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Embrace Progress: You Can’t Fight Mother Nature by Daniel Grob, DDS, MS, Editorial Director

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Header: You Can't Fight Mother Nature: How educating patients can reduce treatment

How many times have you sat across from a potential patient's parent and listened to him or her go on and on about how "My teeth were straight until my wisdom teeth came in"?

Or how many times has a parent said, "The reason my teeth were crooked was because they were improperly treated," even though you can see that his or her underlying skeletal imbalance is similar to that of the child sitting in the exam chair?

Or—my personal favorite—the parent quizzes you on certain equipment your competitor uses, confident that someone has the answer to the perplexing problem of creating that lifetime smile (for a lower cost, no doubt).

Urban legends and old wives' tales seem to dominate the public perception of orthodontics. In one way, it provides us with a source of business. On the other hand, it can contribute to our demise. Oversimplifying and failing to educate the general public, I believe, has contributed to our loss of market share to other providers. I think this problem will get worse if left unchecked.

Have we caused our own problem?
Shortly after I was admitted into my orthodontic residency in the '80s, Dr. Robert Little published a paper declaring that a large number of previously treated orthodontic patients had crooked teeth. What was the point, I thought?

But, confident that I had the answers (like so many other overachieving dental students), I felt that if I developed the correct occlusal plan, made the correct diagnosis and used the proper brackets, that what he described in his paper couldn't possibly happen to me.

For some of us, our quest to be the best had us ignoring the facts and refusing to look deeper, while still believing that because of our grades, class rank and previous connections, our results will be better. After all, we're orthodontists!

Fast-forward about 10 or 15 years, and it becomes apparent that maybe we don't have the answer. I don't mean the obvious non-complier who barely brushed his or her teeth during treatment, who got crooked teeth before the retainers were delivered.

No, I'm talking about the 35-year-old who religiously wears retainers and comes to all of the appointments. The third molars are removed, and later he or she appears in your office, disappointed that those lower incisors or upper laterals are beginning to move to where they were when you started.

What do you say? What do you do? And of course—the elephant in the room—how much do you charge?

If you are like I am, for the first part of your career you ignore the situation, maybe charge a little bit for a new retainer that the patient discards or doesn't wear, or worse, you convince yourself and your patient that there really is no problem at all. The patient leaves and you have solved the problem and avoided confrontation.

Not good.

Let's own the solution
Let me elaborate. If you have been reading this magazine for the past couple of years, you know that I organize treatment planning and active care into three phases or stages: the first 12 permanent teeth, the next 12 permanent teeth and the 12-year molars. During each of these phases there are four components of human biology that pertain to orthodontics. These components are:
  • eruption of the teeth,
  • growth of the jaws,
  • function of the joint, and
  • the effects of facial musculature and breathing on the developing face.
These components are the foundation for a system I follow: Treatment by Twelves. These four elements of orthodontics also contribute to relapse. This is the information we need to share with the general public. If you educate the patient at the beginning and let him or her know what to expect, you're fine. If not, you are making an excuse.

During treatment, if you noticed that the teeth were not moving as quickly as expected, you had to deal with some late growth, or were fighting a nail-biting habit, the patient might understand. If, following the de-banding appointment, you send a letter to the dentist and the patient explaining that the long-term stability is determined by the four elements of biology affecting orthodontics, you are covered and should be able to continue your relationship with your referrer and the patient.

This type of thinking applies to fields outside of orthodontics, as well. Have you been to a cosmetic dermatologist lately? I doubt that he or she does one procedure and then does not expect you to return. Plastic surgeons are prepared to do multiple procedures on patients for dozens of years, with referrals, to boot! Physicians often have to face defeat, in anything from bad lab results up to the loss of patients, and yet their practices survive.

General dentists replace crowns, broken fillings and tooth loss. You need to have a plan—or more importantly, a script—to inform the patient, and a system through which to be financially rewarded, and have the patient smiling!

It has taken me years to come to this conclusion, but I feel that I have solved the problem of retreatment for the relapse patient. This system is essential for the continued growth and ultimate sale (notice I didn't say transition) of the practice and to differentiate the sole or group practice from the corporate model (the corporate model works for many—it is just different).

The nuts and bolts
So how do you start retreatment? The first step is to write down a plan and prepare everyone on the topic. That way you, as the provider, can stay out of the discussion as much as possible. It has always been my tendency to give away the store, either out of guilt, or kind feelings for the patient. But the staffers need to be reimbursed for their efforts, so let them handle it! Having a firm and fair financial policy for retreatment makes the inevitable situations move along swiftly. Also, dealing with it immediately will help ease the pain.

It's important to stay late and get the braces back on. Yes, the braces. Trying to re-align teeth using a retainer on a high schooler who didn't wear a retainer to begin with is about as pointless an exercise as I can imagine.

The importance of retreating your patients for a fair fee cannot be stressed enough. They don't want to be lectured about not wearing retainers. If you haven't already done so, explain to them which element of the four factors of orthodontics applies in their situation.

Retreatment is also key for those who are trying to fix their smiles later in life. Managing an older patient with minor orthodontic relapse who has multiple school-age kids in the wings is one of the keys to growing a referral-based practice. If you don't manage the situation properly, they will not only leave you to be retreated elsewhere—they will also take their families with them.

Retreatment is an important part of orthodontics. Luckily, if you explain the four elements of successful orthodontics as discussed in Treatment by Twelves and are honest with your patients from the very beginning, this process can be as painless as possible. Remember, you are here to help and create a smile that your patient will be proud of for years to come. Treatment by Twelves sidebar



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September 2025
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