The other day I was talking with a friend, and he told me, “I have a great dentist.  He does EVERYTHING – root canals, orthodontics, gum surgery, even wisdom teeth.”  I’ve heard comments like this before, and they make me realize that there is a misunderstanding among the public when it comes to dentistry, which does not exist in medicine.
No one would ever say “I have a great family doctor.  He does EVERYTHING – brain surgery, appendix removals, even liposuction.”  Most people understand – at least in medicine – that no one can be an expert at everything.  Family doctors have their areas of expertise, but what makes a family doctor truly great is in knowing when to refer you to a specialist to get the best possible care.  The same is true in dentistry.
Many people are unaware that specialties exist in dentistry.  Dental specialists are:
  • Orthodontists (experts in straightening teeth, correcting bites, aligning jaws)
  • Oral Surgeons (experts in removing teeth, surgery on the jaws)
  • Endodontists (experts in root canals)
  • Periodontists (experts in treating gum disease)
  • Pediatric Dentists (experts in treating children, patients with behavior problems)
  • Oral Radiologists and Pathologists (experts in diagnosing complex problems of the jaws)
These specialists are dentists who, after finishing dental school, completed another 2-4 years of additional training, specifically in managing their area of expertise.  Thus, an orthodontist has MUCH more training than a general dentist in using braces and Invisalign.  An oral surgeon has MUCH more training at removing wisdom teeth and performing surgery on the mouth.  And so, patients who require these procedures would be well-advised to seek a referral to a specialist.
So why don’t dentists automatically refer patients to specialists?  Well, many of them do exactly that.  But some dentists take continuing education courses, training to perform procedures previously only done by specialists.  And with their additional training, they don’t always see the need to refer patients elsewhere.  Or sometimes they know that a specialist will charge a higher fee for a given procedure, and they will offer to do the procedure themselves to save the patient money.  It becomes difficult, from the patient’s perspective, to know whether to ask for a referral or not in such cases.
To help with the decision making, here is a short (and by no means comprehensive) list of problems for which I would recommend that you seek a referral, no matter how much continuing education your dentist has done:
  • Extraction of impacted wisdom teeth (or any complicated extraction)  (Oral Surgeon)
  • Gum surgery, including grafts and crown lengthening (Periodontist)
  • Gum disease with 5mm or more of pocketing or recession (Periodontist)
  • Root canals of molars (Endodontist)
  • Bone grafting surgery prior to implants (Periodontist or Oral Surgeon)
  • Implant placement where more than 2 implants are to be done, or where the implants are not in the front of the mouth (Periodontist or Oral Surgeon)
  • Orthodontics of any kind, whether braces or Invisalign (Orthodontist)
Although there are general dentists who offer the above procedures in their offices, I think that in a city as well-served by specialists as Toronto, there is no good reason not to see the best-trained person for these highly complicated procedures.  Doing so will give you the best chance for an excellent result and the lowest chances of failure or complications.
You see, a dentist might pull wisdom teeth, but if something goes wrong during the procedure the patient will be sent to an oral surgeon who is trained to handle complications.  Would it not be wise to see that oral surgeon right from the start, knowing that the procedure is a complex one?
A dentist might be a certified Invisalign provider (all that takes is a single, 10 hour course), but if something goes wrong and the teeth or bite do not align, dentists often lack the training to correct the problem.  At that point, they will refer you to the orthodontist you could have seen to begin with, and perhaps avoided the problem altogether.
Dentists are your first line of defense against problems of the teeth and mouth.  They are an integral part of your health-care team, and are the people best suited to help you with cavities, mild-to-moderate gum disease, dealing with missing teeth, and handling esthetic concerns in your mouth.  But for patients with more complex problems of the mouth, seeking a referral to a specialist is just as advisable as seeking a referral to a medical specialist for any other part of your body.