Where did all the periodontists go?

June 1, 2010
Through my travels to talk to dental professionals across America, I speak to many specialists and their teams about the hottest topics in dentistry — practice management and total facial esthetics.

For more on this topic, go to www.dentaleconomics.com and search using the following key words: periodontists, total facial esthetics, general dentist, Dr. Louis Malcmacher.

Through my travels to talk to dental professionals across America, I speak to many specialists and their teams about the hottest topics in dentistry — practice management and total facial esthetics. There are definite trends changing all specialties across the board, whether it’s short-term orthodontics versus long-term orthodontics, adhesive resin endodontics versus traditional gutta percha endodontics, or whether general dentists should provide any of these specialty services.

I would have to say that the biggest change of any dental specialty is in the periodontal field. There has been a real mindset change that deeply affects the profession. I am not commenting on whether this change is good or bad — I will leave that up to the reader to decide.

I have always believed that general dentists are the quarterbacks of any patient treatment case, and we certainly rely on the skills and input of dental specialists, but the ultimate responsibility is on the general dentist.

Here is what many periodontists have told me over the last couple of years — they would rather remove teeth and place implants than actually treat patients through traditional periodontal surgery and try to have them maintain their dentition.

The reason for this is quite simple and every dentist knows this inherently. Patients refuse to take care of their teeth, even after they go through the time, cost, commitment, and pain of periodontal surgery. This is certainly not earth shattering news to any of you.

For years in our practice we’ve had patients who do not want periodontal surgery, but instead would rather maintain the state of their oral health with three- to four-month recall prophylaxis visits. We often predicted that their teeth would fall out within two to three years.

Surprisingly, many of these patients have done reasonably well 20 years later, with the occasional loss of a tooth here and there. This thought was blasphemy to periodontists for years, but it certainly seems that conservative, nonsurgical periodontal recall visits and treatment has helped many patients maintain their dentition so they can function with their original teeth for many years.

As general dentists we know that patients, even with the best periodontal surgery treatment, often relapse and revert to their old habits, and eventually their dentitions fail.

This doesn’t apply to all patients, but to many of them. We have learned that we have to treat people as people and sometimes we cannot change them no matter what we do.

It seems to me that periodontists have caught up with this concept, and that’s where this mind-set has really changed periodontics today. Patients like the idea of implants, which are still vastly underused in North America. Many patients would rather not have to take care of their teeth and have their unsightly, mobile teeth extracted and replaced with implants, which would restore their function and esthetics.

The implant success rate is 94%, and it is hard to argue with such a high success rate compared to the poor long-term success rate of traditional periodontal surgery. This is primarily due to the fact that we have to depend on the patients to keep up their regimen for the long-term success of their natural dentition.

New procedures such as the Wavelength optimized Periodontal Therapy (WPT) procedure with the Powerlase AT Laser by Lares Research, and LANAP procedures done with the Periolase laser by Millenium Dental, provide minimally invasive solutions for patients who want to keep their teeth without invasive periodontal surgery. Laser periodontal treatment will continue to develop and become even more effective in the future.

Procedures such as implants and minimally invasive laser periodontal therapy will improve and change the way we practice in this decade. Is this good or bad? You are the dental clinician. This is for you, the periodontist, and the patient to decide.

Dr. Louis Malcmacher is a practicing general dentist and internationally known lecturer, author, and dental consultant known for his comprehensive and entertaining style. An evaluator for CLINICIANS REPORT, Dr. Malcmacher is the president of the American Academy of Facial Esthetics at facialesthetics.org. Contact him at (440) 892-1810 or e-mail [email protected]. His Web site is www.commonsensedentistry.com, where you can sign up for a free monthly e-newsletter.

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