So let’s say that I’m sitting here in front of my computer and contemplating life and death and how well life has treated me over the years. Maybe it was God’s will or maybe it was just having a positive, thankful attitude as I “grew” up. Whatever it was, let’s just say that I’m sitting here feeling that life has given me many lessons over the years but in the end has brought me more happiness than sadness.

And let’s say that as i dwell on these feelings I develop an urge to give something back — something unique, helpful, and selfless.

I’m a dentist.

I was forced through crazy challenges in school to get to where I am. I’ve been through another school — the school of hard knocks — through my career, and I’ve survived. In fact I’ve become an awesome dentist because of Hard Knocks.

I need to give back, but I don’t want to give my hard earned money away anonymously to local charities that I don’t know anything about. I’m pretty content with the couple of bucks I give to my church every week or ten. My skills are too valuable to not utilize as much as I possibly can fixing people’s teeth, so I don’t have time to volunteer at the food bank.

I feel the need to give back though. Where can I apply my unique skills and knowledge to help people? Where can I do this and show them how skillful and knowledgeable I am, where these people would love me and line up to see me, where I would be “The Man” to them. El Hombre….spanish…latin….

Guatamala, Honduras, Mexico. Hmm.

Wow. I see it now! I can collect equipment and supplies from donors from whom I buy lots of stuff at my practice. I might be able to enlist some dental students to come and help out. I don’t care if I have to pay to travel and stay down south because it’s money well spent to help people. The homeless here in my town don’t need my money like these people do.

When I get down there I’ll show them how much better dentistry in Canada is than in their impoverished community. I’ll put in white fillings, save their teeth rather than pull them, use anesthetic, and wear a mask and gloves. I’ll *help* them. The line to see me will be days long. Unfortunately, as much as I’d love to help these people forever, I have to come back home to make some money. Maybe I’ll stay for a week or two.

I do wonder, though, what might happen after I leave. Might these people not want to see their tooth-pulling, painful dentist anymore? Will they wait and wait and wait for my return while losing tooth after tooth unnaturally? Will that be because they’ve lost confidence in the entire medical or dental system in their country? Would I have caused that?

There would be no lines to see their dentist and so no encouragement of the local profession to improve. I would have decreased national morale among both dentists and their patients and I might not be welcomed back again. I might single-handedly cripple an already precariously perched medical/dental system — all because I wanted to feel good about myself.

So…maybe what I’ll do instead of all of that is take my supplies and equipment and dental students and go to the local health department down there. I’ll tell them that we’re only there for a couple of weeks and we want to help. Have no doubt that we will help. We will suction, mix, clean, and offer advice to the local dentists. We will show them how to use the materials we are supplying. We will show them how we do things by allowing them to do the things themselves while we watch. This is positive, this creates growth, this is beyond ego, and is the greatest thing that we as a human can do.

But how many of us who volunteer do this? How many of us would even want to be seen as subservient to the local professional in that small community you want to help? How many of us need to grow up a bit?

There are certain referring dentists with whom I work well and there are others who have tried me out in the past, but for various reasons send elsewhere now. No hard feelings, no worries.

Just as you can’t please every patient, you can’t be everything to every dentist either. The patient comes first, and if they get more streamlined, effective care via a different generalist-specialist combination, I’m fine with that.

You two or three constant readers of my blog know that I have no problem with patients or dentists looking elsewhere for treatment if they don’t want to abide by my office policies. My treatment philosophies and office policies are what they are for very good reasons and were developed through my years of practice from both scientific evidence and experience.

And yet there are still dentists that try to bully me every now and then. I still have a few things to learn about dealing with them. I react impulsively and aggressively.

Thanks to my co-workers I’ve been able to keep myself under control with this latest episode. They really are the best and I am unfathomably lucky to have them watching over me.

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Just got a phone message from a referring dentist that I was hoping had stopped referring patients my way. The reason for that is a long story in itself and for a post some other day.

The back-story revolves around a patient from this dentist whom I saw for a consultation last week. She’d had root canal treatment done fairly recently and is experiencing persistent, residual symptoms. In my letter back to the dentist I mentioned, among other observations, “poor interproximal restorative margins”.

So this patient’s dentist calls today and says that she doesn’t see poor restorative margins on the PA that she has of the tooth (a recent PA of which I have a copy). She’s not sure where my assumption of poor restorative margins came from and would like a copy of my PA to see what I saw.

Here’s my PA which is not really significantly different from her PA — and this is just what you can see on film. My explorer got stuck under the mesial margin so heavily that I could probably have pulled that whole filling out if I had applied more force.

Dear Other Endodontist In Town,

You are a nice guy and everything, but I wanted to send you a note to say that you are embarrassing me. In fact, you are degrading the specialty of Endodontics as a whole.

When you do work like this and tell the patient that everything is good and then the patient ends up seeing me a short time later with persistent or recurrent issues I end up having to do lots of damage control. After all, this tooth was treated by an endodontist, and he didn’t say that he had any trouble with the tooth.

In fact you did have trouble getting around the curve in the MB root. You had trouble getting the job done properly in the excessively short amount of time that you booked for the treatment. So much, in fact, that you over-instrumented the coronal aspects of all the canals and then created a strip perforation on the distal aspect of the MB root.

I have seen better work done by a dental student. Shame on you, and shame on the rest of us for allowing you to pass your specialty certification exams. A higher standard of treatment is implicit in the referral of the patient to your office.

Or maybe you were more conscientious and skillful in the past and for medical reasons you are not physically capable of doing better work now; or maybe greed has gotten in the way?

As specialists, when we fuck a tooth up, we always do a first class job — So much so that I have recommended that your patient have this tooth extracted. It is unlikely that I will be able to get around your ledged curve, fix your perforation, fix the obturation in the other canals, and leave the tooth strong for the long-term. In this case an implant is a better option than retreatment.

Stuff hits the fan in specialty offices all the time, it’s unavoidable when we see the tough cases. It’s always a good idea to be up-front with your patients and explain these complications or unexpected results to them. They usually understand that you tried your best.

They are hard-pressed to think you tried your best when those unexpected results and complications are explained after the fact from one of your peers.

Yours Sincerely,

Peri Apex, The Other Endodontist In Town.

Ignorance is bliss isn’t it. I feel sorry for this commenter’s patients. This is an answer to this question at Yahoo Answers.

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.

The poster tried to suck me into a pointless argument here.