Embrace Progress: So Just Whose Patient Is It? by Daniel Grob, DDS, MS, Editorial Director

More than 25 years ago, my business partner went to an AAO luncheon attended by many of the trustees and other notables.

Concerned at the time about the intrusion of non-orthodontists into our specialty, he had the nerve to stand and suggest that it may be time for us as a specialty to go it alone.

During that tumultuous period, pedodontists were offering orthodontics by performing Phase I treatment, collecting most of the insurance and then referring patients to orthodontists for the braces to "finish the job."

You can imagine how the patients welcomed those referrals!

Some general dentists were enrolled in light-wire courses and of course our extraction protocols were the "cause" of TMD because, after all, orthodontists "didn't care" what happened to their patients' TMJ.

In other words, just like there are optometrists and ophthalmologists, as well as chiropractors and medical doctors, perhaps orthodontists should declare themselves a separate medical specialty, independent of dentistry.

The thought process went like this: All patients need a general dentist. If patients are seen by an orthodontist, a referral most likely would have to be made to a dentist. Everybody wins!

But my business partner's suggestion never left the room. Arguments for maintaining the status quo included questions and statements such as:

• Where would we get referrals?
• What about cleft-palate patients and others needing medically necessary treatment?
• If you just do good work, you'll do well!
• It would take years to re-educate and reposition ourselves.
• What would we do without the American Dental Association?

What have we learned?
Now, 25 years later—and after decades of anxiety, loss of patients, and spending countless millions of dollars educating the public for its own good (after all, we went to school longer!)—can we say that our leaders were correct to maintain the course?

Even as we enter the second century of practicing the third-oldest medically related board specialty, the arguments for a separate licensure—independent, yet related to dentistry—are just as valid today as they were then.

Although politics, insurance reimbursement practices and patient perceptions are pretty much in place to maintain the situation as it stands, many forward thinkers have moved in the direction suggested decades ago—without the help of organized dentistry. Our orthodontic education system is married to the ADA as well as the AAO.

Orthodontists are recognizing the trend, acknowledging our mistakes and taking action. Numerous business plans are appearing that highlight the importance and necessity of keeping orthodontics at the gates of oral health.

I don't know if you noticed, but a question on applications for malpractice insurance asks if we record periodontal probing on our patients.

Even though we all know that orthodontics does not cause white spots on teeth, we are indirectly held responsible for their occurrence despite informed consent, fluoride prescriptions and calls and letters to the family dentists.

Sounds like we need to be general dentists … or supervise some!

A possible new trend
A recent post on the Orthotown message boards made the suggestion that newly graduated orthodontists purchase general practices instead of orthodontic practices.

For years, I've told prospective orthodontic residents that they should first open a general dental office. When the business is capable of hiring a dentist, the prospective resident should go to orthodontic school and continue growing the business with a second office. Once the resident graduates, a referral network is built in.

Since opening an office just two years ago and utilizing updated marketing efforts and experience, I've found that:

• Fifty percent of new patients need a dentist referral.
• Patients ask if our office can do cleanings and refer for cosmetic work.
• I find myself performing cosmetic treatment-planning consultations for patients, their relatives and their friends to help guide them through their cosmetic procedures.
• We don't need to rehash the countless numbers of patients who appear at age 15 still waiting for all the teeth to fall out, only to find extra, missing and impacted ones preventing the dentition from fully developing.
• I regularly work with very capable and talented dentists who incorporate total patient care into their treatment plans. Recently in my practice (and I'm sure yours as well):
• An adult patient with restorations on virtually every tooth in his mouth visited me for straight teeth requiring crossbite correction. After a failed aligner attempt, he'd decided to check out an orthodontist—he was seeking a nicer smile.
• Another adult, following the restoration of 18 of her 28 natural teeth, was told to use Invisalign to straighten her lower incisors. She decided to get a second opinion.
• Sleep apnea patients are appearing with posterior open bites after their dentists tried to cure their sleep apnea and told them, "Oh, by the way, wear this appliance in the morning to bring your teeth back together."
• I've had patients present to the office proclaiming that their dentist is also an orthodontist … we all have!

If any of you are members of cosmetic or restorative study clubs, I'm sure you realize that frequently, orthodontics is looked to first as the solution to—or as a valuable adjunct to—total cosmetic restoration.

Final thoughts
Someone once said, "Don't make it better; make it different."

This doesn't mean you bring donuts instead of bagels to your referring doctors. Positioning your practice and specialty as the first step in creating a smile is a great place to start.

We started as a referral-based specialty charged with delivering straight teeth in Class I occlusion. We have certainly morphed into much more than that, and need to look inward to what we offer and how we offer it.

This will take more than the AAO touting our educational background and superior knowledge.

As another wise person once said, "Don't sell the tools you have; sell the problem you solve."

In other words, touting your brand of braces, comfortable waiting room, etc., isn't the point. We are knowledgeable in total smile creation and management, and should position ourselves as such.

There are many new and creative ways to incorporate our care, skill and judgment into everyday dentistry and its associated delivery model. We know that an orthodontic evaluation is the place most patients should begin their dental-health journey. Let's point everyone in the right direction.