Ethical Dilemma at Corporate Orthodontic Office

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5+ Year Member
Aug 3, 2017
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I've spent 25 years in private practice and decided a change was necessary. Therefore I started to work part time for a Corp office. I still have my 2 private practices. I've been at the Corp office for 5 months. I actually enjoy the "change".

I had a 14 yr old girl come in for a retainer check. I had never seen her before. She told me that she thought her teeth were moving. I assumed it was maybe a single tooth whereby I could just tighten the Hawley ret and maybe some IPR. NOPE. Her alignment and occlusion was a serious MESS. Teeth were not parallel. Improper angulations. Improper alignment. Marginal ridges not level. Improper EVERYTHING. You literally could not tell that this patient had orthodontic treatment.

I am not one to disparage any dentist or specialist. I went back to read the tx notes looking for any reason why this kid's teeth were so terrible. Early deband due to lack of $$$? NOPE. Early deband due to lack of proper OH? NOPE. Early deband due to lack of cooperation with elastics? NOPE. Whats worse is that I can tell that the retainers were made to fit HER situation. This innocent kid trusted her orthodontist and wore her retainers ... as instructed.

I tightened her retainers. Told her to wear them full time for an additional 3 months and then we'll re-evaluate. I know full well .... that nothing is going to improve.

So ... the question. What would you say to this little girl and her family in 3 months when she returns? Getting Corp to retreat her for free is unlikely ... but possible. Maybe I just answered my own question.

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I would definitely talk to the doctors who are up there in management. We've had some cases that weren't properly managed, and subsequently needed retreatment and the managing orthodontist allowed us to continue tx at no charge.

Glad she is in better hands with you.
I'd present that to your managing dentist, say it was in your opinion substandard, especially since the patient appears to have been compliant as per the notes, and that it needs to be redone. You've got the experience to show that this isn't just something you're misinterpreting, and it really is a case that needs the treatment to be redone. If you present it like that, and that you're upholding this as your standard of care, and you're firm about it, I don't think they'll have too much of a problem re-doing it.

Good luck!
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Well .. I'll go to battle for this young girl and see what the managing dentist has to say. I've got some pull since I'm treating the managing dentist's 3 kids. :)
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Sometimes it really pays off to reinforce the point that you have high standards. I think as long as you present it logically, it won't be a big deal. I'm sure they're doing enough volume that one case won't hurt much.
Another nice thing about bringing it up is it shows to your GPs that you probably won't be doing **** work that needs to get redone when you leave (as you are doing). But who knows how they'll take it considering profits and all.