I can give you my story and what led me to perio.

Long story short, I have been working in a community center/county hospital as a general dentist for years. We do everything from crown/bridge, endo, ext, all the way to ER consults, extractions, I&D in the OR on admitted patients. If your goal is to practice medicine and be a surgeon, then obviously OMS is the way to go. You will have the ability to truly change lives in a very big way, not to mention save lives.

If you are doing this, even partly, for ego then forget it. OS maybe the "top" of the dental world, but they are still at the bottom in the eyes of many other physicians and surgeons. Anesthesiologists look at OMS doing sedation the same way that Eli Manning (poster above) does GPs sedating patients. Surgeons will always see you as a dentist, no matter how much extra training you attain. I often hear the ENT and Plastics attendings and residents refer to the OMS as "tooth fairies". There are more cordial scenarios I'm sure, but at the end of the day you chose to be a dentist and not a "doctor" and a OMS residency will not change that.

The decision became clear to me the more time I spent learning about implants, GBR, peri-implantitis, etc. Almost all the implant literature comes from Perio. Most of the top clinicians in the realm of implants/GBR are periodontists, there are some notable exceptions Urban, Pikos, Buser, etc. but by in large all Perio. I am obsessive and love the cleanliness of their surgeries, sutures, soft tissue management. Although the two specialties have alot of overlap in private practice the mentality entering each program seems to be very different.

Do you want to make a huge difference? changes lives with surgery? be in the OR? have a huge breadth of procedures? Make a ton of money doing sedation and wizzies?

Do you want to be an extremely precise and obsessive periodontist who has many intricate procedures that some may deem tedious? Are you interested in a masters, research thesis, deep understanding of things like oral systemic health, microbiology, etc? Do you want to see patients on a long term basis or one and done?

…. Not sure what people you talk to, but the tooth fairy comment is a new one for me. Anyone who thinks like that has some level of ignorance. Interesting too because the hospital I work at for my residency… this is not the case in the slightest… actually our relationship with plastics and ENT are strong and respectful. This isn’t about what tier you or anyone believes you exist in either, it’s about filling the gap in healthcare that’s needed. You have to be pretty arrogant and lack fundamental knowledge to make those comments.

 

[deleted1047421]

OS maybe the "top" of the dental world, but they are still at the bottom in the eyes of many other physicians and surgeons. Anesthesiologists look at OMS doing sedation the same way that Eli Manning (poster above) does GPs sedating patients.

OMFS has a proven safe and effective track record with providing anesthesia.

I’ve never heard of such claims that anesthesiologists don’t look well upon oral surgeons providing anesthesia.

After all, they are the ones who are teaching oral surgeons in the first place.

During residency, I had the greatest experience in anesthesia, because I had seriously the most awesome anesthesia attendings who provided me with the best possible experience ever. My omfs department had a very good relationship with the anesthesia department. The anesthesiologist in charge would even let me choose my own room/cases.
My absolute favorite : bariatric sleeve gastrectomies. I’d paralyze them with vecuronium and bag mask ventilate morbidly obese patients for two minutes prior to intubation.
When I told my anesthesia attendings I wanted to break my departmental record for things like graduating with the most intubations in my department etc, they tried their best to make it happen. They knew how hungry I was because I’d show up an hour earlier than their other residents and stay late into the evening. I would hold my piss for hours because I didn’t want anyone messing with the anesthesia machine while I was gone.

I’ve had more than one anesthesia attending tell me proudly that I could intubate better than the some of their own anesthesia residents.

If they hated us (oral surgeons) so much then why go out of their way to teach us?

 

[D1Bound]

Trauma is something noone wants to do including some OMFS so there is a huge lack of care in that regard.

Neurosurgery tends to be a very "dickish" mentality but rightfully so. 100+ hours of work even as an attending on call weeks.

One thing people have ignored is that perio is making a revival as a specialty. It's becoming heavily the favorite for implant referrals in dental schools. There's been a shift in the last 10+ years. I think this will be reflected in referrals in private practice as well. If implants are what you want to do, then by all means do perio. There are some absolute powerhouse perio programs like San Antonio and UAB. These programs train you to do all on Xs, direct/indirect sinus lifts, different types of grafting, PRFs with some exposure to IV sedation etc. UAB perio residents place more implants than the majority of graduating OMFS residents in the country- they're placing more implants than OR heavy OMFS programs like jacksonville, michigan, parkland, etc.. They place upwards of 150+ implants by graduation. Absolutely unheard of but if you can get yourself into one of these programs and are just interested in dentoalveolar, I think you would be very happy with being a periodontist. But keep in the mind the quality of perio programs is also super variable. There are still some that barely do any implant surgeries and definitely no sinus lifts, etc and stick to classic perio procedures.

If you want even less training and are more cowboy, there are also GPR programs placing 75-100 implants in a year per resident. They are also teaching sinus lifts, and even sedation. The famous ones for this are San Antonio VA and the Foundry in Birmingham (No idea why San Antonio and Birmingham are such dentoalveolar hubs - their OMFS programs also do a lot).

I don't think anyone outside of OMFS should sedate but that's another topic so if that's something you want to do, please do OMFS or get yourself an actual anesthetist whether its a DA, CRNA or MD.

IF you want to operate and do bigger surgeries like double jaws, etc. I think that's a great reason to go into OMFS. Going into OMFS to just place implants makes no sense. You could do that by doing perio and do it in 3 years without having to suffer the hours and general surgery.

I still don't quite get why periodontists are so popular in the area of implants. If something goes south, who has the ability to trache a patient? After seeing an emergency in the dental office I just don't think I'd ever let anyone touch me with anything surgical except an OMFS.

 

[Masterus]

Periodontists take their time and really focus on placing the implant well. OMFS do place it well as well, but in a dental school setting, you usually hear about the OMFS residents messing up the implants. Both can place implants well, but perio is winning the war in dental schools due to a lot of factors not just who does it better. A lot of it has to do with the easier accessbility of perio residents because they are always in the clinic.

Most OMFS are not trained to trach a patient. They're trained to mask ventilate and to get an emergency airway but not a surgical airway. If you ask an OMFS the number of emergency surgical airways they've done, I'm pretty sure a lot will say 0. Unless you go to one of the bigger surgical programs, you probably will not be slash traching a patient.

 

[bergus95]

Periodontists take their time and really focus on placing the implant well. OMFS do place it well as well, but in a dental school setting, you usually hear about the OMFS residents messing up the implants. Both can place implants well, but perio is winning the war in dental schools due to a lot of factors not just who does it better. A lot of it has to do with the easier accessbility of perio residents because they are always in the clinic.

Most OMFS are not trained to trach a patient. They're trained to mask ventilate and to get an emergency airway but not a surgical airway. If you ask an OMFS the number of emergency surgical airways they've done, I'm pretty sure a lot will say 0. Unless you go to one of the bigger surgical programs, you probably will not be slash traching a patient.

How much implants does the average Perio resident place?

 

[Masterus]

How much implants does the average Perio resident place?

I think that number is in flux for perio because implants is an emerging procedure for them. I wouldn't be surprised if that number is nearing 50 now as well. Unlike OMFS, perio is in clinic for 3 straight years. That's 36 months of straight clinic. Think about how much OMFS is in clinic. Some programs they're in clinic for 2 days a week only placing implants in their last 2 years. The average OMFS resident in the country places about 50 implants. There are some programs that place far more than that but that is far from the norm. Grads both perio/OMFS are having to learn more about implants in private practice. Some OMFS programs are barely placing any implants because there are no hard CODA requirements for implant numbers - you just need to be educated on implants. Just like some perio programs are barely placing implants too. OMFS training in the US is maybe one of the most diverse and dissimilar specialties in all of medicine and dentistry. It's crazy what how vastly different oral surgeon skillsets can be from each other.

 

[bergus95]

I think that number is in flux for perio because implants is an emerging procedure for them. I wouldn't be surprised if that number is nearing 50 now as well. Unlike OMFS, perio is in clinic for 3 straight years. That's 36 months of straight clinic. Think about how much OMFS is in clinic. Some programs they're in clinic for 2 days a week only placing implants in their last 2 years. The average OMFS resident in the country places about 50 implants. There are some programs that place far more than that but that is far from the norm. Grads both perio/OMFS are having to learn more about implants in private practice. Some OMFS programs are barely placing any implants because there are no hard CODA requirements for implant numbers - you just need to be educated on implants. Just like some perio programs are barely placing implants too. OMFS training in the US is maybe one of the most diverse and dissimilar specialties in all of medicine and dentistry. It's crazy what how vastly different oral surgeon skillsets can be from each other.

Average implant numbers at most programs I interviewed at were well over 100. Some, Monte, Loyola, VCU were in the several hundreds. Not sure where your info is coming from. Also soft tissue management is completely different than hard tissue management. Spending all the time in clinic means nothing if all it is are SRP’s. Clearly it isn’t doing implants nonstop

 

[Masterus]

Monte and VCU are outliers. Monte does a lot of dentoalveolar relative to other OMFS programs and somehow that has large implant numbers without a dental school or VA - most likely do to the subsiziding from the hospital on the implants. They are less OR heavy. VCU is one of the top 4 year OMFS programs and has a strong clinic presence as well. You absolutely cannot use that as a standard to examine what an average OMFS resident does. Loyola I've also heard is dentoalveolar heavy but just your average program and isn't very OR heavy. Look at Rutgers one of the busiest OMFS programs in the northeast - they only placed 400 implants as an entire program in one year. How many implants is MGH placing with both a perio residency, implant dentistry residency and only 4 focused months at the dental school as a 5th year and then 1 year as a chief rotating in the ORs for the most part between MGH and BCH.

Look through the list of all OMFS programs and ask your local NYC hospital program how many implants they do. Programs without VAs and dental schools are on average very weak in implants. Even a dental school doesn't guarantee high implant numbers these days. My numbers come from my huge networking in OMFS and talking to residents and grads. I think sometimes people will overestimate implant numbers a bit when talking to applicants to get you to go to their program. Programs need to supply the actual CODA numbers.

36 months of clinic is a lot of time for a perio residency to place implants do all the SRPs they want and much more. That's why prosth departments are flocking to their perio departments to place their implants. Perio is getting good outcomes for prosth - they take longer to angulate, take more x-rays, etc. It seems like multiple dental schools have given the implant crown to perio now and that's the trend.

 

[bergus95]

Monte and VCU are outliers. Monte does a lot of dentoalveolar relative to other OMFS programs and somehow that has large implant numbers without a dental school or VA - most likely do to the subsiziding from the hospital on the implants. They are less OR heavy. VCU is one of the top 4 year OMFS programs and has a strong clinic presence as well. You absolutely cannot use that as a standard to examine what an average OMFS resident does. Loyola I've also heard is dentoalveolar heavy but just your average program and isn't very OR heavy. Look at Rutgers one of the busiest OMFS programs in the northeast - they only placed 400 implants as an entire program in one year.

Look through the list of all OMFS programs and ask your local NYC hospital program how many implants they do. Programs without VAs and dental schools are on average very weak in implants. Even a dental school doesn't guarantee high implant numbers these days. My numbers come from my huge networking in OMFS and talking to residents and grads. I think sometimes people will overestimate implant numbers a bit when talking to applicants to get you to go to their program. Programs need to supply the actual CODA numbers.

On average, omfs programs place multiples what Perio programs place. If you show me any different I would believe you.

Also implants biggest limitation is something OMFS is best able to handle, adequate bone.

 

[Masterus]

On average, omfs programs place multiples what Perio programs place. If you show me any different I would believe you.

Also implants biggest limitation is something OMFS is best able to handle, adequate bone.

Great! you agree with what I said originally - OMFS residents on average place 50 nationally. Perio places less than this but is approaching those numbers due to the nationwide dental school shifts in implant referrals. You're at a program not associated with any dental schools so you do not see the struggle with perio. I've talked about this with so many fustrated OMFS residents from my cycle.

PM if you want numbers.

 

[deleted1047421]

I went to a OR heavy 4 year Program that had OR cases 7 days days a week, with a huge emphasis on orthognathic and trauma.

My graduating number of implants was well above 300. (308 to be exact).

It wasn’t just the implant number that made my experience good, it was the complex grafting/ tissue engineering that came with the implant surgery. I did a ton of large ridge augmentations, sinus lifts, biological grafting, and my personal favorite - ramus grafts.

There seemed to be a lot of programs that I interviewed at that were OR heavy and placed a lot of implants. Again I wouldn’t know the true numbers.

Most of these programs (my program included) focused on the basic full scope (trauma, orthognathic, benign path, reconstructive, Tmj, infections, dentalalveolar) and not expanded scope (cancer, craniofacial, cosmetics).

 

[C.elegans]

I think that number is in flux for perio because implants is an emerging procedure for them. I wouldn't be surprised if that number is nearing 50 now as well. Unlike OMFS, perio is in clinic for 3 straight years. That's 36 months of straight clinic. Think about how much OMFS is in clinic. Some programs they're in clinic for 2 days a week only placing implants in their last 2 years. The average OMFS resident in the country places about 50 implants. There are some programs that place far more than that but that is far from the norm. Grads both perio/OMFS are having to learn more about implants in private practice. Some OMFS programs are barely placing any implants because there are no hard CODA requirements for implant numbers - you just need to be educated on implants. Just like some perio programs are barely placing implants too. OMFS training in the US is maybe one of the most diverse and dissimilar specialties in all of medicine and dentistry. It's crazy what how vastly different oral surgeon skillsets can be from each other.

Agree with most of what you said. Though I honestly think out of the 3 years of postgrad perio education, alot of it is dedicated towards didactic lectures, journal clubs, research, and other non-clinical tasks. Plus most perio clinics are a 9-5pm type of deal where the perio residents see anywhere between 3-5 patients at most in a single day (~40hr work weeks). Basically, in terms of number of clinical hours logged, perio will hover closer to 6000 hours at the end of the 3 years while OMFS will be closer to 18000-19000 hours at the end of 4-6 years. You are right in that perio seems to be generally winning over dental students and getting the student referrals because they have more time to be available around the predoc clinics. Although, I have heard some rather concerning things from several students who have told me that some perio residents advertise themselves as "basically an oral surgeon" to dental students to convince them to direct referrals towards perio instead of OMFS 😬

 

[Flashes23]

Almost every program I interviewed at for perio (13 programs) placed near or over a 100 per resident. But again it's not about number of placements, you can go to some third world country and sink in 100 implants in a couple of weeks that doesn't make you an OMFS or Perio. The advantage Perio has is that many programs work DAILY with prosthodontists, if not prosth then atleast with other restorative departments. In the real world when you do the surgical part of an all-on-four, or even a single implant for that matter, you often have to hand-hold and guide the general dentist. Perio's get a well rounded education, dentally speaking, because they work closely with Ortho, Prosth, Endo. Treatment planning is the key to success.
Perio's never leave the realm of dental and are trained to manipulate soft tissue around implants with incision design, grafting, as well as suturing. I can always tell whether an OS or Perio is doing the surgery based on instruments used (Buser vs Molt 9, needle holder vs Castroviejo, 5/6.0 sutures vs 3/4.0). It's generally a cleaner, more precise procedure, not ripping papilla, flap perforations, etc. Again almost all implant literature comes from Perio's, almost all the "thought leaders" and world class lecturers in implants are Perio's (notable exception Buser,Urban,Misch,Pikos, etc). Peri-implantitis is also managed by Perio, generally.
In residency OMFS are preoccupied with life saving/altering procedures, many cannot be bothered with worrying whether an implant has a 1mm of recession, etc. If Perios advertise that they are basically "oral surgeons" it isn't because they can do anywhere near the amount of procedures that a OMFS can do, it's that 9/10 OMFS choose to do nothing but simple dento-alveolar surgery and never step foot into a hospital after graduation.

In my dental school we had 6-8 OMFS and 2 Perio. One of which was a new grad the other an older Perio that never placed implants. I left dental school thinking that OMFS were the leaders in the field of implantology, and everyone else was just offering compromised care. This simply isn't true, many many defects and complications center around soft tissue/bone. It is a lot easier to teach a Perio to work with bone, then it is to teach an OMFS to work with soft tissue. How many GP's do you know that ever get into soft tissue grafting? Insane learning curve. NEVER EVER did I think I would want to do Perio! Once you get out and starting working alongside specialists, you get a better idea of what they do day in and day out. Hopefully, people keep thinking that Perio's just do SRPs all day, I don't need the competition 😉

 

[bergus95]

Go on Indeed, type in Oral Surgery jobs, then type in Periodontist jobs. You’ll get a good idea of what’s out there. It’s not even close.

 

[schmoob]

I still don't quite get why periodontists are so popular in the area of implants. If something goes south, who has the ability to trache a patient? After seeing an emergency in the dental office I just don't think I'd ever let anyone touch me with anything surgical except an OMFS.

You have a lot to learn.

Maybe because Perio are gum and bone specialists? Implants are literally focused on the periodontium. Also why would anyone need to be trached from placement? That doesn’t make sense. A patient is more likely going to need a trache from an endo mishap and God knows they are not trained to do that.

I’ve restored tons of implants placed by both Perio and OS. In general I have had better outcomes with Perio. They seem to understand that implants are restorative-driven, not surgically. Again, these are just my personal experiences based on the particular doctors I’ve worked with. Don’t get me wrong I have seen beautiful results from OS and not so great placements from Perio, I’m just sharing my personal experiences.

If it wasn’t for losing the referral I would actually prefer to send the case to prosth for placement and restoration. I have seen some fantastic work from them.

 

[deleted1082923]

Go on Indeed, type in Oral Surgery jobs, then type in Periodontist jobs. You’ll get a good idea of what’s out there. It’s not even close.

This is very true. It’s much easier to get a job as an oral surgeon vs a periodontist. I have done quick job searches like bergus and the difference is honestly very stark. While a periodontist may be able to do the same procedure as an oral surgeon (albeit with less speed, efficiency), most DSOs and private practices don’t want periodontists. Why would they, when you can hire someone who is more qualified, and someone who can actually do the sedation, which is often needed when placing multiple implants or doing extensive dentoalveolar surgery. It just makes more sense to hire an oral surgeon.

 

[deleted1047421]

The advantage Perio has is that many programs work DAILY with prosthodontists, if not prosth then atleast with other restorative departments. In the real world when you do the surgical part of an all-on-four, or even a single implant for that matter, you often have to hand-hold and guide the general dentist. Perio's get a well rounded education, dentally speaking, because they work closely with Ortho, Prosth, Endo. Treatment planning is the key to success.

You can’t overgeneralize.
Every one of my 308 implants I placed was supervised by a prosthodontist attending. My implant director in my residency program was a renown prosthodontist. In fact you probably read one of his books.
Every implant I placed was treatment planned with a prosthodontist.
In terms of implant placement, every pilot drill/guide pin radiograph was reviewed and critiqued prior to final osteotomy and implant placement. I learned to have every single implant to eventually be screw retained. Cement retained restorations from my implants was the rarity not the norm. If it was a guided case, a prosthodontist was also involved in the workflow.

When it came to complicated grafting.
Same thing - he was involved in every surgery.

I can always tell whether an OS or Perio is doing the surgery based on instruments used (Buser vs Molt 9, needle holder vs Castroviejo, 5/6.0 sutures vs 3/4.0). It's generally a cleaner, more precise procedure, not ripping papilla, flap perforations, etc.

Lol at this point I don’t know what to say anymore. Can’t seem to reason with someone like you.

 

[Flashes23]

You can’t overgeneralize.
Every one of my 308 implants I placed was supervised by a prosthodontist attending. My implant director in my residency program was a renown prosthodontist. In fact you probably read one of his books.
Every implant I placed was treatment planned with a prosthodontist.
In terms of implant placement, every pilot drill/guide pin radiograph was reviewed and critiqued prior to final osteotomy and implant placement. I learned to have every single implant to eventually be screw retained. Cement retained restorations from my implants was the rarity not the norm. If it was a guided case, a prosthodontist was also involved in the workflow.

When it came to complicated grafting.
Same thing - he was involved in every surgery.

Lol at this point I don’t know what to say anymore. Can’t seem to reason with someone like you.

Ohh I will be the first to admit that these are just vast generalizations. Your experience is definitely out of the norm for an OMFS program. I'm sure you are an outstanding clinician. There are a lot of generalizations made on this entire thread, my goal is for dental students reading through this thread to get a realistic outlook on both specialties. There are a lot of students that are very ignorant to what both specialties actually do in the real world. Some even that think traching a patient is requisite skill for dental alveolar surgery 🙄.

 

[deleted1047421]

I’ve restored tons of implants placed by both Perio and OS. In general I have had better outcomes with Perio. They seem to understand that implants are restorative-driven, not surgically. Again, these are just my personal experiences based on the particular doctors I’ve worked with. Don’t get me wrong I have seen beautiful results from OS and not so great placements from Perio, I’m just sharing my personal experiences.

Thank you for your post.

Restorative clinicians will send all their implants to an implant surgeon that will do a good job (implants easy to restore - screw retained, and minimal to no bone loss), and treat their patients well. It’s doesn’t matter if they are an oral surgeon or periodontist.

All omfs residents reading your post should take note that implants are a prosthetically driven treatment that happens to have a surgical component.

That being said when I graduated and arrived into town all the implants were referred to the local perio. Since then a lot of the dentists I work with have changed their referring patterns and refer a ton of implants to me.

Here are some of the complaints:
1) she can’t do complex bone grafting and therefore many cases that required large sinus lifts and large ridge augmentations, she didn’t want to do.
2) many of her implants placed just weren’t done well and she had a lot of bone loss/ failures on many of her implants.
3) a good amount of her implants were not screw retained.
4) she threw her restorative dentists under the bus when there were failures directly blaming the dentist in front of the patients saying that the implant had bone loss due to the crown the dentist made.
5) wasn’t comfortable treating patients that were medically compromised. For example - full mouth extractions and implant placement on patients who are on warfarin.

I’ve had those dentists tell me they will only send implants to me after seeing that I do good work and treat patients well.
They like how I get the vast majority of my implants screw retained. They like that if the patient doesn’t have enough bone - I will do what is necessary to make sure that I bone graft successfully so that the implant will be easy to restore. They like that my implants rarely have bone loss (whereas they have seen some of their other providers send them implants ready for restoration already with existing bone loss).

 

[OMSDoc]

Do perio.

 

[bergus95]

Do perio.

Lol why?

 

[D1Bound]

Lol why?

Time to reach for the popcorn

 

[OMSDoc]

Lol why?

I do not see any difference in job security, but they are different professions. One of my closest friends is a periodontist, he does extremely well. He has much better hours than I do. The surgery is not the hardest part. The most difficult part is getting 5 of your employees to get along under one roof.

The original poster has not conveyed the passion (at least to me in this thread) that they want to help people in dire need, which is what oral and maxillofacial surgery is all about. He/she stresses the importance of their interest, attention span, and pocket book.

I know of no loose implant abutment that cannot be managed until the next business day. And any life-threatening periodontal infection is managed by oral and maxillofacial surgeons.

More than a few times I have been in the OR on Christmas day, draining an infection or treating a fracture. And I am happy to do it. This is what I do. My mother told me at an early age that I would have to do this if I became an oral and maxillofacial surgeon.

And believe me, the patient and/or families thank God that the OMS is there to do it.

Moreover, my wife and family understand and are very supportive. They are not giving me a hard time about not making enough money.

Merry Christmas!

 

[nonociceptors]

Depends if you want to sit around reading journals and circle jerking over biologic width

 

[Big Time Hoosier]

Depends if you want to sit around reading journals and circle jerking over biologic width

Big Hoss

 

[periopocket]

Depends if you want to sit around reading journals and circle jerking over biologic width

This is actually very true.

I just about died with the 30-60 bull**** articles they had us read, felt like time wasted at some
Points, I would of much rather been spending that time treating patients.

 

[OMaxFace]

This was an entertaining thread.

In the end, do whatever you want and get off the toxic cesspool that is SDN.

I'm over the prestige and ego that comes with all these specialties. Doesn't matter in the end.

 

[2TH MVR]

This was an entertaining thread.

In the end, do whatever you want and get off the toxic cesspool that is SDN.

I'm over the prestige and ego that comes with all these specialties. Doesn't matter in the end.

Not sure I agree about the "toxic cesspool that is sdn". A toxic cesspool would be Dental Town.
But. Yes. In the end ..... it really doesn't matter.
Money and ego is nice, but if that is all you are concerned with .... you'll never be really satisfied. Odds are none of you will be making Bezos or Musk money regardless of what area of dentistry you go into. None of you. But most of you will be living a nice life. That's what dentistry can offer.
Not saying money isn't necessary to pay off bills, buy food and toilet paper, pay off sports gambling debts, pay student loan debt, etc. etc. But at some point you have to realize that you will be "working" at your desired profession 8 hrs a day, 4-5 days per week .... for a long time. You better damn well like what you are doing.

Think "lifestyle" and what you are truly interested in. Not what the popular specialties are.

 

[DDS9994]

Not sure I agree about the "toxic cesspool that is sdn". A toxic cesspool would be Dental Town.
But. Yes. In the end ..... it really doesn't matter.
Money and ego is nice, but if that is all you are concerned with .... you'll never be really satisfied. Odds are none of you will be making Bezos or Musk money regardless of what area of dentistry you go into. None of you. But most of you will be living a nice life. That's what dentistry can offer.
Not saying money isn't necessary to pay off bills, buy food and toilet paper, pay off sports gambling debts, pay student loan debt, etc. etc. But at some point you have to realize that you will be "working" at your desired profession 8 hrs a day, 4-5 days per week .... for a long time. You better damn well like what you are doing.

Think "lifestyle" and what you are truly interested in. Not what the popular specialties are.

I have actually found DT to be quite informative, what makes you say that?

 

[2TH MVR]

I have actually found DT to be quite informative, what makes you say that?

Too commercial with supposed experts selling their products and services.

 

[DDS9994]

Too commercial with supposed experts selling their products and services.

gotcha, they have cracked down quite a bit in that stuff, but if you filter thru it, there are some serious seasoned docs in there, who over the years have given out financial advice that is worth it weight in gold, Im talking investment advice that smokes the majority of so called " advisors " I have sat down with.

 

[schmoob]

gotcha, they have cracked down quite a bit in that stuff, but if you filter thru it, there are some serious seasoned docs in there, who over the years have given out financial advice that is worth it weight in gold, Im talking investment advice that smokes the majority of so called " advisors " I have sat down with.

I agree. But I think there are too many “experts” there. A lot of overly confident people handing out clinical, management, financial advice that’s terrible. Not enough humility among the members. You really need to sift through the garbage to find the good information.

 

[periopocket]

SDN = OMFS/ORTHO dominated kingdom
vs.
Dental Town = GP dominated kingdom

Pick your poison.

 

[DDS9994]

I agree. But I think there are too many “experts” there. A lot of overly confident people handing out clinical, management, financial advice that’s terrible. Not enough humility among the members. You really need to sift through the garbage to find the good information.

Hmmmm, I havent really looked at alot of the clinical stuff in years, but some of the best financial advice for dentists is easily on DT, a few arent humble but for the most part most are very helpful, I would be curious about the "terrible" financial advice you have seen.