Virtual Reality: Orthodontic Consultations by Dr. Emily Howell

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Virtual Appointments: The Reality 

Orthodontic treatment and acceptance have become an out-of-office experience, but success depends on how you and your team communicate virtually


by Dr. Emily Howell


Editor’s note: During my initial phone conversation with this year’s Townie Choice Awards cover feature winner, Dr. Emily Howell, I asked to what degree her business had bounced back after the COVID shutdown—whether fears about disinfection practices and aerosol contamination had slowed patient visits.

As it turns out, Howell had smartly pivoted to virtual consultations for many patient visits, including consultations with potential new patients. In fact, of her practice’s 430 new-patient consultations over the past year, 275 were done virtually.

“Doesn’t that make it hard to build a connection with patients and their parents?” I asked. “This is a high-dollar purchase for most families.” Howell said that actually, many parents appreciate the high-tech option, which saves them from pulling kids out of school, driving to the practice and the like, and as long as doctors communicate effectively with patients and parents each step of the way, acceptance and compliance could be higher than before.

I asked her to chronicle how she and her team put this practice into action, and her story follows. (To check out her Office Visit feature, click here.)


Before the virtual appointment

It’s all about perspective, communication and chemistry leading up to and during the virtual consultation. Our treatment coordinator communicates, Ruth, very intently via informative emails and text messages leading up to the appointment. If correspondence remains friendly and informative, followed by a quick response through text or email, parents won’t feel like they’re “missing out.”

Ruth collects pictures from the patient, who has watched a video that we made, and places them into a collage like the one we use in the office. She also contacts the patient’s dentist to determine the date of his or her last cleaning, if there’s any pending dental treatment, and if the dentist could send us a current panoramic radiograph.

The treatment coordinator emails the collage, the pan and any other pertinent information about the patient—chief concern, referral source, family members in the practice, etc.—to the orthodontist so the doctor can review records and formulate a proposed treatment plan before the virtual appointment. Then, the doctor replies to Ruth with a quick summary of recommendations to be prepared in advance.

The day of the virtual appointment

After Ruth’s brief virtual “meet and greet” with the patient and parent, the orthodontist logs on and meets the parent—and the patient, too, if available—face-to-face to discuss the recommendations. This takes only about 5–10 minutes of doctor time. The treatment coordinator then explains the details involved in what the doctor just recommended and answers any questions, followed by an email with payment options.

We always explain to patients and parents that our recommendations are based on the photos they’ve provided and that the suggested treatment could change when our records are taken. So far, all of the parents have understood and agreed. Sometimes, the doctor can’t determine the plan without better photos, or radiographs, and will simply build a relationship to help parents feel comfortable sending their child into our office alone for records—we try to keep parents from hovering in the practice. If parents don’t feel comfortable with this, because of the age or maturity of the child, we will schedule them in our private room for that first appointment. (We screen all parents for COVID, take their temperatures and enforce mask wearing.)

It’s what you say and how you say it

Our treatment coordinator encourages parents to email or text her with any questions or concerns at any time, before or after the virtual exam. Through the years—and especially throughout this pandemic—we have realized that the quality patients are the ones who will follow through and who will notice and appreciate the time and effort we put into our practice. Compare this with patients who call us only to ask about price matching (which we do not do; we have a very friendly response when asked about this, but that’s a subject for another day).

We’ve also realized that a good relationship with the patient and parent is all about verbiage. If you can, calmly and kindly say things such as, “Please know that there is no obligation to start treatment with us. We don’t want you to feel rushed at all, because this is a big decision. We want you to be confident and feel comfortable with the orthodontist that you choose. We strive to give the best quality care to all of our patients and in order to be fair to all of our patients, we aren’t able to match prices or negotiate overall fees.”

Setting up the system

Before you set up a virtual new-patient consultation plan in your office, brainstorm with your entire team to determine the true order of operation. There will always be trial and error. The first few weeks of doing virtual new-patient consultations will feel odd, but the more comfortable you get with it, the more tweaking you do each week to make the next one even better.

Always have the treatment coordinator make a reminder to check in and follow up with the parent or patient within a few days after the virtual consultation. With this mindset, it will just get better and better. Because of the virtual consultations, we’ve been able to see more crucial appointments in the office and spend more needed time with them because we aren’t having to tackle the doctor to hurry up and get into the new-patient room.

Take note that the actual virtual appointments never last more than 10–15 minutes, so we can squeeze in last-minute consultations pretty much any time throughout the day where there are openings. (The treatment coordinator’s work in the lead up to the appointment and follow-up afterward takes additional time but is well worth it.)

Some bonuses to virtual new-patient scheduling

Because photographs are sent to us a few days before the virtual appointment, patients don’t have to be present if they can’t miss school. Moms love this! Many times, parents join the virtual appointments from their office, in their car, from home, and so on. It honestly has been a game-changer, but only because we have tweaked and fine-tuned the overall process so much that it has become a thing of the past to bring patients and parents into the office building for every single new-patient consultation.

This virtual new-patient consultation has also allowed our treatment coordinator to have more office time to follow up with colleagues and parents, so she’s also able to help cover phones and schedule.

Before COVID, we were considering hiring someone else just to make follow-up calls, cover phones and help with more “office work,” but now we have learned to become so much more efficient: Our administrative team has more time to get caught up because there aren’t as many people inside the building waiting to be seen.

Adjunct ideas and time-savers

Even before COVID, our practice used detailed “report cards” to send home with patients, which have been valuable since the COVID shutdown and our subsequent reopening. It’s an easy checklist for the assistant to simply check off how hygiene was today, what might have been broken and was fixed at the appointment, what was done today, what the patient might need to work on, if they’re wearing elastics and when, and when their next appointment is. (We do the latter chairside now, so admins don’t see any patients face-to-face.)

We also have lots of procedure codes that autopost emails to parents about elastics, hygiene and retainer wear with patient pics and office videos. No more retainer checks at all in our office! We even have a video for expansion patients, which includes instructions on how to turn the device and reminds them to send photos to us after three weeks so we can determine if they’re turning correctly or whether more expansion is needed—without them ever having to come to the office to do so.

We used to have patients with poor oral hygiene come back in two to three weeks to have us check on it. Now we send a letter to the parents with a picture of how the patient looked today and ask them to encourage the patient each day to follow our instructions—yes, we have a video for that too!—and take a follow-up photo in two weeks so we can see progress.

The same goes for recalls who are ready to start but brushing is not up to par: The email instructs them to take a picture in three weeks to show us improvement before we’ll book any appointment for the braces. One patient with subpar hygiene slowly improved over time and sent a series of pictures to us over several months. Now, her hygiene is finally up to our standards for braces. We are proud of her and now feel confident that the treatment will be not only an orthodontic but a dental hygiene success.

Treatment acceptance is now virtual too

We no longer do in-office consultations for signing paperwork, either. Explaining and deciding upon financial contracts, procedures and policies is all done on the phone and acceptance is given via RightSignature. When the new patient comes into the office for the first time, paperwork has already been signed and down payment taken care of, so we’re not waiting on a consult that took way too long or payments that haven’t been made.

We allocate one hour total for this first in-office experience to take records, have the doctor verify the original treatment plan, and place the upper braces. Many times, the patient has already watched our “what to expect/oral hygiene” video at home; if not, we allow them to watch it on their phone or our tablet in our office while we clean/ treat other patients, so that saves a step as well. (We do have a private room for younger, special needs, immunocompromised and elderly patients that, if required or parents request to come in, must be reserved on a special block on our schedule in advance.)

I believe that we’ve made a name for ourselves in the community as a family-friendly atmosphere with a much more conservative approach compared with most orthodontic offices, yet everyone also knows we are progressive with the latest technology.


Author Bio
Dr. Emily Howell
Dr. Emily Howell, earned a BBA in management information systems and graduated summa cum laude from the University of Georgia before earning her DMD and certificate in orthodontics and dentofacial orthopedics from the Medical College of Georgia. She opened her own practice in 2007 and is a diplomate of the American Board of Orthodontics and past president of the Clarke County Dental Society.


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