The Human Touch by Dr. Susan Blair

This doctor, a dual-credentialed orthodontist and pediatric dentist, shares suggestions from both sides of the practice on how to boost referrals

by Dr. Susan Blair

• Stock the box with products from other local businesses and make sure it’s labeled as such.
• Call the office and speak to a front desk team member or office manager to ask if there are any favorite treats, dietary restrictions, etc.
• On the same call, make sure you have the names of all associate doctors and confirm the correct spelling of each one.
• Repetition can help you be memorable! If an office calls to thank you or say they particularly liked something, send it again.

• Phase 1 treatment versus monitoring. What to watch for, when to refer. Most pediatric dentists take panoramic X-rays for patients in early mixed dentition and learn certain information about upper canine angulation, crowding, ectopic teeth, etc.
• Focus on newly trained pediatric dentists or new practices. Older pediatric dentists learn their ways and get set in what they like and don’t like in orthodontists. Find out what they like (or don’t) and if your practice style fits, make sure they know that! If not, move on and look for other providers in the area.
• Pediatric dentists providing treatment themselves. This is more rare in the past decade because of the high incidence of caries, and the American Academy of Pediatrics and the American Academy of Pediatric Dentistry’s great job of raising dentists’ awareness of the importance of seeing babies and young kids early (as well as the drop in orthodontic education in pediatric residencies), but some pediatric dentists may be interested in doing expanders or some limited orthodontics themselves. This isn’t ideal, but it can be an opportunity to teach the dentists and gain future referrals and patients referred that are outside of the dentist’s comfort zone. (Educate them on what that is or should be!) With the increasing focus on airway, some pediatric dentists are exploring early expansion, as well as trainer appliances like MyoBrace and Healthy Start appliances.

• Bracket type/placement. My orthodontic office had some mutual patients with a different pediatric dentist in the area who had minimal exposure to the Damon bracket system and told multiple parents that it was “wrong” to put brackets on baby teeth or that we had accidentally put brackets on baby teeth thinking they were adult teeth. This was frustrating, but could have been avoided if we had educated this office better on our treatment philosophy.
• Retainer protocols. At one pediatric office I’ve worked in, the local orthodontist had kids wear their post-Phase 1 retainers all the time—even when eating. We had issues with white spot lesions and decay developing, and it’s important to have a conversation between specialists so we can best care for our patients.
• Imaging/CBCT. At the beginning of my career, I worked as a pediatric dentist in an area with an orthodontist who took a CBCT for all his imaging. I wasn’t educated on the type of CBCT he was using—one I now use myself with a significantly lower dose than a traditional pan!—and I mistakenly told a few parents that the amount of radiation was “overkill” and I preferred to work with another orthodontist. Stupid on my part, but had the orthodontist and I communicated better and had they educated me on the type of machine they were using and radiation dose, it could have changed the outcome and our referral pattern.
• Communication on referral for caries. At the pediatric office, we had recently seen a patient for a recall and the orthodontist referred back to us, saying there was a cavity that needed filling. The patient’s parents were understandably annoyed, because they had just been at the dentist! The orthodontist had noticed a stain on a small buccal groove on a lower molar, which we’d marked a year or two prior as a “watch” to monitor and had been stable since. The bracket had come off and the orthodontist noticed the stain or potential cavity. I get that the orthodontist needed to comment because of potential liability if it was a cavity or developed into a cavity—especially putting a bracket back over it—but the referral could have said “evaluate for a cavity or stain.” Send a note to have the dentist “check,” etc., outline why you’re concerned and ask the patient when they were in for their last recall. If they were just in, a phone call would be a nice courtesy. That way, no one is “wrong” and both parties can communicate about proper treatment.
• Pediatric dentists love to be in contact. Sharing your cellphone number with the pediatric dentist and asking them to reach out if they have any concerns can go a long way. Pediatric dentists and their teams are very concerned with oral hygiene; letting them know you care and that you’re closely monitoring or recommending three-month recalls makes the pediatric dentist and their hygienists feel better!

Dr. Susan Blair, a member of Orthotown’s editorial advisory board, is a board-certified pediatric dentist and a board-certified orthodontist. Blair owns two pediatric dental/orthodontic offices in the Chicago area with her husband, orthodontist Dr. Nick Riccio; before that, she worked as a pediatric dentist for 10 years in private pediatric dental and combined pediatric/orthodontic offices.