Dental professionals etiquette towards each other?
Answers:
Thank you, Heather. This came from a member who I really respect myself, so I let the remark pass. I will comment on it here, since my remarks will not be attached to his name. I would not want to destroy the credibility that he has built with other users.
I enjoy surgery and I even do some surgical extraction of impactions in the office if the patient does not want general anesthesia. I am certain that many dentists do not do this. I have never once felt that the reason was that they were too lazy. I wonder if some dentists feel that all dentists should be doing all of their own surgery. With such a strong opinion, I imagine we might hear, "No dentist has any business doing any surgery in the office. This is what oral surgeons are for. Any dentist who does surgery is putting his patient at risk and they are only doing it for the money." Do ya think?
I used to do almost all of my own root canal procedures, but found that it was too disruptive of my schedule. I no longer do molars. I can DO them okay, but it takes me twice as long as it takes the specialist who does nothing else, all day, every day. I feel the patient is better served. If you don't do root canal procedures at the "100% Best" level, you are spinning wheels and the tooth is doomed to failure. This is what the speciliats are for.
And, Dr. Albert, I agree with you. I would be inclined not to criticize another dentist's work. I was not there when it was done and I don't know what conditions existed before it was done. I don't know how well the patient cooperated during the procedure. I will not look at obvious malpractice and lie about it, but I will always try to allow for operating under the worst conditions when I evaluate what another dentist has done.
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Addition to the discussion:
I have been in practice for 31 years. I, too, used to do all of my own endo, especially when I was under 5 years in practice and had plenty of openings in the schedule. I still do all 1- and 2-canal teeth. My problem is that it takes 2-to-3 weeks for ANYONE to get an appointment in my practice. I can't fill up the schedule with molar endo's where the patient will have to wait weeks to be seen. The endodontist can usually see them in a day or two. Yes, I will open a tooth at an emergency visit, but I would then need to reappoint the patient in 2-3 weeks. Most people do not want to wait that long. "Making money" is not the problem, because I could simply charge as much as I wanted to charge for the time spent. I still would not cost as much as the specialist, but the patient would suffer through 2 hours in the chair instead of one. I don't have a surgical microscope, either. I do use Orascoptic telescopes and just seeing how much that improved my endo makes me realize that the scope should be used almost all the time, especially on molars. I'm not going to spend upwards of US$5-6,000 to buy one, either. There are specialists who spent a couple of years in school learning how to use them. Have you seen how your cases look in 10-20 years? Obviously not. How many 4th canals do you find in upper first molars? Are you finding them at least 25% of the time? If not, you are not completing the endo properly. For that matter, how many 5th canals do you find?
I don't especially like doing dentures, either. I solved that problem by raising my fee to the point that hardly anyone ever asks me to make their dentures. When I _DO_ make dentures, I never take shortcuts as they only lead to problems down the road. I never resent it when we have a visit or two for post-insertion adjustments. It's all built into the fee. My reline fee is even built into the immediate insertions cases and I do my own pre-prosth surgery as well as open flaps for immediate insertion cases. If someone calls askign fro the denture fee, mystaff is trained to ask, "Are you looking for a low fee?" If the patient says that they are, we just tell them which office to call for the lowest fee in town. Everyone wins in that situation, don't they? I just saw a patient for whom I made dentures over 25 years ago using the neutral zone technique and a pantographic records transfer. She is makingout well, but just thought that it must be time for new teeth. She's 80 years old. Her teeth look like they were made last month. I CAN do dentures, but I just prefer not to. It's the same with molar endo. I'll do a teenager or young adult where the canals are pretty much full-sized, but rarely will I tackle something that would be better done by someone who loves doing root canals so much that they chose to do nothing else, all day, every day.
I was young and cocky once myself, but I was never arrogant.
"Judge not, lest you be judged."
Why not go to http://health.groups.yahoo.com/group/sam... and put in a request for membership. I invite _all_dental_professionals_ using this service to do the same. We can hold these discussions amongst ourselves in relative private in a forum that is designed for give and take. It's a small vestige of a group I used to run over on CompuServe starting over 20 years ago. We are all friends and we agree to disagree sometimes.
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Endodontists DO exist. I use them when it is in the best interest of my patients.
itz a dog eat dog world. in this world which is run by money, a dentist may be mad because they lost money to another dentist.
HEATHER,
THE REAL REASON WHY, IS THAT IF ANOTHER DENTIST ACTUALLY SAYS THESE THINGS HE HAS NOT LEARNED THE UNIVERSAL TRUTH OF 'WHAT GOES AROUND...DES INDEED COME AROUND.'
EVEN AS I WAS A DENTAL STUDENT I ALWAYS HEARD MY PROFESSORS SAY THAT YOU HAVE NO BUSINESS CRITICIZING OTHERS WORK.
Well in some cases being a professional does not change who someone is. In this case the person has a lack of respect and one would need to question their morals or some other underlying reason they would act this way. It is true that as a dentist that you will come across some work of another dentist that you don't think was done right. You need to inform the patient of the problem, not to take judgement because you don't know what circumstances surrounded this problem. Then you can talk to the dentist if you have a problem with something he does and try to resolve it.
HeatherS, you I suppose you are expecting an answer from me.
I don't how how long ago you graduated from dental school, so perhaps you've been in practice so long that you've just learned to accept the status-quo.
There is a horrendous problem in the dental profession, both at the educational level and the pratical level. There are ten different kinds of dental doctors, 9 of whom deal with problems almost exclusively within the confines of the mouth--a hole in the head the size of a tennis ball. Obviously, there's not much turf to go around, so what happens? 1. you get a lot of overlap between the jobs of specialists, and 2. you get specialists who isolate their practices to very few types of problems and procedures.
Take endodontists for example. There is absolutely no justification for their existence. None whatsoever. How do I know this? Because the scope of their work is exceedingly limited (root canals, endo retreatments, post spaces, apexification procedures, and apicoectomies), . So limited in fact, that it could easily be incorporated into a dental school curriculum for general dentists to learn. Certainly, any general dentist (with a little bit of practice) can learn to do all of these procedures. I did.
The fact of the matter is that there are general dentists who don't know how to do it and don't want to learn, Why? Because they don't want to bother with it and because they know they can make more money performing crown and bridge. And of course, there are plenty of endodontists who are just happy to feed off these lazy, greedy dentists, doing root canals day in and day out at literally 150% or more the cost of a root canal performed by a general dentist.
This approach does not serve the dental profession well. It makes us look absolutely ridiculous! The fact that a patient who comes in with an endodontic tooth problem and cannot be treated by his dentist sounds preposterous. Moreover, it doesn't serve the patient well.
If you're too incompetent to do your own molar endo with similar speed and quality as an endodontist, you shouldn't have a license to practice dentistry.
I am also a firm believer that periodontics and orthodontics should not exist either. These are services that general dentists should be able to perform as well. How do I know this? Because there are many general dentists who perform all of their own perio surgeries and general dentists who handle all of their own ortho!
Same with prosthodontics and pedodontics.
With the exception of oral and maxillofacial surgery and oral path, none of the dental specialties are sciences that are diverse enough to warrant doctors who study them exclusively (the way a cardiologist studies cardiology, or a plastic surgeon studies plastic surgery, or an ENT studies the head and neck). Endodontics, ortho, pedo, prosth are all tiny disciplines that can easily be incorporated into the scope of a general dentists practice.
But they're not. Why? Because everyone with a DDS or DMD is interested in making money...especially the specialists. And the schools are more interested in preserving the work-load for the specialists by keeping their students ignorant of anything but the most basic endo, pedo, prosth, and teaching them absolutely nothing about ortho.
Think about it this way, Heather: what type of work is unique to the general dentist? Fillings. That's it. That is the only kind of work we do for which there isn't a specialist.
This doesn't strike you as absolutely ridiculous?
DR. SAM & DR. ALBERT:
Dr. Sam, you said it yourself: you don't do molar endo because it "disrputs your schedule" and because the endodontist can do it faster. Ask yourself this: what if endodontists didn't exist? General dentists would become more competent at molar endo! And, patients wouldn't be charged the specialist premium for a procedure that a general dentist OUGHT to be able to do!
Dentistry should consist of three types of doctors: general dentists, oral pathologists, and oral surgeons. Why do I say this? Because there are general dentists who treat kids, perform ortho, perform all their molar endo, perform their own perio surgery, their own prosthodontic work, etc. Oral pathologists cover the diseases of the oral cavity and maxillofacial region, and oral surgeons are there to handle the more involved surgeries (i.e. orthognathics, vestibuloplasties, pathology, etc.). Between these three doctors (if general dentists were trained PROPERLY in dental school), everything within the dental profession would be covered. Everything. But that will never happen because there are too many general dentists who are perfectly content sticking with the money-making routine work and too many specialists perfectly content doing root canals and sedating kids day in/day out for obscenely high fees.
I perform the majority of my third molar extractions, virtually all of my preprosthetic surgeries, and 99.999 percent of my extractions of surgically-erupted teeth. I also treat many children, and when I get training to sedate patients, I will treat all of my pediatric cases. I also perform virtually all of my own endo, referring to endodontists the cases that are borderline hopeless (and often turn out to be untreatable).
I am am under 5 years in private practice, mind you. I have a long way to go in my career and thus plenty of time to learn to do the things we general dentists SHOULD have been taught in school.
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