Embrace Progress: Controlling the Message by Dr. Daniel Grob

Dentaltown Magazine

Orthodontists can’t rely on outside referrals to bring in patients—so how do we get our recommendations known?

by Orthotown Editorial Director Dr. Daniel Grob

“See your dentist every six months.”

How often have you—or your friends, relatives or anyone else, for that matter—heard that phrase? Probably more often than you realize; in fact, it’s even a highlighted portion of my Informed Consent Statement that patients agree to before we place any appliances in my orthodontic practice. Of course it is, because it’s our duty to keep patients going to the dentist so they may receive the necessary care while we “straighten” their teeth.

“Every six months” is embedded into our culture, our advertising and even our behavior. Why is it that insurance companies actually pay for tooth cleanings and checkups every six months? (And how is it “insurance” if the company knows that it will be paying every six months for a known benefit and condition? That’s for another column.)

Speak it into existence
How did this phrase become ubiquitous in our society? It was probably because the powerful American Dental Association rallied, lobbied and insisted that any entities that wanted to earn the ADA Seal of Approval parroted that statement.

“First dental visit by age 2, and first orthodontic visit by age 7.” That’s also a recommendation … but we hardly see it used.

While the American Association of Orthodontics and some state boards have focused on stressing the advanced education of our members, they expect consumers to somehow extrapolate when and why they’re supposed to feel compelled to see us for their orthodontic care. In fact, it’s referred to as “smile care” now—gee, why didn’t we think of that?

Why am I pounding the table about the same old thing? I’ve been preoccupied by an event that happens all too frequently in the everyday practice of orthodontics—dentists’ failure to refer patients.

Most orthodontists either wait for referrals from “their” referral sources because they believe those sources know best—(“at least what’s good for them,” I mutter)—or they’re of the “If you do a good job, you’ll survive and prosper no matter what” mindset. Meanwhile, more general dentists are holding on to patients for aligner treatment, or even traditional orthodontic treatment, in their own practices instead of referring them out.

Who’s watching out for us?
On a recent Saturday, while I was examining two young patients with some obvious but not severe orthodontic issues, I couldn’t help but notice their younger sister sitting across from me at the exam table. I asked the mother, kind of jokingly, “When are we going to examine her?” The mom said that her dentist didn’t mention that the daughter had needed anything.

While we were finishing up the two older siblings, my NPC jumped into action. Within a few minutes we had a cephalometric X-ray, pano and photos, and alerted the mom to the facts: There were two missing lateral incisors (and, hence, a space between her permanent incisors—and this girl was 10 years old!) and one impacted cuspid.

Fortunately, my team was organized, swift and complete, and within a few minutes we had spacers in all three children.

Her dentist had never bothered to suggest treatment for the girl. I’m sure something similar has happened to you.

It’s time to get the word out
Why aren’t we—and the dental industry in general—doing a better job at getting out the message that children should see a dentist at age 2 and an orthodontist at age 7? Why aren’t the people who keep recommending that patients need to “see the dentist every six months” also promoting they need to see the orthodontist at age 7?

Years ago, I penned a CE course for Orthotown that attempted to answer the question of when to refer. I think that this article, titled “Treatment by Twelves,” identifies all of the major dental, skeletal and habit changes responsible for malocclusion and what to look for at certain ages. It attempted to make referrals simple and concise by creating a mnemonic for the times when it’s recommended to visit an orthodontist.

  • The first 12 permanent teeth. After these have erupted, it’s an appropriate time for early evaluation, including habit correction or myofunctional therapy. A single-tooth unilateral or bilateral crossbite affects jaw function and future eruption of teeth, and it’s almost universally suggested that it be corrected at this stage.
  • The next 12 permanent teeth. The “gold standard” of treatment is during the adolescent growth stage: Jaws are developing through apposition and resorption in the posterior of the mouth, so distilization is possible, and treating the upper arch first to develop the smile allows monitoring skeletal growth, allowing for the jaw to open and close on its hinge and lower teeth to erupt into the upper teeth without assistance, etc.
  • The four 12-year molars. Generalized spacing, missing teeth and Class III skeletal growth are all best managed when all teeth have erupted and growth is stabilized.

I promote the “Treatment by Twelves” idea on my practice website to help parents know when to bring in their children for consultations. I’m not relying on dentist referrals—and you shouldn’t be, either.

Our profession is being reduced to a product and excuse to sell plastic. It’s all about the power of the consumer—and that’s not necessarily bad; we just need to embrace it and use the trend to our advantage.

It’s time to create a new smile care specialty that begins with the eruption of teeth and continues through adulthood—not one known for picking the “right” time for “braces or aligners.” It’s time to define what we stand for, what we care for, how we do it and on whom we do it.

As one successful orthodontist I knew in Tucson once said: “You don’t get control, you take control.”

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