Office Visit: Dr. Chris Teeters by Kyle Patton

Orthotown Magazine 

This Townie is so committed to the profession, he’s created an online study club, a popular annual conference, a new appliance and the world's only all-orthodontist band

by Kyle Patton, associate editor
photography by Jim David

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.

His alarm goes off at 5:02 a.m.—it’s all the way in the bathroom, so he can’t keep snoozing even if he wants to. If the early bird gets the worm, this Townie has never once missed breakfast. And when it comes to everything Dr. Chris Teeters has a hand in, that early wakeup still leaves many wondering how he finds the time to run a thriving orthodontic and pediatric dentistry partnership practice, teach continuing education courses, manage one of the profession’s largest online study clubs, invent appliances, rock out with an all-orthodontist band, win bodybuilding competitions and (last but not least) raise four children.

In our exclusive Q&A, we check out Teeters’ half of the Phoenix-area practice he shares with his wife, a pediatric dentist. He chats about the power of online communities, how he came to create an ectopic molar correction appliance, applying personality tests to better connect with patients, and a lot more.

Dr. Chris Teeters

University of Nevada School of Dental Medicine;
University of Minnesota School of Dentistry orthodontic residency

Affiliated Orthodontics,
Peoria, Arizona

3,800 square feet

Give us an overview of your practice.
For the past 11 years, I have owned a dual orthodontic and pediatric dental practice in Peoria, Arizona, with my wife, Dr. Morghan Teeters, a pediatric dentist. The practices have different names but share a door and records center.

We have a strong focus on early intervention and aim to see every child at age 7. However, we rarely treat at this age unless it is aimed with the focus of preventing issues that could have a less favorable outcome if treated later.

There’s a growing trend of orthodontic/pediatric partnerships. What has your experience been?
I strongly believe there are numerous benefits to forming an orthodontic partnership with a pediatric dentist, because the partnership ultimately benefits the patient much more than an isolated practice can.

Many orthodontic challenges—especially severe crowding, crossbites, impacted teeth and ectopic eruption of permanent teeth—can best be solved when they’re addressed early, and having a pediatric dentist screen for these potential concerns allows us to catch these issues before it may be too late to intervene effectively.

It’s also helpful to make sure that patients who are currently in active treatment are regularly seeing their pediatric dentist every three to six months. Having a second eye on potential tooth decay, periodontal disease, oral hygiene challenges and space maintenance considerations on the orthodontic side helps ensure that the patient’s dental health is always in check.

As a member of Orthotown and the co-founder of Orthodontic Pearls, you understand the power of online communities, especially in this profession. What’s your message to those who might be hesitant to engage online?
Online communities in orthodontics are one of the greatest things that have emerged in the past decade, and every orthodontist should take advantage of them because we all can benefit from a group of colleagues to share with and learn from.

Online orthodontic communities such as Orthotown and Orthodontic Pearls are not only invaluable resources for business and clinical challenges you may face—they also contain archives of cases, clinical pearls and business advice from colleagues worldwide. They’re essentially free Wikipedias of orthodontics that are available in the palm of your hand. You can post a case you’re struggling with and within minutes have dozens of comments from colleagues and top clinicians giving you personalized advice about your case.

You also teach CE courses and present on a variety of topics, including the importance of personality tests. How do you implement the tests in the office?
It has been helpful to teach CE courses at general and pediatric dental practices on topics such as early intervention and multidisciplinary care, but I’ve had the best response and enjoyment when teaching doctors about the DISC assessment and administering it during a lunch-and-learn CE session.

Although there are many different personality tests out there, I believe the DISC is the most applicable and the easiest to implement. When it comes to the consultation, the treatment coordinator needs to get a sense of the patient or parent’s personality.

As a brief overview:
  • “D” personalities are direct, and the goal is to present the information as concisely and quickly as possible.
  • “I” personalities are more social types who want to become your friend and usually are the types you can share light-hearted humor and stories with.
  • “S” personalities are steady and want to know they can trust you. It will be wise to smile often with a pleasant tone of voice and emphasize how you’ll take great care of them.
  • “C” personalities are conscientious, often arriving at your practice early with a notebook. They’ll be the ones who are interested in how many millimeters of overjet their child has.
So you can see how it wouldn’t be the best approach to, say, interact with a direct personality by focusing on relationship-building conversations or minute details. The same is true with relationships between team members. If the golden rule is to treat others the way you want to be treated, then the platinum rule is to treat others how they want to be treated. Leveraging personality types is an efficient way to relate with others more effectively, which is great for building team culture and patient rapport.

Cone beam computed tomography has resulted in superior diagnostics by being able to see the patient as a 3D volume rather than a 2D construction of a 3D person. This has allowed for incredible accuracy in repositioning appointments, provided detailed information for impacted canine locations, and has become extremely valuable as a consultation tool to help explain orthodontic challenges to patients and parents. This would be the one piece of technology that would be hard to practice without.

In a poll years ago that asked which bracket our colleagues used in practice, the top choice was American Orthodontics by a landslide. As a new graduate at the time, I figured other members in the group had more years of practice and knew far more than I did, so I switched to American brackets and haven’t looked back. They allow me to finish well and are highly predictable in the torque and tip expressions of my prescription. The points system to purchase adhesive and auxiliaries is another excellent perk, and our local rep is great to work with.

We recently switched to Angel Aligners because their software is surprisingly intuitive and I find having the buttons integrated into the plastic incredibly efficient and easy to implement. It’s made it so much easier to not have to bond buttons to the teeth! The comprehensive treatment option includes up to six years of included refinements, and retainers are included as well. They also don’t have a tiered program you have to maintain. Having tried multiple other aligner companies, this is the first company that I believe has truly rivaled Invisalign with a comparable—and in some ways superior—product with intuitive software and excellent finishing capabilities.

Edge practice management software is a true all-in-one and has been an indispensable part of our practice. The customization options are numerous, allowing our team to create a management system that meets our needs and has most of our service necessities all in one place. This was one of the first cloud-based options and has years of implementing doctor requests to become a truly robust and comprehensive software.

A 2020 Cain Watters & Associates study found that on average, practices that used consultants did better than those that didn’t. Working with this firm helped us identify practice culture challenges, establish a team that is truly supportive of the vision and values of the practice, and implement new strategies to maximize patient care.

I use the 3.5 expanded field loupes with a Dentlight wireless light. Few orthodontists would disagree about the accuracy of bracket placement being one of the most important factors in achieving excellent clinical results, and being able to visualize a tooth at 3.5 times its normal size greatly helps with accuracy. Using loupes has also contributed to the fact that I’ve had almost no back pain from doing orthodontics after all these years.
What are some of the most prominent mistakes you see doctors make when it comes to culture?
In my first few years of practice, I made more mistakes than I care to admit when it came to team culture. I tried to correct every mistake, reprimand team members for every deviation from my unrealistic expectations and tried to gain their loyalty by working every position in the office in hopes they’d see how hard of a worker I was and follow suit.

I couldn’t have been more wrong. It is important to find a management style that works for you, fits your personality and ultimately is consistent with your vision and values.

My biggest advice would be to set up a hierarchy as soon as you can. I’ve found that my relationship with my team has been incredibly strong when I am not the one to deliver constructive criticism. By having a lead for the clinic and a lead for the administrative team, almost all the positive communication comes directly from me and the messages that could be perceived as negative—even if the intention is to help the team member grow—always come from my leads. Although the team may know it’s coming from me, it’s very different if I speak it. My goal is to have a team who wants to work with me indefinitely and couldn’t imagine working anywhere else.

I also want to be a leader who trains other leaders, so I can focus on what only an orthodontist can and should do—things like diagnosis and treatment planning, building relationships with patients, and guiding the vision, values and systems of the practice.

Since I have learned to embrace this style of management, our clinic is running smoother than ever, my stress is much lower and we’ve had almost no team members choose to leave our practice—even during these recent years frequently referred to as “the great resignation.”

You’re not just an authority on the soft-skills side of the business—your clinical and technical skills have led to the creation of an appliance and related treatments.

In a practice that treats predominantly younger patients, I have frequently observed many ectopic first-molar eruptions that have resulted in permanent loss of space and later extraction of premolars (often through surgical removal) when the second premolar becomes impacted from the mesial drift of the permanent first molar.

I had used the Halterman appliance a few times with little success, because the compromised primary second molar is frequently lost during activation of the Halterman arm.

I also noticed that the majority of these ectopic molar cases also presented with a posterior crossbite. This led me to come up with a fusion of the Hyrax arms to the distal bands of a rapid maxillary expander, which has come to be known as the Hyrax-Halterman appliance.

This particular design allows for simultaneous expansion and ectopic molar correction, which in my office has been much more successful at effectively distalizing ectopic first molars and resulted in almost all of these cases regaining the space that was lost and ultimately resulting in a non-extraction final result.
[Click here to see a case study from Dr. Teeters that involves the use of a Hyrax-Halterman device.]

Since the advent of this appliance, orthodontists have shared hundreds of cases online showing its effectiveness. There have been even some additional combinations to the appliance, such as adding facemask hooks to also correct skeletal underbites and another modification adding a bluegrass appliance and tongue tamers. This has made the Hyrax-Halterman a “Swiss Army Knife” appliance for early intervention of multiple concurrent challenges.

You’re excited when presented with a complex, multifactorial case, but to less confident clinicians, these cases can seem daunting. What’s your advice for approaching these cases and reshaping a hesitant mindset?
When approaching a case that seems overwhelming, know that a decision doesn’t need to be made at that moment. In study groups and communities like Orthotown and Orthodontic Pearls, you have the wisdom of thousands of orthodontists to help you! Inform the patient or parent that you’ll be reviewing their records to determine the proper treatment plan over the next week or two and schedule a follow-up consultation.

Then post your records and analysis in one of the forums (provided you block out any identifiable patient data and your informed consent form has language allowing you to share case information with other providers) and work as a team to solve complex cases. Remember, you are not alone!

What’s your favorite patient story?

One of my most memorable patient cases was a young boy with a 20 mm overjet and a severely retrognathic jaw. He was so embarrassed to smile, he’d come into the office wearing a mask—and this was well before the COVID-19 pandemic!

I had informed his parents that we would try a functional appliance but ultimately the patient would need jaw surgery to correct his bite, so my goal was to reduce the amount of surgery needed, provided he had favorable growth and excellent compliance.

As soon as we delivered the twin block—my Class II functional appliance of choice—the patient started coming to his appointments without his mask on. He liked the way his jaw was appearing and the fullness in his face.

He wore the appliance 24/7, and we made two of them over two years. He wore it so well and had such favorable growth that we were able to treat him to a Class I occlusion and resolve his excess overjet completely, without surgery. I’ve seen this patient annually for the past 10 years and he has had less than 1 mm of relapse, indicating a stable result.

He was in tears on the day of his debond, and came in for his annual visit with me with a smile akin to the Cheshire Cat. Seeing him brings me much joy to know that we can drastically change lives for the better.
Chris Teeters Before
Chris Teeters After

Despite everything you have going on, you have a remarkable work-life balance. How do you do it? How can others?
If there’s anything I’m obsessed with, it’s the continual pursuit of personal improvement and maximization of time efficiency. I believe the key to happiness is to achieve a balance in which your five or so greatest passions are pursued every day. Any major imbalance can lead to burnout and dissatisfaction.

My watch alarm is set for 5:02 a.m., and I keep the watch in the bathroom so I can’t hit snooze. I do a one-hour weight workout while listening to music or podcasts, and follow that with 30 minutes of practicing guitar on the treadmill. By making time for music, fitness, orthodontics, family and faith every day, I feel like I can be the best and happiest version of myself. The key is to use your calendar to set you free. Although it may seem counterintuitive to have a schedule, if you are the architect of that schedule, you can build habits that ensure over time you’re doing more of the things you enjoy every day. Don’t rely on motivation, because that is temporary and will vary based on your mood. Habits, once reinforced for a relatively short period, will continue to work almost autonomously when motivation runs out, and are ultimately the most effective way to reach your personal and professional goals.

Tell us about the Mother of Pearls Conference and its growth.

Online study groups are amazing, but there’s one key component missing: in-person connection. Six years ago, the Orthodontic Pearls administrators and I began hosting the Mother of Pearls Conference, a live CE event. This year’s conference, planned for Oct. 10–12 in Scottsdale, Arizona, will feature 24 speakers, 50-plus exhibitors and a social event featuring the world’s only all-orthodontist band, Relapse.

Speaking of Relapse … you’re a part of it!
I am, along with some other orthodontists who were members of the Orthodontic Pearls Facebook study group. We played our first show at the 2018 Mother of Pearls Conference, and much to our surprise, the audience enjoyed it so much they shouted for an encore! Since then, the band has been invited to perform at three or four orthodontic events every year, including Invisalign’s 25th anniversary gala, and we recently headlined the AAO Annual Session in a sports arena for 6,500 colleagues. Relapse is currently being considered for international conferences in Spain and China!
[To learn more about Relapse, click here.]

How did you find your way into orthodontics?
Orthodontics has been a dream for me since I was a young boy. I had my teeth straightened by an orthodontist and thought, “How do they make my teeth move like that?!” I love seeing the excitement of patients getting their braces off, and I still remember what it felt like to have my crooked smile—which kids used to tease me about—become what my friends have referred to as a “million-dollar smile.” I wanted to bring that joy I felt to others in hopes that it would change their lives in the way it changed mine.

Give us a snapshot of your life outside of orthodontics.

My greatest joy comes from spending time with my wife and our four kids, Blake, Ava, Luke and Austin. We enjoy spending time with our friends, going out to eat or playing a game of pickleball. I serve and play guitar at my local church twice a month.

Over the past year, I also committed to a rigorous weightlifting and clean macro-based nutrition plan, and have won two men’s physique competition divisions! I’m grateful for the experience, and plan to continue a lifelong journey of health and happiness.

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