Turf wars

I remember a time in dentistry back when I started over 30 years ago when dental clinicians were more collegial to one another.

Louis Malcmacher, DDS, MAGD

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I remember a time in dentistry back when I started over 30 years ago when dental clinicians were more collegial to one another. I’m not talking about general dentists amongst themselves. Sure, there is always competition among local dentists. If anything, general dentists have become much more helpful with one another through the advent of websites such as DentistryIQ.com that bring together communities of dentists to post cases, offer advice and criticism, and even offer real help in discussing the different options available for better patient treatment.

I want to focus on something that I think has gotten worse over time, and that is the relationship between general dentists and dental specialists. This also applies to the different dental specialties themselves. In many areas, instead of working together, there are real turf wars going on and we cannot sweep it under the carpet any longer.

Let’s use dental implants as an example. Implant dentistry is an exciting field that is growing rapidly. There is no question that a large group of general dentists are getting more and more involved in the surgical placement of implants.

Periodontists have started to place implants, endodontists are now starting to add them to their practice, and there are even some orthodontists who are surgically placing implants. I know this upsets some in the oral surgery community.

I was surprised to be cornered

I often speak to study clubs that include many general dentists and specialists in the community. At one such recent event, I covered new instruments in exodontia as well as Botox and dermal fillers for facial pain and facial esthetics.

After the event, some oral surgeons cornered me and told me that I, as a general dentist, have absolutely no business talking about extractions, and one oral surgeon told me it is malpractice for a general dentist to place an implant. This has happened on more than one occasion, where dental specialists contact me to say they are upset that I have written articles on surgical, endodontic, periodontic, and orthodontic procedures.

I really do understand why there are turf wars in dentistry. I would love to believe that these specialists are altruistically concerned purely about patient protection. I really think most of them are just hiding behind that façade — the real issue is simple economics and the threat of losing business.

If general dentists are going to become proficient at extracting teeth, implants, endo, and ortho, specialists will worry about how they are going to make a living and feel very threatened. What a small-minded mistake they are making!

Historically what has happened is that the whole dental industry has grown as general dentists have added new services to their practices and patients have more access to care. It’s no secret that most general dentists treat endodontics in their daily practice. Have endodontists suffered? No. The specialists who have lost business are the ones who have the “turf war” attitude, which discourages general dentists from referring to them.

Orthodontics has exploded in this country with the advent of cosmetic orthodontic systems such as Six Month Smiles and Invisalign. Have orthodontists suffered? Only those who have the “turf war” mentality and have refused to help general dentists grow.

Any smart dental specialist knows that the more their referring general dentists know about these treatments, the more dentists realize what they can and cannot treat, and recognize more quickly when a dental specialist is needed. These well-trained general dentists refer even more patients than they did before.

By the way, I love the dental specialists I work with. They include endodontist Dr. John Nardi, periodontist Dr. Cliff Thomas, oral surgeons Dr. Bill Francis and Dr. Thomas Murphy, orthodontist Dr. Tom DiMassa, and pedodontist Dr. Diana Kyrkos. Why do I love them? They communicate, encourage me to try new things, and realize that working together results in the best patient treatment possible.

Let’s stop the turf wars in dentistry. Life is too short. The more often general dentists are well trained in all procedures, the more everyone benefits — especially our patients.

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 by email at drlouis@FacialEsthetics.org. His website is www.commonsensedentistry.com, where you can sign up for a free monthly e-newsletter.

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