Catching Up With: Dr. John Graham

When it comes to new opportunities, nobody’s more eager and excited to take a chance than Orthotown editorial board member Dr. John Graham. The Salt Lake City orthodontist began his medical career as an oral and maxillofacial surgeon, but realized it wasn’t a good fit and pivoted into a new specialty—one that not only allowed him to share time with his family but also offered the chance to design his practice with a radical new mindset to what an orthodontist’s office should look like.

In our Q&A, Graham also discusses his clinical mindset—from the dramatic effects that sagittal-first treatment has had on his patient treatments to the instruments and tools he wouldn’t practice without.

You’ve transformed your career several times. Tell us about your history of practice, and what’s been your biggest motivation for such changes.

I initially went down the path of oral and maxillofacial surgery—I trained at Parkland Memorial Hospital in Dallas and received my medical degree from the University of Texas Southwestern Medical School. I loved my medical and surgical training—loved it!—but what I did not enjoy was the lifestyle. I valued my time with family, but I had very little time for that while working in OMFS.

I am married to a very understanding pediatric dentist who supported my decision to switch specialties. That was not only a great move for my family and my personal life, but it was also a transformative time in my life. It taught me that your happiness is in your control, at all times; if you aren’t happy, you have only yourself to blame because you can change your life at any time and in any way.

That has been a learned skill for me, and I’ve put it to the test multiple times. For example, we weren’t happy in our initial landing spot, Phoenix, so at the age of 45 I started a new practice from scratch in Salt Lake City, and we’ve never regretted that for a minute.

We heard that the building that houses your current practice has quite a history. Tell us about the work that was required to make such a transformation happen.

Through a series of politically motivated moves and countermoves, the city had changed the zoning of the property to noncommercial. Because of that, this prime corner in Salt Lake, an old former chiropractic office, sat vacant for more than four years. It wasn’t empty, per se, because it became a crack house, with homeless individuals taking up residence in the building.

In my mind, though, I couldn’t let that property go: It’s on such a busy corner that its visibility would’ve been more significant than my previous Salt Lake office by orders of magnitude. I ultimately partnered with a builder and developer on the site. He taught me a great deal about city politics and—long story short—after many planning commission and city council appearances and votes, we had the zoning changed. That entire experience, like my change in specialties, can be summed up in two words: worth it!

What sets your practice apart from other offices?

When I built the building, I wanted it to become a landmark in the city; I wanted people to use it as a waypoint when giving driving instructions to visitors in Salt Lake City. It was vital that it could stand out in a nonpretentious yet striking way, and I think the mission was accomplished.

I designed the interior with the goal of confusing people—by that, I mean I wanted people to wonder if they had entered an orthodontist’s office and to double-check their location to be sure. Every architectural norm that I had observed in my many years of practice I consciously avoided, right down to having no wall or separation between the lobby and the clinic. It has been wonderfully successful.

Clinically, what has made the most significant impact on your practice within the past three years?

Incorporating the sagittal-first treatment philosophy has radically changed the way I practice, my treatment times and my patients’ experience.

Some people in the orthodontic world would suggest that this is nothing new, that it’s nonimpactful and doesn’t seem to be different. That’s not the case for me: The psychological and behavioral advantage I have in doing the heavy lifting, from a compliance standpoint, from Day 1, is remarkable.

Patients walk into an orthodontist’s office ready for change, prepared for an interruption in their daily routine. I capitalize on that willingness by starting my AP correction on the very first day. The shift in the tenor of my office is demonstrably different. There are always going to be noncompliance issues, but I can tell you in all honesty that I’m rarely compelled to have a noncompliance discussion with my patients. That observation alone has made my life and the lives of my staff much happier. Treatment times have radically decreased across all patient categories in my office, which in turn has reduced hygiene issues, burnout and all of the negative aspects of long treatment times.

With solo practices facing more competition from corporate dentistry and direct-to-consumer orthodontics, where do you see the future of orthodontics moving, and how can doctors prepare themselves for success in that environment?

There’s no question that the tooth-moving landscape is changing at breakneck speed. I love that! The general awareness of orthodontic treatment has increased dramatically, and I’m benefiting from it. I’m a firm believer in an abundant mindset, and everything I’m witnessing tells me that the untapped and untreated patients in the U.S. are starting to wake up to the option of orthodontics. Some will go the way of at-home treatment not supervised by a doctor, and many will choose to have a doctor involved in their case. I refuse to let increased orthodontic competition and marketing dictate my happiness with this great profession. All ships will rise with the elevated awareness of treatment options, and for those who fear it or claim that our specialty is dying, I suggest looking at the actual numbers of treatment-eligible individuals in this country. There are more patient opportunities than any of us could handle, and we need to tap into that wellspring and deliver excellent care and experiences. What a great time to be an orthodontist!

Over the past year, several companies have introduced their own clear aligner options. Which system are you using, and why did you choose it?

I use both Henry Schein Orthodontics’ SLX Clear aligners and Invisalign. I cut my teeth on Invisalign and have become proficient at treating a multitude of cases and ages with it. SLX Clear is remarkable, and I’m using it in more and more patients. The clarity of the aligners is striking, and the adaptation around the clinical crowns is excellent. In many cases, I don’t need to use attachments because of this remarkable adaptation, and patients do notice and prefer the clarity over other options. Both products allow me to offer aligner therapy to the majority of my practice, in not only adults but teens and preteens as well.

Do you think there’s still a place in ortho for fixed appliances? If so, which bracket system are you currently using?

Absolutely. There are many treatment scenarios that demand the use of a fixed appliance, but braces will never go away. They’re such a useful tool to a good practitioner, just like aligners. Knowing when to use which or when to combine both is the mark of an excellent clinician. (I’m still learning every day.) I use Henry Schein Orthodontics’ Carriere SLX 3D passive self-ligation system along with its new Carriere M-Series three-wire sequence for many of my patients. I’d never consider practicing with anything other than self-ligation; it’s how I’ve always treated my patients, and the advantages that exist with the SLX 3D brackets make them better than the alternatives, in my opinion.

Tell us about your life outside of the practice.

We’re an active family with four children. Our daughters are in dance and sports, which keeps us busy. I enjoy investing in startups, traditional securities and crypto-assets. My 16-year-old son is an active, successful investor and teaches me a ton. It’s like being in school every day, and I love it.