Periodontics as a Specialty
Here Today, Gone Tomorrow? Musings of a 25-Year Traveler
I entered my periodontics training program 25 years ago, in July 1984. My mentor, Dr. Gerald Bowers stated (too often to count) that the definition of success in periodontics is, “the preservation of the natural dentition in health, comfortable function, with acceptable esthetics, for the life of the patient.” I have to wonder how often this definition is repeated in training programs or elsewhere in this era of titanium-supported dentitions? My purpose for writing this is to focus on the traditional view of success in periodontics and my view of what is happening to the specialty today.
First, three definitions will help set the stage:
- Commodity: basic items or staple products.1
- Commodify: to treat as or make into a mere commodity.1
- Specialty: a branch of medicine or nursing (or dentistry) in which the professional is especially qualified to practice by having attended an advanced program of study, by having passed an examination given by an organization of the members of the specialty.2
When I completed my training, the common use of endosseous root form implants as a routine mode of therapy was in its infancy. Early placement techniques required special surgical training and preparation that was normally within the purview of periodontists and oral surgeons. Over the years, for a number of reasons—some scientifically based and others based on marketing by implant vendors and clinician demands—the surgical placement of implants has moved from the confines of a specialty item to that much more of a commodity. If periodontists, oral surgeons, endodontists, prosthodontists, and general dentists all place implants, how special can that be? To be sure, there are some situations where complex bone augmentation techniques are required, but how many of those patients are out there and can they afford the fees involved?
The recent focus in periodontics and periodontics training programs has been on implantology. Ask any program director what residency candidates are interested in. Most candidates ask how many implants they can expect to place, will they do sinus lifts or other types of advanced grafting, and other implantology-related questions. My guess is that there are few candidates who want to know if they will be proficient in diagnosis, nonsurgical therapy, control of inflammation, and resective surgical procedures when they finish their programs.
For the past 12 years, it has been my privilege to teach in both major courses that prepare periodontists for the written and oral parts of the certification exam of the American Board of Periodontology (ABP). As part of the preparation course for the oral examination, candidates are challenged by “mock board” clinical scenarios involving the treatment of periodontitis and implant-related issues. It is both my perception and the view of other colleagues that many of the young clinicians know a lot about growing bone where it has never been grown before but are woefully ignorant of the diagnosis, microbiology, immunology, treatment planning, and proper treatment of the aggressive and chronic forms of periodontitis in the natural dentition (redundancy intentional). As implants continue to become commodified, where does that leave the specialty of periodontics?
A second assault on the specialty is in dental education. Many schools have moved to a general practice model for the clinical years. While some schools have maintained good general dentist/ specialty interactions, all too often the specialties, not just periodontics, have been marginalized.3 This statement will be widely refuted by deans and general practice leaders of these schools; however, my experience interviewing candidates for AEGD/GPR programs and subsequent interactions with these residents from several schools using this model supports my assertion that many dental school graduates have minimal experience in clinical periodontics. If new general practitioners do not have a sound biological foundation in periodontics and cannot diagnose and treat or refer when appropriate, what does that mean for our patients and the general practitioner’s ability to discern between effective therapy and techniques with minimal or no scientific validity?
One of my colleagues summed it up best: “We’re a specialty in terrible need of an identity.” 4 I agree. Our identity should be as a specialty focused on diagnosing and treating oral acute and chronic inflammatory diseases of the periodontium and mucosa, educating our patients on the relationship of oral inflammation to the rest of the body (not necessarily a causal relationship, but that is fodder for another commentary), and helping them to maintain their natural dentition with the titanium dentition as an alternative, but not the default choice.
1. Webster’s New World College Dictionary. 4th ed. Cleveland, OH: Wiley; 2002.
2. Mosby’s Medical, Nursing, & Allied Health Dictionary. 6th ed. St. Louis, MO: Mosby; 2002.
3. Glickman GN. Beyond the crossroads: educators at the controls. J Endod. 2009;35:751.
4. AAP News. American Academy of Periodontology, Chicago, IL: April-June 2009;8.
About the Author
Francis G. Serio, DMD, MS, MBA
Professor and Chairman
Department of Periodontics and Preventive Sciences
University of Mississippi School of Dentistry
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