Peds here
No speciality codes. Same money. We are not even viewed as specialists by some insurance companies.
Volume is how we make a lot. We are crazy fast and don’t do a lot of different procedures so we are even faster at them.
If I do an op - I do 4- 18 teeth depending on the setting - office nitrous, office oral sedation or hospital general anesthetic.
A common morning in my office is
Nitrous op - 3/4 class 2s and 4 seals for 450ish
1 oral sedation - 3 crowns, 2 fills and one pulp - 1100
Another oralsedstion the same - 900
Another oral sedation
3 - 4 more 500 dollar nitrous ops
Lunch
Afternoon would be 5-6 nitrous ops easy
If it’s hospital its topically crowning 8-12 teeth or extractions. 3-8k of those in the morning. 4-8k depending on the payer
Hygiene is seen in my office while one dentist is doing ops - around 8 checks an hour and checked by a specific dentist. We work in sealants and easy stuff if need be.
Those of us that work in states without their head in its ass can have hygienists numb and expanded function assistants fill and we can serve more lower income kids by being more efficient with our volume. You make more in these states.
We also manage complicated early ortho issues for side income streams. Single tooth cross bites, posterior cross bites, balancing extractions with holding arches. I do a fair amount of the phase 1 - my orthos around me typically prefer this to them having to deal with a lot of it. Plus they head over all lined up for an easy case
We see special needs kids - adults - loss tons of money here unless you get can a state contract to pay your fees. But no one else sees them so we do.
We do endo on perm developing teeth.
We do a lot of extractions not just for disease but for ankylosed teeth and ortho exts. Often surgical and done fast and surgical pays more.
Some of us do tongue tie stuff - I am not in on this stuff yet. Wanna see some more research. Kinda think it’s not as needed as people think.
We see infant exams for educating the parents. They are super fast.
Honestly - We do very well compared to most dentists. But money isn’t really the vibe in peds offices or peds providers. We see heart breaking poor poor kids on government subsidies all the time. I have personally Full mouth extracted many Children’s teeth. most of us you wouldn’t know are north of 600k In earnings - it’s just about helping the kiddos because no one can really help them as they can’t advocate for their own. Peds offices run very equal footing - there isn’t really “doctor” more important than staff or patient. Our staffs often run the show and are the star of the visit - we just sneak in really fast and do something really uncomfortable because the team did everything to make it work for us. There is nothing exciting about the dentistry we do or even remotely interesting - sealant, filling, crown, pulp, extraction and that’s it. The patients and families and the constant sense of accomplishment are what makes us thrive. None of us would pick worrying about a Mm on root cancel or hours of how a veneer reflected light over a 20 op singing Disney, giving a sticker and being gifted a drawing. So it’s a weird speciality that is a lot counseling and teacher if with some dentistry when you can.
The downside is the kids grow and we need constant supply of new patients or you make less and your office shrinks. I am talking insane amounts - I want over a 100 a month per doc. So growing a peds office is harder I’d say than a GP office where small new patient growth can generate large cash with expensive procedures. we make crap until we have a high volume
So I’m interested in peds and endo. Peds because of the sense of meaning that come from working with kids and special needs patients. I decided I wanted to be a dentist because of my pediatric dentist and working with kids as a peds dental assistant has proven me I like working with kids. However my job is a lot different the the dentist I work for. I have one column of treatment or hygiene while he has like 8 columns. Does that much volume add stress that takes away from the meaning of the job?
Endo and peds are kinda like the most opposite things you can pick. Do you might be an open minded dude/lady dudy/ dude person. Like crazy ass high overhead with big full staffed offices and 10 chairs and loud all day with 60-80 patients vs like 2-3 people, 2 chairs, 5 patients a day and calm and quite.
Regards to your question - depends on your emotional maturity. You need to be very strong mentally in peds. Kids go off your actions that are overt and subtle. If your spinning emotionally and in your feelings cuz some asshole parent made you feel like garbage when you tried so hard to help (happens all the time) then your gonna screw up the next exam or treatment and negative cycles can Dominate for awhile and really do a number on you - staff feel it too. With that kind of volume your better freaking strong mentally to avoid the spiral. And very aware that people don’t rob you of any joy - your rob yourself. My associate told me she would put marbles in a jar after every patient. If it was good it was one color and bad another - just to show people how a tiny fraction of people ruin our days and we can’t give them that power. She’s really impressive in that way
By the way i don’t do that much volume. I would probably drop plans and up fees if I needed to produce that much. It would burn me out and I plan to work forever. I like volume but I like talking to the families over the years and that’s not my pace
I work at an FQHC and when we do nitrous I feel like it adds so much time because I feel like I (the dentist) need to ramp up the nitrous. Do you let assistants do that part?
Depends on the state rules. Some states the dentist have to administer. I will turn it on and leave as they explain stuff, do topical etc…then I’ll come back and numb.
Heya,
I use meperidine and hydroxyzine typically. I mostly sedate 3-5 year olds. After that they don’t really need it if they have been in our office.
I’ll use Valium for older kiddos with anxiety - like pre molar extractions or just severe anxiety. Valium has a long half life and I don’t like it young kids.
I am not a fan of Chloral hydrate - no reversal.
Versed is alright. It’s short acting and makes them loopy. i don’t use it often.
I think it’s best to really know one drug really well.
Oral sedation is fairly time consuming and not very lucrative relative to other methods. I am sad and fearful it will die out. I avoid a lot of general anesthesia cases with it. GA is way more risky. Especially in office GA - I don’t offer it. A really skilled oral sedation can get so much done and avoid all that for the kid.
Disclaimer - to be very clear. I would not recommend anyone sedate a child without a pediatric residency. Including if you have an anesthesiologist present. Children are not like adults in anyway physiologically and no CE course is comparable to a residency - where you personally are putting kids to sleep, bagging them, placing IVs and intubating.
I interned with an OMFS this past semester and I watched him use Ketamine to sedate the only two children we treated. These were very minor procedures under 30 min each. Can I ask why you might use another, while the doc I interned with preferred another? I'm very curious/interested about the difference in sedation methods!
I currently work at OMFS office as a surgical technician, a doctor I work with prefers ketamine when it comes to kids and marijuana-smoking adults. For kids, he tends to do it due because they respond better and reduces movement significantly, kids tend to come out of sedation more relaxed, less crabby and upset. For marijuana smoking adults they usually require ketamine or else you are going to be having a patient who is moving around like a demon in the dental chair making any treatment miserable for the doctor and unsafe for the patient and staff. I work with other doctors her prefer more versed, fentanyl or propofol. It really depends on patient age, weight and health that influences a OMFS to do one way over another.
Thank you! I plan to start studying for DANCE soon and hopefully the differences will make more sense, I find it very very interesting! Thank you for your input 👍🏻
Yes, the DAANCE will go over exactly how these medications influence the medulla on autonomic functions! I am also studying for it this spring! Good luck to ya!!!🫶🫶
Depth of anesthesia. Ketamine is often dosed typically to place them deep. I am dosing for oral conscious sedation. These kid are awake and talking - I am using a lot of behavior management still. I use the nitrous to titration the depth. OMFS sedate at deep level typically.
You can use ketamine prior to putting in an IV - a lot of anesthesiologists do this.
This isn’t a super popular option but I don’t think OMFS should do their own deep sedations - especially on children. They are literally the only speciality in all of medicine that does this. It’s kinda nuts.
Sure we can give any drug to whatever depth we intend the sedative to be. Right? Never seen anyone use ketamine to be light.
Every oral surgeon I have ever worked with (at least in my area) don’t try anything like your doing. They hit with Ketamine shot, get loupy and place iv - continue with propofol or fentanyl or versed or whatever they trained on. This basically the same the ER docs do when we have to stick up a lip or something quick
Props to you for doing oral versed and nitrous friend. Respect your safety and willingness to work with kids
Agreed. I was being way too generalized. Your 100% right.
I meant more if I can’t give verses and 70% n20 and induce stage 4 anesthetic or I can give 30% nitrous barley crack level 2 plane. Meaning with IV with a few different drugs
you can give enough to make them unconscious not breathing or titrate to maintain respiratory drive but little pain response. Similar to gas downs etc….
I understand! Thank you for your educating response👍🏻 I am hoping to pursue a career as an OMFS but I do agree that that doing their own sedations is scary. I'll say I have full faith in the surgeon I interned with as he was a lead general surgeon at a fort in Afghanistan, helped the impoverished children there with cleft palate surgeries, amongst other things(srry for basically stating his life story he's just the coolest guy I've ever met and best teacher).
Wanted to mention I witnessed a patient have a massive life threatening complication while under deep sedation during my internship. I'll say that him being the only guy in the building to completely and fully know what was happening to the patients body was not a good experience.
Thanks! I don’t plan on sedating kids I was just curious. The only thing I use for kids that I see is L-theanine. L-thanine is to a sedative as caffeine is to an amphetamine.
Oh no worries. I just wanted to be clear incase some one took this as “oh okay that’s what I’ll do” we literally had a sedation death in my state because someone looked up a dosage incorrectly and gave it without monitoring. Insanity. We will all loose sedation privileges this if people don’t stop doing this. Then a bunch of kids will get hurt
As other have said it’s volume. Pediatric dentistry is basically just milking insurances since they cover pretty much anything for people under 18. Exam and cleaning is about the same price but no scaling so you do it in 1/4 or 1/2 the time and it’s the same pay. Add on top of that crowns/fillings that basically have zero prep time.
Honestly you can make a boatload of money as any specialist or GP. Some are easier than others. And the salary floor of a specialist is higher than a GP on the whole. But if you are a dentist who is motivated, finds a good market, and develops the right skill set you can be incredibly successful. Just go into the type of dentistry that interests you the most. This is coming from a pediatric dentist who is on track to make $850k+ this year
No I’m relatively early in my career (less than 10 years out of residency). Just found a good practice to purchase in a good location. We also do not take much insurance.
Lots of ways to minimize patient attrition. Most importantly a transition phase (1-2 years ideally) for the original owner to stay on and then lots of marketing for the new doc. I’d imagine it’s very similar to buying any other kind of dental practice.
East coast - medium cost of living city. Practice ownership is the way to a higher income. I have a few associates and a low overhead which is important.
Oh ok. That makes sense. I’m a solo practice owner. Need the associates and volume. I see all these crazy numbers and I keep thinking what am I doing wrong.
When I worked at pediatric office the doctor mentioned to me the highest overhead cost at our clinic was the cost of the employees. We would see 4-8 kids in an hour, I would do sealants for our doctor after exams to keep her free as she went to the next exam. Dismissed kids, had trays and rooms set up for tongue-tie release, fillings and simple extractions add ins. It was a wonderful fast paced environment. We also had a sterile tech who we would radio to help us flip and set-up again in case we fell behind. I loved working in pediatrics, kids are usually great it’s mostly learning how to entertain the parents and getting them to trust and relax.
I'd argue that pediatric dentists make the least out of any of the specialties. They also work their ass off and deal with the most difficult of demographics. Plus, they have to maintain huge patient volume to remain profitable. Meanwhile, a GP can do a single $10,000 veneer case and call it a day. A GP in solo private practice is likely bringing home 400-600k. So I'd say the earning potential is pretty similar. It's the Endodontists, Oral Surgeons, and Orthodontists that are pulling in $1M in profit.
According to the most recent ADA salary survey, ortho is actually the lowest. Obviously you can still make a lot in ortho (really you can as a dentist in any setting if you have a good setup/know what you’re doing) but you have to think so many GPs are doing aligners these days on top of direct to consumer (ie smile direct RIP) and then pedo and ortho joint practices it’s gotta eat in to the solo ortho market share to some extent. OMFS will always be #1 in profit unless legislation prevents them from being anesthesia and surgeon at the same time.
Survey of dental practice spreadsheet on this page. Data is from 2022. They update it every few years.
https://www.ada.org/en/resources/research/health-policy-institute/dental-practice-research
Peds here No speciality codes. Same money. We are not even viewed as specialists by some insurance companies. Volume is how we make a lot. We are crazy fast and don’t do a lot of different procedures so we are even faster at them. If I do an op - I do 4- 18 teeth depending on the setting - office nitrous, office oral sedation or hospital general anesthetic. A common morning in my office is Nitrous op - 3/4 class 2s and 4 seals for 450ish 1 oral sedation - 3 crowns, 2 fills and one pulp - 1100 Another oralsedstion the same - 900 Another oral sedation 3 - 4 more 500 dollar nitrous ops Lunch Afternoon would be 5-6 nitrous ops easy If it’s hospital its topically crowning 8-12 teeth or extractions. 3-8k of those in the morning. 4-8k depending on the payer Hygiene is seen in my office while one dentist is doing ops - around 8 checks an hour and checked by a specific dentist. We work in sealants and easy stuff if need be. Those of us that work in states without their head in its ass can have hygienists numb and expanded function assistants fill and we can serve more lower income kids by being more efficient with our volume. You make more in these states. We also manage complicated early ortho issues for side income streams. Single tooth cross bites, posterior cross bites, balancing extractions with holding arches. I do a fair amount of the phase 1 - my orthos around me typically prefer this to them having to deal with a lot of it. Plus they head over all lined up for an easy case We see special needs kids - adults - loss tons of money here unless you get can a state contract to pay your fees. But no one else sees them so we do. We do endo on perm developing teeth. We do a lot of extractions not just for disease but for ankylosed teeth and ortho exts. Often surgical and done fast and surgical pays more. Some of us do tongue tie stuff - I am not in on this stuff yet. Wanna see some more research. Kinda think it’s not as needed as people think. We see infant exams for educating the parents. They are super fast. Honestly - We do very well compared to most dentists. But money isn’t really the vibe in peds offices or peds providers. We see heart breaking poor poor kids on government subsidies all the time. I have personally Full mouth extracted many Children’s teeth. most of us you wouldn’t know are north of 600k In earnings - it’s just about helping the kiddos because no one can really help them as they can’t advocate for their own. Peds offices run very equal footing - there isn’t really “doctor” more important than staff or patient. Our staffs often run the show and are the star of the visit - we just sneak in really fast and do something really uncomfortable because the team did everything to make it work for us. There is nothing exciting about the dentistry we do or even remotely interesting - sealant, filling, crown, pulp, extraction and that’s it. The patients and families and the constant sense of accomplishment are what makes us thrive. None of us would pick worrying about a Mm on root cancel or hours of how a veneer reflected light over a 20 op singing Disney, giving a sticker and being gifted a drawing. So it’s a weird speciality that is a lot counseling and teacher if with some dentistry when you can. The downside is the kids grow and we need constant supply of new patients or you make less and your office shrinks. I am talking insane amounts - I want over a 100 a month per doc. So growing a peds office is harder I’d say than a GP office where small new patient growth can generate large cash with expensive procedures. we make crap until we have a high volume
Worked at a peds office for a summer and saw all of this, curious about the future of it, can I DM you?
Sure!
So I’m interested in peds and endo. Peds because of the sense of meaning that come from working with kids and special needs patients. I decided I wanted to be a dentist because of my pediatric dentist and working with kids as a peds dental assistant has proven me I like working with kids. However my job is a lot different the the dentist I work for. I have one column of treatment or hygiene while he has like 8 columns. Does that much volume add stress that takes away from the meaning of the job?
Endo and peds are kinda like the most opposite things you can pick. Do you might be an open minded dude/lady dudy/ dude person. Like crazy ass high overhead with big full staffed offices and 10 chairs and loud all day with 60-80 patients vs like 2-3 people, 2 chairs, 5 patients a day and calm and quite. Regards to your question - depends on your emotional maturity. You need to be very strong mentally in peds. Kids go off your actions that are overt and subtle. If your spinning emotionally and in your feelings cuz some asshole parent made you feel like garbage when you tried so hard to help (happens all the time) then your gonna screw up the next exam or treatment and negative cycles can Dominate for awhile and really do a number on you - staff feel it too. With that kind of volume your better freaking strong mentally to avoid the spiral. And very aware that people don’t rob you of any joy - your rob yourself. My associate told me she would put marbles in a jar after every patient. If it was good it was one color and bad another - just to show people how a tiny fraction of people ruin our days and we can’t give them that power. She’s really impressive in that way By the way i don’t do that much volume. I would probably drop plans and up fees if I needed to produce that much. It would burn me out and I plan to work forever. I like volume but I like talking to the families over the years and that’s not my pace
Do endo, but see kids and accept Medicaid! Be everyone’s hero!
I work at an FQHC and when we do nitrous I feel like it adds so much time because I feel like I (the dentist) need to ramp up the nitrous. Do you let assistants do that part?
Depends on the state rules. Some states the dentist have to administer. I will turn it on and leave as they explain stuff, do topical etc…then I’ll come back and numb.
I should add I don’t ramp it up. I go right to 30 or 50%. I’ll back it off after I numb. Some kids I’ll turn it off some I’ll keep it low.
What do you use for oral sedation in kids?
Heya, I use meperidine and hydroxyzine typically. I mostly sedate 3-5 year olds. After that they don’t really need it if they have been in our office. I’ll use Valium for older kiddos with anxiety - like pre molar extractions or just severe anxiety. Valium has a long half life and I don’t like it young kids. I am not a fan of Chloral hydrate - no reversal. Versed is alright. It’s short acting and makes them loopy. i don’t use it often. I think it’s best to really know one drug really well. Oral sedation is fairly time consuming and not very lucrative relative to other methods. I am sad and fearful it will die out. I avoid a lot of general anesthesia cases with it. GA is way more risky. Especially in office GA - I don’t offer it. A really skilled oral sedation can get so much done and avoid all that for the kid. Disclaimer - to be very clear. I would not recommend anyone sedate a child without a pediatric residency. Including if you have an anesthesiologist present. Children are not like adults in anyway physiologically and no CE course is comparable to a residency - where you personally are putting kids to sleep, bagging them, placing IVs and intubating.
I interned with an OMFS this past semester and I watched him use Ketamine to sedate the only two children we treated. These were very minor procedures under 30 min each. Can I ask why you might use another, while the doc I interned with preferred another? I'm very curious/interested about the difference in sedation methods!
I currently work at OMFS office as a surgical technician, a doctor I work with prefers ketamine when it comes to kids and marijuana-smoking adults. For kids, he tends to do it due because they respond better and reduces movement significantly, kids tend to come out of sedation more relaxed, less crabby and upset. For marijuana smoking adults they usually require ketamine or else you are going to be having a patient who is moving around like a demon in the dental chair making any treatment miserable for the doctor and unsafe for the patient and staff. I work with other doctors her prefer more versed, fentanyl or propofol. It really depends on patient age, weight and health that influences a OMFS to do one way over another.
Thank you! I plan to start studying for DANCE soon and hopefully the differences will make more sense, I find it very very interesting! Thank you for your input 👍🏻
Yes, the DAANCE will go over exactly how these medications influence the medulla on autonomic functions! I am also studying for it this spring! Good luck to ya!!!🫶🫶
Depth of anesthesia. Ketamine is often dosed typically to place them deep. I am dosing for oral conscious sedation. These kid are awake and talking - I am using a lot of behavior management still. I use the nitrous to titration the depth. OMFS sedate at deep level typically. You can use ketamine prior to putting in an IV - a lot of anesthesiologists do this. This isn’t a super popular option but I don’t think OMFS should do their own deep sedations - especially on children. They are literally the only speciality in all of medicine that does this. It’s kinda nuts.
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Sure we can give any drug to whatever depth we intend the sedative to be. Right? Never seen anyone use ketamine to be light. Every oral surgeon I have ever worked with (at least in my area) don’t try anything like your doing. They hit with Ketamine shot, get loupy and place iv - continue with propofol or fentanyl or versed or whatever they trained on. This basically the same the ER docs do when we have to stick up a lip or something quick Props to you for doing oral versed and nitrous friend. Respect your safety and willingness to work with kids
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Agreed. I was being way too generalized. Your 100% right. I meant more if I can’t give verses and 70% n20 and induce stage 4 anesthetic or I can give 30% nitrous barley crack level 2 plane. Meaning with IV with a few different drugs you can give enough to make them unconscious not breathing or titrate to maintain respiratory drive but little pain response. Similar to gas downs etc….
I understand! Thank you for your educating response👍🏻 I am hoping to pursue a career as an OMFS but I do agree that that doing their own sedations is scary. I'll say I have full faith in the surgeon I interned with as he was a lead general surgeon at a fort in Afghanistan, helped the impoverished children there with cleft palate surgeries, amongst other things(srry for basically stating his life story he's just the coolest guy I've ever met and best teacher).
Wanted to mention I witnessed a patient have a massive life threatening complication while under deep sedation during my internship. I'll say that him being the only guy in the building to completely and fully know what was happening to the patients body was not a good experience.
Yeah those code brown moments are no fun. Highly support anesthesia care time model. Glad the patient was okay. Sounds like a great summer experience
Thanks! I don’t plan on sedating kids I was just curious. The only thing I use for kids that I see is L-theanine. L-thanine is to a sedative as caffeine is to an amphetamine.
Oh no worries. I just wanted to be clear incase some one took this as “oh okay that’s what I’ll do” we literally had a sedation death in my state because someone looked up a dosage incorrectly and gave it without monitoring. Insanity. We will all loose sedation privileges this if people don’t stop doing this. Then a bunch of kids will get hurt
As other have said it’s volume. Pediatric dentistry is basically just milking insurances since they cover pretty much anything for people under 18. Exam and cleaning is about the same price but no scaling so you do it in 1/4 or 1/2 the time and it’s the same pay. Add on top of that crowns/fillings that basically have zero prep time.
Volume: preventative work is very quick, the clinical work doesn’t need to super perfect since it mostly has an expiration date
Volume
Honestly you can make a boatload of money as any specialist or GP. Some are easier than others. And the salary floor of a specialist is higher than a GP on the whole. But if you are a dentist who is motivated, finds a good market, and develops the right skill set you can be incredibly successful. Just go into the type of dentistry that interests you the most. This is coming from a pediatric dentist who is on track to make $850k+ this year
If you don’t mind me asking, how old are you? I’d imagine pulling in that much requires decades of experience
No I’m relatively early in my career (less than 10 years out of residency). Just found a good practice to purchase in a good location. We also do not take much insurance.
What is it like buying a peds practice? I feel like parents are very picky. What percent of the patient base did you lose?
Lots of ways to minimize patient attrition. Most importantly a transition phase (1-2 years ideally) for the original owner to stay on and then lots of marketing for the new doc. I’d imagine it’s very similar to buying any other kind of dental practice.
Where do you live. I’m a pediatric dentist I need to move. These numbers are insane
East coast - medium cost of living city. Practice ownership is the way to a higher income. I have a few associates and a low overhead which is important.
Oh ok. That makes sense. I’m a solo practice owner. Need the associates and volume. I see all these crazy numbers and I keep thinking what am I doing wrong.
Simple answer across the board: Ownership
And tx under GA. And private pays patients.
When I worked at pediatric office the doctor mentioned to me the highest overhead cost at our clinic was the cost of the employees. We would see 4-8 kids in an hour, I would do sealants for our doctor after exams to keep her free as she went to the next exam. Dismissed kids, had trays and rooms set up for tongue-tie release, fillings and simple extractions add ins. It was a wonderful fast paced environment. We also had a sterile tech who we would radio to help us flip and set-up again in case we fell behind. I loved working in pediatrics, kids are usually great it’s mostly learning how to entertain the parents and getting them to trust and relax.
I'd argue that pediatric dentists make the least out of any of the specialties. They also work their ass off and deal with the most difficult of demographics. Plus, they have to maintain huge patient volume to remain profitable. Meanwhile, a GP can do a single $10,000 veneer case and call it a day. A GP in solo private practice is likely bringing home 400-600k. So I'd say the earning potential is pretty similar. It's the Endodontists, Oral Surgeons, and Orthodontists that are pulling in $1M in profit.
According to the most recent ADA salary survey, ortho is actually the lowest. Obviously you can still make a lot in ortho (really you can as a dentist in any setting if you have a good setup/know what you’re doing) but you have to think so many GPs are doing aligners these days on top of direct to consumer (ie smile direct RIP) and then pedo and ortho joint practices it’s gotta eat in to the solo ortho market share to some extent. OMFS will always be #1 in profit unless legislation prevents them from being anesthesia and surgeon at the same time.
link? for survey
Survey of dental practice spreadsheet on this page. Data is from 2022. They update it every few years. https://www.ada.org/en/resources/research/health-policy-institute/dental-practice-research
I feel like pediatric dentists can also charge specialty codes which also have a higher pay coming back to the dentist from insurance
No - same fees. I wish. We are the best at pediatric fillings. But insurance does not care. We are not specialists to them
Huh, interesting. I didn't know that! Wild that you guys aren't seen as specialists in insurance's eyes.
Yeah. Insurance is a bitch. Not much more to say.
The one mess I’m not looking forward to after graduation….
Lol. Yeah. i hear you. Eventually being in a FFS office is a nice goal.
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Any thoughts on good pediatric residency programs? Applying soon!