The Perio Stigma

[dontwakeme]

It seems like there's a lot of disdain for perio on these forums. How come? In other words, why does perio tend to be the least competitive speciality?

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[drhobie7]

The cornerstone therapy for the specialty of periodontics has always been scaling and root planing. Most people don't enjoy SRP that much.

In addition, surgeons generally don't care for them because they sometimes tread onto the specialty of oral and maxillofacial surgery when financially advantageous, and defer to a surgeon when a mistake is made and complications arise. Typical examples are complications of dental implants, bone grafting, and third molar extractions.

 

[ItsGavinC]

Perio isn't the least competitive specialty, but there are lots of jabs taken at perio around here. As was said, most students don't appreciate non-surgical perio (SRP).

Surgical perio stuff is pretty cool, in my book, that that's the type of stuff that the average dental student gets minimal exposure to.

 

[Gulch]

Surgical perio stuff is pretty cool, in my book, that that's the type of stuff that the average dental student gets minimal exposure to.

By "surgical perio" do you mean the bone grafting, implants, etc. that Dr. Hobie said OMFSs wish periodontists didn't get into? It seems to me like perio is unpopular with students for what is has traditionally been and unappreciated by oral surgeons who don't like periodontists doing the fun stuff (surgical perio?)

 

[north2southOMFS]

By "surgical perio" do you mean the bone grafting, implants, etc. that Dr. Hobie said OMFSs wish periodontists didn't get into? It seems to me like perio is unpopular with students for what is has traditionally been and unappreciated by oral surgeons who don't like periodontists doing the fun stuff (surgical perio?)

?

I think most american students don't like it because SRP sucks, everyone had a bad experience with their nazi like perio department in dental school, and if you become a periodontist in todays world you have to tell lies like "our specialty is thriving..", then sneak around and spend all day putting in implants and taking out teeth to make money.

 

[drhobie7]

As was said, most students don't appreciate non-surgical perio (SRP).

The foundation of all periodontal therapy, including "surgical" periodontal therapy, is accessing and removing calculus (SRP) and establishing a cleansable periodontium. I swear I'm not making this up. I actually LEARNED this in my periodontics class! My reference is H. Takei, co-author of the widely used book Clinical Periodontics.

 

[Gulch]

?

I think most american students don't like it because SRP sucks, everyone had a bad experience with their nazi like perio department in dental school, and if you become a periodontist in todays world you have to tell lies like "our specialty is thriving..", then sneak around and spend all day putting in implants and taking out teeth to make money.

! that's pretty much what I was trying to say. still, what exactly is "surgical perio?" Forgive my D1 ignorance please.

 

[Daurang]

I have seen in numerous literatures and ce courses showing simple bone grafting of advanced and seemly hopeless perio cases with incredible results. When I refer my patients for similar treatment, the result is always extract, artificial bone, and implant costing $6000 for one tooth.

 

[crazy_sherm]

! that's pretty much what I was trying to say. still, what exactly is "surgical perio?" Forgive my D1 ignorance please.

More "traditional" perio surgery usually consists of crown lengthening, soft tissue grafts, regeneration procedures, and pocket reduction procedures. They mainly deal with small modifications to the alveolar bone or gingiva. There are some brief explanations here: http://www.perio.org/consumer/procedures.htm

 

[toofache32]

I was always dismayed at the futility of periodontal treatments. These people don't suddenly get religion and start flossing. The only cure for periodontitis is a #150 forceps.

 

[Gulch]

More "traditional" perio surgery usually consists of crown lengthening, soft tissue grafts, regeneration procedures, and pocket reduction procedures. They mainly deal with small modifications to the alveolar bone or gingiva. There are some brief explanations here: http://www.perio.org/consumer/procedures.htm

thanks. that was really clear (good site). so, implants and hard tissue grafts are NOT traditionally considered perio surgery...and if left to oral surgeons would not be part of the perio vocabulary.

 

[aphistis]

?

I think most american students don't like it because SRP sucks, everyone had a bad experience with their nazi like perio department in dental school, and if you become a periodontist in todays world you have to tell lies like "our specialty is thriving..", then sneak around and spend all day putting in implants and taking out teeth to make money.

I think this covers just about everything.

 

[Dr. Dai Phan]

I think the reason for perio bashing here is that ego ladden OS residents want to have the EXCLUSIVE title to the word "surgery". To call SRP surgery or placing implant "surgery" a bit much but tissue grafting or correction of bony defects in my book is surgery. DP

 

[vize]

I think the reason for perio bashing here is that ego ladden OS residents want to have the EXCLUSIVE title to the word "surgery". To call SRP surgery or placing implant "surgery" a bit much but tissue grafting or correction of bony defects in my book is surgery. DP

I agree. After speaking with numerous general dentists, they all say that periodontists place the best implants. I don't know how true this is, but it seems fairly accurate coming from the people referring out. So I wouldn't say they're sneaking around trying to place implants because, according to GPs, they are the best at doing it anyway!

 

[OMFSdoc]

I think the reason for perio bashing here is that ego ladden OS residents want to have the EXCLUSIVE title to the word "surgery". To call SRP surgery or placing implant "surgery" a bit much but tissue grafting or correction of bony defects in my book is surgery. DP

If periodontists are considered surgeons, then all dentists are surgeons. This however, is just not true. A "surgeon" i.e. general, pediatric, CT, plastic, ENT, OMFS, colorectal, orthopedic etc. spends time training on a general surgery service. Without this general surgery training, none of them would be able to complete their residencies. That is why they are considered surgeons. A periodontist spends no time with general surgery and is therefore not a surgeon. They are dental specialists that do some surgical procedures, but they shouldn't call themselves "surgeons" because of it.

Ok, bring the noise...

 

[EuroOMFS]

After speaking with numerous general dentists, they all say that periodontists place the best implants. I don't know how true this is....

This is of course total BS. It doesn't really matter if it's an OMS, periodontist, prosthodontist or a GP, there are people in all groups who are good at placing implants, and there are people in all groups who are not as good.

However I doubt any GP would refer a patient to a periodontist for a bone graft from the tibia or iliac crest. OMS is the only speciality that can do it all. Other specialities will always have to rely on OMS to some extent.

 

[OceanDMD]

I agree. After speaking with numerous general dentists, they all say that periodontists place the best implants. I don't know how true this is, but it seems fairly accurate coming from the people referring out. So I wouldn't say they're sneaking around trying to place implants because, according to GPs, they are the best at doing it anyway!

I don't think this is necessarily true. Periodontists often take more care with the tissue management when placing implants (Im not saying OMFS doesn't as well in some cases), which is paramount when restoring anterior teeth. As far as placement, placing implants is really cookie cutter. The work is in the planning and bone/sinus management. If a patient is bone deficient, and you need an autograft, do you really want a periodontist cutting and pasting your tissue?

 

[vize]

I don't know of many people who would want to risk being crippled by getting bone taken from their leg, when a periodontist can just take it from their chin. And I'm not saying all dentists cannot place good implants, I'm saying from what I've heard from GPs, their periodontists have placed the best ones consistently. The oral surgeons have many other things to worry about. You're right, oral surgeons are the final go-to for dental treatment - maybe that's where all the unnecessary arrogance comes from.

 

[OceanDMD]

If periodontists are considered surgeons, then all dentists are surgeons. This however, is just not true. A "surgeon" i.e. general, pediatric, CT, plastic, ENT, OMFS, colorectal, orthopedic etc. spends time training on a general surgery service. Without this general surgery training, none of them would be able to complete their residencies. That is why they are considered surgeons. A periodontist spends no time with general surgery and is therefore not a surgeon. They are dental specialists that do some surgical procedures, but they shouldn't call themselves "surgeons" because of it.

Ok, bring the noise...

SEMANTICS

 

[DDS 08]

Perio gets a bad rep, because of the things they do. I was talking to a pros. faculty member the other day and he was telling me how just this week he had one of his patients come back in who he had sent to a periodontist for some perio tx. and the perio guy had placed an implant in an edentulous area between two teeth that needed to be crowned without consulting him. He then had to explain to the patient that even thought they weren't going to be doing a bridge any longer which would have taken care of the crowning those two teeth and filled the edentulous, those teeth still needed to be crowned and and the implant restored. I have heard similar stories from other dentists, they send a patient out for perio tx and get them back with implants. It's also a problem in our clinics at school. If you need the grad perio residents to do some kind of C/T graft or flap it takes months to get the patient in, but if you have a patient that might be interested in an implant these guys are down on the clinic floor in a second to try and persuade the patient into getting one. They usually also convienently don't mention that bone grafting or sinus lifts may be needed. I also hate the fact you can't understand half of them.

 

[S Files]

it's funny how perio's just keep repeating "we handle soft tissue the best" and after repeating enough times i guess everyone starts believing them.

i respect perio for the complex crown lengthening, gingival grafting and surgical / non-surgical scaling root planning procedures. i do think research (systemic relationship) done by perios - sure hasn't found a causal relationship but nevertheless has produced some good evidence.

but basically they get a bad rap for a couple reasons. in many programs they get a little crazy with the perio plastic surgery title, draping the entire operatory excessively, etc. and more importantly, whenever a specialty starts impinging onto anothers' area of expertise, they should expect a backlash. for instance, some perios are trying to do impacted 3rd molars. many are starting to do them in private practice. but as soon as a problem arises, or the more complex cases arise, it's off to omfs.

 

[north2southOMFS]

I don't know of many people who would want to risk being crippled by getting bone taken from their leg, when a periodontist can just take it from their chin.

Nice. You are clearly now showing your complete lack of knowledge of bone grafting risks and complications, as well as your complete lack of knowledge of when a hip or tibia needs to be done vs a chin. But then again, maybe you'd rather everyone walk around with a dent in their chin.

 

[drhobie7]

I don't know of many people who would want to risk being crippled by getting bone taken from their leg, when a periodontist can just take it from their chin. And I'm not saying all dentists cannot place good implants, I'm saying from what I've heard from GPs, their periodontists have placed the best ones consistently. The oral surgeons have many other things to worry about. You're right, oral surgeons are the final go-to for dental treatment - maybe that's where all the unnecessary arrogance comes from.

OK, you are not yet a 1st year dental student so it's expected that you will be somewhat naive and excited by the limited information you have acquired to this point. The iliac crest (which is the hip, not the leg) is a safe and common location for bone harvesting associated with little morbidity when done properly. Iliac crest bone grafts are done on a regular basis at many oral and maxillofacial surgery residencies. You can't get that quantity of cancellous or cortical bone from any intraoral site, and I doubt if you could get it anywhere else on the body as easily.

As mentioned previously, a common story from GPs I know is that periodontists have acted in financial self-interest (by placing implants not requested by the GP) when referred a patient with a very specific treatment plan, often crown lengthening/pocket reduction. It is a breach of trust and professional conduct to initiate costly, irreversible restorative treatment without consulting the restorative dentist. I can not say enough about how messed up that is! It's a bummer because one of my best friends is going into perio. But what can I say? Sometimes good people make bad choices. Okay, okay. I'm sort of joking.

Perio has an unenviable task. Their specialty took a major hit with the advent of the dental implant. It no longer became necessary to save a tooth at all costs. So much of their specialty revolves around that. It is built into their philosophy. Now they are trying desperately to preserve their future by becoming implant specialists. This propaganda is frequently promulgated by claiming superiority with soft tissue. This is a slap in the face to oral surgeons who have far more surgical experience with far more friable and delicate tissues (e.g. nasal mucosa, the orbit, nerves, vessels, skin, and undoubtedly more that I'm unaware of. Gingiva is one of the most forgiving tissues in the body. Do a few perio surgeries and you'll immediately recognize this. The stuff is incredible.

Ok, I'm done. If you want to do perio that's great. But do PERIO: pocket reduction, crown lengthening, S/RP, CT grafts, gingival grafts, pedicled whatchamajiggers, gingivectomy, bone in a bottle grafting, molar hemisection, root amputation....and sure why not let 'em do simple implants. But don't expect to do treatment under the umbrella of oral and maxillofacial surgery and not catch any flak for it, especially when complications arise.

 

[toofache32]

What is this "soft tissue" you guys keep talking about?

 

[OceanDMD]

OK, you are not yet a 1st year dental student so it's expected that you will be somewhat naive and excited by the limited information you have acquired to this point. The iliac crest (which is the hip, not the leg) is a safe and common location for bone harvesting associated with little morbidity when done properly. Iliac crest bone grafts are done on a regular basis at many oral and maxillofacial surgery residencies. You can't get that quantity of cancellous or cortical bone from any intraoral site, and I doubt if you could get it anywhere else on the body as easily.

As mentioned previously, a common story from GPs I know is that periodontists have acted in financial self-interest (by placing implants not requested by the GP) when referred a patient with a very specific treatment plan, often crown lengthening/pocket reduction. It is a breach of trust and professional conduct to initiate costly, irreversible restorative treatment without consulting the restorative dentist. I can not say enough about how messed up that is! It's a bummer because one of my best friends is going into perio. But what can I say? Sometimes good people make bad choices. Okay, okay. I'm sort of joking.

Perio has an unenviable task. Their specialty took a major hit with the advent of the dental implant. It no longer became necessary to save a tooth at all costs. So much of their specialty revolves around that. It is built into their philosophy. Now they are trying desperately to preserve their future by becoming implant specialists. This propaganda is frequently promulgated by claiming superiority with soft tissue. This is a slap in the face to oral surgeons who have far more surgical experience with far more friable and delicate tissues (e.g. nasal mucosa, the orbit, nerves, vessels, skin, and undoubtedly more that I'm unaware of. Gingiva is one of the most forgiving tissues in the body. Do a few perio surgeries and you'll immediately recognize this. The stuff is incredible.

Ok, I'm done. If you want to do perio that's great. But do PERIO: pocket reduction, crown lengthening, S/RP, CT grafts, gingival grafts, pedicled whatchamajiggers, gingivectomy, bone in a bottle grafting, molar hemisection, root amputation....and sure why not let 'em do simple implants. But don't expect to do treatment under the umbrella of oral and maxillofacial surgery and not catch any flak for it, especially when complications arise.

Gosh, if we were really grafting from the "leg", Id probably try it as a GP ....Its great to have a nice competent talented OMFS to refer to. However, patients tend to want to keep all of their treatment with the Dentist they are comfortable with(usually their GP), especially the high anxiety patients. Implants can be placed by any dentist/specialist/periodont/omfs..... that is trained sufficiently to place them. You dont need to have a title beyond general dentist to do "surgery" on patients (although in this thread us general dentists don't qualify as surgeons). Thats like saying a general dentist is not qualified to treat a tooth with a root canal,..why? Because there are endodontists out there with MICROSCOPES! I personally find it strange why anyone would specialize(with the exception of OMFS, particularly treating pathology, trauma, and jaw reconstruction) when as a general dentist, when you graduate, you really begin your learning and internal specialization. GENERAL DENTISTS PLACE IMPLANTS everyday. Its not brain surgery. If you get the proper training, do the proper treatment preparation, you can place implants, treat molar endo, treat ortho cases, etc.... I can't understand why dental professionals criticize other specialties or GPs unless there is a specific incidence of miscare or unethical treatment of a patient. JMHO

 

[groundhog]

Well, I might prove to be an emperical test case for the OMS/Perio implant debate (although very limited in numbers and not exactly apples/apples).

I had one molar extraction and two implants done by a dental school perio resident a few years back. Now I'm about to get another molar extraction/implant done by a private practice OMS very soon. The extraction/implant situations are almost identical. The OMS is going to do #19 that has a root canal with the distal root broken away from the tooth. The perio resident faced almost the same scenario with the same tooth on the other side of my lower jaw..(what # is that?) except the distal root had decayed away instead of breaking away from the tooth.

Well to start off, the OMS recommends that I get IV sedation (more mulla) for the extraction whereas the perio resident felt that a vallium pill would be just fine...(which it was). The OMS also plans on stuffing some artficial bone back into the hole just to make sure that a good base is established for the implant (again more mulla). That was never mentioned as being necessary by the perio resident. Then I went on to tell the OMS that the upper implant (which the perio resident also did) required a sinus lift. It was to be done by the classic approach through the roof of my mouth, but when I showed up for the lift, the resident announced that it was my lucky day because an adjucnt faculty perio practitioner who had developed and been successful with an "up fracture" technique was on hand to supervise the resident in the procedure and that I was the annointed patient. That turned out great too. The OMS responded that he never uses that technique for sinus lifts because he feels it creates too much risk for damage and infection (more mulla requiring 2 separate surgical procedures instead 1 all inclusive).

I have great dental insurance, so I'm going to follow though with the OMS as I see this as a great opportunity to compare notes. I'm not casting any dispersions on the OMS (he has whacked the wizzies from all five of my kids and did a great job each time). I think he may be just a bit more conservative in his approach and perhaps that is due to his training and experiences.
Will report more as this story develops.

 

[NWOMS]

I agree. After speaking with numerous general dentists, they all say that periodontists place the best implants. I don't know how true this is, but it seems fairly accurate coming from the people referring out. So I wouldn't say they're sneaking around trying to place implants because, according to GPs, they are the best at doing it anyway!

To prove you wrong ask our grad pros dept who places the best implants. Despite having a perio department that places implants, grad pros refers ALL dental implants to our resident oral surgery clinic.

 

[Jaybe]

I thought Perio was basically for people who want to be able to SAY they specialized, but don't really WANT to specialize. Sort of to stroke their own ego. You know, the kind of people who want to charge higher fees, but don't really care what they are doing to justify those fees.

Any Thoughts. . .

 

[vize]

Yes! Many thoughts... for one, groundhog proved everything I've been saying about oral surgeons being arrogant (even though that may not have been what he intended). To drhobie and all the omfs, yes, I don't know much yet; but from what I do know, there are maaany periodontists making good money off of implants plus their original speciality (SRPs, sinus lifts, grafts, etc.) The whole reason I posted here to begin with is because perio is where my heart is, and every time I visit this forum or the residency forum I see OMFS bashing on perio as if it's an obsolete specialty. The fact of the matter is that oral surgeons hate that they spend 100-hour weeks as a hospital resident doing the same stuff as periodontists, while the periodontists are out on the beach with 2+ females bringing in nearly the same amount of dough (exaggeration, slightly). Sure the averages do not show it, but I do not need the averages to show what I've already been shown from numerous periodontists. Why would you even want to be an oral surgeon? You might as well apply to medical school and go through the same exact residency (at least then you'll get some respect).

OceanDMD, I agree. If I do not get into a perio residency, general dentistry is where I'm headed. Not only would it allow me to focus on whatever I'm best at, but it would allow me to increase volume for my perio specialty later in life.

Jaybe, it's funny you mention the fees aspect because, as groundhog pointed out, that seems to be exactly what oral surgeons are concerned about!

 

[PFM]

I thought Perio was basically for people who want to be able to SAY they specialized, but don't really WANT to specialize. Sort of to stroke their own ego. You know, the kind of people who want to charge higher fees, but don't really care what they are doing to justify those fees.

Any Thoughts. . .

I would suggest you re-read this thread and tell me who has the real ego problem. Honestly, this thing w/ implants is getting old. Any dentist can place them and if other specialties were to be more proactive on placing implants OMFS would also discredit them (there's ego for you). Why you ask? MONEY. I admit OMFS surgeries are pretty cool but lets face it, most of you guys are just going to be extracting thirds and placing implants in your private practices anyway. Only the most talented OMFS surgeons do the the more complicated procedures. And what do the more talented OMFS surgeons say about this subject? "who cares about implants if in this specialty you get to reconstruct broken faces".

The only reason why we're all having this discussion is because of the few demi-god OMFS residents with little experience that think they are better than other dentists. Can you say ego.

Personally, I think all of the specialties are important and the focus should be on the patient's well being rather than money.

OMFS residents: don't dumb yourself by attacking other specialties. There are enough patients to go around. Have some self respect and try to do more complicated procedure rather than bashing other specialties just because they are also doing implants.

 

[drhobie7]

The fact of the matter is that oral surgeons hate that they spend 100-hour weeks as a hospital resident doing the same stuff as periodontists, while the periodontists are out on the beach with 2+ females bringing in nearly the same amount of dough.

So silly. I hope they have you rotate through oral surgery at Michigan. You should tell the chairman they are nothing more than overworked periodontists. He'll have some choice words for you.

If I do not get into a perio residency, general dentistry is where I'm headed.

Unless your grades and board scores are dismal, you'll get in. Perio is not a competitive specialty. I'd take being a GP over perio any day. As a GP you can do everything related to implants that a periodontist can do plus all the fixed pros as well. There are GPs out there doing sinus lifts and ramus grafts. All it takes is some CE courses and balls.

You keep talking about oral surgeons being arrogant. The way I see it oral surgeons are simply defending their hard earned skills from the defamation of certain periodontists who claim blanket superiority when it comes to soft tissue and the 'esthetic region' of the mouth. I see those periodontist as the arrogant ones.

It will be interesting to see if you still want to do perio when you graduate in 2011. The implant market will have changed dramatically by that time. It is the goal of every implant company to put implants in the hands of GPs not specialists. They will continue to make implant placement and restoration easier and more successful until GPs are placing and restoring as many implants as possible. I'm not sure where perio will be left in the wake of that, but it certainly won't be providing pre-prosthetic reconstruction or bone grafting many aging patients will need before they receive dental implants.

 

[drhobie7]

If other specialties were to be more proactive on placing implants OMFS would also discredit them.

Not true. Both endo and pros have made a foray into the realm of dental implants. However, perio has a track record of infringing onto the scope of practice of oral surgery. I'm not sure if you're planning on specializing or doing general practice, but imagine if hygienists started doing amalgam and composite restorations. I doubt you'd like that very much.

most of you guys are just going to be extracting thirds and placing implants in your private practices anyway.

Most oral surgeons I know practice full scope oral and maxillofacial surgery.

Only the most talented OMFS surgeons do the the more complicated procedures.

Tell that to Dr. Peter Moy. He primarily does implants, but you'd be hard pressed to find anyone who thinks he is not talented.

And what do the more talented OMFS surgeons say about this subject? "who cares about implants if in this specialty you get to reconstruct broken faces".

I don't think surgeons who focus on trauma, orthognathics, pathology, and the hospital based surgeries would say this. Many of them appreciate the advent of the dental implant as a way to increase their interactions with their dental colleagues. Some do think it is the worst thing to happen to oral surgery, but others think it's the best thing.

The only reason why we're all having this discussion is because of the few demi-god OMFS residents with little experience that think they are better than other dentists.

I've never seen or heard an oral surgeon display the opinion that he/she is better than another dentist. Most experienced oral surgeons I know will tell you general practice is the most challenging area of dentistry. This topic was started because the OP wanted to know why perio has a stigma. There are several causes of this stigma, one of which is their infringement onto an important aspect of oral surgery: dentoalveolar surgery. It's not all about money. If periodontists wanted to do a 4 hour orthognathic surgery for $1,500 a jaw I guarantee there would be a greater uproar. I see the underlying problem as a lack of professional courtesy. If you want to do perio that's great. But like I said earlier, do PERIO. Do pocket reductions, crown lengthening, gingival and CT grafts, intrabony pocket grafting, and SRP. Don't do perio because you don't like the true periodontal procedures and really want an easy road into dentoalveolar surgery.

Personally, I think all of the specialties are important and the focus should be on the patient's well being rather than money.

What is best for the patient is providing them with treatment by the most experienced practitioner. If this treatment is dentoalveolar surgery the most experienced practitioner is an oral surgeon.

Have some self respect and try to do more complicated procedure rather than bashing other specialties just because they are also doing implants.

Like I said previously, perio brought this on themselves when they encroached on the scope of practice of traditional oral and maxillofacial surgery and claimed superiority on esthetics and soft tissue management.

 

[OceanDMD]

Hands down, the most difficult residency is OMFS. The dual DMD DDS/MD degree programs are quite the accomplishment. I have alot of respect for those guys that go through that, however, its a shame the few that DO tend to project that demeaning/egotistical attitude. I was intimidated on several occassions in dental school by residents and profs. Regardless, when it comes to emergencies, more complicated medical history issues, crazy path, the OMFS is the man to go to. For all you surgeons, or want to be surgeons out there, kiss your GPs rears! Send them bourbon on Christmas, and wine and cheese on New Years. We can keep you really busy.

As far as periodontist go, how many of you future GPs/current GPs want or are comfortable with grafting tissue and surgical SRP? If I have a patient with 6-7-8-9mm pockets, no mobility, I am sending straght to the periodontist. This is their importance. Implants are a nice production maker that is coming along in all specialties. You could make an argument that endodontists are the most qualified to place implants. How many of you OMFS use a scope during your surgical procedures?

 

[QCkid]

I also hate the fact you can't understand half of them.

This is so true at my school as well.
I was talking with one the other day who was from India and asked why they all were so desperate to come here (just to see what he would say). After talking about it for awhile, he said that when you cut out all the bull, most of them will admit its just to make lots of money. I said," You don't do well in your own country"? He replied that they do very well there too, but that the lifestyle and money here is the best. I was a little annoyed and I told him that I dont want to see people coming here "just to make money". I said, "We want people from other countries but we need people of integrity, honesty, and honor. People who will work hard and do the right thing and not just for the money". People who are here for the money are simply here to take advantage.
I was also talking to someone from Iran who basically said the same thing that the money and lifestyle are the most important thing it seems to them and that they push procedures to make money (they didn't say it exactly like this of course). I have to admit I have seen this happen several times and have also had it happen to me and family members outside of D-school and all of them involved foreign trained dentists.

 

[QCkid]

I personally find it strange why anyone would specialize(with the exception of OMFS, particularly treating pathology, trauma, and jaw reconstruction) when as a general dentist, when you graduate, you really begin your learning and internal specialization. GENERAL DENTISTS PLACE IMPLANTS everyday. Its not brain surgery. If you get the proper training, do the proper treatment preparation, you can place implants, treat molar endo, treat ortho cases, etc.... I can't understand why dental professionals criticize other specialties or GPs unless there is a specific incidence of miscare or unethical treatment of a patient. JMHO

Yes, but you don't know what you don't know. I have a friend here in D-school who's dad is a dentist that does lots of Ortho. He did all the ortho on his own kids. My buddy has straight teeth but also has almost an edge to edge bite with shortened root tips and popping and clicking in his jaw, but his dad thought he did a great job. My buddy thought that his dad did well too until after we had ortho classes and labs.

 

[QCkid]

I would suggest you re-read this thread and tell me who has the real ego problem. Honestly, this thing w/ implants is getting old. Any dentist can place them and if other specialties were to be more proactive on placing implants OMFS would also discredit them (there's ego for you). Why you ask? MONEY. I admit OMFS surgeries are pretty cool but lets face it, most of you guys are just going to be extracting thirds and placing implants in your private practices anyway. Only the most talented OMFS surgeons do the the more complicated procedures. And what do the more talented OMFS surgeons say about this subject? "who cares about implants if in this specialty you get to reconstruct broken faces".

The only reason why we're all having this discussion is because of the few demi-god OMFS residents with little experience that think they are better than other dentists. Can you say ego.

Personally, I think all of the specialties are important and the focus should be on the patient's well being rather than money.

OMFS residents: don't dumb yourself by attacking other specialties. There are enough patients to go around. Have some self respect and try to do more complicated procedure rather than bashing other specialties just because they are also doing implants.

Its difficult to make a living off of pro bono procedures which is what orthognathics and "fixing broken faces" usually are.

 

[OceanDMD]

Yes, but you don't know what you don't know. I have a friend here in D-school who's dad is a dentist that does lots of Ortho. He did all the ortho on his own kids. My buddy has straight teeth but also has almost an edge to edge bite with shortened root tips and popping and clicking in his jaw, but his dad thought he did a great job. My buddy thought that his dad did well too until after we had ortho classes and labs.

Nice example. Apparently his dad didn't do his homework. If a general dentist does that right training, he can treat ortho cases to the standard of an orthodontist. edge to edge???? please, how can anyone feel this is a good result. Shortened root tips....thats inappropriate force control(although some are just prone to this happening regardless of the treatment). Let me guess, you are interested in ortho residency after your dmd/dds degree...

 

[Jaybe]

Nice example. Apparently his dad didn't do his homework. If a general dentist does that right training, he can treat ortho cases to the standard of an orthodontist. edge to edge???? please, how can anyone feel this is a good result. Shortened root tips....thats inappropriate force control(although some are just prone to this happening regardless of the treatment). Let me guess, you are interested in ortho residency after your dmd/dds degree...

Yeah, you guys should listen to OceanDMD - he's right. all you need to practice Standard of Care Orthodontics is a Greyhound bus ticket to the nearest Holiday Inn Weekend (or Weeklong) ortho CE course. There you have it! Now you're as good as the Orthodontists coming out of the 2-3 year residency programs across the country!

What an *ss!!!

 

[HITMAN]

This is so true at my school as well.
I was talking with one the other day who was from India and asked why they all were so desperate to come here (just to see what he would say).

You are a fool if you do not understand why people from other countries want to live here. You obviously have never been to India, Iran, or any developing nation. Do not comment on matters which you fail to comprehend.

After talking about it for awhile, he said that when you cut out all the bull, most of them will admit its just to make lots of money. I said," You don't do well in your own country"? He replied that they do very well there too, but that the lifestyle and money here is the best.

Even more evidence of your ignorance regarding the quality of life in foreign countries. After the Indian doctor said that "the lifestyle and money here is the best" and that many come here to make "lots of money", you failed to ask him what constitutes a "lot of money". To you, obviously, it's enough money to drive a benz, live in a million dollar home, put your kids through college without acquiring significant debt, dine out whenever and wherever you feel like, etc. But in a poor country like India, where 700 hundred million people out of 1.1 billion lack access to adequate sanitaton facilities (http://www.csmonitor.com/2007/0215/p04s01-wosc.html), where the per capita income is $3,320 (rank:122 out of 181, http://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28PPP)_per_capita) a "lot of money" means something different entirely. It means you have food on your plate, clothes on your back, a roof over your head, access to running water and sanitation facilities, and electricity. Things most of us living in this country take for granted. In regards to lifestyle, it means living in a country with a lack of significant corruption and enjoying the freedoms that go hand in hand with living in this country. It means you won't be picked up off the street in Iran and taken to jail for a flogging because you decided to wear denim jeans today, and denim jeans are a sign that you have been influenced by western culture. It means you'll never have to worry about significant political or police corruption. You'll never experience corruption so bad that it'd make the New Orleans Police Department look like the NYPD, or leaders like Dick Cheney/Rep. William Jefferson (D) look like Gandhi. It means you'll never be imprisoned for criticizing Ahmadinejad in Iran or Hosni Mubarak in Egypt.

:I was a little annoyed and I told him that I dont want to see people coming here "just to make money". I said, "We want people from other countries but we need people of integrity, honesty, and honor. People who will work hard and do the right thing and not just for the money". People who are here for the money are simply here to take advantage.

You are a racist and a xenophobe. The second you saw that you would be treated by an Indian doctor, you assumed his purpose for being in this country was inspired by greed and a desire to exploit the American patient population. Without cause, you interrogated your doctor on his motives and assumed that he was here "just to make money". You then had the gall to lecture him on honor, integrity, and honesty.

I was also talking to someone from Iran who basically said the same thing that the money and lifestyle are the most important thing it seems to them and that they push procedures to make money (they didn't say it exactly like this of course). I have to admit I have seen this happen several times and have also had it happen to me and family members outside of D-school and all of them involved foreign trained dentists.

I find it interesting that so many evil foreigners just walk right up to you and tell you what horrible people they are. It would be interesting if you, too, confessed your true malignant nature, but that would require honor, integrity, and honesty, now wouldn't it?

 

[Envision]

You are a fool if you do not understand why people from other countries want to live here. You obviously have never been to India, Iran, or any developing nation. Do not comment on matters which you fail to comprehend.



Even more evidence of your ignorance regarding the quality of life in foreign countries. After the Indian doctor said that "the lifestyle and money here is the best" and that many come here to make "lots of money", you failed to ask him what constitutes a "lot of money". To you, obviously, it's enough money to drive a benz, live in a million dollar home, put your kids through college without acquiring significant debt, dine out whenever and wherever you feel like, etc. But in a poor country like India, where 700 hundred million people out of 1.1 billion lack access to adequate sanitaton facilities (http://www.csmonitor.com/2007/0215/p04s01-wosc.html), where the per capita income is $3,320 (rank:122 out of 181, http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_per_capita) a "lot of money" means something different entirely. It means you have food on your plate, clothes on your back, a roof over your head, access to running water and sanitation facilities, and electricity. Things most of us living in this country take for granted. In regards to lifestyle, it means living in a country with a lack of significant corruption and enjoying the freedoms that go hand in hand with living in this country. It means you won't be picked up off the street in Iran and taken to jail for a flogging because you decided to wear denim jeans today, and denim jeans are a sign that you have been influenced by western culture. It means you'll never have to worry about significant political or police corruption. You'll never experience corruption so bad that it'd make the New Orleans Police Department look like the NYPD, or leaders like Dick Cheney/Rep. William Jefferson (D) look like Gandhi. It means you'll never be imprisoned for criticizing Ahmadinejad in Iran or Hosni Mubarak in Egypt.



You are a racist and a xenophobe. The second you saw that you would be treated by an Indian doctor, you assumed his purpose for being in this country was inspired by greed and a desire to exploit the American patient population. Without cause, you interrogated your doctor on his motives and assumed that he was here "just to make money". You then had the gall to lecture him on honor, integrity, and honesty.



I find it interesting that so many evil foreigners just walk right up to you and tell you what horrible people they are. It would be interesting if you, too, confessed your true malignant nature, but that would require honor, integrity, and honesty, now wouldn't it?

Nicely written

 

[MsPurtell]

Yep, I agree. Nicely written.

Nicely written

 

[Jaybe]

io

 

[captaintripps]

The Bush/Cheney Administration and the Catastrophe in Iraq are evidence of the worst form of political corruption. Hijacking a democracy with substantial death and unforeseen consequences to follow.

 

[Jaybe]

You are a fool if you do not understand why people from other countries want to live here. You obviously have never been to India, Iran, or any developing nation. Do not comment on matters which you fail to comprehend.



Even more evidence of your ignorance regarding the quality of life in foreign countries. After the Indian doctor said that "the lifestyle and money here is the best" and that many come here to make "lots of money", you failed to ask him what constitutes a "lot of money". To you, obviously, it's enough money to drive a benz, live in a million dollar home, put your kids through college without acquiring significant debt, dine out whenever and wherever you feel like, etc. But in a poor country like India, where 700 hundred million people out of 1.1 billion lack access to adequate sanitaton facilities (http://www.csmonitor.com/2007/0215/p04s01-wosc.html), where the per capita income is $3,320 (rank:122 out of 181, http://en.wikipedia.org/wiki/List_of_countries_by_GDP_(PPP)_per_capita) a "lot of money" means something different entirely. It means you have food on your plate, clothes on your back, a roof over your head, access to running water and sanitation facilities, and electricity. Things most of us living in this country take for granted. In regards to lifestyle, it means living in a country with a lack of significant corruption and enjoying the freedoms that go hand in hand with living in this country. It means you won't be picked up off the street in Iran and taken to jail for a flogging because you decided to wear denim jeans today, and denim jeans are a sign that you have been influenced by western culture. It means you'll never have to worry about significant political or police corruption. You'll never experience corruption so bad that it'd make the New Orleans Police Department look like the NYPD, or leaders like Dick Cheney/Rep. William Jefferson (D) look like Gandhi. It means you'll never be imprisoned for criticizing Ahmadinejad in Iran or Hosni Mubarak in Egypt.



You are a racist and a xenophobe. The second you saw that you would be treated by an Indian doctor, you assumed his purpose for being in this country was inspired by greed and a desire to exploit the American patient population. Without cause, you interrogated your doctor on his motives and assumed that he was here "just to make money". You then had the gall to lecture him on honor, integrity, and honesty.



I find it interesting that so many evil foreigners just walk right up to you and tell you what horrible people they are. It would be interesting if you, too, confessed your true malignant nature, but that would require honor, integrity, and honesty, now wouldn't it?

First, I actually don't think this was "well said" at all. Second, I actually like all kinds of foreigners, especially Indians.

As someone who goes to India about every year, I can say that the 700 million poor and destitute in that country are NOT the ones immigrating to America (or anywhere else) for better opportunities. They, sadly, are not afforded the opportunity to increase their lot in life. The ones that ARE immigrating are usually already highly educated. Many are Doctors, Researchers, Computer Engineers, and Businessmen. They are members of the Middle and Upper Classes in India. They make a decent living in India. Some are even absolutely rich BEFORE they immigrate.

Sure, they can MAKE more money here, but they also have to SPEND much more here. Therefore, your statistics regarding per capita income are misleading.

Examples: It is VERY EASY to get a full time servant in India who will live with you and cook and clean every day for about 20 dollars a MONTH! For about the same amount of money, you can hire a full time driver who will drive you around town whenever you need it. You can hire a private taxi to drive you around for the ENTIRE DAY for about 20 dollars. You can get a plane ticket across the country for 100 dollars very easily. Even a foriegner paying "skin tax" can easily rent a very spacious and nice apartment for $300 a month. My point is that the lifestyle these professionals are leaving behind is not too shabby.

I cannot speak to the situation in Iran, or many other countries with political oppression, but I do know that Indians rarely immigrate to seek political asylum.

I really don't think you can call this person a racist and a xenophobe based on this post. He is only making the same observations that any American who has spent much time with educated Indians IN INDIA would make. When I go there and see all the problems that persist there, I can't help but be a bit irritated by the fact that so many of their educated population are fleeing as fast as they can. They are leaving behind the uneducated and corrupt to perpetuate the problems.

 

[north2southOMFS]

You are a fool if you do not understand why people from other countries want to live here. You obviously have never been to India, Iran, or any developing nation. Do not comment on matters which you fail to comprehend.



Even more evidence of your ignorance regarding the quality of life in foreign countries. After the Indian doctor said that "the lifestyle and money here is the best" and that many come here to make "lots of money", you failed to ask him what constitutes a "lot of money". To you, obviously, it's enough money to drive a benz, live in a million dollar home, put your kids through college without acquiring significant debt, dine out whenever and wherever you feel like, etc. But in a poor country like India, where 700 hundred million people out of 1.1 billion lack access to adequate sanitaton facilities (http://www.csmonitor.com/2007/0215/p04s01-wosc.html), where the per capita income is $3,320 (rank:122 out of 181, http://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28PPP)_per_capita) a "lot of money" means something different entirely. It means you have food on your plate, clothes on your back, a roof over your head, access to running water and sanitation facilities, and electricity. Things most of us living in this country take for granted. In regards to lifestyle, it means living in a country with a lack of significant corruption and enjoying the freedoms that go hand in hand with living in this country. It means you won't be picked up off the street in Iran and taken to jail for a flogging because you decided to wear denim jeans today, and denim jeans are a sign that you have been influenced by western culture. It means you'll never have to worry about significant political or police corruption. You'll never experience corruption so bad that it'd make the New Orleans Police Department look like the NYPD, or leaders like Dick Cheney/Rep. William Jefferson (D) look like Gandhi. It means you'll never be imprisoned for criticizing Ahmadinejad in Iran or Hosni Mubarak in Egypt.



You are a racist and a xenophobe. The second you saw that you would be treated by an Indian doctor, you assumed his purpose for being in this country was inspired by greed and a desire to exploit the American patient population. Without cause, you interrogated your doctor on his motives and assumed that he was here "just to make money". You then had the gall to lecture him on honor, integrity, and honesty.



I find it interesting that so many evil foreigners just walk right up to you and tell you what horrible people they are. It would be interesting if you, too, confessed your true malignant nature, but that would require honor, integrity, and honesty, now wouldn't it?

Whoh.... Easy their chief.

I work all day in a hospital full of medical residents and know many of them pretty well, and if you've ever seen a medical service it sorta looks like a multicultural event if you can imagine it. And i will tell you that NONE of these residents who came from india or iran or wherever you spoke of were the ones living without running water or sanitation facilities. ALL of them came from affluent families in these countries you speak of, where most got good education and got into expensive medical schools on their families money. Hell, most of them tell me back in their country they had servants. Don't play the high horse here pal, it won't fly.

And guess what else. We all got into this dentistry gig for the money, the job, and lifestyle. Do you think anyone here would take out hundreds of thousands of dollars in loans, spends countless hours in school and the hospital just to get paid what the guy diggin' ditches gets paid? Hell no. You put in the time, you get a better life. That is why America is great. (now if we could just stop the socialist democrats from trying to reverse this.....)




Damn. I just read the post above me and basically he beat me to this point. Oh well, i'm leaving it anyway.

 

[Mustt Mustt]

I am an Indian born student going to dental school right now in US. I agree with most of the stuff said by "Jay Be" regarding that most of the people that come to US and go to school in US come from very well educated families and are in Upper middle class. This was very very true untill last 5years. In the last 5 years many many indians from lower middle class have gotten college education and came to america and helped their family live a good life in india with basic necessities. However, I think that most of this people from lower middle class I am talking about are in the engineering world, but people in healthcare field are increasing as well.

Here is why people want to come to US. India is a great conutry and affords great freedom to their citizens. Government is corrupt and if you are not wealthy enough sometimes mistreatments are seen by people with money. For example, sometimes Medical and dental school seats can be BOUGHT in some Private schools in india if you have enough money. You can have the best grades and smart but they want donations and can't get admissions and some times miss by one point and you basically don't have good career left ahead of you.
My cousin who was smart and did well in every subject in HS except chemistry but could not get admission in to college for anyting. He worked in a restaurants in India for $20 a month for two years and decided that he would try his luck in america and hope for better future. University of Washingtons wanted him and assisted him in his education of being an Electrical engineer. He right now works for Boeing and makes very very good living and has changed not only his life but also lives of about 20 people back home by helping them through school etc. Now this is not a talent leaving India becasue he would have never been more than a Taxi driver/restaurant worker for $ 20 a month in India but he was offered and opportunity in US to better his life so he left India. No matter how many people are leaving India I will tell you that India is very very rich in talented people. Biggest problem facing India today are not lack of talent or people leaving for other countris but Population, Poverty and Unemployment are the biggest isssues. I know so many people that had no Job in India in mid 90's and were thought to be useless by indian companies and were never offered a good job. Migrated to western world where their talent was utilized and made a great living and prospered.

I was born in a lower middle class family in India and my parents never went to school and can't write their own names. I graduated from HS in India and probably would have worked in a farm rest of my life for $40 a month. I was offered a chance by US government to better my life and they gave me one more chance to make somting out of my life. I am very fortunate to be in US and I am glad that US has afforded me opprtunity to become a detnist and live a good life. It took six years of really hard work for my family and me to be where my family is today. My dad works as a Dishwasher for 16 hours a day and my mom cleans hotel rooms at Holiday Inn 10 hours a day for less than $7 an hour, but this is good enough to get by unitll me and my sister could finish school and say good by to poverty for sometime. When I was in undergrad at Michgan I was on full scholarship but I worked almost 35 hours a aweek while going to school full time to help myself and help my family. I missed out on a lot of fun in undergrad but I am happy to sacrifice for a better future and I have nothing to complain about. It takes very very hard work ones you come to America to come out of the poverty. But, the real kicker is that it is possible in america to go from trailerpark to millionaire in one generation with dignity, honesty and principles. In US you are rewarded for your hard work and that is why people want to come here, and that is why I wanted to come to US and live here. I am not in dentistry just for money. I like to make a good living and my goal is to help some people back home who live on less than $1 a day so they have an opportunity to make something out of themselves. I am not here to rip people off to make millions and that is true for most immigrants that come to this country. All they want is a better life. I agree there are exceptions but so there are americans who want to rip other americans off too so that is just human nature. From here and there I hear some racist comments from some immature people out there but I try to ignore it and work on my goals in life.

Mr. "JayBe" so my point is that India is not missing me or about 50 other people I know becasue we would have never had a chance to make a good career in India and have ended up working for some wealthy man and driving his car and cooking his food for less than $30 a month. Our real talent would have never been utilized in india but in US we were offered a chance to make something and change not only our life but also the lives of our family members.

To sum up my book about why people come to America from India. Becasue it is the land of opportunity and that's a fact. I am very very fortunate and owe a lot to the america for the opportunity it has given me and it will take years of good deed from me to pay off this debt of gratitude. What makes US great is that we all (well almost all) have migrated to this country at one point or another and love and cherish it as our country and try to make it better.

 

[shabu2]

How did this turn from a Perio to India thread.

BTW. Dr Hobie rocks.

 

[HITMAN]

T/F:
ALL of them came from affluent families in these countries you speak of, where most got good education and got into expensive medical schools on their families money. Hell, most of them tell me back in their country they had servants.

I'm going to go with false on this one. By the way, it's generally a good idea to avoid using anecdotal evidence to support your arguments. Nobody cares if your uncle's grandfather's sister's friend's daughter knows 9 internationally trained dentists and thinks 8 of them are rich. Unbiased data carries much more weight.

And guess what else. We all got into this dentistry gig for the money, the job, and lifestyle. Do you think anyone here would take out hundreds of thousands of dollars in loans, spends countless hours in school and the hospital just to get paid what the guy diggin' ditches gets paid? Hell no. You put in the time, you get a better life. That is why America is great. (now if we could just stop the socialist democrats from trying to reverse this.....)

Nice to see that you agree with me here. There is nothing wrong with wanting to improve your quality of life and that of your family. There is something wrong with a person who wants to portray Indian and Iranian dentists who are trying to improve their lives as greedy and exploitative people who lack honor, integrity, and honesty and are here to "push procedures" "just to make money".

If you reread QCkid's post (below) you'll see that this is exactly what he does. He is a racist and a xenophobe, and if you are trying to defend his post then you, too, are part of the problem. Sorry "pal", but around here, that just won't "fly".

This is so true at my school as well.
I was talking with one the other day who was from India and asked why they all were so desperate to come here (just to see what he would say). After talking about it for awhile, he said that when you cut out all the bull, most of them will admit its just to make lots of money. I said," You don't do well in your own country"? He replied that they do very well there too, but that the lifestyle and money here is the best. I was a little annoyed and I told him that I dont want to see people coming here "just to make money". I said, "We want people from other countries but we need people of integrity, honesty, and honor. People who will work hard and do the right thing and not just for the money". People who are here for the money are simply here to take advantage.
I was also talking to someone from Iran who basically said the same thing that the money and lifestyle are the most important thing it seems to them and that they push procedures to make money (they didn't say it exactly like this of course). I have to admit I have seen this happen several times and have also had it happen to me and family members outside of D-school and all of them involved foreign trained dentists.

 

[ItsGavinC]

Great, a thread about India. <sigh>.