Dr. Froum, you are now a world-renowned periodontist. Why did you decide to specialize in periodontal services?
After dental school, I completed a general practice residency at Brooklyn’s Veterans Administration Hospital, where I had the opportunity to do all aspects of dentistry. I found periodontal work to be both the most interesting and the most evidence-based and scientific specialty. I also noticed that when we performed periodontal procedures, patients also got better systemically. Even then, we had some feeling that periodontal disease was related to various systemic diseases.
I found that periodontics was the dental subspecialty that was closest to being a physician of the body. I was more interested in rebuilding lost bone and tissue than in taking out teeth. With a background in chemistry and biochemistry, it made biological sense to me to save teeth rather than replacing them, effectively keeping the biology of the body in place.
What are the key differentiating factors that separate you from other dentists and periodontists in the crowded Manhattan space?
I have always felt that the best dentist is not only good with his hands but also with his mind. I was always interested in clinical applications of periodontal treatment, and I have published more than 180 peer-reviewed papers on the subject. I am currently Adjunct Clinical Professor as well as the Director of Clinical Research in the Department of Periodontology and Implant Dentistry at New York University College of Dentistry. I have taught for over 30 years. As a teacher, you see a lot and you learn a lot.
So, I have extensive experience in both clinical teaching and being in full-time practice five days a week. I have written a book on dental implant complications and chapters in several other books on periodontal problems, where I analyze the cause of the problem, how best to solve it, and what to do if the problem is not solved. At this point, I feel very confident in diagnosing periodontal issues, determining the simplest solution, and executing the chosen procedure to help patients retain their teeth for life.
By this point in my career, many periodontists in New York City have actually learned from me. Either I taught them in school, or they have attended my lectures to learn the most current techniques. As a clinical teacher, I have to be really up on the latest technology and proven techniques, and I use them routinely in my practice.
What are the most important questions that a prospective patient should ask a periodontist?
I think patients should ask the same questions as they would ask a doctor in any field. I would ask, in this order:
1. “Exactly what is my problem and why is it occurring?” The doctor should be able to very plainly explain what the problem is, why it happened, and what the recommended treatment is.
2. “How predictable is the treatment?” Or, “Is this something chancy, or something that is likely to work?” The doctor should be able to reference studies that discuss the treatment and its success rates. He should also be able to articulate what the patient can do to help maximize success. Any treatment is a partnership, and a doctor who cannot clearly explain the patient’s role in treatment has just lost half the team.
3. Next should be a series of questions regarding healing time, effects on the patient’s daily routine, and other possible treatment options. The doctor should be able to answer these questions with confidence, and patients should be especially wary if the doctor claims there is only one treatment option. Most diseases have several options for treatment, and the patient should be comfortable with the one that is selected.
4. “Doctor, how much is this going to cost me?” Doctors should be able to tell a patient the exact costs from beginning to end, with no hidden surprises. Many patients ask if I take their insurance, and in our office, we don’t get paid through the insurance companies. Instead, we fill out forms for patients to submit to their own company, and we also write letters when necessary to clarify exactly what the diagnosis and treatment were and why we selected that particular treatment.
If a patient doesn’t leave the doctor’s office with the confidence that the doctor is there no matter what, then that’s a red flag. It’s important to me, when seeing a doctor, to ensure that the procedure being done is the best and most predictable for me and that it will lead to the best outcome. It’s also important to me to know that if I had an emergency, the doctor would be there to help me through it. So, I make sure to provide that same level of service to my patients. I give them my cell phone number and instructions to call with any problems.
What happens if a tooth is hopeless and has been removed or has to be removed, what are your recommendations?
If a tooth is missing (or will be missing after removal) there are several options? Patients always ask me what if I don’t replace it? Other than missing 3rd molars or wisdom teeth, the loss of a tooth and the space created can result in adjacent teeth migrating toward the space. In addition, the opposing tooth (the tooth that was biting into the one removed) will move down (if it’s a missing lower tooth) or up to try to fill the space. This tooth migration can result in a bite change that might affect the jaw and cause a temporomandibular joint problem (TMJ). This can lead to pain, headaches and uncomfortable biting.
Replacement options include:
1. A removable bridge
2. A fixed bridge being held by adjacent teeth
3. An implant supported tooth replacement.
The first of these is the least expensive but must be removed to be cleaned and oftentimes loosens up when talking or eating. The second option is a fixed bridge but requires preparing (cutting down) healthy teeth to make crowns to hold the bridge. The missing tooth is replaced by a false tooth. The last option an implant is the best replacement in terms of Biology. It replaces the missing tooth, (teeth) without cutting any healthy teeth. It also preserves the jawbone and prevents bone shrinkage that occurs with both removable and fixed bridges. It restores the bite and space with a natural looking tooth. If placed properly and with good home care, it can last the lifetime of the patient. I’ve been placing dental implants for over thirty years with over a 90-95% success rate.
Dr. Froum, you have been awarded the Master Clinician Award by the American Academy of Periodontology. Could you explain the award?
I was very proud to receive the Master Clinician Award from the American Academy of Periodontology. The Academy represents all the periodontal specialists in the country and many around the world. Once a year, the members vote to give one periodontist the Master Clinician Award. The selected periodontist has shown excellent skills in the profession and has been available to teach those skills to other periodontists. It is recognition by the Academy that I am one of the best clinicians in the country. It is an honor to be recognized by my peers for my work and my contributions to the field.
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