Should General Dentists Even Be Extracting Teeth?
It is pretty safe to say that dentistry started because people needed diseased and painful teeth extracted. Looking back to ancient times, tooth extraction was one of only a few dental treatments performed.
Modern dentistry, of course, is now a highly advanced combination of art, science and technology that has given rise to numerous areas of specialization. Most general dentists work with and rely on collaboration with fellow dentists and specialists to meet the needs and desires of their patients. Complexities and advancements in dental treatment have segmented the practice of dentistry into compartments that are increasing in exclusivity.
General dentists remain trained, qualified and capable of providing their patients a wide range of dental treatments, however, many may not be offering the full scope of dental care in their dental practices. Why is this the case?
The History of Organized Dentistry
How did general dentists start to get squeezed out of the tooth extraction business? To answer this question, we first need to review the history of dentistry, particularly in the United States. Prior to the 19th century, dentistry was largely unorganized and unregulated.
The world’s first dental school, the Baltimore College of Dental Surgery, was established by Horace Hayden and Chapin Harris in 1840. Shortly thereafter, dental training began to incorporate consistent principles, techniques and philosophies that shaped modern dentistry.
You can be sure that extractions were an area of strong focus for early dental students. As science and technology advanced, areas of specialization began to emerge. The specialty of oral and maxillofacial surgery did not begin to take shape until 1918, and officially recognized by the ADA as a specialty in 1947.
Throughout dental history, dentists have been the primary oral health practitioners. They have historically provided the full scope of dental practice, including extractions. Until very recent history, general dentists have been relied upon by patients to meet all of their dental needs.
Why on earth would a dentist, trained and qualified to practice the full scope of dentistry, feel that he/she should not include extractions in the scope of their practice?
Because of the rigid delineation of dental specialties, such as oral and maxillofacial surgery and periodontology, specialists have tried to assume ‘ownership’ of exodontia procedures and marketed to create the illusion that general dentists are no longer as qualified to perform these procedures.
For political and economic reasons, or perhaps because other disciplines in dental school have expanded their share of the teaching time available, dental schools have de-emphasized surgical training for general dental students, leaving many of them largely underprepared to safely and efficiently provide these basic surgical services to their patients.
As a result of changes in dental culture and training, there are now many dentists who are inadequately prepared to provide this core dental service, but basic office oral surgery is still included within the scope of practice for general dentistry. Is this a freedom that could change in the future? It is up to today’s dentists to maintain their right to practice the full range of dentistry in order to meet the needs of their patients.
It is imperative to the profession that surgery be maintained as it should be, because without the ability to provide these treatments, access to care, particularly in under served areas, can be adversely affected. As of 2018, 42% of Americans do not see a dentist at least once per year. This is a number that is increasing, rather than improving, and is down from 38% in 2016. With a large percentage of the population only seeing a dentists about once per year, or less, it is imperative that when they do see a dentist, that dentist can provide the care that they need, when they need it.
Patients Expect to Receive the Treatment They Need From Their General Dentist
Today’s general dentists know that in order to build a thriving practice and increase patient loyalty, they need to provide their patients with more of the services they want and expect.
Patients want:
- Outstanding patient service
- Good value
- Convenient care, including easy access to the services they need
Patients expect to receive all of their dental care from their general dentist. With very few resources for appropriate training programs beyond dental school and specialty training programs, there is a need for a training program that makes it possible to meet the needs and expectations of today’s dental patients.
” There is a need for a training program that makes it possible to meet the needs and expectations of today’s dental patients”.
– Dr. Karl Koerner
The Koerner Center for Surgical Instruction
One notable proponent of surgical dentistry, Dr. Karl Koerner, recognized the need for a truly comprehensive oral surgery training program geared toward general dentists. He has made it his mission to teach oral surgery to general dentists, and has done so for thousands of dentists over the past three decades.
Dr. Koerner has worked to develop an opportunity that provides a complete and well-rounded educational experience. Many general dentists who recognize their patient’s need for these procedures, cobble together their own advanced training through attending a myriad of day and weekend courses, hoping to achieve proficiency. This method leaves holes in the educational experience and inhibits true proficiency in the art and science of dental surgery. Dr. Koerner co-founded the Koerner Center for Surgical Instruction, together with Dr. Dave Roberts, in order to fill those holes and equip general dentists to meet the oral surgery needs of their patients with safety, efficiency and confidence.
KCSI’s thorough and structured curriculum ensures appropriate didactic education, and combines this knowledge with clinical experience in a lab setting, and with live patients. The program provides a complete educational experience in four distinct continua. KCSI’s program consists of 24 hours of didactic and hands-on lab experience in Continuum 1, then over 100 additional hours via the self-paced online Continuum 2. Upon completion of these two modules, students can continue on to a live patient course in Continuum 3, and achieve certification upon critical evaluation of 30 cases and KCSI Board Review. The program includes over 200 hours of education, and includes evaluation for proficiency prior to certification.
General Dentists may attend a one day introductory course, or participate in the 24 hour Continuum 1 with hands-on lab, prior to deciding to complete the full program. For more information about KCSI and the important surgical training provided by the faculty, visit www.koernercenter.com.
Statistics source: American Dental Association https://www.ada.org/en/about-the-ada/ada-history-and-presidents-of-the-ada/ada-timeline
Your schedule is full including half an hour for an extraction in the afternoon – a lower first molar. As you get into the procedure… first, it won’t go numb. When it finally does, the tooth shatters with forcep pressure, roots are now broken off at the bone level, and things keep going downhill from there…. you’re struggling and the patient knows it. So much for a half hour! Eventually you make the call to refer the patient to a surgeon who can work the patient in that afternoon. But now you’re stressed out, your team is frustrated, and you’re running way behind which carries over to the rest of the afternoon. To top it off, your patient doesn’t have the same confidence in you as before and you feel defeated.