was Perio and Endo ever competitive?

[stevesteve121]

from what i have gathered by reading various posts on here since a couple of years ago, the 2 most competitive specialties currently are OMFS and Ortho, with Pedo being increasingly so.

at the same time i know there are other dental specialties: prosth, endo, perio.. [are the main ones]. But these 3 specialties are less competitive due [mainly] to the lack of compensation (correct me if im wrong here). I also have seen old (2004/2006) salary report figures which showed that endodontist were making significantly more than ortho.

I understand that this may be a result of many changes that have occurs in dentistry, technological and otherwise.

So my main question are:

was Prosth, Endo, Perio ever competitive residencies to get into?

did those specialist's salary decrease over the years?

if so, what are the major reasons for such instability of dental specialities and what does this indicate for the future of OMFS, Ortho and Pedo?

tia

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[Regmata]

Endo is still quite competitive...just not as popular

 

[senpai]

from what i have gathered by reading various posts on here since a couple of years ago, the 2 most competitive specialties currently are OMFS and Ortho, with Pedo being increasingly so.

at the same time i know there are other dental specialties: prosth, endo, perio.. [are the main ones]. But these 3 specialties are less competitive due [mainly] to the lack of compensation (correct me if im wrong here). I also have seen old (2004/2006) salary report figures which showed that endodontist were making significantly more than ortho.

I understand that this may be a result of many changes that have occurs in dentistry, technological and otherwise.

So my main question are:

was Prosth, Endo, Perio ever competitive residencies to get into?

did those specialist's salary decrease over the years?

if so, what are the major reasons for such instability of dental specialities and what does this indicate for the future of OMFS, Ortho and Pedo?

tia

Endo is still competitive straight out of school with a little more flexibility after having practiced or completed a GPR/AEGD, etc. It seems as though it has recently lost some interest due to prospects of it being a dieing field. Can be quite lucrative however and length of programs are only 2-3 years with paid stipends in many cases.
Pros hasn't had much popularity, IMO, due to: 1.) It is not a lucrative specialty comparatively (ADA reports say only making $5,000 more a year than the average GP), 2.) Long, intense, expensive residencies in many cases (3 years, crazy amounts of lab work, and often outrageous tuition although some are stipened), 3.) Patient pool (majority are elderly).
Lack of interest in Perio, IMO, revolves around: 1.) The specialty cannot survive without implants (which is risky as everyone is placing implants these days), 2.) 3-year, expensive residencies, 3.) many people are turned off by the treatment philosophies of perio, how they themselves regard their own specialty, and their research practices. Some perio's can do very well financialy, however, averages are significantly less than the other specialties (excluding pros) based on the ADA reports.

 

[yappy]

Is endo really going out? I have always thought it seemed like such a cool area of dentistry. Do you think it is worth going into in the future?

 

[jpark9]

Endo is still competitive straight out of school with a little more flexibility after having practiced or completed a GPR/AEGD, etc. It seems as though it has recently lost some interest due to prospects of it being a dieing field.

I think Endo is not a dieing field and it has always been competitive. Although implants are being more popular these days, many patients do not want to go through 3-6 months of healing period to have the restoration. Also many patients want to keep their own teeth rather than having a titanium rod in their mouth. Lastly, you will feel the texture and chewiness of the food better with natural PDLs. 🙂

 

[armorshell]

Endo is still competitive straight out of school with a little more flexibility after having practiced or completed a GPR/AEGD, etc. It seems as though it has recently lost some interest due to prospects of it being a dieing field. Can be quite lucrative however and length of programs are only 2-3 years with paid stipends in many cases.
Pros hasn't had much popularity, IMO, due to: 1.) It is not a lucrative specialty comparatively (ADA reports say only making $5,000 more a year than the average GP), 2.) Long, intense, expensive residencies in many cases (3 years, crazy amounts of lab work, and often outrageous tuition although some are stipened), 3.) Patient pool (majority are elderly).

I don't know what makes you think the majority of prosth patients are elderly, but that couldn't be further from the truth. Now, if you wanted to say all their patients are crazy, you might be on to something. There's no shortage of people trying to get into prosth residencies though, mind you.

 

[Phidippides]

I don't know what makes you think the majority of prosth patients are elderly, but that couldn't be further from the truth. Now, if you wanted to say all their patients are crazy, you might be on to something. There's no shortage of people trying to get into prosth residencies though, mind you.

From the Pros private practices that I have seen (not too many), they have almost the same patient pool as the GPs. They had their own RDHs that did the recalls on their own patients and then they also received referrals for the "crazy patients" from other GPs.

I don't think anyone can just walk into a pros residency. It is not as hard to get into as ortho but still you gotta be on top of your game. And from what I hear pros residency can be demanding with your time with long hours of doing all of your own lab work and from treating all the patients that for some reason (i.e. craziness) are not being seen by the private practice doctors.

Endo is also competitive for multiple reasons. It is very lucrative and provides a good lifestyle. There is not a lot of demand during residency as far as time commitment goes. It has always been competitive. As far as a dying specialty... I doubt it. I think I would rather have my own teeth even if they are non-vital.

 

[wigglytooth]

Any specialty that supports maintenance of teeth (endo, perio) will never die due to implants. Don't forget that perio does a lot of grafting/regenerative procedures and so far seems to be taking the responsibility for managing failing implants. I've also heard of endo doing work with pulp stem cells to help regenerate pulp tissue. There is always going to be a portion of the population that would and could do anything to maintain their natural teeth.
Specialties will always take the crazies, the complex patients, or the procedures that GPs are just not interested in doing or failed to do properly. I think it's foolish to ever say a specialty is "dying." Maybe slow, but not dying.

 

[southomfs]

I hardly think that perio is taking responsibility for managing failing implants.

 

[wigglytooth]

I hardly think that perio is taking responsibility for managing failing implants.

Who then? I don't think OMFS would take the time to address peri-implant mucositis or peri-implantitis.. ok they are stupid names but would a patient want to "extract" their failing implant and place another or would they want to try to maintain their investment?

 

[GTFOOMICT]

Who then? I don't think OMFS would take the time to address peri-implant mucositis or peri-implantitis.. ok they are stupid names but would a patient want to "extract" their failing implant and place another or would they want to try to maintain their investment?

I think your definition of implant failure is off. Perio can handle the hygiene problems if they want though. If my implant patient had peri-implant inflammation at recall, they'd get treated and counseled in my office. But when it does fail, are you going to refer to the site preparation as jaw bone reconstruction surgery?

 

[ObviousGuy]

I hardly think that perio is taking responsibility for managing failing implants.

At my school they didn't take responsibility for causing failed implants either.

 

[charlestweed]

I hardly think that perio is taking responsibility for managing failing implants.

At my school they didn't take responsibility for causing failed implants either.

I guess neither of you work in the real world. Since dental implants don’t have 100% success rate, it is not uncommon for a specialist (perio or OS) to deal with implant failures. If a specialist doesn’t know how to manage implant failures, then he/she can forget about getting the referrals from the GPs…he/she should forget about setting up a private practice…he/she should just go back to practice general dentistry.

If you have not seen implant failures during your residency training, then you have not placed enough implants.

 

[armorshell]

I guess neither of you work in the real world. Since dental implants don’t have 100% success rate, it is not uncommon for a specialist (perio or OS) to deal with implant failures. If a specialist doesn’t know how to manage implant failures, then he/she can forget about getting the referrals from the GPs…he/she should forget about setting up a private practice…he/she should just go back to practice general dentistry.

If you have not seen implant failures during your residency training, then you have not placed enough implants.

I don't think you understood what was being said there.

 

[charlestweed]

I don't think you understood what was being said there.

My bad. When Wigglytooth said peri-implantitis, I thought he meant the failure of an implant to integrate. My apology to both Southomfs and Obviousguy. The term “peri-implantitis” sounds silly because bone loss around the implants is not caused by bacterial activities. Implants don’t experience the same kind of bone loss that the natural teeth do. There is no PDL around the implant and the smooth implant surface prevents adherence and formation the destructive bacterial matrix. This is why people who lost their teeth due to perio can get dental implants and their implants usually last longer and require less maintenance than their own natural teeth.

Periodontists can do soft connective tissue graft to cover the exposed implants and this is mainly for cosmetic reason. I don’t think anybody can “regenerate” the bone that was loss around the implants.

 

[papichulo]

Financially speaking?

 

[senpai]

Financially speaking?

Right now, this very second it is although some practices have seen a slight decline. Who knows what the future will hold...
If you're thinking about endo you had better love it. You couldn't pay me enough to get me to do endo all day. Money isn't always the best motivator IMO.

 

[DrReo]

Financially speaking?

Of course!

 

[amalgamator42]

I think you all have skipped an important point. With all the new technology in endo, most GPs are keeping it in-house.

 

[DrReo]

I think you all have skipped an important point. With all the new technology in endo, most GPs are keeping it in-house.

With all the new technology in oral surgery, most GPs will be removing most thirds and placing their implants.

 

[senpai]

With all the new technology in oral surgery, most GPs will be removing most thirds and placing their implants.

That's ok, OMFS still has such a broad scope that they could still make a fine living - TMJ disorders, benign & malignant pathology, orthognathic surgery, cosmetics, craniofacial, reconstructive, trauma, etc., etc., etc. even cross over and do a plastics or ENT residency as many have.

Perio, on the other hand, without implants --> DEAD

 

[DrReo]

That's ok, OMFS still has such a broad scope that they could still make a fine living - TMJ disorders, benign & malignant pathology, orthognathic surgery, cosmetics, craniofacial, reconstructive, trauma, etc., etc., etc. even cross over and do a plastics or ENT residency as many have.

Perio, on the other hand, without implants --> DEAD

Because you're quoting the most lucrative and sought after procedures that every oral surgeon, I mean oral and maxillofacial surgeon, chooses to do.

 

[charlestweed]

Perio, on the other hand, without implants --> DEAD

Very true….but…..The good thing is there are very few dental schools that teach the dental students how to place implants. Most implant cases at schools are reserved for perio and OS residents. There are not a lot of GPR programs that teach implants either. CE classes don’t adequately train the GP to diagnose, treatment plan, and place implants.

What prevents the majority of the GPs from placing implants in their offices is the fear of getting sued by the patients. Owing $300-400k in student loans is stressful enough.

 

[senpai]

Because you're quoting the most lucrative and sought after procedures that every oral surgeon, I mean oral and maxillofacial surgeon, chooses to do.

I'm talking about making a living. There are plenty of Surgeons who do just fine building there practice around any one of those areas. Try putting food on the table as a super hygenist doing Scrp's and crown lengthenings.

 

[DrReo]

I'm talking about making a living. There are plenty of Surgeons who do just fine building there practice around any one of those areas. Try putting food on the table as a super hygenist doing Scrp's and crown lengthenings.

Making a living from their other aspect of practice? Hygienist do just fine.

I notice you have no respect for Perio, yet displaying your superior spelling abilities, so there's no point in arguing.

 

[drgoro]

Because you're quoting the most lucrative and sought after procedures that every oral surgeon, I mean oral and maxillofacial surgeon, chooses to do.

You know, this quote and a couple of other posts you have made make it seem like you have a serious inferiority complex, let's be real. YOU WILL NEVER BE AN ORAL SURGEON OR MAKE ENOUGH SNIDE REMARKS TO FEEL BETTER ABOUT SUBPAR BOARDS SCORES WHICH ULTIMATELY HAVE EXCLUDED YOU FROM EVEN GETTING BEYOND THE FIRST STACK OF APPLICANTS (intentionally all caps, not to convey anger, but clarity of a point you may have not yet realized). Deal with it. OS> perio, since beginning of time, now and forever more. Rationalize all you want, I went from 3 sets of wizzies in the AM, a chin harvest at noon, ORIF mandible for afternoon to just now closing up a ludwigs pt, perio..please, I got more interesting stuff out of my infection guy than any of your posts

 

[aplcodoc]

With all the new technology in oral surgery, most GPs will be removing most thirds and placing their implants.

With all the marketing to GP's, quite a large percentage of Ortho is also in the hands of General Dentists. Don't get me wrong. There are those GP's who study the biology and mechanics of Ortho, and do a great job with case selection etc.... but there are also those who do it all with mediocre results

 

[caffeinehigh]

You know, this quote and a couple of other posts you have made make it seem like you have a serious inferiority complex, let's be real. YOU WILL NEVER BE AN ORAL SURGEON OR MAKE ENOUGH SNIDE REMARKS TO FEEL BETTER ABOUT SUBPAR BOARDS SCORES WHICH ULTIMATELY HAVE EXCLUDED YOU FROM EVEN GETTING BEYOND THE FIRST STACK OF APPLICANTS (intentionally all caps, not to convey anger, but clarity of a point you may have not yet realized). Deal with it. OS> perio, since beginning of time, now and forever more. Rationalize all you want, I went from 3 sets of wizzies in the AM, a chin harvest at noon, ORIF mandible for afternoon to just now closing up a ludwigs pt, perio..please, I got more interesting stuff out of my infection guy than any of your posts

I can't even listen to this garbage. Go take your "I'm a physician of the mouth" rant elsewhere. In the end, you're still a dentist, not a doctor. 😉

 

[armorshell]

I can't even listen to this garbage. Go take your "I'm a physician of the mouth" rant elsewhere. In the end, you're still a dentist, not a doctor. 😉

Nothing in that post even comes close to claiming what you're talking about.

 

[ObviousGuy]

I can't even listen to this garbage. Go take your "I'm a physician of the mouth" rant elsewhere. In the end, you're still a dentist, not a doctor. 😉

Last I checked dentists are awarded a doctorate degree. Yes we are all dentists, we should be proud of our roots. Fortunately for society OMFS has a good grasp on the middle road between dentistry and facial surgery. I can't imagine what would happen to the patient population at my hospital if I wasn't around. When was the last time a plastic surgeon treated CGCG with great success? Not as often as the 'physician of the mouth', I can assure you that. 30 people a week would die at the county hospital if we weren't around to drain the infections appropriately. Guess what happens when ENT and plastics (the 'real' doctors according to you) have a complication related to facial trauma? Guess who's door they come knocking on? OMFS.

In the end, if you got rid of both specialties and let the GP's try to handle both patient populations that each specialty treats...well, the OMFS patients would suffer a great deal more, more people would die, more pathology would go undetected and extractions would take a whole helluva lot longer.

I guess if you weigh each specialty by the amount of lives they save, OMFS is more important.

When you are doing pocket regeneration or whatever the hell gay name you guys give biological width regeneration on an 8mm pocket, and I am in the OR removing a 5 cm section of the entire mandible, then cutting down on a fibula or hip to then reconstruct said mandible, you can think that I am not a doctor. When I was on trauma and 'ran the bowels' 5 times a night on GSW's by myself, then you can continue to think I am not a doctor (yes the attending would poke their head in and ask 'how is the tooth fairy?', we would get a laugh, and then they would leave while I continued to repair enterotomies and search for bullets, fine, I am a dentist. A dentist who is damn good at soft tissue manipulation, extractions with awesome anesthesia, implants x 5 in max and mand that I can place temporary prosth on same day in two hours, facial trauma guru, double jaw in 2.5 hours by myself, the list goes on.

Yeah, I wonder why we think perio can be douches when they talk.

 

[senpai]

A dentist who is damn good at soft tissue manipulation, extractions with awesome anesthesia, implants x 5 in max and mand that I can place temporary prosth on same day in two hours, facial trauma guru, double jaw in 2.5 hours by myself, the list goes on.

Yeah, I wonder why we think perio can be douches when they talk.

How dare you claim to be good with soft tissue. There is no way that proper soft tissue manipulation when reparing facial lacerations, cleft lips/palates, blepharoplasties, etc., etc. is more critical than when perform intra-oral perio procedures.

 

[sarah_bellum]

Yeah, I wonder why we think perio can be douches when they talk.

 

[fonze]

With all the new technology in oral surgery, most GPs will be removing most thirds and placing their implants.

Seriously!?! What “new technology” in oral surgery allows a GP to take out thirds to a point that it will actually impact OMFS? You have to be kidding. Technology will impact the bottom line of endo and perio way before OMFS.

 

[dragonteeth]

Well if they ever make post-grad residencies mandatory for GPs as they have discussed off and on for several years, I think we would see a bit more of a dent placed in all of the in-office specialities' patient flow. However, most GPs look at the chairtime vs production equation first. Most GPs can prep two crowns in the time it takes them to do one molar endo well (key word...well). Plus a lot of GPs who poured money into high tech equipment got burned when the recession hit and demand dropped. I figure a lot of folks might position themselves a little more conservatively in that regard for the next decade or so.

Being neither a periodontist or an oral surgeon, I have no dog in that fight. But I will say this.... Having been around the block a while in private practice, in uniform, and now as a 2yr GPR resident, I've interacted with a fair number of specialists of all types. If you're as much of an arrogant *****hole to me or to my patient as some of you have been to each other on this thread, then I'd be damned if I'd send a single referral your way. Our patients' problems do not exist simply to be ammunition for our own personal pissing matches, and it takes away every shred of dignity our profession might claim when we attempt to reduce them to such.

We should not strive just to be doctors. Any idiot can be one if he works hard enough (and yeah I've known enough oral surgeons to know a few idiots who've made it through there too). Rather we should strive to be healers. Yes, you put the motorcycle trauma kid's face back together, but did you have a kind word of reassurance and empathy for his family? You might have taken out the little 4 year old's tooth, but did you have her giggling the whole time and no longer afraid of the dentist when she leaves? You might have reconstructed a middle aged woman's shattered teeth, but did you take the time to say how proud you were of her to finally walk away from the husband who had beaten her for years?

If you can say yes to those questions, then you have my respect. If you cannot, then in my eyes you're nothing more than an overeducated monkey pounding sand into a hole.

 

[Salmon1]

Well if they ever make post-grad residencies mandatory for GPs as they have discussed off and on for several years, I think we would see a bit more of a dent placed in all of the in-office specialities' patient flow. However, most GPs look at the chairtime vs production equation first. Most GPs can prep two crowns in the time it takes them to do one molar endo well (key word...well). Plus a lot of GPs who poured money into high tech equipment got burned when the recession hit and demand dropped. I figure a lot of folks might position themselves a little more conservatively in that regard for the next decade or so.

Being neither a periodontist or an oral surgeon, I have no dog in that fight. But I will say this.... Having been around the block a while in private practice, in uniform, and now as a 2yr GPR resident, I've interacted with a fair number of specialists of all types. If you're as much of an arrogant *****hole to me or to my patient as some of you have been to each other on this thread, then I'd be damned if I'd send a single referral your way. Our patients' problems do not exist simply to be ammunition for our own personal pissing matches, and it takes away every shred of dignity our profession might claim when we attempt to reduce them to such.

We should not strive just to be doctors. Any idiot can be one if he works hard enough (and yeah I've known enough oral surgeons to know a few idiots who've made it through there too). Rather we should strive to be healers. Yes, you put the motorcycle trauma kid's face back together, but did you have a kind word of reassurance and empathy for his family? You might have taken out the little 4 year old's tooth, but did you have her giggling the whole time and no longer afraid of the dentist when she leaves? You might have reconstructed a middle aged woman's shattered teeth, but did you take the time to say how proud you were of her to finally walk away from the husband who had beaten her for years?

If you can say yes to those questions, then you have my respect. If you cannot, then in my eyes you're nothing more than an overeducated monkey pounding sand into a hole.

I couldn't agree more.

 

[KristopherTruth]

Well if they ever make post-grad residencies mandatory for GPs as they have discussed off and on for several years, I think we would see a bit more of a dent placed in all of the in-office specialities' patient flow. However, most GPs look at the chairtime vs production equation first. Most GPs can prep two crowns in the time it takes them to do one molar endo well (key word...well). Plus a lot of GPs who poured money into high tech equipment got burned when the recession hit and demand dropped. I figure a lot of folks might position themselves a little more conservatively in that regard for the next decade or so.

Being neither a periodontist or an oral surgeon, I have no dog in that fight. But I will say this.... Having been around the block a while in private practice, in uniform, and now as a 2yr GPR resident, I've interacted with a fair number of specialists of all types. If you're as much of an arrogant *****hole to me or to my patient as some of you have been to each other on this thread, then I'd be damned if I'd send a single referral your way. Our patients' problems do not exist simply to be ammunition for our own personal pissing matches, and it takes away every shred of dignity our profession might claim when we attempt to reduce them to such.

We should not strive just to be doctors. Any idiot can be one if he works hard enough (and yeah I've known enough oral surgeons to know a few idiots who've made it through there too). Rather we should strive to be healers. Yes, you put the motorcycle trauma kid's face back together, but did you have a kind word of reassurance and empathy for his family? You might have taken out the little 4 year old's tooth, but did you have her giggling the whole time and no longer afraid of the dentist when she leaves? You might have reconstructed a middle aged woman's shattered teeth, but did you take the time to say how proud you were of her to finally walk away from the husband who had beaten her for years?

If you can say yes to those questions, then you have my respect. If you cannot, then in my eyes you're nothing more than an overeducated monkey pounding sand into a hole.

Well said. Every thread on SDN ends in a pissing match or two guys trying to challenge each-other intellectual wits. This site is lame. I'm off that..