Orthodontic Care

As an orthodontist, it pains me to watch patients and parent make critical mistakes regarding their orthodontic care.  All too many times, I’ve been approached by a mom for advice about a problem she or her child has encountered in the course of orthodontic treatment.  Or a patient shows up at the office for a second opinion, whether in braces or already out of them.  Problems I’ve seen and heard include:

  • “I have been going to my dentist for years and how come no one ever told me that my son’s eye tooth is growing in the roof of his mouth”?
  • “I trusted my dentist to tell me if my child needed any treatment, and now he’s a senior in high school.”
  • “I went to the orthodontist who waited for waited for my permanent teeth to grow in crooked, then he pulled 4 of my permanent teeth, and now my smile and face looks caved in.”
  • “I found out my orthodontist wasn’t really an orthodontist.”
  • “My dentist told me he could do my braces, and my bite has not been right ever since.”
  • “I have to have braces again for a second time by an orthodontist.”

The parents almost always confide, “Something just didn’t seem right from the start, I wish I had paid attention to my instincts at the very beginning. “

Anyone can Google “braces” and get all the technical information they need to learn some simple basics about how orthodontic treatments work and what they can do.  Almost every orthodontist in practice has a website, and they all say virtually the same things, because 95% of them were designed by the same two companies! But there’s also a lot of just plain wacky information out there, too.  It can be hard to discern the truth from the hype and to get the answers to our real questions.

Now I’m not sharing any secret, but its information that is not generally available to or known by the general public.  It’s information that I’ve learned through over 22 ears of private clinical practice.  It’s information that may not be “politically correct” and may make me unpopular with some of my colleagues.  But its information I would want my own family and friends to know before they start any orthodontic treatments for the themselves or decision for your (or your child’s) lifetime of health and wellbeing!

So, let me share my insider’s perspective with you.

How to Avoid 5 Costly Mistakes when Choosing Orthodontic Care

1. Picking or taking advice from an orthodontist who’s not really an orthodontist.

An orthodontist is someone who actually has to become a dentist first and complete and graduate from 4 years of dental school training. After becoming a dentist, an orthodontist is required to complete an additional two- or three- year post dental school residency at an accredited university training program.  All residencies involve intensive clinical instruction and oversight, and some require the completion of a Master’s thesis.   Typically, a dentist has to have been in the top 5-10% of his or her dental school class and have scored really high on the national dental board exam to get accepted into an orthodontic residency.

What is confusing to the public is that any licensed dentist can legally provide orthodontic services because of their basic training in dental school which includes minor tooth movement usually with removable appliances but may actually include a few braces.  But there are quite a few dentists who want to provide every service their license will allow no matter what experience or training that they have had.  Just about every month there’s another article in a throw-away dental magazine encouraging dentists to offer orthodontic treatment (and, yes, even Botox) to their patients in order to increase their profits in a down economy.  Why should they refer so much potential income out the door to specialists when they can do it themselves?

To meet this demand, there are several companies and organizations that offer orthodontic training for general and pediatric dentists.  Some are pretty pricey and involve a series of weekend courses.  At least one even offers an organizational membership and credentialing process that sounds almost official.  Check out orthodontics.com/StaticPage/society_credentialing

You may be quite shocked to know that some “companies” require only two to three days in order to become “Certified” or a distributor or their product such as Invisalign, Six Month Smile, FastBraces, or Powerprox Six Month Braces.

Just so you know, the AAO, or the American Association of Orthodontists (mylifemysmile.org) is the recognized professional organization for orthodontic specialists, however, there are many other names of organizations that attempt to provide credibility for their doctors who pay them thousands of dollars to sign up for their “weekend motel courses”.

I should also tell you that so long as dentists don’t infer specialization, they can legally advertise that they provide orthodontic services, so be careful if you see anyone who advertises that they do “Specialty care”, as it is very likely that they would like for you to believe that they are specialists when in fact they are not.  However, they are supposed to treat to the same standard of care as a specialist if they are offering specialty services as a pediatric or general dentist.

Now, a non-specialist dentist can get his or her hands slapped by the state licensing board for listing himself or herself as a specialist in the yellow pages.  But the internet is a whole new world, and state boards’ advertising regulations seem to have flown out the window.  The bureaucracy just can’t keep pace with technology.

When I Google “orthodontist”, several names come up (especially in the ad boxes at the top and on the right) that aren’t actually orthodontists, but whose offices provide some type of orthodontic treatments.  Now I’m a big Google fan; I use it ALL the time.  But this is a huge shortcoming with their search algorithm that most people don’t realize or understand.  Even the online yellow pages site gets specialists wrong, so it’s definitely “patient beware” when searching for specialists on the internet.

Make no mistake, there are some non-orthodontists out there providing acceptable orthodontic treatments.  But here are my concerns about orthodontic treatment provided by general and pediatric dentists:

Invisible trays and six-month braces treatments are only geared for mild to moderate crowding or spacing and can have little to no effect on underlying structural problems with the bite or airway for normal breathing..

Once they’ve done the easy part of straightening the teeth, how are they going to keep them that way if the underlying structural and functional problems are not addressed with treatment?

Do they really know the limits of what their treatments can provide?  And do they know how to manage when things go wrong?

I can’t see how their prices can be less than a trained orthodontist’s.  The instruments, supplies, employee training, and even paperwork are so specialized that it would be hard to be efficient and profitable if you didn’t do orthodontics all day every day.

Most dentists simply don’t have the experience in diagnosis and treatment to anticipate or manage the problems that can get a case off track.  As Socrates famously said, “The more I learn, the more I learn how little I know.”  Beware of the overconfidence of incompetent.

These dentists cannot have gotten even a portion of the experience and training in their weekend courses that a trained orthodontist gets in an accredited two to three-year orthodontic residency.  And just who do they practice on to get their experience?  Their own privately paying patients?

2. Choosing an orthodontist employed by a corporate dental company

It’s scary to me to imagine working as an employee for a corporation owned by non-dentists or by dentists who do not work in the practice. Often, orthodontists and other specialists working for these chains will work in several clinics on a rotating basis.  They do not have direct control over their employees, policies, or even the treatments or materials that they can offer. Or sometimes, orthodontic patients, the orthodontist, and the orthodontic assistants are brought into the dental offices over a long weekend, once a month, or on specific “ortho days”

Orthodontic treatment is a process which takes an incredible amount of attention to detail in making sure things go right and your results are the best they can be. In addition to regularly scheduled “adjustment visits” which are carefully planned in order to save time and optimize care, there are occasional loose braces and other unpredictable circumstances which may require an office visit on a very short notice. If any of these unpredictable visits are necessary, can it wait until the next “ortho day” or the next time the out of town orthodontist visits the clinical or dental office before the issue is tended to? You may not have a choice if you have signed up for orthodontic services with the company owned dental clinic. Choosing an office with full time service and even extended hours is usually a better choice which can even save you money in the long run.

Another problem is having a revolving door of orthodontists participate in completing your orthodontic treatment plan which can significantly delay and/or compromise your results. Orthodontists are trained in different schools and can have a wide range of treatments that they offer or refer which are based on their training and experience. By having constantly changing treatments prescribed by a constant change in treating orthodontists means that at your treatments can also change course frequently resulting in delays and you need to have braces on longer than needed. In addition, you will more than likely need to make many more unnecessary treatment visits to the office to get the same result as you would from another office.

3. Going to an orthodontist simply because their general or dentist referred them there.

Don’t get me wrong, I love getting patients from referring dentists.  It is incredibly rewarding to have professional relationships with quality providers who treat their patients well and want them to be treated well by quality specialists.  I value and seek these relationships, and work hard to keep them going.

That said, your dentist’s favorite orthodontists may have been a classmate in dental school who helped him pass anatomy and are now in the same study group.  That buddy went on to an orthodontic residency, and now they play golf together every weekend.  Or perhaps there’s an orthodontist who takes your dentist snow skiing or duck hunting or deep sea fishing every year. So don’t be surprised that sometimes even a busy and successful orthodontic practices are left out of the referral loop by your dentist just because they are not actively going out to buy referrals from dentists in the lunch circuit. Or, do you think your interests are best served by the strong endorsement referral you are given by the dentist who just met with his orthodontic lunch buddy? Is this the best orthodontist for you?  Maybe; maybe not.

Then there is the all too common dentist variety who proudly chooses to be “politically correct” and do not refer at all but instead delegate all referral activity to their staffs who truthfully usually have no credible basis for their referral selection for you except for the fact that their best friend works in the office they are referring you to and in turn will receive preferential treatment for herself serving actions that may or may not serve you well. Or, we all know about the dentist who refers you to an orthodontic specialist and the staff member who strongly urges you to see her orthodontic favorite for similar reasons or motives, none of which are necessary in your best interest.

I have known of referral patterns so entrenched that the specialists and/or the dentists have jeopardized the patient’s best interest in order to protect the referral relationship.  Talk about the tail wagging the dog!

(If your dentist refers to an orthodontist, be sure to check them out thoroughly to make sure they provide you with the care you deserve.)

Just because an orthodontist is pals with your dentist and their staff members, doesn’t necessarily make them the best choice for you or your child. It’s just good to be aware of the “good ‘ole boy” network and make sure that you don’t get trapped in it.

4. Waiting for all of your child’s baby teeth to fall out before being seen by an orthodontist

Let’s face it; most of us are very busy people, including dentists. The truth of the matter is that just because you or your child were not referred to an orthodontic specialist at your last cleaning appointment or check up at your last visit to the dental office does not mean that it is not in your best interest to see the orthodontist. Your dentist or hygienist typically focuses on things that they do best which is keeping your teeth clean and healthy and may shy away from having conversations about orthodontics because of not being necessarily focused in that area. In addition, it is not helpful that orthodontics, in general, is sometimes perceived as an unnecessary “cosmetic “luxury or expense that can be delayed or even avoided.

Surprising to many, including even some dentists, the American Association of Orthodontists recommends a screening exam by an orthodontic specialist no later than age 7. By waiting until all of the permanent teeth are in and fully erupted only means that you potentially could be allowing a minor problem advance to more serious stages which would require even more costly and invasive procedures such as permanent tooth extraction or surgery later on to correct the problem.

In addition, we are finding a large number of our younger patients who we see for orthodontic screening exams that their airway and breathing can often be compromised which can affect a child’s overall health and wellbeing during some of the most critical stages of normal growth and development including the brain. Some of these children come to us misdiagnosed with ADHD and other disorders and often on medication for these conditions. A specialist in orthodontics who has advanced training and experience in Dentofacial orthopedics is the only specialist in dentistry or medicine who can make structural changes and or corrections in a child to improve airway and breathing  without the need for surgery or medications. Some general, pediatric dentists and orthodontists prefer not do any treatments until all baby teeth are lost. These orthodontists usually feel as though it is more “cost effective” and “efficient” to do all of the treatments in one single “costly” phase rather than intercepting and correcting orthopedic problems early, and then follow with a short session of braces after all of the permanent teeth have all erupted.  In my opinion,   these orthodontists are more interested in serving their own interests than yours and want to get paid more for their time and see interceptive treatment as unnecessary when in fact there are often more benefits than not  to  patients seen no later than age 7. In contrast, choosing a specialist in orthodontic and Dentofacial orthopedics who is experienced and trained on early detection, airway optimization and associated treatment strategies if needed are more equipped to provide more benefits to you and is acting in your best interest.

5. Choosing an orthodontist just because their office is close to your home to save time and money.

Your time is valuable.  You shouldn’t have to spend all of your time driving back and forth across town to get to from work to your child’s school, to the orthodontist, and then back again.  But sometimes it is worthwhile to go visit some offices that may not be located close to your home for many reasons. First of all, some orthodontists may use older treatment strategies and technologies which require constant monitoring and are “adjustment intensive”. Having treatment completed in these offices will require up to 40% or more back and forth visits to the office for these monitoring and adjustment visits to get the same result. These older traditional braces systems also take up to 40% more overall time. Newer bracket systems utilize 3D scanning technology which enables braces to be mounted and adjusted with much more accuracy than manual placement methods. Because of the these newer systems, you can actually save more time and money even if you have to drive a little farther to the office for the less frequent visits.