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Office Visit: Dr. Bridget M. Powers by Kyle Patton, associate editor

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Office Visit: Dr. Bridget M. Powers 

This California Townie shares her pivotal role in the evolution of clear aligners and her hopes to shape the future of airway treatments

by Kyle Patton, associate editor
photography by Lori Eanes

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.
The story starts on a farm in Washington state. A girl stares at her teeth in the mirror, her lips pulled back—not in a bright and happy smile, but instead in a self-conscious display that reveals something she wishes she could change. Like many in the profession, Dr. Bridget M. Powers’ first case, in a way, was her own. By high school, her mind was made up: “I thought orthodontics would be such a great job to help people feel better about themselves,” she says. Now, nearly a quarter-century into her career, Powers has a new and thriving Bay Area practice after spending nearly 20 years in a small office. Her remarkable career includes being the sole researcher at Invisalign when the company was only a startup, her continued efforts to spearhead proactive airway treatment for children in honor of her daughter, and breaking ground on a new office twice the size as her previous practice.

In our exclusive Q&A, we visit Powers in her Walnut Creek, California, practice, where she chats about the fascinating evolution of clear aligner technology, challenging the treatment zeitgeist of sleep apnea in children, how to successfully break ground on a dazzling new facility and more.
OFFICE HIGHLIGHTS
NAME:
Dr. Bridget M. Powers

GRADUATED FROM:
Northwestern University Orthodontic Program

PRACTICE NAME:
Smile Power Orthodontics, Walnut Creek, California 

PRACTICE SIZE:
2,650 square feet; 5 ops and 2 private rooms

TEAM SIZE:
11
How’d you find your way into orthodontics?
When I was a young teen, my smile affected my confidence and self-esteem. I had a narrow palate and a lateral incisor in crossbite. I remember my parents taking me to an orthodontist who gave me a tongue depressor and told me to bite on it. What? In any case, orthodontics was not a priority or affordable. When I was in high school, I thought that would be such a great job to help people feel better about themselves.

After I graduated from high school, I looked around the world and even with a much-needed scholarship to stay in South Dakota, I decided I was going to Berkeley and headed to the sunshine in California. At that time, I had no guidance on the journey of becoming a doctor—there were no doctors in my family, and I didn’t know about dentistry other than seeing one if you had a cavity. I arrived in California with little but a big dream, and started working and signing up for dental assisting school. Just as that happened, the universe intervened and I received an academic scholarship from a college where my best friend went to school in New Mexico. There, I started taking the classes I liked: biology, chemistry and physics.

I returned to California, waitressing to save money, continuing my studies at community college, and then bought my own braces at age 19. Yes, I saved my tips to buy my own braces! I still remember the bite plate and the spring to open the space catching my lip. While going to college, I expanded my work experience, learning computers, bookkeeping and even some entry-level programming.

When I received my invitation to attend Berkeley, I called up my orthodontist and asked if I could shadow and ask questions. He said, “I would love to, but we’re too busy. We need a bookkeeper.” I said, “Well, I can do that!” And there it began. I worked on a computer system called MacBraces. They hadn’t balanced the books for quite some time, and with my computer experience, I found a programming error the company fixed. Whenever I could, I would ask questions, help in the lab and even trim wires. The first time, I was so nervous, my hand was shaky. I called the sterilization equipment a “toaster oven.” The team would kindly chuckle and say I was never going to be an orthodontist.

During my time at Berkeley and working for my orthodontist, I also worked teaching aerobics, which came in handy when I started an exercise program in dental school.

So that part of the story concludes with a dental degree from the University of the Pacific, San Francisco, and the special day I got the call saying I was accepted into the orthodontic program at Northwestern University in Chicago. There, we learned custom treatment planning using a variety of approaches. We had advanced training in surgical orthodontics, cleft lip and palate and early treatment. It was there I further used computers with cephalometric tracing and prediction tracings; as I earned a master’s degree, I used computers to estimate the accuracy of mandibular advancement surgery. What I didn’t know was how this computer expertise would affect my career.


You were in on the ground floor of Invisalign! Tell us about those first few years, the challenges and your thoughts on clear aligner therapy today.
So, who doesn’t love Chicago? But I missed the California sunshine, my life and my friends, so I headed west again. I started work like many do— at a corporate office, where I gained valuable experience, learned staff management and patient communications. I sent a résumé to the South Bay, where I knew just a few orthodontists, and it got in the hands of an unknown company called Align Technology. They were cryptic at first, contacting me for a potential job but asking me to sign a nondisclosure agreement—I didn’t know what that was at the time!—so I could meet the founders about the opportunity.

I thought it would be a great opportunity to put computers and orthodontics together and give me the runway to work on product development.

Early on, we were using lightscanning technology to capture images. That has inherent inaccuracies, though, because the tooth curve may be in the shadows of a straightline beam. We moved on to destructive scanning, where a stone model was encased in resin and placed in a destructive scanning machine that shaved off one slice at a time and took a picture. The depth of the cut was a determining factor in the accuracy. Then, using those slices to build a computer model, they could then be manipulated.

In those early days, there were only nine of us, including brilliant programmers from Stanford. We would use stereolithography technology to 3D-print models, all while using standard vacuform techniques to make the aligners. No way to label them yet other than labeled Ziploc bags. I was also on the team that named the product! A brilliant marketing employee from UC Berkeley put us all in a room with a whiteboard and challenged us to think of any word that would describe what we were doing: cloud, clear, ghost, window … and with that, the name Invisalign was born.

The future of clear aligner therapy is very positive, with advancements such as remote monitoring and early treatment. I am using aligners to aid in early anterior crossbite correction in 4-year-old patients with elastics and buttons with good success.




How did you approach your new office build? Any tips?
I love design. I love the details. To me, making smiles and designing a building had a lot in common. My husband (who had joined the practice as the administrator) and I made the bold decision to buy land with an old house on it, tear down the house and build a state-of-the-art facility. The building had been iconic for having an old sign—something about “divorce for men only.” When my Smile Power sign replaced it, there were a lot of calls cheering the positive change.

The inspiration for my office was a building in Truckee, California, where my family had many adventures. I kept a copy of it on my desk for years until the opportunity presented itself, then hired a general architect and contractor, and with the help of a home designer began the process.

Explaining functional pieces of clinical operations or lab to a nondental person was a new language for them, but what they did was a new language to me as well. I thought about how every person might experience the space for the functional design:
  • We have a tall table with charging ports for working professionals.
  • A colorful table with storage in the chairs holds paper and crayons for patients’ younger siblings.
  • We have dual monitors and stand-up desks for the doctors.
  • The patients are greeted at eye level by the front office team.
  • A TV is wired for laptop access for community presentations.
  • We restock cassettes and supplies from sterile through the cabinet so as not to disrupt clinic flow.
  • Of course, it must look pretty, too!
The team that worked on the building reminded me of the early team at Align Technology. There was a passion for each piece and so many talented people. Their hearts and souls went into making such a great place to work and to help the community find their smiles.


Tell us about your favorite office features.
Function first: We have a break room with enough room for a yoga class and community seminars. We started an airway study group that uses our lobby and Zoom to reach more people about airway health and connect with multispecialty partners for the benefit of our commuity.

Healthy spaces: The facilities were designed before COVID-19 and still have healthy designs. We have 7-foot separation between chairs; large, tall ceilings; filtered air; and antibacterial surfaces thanks to a product called Krion used in hospital facilities. We have a semiprivate room for immune-challenged families or patients who just prefer it. And team members have the option of sit-down or stand-up work preference, headsets and dual monitors for healthy work spaces. The open facilities and design help us make each day count!


On the clinical side, you’re a staunch supporter of treating airway issues—especially in children. Why?
More than a decade ago, I learned about sleep apnea from my advanced dental study group that invited the best speakers from across the country.

Years later, an orthodontic supply company offered an intensive sleep apnea course and persuaded me I could help even more people. I bought into the watch and the binder and the systems, but each time I talked about what I’d found, patients weren’t ready to hear that from the person closing their diastema.

Big speed bumps were inevitable. Some treatments, when it turned to exploring a deeper possible medical issue, came to a halt. Some patients were agitated when they heard more than they wanted. I slowly retreated from the discussions and the watch started gathering dust. I now ask permission to show them when I see something and ask direct questions that may indicate sleep apnea.

I didn’t anticipate how close to home the issues of sleep apnea would hit. My journey into pediatric sleep apnea began with my daughter: When she was 4, she began having issues the medical profession didn’t have answers to, including dark circles under her eyes, digit sucking and polyuria. If you were to look at photos, you’d see signs of tooth grinding and a tongue thrust. The tongue was impeding the airway space because of an insufficient maxilla. As Dr. Soroush Zaghi says in his airway health lectures, “The box is too small!”

I ordered my own CBCT—we didn’t have one at the practice then—and a sleep study. Turns out, my daughter had a moderately blocked airway and sleep apnea.

When you face a medical issue, you quickly become an avid learner so you can make the best decisions for your child. I went on a journey with the ENT about whether to pursue surgery, but I did what I knew at the time and opted for an expander. Later, my daughter had a microimplant-supported expander with a facemask to open her airway. She had a dramatic change in her sleep and behavior. Now she can sleep with her mouth closed!


Tell us about two of your favorite pieces of clinical technology.
The No. 1 piece of technology in my office is the CBCT. The ability to see in 3D and map the airway is invaluable. The MSE is planned with the coordination of the STL model file, STL MSE file and the CBCT to enhance success. For my team, it is the 3D scanner. The near-elimination of taking alginate impressions and the ability to send and manage digital imaging with our lab partners means a huge boost in quality of work life and accuracy.


What has worked for you on the practice management side of the business?
I took over an existing office with just two employees, a handful of patients and lots of room for growth. In the early days of development, if one employee missed work, then half your workforce was out and it was hard on the remaining team. When we grew enough to afford four people—two in the front and two in the back—the workplace could remain functional, especially if the front office had the missing coverage. That task could be allotted for a different day.

Now with a moderate-sized team of 11, we don’t skip a beat when someone wants to take some time off, whether it’s planned or not. When you have a large enough business to take care of your team, it brings stability, better pay and benefits that attract stronger team members.

For many years, I read about which roles and responsibilities for employees of an orthodontic practice were most valuable. What I found was that people bring different skill sets to your team. If you can figure out what those skills are and capitalize on their growth and development, employees are more satisfied with their work and the team is more productive. I think about it as a list of all the tasks that go with our job and give them to the people who can serve those tasks the best. We also cross-train extensively. The clinical team has been referred to as “junior doctors,” and I show them what we’re doing and why, so they can be engaged in the treatment process and be knowledgeable when they communicate with patients and parents.

There is also a monetary investment in the team. Retaining high-quality team members is one of the most important aspects of running an orthodontic practice. Employees have had the opportunity to enroll and benefit from a 401(k) as well as other benefits, but this expensive benefit didn’t really receive the appreciation that it deserved until the plan was switched to a self-directed fund.

With educational classes on investing from my husband, who has a background as a financial advisor to professional athletes, the team was finally able to see what a benefit it is for them and our investment in their future. Now the team is excited to see their funds grow and appreciates the investment the business is making for their future.

We provide a medical reimbursement account that allows flexibility for employees to select the health care they individually require. We also pay for cellphones because we communicate via text so much.


What are the most effective patient education tools in your office?
Pictures and videos. Our patient education software shows videos and photos of diagnostic and treatment principles. What I love about it is the years of cases that are built into the software, so I can show a patient someone who looks similar to them and walk them through the process of correction—including options they may not have thought about, such as gingival contouring or buildups on lateral incisors.

Personal stories are how we share our love of orthodontics. Team members have stories to share, such as their own MSE or surgery for sleep apnea or buildups on the lateral incisors. We practice what we preach!


Top products
3D Planmeca Viso
3D PLANMECA VISO
Being able to visualize the skeletal and dental architecture and airway in 3D elevates your diagnostic ability.

CASEPRESENTER SOFTWARE
Developed by orthodontist Dr. Tom Griffin, this software allows us to show patients diagnostic and treatment information with photos and videos. What stands out with this program is the ability to show treated cases of patients rather than simulations. Real cases can be uploaded as examples, which helps patients have clarity for a case that looks just like theirs.

PITTS BRACKET PLACEMENT TECHNIQUE
Dr. Tom Pitts has transformed the way I look at smile design and bracket placement. Because we incorporate some of his techniques, our patients achieve better results.

DENTAURUM TADS
The mentorship program with Dr. Sebastian Baumgaertel and Dentaurum gave me the confidence and knowledge to achieve high success in TADs placement. With these techniques, cases have had better outcomes.

MAXILLARY SKELETAL EXPANSION (MSE)
Specifically, Dr. Won Moon’s maxillary skeletal expander appliance has changed the way we can help people with aesthetic and functional improvement. We also use the MSE in conjunction with a traditional facemask to promote maxillary advancement and airway improvement.
Talk about the “Smile Power Way” and your intern program.
The Smile Power Way is a set of procedures and protocols that streamline our work efficiency. It is a tedious process, but it can yield big results. After growth was complicating our schedule and we started feeling squeezed in the clinic, a full overhaul of the scheduling was performed with doctor time scheduling in mind.

When our office was on high alert during the 2020 pandemic, we consolidated our schedule, and then were well behind our typically punctual practice because of deficiencies in the way we were working and sterilizing handpieces. Each employee was working differently enough that the flow was choppy.

With much effort, each step was written down, including what was to be prepared, what we say, how we say it and so forth. Now, my team doesn’t love the drill-down on the procedures, but they do reap the rewards of the progress and now we have meetings where we discuss speed bumps and clarify and streamline any parts of the practice that need revisions.

Sometimes old-school methods work, too. We have taken the steps with the state of California for assistant training certification; the books have been written and procedures developed. What we found works with us is a little more of a traditional hands-on learning approach.

We participate in a local community college intern program (the school I attended) to bring in new faces and teach them as much as they want to learn. When a position opens, we can offer it to the best and brightest. One of our interns was accepted into Berkeley and is getting ready to apply to dental school. She wants to be an orthodontist!


What’s a trend in the profession you love?
The trend in orthodontics I appreciate is the application of technology for better, faster orthodontic outcomes— technology such as 3D radiographs, 3D scanning with artificial intelligence and the InBrace lingual braces. On the administrative side, we are able to have cloud-based management programs, better insurance processing integration and online appointment scheduling.

I support the message of examinations that are paid. We have a lot of expertise to share, and that knowledge is valuable. Our expertise as specialists is undercut if we’re offering free exams. When I take my children or pets to their professionals for their expertise, that time is valuable and I pay for it.

My practice has been charging for exams for well over a decade. Most of the time, it’s covered by an insurance benefit and the people who seek our advice are more committed to care.


What’s the most valuable piece of financial advice you’ve put to work?
My husband, Ken, has a background in investing and financial wealth management, so we have maximized retirement assets to decrease our tax burdens.

Professionally, engaging your team members to allow them to be a part of their own financial success story helps create a cohesive team that cares about each other.


What’s your most controversial opinion regarding the profession?
I’d like to see our esteemed professional organization provide more advanced learning paths for airway health to its members. A big step in the right direction was the white paper on sleep apnea. I used to say, “Don’t wait; send them by age 8.” But now it’s age 4. We could do more!


Give us a snapshot of your life outside of orthodontics.
I am a mother to three children. My time after school and on the weekends is committed to their passions.

Outside of my family, I’m an avid reader, particularly in the fields of health and business. I’m also a runner; I committed to running 13 half-marathons, and now that I’ve accomplished that, I run just for fun and do shorter races. I recently finished a 10K in Nashville.

I also love to create and invent. I earned a provisional patent on a medical maternity device, wrote my first children’s book about breathing, and am developing a “breathe box” to help young kids grow their best faces.

Orthotown Magazine
November 2023
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