Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

Managing Expectations by Dr. Blair Feldman, DMD, MS

Start Discussion More by this author (5)


I'm frequently asked by orthodontic residents about important concerns that challenge them during their residency. They have questions about practice setups such as solo or group, individual or corporate. I also get clinical questions—how to regularly bond second molars without failure, traditional brackets vs. self-ligating, and direct-versus-indirect bonding. All of those questions are important and involve a discussion, not just a simple answer. Those discussions with residents, year after year, help me as much as the conversations help them (hopefully).

But the question that doesn't often get asked, and the question that I challenge myself to answer is: "How do I best manage my patients' expectations of their potential orthodontic treatment and results?" Like the previous questions, there is no one simple answer. In my opinion, this is the underlying question that should resonate in orthodontists' minds throughout their entire professional career.

Orthodontic treatment is popping up everywhere—in nearly every pedo office (it seems) and in many general dental offices. Walmart is now offering dental services in its stores in Canada. Surely they are looking at "Walmart orthodontic treatment." You can even perform your own orthodontic treatment with services such as SmileCareClub.

When I think about the fundamental difference between orthodontic treatments performed by an orthodontic specialist versus treatment performed by a general dentist (or by yourself with a DIY kit), I think the most significant difference comes down to two words—managing expectations.

Beyond providing exceptional results, an orthodontic specialist should be able to use his or her additional education and experience to give potential patients a highly accurate description of what they can expect to achieve during treatment. This description could include an accurate depiction of results, timing, future dental work, and amount of discomfort. The range of treatment options should be vast since we are the specialists—the ones who hold the most knowledge and experience about orthodontic treatment.

The case I'm showing here involves a 13-year-old boy. His most notable orthodontic concerns are CL3 molars, an apparent CL3 skeletal pattern, anterior crossbite, and dental midline deviation (Figs. 1, 1a & 1b). Spoiler alert—this is not a finished case.





This boy came to our office via the Smiles Change Lives (SCL) program. Through this program, we treat patients at no charge. Patients pay a small fee to SCL and fill out applications to prove that they fall into the working-poor category and would otherwise be unable to afford orthodontics. Many times, the children submit a personal letter to the orthodontist explaining why orthodontic treatment will improve their lives. My team shares these letters, which are often passionate, honest and hopeful. They inspire us to continue treating these important cases.

The patient's chief concern was that his bite made him look "funny" and he just wanted a "normal" bite like his friends. Unique to this patient's bite was the fact that, upon manipulation, he could place his anterior teeth edge to edge—meaning that this was potentially a pseudo crossbite of the anterior teeth.

My treatment plan recommended 14-18 months of orthodontic treatment. My treatment would include braces on the upper and lower teeth (American Orthodontics Empower brackets) and would disarticulate the bite with the use of composite bite turbos placed on the lingual of the mandibular central incisors. I create the turbos using Mini Molds (Anterior Bite Ramp). He would wear elastics as needed throughout treatment. I started him on a light (3/16" 2.5oz) CL3 vectored elastic starting on the day of his bonding.

    The benefits of using Mini Molds in this case include:
  • Disarticulate the teeth to allow for efficient leveling and aligning of the upper arch.
  • Prevent the patient from returning to his anterior crossbite.
  • Prevent the lower teeth from hitting the upper brackets causing potential damage to the enamel.
  • Add intrusive forces to the maxillary and mandibular anterior teeth.
When the patient returned for his first adjustment eight weeks after bonding, I took a set of progress photos as shown in Fig. 2. The patient was excited to show me the changes he observed in his bite and wanted me to show him his pre-treatment photos so he could admire the change (Fig. 3).





His next question made me hold back a laugh and check to make sure he was being serious. He asked, "Am I almost finished?"

As the father of two young boys I am used to getting questions that initially seem outrageous, but upon further inspection force me to consider my answer carefully. I used the same consideration with my answer for this young boy.

"Your teeth and bite look great and you have had some terrific changes," I said. "You may even be ahead of schedule. My goal is to spend the next appointments adding details and stability to your bite so that it lasts a lifetime. Is that okay with you?"

He smiled and laid back in the chair and said, "Okay, I was just asking." I proceeded to move him to the next archwire and complete the day's appointment. I felt confident that we now had a mutual understanding that my goals for his treatment were more than cosmetic.

This case reminds me of a question that my marketing and business coach, Dustin Burleson, encourages his doctors to ask patients in the initial exam when confronted with a patient who has been told by their dentist that they can offer Six Month Smiles.

"I'm curious, what is more important to you?" he asks. "Completing treatment in a short amount of time, or doing orthodontic treatment once so that you never have to do it again?"

The truth is, I am able to provide either solution—fast treatment or complete orthodontic treatment. As long as the patient and I are on the same page we can proceed. Since I began asking that question none of my patients have chosen the option that involves short treatment. This is because our team does a great job of educating patients on the value of complete treatment.

The AAO has the following quote on its homepage: "An orthodontist has the training, experience and treatment options to make sure you get your best smile." Our daily challenge is to help patients understand the value of an investment in our services. Through our improved communication inside the office and within our marketing, we increase the chances that our patients truly understand the services we provide. In the end, everyone is happier.


Dr. Blair Feldman is an orthodontic specialist practicing in Arizona and is an adjunct professor of orthodontics at A.T. Still University in Mesa, Arizona. He's a proud member of the American Association of Orthodontists, the American Dental Association and the Arizona Dental Association. Feldman completed his undergraduate studies at the University of Michigan with a bachelor of arts, after which he received his DMD from the University of Pennsylvania.
Orthotown Magazine
April 2024
Orthotown Magazine April 2024 Read Current Issue Read Archived Issues
Sponsors
Townie® Poll
Which area is most challenging for your office?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2024 Orthotown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450