Periophobia

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brengy

brengy

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brengy said:
Just wondering why most of last year dental students scared of perio programs can someone help me to understand it and don't tell me it is research or dying specialty or all this type thing because it is not at all…why you guys have periophobia?????
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I have seen this as well. As a periodontist, it saddens me, but does not surpirse me.

For a few reasons:

1. On average, perio doesn't make nearly as much money as the other specialties.

2. Perio is supposed to be the "research" specialty and most dental students would rather gouge their eyes out than do research.

3. Most perio faculty at dental schools torture dental students and give students the (false) impression that perio is filled with miserable people who take themselves too serious, are often unprofessional, overly picky and arrogant.

4. While perio is not a "dying specialty", periodontists are not doing much perio surgery anymore. It seems like the specialty is moving more toward extractions and implants, which general dentists are capable of doing. The niche for perio has been and always will be with regard to the management of periodontal disease, surgically or otherwise. Once we turn our backs on this (as we are doing now), we don't really have a niche to speak of.

5. Perio is not a popular specialty with domestic grads. As such, a lot of residency spots are filled with FTDs, who often have a tough time connecting with students here. As such, there are few role models for students among the periodontal resident population and this adversely affects the quality of students and number of students applying to perio.

6. The best students go into ortho, OMFS or endo (or GP). These students are often role models for others and will encourage younger students to follow in their footsteps.

Just my 2 cents. I could be wrong.
 
I agree with the number 3, but I believe it is not a false impression , that is how it looks like to me. Except one or two faculty at my school, the rest of profesors were more arrogant than many oral surgeons !!

FTD do fill the spots but I would caution anyone to say that they have a tough time connecting with students. By the way there are FTD s who pay the price of obtaining the american dental degree and then pursue perio residency, I guess it does not matter, they will stay as an FTD regardless !
 
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You are clueless if you think Perio is going away. Perio is stronger now more than ever because of implants. As a private practice GP, I like working with periodontists more than oral surgeons for any soft tissue grafting and implant procedures. We referred to a periodontist for implants in practice because he just got it done and managed soft tissues finer than most oral surgeons could ever do.

I really like my oral surgeon and referred many many cases to their office, including implants. Most of these implants were the more complicated cases including extensive bone grafting, alveolectomies, and hybrids etc.

I do not wish to make it seem like I am bashing oral surgery for implantology but the periodontist was better trained for soft tissue sculpting, aesthetic implant placement, and attention towards comprehensive care dentistry.

Sorry guys, it's what I've seen, not to say what is everywhere as other parts of the country it may be the opposite.
 
As an oral surgeon, my feeling was always this: Why do perio when you could do oral surgery? The scope of surgical procedures with OMS is so much greater. Perio surgery is dying because GP's are sitting on the perio disease until a late stage and then just extracting the teeth. With OMS you can do orthognathic, facial trauma, major bone grafting for reconstruction, resect tumors and remove cysts, wisdom teeth, implants and implant related grafting procedures, perform general anesthesia in your office, ect.... This notion that perio handles the tissue better is baloney. Oral surgeons have much greater appreciation of soft tissue management - I don't see any periodontist's putting together a mangled face or re-anastamosing a lacerated parotid duct with the precision that OMS's can. Pretty sure you need to be proficient in soft tissue management when doing a cosmetic closure on a through and through lip laceration on a 18 year old girl. This whole idea of perio being superior in soft tissue management needs to stop being perpetuated.
 
mike3kgt said:
You are clueless if you think Perio is going away. Perio is stronger now more than ever because of implants. As a private practice GP, I like working with periodontists more than oral surgeons for any soft tissue grafting and implant procedures. We referred to a periodontist for implants in practice because he just got it done and managed soft tissues finer than most oral surgeons could ever do.

I really like my oral surgeon and referred many many cases to their office, including implants. Most of these implants were the more complicated cases including extensive bone grafting, alveolectomies, and hybrids etc.

I do not wish to make it seem like I am bashing oral surgery for implantology but the periodontist was better trained for soft tissue sculpting, aesthetic implant placement, and attention towards comprehensive care dentistry.

Sorry guys, it's what I've seen, not to say what is everywhere as other parts of the country it may be the opposite.
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Another GP here with a slightly different experience.

I, like many others, was taught in dental school that periodontists were "more careful" with the soft tissue. However, after practicing as a GP for 7 years, I will say the following: there are good periodontists and bad periodontists and there are good and bad oral surgeons. Our group refers implants to both oral surgeons and periodontists and the results, including esthetic zone implants, are absolutely comparable.

What I have noticed is this - the periodontist has a relatively limited set of tools relative to the oral surgeon. I have seen this in my own patients - the periodontists will push bone grafts even if its debatable whether they are actually necessary. For large gaps, they prefer to use synthetic substitutes rather than autogenous bone, though I have not seen any peer-reviewed evidence that suggests that "bone in a bottle" is better.

Finally, with regard to complications, I feel much more confident sending a complicated case or a patient with a complicated medical history to an oral surgeon. It has been my experience that periodontists are not good at handling complications. I recently had a patient in whom the greater palatine artery was severed during a CT graft procedure (had to be sent to the emergency room because the periodontist didn't know what to do).

This is not meant to be an OMFS v. perio thread (I like working with both!), but I wanted to give my perspective. I think that dental schools nowaday perpetuate the myth (i.e. there is absolutely no evidence to support the claim) that perio is the "soft tissue specialty" or the "plastic surgeons of the mouth".

If there is any specialty in dentistry that is "the plastic surgery of the mouth" by history or procedural foundation, it is OMFS. I find it hard to believing anyone who says that an OMFS who repairs lip lacerations that cross the vermillion border, does eyelid and parotid duct repairs and also sutures nerves (and in some cases does vascular anastamoses) back together "can't handle soft tissue" as well as a periodontist.

It seems to me (and my partners) that sometimes people equate "taking a long time to do something" with "being more careful". I recall the periodontists in DS saying that they should extract teeth because they had better sterile technique than the oral surgeons. They used to drape the entire patient to extract a single tooth. To the external observer, this may appear that they are being careful. To the trained eye, however, this looks like a huge was of time and money, with no evidence to back it up and little efficacy (especially since the mouth is not sterile to begin with and almost every periodontist I see has, in some way during the procedure, violated sterile technique by touching their mask or hat).

I'll get off my soapbox now.
 
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brengy said:
From what you guys saying I get that the periodontist and the oral surgeon get in fights for patients and cases play hard ball against each other if they work in the same place like school or pig offices such thing I hoped that they would get along unless there is regulations who gets what ????
Plus training and just the training is the magic word to decipher between them…
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Hahaha, so now I know what it is like when somebody puts a foreign language into an internet translator.
 
bleach said:
FTD do fill the spots but I would caution anyone to say that they have a tough time connecting with students. By the way there are FTD s who pay the price of obtaining the american dental degree and then pursue perio residency, I guess it does not matter, they will stay as an FTD regardless !
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It is good that perio programs accept a lot FTD. Most of them will either go back to their home country or become perio instructors when they finish their residency training. This means less competition and better job market for US trained periodontists.
 
OMSPlayer05 said:
As an oral surgeon, my feeling was always this: Why do perio when you could do oral surgery?
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No, you couldn't. It is easier to get accepted to a perio program than to an OS program.
OMSPlayer05 said:
Perio surgery is dying because GP's are sitting on the perio disease until a late stage and then just extracting the teeth.
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….and the periodontist will then place implants. It is because of this lack of proper perio care from many GPs that creates more opportunity for periodontists to place a lot implants. As Mike3kgt mentioned, periodontists pay more attention toward comprehensive care dentistry….ie deliver/reline/adjust the stay plate (or RPD) for the referring GP, teach rookie GPs how restore implants and how to communicate with the lab tech, help the GPs tx plan complicated restorative cases etc. The OS are usually too busy to do these things.
OMSPlayer05 said:
With OMS you can do orthognathic, facial trauma, major bone grafting for reconstruction, resect tumors and remove cysts, wisdom teeth, implants and implant related grafting procedures, perform general anesthesia in your office, ect....
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It depends where you get your perio training at. Most periodontists I know do ramus/chin grafts….synthetic bone grafts (aka bone in a bottle) are unacceptable for dental implants. They routinely hire dental/medical anesthesiologist to do IV sedation for them.
 
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brengy said:
Hey mike3kgt Funny huh? Using Google translator...I read my quote again and it was really funny lol…But at least I can see some of you had jealousy and prejudice against FTD
1-Better grades in Boards
5- For those angry at FTD’s they just need to relax and see what is wrong with them? not what is wrong with foreign trained Dentists ?
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Where did you read anything about jealousy and prejudice?

FTDs do well in US board exams and dental schools because they ALREADY were dentists back in their home country. A new dental student obviously can't compete against an older student who ALREADY practiced dentistry in his native land. Any mediocre FTD should obviously do better than the average US dental student.

Secondly, I was trying to get info regarding dental licensure in other countries. Where I'm practicing ( in the US ), there is so much competition and lack of respect for dental services. I'm not doing well as a dentist and was thinking of moving out of the country. Guess what? Other countries make it hard as hell for me to get dental licensure there. So it works both ways. FTDs may have a hard time getting licensed in the US but the US-trained dentists also have great difficulty in getting licensure in a different country. So we're even in terms of the privilege to practice.

No one here has anything against FTDs. This is America, and rewards await for those who are hard-working and honest.

But many folks here, however, don't like insecure FTDs who complain about how hard it is to be a dentist in the US and about how much "smarter" and "experienced" they are for the reasons described above.
 
brengy said:


Hey mike3kgt Funny huh? Using Google translator...I read my quote again and it was really funny lol…But at least I can see some of you had jealousy and prejudice against FTD's because of those reasons…the bottom line here English is not their first language but they get:
1-Better grades in Boards
2-They get better evaluations in interviews because they are dedicated, goals oriented, well spoken, well educated and they don’t take anything for granted like some others.
3- Better residencies and better job offers later on .
4- It is not a weakness to have a different language but on the contrary it is a plus.
5- For those people angry at FTD’s they just need to relax and see what is wrong with them? not what is wrong with foreign trained Dentists ?

mike3kgt this is for the records if you don’t like my thread why you participate in it. Just do a different one and write all your funny comments in there.
And always remember FTD is one of your college friends or a coworker.

Google translator is awesome..
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Hahaha, I guess I hit a nerve... time for root therapy!

BTW, if you actually believe all of this, I am amazed. I have seen some excellent FTDs and some terrible ones. The reason many state boards have trouble accrediting FTDs is that many schools and programs have across-the-board standards it's hard to pin down. Some schools in some countries, all they do is extract and graduate without having to do a crown... others they have so much clinical experience, no US trained dental grad can come close.

While you can argue that there is a lot of variability in US trained grads on an individual basis, most schools are pretty standardized due to COTA. While they'll differ in actual #'s of procedures, most are on a same level of knowledge when it comes to dental procedures.

All of what you said is inaccurate except for:
4- It is not a weakness to have a different language but on the contrary it is a plus.
Everything else is equivalent... we all have EQUAL chances of the aforementioned.

Diversity is the strength of America, including dentists.
 
To Charles Tweed: the point is, the skill set of an oral surgeon is vastly greater then a periodontist in terms of training, knowledge, ability to handle complications, ect... yes there is a small amount of overlap in terms of implant related surgeries otherwise the skill sets are not even close.
 
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Here goes my humble opinion about the perio vs omfs debate:

I find it interesting to read about the history of surgical procedures because it gives us an idea of how we got to where we are now. OMFS started placing implants when perio was limited to Scaling and rp. As OMFS scope expanded to include craniofacial , cancer , cosmetics, ... , Perio started doing more research about implants to the point that they claim that they own it!!! I was at a lecture by Fonseca and he raised the point that if a specialty want to own a procedure it has to do tons of research and publication about it. He was referring to orthognathic surgery and how some plastic surgeon are trying to do it and that we might lose it if we don't publish about it.
If you think logically ( hopefully without bias ) about the amount of training , knowledge, and skill required to be an OMFS Vs. Perio you would find it very different.
OMFS : 4 years of residency/ calls with only 2-3 weeks / year vacation working upto 80 hours/ week. no thanksgiving vacation, no christmas break... at least 48 months of training. number of implants anywhere from 50 to 200 in some programs. ( as far as i know )
Perio: 3 years including a master ( research project ) , 2 weeks christmas break , upto 2 months in some programs summer break , thanksgiving , spring break = about 6 - 9 months of breaks. hours are 9-5 at most. weekends off. I know that some of programs they spend the first year doing S/RP only and they start placing implants in the second year. Number of implants placed range between as low as 20 to 200. However, a lot of time is spent in perio in studying the literature and memorizing studies and names to pass the boards more than in OMFS.

The claim that perio handle soft tissue better is absolute B.S. given the facts mentioned above. If you do it slower that doesn't mean that you do it better or more careful!

The bottom line:
you could find excellent periodontists in placing implants and you might find bad ones. you would also find excellent OMF surgeons in placing implants and you might find bad ones. It doesn't matter how many implants you put in residency. I think there was a study that mentions after 50 you hit a plateau anyway. It all comes down to the dentist himself and the standards he sits for himself.
 
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OMSPlayer05 said:
To Charles Tweed: the point is, the skill set of an oral surgeon is vastly greater then a periodontist in terms of training, knowledge, ability to handle complications, ect... yes there is a small amount of overlap in terms of implant related surgeries otherwise the skill sets are not even close.
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I disagree with the statement that the OS have greater skill sets than perio. Although there are many similarities in OS and perio, OS and perio are 2 separate specialties. The GPs don't refer patients to OS for crown lengthening, pocket reduction surgery, connective tissue graft, periodontal bone graft, free gingival graft because they know the periodontist can perform these procedures better than the OS. The GPs don't refer patients to periodontists for wisdom teeth extraction, oral cancer tx, root tip removal because they know the OS are better at handling these procedures.

For the overlapping procedures such as implants, sinus lift, implant related-bone graft, canine exposure, frenectomy, gingivectomy etc…, periodontists are just as competent in performing these procedures as the OS.
 
brengy said:
Dear mike3kgt:

"I may disagree with what you have to say, but I shall defend, to the death, your right to say it."-Voltaire


I see that you have a sense of humor :thumbup:

I am using and quoting here your own words and both of them totally inaccurate.

11-13-2007, 04:47 PM
(Just about every international student who I have spoken with have mentioned to me that the standard of care here in the US is far above that of where they came from. Most have told me and the professors that coming to the US has increased their ability as clinicians and dental school where they came from is nothing like here in the US.)

01-28-2009, 08:59 AM
(Things are changing in SoFla... too expensive, people have become coarse and unfriendly, and nobody can actually speak English and go as far as to say we should learn Spanish because we are in "Florida.")

I will leave it as is for now I will not add anything more.I rest my case.:laugh:
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Hahaha, awesome. Keep looking back and maybe you'll even see threads about how, during my first year, I thought dental school was the most amazing thing in the whole world.

I absolutely believe that diversity is a great thing, including language. Do I think we should utilize the English language as the primary language in the US, hands down yes. Would I practice in Miami... nope, for many reasons including the language barrier! Then again, this thread is not meant to go into these topics.

There are quite a large group of dentists who resent foreign trained dentists... I am certainly not one of them. I am in favor if you want to come from another country to the US to practice as long as you go through the requirements put forth by their state boards. Florida, as an example, "a 2-year supplemental dental education program at an accredited dental school and receives a dental diploma, degree, or certificate as evidence of program completion." Refer to Rule 64B5-2.0146, F.A.C. for clarification. Do the 2 years like everybody else and the board will let you in.

But yes, I do think you have the right to say what you want to say, regardless if I agree with you or not.

But hey, if you have a chip on your shoulder about this topic, then keep up this battle because it certainly seems to bother you more than me. I already have a full dental license for three states and can legally obtain licensure in more.
 
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