I’m on a plane.  Just completed a great vacation with my family.  It’s something that my wife has always done,  made sure that there is a great family vacation for the whole family every year.  You have your wonderful traditions too.

If you don’t want to consider the future of perio,  please don’t read on. I promise I won’t make this depressing,  because I don’t think our future is depressing.  But I will rattle you a bit, maybe more than a bit.

I’ve had a great career.  I still do.  Long ago, I learned that I had to continually recreate myself and my practice.  Recreate. Recreate because patients demanded it. Recreate because the technology allowed for it. Recreate because the literature supported it.

Thirty years ago, I decided to do nothing but non-surgical periodontal treatment for chronic periodontitis for a full year. This was at a time when surgical perio and non-surgical perio was hotly debated. I spent some time with Perry Ratcliff, saw what he did,  and tried to duplicate it. It was fun, interesting, and rewarding.  Most of my patients did very well.  And for those who didn’t do well enough after a year, I surgically treated them. In fact, I made a very earnest deal with my patients.  I told them that I would do non-surgical treatment, and if after a year either of us weren’t happy with the result, I would do the surgery at no charge. I learned a lot. I saw what could happen by doing treatment and just waiting. Of course,  I would not put my patients at risk, and any acute conditions would be treated surgically if necessary.  The point was that I had created the luxury of observation,  and while you may feel that in some way I put my practice and patients at risk, I did not. What I did put at risk was dogma. And what occurred was that dogma did not survive.

It’s more than 30 years later. And dogmas are still there. The dogmas may be different,  but still there.

One of the worst dogmas one can retain is maintaining the same business model.  Because business models change. There is the hope that the periodontal business model is somehow going to revert to what it once was, that with the right “education,” we will stimulate referrals. And you know what?  That era is coming to a close. Corporate dentistry is upon us. Many dentists, for several reasons, see no need to refer to a periodontist.  And most importantly, patients are increasingly dissatisfied with the current referral model of treatment. You’ve seen it. Your patients have told you that. You can name all the reasons as well as I. The business model is failing, and just because it may be “hanging on,” does not mean it is surviving. 35 mm. film “hung on” for quite a while. Larry Page of Google said it best. “The reason companies don’t survive is failure to predict the future.” Where is Eastman Kodak now?

I have worked at public relations and marketing for a long time, public relations to do good for the community and marketing to bring patients in need directly to me.  They go hand in hand. When I first advertised dental implants for denture stabilization, I discovered something, something that I did not expect. There were many patients who saw me not for denture stabilization, but because they had given up on dentistry. That was the majority of patients who sought me out. The stories were often the same. They were tired of spending thousands of dollars on a tooth, just to see it fail.  They were and are looking for expert advice and predictable treatment.

Do you feel that the current referral model produces expert advice and predictable treatment?  Do you, in your heart of hearts, have full confidence that the entire treatment plan can be executed well by every person who refers to you? And when it doesn’t go well, then what?  The patient is left in the middle, has lost confidence in our profession.  We can say, “Well it wasn’t our fault. We got the perio correct. It failed in the hands of the restorative dentist.”  Is that good enough?

You and I both know that some of the referring dentists that we work with won’t get the margins right and won’t get the occlusion right.  Check your implant crowns with Shim Stock and you know what I mean.  They may insist upon a treatment plan that you know won’t work, but you don’t want to offend the referring doctor for fear of losing the referral source. What does that say for integrity in patient care?  Can we be satisfied enough to think that at least the patient had the advantage of being referred to a periodontist?

It’s only the select few that have the skill, the desire, the training, and the integrity to pull off an excellent restorative result in a complex case.  And it’s even fewer that will work hand in hand with you to produce that result, from diagnosis to treatment.   And when after working so hard, you see a compromised restorative result, what do you do?  The mask does not hide your eyes.

Well, the discerning consumer is educated too.  He or she knows margins.  He or she knows occlusion. He or she is demanding regarding cosmetics. And that consumer is fed up with the existing referral model.  They don’t know where to go.  They don’t know who to see. But they do know that they want an expert, that they want expert advice and treatment that is predictable.  So do you in every aspect of your life. Would  you be satisfied with a windshield wiper replacement that still streaked? Or a roof that leaked a year or two after replacement?  Of course not. Don’t we seek the best when we are faced with life-changing decisions? Patients with complex dental problems want an expert and they are willing to pay for expertise because they realize the consequences of not doing so.  Is it everyone who wants this? No. It is the consumer who wants the best and is seeking the best. And in my experience, income is only one factor that plays a role in that. The larger factors are comfort and competence.

What specialty of dentistry takes the responsibility for full diagnosis and treatment planning?  Periodontics.  What specialty of dentistry is fully trained to observe biological response? Periodontics.  What specialty of dentistry is the “go to” specialty for dental and periodontal problems?  Periodontics.  And I’ll add a fourth question. What specialty of dentistry, if fully in charge of the restorative result, would be sure that every margin is correct, that occlusion is correct, and that full  treatment planning precedes every case?

That means that each of us has to raise our responsibility level.  When one’s responsibility level rises, people flock to that person.   You can name at least five people whom you know who go the extra mile.  And that’s what patients are looking for, heightened responsibility because that will provide better results.

Some are prematurely lamenting the end of perio.  It doesn’t have to be that way. Because if patients are looking for increased responsibility for their dental problems, they will find the periodontist.  But they will find the periodontist only if that periodontist is willing to put it on the line, take full responsibility for their case.  That doesn’t mean that the periodontist has to do the restorative dentistry, but it means that the periodontist becomes the referral source to excellent restorative dentists. It means that the periodontist is checking the restorative dentistry to be sure that it is done correctly, and orders it to be redone if it doesn’t meet standards.  It means that the periodontist will have to make the decision to extract rather than try to “save” a compromised tooth. It also puts the onus on us to have strong treatment planning skills and to have the communication skills to allow the patient to see the logic in the treatment plan. It means that patients have a “clear choice” to the one modality of treatment that the implant centers offer. That’s what patients are looking for. As a private practice, primary care periodontist, I can assure you that this can be the future of periodontics and that if we espouse that level of responsibility, people will seek you directly just as they have sought me. I can also assure you that the quality of care will rise as we raise the bar.

It means the end of the old business model, and to survive, a new business model poised to take its place as patients seek the dental expert, the periodontist.

The largest segment of our population,  the Baby Boomers,  need high quality,  predictable treatment.  They are the present day potential dental cripples.  They need our expertise, they want predictability, and they have the money to pay for it.  And it’s only a business model that is keeping them from seeing us first.

So let’s understand that the market has indeed changed, and that it has changed in our favor.  It is not one that cares as much about modalities as it cares about predictability. That is where PR and marketing can be at their finest.  Because if done consistently and correctly, the patients who need us the most will find us.

So let’s understand that we need the best to be in our specialty. We need to elevate our responsibility level to our patients.  We can take the role of Directors of Complex Dentistry.  And with the correct business tools, we can and will attract the patients who need us and create better oral health and dental lives for our patients and for ourselves.

That will be the re-creation of our profession.

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