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14/03/2013 at 2:38 pm #11290site_adminOnlineRegistered On: 02/09/2011Topics: 90Replies: 101Has thanked: 23 timesBeen thanked: 1 time
1) Please describe the current dental continuing education scene in USA: Many newly ordained dentists want more training before entering private practice, so they continue their education in a hospital residency, enlist in one of the branches of the armed forces, or enter a specialty program. In the state of New York, dentists must get one year of post-doctoral training before being allowed to practice. Keep in mind that most dentists in theUS have also completed four years of college education.
Most specialty programs (I am a periodontist), have extended their curriculum by a year, so to become a periodontist, for instance, training is an additional three years after dental school. Oral surgery is four years & it is a combined medical/dental degree.Once a dentist enters practice, we are required to continue our education for licensure (which is mandatory in the US) on average of 20 hours per year. To this end, courses are taken in person or online.
2) Please describe the current Periodontology scene in USA: Periodontology, in my opinion, is undergoing a revolution, but it is a revolution that is taking different forms in different parts of the country. I would like to say this is a good thing, but it is not, & the engine driving this is a reflection of the economy & how perceptions are in constant flux. Let me explain.
When I first started out in dentistry, the roles for each specialist were clearly defined. Endodontists performed root canal therapy, periodontists treated the supporting structures of the teeth but did not fabricate restorations, & oral surgeons removed teeth, treated pathology, trauma, etc. General dentists restored teeth. This is simplistic but reflective of the dental profession in the USi n the mid-70s. What contributed to changing these paradigms? Fluoride, implants, & new dental materials. Why fluoride? Because the decay rate in the US dropped by 70%. Once this happened, the severity & incidence of periodontal disease dropped to maybe 50% of what it was. Why? The reduced rate of caries meant fewer restorations. Fewer restorations meant less iatrogenic dentistry. Less gingival irritation meant less severe periodontal disease.
This is a long answer, but it is worth understanding. While the dynamics of fluoride, reduced caries & less periodontal disease were taking place, the advent of better ceramics, veneer laminates, & implants become the new treatment modalities that continue to keep GPs & periodontists busy. Then the oral surgeons discovered implants (in the US they followed the periodontists), but there was enough for all to treat for the next twenty years. But the gold rush for cosmetics began to dwindle, the economy in 2007 became bad here & around the world, & that’s when the dental world turned a bit on its head in the US. What do I mean? GPs are the gatekeepers for their patients’ dental care & many, not all, stopped referring patients for treatment to specialists & started doing the work themselves. The hygienists did more initial periodontal treatment, the GPs inserted implants, & prosthodontists started inserting implants & now the endodontists are inserting implants. The GPs are performing Invisalign, & now have 40% of that market. The periodontists are fabricating implant abutments & in some cases are fabricating the entire restoration. This is what I mean by the dental profession being turned on its head. The delineations for the specialties are narrowing to the point of becoming indistinct, & the official societies are doing nothing to correct this. Ergo, the state of periodontics is being challenged.
3) What kind of periodontal procedures should a GDP do in his clinic?
They should perform whatever they are comfortable treating. The issue for me is that when general dentists, or for that matter oral surgeons, perform periodontal procedures, are they performing them to the level of expertise of periodontists? Can they handle bleeding emergencies? Suture tissue that shreds? Do they know the latest in bone regeneration? Membranes? Do they understand how positive architecture relates to crown-lengthening. If a dentist understands these procedures, they should be performing them.
4) Your suggestions regarding the maintenance phase of periodontal treatment: This is the single most important dental treatment for all adults. It should be performed regularly, usally every 3-4 months. If I had my way, all patients would alternate one periodontal maintenance visit with the generalist & then one with the periodontist, alternating each time.
5) Some suggestions to increase patient compliance regarding flossing, using oral irrigators etc: This is fighting human nature not to do anything that takes any extra effort. It’s repetition each time the patient comes to the office. Even that doesn’t work. When patients ask if it is important to floss, I tell them to floss “Only the teeth they want to keep.” Nothing I say matters until they have an abscess, need surgery, etc., then some get the oral hygiene religion.
6) How should a GDP train himself in periodontal procedures?
Take courses like the ones we are offering on http://www.expertdentalce.com. If there is a periodontist nearby, visit the dentist & watch them work. Frankly speaking, all dentists receive periodontal training in school; they need to apply what they learned & be critical analysts to the results they are obtaining. The biggest issue for many is they don’t know how to charge for their time…so they ignore this phase of treatment.
7) Your comments of sub-epithelial connective tissue graft procedures: There is less & less need to perform these with newer materials such as Mucograft.
8) The future of Periodontology: The future of periodontology will be in genetic counseling. I don’t think there will ever be a vaccine to eliminate periodontal disease but I do feel the day will come when periodontists are eliminated & the generalist will perform their services.
For one to one consultations on dental practice growth and practice management please contact : todaysmedicalmarketing@gmail.com
14/03/2013 at 2:40 pm #16417site_adminOnlineRegistered On: 02/09/2011Topics: 90Replies: 101Has thanked: 23 timesBeen thanked: 1 time9) Please describe the current state of implantology: Implantology is a slow growing field in the US. While it is the standard of care for single tooth replacements, many dentists do not recommend it simply because they are afraid of what they don’t know & they don’t know enough about implants to recommend them. For example, implants are first being introduced into the dental schools. You would think that after 30 years every school would teach them & every dental student would have some familiarity with them, but that is not the case. For this reason, as our curriculum evolves, http://www.expertdentalce.com will provide a valuable role in enhancing dentists’ education AFTER they leave dental school.
10) Please describe the current state of bone grafting in implantology & Periodontology: More & more grafting is being performed around implants. There are more biologics to choose from & results are getting better & better. Grafts are a mainstay for current therapy.
11) Implantology in medically compromised patients especially diabetics. Your comments: Implants can be inserted in well-controlled diabetics. I see no difference in their healing. Smokers on the other hand, while they may have the same success rate for implant placement, when they have a problem in healing, their problems are exponentially worse than in non-smokers.
12) The future of implantology: The future of implantology will continue to grow & change. We are a long way from providing implants that once inserted, will not have future problems. As time goes on, we are learning about return of inflammation, peri-implantitis, crestal bone loss, etc. Manufacturers continue to alter the implant surface. I don’t think this is important or valuable. What is more important, & we are not there yet, is exactly where to place the implant, what the crown/implant interface should be, should we only have platform switching, do zirconia abutments work, & more. One trend that is occurring is that we now recognize that residual cements from implant crowns are causing problems that need to be addressed. We need to consider implants have vulnerabilities similar to teeth; they cannot be abused.
For one to one consultations on dental practice growth and practice management please contact : todaysmedicalmarketing@gmail.com
14/03/2013 at 2:41 pm #16418site_adminOnlineRegistered On: 02/09/2011Topics: 90Replies: 101Has thanked: 23 timesBeen thanked: 1 time13) A lot of dental procedures with full gory details are available for viewing on sites like http://www.youtube.com. Does this make sense?
No one is forced to watch gory procedures. I don’t. Rational, intelligent people use their reasoning powers to differentiate sensationalism from what is practical. We will never stop patients from seeking out explanations & answers to medical & dental problems from the internet. The intelligent being will take whatever information they discover & they ask a person they respect to explain it. My patients do this & I have not lost patients to internet gore or misinformation.14) How do you train your staff regarding patient counseling?
We spend time talking about customer service & how they like to be treated when they enter a store to buy something. Then we discuss how they like to be treated when they are the patient in a doctor’s office. Once they understand this, they can easily & successfully counsel my patients….& they do.15) Does a GDP require a website: That is a personal decision. I look at a website as a sophisticated business card. If a practice is always busy & receiving new patients from word-of-mouth, why would they need a website? Websites that grow stale are of little value, so if you have a website, refresh it all the time. As a specialist, I feel I have to have one, but I don’t necessarily want new patients to find me in this manner since I have a referral practice from other dentists and patients coming from the Internet & not being referred, seem not to valuable my services in the same way as a strong referral from a dentist.
For one to one consultations on dental practice growth and practice management please contact : todaysmedicalmarketing@gmail.com
14/03/2013 at 2:43 pm #16419site_adminOnlineRegistered On: 02/09/2011Topics: 90Replies: 101Has thanked: 23 timesBeen thanked: 1 time16) How was the idea of http://www.experdentalce.com born?
The idea of http://www.experdentalce.com evolved out of the recognition that the world is changing. Dentists (especially young ones) are studying dentistry on the computer. We did not have computers when we went to dental school, now dental students don’t have textbooks! So my partner, Dr. Frank Murphy & I felt there would be a need for meaningful, purposeful, high quality dental education provided online that was geared to the generalist. That has been our goal from the beginning & I believe we have accomplished this. Cobbling together courses that are connected into modules has furthered this goal. Our mission is to enhance dentists training so that outcomes are better & risks are reduced.17) Advantages of online dental CE: The advantages for online dental CE are many. Theses courses can be taken at the convenience of the dental professional, whether from the clinic when it is quiet or from home. They can be taken day or night, during the week or on weekends. They require no travel or loss of income, or leaving one’s family. They can be reviewed more than once. Lecturers can answer questions via email. This saves time and money for everyone, while improving skill sets and knowledge.
18) There is no human interaction in online dental CE with the speakers. Your comments: On the contrary, questions can be emailed & answered. But if you want to have a one-on-one personal interaction that is live, then this can’t be done via the internet unless one is skyping or participating in a webinar. These formats are fine, but they have specific times attached to them. Our courses are available 365/24/7. Having said that, online CE is not meant to eliminate in-person lectures or courses. It is a means to augment one’s education, in a convenient, high-quality way.
19) How to keep dental deliberations free from the influence of dental trade?
Don’t accept dental trade ads or involvement. We don’t. We are self-sustaining without any corporate relationships. To further insure the purity of our courses, each program is vetted by an academic advisor before we post it to insure the content is current, accurate, & meaningful.20) Your future plans for http://www.experdentolce.com: Our future plans include creating more & more valuable courses for dentists around the world. We hope that our library of courses will serve as a reservoir of knowledge for the dental profession & we will augment the learning curve for every dentist who wants to grow & provide the best dental care for their patients. In addition, we are seeking strategic partners that will help deliver our message.
21) Your plans for countries other than USA: Our plans are straightforward: http://www.expertdentalce.com is a global company. Our mission is to provide online dental CE for the world’s dentists. If anything, the US is a bit saturated for online CE, we encourage dentists from all over the world to take our courses. We expect to announce in the near future, an alliance that will bring us to an additonal 150,000 dentists from around the world.
For one to one consultations on dental practice growth and practice management please contact : todaysmedicalmarketing@gmail.com
14/03/2013 at 2:44 pm #16420site_adminOnlineRegistered On: 02/09/2011Topics: 90Replies: 101Has thanked: 23 timesBeen thanked: 1 time22) An ideal day in the office: An ideal day is a steady flow of patients, all happy & successful, & no emergencies to alter the rhythms.
23) Your future plans: My plans include making http://www.expertdentalce.com successful, treating my patients, traveling, & writing novels. My third novel will be coming out this summer.
24) Your comments on DENTISTRY TODAY.: I feel the journal is ambitious, informative, & of great value. I was the editor of a dental journal for eleven years & I know the hard work that goes into publishing such a project. You are to be commended & I hope your readers appreciate the work that goes into this. The articles are excellent.
25) Your comments on http://www.dentistrytiday.info.: This a great site for sharing information. I enjoy the comments & I urge your members to participate as much as they can. Sharing ideas is a cornerstone of becoming a better clinician.
For one to one consultations on dental practice growth and practice management please contact : todaysmedicalmarketing@gmail.com
15/03/2013 at 11:45 am #16421DENTAL TRACKEROfflineRegistered On: 25/09/2012Topics: 0Replies: 4Has thanked: 0 timesBeen thanked: 0 times24/03/2013 at 5:50 pm #16435site_adminOnlineRegistered On: 02/09/2011Topics: 90Replies: 101Has thanked: 23 timesBeen thanked: 1 timeDear all,
We are continuing with the interview and these are few more questions that Dr. Alan Winter has taken out time from his busy schedule and answered.
1) Some tips to dentists who wish to come on dental lecture circuit.: If dentists which to get on the lecture circuit I would suggest they call their local dental society and volunteer to give a lecture to the society. If possible, they should get on staff at a dental school or teaching hospital and give lectures to the residents and students whenever they are able. They should attend meetings. In time, their work will be recognized and they will be invited to speak on a larger platform.
2) Interesting anecdotes from your clinical practice: The best anecdote from my practice was when I first became a periodontist, I started in an old-time, famous periodontal practice on Fifth Avenue in Manhattan. I looked very young and I would be asked almost daily, if I was old enough to be a dentist. I was 28 at the time and put pictures of my two sons on the wall and said that I was old enough to have children, and I was old enough to treat the patients. Then I added a picture of my third son. When I did that, everyone asked who the childrren were. I said they were mine. They said it couldn’t be, they don’t look like brothers. I must have taken the wrong one home from the hospital.
The fact was they did not look like brothers, but to the best of my knowledge, they were my sons. 🙂 But then I wondered what if I did bring the wrong one home from the hospital….and that is why I wrote my first novel: "Someone Else’s Son."
3) Interesting anecdotes from your speaking assignments: The best story I can tell was when I was lecturing to the Mexican dental society on the topic of "Endo-Perio Relationships." I took Latin and French in school and did not know Spanish. I asked a Spanish-speaking dentist to help make some title slides in Spanish. This was in the late 1980s, before computers, when graphic artists made slides and we used carousels. So there was a slide that was supposed to different the rate of disease by stating: Periodontal disease usually takes years to occur, and endodontic lesions can occur quickly. The work Años means "years" because of the accent mark above the "n." When the accent mark is missing, it means "anus." Translation: periodontal disease forms in the ass! The audience roared with laughter and I could not figure out why? At the end, my host who invited me said, "Dr. Winter, if you ever give this lecture again to Spanish speaking dentists, there is one slide you must change.!"
4) Common mistakes made by fresh graduates: They forget to treat patients as if they were treating their own relatives or friends or themselves. New graduates need to be strong enough to believe that good dentistry will always prevail and that they should not take shortcuts.
5) Your favourite patient: They are all my favourites. If they are willing to sit in my chair and have me work on them, let me inject them, cut them, drill into them, sew them up, and then stand up and say, "Than you," and give me money for it, they are ALL my favourites.
6) Do you think that bone regeneration around teeth with gum recession can ever be achieved?
Yes. I saw a remarkable case of this two weeks ago in Tampa, Florida and the Academy of Osseointegration meeting. This will be possible in the future.
7) How do you maintain cordial relations with GDP’s who refer patients to you?
The key is to keep constant communications, inform them about their patients and see them socially as much as possible. I actually host 2 wine tastings each year where we all get together and have fun. I don’t play golf or tennis, but these are great activities to share with colleagues. You have your cricket and other sports. The key is to create relationships that are meaningful.
8) Do you think CE initiatives can be commercially viable without the participation of dental trade: Yes. I feel dentists will see and appreciate the great value of not having commercial companies interfere with their continuous learning. In time, there will be an eUniversity. I am already involved with creating an eFaculty. Soon, our projects will be commonplace and accepted by all.
For one to one consultations on dental practice growth and practice management please contact : todaysmedicalmarketing@gmail.com
25/03/2013 at 8:11 am #16436Sushma BagulOfflineRegistered On: 07/02/2012Topics: 7Replies: 5Has thanked: 0 timesBeen thanked: 0 times25/03/2013 at 4:44 pm #16441drsnehamaheshwariOfflineRegistered On: 16/03/2013Topics: 110Replies: 239Has thanked: 0 timesBeen thanked: 0 times27/03/2013 at 8:00 pm #16450AnonymousHello. We try to tailor our reminders to our patients. We text and email most patients and find that patients who request or like this, are the most compliant. We do send postcards for those who wish to receive the reminder by mail, and then we call most patients 2 days before the appointment. We do not charge if a patient misses an appointment after all of this effort, but simply move forward. Patients who chronically miss appointments are asked to leave the practice.
27/03/2013 at 8:08 pm #16451AnonymousHello. This is a sensitive subject. If I wanted to be purely objective, the only true specialists should be oral surgeons and orthodontists. After that, pedodontists, periodontists, endodontists, and prosthodontists exist at the whim of the GPs and the work they don’t want to do. This is how it was arouond the world in the 19th century and into the 20th century. In the 1930s or thereabouts, perio and pedo started to become more specialized, and the other specialties followed. Please understand I am not saying that specialists are not needed, they are. And please understand that I do not feel that generalists, as a group, perform all aspects of each speciality at the equivalent level of the specialists who trained 3 asnd 4 more years. It logically doesn’t make sense that they do. However, the gatekeeper for dental care is the generalist. The obvious goal for the dental industry would be to make all generalists into superspecialists. In some instances, that will happen, and it has happened for a few. The greater good would be to raise the bar for all dentists around the world, so that no matter where one receives dental care, it is reasonably the same regardless of locale. So, am I looking for a new career? Not yet. But as I periodontist, I feel my speciality needs to redefine itself and the services it provides or it will go the way of the dinosaur.
06/04/2013 at 2:17 pm #16477drsnehamaheshwariOfflineRegistered On: 16/03/2013Topics: 110Replies: 239Has thanked: 0 timesBeen thanked: 0 times09/04/2013 at 8:37 pm #16481AnonymousPeriodontics is positioned to redefine the specialty based on emerging technologies, new data, etc. Specifically, wouldn’t it be interesting if periodontists performed genetic testing to determine a predisposed risk for periodontal disease (based on a patient’s parents or grandparents dental history). We would have a new role as genetic counselors. Another way the speciality could be redefined is the application of stem cells to reconstruct (regrow?) missing teeth. The technology is here now for this, but it will not be commonplace for many years, yet I believe in our lifetime that we will be involved with this. This does not bode well for the dental implant manufacturers. Lastly, we could become more medically based, screening for a host of diseases that are systemically affected by periodontal disease. You are aware of the usual suspects: cardiac, cerebrovascular, and respiratory to name the main ones. There are other systemic implications for untreated periodontal disease, so it is logical to postulate that the future periodontist will perform more medical screening. If this is the case, will be initiate certain medical treatments? Alan Winter, DDS
10/04/2013 at 6:05 pm #16486drsnehamaheshwariOfflineRegistered On: 16/03/2013Topics: 110Replies: 239Has thanked: 0 timesBeen thanked: 0 times17/04/2013 at 8:05 pm #16513AnonymousForensic dentistry usually refers to post-mortem remains that use teeth for identification. (This is the dental version of a medical examiner). To that extent that a population visits the dentist and has X-rays to be used as reference, forensic dentistry is valuable in all nations. In a global sense, if there are climatic changes that will cause larger and more frequent disasters, forensic dentistry will play an increasingly important role. For this reason, we should encourage all people to have baseline dental X-rays. Dr. Alan Winter
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