What is a prosthodontist, and when should you see one?

The definition

A prosthodontist is a dentist who has completed dental school and then a further three years of full-time, hospital-based residency devoted entirely to replacing missing teeth and rebuilding damaged ones. The word comes from "prosthesis," meaning an artificial replacement for a part of the body, and "odont," meaning tooth.

Prosthodontics is one of only twelve dental specialties formally recognized in the United States, alongside fields such as orthodontics, periodontics, endodontics and oral surgery. A dentist cannot call themselves a prosthodontist without completing an accredited residency; the title is protected in the same way "cardiologist" is for physicians.

What the training covers

The three years are spent almost entirely on the hard cases. Residents learn to plan and place dental implants, to restore them with crowns and bridges, to rebuild entire arches of teeth on implants, to design and fit dentures that actually work, and to carry out full mouth reconstruction when a bite has worn down or collapsed.

A large part of the training is occlusion: the study of how the teeth meet, how chewing force is distributed, and why restorations fail when the bite is wrong. This is the knowledge that general dental training touches only briefly, and it is the reason prosthodontists are the specialists called in when crowns keep breaking or implants keep failing for no obvious reason.

Some residencies, including the University of Michigan program where Dr. Jonathan Berkowitz trained, are surgical as well as restorative. A surgically trained prosthodontist places the implant and makes the tooth that goes on it. Not every prosthodontist does both; it is worth asking.

Prosthodontist vs. general dentist

A general dentist is trained to handle the full range of everyday care: examinations, cleanings, fillings, single crowns, simple extractions, gum care. Many general dentists also place implants, which the law permits without any specialty training; weekend courses on implant placement are widely available.

For a single, straightforward tooth, a good general dentist may serve you perfectly well. The difference shows when the case is complex: several missing teeth, a full arch, a bite that has worn down, a history of restorations that did not last, or an implant that has gone wrong. Those cases need a specialist's planning, because the mistake that matters is usually made before anything is done in the mouth.

This practice has both. Dr. Steven Berkowitz has provided general and family dentistry at 40 West 86th Street since 1988, and his son Dr. Jonathan Berkowitz is the prosthodontist. Most of what happens here on any given day is regular dentistry.

Prosthodontist vs. oral surgeon vs. periodontist

An oral surgeon specializes in surgery of the mouth and jaws: extractions, jaw surgery, facial trauma and implant placement. A periodontist specializes in the gums and the bone that supports the teeth, and also places implants. Both are surgical specialists.

What neither of them does is make the tooth. In the usual New York arrangement, a surgeon or periodontist places the implant and sends the patient back to a general dentist to have the crown made. That works when the two offices plan together carefully. When they do not, the implant ends up in a position that makes a good-looking, well-functioning tooth difficult, and the patient is caught between two dentists.

A prosthodontist starts from the other end: the final tooth is designed first, and the implant is positioned to serve that design. When the prosthodontist is also surgically trained, the whole case stays with one person, which is the arrangement in this office.

When it is worth seeing a prosthodontist

You are considering implants for more than one tooth, or for a full arch. The planning is the hard part, and it is what the specialty exists for.

You have had work that keeps failing. A crown that has been remade twice, a bridge that keeps coming loose, veneers that chip. Repeated failure of the same restoration almost always means the bite is wrong, and remaking it a third time will not change that.

You have an implant that never felt right, or one that has become loose, sore or infected. A prosthodontist can tell you whether the problem is the implant, the crown on it, or the bite, which are three different repairs. Our implant second opinion page describes what that consultation involves.

Your teeth are worn down, short, or your bite has collapsed. This is the territory of full mouth reconstruction, which is prosthodontics in its purest form.

You have never been happy with your dentures. A denture that slips, hurts or affects your speech can usually be improved, and two implants under a lower denture often transform it.

You have been given a large treatment plan and want it checked. A second opinion before a $30,000 decision is sensible, not disloyal, and sometimes the most useful advice is to do less.

Do you need a referral?

No. In New York you can book directly with a prosthodontist. Some of our patients are referred by their own dentist or by an oral surgeon who needs the final teeth made; many find us on their own. Both are equally welcome. Bring any X-rays or treatment plans you have, and if you have none, that is fine too.