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  • Dr. David Alfaro

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Dr. Dave, Dr. David Alfaro, Prosthodontist, General Dentist, Vancouver, Richmond BC

Ok I know that I have been spewing out a quick succession of nerdy dental posts over the last couple weeks, so I apologize if it is getting a little monotonous. But things just keep happening that I need to write about immediately or the moment is lost.

One of the reasons that I write this blog is to help educate people about the role that dental specialists play in the provision of dental care, especially for my own specialty, prosthodontics. People really do not know what a prosthdontist is or what we do.

As I mentioned, I recently joined a Facebook forum for dental specialists, and I decided to take a chance and share my blog with the members of the group. I figured that I was writing about topics that the members might relate to, and ones that they may want to share with friends, colleagues and patients.

Again, to my surprise, a specialist in the group made a comment to me that made me think that not even people in my community know exactly what my role is as a prosthodontist. If you have been reading along, you have seen that I write about all sorts of topics in dentistry and health care, not just limited to my own specialization. An orthodontist in the group mentioned to me that he was surprised that I would be writing about orthodontics, and that it would be like he writing about zirconia, kind of as if I was stepping on his turf. Hey man! We are teammates playing on the same side.

As a prosthodontist, I NEED to know what an orthodontist does. It is a cheesy sports cliche, but when patients present to my office and require the help of other specialists, someone has to be the "quarterback" of that plan, and it is often me, the prosthodontist, who takes on that role.

Let us talk about interdisciplinary dental treatment.

What does interdisciplinary dental care mean?

Dr. Dave, Dr. David Alfaro, Prosthodontist, General Dentist, Vancouver, Richmond BC

When someone presents to my office for the first time, the first step of the process is to perform a comprehensive examination (and history) and to put together some treatment options for them. Many patients will have a diverse problem list, with findings that could include tooth decay, gum disease, necrotic teeth (dead teeth), missing teeth and crooked teeth or misaligned bites, in addition to many other things.

A patient with these problems will be presented with a range of treatment options, with the preferrable route being the comprehensive resolution of the concerns in a coordinated manner. Complex treatment plans such as these could therefore require multiple advanced treatments such as gum surgeries, root canal fillings, dental implants or orthodontics.

Dr. Dave, Dr. David Alfaro, Prosthodontist, General Dentist, Vancouver, Richmond BC

Now this could be done in one office by one person, and increasingly so, this is what is happening in Vancouver. But it is not necessarily the best approach, and it is definitely not the approach I take; I refer. Of course I learned how to do all aspects of dentistry during dental school, but this was at a very superficial, entry level. In dental school we focused on cleanings, fillings and simple prosthodontics, endodontics and minor dental surgery. We do not get advanced training in complex care in dental school.

So I refer.

I know that an orthodontist is going to give my patient a better result than I can if my patient needs braces. I know that if I send my patient to an endodontist, that root canal filling will be completed quickly and under a microscope so there will be a miniscule access opening and maximum conservation of tooth structure. I don't do gum grafts; that takes years of training to really get down.

Yes, it costs more money up front, and my patients may have to go to various other specialists to get their care completed, but, in the end, I can be comfortable that I did everything I can in order to get the patient healthy, with the highest predictability possible. I do not want to be fumbling around with Invisalign in my office, or doing a root canal without a microscope, or "laying a patch" on a botched gum graft. That is not specialized dentistry. I refer.

I have a network of specialists and general dentists that I work with as a team: interdisciplinary dental care.

What is the prosthodontist's role in interdisciplinary care?

Dr. Dave, Dr. David Alfaro, Prosthodontist, General Dentist, Vancouver, Richmond BC

A complex treatment plan that involves multiple specialists needs to be coordinated by someone, and that person is often me, the prosthodontist. When multiple treatments are required and they are to be performed by multiple doctors, they need to be planned and sequenced in a manner that is logical and healthy for the patient, and since the prosthodontist is the one who will be finalizing the treatment, it makes sense for us to be the ones driving the treatment plan.

So as a prosthodontist, I do not just need to know the finer details of my specialization, I need to know about the treatments that my colleagues provide. It is imperative that I understand the predictability of orthodontic treatments, including invisalign. I need to know the limitations, complications and challenges that periodontists face when performing soft tissue grafting procedures. I need to know whether or not a patient needs a hip graft and a referral to an oral surgeon with hospital privileges. You get my point.

Dr. Dave, Dr. David Alfaro, Prosthodontist, General Dentist, Vancouver, Richmond BC

A major component of my specialty training was geared towards just this, being the quarterback of comprehensive treatment plans. We had guest lecturures from all specialities in my prosthodontic classes, we worked on clinical cases in coordination with other residents, and we had a weekly "interdisciplinary treatment planning" course where all of the speciality students were involved and had to present cases for discussion. This seminar was a new concept to the graduate dentistry program and man did it get off to a tough start. Egos and pride got in the way of teamwork. But slowly, it became a very productive, imperative part of the program because we really got to see how the other specialists evaluate and plan their cases. This is essential to know as a prosthodontist.

Of course I did not get to learn the biomechanics of orthodontics, or the difference between different file systems for endo, but we focused on the diagnosis of patients, and the predictability and complications related to treatments.

Prosthodontics is not just about zirconia and emax and vertical dimension.

Prosthodontists are specialists who have to understand each and every other specialization.

So yes, I feel comfortable writing an entry level article on the pros and cons of clear aligners. Every prosthodontist should.

Can't my general dentist do everything?

Dr. Dave, Dr. David Alfaro, Prosthodontist, General Dentist, Vancouver, Richmond BC

Of course they can. But should they?

Complex dentistry is difficult and being good at all aspects of dentistry is very challenging at takes years and years of continuing education. Dental specialists have the advanced training and the experience required to take on more complicated scenarios, and believe me, treatments such as orthodontics, dental implants or endodontics can be very challenging (amongst other things as well).

We are used to seeing specialists in so many other fields, but somehow dentistry is bucking the trend and dentists are deciding to keep everything in house. Lawyers, accountants, physicians, tradespeople, chefs, the beauty field; all of these have specialties that you go to. You don't see a divorce lawyer for a real estate purchase, you don't get your nails done by your hairstylist who sometimes does nails, and you certainly don't ask your physician for a rhinoplasty.

So why would you expect your dentist to be an expert in braces, root canals, extractions, grafting, implants, crowns, bridges, veneers, dentures?.......the list goes on and on.

Dentistry is a broad field and is technically challenging. When my patients require complex dentistry, I rely on interdisciplinary care. By sending my patients to other specialists, I know that they will be getting the best care available.

Doesn't your smile deserve a specialist's attention?

Thanks for reading.

Dr. Dave

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