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The Transformation of
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
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
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
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.
Achieves More (TEAM)
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.
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.
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
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.
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.
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.
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
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
At your option, we can place
fixtures & provisional restorations, permitting case completion
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
Patients with High Expectations
Diagnosis and Treatment
Surgical therapy for external root resorption or
Dr. Fox is available
for coordinated therapy with other dental professionals, private consultation
with colleagues regarding their patients, second opinions, or management of
referred patients - either for comprehensive care or isolated procedures.
Having a special interest in bringing the latest advances in dentistry to
patients, Dr. Fox has cared for discerning people from all walks of life in his
many years of clinical practice.
be assured that the professional reputation and practice integrity of every
referring colleague is always carefully preserved, and faithfully supported.