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Information for Doctors

The Transformation of Dental Practice

Clinical dentistry has undergone a dramatic transformation in recent decades.  Virtually all dental care was provided by general dentists sixty years ago, enlisting the aid of specialists in oral surgery or orthodontics, as necessary.  In the ensuing years, an explosion of knowledge and clinical techniques gradually changed the dental profession.

Dentistry evolved into a complex clinical discipline, subdivided into general dentistry and the specialty areas of practice all dentists are familiar with. General dentists expanded their skills and knowledge to keep up with the rapid pace of change.  Patients benefited from improved methods and new treatment modalities.  Modern general dentists now perform a wider variety of procedures, and more complex care, to their patients than was previously possible.  At the same time, specialty level care has expanded dramatically as well, continuing to offer solutions for many problems beyond the expertise of general dentists.

The Role of Specialists in Dental Care

Although some unusual general dentists (by virtue of their combined talent, special experience, and intensive continuing education efforts) can perform some procedures at the level of a specialist, general dentists can't duplicate the expertise of specialists.  While general dentists continue to use their expertise as primary care providers (delivering most of the country's dental care), they have increasingly referred patients needing advanced care or treatment for more complex conditions to dental specialists.

Of course, every dentist (including specialists) must decide when it is appropriate to treat each patient, and when to refer them to another doctor.  This decision should be based on an honest appraisal of skill levels, patient condition, and preferences of treatment by each clinician.

Putting the best interests of the patient first remains integral to the making the decision of when to refer, and how to effectively manage therapy provided by one or more clinicians to ensure an optimal result for the patient.

Together Everyone Achieves More (TEAM)

Contemporary dental medicine has made dramatic changes in health, function, comfort, and appearance possible.  Achieving the current standards of clinical care often requires the assembly and coordination of a team of one or more dental specialists by the modern general dentist.  In more complex cases, the primary care doctor has become a key member in the multidisciplinary treatment team.

There are areas of overlap in the scope of general and specialty practice (as well as overlap in clinical procedures performed among the different dental specialties), which can be a source of confusion to patients, and concern among doctors.  We believe ethical clinicians will operate within the scope of their education, training, expertise and experience in the interests of providing the best patient care. We also think professional colleagues devoted to serving patients will understand the unavoidable overlapping of different clinical practice areas, support colleagues in this regard, and educate patients with diplomacy as the need arises.

In that context, we also believe that dentists following old patterns of practice - where referrals are not made, or where specialists are not used to compliment the generalist's therapy - are unlikely to succeed in providing the best care on a consistent basis for all patients. Following this outdated model of therapeutic management can adversely affect both patient health and goodwill. Doctors who understand the importance of coordinating therapy among various experts in specific areas of dental medicine must possess or acquire the skills needed to form an effective team.  Doctors who don't adapt will be compelled to limit their patient's access to multidisciplinary or specialty procedures, to the detriment of their patients - and their practices.

Clarifying Prosthodontics as a Clinical Specialty

Prosthodontics, like the other clinical specialties, is a referral based practice offering general dentists (including those with advanced skills) support in difficult prosthetic situations; either for isolated problems or more comprehensive care, as deemed appropriate by the referring doctor. Many dentists have misconceptions about prosthodontics as a specialty, perhaps because prosthodontists are few in number compared to other specialties.  Regrettably, most dental schools have not traditionally taught students how to treat patients in conjunction with a prosthodontic specialist.  General dentists are often concerned about the overlap between their own services and in those provided in the prosthodontic specialty practice.  Clearing up some common misconceptions may be helpful to clinicians.

There is some overlap in the types of procedures offered by prosthodontists and general dentists, but prosthodontists typically manage more complex patient problems. Prosthodontists also provide specialty level care for complex conditions which are beyond the inclination or ability of virtually all generalists to treat.

The situation of overlapping procedures between prosthodontists and general dentists is not unique. It is no different from treatment of simpler cases of periodontal disease, endodontic therapy, extractions, or pediatric patients by general dentists.  Providing such services does not preclude referral to periodontists, endodontists, oral surgeons or pedodontists - as the situation warrants.  It would be misguided for generalists to believe they can replicate the special skills, experience and knowledge that prosthodontic specialists offer; or for general dentists to undertake  treatment of problems prosthodontists are better able to manage.

Our Policy for Referred Patients

Like other specialty practices, our office provides specialty level care to adults contacting us directly, without a referral from another dentist. We also refer to other dentists when it is best for the patient.

Please note, however,  that patients who are referred to Dr. Fox by another dentist are not eligible to receive all of their care with Dr. Fox, unless the referring dentist has explicitly granted his or her permission to our office. 

We believe this policy is an expression of both our professional integrity, as well as our respect for professional colleagues. We would rather refuse to care for a patient, than violate this policy.  This policy is made clear to patients in our office, and is clearly stated on our website page for the general public which explains why a dental specialist may be needed. In the event that this issue is raised by a patient, we routinely reiterate our policy to the patient and also apprise the referring doctor of the conversation.

 

Doctors who extend us the privilege of participating in their patient care know we value their confidence in our professional integrity, and they realize mutually beneficial referral relationships require we uphold high standards in this regard. Thirty-seven years of successful referrals to Dr. Fox with collaborative care substantiate the consistency of his words and actions in maintaining referral relationships.

 

Should you have any concerns or questions about this issue, please feel free to discuss them with us.

A Different Resource for Your Team

Dr. Fox, and the resources of his special practice, are available to assist professional colleagues in developing optimal strategies for improving their clinical practice and meeting the needs of their individual patients.

As a dual specialist in prosthodontics and periodontics, Dr. Fox is qualified to offer you and your adult patients unusual expertise in:

	Treatment of failure in the restored dentition
	Temporomandibular disorders and craniofacial pain
	Complex Dental or Periodontal Problems
	Esthetic Dentistry and Patients with Difficult Esthetic Concerns
	Restorative & prosthetic dentistry for patients with periodontal diseases
	Occlusal pathology, Loss of Vertical Dimension, or Posterior Bite  Collapse
	Oral rehabilitation, Periodontal-Prosthesis
	Implant Dentistry At your option, we can place fixtures & provisional restorations, permitting case completion  with a straight forward crown impression & insertion in your practice. Surgical or prosthetic phases of therapy can be provided
	Coordinated Therapy with Other Periodontists (including those placing implants)
	Diagnosis and Treatment of Oral Diseases and Conditions
	Challenging Denture Cases
	Patients with Medically Complex Conditions
	Xerostomia Patients
	Patients with High Expectations
	Diagnosis and Treatment Planning
	Surgical therapy for external root resorption or periapical disease