My General Dentist does ORTHO!

[FlossY]

Hey guys! I am actually a pre-dent and I am also new here......Today i found out that my General Dentist does ortho. work!
I was wondering if this is even legal (since she does not have a speciality degree)
Is this smart on her part ( when orthodontist find out less referals for her)
Also she is new here in my small town and it seems that she is doing pretty well buisness wise (so maybe this is working for her now but what about the future)?!?
Do all General Dentist do a little ortho work (like on their staff/friends)

Thanks For reading! Everyones 2cents counts.....

---

Members don't see this ad.

 

[DrTacoElf]

Yes its legal as long as she is up to the standards in her quality of work. She probably hand picks the best cases to deal with.

 

[FlossY]

Yes its legal as long as she is up to the standards in her quality of work. She probably hand picks the best cases to deal with.

So it would be smart for her to just do like ones that arent so straining/difficult and refer out the ones that are!

 

[12YearOldKid]

Hey guys! I am actually a pre-dent and I am also new here......Today i found out that my General Dentist does ortho. work!
I was wondering if this is even legal (since she does not have a speciality degree)
Is this smart on her part ( when orthodontist find out less referals for her)
Also she is new here in my small town and it seems that she is doing pretty well buisness wise (so maybe this is working for her now but what about the future)?!?
Do all General Dentist do a little ortho work (like on their staff/friends)

Thanks For reading! Everyones 2cents counts.....

Holy crap!!!! Are you serious?!!! A general dentist doing specialty procedures?!!!

Just joking with you. In reality, there is a specialty for every dental procedure that doesn't involve amalgam.

If general dentists DIDN'T do specialty procedures there wouldn't be enough specialists to fill the need --- and general dentists would be pretty poor. ~75% of endo is done by GPs, ~50% of ortho is done by GPs and most extractions are done by GP's. Specialists are there to tackle the cases that are beyond the training of the GP. As long as the GP has the appropriate training there is no reason he shouldn't be doing specialty procedures.

 

[Dental916]

As long as she doesn't say that she specializes in orthodontics...she is fine by all means.

 

[Jone]

Very little of a GP's business comes from an orthodontist referring to them. She has nothing to worry about.

Is this smart on her part ( when orthodontist find out less referals for her)

 

[reccos]

Hey guys! I am actually a pre-dent and I am also new here......Today i found out that my General Dentist does ortho. work!
I was wondering if this is even legal (since she does not have a speciality degree)
Is this smart on her part ( when orthodontist find out less referals for her)
Also she is new here in my small town and it seems that she is doing pretty well buisness wise (so maybe this is working for her now but what about the future)?!?
Do all General Dentist do a little ortho work (like on their staff/friends)

Thanks For reading! Everyones 2cents counts.....

The only time GPs refer anything to a specialist is if they don't wanna do it or its too complex for them or if its truly out of their scope and they don't know how to do it. There's somethign in every specialty that GP's do endo, ortho, prostho, oral surg (extractions), perio etc etc

 

[FlossY]

Can she advertise that she does ortho. or would that be crossing the line?

 

[drhobie7]

Can she advertise that she does ortho. or would that be crossing the line?

To be compliant with ethical guidelines, she can say she provides orthodontics/braces but must make clear that she is a general dentist. She cannot use the word 'specialize' or 'specialist' in any advertisement or say she is an orthodontist. She can say "general dentist providing braces".

 

[Dr. Pedo]

To be compliant with ethical guidelines, she can say she provides orthodontics/braces but must make clear that she is a general dentist. She cannot use the word 'specialize' or 'specialist' in any advertisement or say she is an orthodontist. She can say "general dentist providing braces".

She can also dedicate her entire practice to doing only ortho or any other specialty she wants. Two GPs I know limit their practices one to endo the other to pedo. You can basically do anything you want as a GP-----but you best be good at what you do because you are held to the same standards as a specialist. The GP's ad in the phonebook reads: Dr. X a dentist: practice limited to endo. All the GPs in his town (which has no endodontist) found out his endo abilities and constantly bugged him to take on cases for them-----now he is too busy to do anything else!!!! And too rich to care !

 

[Kniles5]

Hey guys! I am actually a pre-dent and I am also new here......Today i found out that my General Dentist does ortho. work!
I was wondering if this is even legal (since she does not have a speciality degree)
Is this smart on her part ( when orthodontist find out less referals for her)
Also she is new here in my small town and it seems that she is doing pretty well buisness wise (so maybe this is working for her now but what about the future)?!?
Do all General Dentist do a little ortho work (like on their staff/friends)

Thanks For reading! Everyones 2cents counts.....

My dad also does ortho as a general dentist. It has done him quite well. He does a whole lot of cases and he is incredible at what he does. He takes courses and reads new ortho text books and journals. He is constantly educating himself. He says he will be doing ortho until he dies. He always tells me "when I am in my eighties, just wheel me in there!"

 

[Sprgrover]

Hey guys! I am actually a pre-dent and I am also new here......Today i found out that my General Dentist does ortho. work!
I was wondering if this is even legal (since she does not have a speciality degree)
Is this smart on her part ( when orthodontist find out less referals for her)
Also she is new here in my small town and it seems that she is doing pretty well buisness wise (so maybe this is working for her now but what about the future)?!?
Do all General Dentist do a little ortho work (like on their staff/friends)

Thanks For reading! Everyones 2cents counts.....

It's totally legal. She just has to announce herself as a general dentist providing ortho treatment. General dentists are able to routinely perform a lot of specialty procedures. It depends on the dentist and his/her level of comfort with the area - for example, some dentists are very comfortable with endo while others I have been told will refer all endo work out (crazy, I know).

 

[Kniles5]

Can specialists have hygienists? I mean, that would be a real draw back to specializing. Everyone should come in every six months for a cleaning, so hygienists generally produce a whole lot of money. I guess it wouldn't be that they couldn't have one, but who goes to an endodontist to get a cleaning? That is where being a GD is beneficial. You can polish your skills in a particular area and choose all of your cases. My dad keeps his ortho chairs full all day, but he also has two hygienists and does fillings, crowns, root canals and dentures. He keeps cases he wants and refers out ones he doesn't want.

 

[Generallee]

Hey guys and gals,

Check out this general dentist that set up his practice primarily as an Ortho office. He journals his experience from the time he started up the office to now on the forums at www.dentaltown.com. It's really interesting to read the trials and successes this man is having. This idea definitely has my ears perking...

http://www.6monthsmiles.com/

 

[12YearOldKid]

Can specialists have hygienists? I mean, that would be a real draw back to specializing. Everyone should come in every six months for a cleaning, so hygienists generally produce a whole lot of money. I guess it wouldn't be that they couldn't have one, but who goes to an endodontist to get a cleaning? That is where being a GD is beneficial. You can polish your skills in a particular area and choose all of your cases. My dad keeps his ortho chairs full all day, but he also has two hygienists and does fillings, crowns, root canals and dentures. He keeps cases he wants and refers out ones he doesn't want.

The only specialists with hygienists are perio (duh ) and pedo.

 

[Kniles5]

The only specialists with hygienists are perio (duh ) and pedo.

Orthodontists sometimes have hygienists too. But, as a periodontist, you primarily concentrate on problems with supporting structures of teeth. I guess that is a lot of work for a hygienist. But, who seeks out a periodontist to go to for cleanings? You would primarily have referred patients with gum disease or whatever. Doesn't sound too terribly lucrative to me. Don't get me wrong; you should always do what you enjoy. I just think the GD is much more flexible.
But even a pedodontist. Why would a kid need a scaling? Just get your assistant to give em' a prophy and you look around and scrape some of the candy off. Hygienists are expensive, especially if you don't use them.

 

[fightingspirit]

guys, if a GP does orthodontics, is he/she not more prone to lawsuits than a certified orthodontist? just wondering

 

[Kniles5]

guys, if a GP does orthodontics, is he/she not more prone to lawsuits than a certified orthodontist? just wondering

My dad has practiced 35 years and has never been sued.
Ortho cases are so long term and the work ups are so unique. I think that in a way that makes orthodontists less of a target, I might be wrong. I can see a GD practicing oral surgery more at risk.

 

[fightingspirit]

35 years of practicing and never been sued.
Ortho cases are so long term and the work ups are so unique. I think that in a way that makes orthodontists less of a target, I might be wrong. I can see a GD practicing oral surgery more at risk.

thank you for the input

 

[jpollei]

Another thought for the OP: a couple of reasons that many GP's won't do any ortho in their practice (besides the fact that many of them think it's the most boring thing they ever spent time on in dental school).
There are high associated initial costs (stocking archwires, brackets, additional instruments, an in-house ceph, etc.), and many doc's want their offices to be as efficient as possible. Makes sense. Productive dental offices run like machines with what they do to maximize profitability. So, if you are only dabbling in ortho or treating a patient here or there, it is often not worth the relatively small additional income. You'd need additional staff training, extra practitioner CE, potential adjustments to your malpractice (depending on the state), possible changes with existing practice scheduling, etc.
Bottom line is if you do enough cases you'll overcome both of these things; doing just a few each week might not be enough, though.

 

[jpollei]

35 years of practicing and never been sued.
Ortho cases are so long term and the work ups are so unique. I think that in a way that makes orthodontists less of a target, I might be wrong. I can see a GD practicing oral surgery more at risk.

I agree about OMFS being more at risk.
For another perspective on Kniles5's experience doing otho, I'll share something I was told by the largest dental malpractice firm here in NC about GP's being sued for doing ortho vs formally trained orthodontists in NC. They said that gp's were in fact more at risk. Their statement was to the effect that any time a case went before a jury--which is only rarely with ortho--the jury is/can be swayed when they are informed the gp was never formally trained. It sucks to say it, but unfortunately plaintiff attorneys in these cases tried to paint a picture of inept, untrained GP's. And the jury tended to agree more often than when that card can't be played (i.e. with a orthodntist who had received formal training).

The reality is that good docs--whether GP or ortho--will probably never have problems because there are so many ways to accomplish the same outcome and they don't make boneheaded moves. A doc like Kniles5 is probably a great example of this. All I'm trying to illustrate is the potential is there if a problem does arise for there to be a worse outcome for a GP doing ortho than a formally trained one if for no other reason than because a GP may not appear to be as "qulified" in the eyes of a jury.

 

[Kniles5]

Bottom line is if you do enough cases you'll overcome both of these things; doing just a few each week might not be enough, though.

This is very true. You have to have at least a couple ortho cases a day. But, in my opinion, most ortho stuff isn't that time consuming. From what I have seen, you make small manipulations after the banding process. It is the banding that is the most time consuming, and hopefully, that only happens once. Your assistant can change o's, while you work on that root canal and wait for operatory five to numb up for the filling. A good office definitely runs like a well-oiled machine.

 

[Kniles5]

A doc like Kniles5 is probably a great example of this.

I must apologize for coming off as the doc. My dad is actually the good doc that has been practicing 35 years. I just hope to one day be as in love with dentistry as he is. I am real close now.
From what he has told me, a general dentist can do anything they want to do, but it is up to them to make sure they do it damn well. He isn't a big fan of implants or oral surgery, so he refers them out. I think it is important to know your own strengths and most importantly, where your true talent is. Like someone said, many find ortho boring. My dad loves it. That is what is incredible about this profession.

 

[Smilemaker100]

Hey guys! I am actually a pre-dent and I am also new here......Today i found out that my General Dentist does ortho. work!
I was wondering if this is even legal (since she does not have a speciality degree)
Is this smart on her part ( when orthodontist find out less referals for her)
Also she is new here in my small town and it seems that she is doing pretty well buisness wise (so maybe this is working for her now but what about the future)?!?
Do all General Dentist do a little ortho work (like on their staff/friends)

Thanks For reading! Everyones 2cents counts.....

Although general dentists receive a bit of exposure to malocclusal problems (orthodontics) while in dental school, they are able to diagnose them but not treat all of them unless they have a certain amount of continuing education. Most general dentists should be competent in placing at least some space maintainers and Hawley appliances for small tooth movement. I`ve seen a trend of more general dentists placing Invisalign (transparent mouthpieces which produce minor tooth movement) but that is only because they have received advanced training.

Pedodontists (pediatric dentists) receive more ortho training than general dentists, however they are not competent to take care of major occlusal problems. In fact, in the news recently (FRONT PAGE), there was a lot of hype surrounding a pedodontist that taught at my dental school. Apparently, she had misdiagnosed her ortho cases and treated patients with malocclusal problems beyond her expertise. The results were considered to be disastrous and when experts studied her cases, they realized that many of them should have been handled by an orthodontist. Last I heard, she was still able to practice orthodontics in private practice despite the lawsuits.

So in summary, I would say that a general dentist can handle SOME ortho cases if he has the training. However, he/she is not allowed to advertize themselves as being an orthodontist nor are they allowed to charge specialty fees. And finally, my last advice to you,a future dentist, is not to treat patients with specific treatments which are beyond your competency unless you feel confident with your training. When in doubt, consult a specialist!

 

[FlossY]

You guys/gals are awsome keep the replies coming......

 

[aphistis]

Why would a kid need a scaling? Just get your assistant to give em' a prophy and you look around and scrape some of the candy off. Hygienists are expensive, especially if you don't use them.

Assistants aren't trained to do prophies, and letting one put a scaler in a patient's mouth is illegal.

 

[Kniles5]

Assistants aren't trained to do prophies, and letting one put a scaler in a patient's mouth is illegal.

Assistants doing prophies is definitely legal in VA. I don't know about other states, but it is a part of the program.
That is why I said YOU take a scaler and scrape some candy off.
It definitely makes sense to have your assistants doing prophies. Why pay a hygienist to do it when an assistant can do it. I don't know about other states but I am POSITIVE they train them to do it in VA. At least they did in 1996.

 

[HuyetKiem]

Assistants doing prophies is definitely legal in VA. I don't know about other states, but it is a part of the program.
That is why I said YOU take a scaler and scrape some candy off.
It definitely makes sense to have your assistants doing prophies. Why pay a hygienist to do it when an assistant can do it. I don't know about other states but I am POSITIVE they train them to do it in VA. At least they did in 1996.

Darn, is it illegal ? Let your DA does coronal polishing and then bill the patient or insurance comp. for prophy fee.

 

[lgreen_aci]

You'll see GD's doing ortho all the time, but what seperates the GD from the specialist is dentofacial orthopedics. Most GD's I've seen just do simpler stuff like invisalign and cosmetic teeth straightening. I haven't seen GD's however correcting jaw problems, overbites, overjets, etc, so much. I am glad I had my ortho done at w/ a specialist though (since that is how I got interested in dentistry!)

 

[12YearOldKid]

Although general dentists receive a bit of exposure to malocclusal problems (orthodontics) while in dental school, they are able to diagnose them but not treat all of them unless they have a certain amount of continuing education.

That is true with just about every aspect of dentistry -- even crown and bridge.

However, he/she is not allowed to advertize themselves as being an orthodontist nor are they allowed to charge specialty fees.

They can charge whatever fee they want to for their sevices. They can charge 3 bazillion dollars for an ortho case if they can find a patient who will pay that. Some insurance companies will allow a higher reimbursement for a specialist doing a procedure than a GP - but the GP still controls his fee schedule.

 

[12YearOldKid]

Assistants aren't trained to do prophies, and letting one put a scaler in a patient's mouth is illegal.

Depends on state law. Some states allow DAs to do coronal polishing.

Some docs who can't find a hygienist in their area will do the scaling in conjunction with the exam and then let the assistant do the coronal polish and floss. The polish is what the public thinks they are paying for anyway.

 

[12YearOldKid]

I agree about OMFS being more at risk.
For another perspective on Kniles5's experience doing otho, I'll share something I was told by the largest dental malpractice firm here in NC about GP's being sued for doing ortho vs formally trained orthodontists in NC. They said that gp's were in fact more at risk. Their statement was to the effect that any time a case went before a jury--which is only rarely with ortho--the jury is/can be swayed when they are informed the gp was never formally trained. It sucks to say it, but unfortunately plaintiff attorneys in these cases tried to paint a picture of inept, untrained GP's. And the jury tended to agree more often than when that card can't be played (i.e. with a orthodntist who had received formal training).

All I'm trying to illustrate is the potential is there if a problem does arise for there to be a worse outcome for a GP doing ortho than a formally trained one if for no other reason than because a GP may not appear to be as "qulified" in the eyes of a jury.

This is a very good point. You will hear all the time that if you are doing specialty procedures you will be held to the standard of a specialist. But the truth is that if it ever goes to trial GPs are actually held to a higher standard than the specialist.

That may not be fair, but lawyers don't worry too much about playing fair.

 

[Kniles5]

That may not be fair, but lawyers don't worry too much about playing fair.

Sooooo true. I guess that is why lawyers rank higher on Money's best professions. They don't have to worry about having themselves sucking their own blood.

 

[Kniles5]

Darn, is it illegal ? Let your DA does coronal polishing and then bill the patient or insurance comp. for prophy fee.

this is rediculous. THE DENTIST PAYS THE ASSISTANT!! Why not get the most out of their service? How hard is a freaking prophy!! It isn't like the dentist and hygienist aren't going to go in there and check the patient after it is done!! No, I guess you can go ahead and pay your hygienist $70,000 a year to do their prophies. Cause it would be wrong to have your assistant, who makes $23,000 to do it, even if it is legal. What ever you think is right.

 

[Kniles5]

Okay, I really didn't mean to come off so harsh earlier. It is just that I know several dentists that use assistants to do prophies; it is just smart when they are trained for it. It is pretty common where I am from. Anyway, why are there such huge differences state by state when it comes to crap like that? Why would a state ever make it illegal for your DA to do that for you? A prophy isn't difficult. Maybe I am wrong. But, do you agree?

 

[leehrat]

Okay, I really didn't mean to come off so harsh earlier. It is just that I know several dentists that use assistants to do prophies; it is just smart when they are trained for it. It is pretty common where I am from. Anyway, why are there such huge differences state by state when it comes to crap like that? Why would a state ever make it illegal for your DA to do that for you? A prophy isn't difficult. Maybe I am wrong. But, do you agree?

my hygienist does my prophy. the actual dentist just waltzes in and checks my teeth for ~5 minutes (provided there's nothing wrong).

 

[DcS]

Okay, I really didn't mean to come off so harsh earlier. It is just that I know several dentists that use assistants to do prophies; it is just smart when they are trained for it. It is pretty common where I am from. Anyway, why are there such huge differences state by state when it comes to crap like that? Why would a state ever make it illegal for your DA to do that for you? A prophy isn't difficult. Maybe I am wrong. But, do you agree?

In NC it's legal, in fact I was just in a pedo practice that employs 4 or 5 assistants to do exactly what you said (and zero hygienists). They will do coronal polishing and when the dds comes to check he will scale if necessary. If he does, he bills for the prophy, and if he doesn't there is a charge for a coronal polishing. Much more cost effective if you think about it.

It's sad that I took the NC jurisprudence exam about 3 weeks ago and already forgot the answer...but I'm pretty sure that DAs have to take a 7 hour training course in coronal polishing to be able to do it here.

 

[UNCdentalguy]

DcS, I must have studied much harder for the JP exam than you because I clearly remember that DA's must take a seven hour coronal polishing course. Shame on you for not knowing the laws!

 

[kilani]

At least they did in 1996.

They still do, not too many clinical things that they can do on their own, but coronal polish is one of the things that we train them to do, and the VA board doesn't consider it expanded functions either.

 

[aphistis]

Okay, I really didn't mean to come off so harsh earlier. It is just that I know several dentists that use assistants to do prophies; it is just smart when they are trained for it. It is pretty common where I am from. Anyway, why are there such huge differences state by state when it comes to crap like that? Why would a state ever make it illegal for your DA to do that for you? A prophy isn't difficult. Maybe I am wrong. But, do you agree?

My fault for not being clear enough on what I meant. When I said prophies are off-limits, scaling is what I was thinking about. I should've just said what I meant.

 

[Kniles5]

My fault for not being clear enough on what I meant. When I said prophies are off-limits, scaling is what I was thinking about. I should've just said what I meant.

Thanks for the response.

 

[rocknightmare]

i am surprised that the dental hygine community hasn't started an uprising on the prophy thing.. i guess they might sooner or later..

 

[ShawnOne]

In California DA can't legally perform coronal polishing. RDH can in certain public health clinics as specified in Business and Professions Code Section 1777 (effective January 1, 2005). RDH can with general supervision, which means based on instructions given by a licensed dentist, but not requiring the physical presence of the supervising dentist during the performance of those procedures.

so dont come here