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    Regarding the lack of definitive treatment for “Periodontitis the Disease” because of untimely referrals by the GP office, this topic has previously been addressed on numerous occasions, to no avail.

    If we subjectively analyze the situation, we are very much to blame. We blame the schools, the AAP, the corporations etc. and of course, each entity is a problem. However, as I have previously written, how often do we see a basic “Periodontitis the disease” program at major meetings? seldom!

    For those of us who run study clubs, when did you last have a structured program for dentists and hygienists on fundamental periodontics? For those on program committees, why are we almost embarrassed to promote periodontal CE (and not esthetics or crown lengthening) for inclusion on CE programs.

    I think we all need to look in the mirror and see what we can individually do to promote the value of periodontics and comprehensive care dentistry within our communities through structured CE. This also includes teaching at dental schools, graduate programs and hygiene schools.

    I look forward to your thoughts.



    I always enjoy your passion for diagnosing and treating perio. You are on target. This has to be our focus.



    Yes, I agree with Mark and Colin. However, I believe that we are subject to, and will thus fail because of a few features common to all humans. Those features are best presented by a few well know sayings. They are:

    1. We don’t know what we don’t know

    2. You can lead a horse to water but you can’t make it drink

    3. When the student is ready, the teacher shows up

    Every time I hear a generalist say, “I do my own Perio”, I want to scream. This is a reflection of feature #1 and I say that the dental schools teach dentistry as though it is a trade school; passing on technical rather than conceptual education – which results in a dangerous degree of ignorance and thus inaccurate focus about Periodontitis and its treatment. We are all so techniques-performance oriented therefore often mis-apply technique. I see this feature while reading our own list-serve’s polylogues.

    Even if four-year educated dentists were more knowledgeable, practice is a procedurally/dollar-based endeavor for many dentists as opposed to a more altruism-based practice of doing the best for the patient. Although I believe that all dentists will state that their first objective is to treat the patient well, I believe that many are not critically honest about what drives them and what they do. I believe that the individual practitioner is culpable regarding this, not Periodontists.

    I submit the following with a caveat: After 30+ years of running study clubs, conducting CE course, relating to individual practitioners about casework in a pedagogical manner, I determined that I have been relatively incapable of shifting practitioners toward the goals that we are discussing and feel are ideal. The caveat: I have learned over the decades that, I am not the most capable of people; not the superman I once felt I was. So, maybe my ineffectual attempts are related to my inabilities and others have been much more effective.

    Would any of you have an RCT performed by a generalist rather than a fully equipped (intellectually and armamentarium-wise) Endodontist? Would you have a LaForte Down-Fracture performed by a generalist? Would you have a crown lengthening surgery performed by a generalist or a trustworthy Periodontist? That’s in the technical realm. Let’s shift to the intellectual realm. Who would you rather have monitor your periodontal status if you had a history of Periodontal Disease – a generalist or a Periodontist? Who would you want to diagnose a tooth with a questionable endodontic response? And, so forth. What would many of our general-dental colleagues do regarding these hypotheticals?

    Is there a solution for this problem or is that the way the world is and will be for many years to come?



    I love this polygogue so thanks for the mind fodder.
    I think we all understand your frustration -think we all share this common experiences and feel the same way.
    I do think however that it is hard to paint all GP’s with the same brush-it is certainly not fair to those that do not practice that way. The problem is that most do and we are dependent on the GP market so our survival is dependent on the market place. We wish we were in control because it would increase our level of comfort. But, we are not an that is upsetting.

    What you say about our training programs is true.
    What you say about what drives the average human being is true and if we look closely…the direction of dentistry is headed towards more corporate dentistry to increase access, drive down costs and will continue to promote the piece meal fix it up, one tooth at a time, often shitty dentistry that is so frustrating to see. But that is what continues to happen much to our dismay. You are who you are because of what you believe and because of what you value. That is what I love about you.

    The other side of the coin is that there are some GP’s that fall onto the right side of the bell curve. 5-10 %of the market. A small percentage and we are all competing to find them. As the model of delivery changes they will be pressured more and more as we are. I don’t think the there are any new answers-don’t think there is a solution beyond what we already know and do-and the pie is shrinking. Tomorrow will likely not look like yesterday and we don’t like it.

    I once heard Lou Holtz interviewed after winning a championship and the reporter asked him how he was able to motivate his players so well.
    Lou said that he did not consider that he was able to motivate anyone.
    When the reporter went on to question his track record of success and asked how Lou could possibly think that he did not motivate anyone and if Lou really believed that this was indeed true asked how he managed to be so successful.

    Lou replied, “I find people that are already motivated.”

    Those people are harder and harder to find just like a great employee or in your case… a great woodie.
    I think our entitlement culture tends to promote victimization and none of us is immune.
    We sacrifice and work our asses off-we sacrificed to become periodontists, we sacrifice to be the best we can be in time, money and emotional output and this issue strikes at the heart of who we consider ourselves to be in the world. And, it’s just not fair!

    Tony-I know you know this story but for those who don’t-here goes.

    The Boy and the Starfish
    A man was walking along a deserted beach at sunset. As he walked he could see a young boy in the distance, as he drew nearer he noticed that the boy kept bending down, picking something up and throwing it into the water. Time and again he kept hurling things into the ocean.

    As the man approached even closer, he was able to see that the boy was picking up starfish that had been washed up on the beach and, one at a time he was throwing them back into the water.

    The man asked the boy what he was doing, the boy replied,”I am throwing these washed up starfish back into the ocean, or else they will die through lack of oxygen. “But”, said the man, “You can’t possibly save them all, there are thousands on this beach, and this must be happening on hundreds of beaches along the coast. You can’t possibly make a difference.” The boy smiled, bent down and picked up another starfish, and as he threw it back into the sea, he replied.

    “I made a huge difference to that one!”
    ~Author Unknown~

    I say -be who you are committed to be and make the biggest difference you can to everyone you can when ever you can and stop being pissed off (though it is better to be pissed off than pissed on)

    that the world is treating you/us/patients unfairly. It is… but so what? That does not mean to stop being an idealist and living your values every day.

    It is healthier to be grateful for what we have build-for the gifts we have been given and the opportunities that we have made and the opportunities that we have been given.

    If this sounds Pollyannaish so be it but an attitude of gratitude versus what don’t have or wish we did it goes much farther every day towards being happy and satisfied.

    I am grateful every day because I know it can be taken from me at any moment without warning.

    Remember what Ed Rosenberg always told us when we got too damn serious about a millimeter of tooth or tissue: “They’re just F—-ing gums.”

    I know it is more than that -I know that is more to it than that and I know that you know the difference that you have made in the world. Just keep going!


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