Office Visit: Dr. Glenn Krieger by Kyle Patton, associate editor

Orthotown Magazine 

by Kyle Patton, associate editor
photography by Danny Fulgencio

Orthodontists spend most of their working hours inside their own practices, so they usually don’t get many opportunities to see what it’s like inside another doctor’s office. Orthotown’s recurring Office Visit profile offers a chance for Townies to meet their peers, hear their stories and get a sense of how they practice.

Dr. Glenn Krieger spent the first two decades of his clinical career hunched over drilling and filling before he hung up the high-speed and said hello to ortho. Those 20 years of general dentistry, though, gave him a unique lens through which to view the specialty, and he’s been giving back to the profession in a variety of ways since. An expert in clinical photography, the creator of a popular online group and website, and a world-traveling presenter and educator, Krieger is a stellar example of excellence in and around the orthodontic profession.

This Dallas-area Townie travels internationally teaching clinical photography and case acceptance techniques to orthodontists and dentists alike. He also founded the Orthopreneurs website and podcast for orthodontic practice owners. In this month’s Office Visit, we meet up with this doc, check out his impressive digital tech suite, discuss the next evolution of clear aligner therapy, get some clinical photo tips and more.

Office Highlights

Glenn Krieger, DDS, MS, FAGD

Graduated from:
Nova Southeastern University

Practice name:
Krieger Orthodontics,
Lewisville, Texas

Team size:
3,200 square feet;
12 staff

Your patient demographic is unique; your practice centers around adults. Why is that?

Where I practice, many pediatric dentists already have an orthodontist in-house, so for my practice to thrive, I needed to find some way to get new patients. It just so happened that my previous history with adults made me very comfortable treating adults in a way that most orthodontists aren’t.

I love kids, but the more adults I treated, the more I realized the profound impact it had on their lives and their appreciation for it in a way that kids simply don’t have. For instance, when I ask a 12-year-old whose braces are about to come off, “How do you like your smile?” their typical answer is, “I don’t know. I really don’t look.” When I ask an adult the same question, they beam and tell me how much I’ve changed their life. That’s what keeps me going every day.

I also love treating surgical interdisciplinary cases with my local oral surgeon. It’s so exciting when you can make skeletal changes and help enhance someone’s self-esteem, facial changes and their ability to breathe in a way that orthodontics alone cannot accomplish.

Your practice isn’t completely adult patients, though. You have a certain vantage on airways in children, especially.

A lot of people have been talking about airway and sleep in kids and adults. Many are treating it in unscientific ways; I just can’t endorse that. However, if you look at the scientific literature at respected institutions such as Stanford, you start to see that many people are walking among us suffering because they have poor sleep.

In children, it has been demonstrated scientifically that if they don’t sleep well, there is a cognitive deficit that never recovers. So we have to be prudent in the way we approach this process and treat it scientifically— and, more importantly, as part of an interdisciplinary team. I always say that anyone who tells you they can solve all of somebody’s airway problems by themselves should not be trusted. That’s why I work with a pediatric dentist, an ENT, an oral surgeon, a myofunctional therapist and a general dentist—because I can’t do it alone. We work as a team and we succeed as a team.

The crazy number is that up to 3% of children today have actual sleep apnea, which is the worst of the worst. That means that if you go to your child’s classroom, there’s a good chance that at least one child in that room has severe sleep apnea. As gatekeepers in orthodontics, we should be looking for this, at the very least.

Let’s check out your practice. There’s a lot to love about it, but what stands out to you most?

Everybody thinks their practice is the best out there—or at least I hope they do. Everybody also thinks that they have that one thing that makes their practice unique, and it probably does to some extent. In my practice, it’s light-heartedness. Anybody who comes to visit my practice knows that I take my orthodontics remarkably seriously, but everything else is a joke. I joke with patients, I joke with the team, I laugh, we role-play. If you listened to the office carefully, you’ll hear a lot of giggling throughout the day. I figure if it makes our office somewhere that patients and team members can’t wait to go, I’ve accomplished my goal.

Your office has an impressive suite of digital technology, including a full lab. What opportunities does this create for your practice?

We talked about airway and sleep earlier; I can’t begin to diagnose it without a CBCT. That also allows me the opportunity to do three-dimensional evaluations of bracket repositioning or midcourse corrections.

We also have a couple of iTero scanners. That’s been a game-changer, because who wants alginate? Last but not least, we have eight different 3D printers from different manufacturers, each serving its purpose, and a full-time digital lab manager and a full-time digital lab tech to serve the lab needs for all three of our offices. It’s allowed us to do so much more in the office relative to extended retainer programs and in-office aligners for either finishing a case or minor tooth movement.

What’s your secret to getting good reviews?

I’ve got 500 reviews with a five-star average. The key is providing great service. Now, let’s be honest that most patients don’t know the quality of care they’re getting, but let’s assume we’re doing good ortho. You as the doctor must lead the way by asking for reviews yourself. When your team starts seeing that, they also start asking.

I have so many friends who are afraid to ask and expect their team to do it for them. Sometimes you can get away with that, but most of the time, the team needs to know that you are on board as well. It comes naturally when people say how much they love you or how great the outcome is. All you have to say back is, “I’m so happy to hear that. It would mean the world to me if you would give us a Google review. Would you mind?”

You spent 20 years in the world of cosmetic dentistry before coming to orthodontics. What inspired the change? What surprised you the most when you entered the specialty?

Twenty years of practicing and doing lots of full-mouth rehabilitations was taking a toll on my body. My hearing was starting to go because of the high-speed. I was beginning to get carpal tunnel syndrome, and my shoulders were always aching.

I also was getting tired of every procedure requiring some form of resection, tooth extraction or pulp removal. I wanted to work with biology, not against it.

When I entered the specialty, I was truly blown away by how little general dentists, including myself, previously, really understood the biology and physiology behind orthodontic tooth movement.

Outside of practice, you also founded Orthopreneurs, a set of resources for orthodontists.

Orthopreneurs was started on a lark because I was the oldest and most experienced orthodontist ever coming out of residency. I was surrounded by a lot of younger docs who would ask me basic business questions, which I would be happy to answer—things like:

• “How do you find an accountant?”
• “Does this contract look good?”
• “How should I market my practice?”

These are pretty straightforward things that you learn as you practice. So I developed Orthopreneurs, a Facebook group where almost 5,700 orthodontists (as of this printing) come together to help each other solve their problems.

For those who don’t feel comfortable sharing in a public environment, we created Orthopreneurs, RD, which is a private, geographically exclusive group of orthodontists who are high achievers. Members pay to be a part of this group and sign a nondisclosure agreement, but it allows freedom and security to share because everybody feels safer.

You’ve helped countless docs. What are three mistakes you see orthodontists make?

Orthodontists are amazing individuals because by and large, they are really smart, really accomplished, and had to be the crème de la crème to get to where they are. What happens as a result is that many times, they believe they have all the answers themselves.

So the first thing that I would say is to be comfortable asking for help. There is no shame in that, because we don’t know what we don’t know.

A second mistake I see is people complaining that their personal life infringes on their business life. People tell me about their young kids or their group affiliations preventing them from taking continuing education or traveling to meetings, or courses. The best investment you can ever make is in yourself. You must! You have to have a balance in life. Becoming the best orthodontist and the best business owner goes hand in hand with an otherwise balanced life.

The third mistake I see is people being afraid to take chances. Many people just want a safe road; sometimes, taking that chance or listening to that little voice telling you the right way to go is what you have to do. Don’t be scared! Put yourself out there when it comes to opportunities. Measure every opportunity and evaluate it deeply. If it seems to make some sense, don’t be afraid to step outside your comfort zone.

What do you think is the biggest challenge in orthodontics?

The one that we haven’t seen yet. Every challenge now in front of us can be handled: GPs doing more ortho, for instance, is not a challenge because they’re never going to take the cases that float my boat, like surgical or adult cases with interdisciplinary elements. They’re not taking extensive Class II or overjet cases—they’re taking Class I, some minor crowding, etc. So I don’t see that as a huge threat to us. At-home aligners, I don’t think they’re going to take over what we do.

But what’s the threat that we don’t know about? What if artificial intelligence merges with a new technology that potentially allows us to be bypassed? If you think that can’t happen, look at history for some great lessons. Every industry that’s disappeared has been supplanted because of some technological change that made the original providers obsolete. Imagine if an app allowed patients to scan their teeth at home and AI allowed a perfect setup to happen with monitoring done through AI as well. I’m not saying that this is going to put orthodontists out of business immediately, but if there’s that kind of technology, what’s our response?

The biggest threat to orthodontics is one we can’t comprehend yet. But think about where things were 10 years ago and where we are today, and know that technology is only increasing more quickly, and companies are out there investing more money every day to get the lion’s share of what we consider the greatest profession on earth.

Top Products

Form 2 desktop 3D printer, Formlabs
Our first 3D printer was a perfect way for us to dip a toe into the world of 3D printing. We now have four of these (among others).

i-Cat FLX CBCT, Kavo Kerr
Being able to see your new patients, progress and finished cases in 3D is amazing. If you haven’t practiced with it, you don’t know what you’re missing.

iTero Element intraoral scanners
These allowed me to scale up my aligner practice when I started seeing more adult patients. Yes, it’s a greater expense than alginate, but it paid off in productivity and flow of the office.

Biostar thermal forming machine,Great Lakes Dental
Our workhorse for the past seven years. It’s comforting to know that we don’t even think about it—it’s just there, working, doing what it’s supposed to do for our in-house digital lab.

Designs for Vision loupes
I’ve been using these since a mentor introduced me to them in 1994. I couldn’t imagine working without magnification, especially as I get older.

Clinical photography is a passion of yours. What tips do you have?

Many amazing clinicians out there do remarkable orthodontics but refuse to become amazing photographers, which is odd to me. If you’re doing great work, why not have amazing images to show it off and use it as a tool for practice growth?

You need to spend time learning how to do exceptional clinical photography. Then you have to practice it—in the practice zone. This applies to all newly learned skills. Don’t go learn techniques and immediately try to implement them on patients; practice them on days off. Help your team train. Once they’re experts, set them loose and have them make your practice look amazing, because without great images, it’s harder to present cases to patients.

What’s your favorite patient story?

I’ve got a good one for you. My passion is helping two types of individuals: veterans of the armed services, and those with low self-esteem who can’t afford treatment.

I got a call from a local high school principal about a student with developmental delays who was being bullied because of her smile, but came from a family who couldn’t afford orthodontic care. The principal asked if I could help in some way, and I said “absolutely” without hesitation. The patient ended up being a four-bicuspid extraction case. A couple of years later, when we were done and we showed her smile to her in the mirror, she couldn’t stop crying and hugging every one of us in the office. Most of us started crying, too.

The saddest part was that when the patient looked in the mirror and was done crying, she told my assistant, “Now I can have friends.” That broke my heart because all too often, too many people are being bullied and their self-esteem is destroyed. To think that this poor young lady thought that having straight teeth would finally let her have friends because of how badly she’d been bullied was heartbreaking.

But let me tell you, we all went home with a huge smile on our faces that night.

What’s your most controversial opinion about orthodontics?

I think that many—not all—generations of orthodontists who came before us are responsible for a lot of the challenges we face today. I see orthodontists in their 70s practicing well longer than the doctors they took over for, who handed them the practice for next to nothing. They didn’t face huge student debt, communities oversaturated with orthodontists, general dentists doing ortho or at-home aligner companies competing with them.

They also didn’t hire younger docs, or allow the next generation of providers to come in with new ideas and techniques. They often asked exorbitant prices for practices that had in many ways been neglected. Minimal technology upgrades, minimal investment into infrastructure. They oversaw the largest stock and real estate market growths in our country’s history, and yet they often make it hard for young docs to get into a community. And many ask why the OSO/DSO movement, which gives doctors a way to get a job straight out of school, flourished?

While this won’t be a popular comment among that generation of orthodontists, many of the ills we face today that I mentioned earlier—as well as insurance involvement, student debt, and lots of other issues—all came about on their watch, not ours. So they left the next generation with a world that requires significant debt to enter into the profession, less opportunity, more saturation and the inability to buy a practice when they want to. That’s the truth. While it may not make me a lot of friends, I am an advocate for the younger orthodontists who are faced with more business challenges unique to their practice lives.

What’s the No. 1 challenge facing young graduates today?

I think today’s graduates face an amazing and challenging workplace—there’s a lot of student debt, but there’s a lot of opportunities. I don’t think orthodontics is on a downward slope; I think there’s a tremendous opportunity to do amazing things in our profession. We just have to be smart about how we bring these younger, debt-burdened orthodontists into the profession in a way that allows them to enjoy it and pay back their loans, as well as having some form of fulfillment. We need to have grace when it comes to the next generation. I don’t feel like there was much grace from the group before us. I hope to see that change.

You’ve seen aligner therapies evolve. What’s next?

I think we’re trending in the direction of treating people more efficiently—understanding the biomechanics, monitoring them remotely and minimizing the difficulties that they go through during treatment. The more aligners we do, the better we’re getting, the better we’re understanding it, and the better we’re making the outcomes as well as their journey.

Many orthodontists are still under the impression that you can’t get as good of an outcome with clear aligners as you can with braces. I, and many others out there, can show you cases where we are getting as good of a result—if not better—than we could have gotten with wires and brackets.

You and your partners recently joined a Smile Doctors network. Are OSOs and DSOs a challenge to the profession?

Because we partnered with the Smile Doctors network, we sold the equity in our practices. The newest model of orthodontic service organization (OSO), which has been around for the past couple of years, allows orthodontists to maintain the autonomy of practice without being told how they have to do things.

We loved that we spoke with many doctors who were happy with the Smile Doctors model—and unlike the early days, in which the practice had to be branded a Smile Doctors practice, our practice still says “Krieger Orthodontics” on the outside.

So, we get to choose our brackets and the way we treat; we get to set our fees. We get to market the way we want. We get to do things the way they’ve always been done. I think that as long as OSOs allow their partner doctors to practice autonomously, this model is not a problem. The biggest issue is when the quality of care is dictated by those who are not orthodontists. The day that happens is the day I stop practicing in that model.

If anyone wants to ask about our journey and what I’ve learned, I’m happy to share our experiences

What’s your life look like outside of orthodontic practice?

Between Orthopreneurs and helping my partners run our practices, life doesn’t offer a lot of free time! I try to spend time with my college-age daughter, my twins who are seniors in high school, and my wife of 27 years. I’ve tried to spend my nights learning how to play the guitar, but have little talent. I’ve loved trying to smoke all forms of kosher meat on all forms of grills, whether it’s engineered charcoal, gas or wood. Of course, we love to travel the world and experience new things.

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