- Dr. David Alfaro
Whenever I meet someone new and they ask me what I do for work and I tell them that I am a prosthodontist, almost everyone asks me what that is. Then...when I explain that prosthodontics is a speciality that focuses on prosthetic dental rehabilitation using crowns, bridges, implants etc. for complex problems, people often respond....."well....isn't that what my dentist does?"
Part of my role as a Prosthodontist is helping raise awareness of what we do and what differentiates us from general dentists. This is tricky to do because no matter how things are worded, some people can interpret what I am saying as either me being conceited and arrogant, or demeaning to non-specialist dentists. Obviously that is not the goal.....I want people to know more about my specialty.
But..... there are differences between dentists and specialists that people should be aware of.
Let us talk about Prosthodontics.....again.
How does one become a dentist?
My path to dental school was not easy; all of my friends know that. I was a band geek and studied music for 5 years and then went back to SFU after I decided, well, that I needed a reliable career. And that was tough. After a half decade of jazz studies, where making music was my homework, getting back in the flow of real academia took some time. So my grades weren't so hot the first year back. It didn't really sink in that my poor first year would hurt me until I got rejected by UBC Dentistry ......twice. I mean, I aced my DAT, but my 3.55 GPA just wasn't up to their standards, and I guess I was not a good interviewee.
But Columbia University took me with open arms, and as I find so often in life, things happen for a reason: I became a dental specialist because of it.
Dental school in Canada and the US is 4 years long at pretty much every program, but they are all quite different. Columbia has an extremely challenging curriculum, one where we had to complete the first 2 years of medical school at the same time as our basic dental training. Once in the clinic, we were required to complete credits in various specialty programs, had extensive hospital training, and were encouraged to do externships at other schools in their specialty programs, to help us understand that complex dentistry is hard. Historically, over 95% of Columbia Dental students enter a residency after graduation, with most of my classmates having become specialists.
Not every school is like this.
Some programs are not even associated with a medical school, and traditionally, very few students complete a residency (at least locally). I have said it many times, but a dental residency is imperative to really start to understand complex dentistry. The reality of dental school is that it is a quick 18 months of clinical training where you get to learn how to do basic dentistry; fillings, a couple crowns, maybe a bridge, no implants, simple surgery, simple root canals, basic orthodontics......stuff for the entry level general dentist.
And believe me......dentistry can get way harder than that.
So how do dentists learn complex dentistry?
This is one of the major differences between a specialist and a general dentist; how complex technical and didactic skills are acquired. A general dentist can perform whatever treatment they feel competent performing, and many dentists are very skilled at complex dentistry. But they didn't get there overnight. It takes years and years of continuing education courses, and trial and error in the practice, to learn advanced techniques. It is really a lifetime process.
Dental specialists, on the other hand, dedicate a full 3 years (after completing dental school) to the acquisition of these complex skills. A typical residency program has thousands and thousands of hours of clinic time, with direct supervision from specialists. And then there is the reading. So much reading. Specialists have to understand how treatments and philosophies have developed, and the evidence (or often lack of evidence) behind them. This type of training is above and beyond even the best of continuing education courses, and it would take a decade to acquire that training while in private practice as a general dentist.
In Canada, most specialty programs require the completion of a Masters thesis, and then in order to be registered as a specialist, there is a crazy hard two part board examination. I completed my specialty program at UBC, and my Masters thesis focused on digital impression technology.
So....there are differences in how dental specialists and general dentists learn to perform and manage complex dental care.
What does a prosthodontist do?
There is also a big distinction between how dental specialists practise and how general dentists practise.
Most of you probably go to a general dental practice where the main focus of the office is hygiene and prevention. You get called in every 6 months, the hygienist cleans your teeth, checks your gums and looks for tooth decay, and then the dentist comes in and does a "hygiene check", and if they find something, you get scheduled for the treatment. The dentist spends his or her time going between many rooms, checking on patients, and performing routine treatments such as fillings. This has long been a successful way to provide good, efficient dental care to patients.
But....what happens when something complicated pops up? Can a dentist continue to perform hygiene checks, and be working "two columns" (or more), when a patient requires a treatment that deserves undivided attention for a long time? When something challenging must be completed, like crown and bridge dentistry or implant dentistry, modifications to the usual patient flow are then imperative, which complicates scheduling, and leaves resources underutilized....that is if the dentist chooses to give his or her undivided attention to the more complicated treatments in the first place.
This is often a debate in practice management: do you disturb your usual patient flow to take on more complex treatments in order to retain the potential revenue, or do you maintain your practice efficiency and refer out complicated dental work that will disrupt workflow? Nowadays it feels that everyone is keeping things in house. Is that really the best way to provide complex care?
As a specialist, I spend most of my days performing complex dentistry, and I have set up my office to operate in a manner that allows me to provide my patients with one on one care throughout their whole procedure. Yes, I have a small handful of patients who come to my office for cleanings and basic dentistry, but most of the time my day involves complex crown and bridge dental work, managing broken down dentitions, working with dental implants, and lots of surgery. Lots.
These are long appointments that require my undivided attention. Furthermore, patients are often nervous when it comes to any dentistry, let alone complicated dentistry. It really helps calm people down if the office is quiet, and they know that they are my team's sole focus, and that I am not running around distracted, coming in and out of the room while checking on other people.
As you can see, there are various differences between how dental specialists and general dentists practise dentistry, and it has nothing to do with who is better or who is worse, but more so to do with the type of dental cases that are the norm in their practices. Yes, general dentists can do what I do, and what other specialists can do, but specialists have focused their training and have designed their offices around the provision of complex dental care, and we spend our days doing hard stuff. This is very different from the average dental office, where the majority of patients just need a cleaning and a filling from time to time, and tougher cases may only come around a couple of times a month.
I hope that in reading this, you get a better understanding of what make me a dental specialist and what makes my practice is different than a general dental practice.....and that you don't consider it bragging about specialty dentistry or putting down non-specialists. If you ever have any questions about dental crowns, bridges, implants, veneers, surgery etc.....please feel free to come and have a consultation. I often work together with general dentists, so they shouldn't be offended if you want a second opinion.
Being well informed before beginning any treatment is the smart thing to do!
Thanks for reading!