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  • Dr. David Alfaro

Continuing Dental Education

Dr. Dave, blog, Dr. David Alfaro, dentist, prosthodontist, dental implant, beer, pizza, richmond

So I received an email today from a dental implant company promoting a course. It is quite common for companies to sponsor lectures and courses in dentistry, with the ultimate goal being to introduce dentists to their products and services. Business is business, and along the way there is some education.

On one hand, this is a great way for dentists to gain experience and to earn those CE requirements, and unlike my friends in the medical field where company sponsored events are really getting cracked down on.......there is usually free food and free swag.

But on the other......these courses are getting way too advanced. The email I received today was for a two day course on lateral window sinus lifts. What in the world is that?

Let us talk about sinus lifts.

Dr. Dave, blog, Dr. David Alfaro, dentist, prosthodontist, dental implant, beer, pizza, richmond

When someone has their teeth removed, the tendency is for the supporting bone to "atrophy", or to shrink. Just like muscles get smaller if you don't use them, the jawbone shrinks if there are no forces being applied to them by the teeth. This poses a problem for future dental implant placement, especially in the back teeth area of the upper jaw. Just above the roots of these teeth are the maxillary sinuses. If you have ever had a cold or allergies, this is the area underneath your eyes that feels stuffed up and full of pressure.

The maxillary sinuses are air spaces within the skull, that are lined with a membrane. If someone has had a large amount of bone atrophy in the posterior maxilla, one of the options to regain the bone volume required for dental implant placement, is to graft INSIDE THE SINUS.

There are various approaches to this, but anyone who has been involved in sinus lifting procedures knows that this is not a minor dental procedure. When there is a large volume of bone required, or if the anatomy demands, the "lateral window" approach is often the technique that is chosen. To complete this, the gums are reflected off of the jaw bone, a chunk of bone is cut away from the jaw exposing the sinus membrane, and then the membrane is pushed up and bone is placed underneath it, in essence making the jawbone taller, thus allowing for dental implants to be placed.

This is a complicated procedure with some serious potential risks, including injuring large arteries (bleeding), and perforating the sinus membrane (chronic sinusitis).

Dr. Dave, blog, Dr. David Alfaro, dentist, prosthodontist, dental implant, beer, pizza, richmond

I perform quite a bit of complicated dental surgery and implant surgery, but there is no way in the world that I am going to start doing lateral window sinus lifts in my practice.....and I have assisted in dozens of these surgeries, in various settings. I understand that with the risks involved, and the complexity of the procedure, that this treatment is best left to be performed by people who have received extensive surgical training, and then also perform the procedure on a regular basis. It is not an "oh I do a couple of sinus lifts a year" thing. This procedure requires repetition to master.

Yet here I am reading an email promoting a course where dentists can learn how to do a sinus lift in two days.

This is unacceptable.

Dr. Dave, blog, Dr. David Alfaro, dentist, prosthodontist, dental implant, beer, pizza, richmond

It lowers the standards of training required to master complex treatments. Sinus lifts are not taught in dental school; they are too complicated. Many dentists have not done a residency of any sort so they have not been in operating rooms, and they have not really dealt with big surgical complications. Those who have will understand that the sinus lift is not a procedure for dentists who do not have extensive surgical training. Furthermore, the patient population in a general dental practice does not often require lateral window sinus lifts, so realistically, this treatment would be very infrequently performed in a general practice setting.

I have a very dental implant driven practice, yet I only have a handful of patients a year that actually require a lateral window sinus lift (which I refer out); there is no way that I would have the demand for this procedure in my office to be able to be performing it on a regular basis to truly be competent at it. Especially after a two day course. And there is no way in the world that I would be able to perform a sinus lift better than a properly trained oral surgeon or periodontist. Even graduates from GPR (hospital residencies) programs may have only done a couple of them during training, if they got to at all.

Dr. Dave, blog, Dr. David Alfaro, dentist, prosthodontist, dental implant, beer, pizza, richmond

The reality of continuing education today is that companies are promoting complicated procedures to be completed in the general dental office. Business is business. It is in all of these companies best interests to get more dentists using their products. If more dentists are doing sinus lifts, more elevators are sold. The more Invisalign that is being done, the more trays they sell. When people place implants on an angle, like is required for the "all on four" technique, we have to buy an extra thousand dollars in parts to correct this angle.....instead of maybe placing the implants properly. And anyone who has taken the "pin hole" course knows that tuition is insane and the instruments cost a fortune. Business is business.

This is not a new thing. Continuing dental education has always been product promotion driven. But things are getting way too complicated; it is no longer about what composite to use for molar fillings, or what core material makes the best foundation. The realm of general dentistry is getting expanded to include treatments that are very advanced. But do you want your dentist performing complex treatments on you because they took a course and bought a bunch of instruments, instead of referring to someone with more formal training? Complex surgery, orthodontics, dental implants, and even complex endodontics.....these are hard clinical skills to acquire, and are best taught in a residency. Yes, weekend courses and even multiple session programs are available for general dentists, but nothing replaces specialty training.

Dr. Dave, blog, Dr. David Alfaro, dentist, prosthodontist, dental implant, beer, pizza, richmond

Many general dentists are signing up for these complex courses. Many have completed some sort or residency, or have taken extensive continuing education. But some haven't, so they may not recognize the true complexity of the procedures (and products) being promoted. If a dental rep comes along promoting a course, telling the dentist "oh yea, come check it out, you will see it is easy to do and it will be a great service to offer your patients".......and the dentist has not completed a residency or very much CE, well they may just not have had the exposure to complex dentistry to really understand how challenging things are. And then there is the whole demand thing, are the dental needs of the patient population in a general dental office complicated enough so that the dentist is performing complex treatments with the frequency required to truly be comfortable and competent in advanced treatments such as sinus lifts?

Dental specialists have 2-3 years of training on these complex procedures, in a setting that is not driven by companies.....well at least the rules are stricter in university and hospital settings for companies to come and promote their products. This is a much more unbiased approach to learning complex dentistry than taking a course put on by a company who's goal is to push products and augment market penetration. Furthermore, specialists design their offices to be able to regularly provide complex dentistry, they spend their days dealing with advanced treatments and managing complications, and have a dental team well versed in specialty care. Repetition is key to mastering any skill.

If you have been recommended a complex treatment such as advanced dental surgery, orthodontics (including Invisalign), dental implants, or even complex root canals, consider having a consultation with a dental specialist.

Thanks for reading!

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