September 3, 2015
There are numerous registrable and recognised dental specialist titles such as endodontists, paediatric dentists, orthodontists, oral & maxillofacial surgeons, prosthodontists, periodontists, among other specialties. These specialists practice in a niche area of dentistry in which they were trained. However, most of those various areas of dental practice are also part of the training that general dentists receive, and the question often arises amongst my colleagues when to refer?
I recently came across one such question in a private dental forum on facebook, Dental Product Review, where one of the dentists posted a question “Should general dentists provide orthodontic treatment (or should they refer the patient to a specialist)?” The most interesting aspect of that post was not so much the question itself, but the replies by some of the member dentists who drew a parallel to situations where general dentists do dental implants. Its interesting because it would appear that even my esteemed colleagues often find it puzzling to know not only when to refer, but also who to refer to.
I think its important that all dentists have the capacity to understand orthodontic problems and prospects of success so they can discuss options with their patients.
Where they have the training and skill to further diagnose and treat selected orthodontic cases, this can be beneficial and highly convenient for the patient.
But we have in our industry people who receive specific training in orthodontics, specialist orthodontists, and who posses the type of knowledge, skill and experience that is more than only pure mechanics. Referral is always an option, and in fact a requirement in certain cases. I say this with some reservation because there is no clear consensus, even amongst specialist orthodontists, in areas such as extraction VS non-exo, occlusal schemes, early treatment, accelerated orthodontics, surgical cases and importantly, long term consequences and airway considerations. So like any other area, dentists should refer to specialists whose philosophies in practice are aligned with their own, because the feasibility of treatment and long term consequences ultimately should be part of any general diagnosis/plan. Its just as important for specialists to undertake further training and development and to understand and not be avert to progress and changes as they occur in the industry.
However, my friends, unlike specialisation in ortho, endo, perio, paedo, etc., in the area of Implant Dentistry, to which some of DPReviewers refer, there is NO registrable specialty dedicated to dental implants!
The “specialists” who provide implant treatment are specialists in other areas. They are NOT implant specialists. They are specialists in other areas of dentistry who also happen to do implants. These specialists must all undertake the same or similar further training as general dentists to develop knowledge and skills in this area. It has been my observation over time that a multi-disciplinary background of a dentist is certainly an advantage, compared to the limited niche of a specialist when it comes to dental implants. But I also say this with some reservation because being a ‘Jack of All Trades’, for a lack of a better phrase, a general dentist may lack the ability to exercise strict discipline and focus, which typically forms part of any specialist training. So the best thing to have would be a registrable implant specialty. But regretfully there is none!
Whilst not a ‘specialist’, having been in a self-restricted practice exclusive to oral implantology and dento-facial surgery for many years now I have been fortunate to work in an implant-surgical capacity with some of the top dentists in Australia and abroad. I am in a position where I get to see many patients who come for a second opinion after problems following treatment elsewhere, and in many cases treatments by “specialists”. The main problems/issues that I see with non-implant specialists doing implants often relates to communication, logistics, mismatched philosophies and poor cross-disciplinary awareness. Unfortunately its often a case of ‘the left hand not knowing what the right one was doing‘, but in implant dentistry this type of coordination is key to success and patient satisfaction!
So whether dentists or non-implant specialists should be doing implants is a very different question to whether they should be doing ortho, where there does exist a specialist to whom one can refer when required.