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Opinion Feedback DENTAL TRIBUNE | May 20104A AD From: Dr. Eric Hamrick Sent: Tuesday, May 11, 2010 To: Louis Malcmacher Subject: Where have all the periodontist gone From: Louis Malcmacher Sent: Tuesday, May 11, 2010 To: Dr. Eric Hamrick Subject: RE: Where have all the periodontist gone Good afternoon, Dr.Yowza. I wanted to briefly comment on your article. I am a prac- ticing, board-certified periodontist who has been in private practice for 26 years. I teach one day a month with the residents at the Medical University of South Carolina School of Dentistry, and also lecture on the topics of periodontics and implant therapy to study clubs both locally and nationally. I enjoyed your article, as I thought the title was very appropriate for our current time in dentistry. What I stress to periodontists, especially the youger ones, is the need for practice diversification. In my practice, here are some of the procedures I provide for my referring doctor’s patients: • Basic periodontal therapy, including the LANAP proceedure, where it is appropriate. • Mucogingival surgery, including a num- ber of different procedures on both teeth and implants. • Implant therapy for both edentulous and partially edentulous patients. This includes multiple types of bone grafting procedures, except for extra-oral grating (from hip or tibia). • PAOO, OR Wilkodontic surgery. • Uncovery of impacted teeth as part of orthodontic therapy. Where I think our profession has failed our patients the most in regard to provid- ing good, comprehensive care, especially periodontal care, is that dentists for the most part have lowered the standard in regard to how they define periodontal health. Just because someone has been through scaling and root planning doesn’t mean they are automatically stable. My experience is that very few dentists do a good re-evaluation to determine what has happened, and they just assume the patient is OK. As you mentioned in your article, some patients are better served by having the guarded teeth extracted and replaced with implants to reach the goal of periodontal health and stability: however, economics often dictates treating some questionable teeth in an effort to keep the dentition intact, which often requires surgery of some form, including the LANAP procedure. I think there will always be the need for periodontists, as I don’t think too many gen- eral dentists are going to tackle the entire list above. Although there is some overlap with us and oral surgeons, I simply say let the general dentist in any given area use the specialist he or she thinks is best for patients and their needs. Thank you for taking the time to read my comments. Sincerely, Eric Hamrick Periodontics of Greenville One Charis Drive Greenville, SC 29615 (864) 271-4330 info@periogreenville.com Either way, my mission is to get a discus- sion going and this article certainly did that. All the best! Thanks and have a great day! Louis Malcmacher DDS, MAGD 27239 Wolf Road Bay Village, Ohio 44140 (440) 892-1810 www.commonsensedentistry.com Hi, Eric, thanks so much for your com- ments. I have gotten a lot of responses to this article, many periodontists ranging from “periodontists should only do evidenced- based periodontal therapy and the rest is bogus,” that I was “crazy and lasers don’t work at all” and “LANAP is a bunch of hooey” to e-mails like yours. of implants. Periodontists typically strive to base treatment planning on scien- tific and clinical evidence, not on what is easier for the patient or profitable for the dentist. General dentists and periodontists live and practice in a society that craves immediate gratification, where patients often demand quick fixes with minimal effort or change in behavior. Both gen- eral dentists and specialists are under- mining their clinical expertise and pro- fessional authority when they succumb to patient-dictated treatment options. That is why the entire dental team of GP, hygienist and specialist must provide a united front in explaining to patients why oral hygiene is important, why they should make every effort to save their natural teeth (if appropriate), and why they should accept the recommended course of treatment, maintenance and the at-home regimen. We would welcome the opportunity to address this topic in greater detail in a Practice Matters rebuttal article. Regards, Samuel B. Low, DDS, MS, MEd President, American Academy of Periodontology Donald S. Clem, III, DDS President Elect, American Academy of Periodontology