Have you ever wondered what motivates a dentist to specialize in something like gum disease? I recently had the privilege of speaking with Dr. Benjamin Young, a periodontist in San Antonio, Texas, and asked him a few questions about the periodontal specialty. He graciously provided us the answers produced below.
1. Tell us about your dentistry background, and how you became involved in periodontics.
My grandfather was a businessman in California and he decided that his two sons should go into either medicine or dentistry for a number of reasons. First, he thought they would have successful lives with less of the hardships that he faced working up the corporate ladder. So my dad went into dentistry and his younger brother became a physician. I was born the second of four kids and from as early a time as we could remember, our parents strongly recommended careers in medicine and dentistry. As a result my younger sister and I are dentists and my brothers are physicians.
Originally, I was heading toward medicine. I don’t know why really except that it seemed a broader field. One night when I was in the middle of high school, my dad came into our room (I shared a room with my two brothers) and sat on my bed. He told me that he had been watching me and taking into account my interests. Compared to my two brothers I was outgoing and fun-loving. They were both more single-minded and studious. He thought for this reason I would make a good dentist because dentists seem to carry more interests outside their professions, whereas physicians are tied more to what they do. It isn’t uncommon for those in medicine to spend 60 to 80 hours a week at work including getting up at all hours of the night in order to care for very sick patients. Dentists on the other hand enjoy weekends. They have time for families and hobbies. This argument made a lot of sense to me so I began to look at dentistry more seriously. Added to this was the fact that my first real paying job was working as a dental assistant for my dad. This allowed me to see dentistry up close and I liked what I saw.
My father was an endodontist and my plan through dental school was to become one myself so I could return home and join my dad in practice. To get through dental school, however, I had to apply for a military scholarship. My brothers were in medical school around the time I was in dental school and my sister would soon come after me. Consequently, there was no way my dad could pay for all of us through our professional educations. So my two brothers obtained Air Force scholarships that paid their ways through school and I was fortunate enough to be accepted into the Air Force as well. To be honest, dental scholarships in the military in the late 70’s were rare. I applied to Army, Navy and Air Force two times each before finally one of them – the Air Force – accepted me.
Of course following graduation from dental school I entered active duty and took a one-year general practice residency that enabled me to do rotations through all of the specialties of dentistry. I didn’t like periodontics in dental school because it seemed boring. But in my rotation we had more time to study the responses of patients to treatment, and I began to appreciate how the management of chronic disease and the surgical reconstruction of lost tissues really improved the quality of life and the outcome of dental care for patients in general. I discovered that what I missed in dental school was the time necessary to see improvement in care. But even after completing this residency I was still thinking I was going to seek specialization in endodontics.
My next assignment following the residency was in Germany. And here is the real reason I eventually decided to become a periodontist. A fellow resident and I reported for duty on the same day and met our new commander. He introduced us to the clinic and told us which treatment rooms we would have. He also told us that he needed one of us to act as the clinic’s endodontist and the other to act as the clinic’s periodontist. Root canals require x-ray and my friend’s treatment room happened to be across the hall from the x-ray machine. My room was 50 yards down a long hallway. It was at that moment I volunteered to take on periodontics. So as silly as it may sound, much of the reason I became a periodontist has to do with a long hallway. The other reason was because my dad suffered a heart attack and retired before I could come home and join him. Since it would no longer be possible for me to work alongside my dad, I stepped back and asked myself what I enjoyed doing the most. The answer had become periodontics.
2. How does periodontics differ from general dentistry?
Periodontics is a sub-specialty of dentistry and periodontists take on the care of the most complicated conditions involving infections in the gums and bone surrounding teeth. When general dentists fail to get the response to care they hope for or when they encounter a confusing presentation of symptoms they then refer to periodontists.
3. What types of procedures does a periodontist perform?
Unless someone wants to become a periodontist, a list of procedures is of little value. Suffice it to say that the specialty is focused on the health of the supporting tissues around teeth. This includes the gums (gingiva), bone, periodontal fibers and the surface of the root of the tooth (cementum). If only the gums become inflamed, swell, are tender and easily bleed, we call this gingivitis. If the gums, bone, periodontal fibers that attach between the bone/gums and root, as well as the cementum surface of the tooth become involved then we call this periodontitis.
Essentially it takes two types of people to treat periodontitis. This first and primary person is the patient. Whatever the patient does every day has more of a long-term effect on the outcome of care compared with what anyone else does every once in a while. The patient has two jobs. The first job is plaque control and in the treatment of periodontitis, this is 80% of what the patient needs. But this leaves another 20% which goes to the patient’s second job. I call this “Appointment Management.” The patient has to take his or her teeth and gums somewhere to get something periodically and the patient’s second job is to know what they need and when and where to go to get it. This will be necessary for the rest of the patient’s life.
The other person needed to treat periodontal disease is a dental professional. The first person a patient should see is usually a general dentist. This individual can determine how advanced the problem is and help the patient obtain the appropriate level of care. If the problem is primarily gingivitis, then the dentist will likely refer the patient to a dental hygienist for a cleaning and plaque control instruction. If the condition is early periodontitis, the general dentist along with the help of the dental hygienist will be able to treat this effectively. Ultimately the patient will be placed into a supportive care program with a recommended interval of documenting examinations (where pockets are measured and bleeding sites noted) and interceptive low-impact care is provided. For patients with advanced disease, it is wise to have a periodontist involved.
Finally, in instances where bone loss or tooth structure loss is too advanced, the state of the art today is to remove teeth and place dental implants. Essentially a dental implant is an artificial root that then becomes the platform for an artificial tooth or teeth. Dental implants should not be considered until general infections in the mouth are well controlled. For this reason, periodontists are trained to place dental implants and manage periodontal disease at the same time. They also are adept at the long-term management of the supporting structures around dental implants and at times deal with managing infections and bone loss around them as well.
4. When should patients be referred to a periodontist?
Dentists usually know when it is time to refer a patient to a periodontist. Sometimes patients are reluctant to go. This is usually a big mistake. My advice to all dentists is to get to know the periodontists around them. Get an idea as to each of their treatment philosophies. They, as well as the other members of their team, have to feel comfortable that the periodontist will support the overall periodontal therapy program of their office. The bit of coordination this requires between the two dentists and their teams will pay huge dividends later on as the quality of patient care and morale improve.
For patients who have concerns and think they may be gum-related, they should feel free to seek the advice of a periodontist directly. Most specialists I know try to keep initial patient encounters as low in cost as possible because they understand the importance of patients feeling comfortable moving forward into care. Personally I find it very useful to have time set aside in my week that is open for brief consultation visits at no charge. These enable patients to get initial concerns and questions answered, many of them having to do with insurance. For practitioners, these no-fee consultations benefit in that patients are not unhappy in these first meetings because they are worried about what this encounter is costing them. Also it reduces the calls where patients simply want to know what something will cost, when neither the office or the patient really know what the problem truly is as well as what are all the reasonable treatment options to solve the problem. It is not uncommon for me to find that what a patient thinks she needs to more than what is truly needed, so it is always best to meet and allow someone to look at the situation before providing fee estimates.
5. What is the NeXsmile procedure?
The NeXsmile procedure is new technology that was developed in San Antonio, Texas. The original clinical proof of concept and business model won a national award from Frost & Sullivan in 2011 because it is a way for people who face the loss of all of their teeth to be restored rapidly with incredible accuracy and at lower cost when compared with similar methods. NeXsmile uses Cone Beam CT scanning combined with rapid manufacturing processes to make and install beautiful strong teeth on a platform of dental implants. Because it is a digital method of manufacturing it opens up the opportunity of creating a virtual dental laboratory as well as the ability for restorative dentists, surgeons and even patients to see 3D modeling of the head and plan procedures without having to leave their homes or offices.
6. What advice do you have to offer to patients with gum disease?
See your dentist right away and don’t wait until it hurts. Remember, most periodontal disease has little to no pain associated with it. This means people can go for years before teeth become loose or painful abscesses form and “force” them into a dentist’s office. Unfortunately, usually when pain is the reason people finally go and have the problem checked out, the teeth may not be salvageable.
7. In your opinion, how can patients best prevent gum disease?
Some people are susceptible to periodontal disease so they may not be able to prevent it. Again it is best to have routine dental check-ups to have this checked out. And as I stated above, plaque control on a daily basis is important. Don’t think you understand how to do this because you were taught by your parents when you were six. Dental hygienists are a wonderful resource for this kind of information.
Thank you, Dr. Young, for sharing this helpful information with us! Don’t forget to check out his website and blog for more information about periodontics.