by Gordon J. Christensen, DDS, MSD, PhD
In this monthly feature, Dr. Gordon Christensen addresses the most frequently asked questions from Dental Economics readers. If you would like to submit a question to Dr. Christensed, please send an email to firstname.lastname@example.org.
I did not receive much education on third-molar removal while in dental school. I remove many erupted teeth and enjoy doing some surgery as a diversion from my mainly restorative practice. As a general dentist, should I be removing impacted third molars?
Answer from Dr. Christensen...
If you like to accomplish some surgery in your practice, the decision about whether or not to remove third molars is an easy one. It is similar to the decision about whether or not to place implants.
The main criteria for making the decision is to determine which types of surgical situations you will accomplish and which ones you will refer. Third-molar removal can be very easy, or it can be a major challenge even for an experienced oral surgeon.
There is a period of time in third-molar development when the tooth buds have developed sufficiently to significantly penetrate the crestal bone, but they have not developed enough to have formed complete root structure. This is a window in time, usually in the late teenage years, when the teeth are relatively easy to remove. The more simple third-molar removals are those that are relatively in line for normal eruption, but the dental arch is not adequate in size to let them come in to normal occlusion. Assuming the patient for whom you are contemplating removal of the molars has been in your practice for a period of years, it is easy to track the third-molar development and to identify the correct time to have optimum opportunity for easy removal.
Dentistry has over 100 techniques which are within the realm of general dentists, and becoming proficient in all of them is nearly impossible. There are procedures in each dental specialty that are easy to accomplish, and these are the ones that general practitioners - educated in the specific procedures - should plan to perform. On the other hand, there are procedures in each specialty which are difficult for even the mature specialist to accomplish. General practitioners must determine which procedures they want to accomplish, and then find courses to educate them in the specific procedures.
In my opinion as a mature prosthodontist who has performed most of the procedures in dentistry multiple times, there are many oral procedures more difficult than removal of third molars at the developmental time described in this answer.
One of our most recent videos, V4103, "Easy Third-Molar Extractions," shows the simple removal of third molars and demonstrates the correct indications and techniques. Call (800) 223-6569 or visit our Web site at www.pccdental.com.
Some of my general dentist friends have started to place implants, in addition to restoring implants. How do you feel about the difficulty of implant placement for a general dentist? Also, if I plan to learn how to place implants, what is the best way to do so?
Answer from Dr. Christensen...
I have placed these two questions in the same column as the previous question about third molars, since they are on the same issue. Both implant surgery and third-molar removal can be simple or extremely difficult. It is your task to determine which type of patient you will treat and which type you want to refer.
When contemplating placing implants, there are a few criteria which relate to whether or not to place the implants as a general dentist. The patient should be healthy. The bone should be adequate in quantity and quality. The patient should not have an abnormal degree of apprehension about the procedure. Unless the general dentist has had significant education, implant surgery should be limited to placement in locations from the anterior of the maxillary sinus on one side of the arch to the same location on the other side of the arch, and to 5mm anterior of the mental foramen on one side of the arch to the same location on the other side of the arch.
If these simple prerequisites are respected, and the general dentist has had adequate instruction on implant placement, I do not see any contraindication to placement of implants by educated general dentists.
In my opinion, all of dentistry is a specialty. Each of the seven clinical specialties, including my own, prosthodontics, has some very easy treatment procedures, and some extremely difficult ones. General dentists have a great amount of diversity in the techniques they use each day. They must determine the scope of their interests, and seek education to broaden their abilities beyond their school experience. The procedures I perform today, as a mature practitioner, do not resemble the education that I received in dental school or in graduate school. The ability of a practitioner is directly related to his or her clinical experience, years of practice, and the continuing-education courses completed. My criteria for referral has always been if I would not do the procedure on myself or my family, then I prefer to refer it to someone better qualified.
You may want to see me, a prosthodontist and restorative dentist, make decisions about implants in V2300, "Making Decisions About Successful Use of Implants," and then place them in a very close-up detailed video - V2301, "Simplified Implant Surgery." Call (800) 223-6569 or visit our Web site at www.pccdental.com.
Dr. Christensen is a practicing prosthodontist in Provo, Utah. He is the founder and director of Practical Clinical Courses, an international continuing-education organization for dental professionals initiated in 1981. Dr. Christensen is a co-founder (with his wife, Rella) and senior consultant of Clinical Research Associates which, since 1976, has conducted research in all areas of dentistry and publishes its findings to the dental profession in the well-known CRA Newsletter. He is an adjunct professor at Brigham Young University and the University of Utah. Dr. Christensen has educational videos and hands-on courses on the above topics available through Practical Clinical Courses. Call (800) 223-6569 or (801) 226-6569.