Odd Orthodontics Ad

[54807]

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Members do not see this ad.

Anyone else find this commercial to be odd?

[YOUTUBE]http://www.youtube.com/watch?v=C1JZ3iO6gg0[/YOUTUBE]

Link

Have you seen many other direct attacks from specialists before? You might be able to argue that they are just educating the public, but it still feels odd.

 

[CanuckDDS]

I like the ad. It doesn't say anything bad about anyone. It just lets the public know what an orthodontist is, some ppl out there think a denturist is the same as an orthodontist (I know it is ridiculous, but the general public just doesn't know).

I was a GP for 4 years and routinely sent patients to an orthodontist. I also saw quite a few patients who had awful ortho done by a GP b/c it was "cheaper", ppl equated cheaper with better and that is wrong. They figured it out when I told them that their kid had pain in their 12 year molars b/c they were worn down to the pulp, since they were the only teeth in occlusion.

There are lots of unscrupulous GP's out there who would not even think twice about telling their patients that orthodontists fee's are not justified and then put in a buccal pit resin "PRR" and charge $150 for 30 sec of work.

The public should know the difference between a GP and an orthodontist or any specialist for the matter...

 

[gd152]

Have you seen many other direct attacks from specialists before? You might be able to argue that they are just educating the public, but it still feels odd.

There is definitely a difference between attacking and defending. Sometimes it is a fine line though.

However, I do feel that orthodontists pay the price and have the right to defend and publicize their additional 2-3 years education in orthodontics beyond dental school. It is only fair to both the orthodontist and the public.

 

[Waitlisted2009]

.

 

[dr bojangles]

i think the ad is fine. i can see how you think it might have a bit of an attacking air about it, but i think very few people perceive that.
i actually like it because it explains the training they go through. lots of people i've told about me going to d-school thought it was a med school specialty

 

[gryffindor]

I went to a meeting recently and met a doctor whose name tag said "orthodontist." After speaking with him in detail, it turned out he is a pediatric dentist who has an associate running all the pedo while he has an entirely separate "ortho" practice doing only easy adult cases with treatment times of less than 1 year. He's got some slick marketing going suggesting he's an orthodontist and makes this ad look like a middle school video project. Why bother doing an ortho residency if all you need is some good marketing to fool the public that you are just as qualified to straighten teeth? Yes, I went through additional training to be a specialist, so I'm glad the AAO is doing something to educate the public about our profession unlike the ADA who is ready to sell my DDS out to ADHPs, DHATs, and GKAS.

 

[CanuckDDS]

I went to a meeting recently and met a doctor whose name tag said "orthodontist." After speaking with him in detail, it turned out he is a pediatric dentist who has an associate running all the pedo while he has an entirely separate "ortho" practice doing only easy adult cases with treatment times of less than 1 year. He's got some slick marketing going suggesting he's an orthodontist and makes this ad look like a middle school video project. Why bother doing an ortho residency if all you need is some good marketing to fool the public that you are just as qualified to straighten teeth? Yes, I went through additional training to be a specialist, so I'm glad the AAO is doing something to educate the public about our profession unlike the ADA who is ready to sell my DDS out to ADHPs, DHATs, and GKAS.

👍
Agreed. If you put in the time you should not have to deal with this crap.

 

[54807]

I do agree with most of the above.

Is this unprecedented though? One of the beauties of dentistry for some is the freedom to do whatever you want as long as you're at the same standard as a specialist (which I actually think is close to impossible...).

That is why I found it odd. There is a feeling of the commercial that says "I am better as an orthodontist, so come to me" and I think this should be absent from healthcare.

 

[OMSfanatic]

]"I am better as an orthodontist, so come to me" and I think this should be absent from healthcare.

Unfortunately, that is just a plain and simple fact. Someone who has training post grad in an area *is* more qualified to do that work, and more importantly is better equipped to deal with/prevent the complications. People who think they are equal to the specialty are the ones who haven't been through the training to see exactly how much learning goes into all the facets. Being on the OMS side of things, I can only give this one relevant example.... We recently had a dentist send us his non healing oral antral fistula. He just threw his hands up and gave him to us saying "I don't know what to do for this." He had no business extracting teeth that were in close proximity to the sinus because he couldn't handle the possible complications. The public has a right to know there are differences between general practioners and specialists in terms of training. That is what that ortho ad was doing, in my opinion... being informative.

 

[Dukie]

Unfortunately, that is just a plain and simple fact. Someone who has training post grad in an area *is* more qualified to do that work, and more importantly is better equipped to deal with/prevent the complications. People who think they are equal to the specialty are the ones who haven't been through the training to see exactly how much learning goes into all the facets. Being on the OMS side of things, I can only give this one relevant example.... We recently had a dentist send us his non healing oral antral fistula. He just threw his hands up and gave him to us saying "I don't know what to do for this." He had no business extracting teeth that were in close proximity to the sinus because he couldn't handle the possible complications. The public has a right to know there are differences between general practioners and specialists in terms of training. That is what that ortho ad was doing, in my opinion... being informative.

I completely agree. I know, as a member of the AAE, that they have been putting together similar ads. The point is not to "attack" as the OP states, but to inform the public that there is a difference between the work done by a specialist and a GP. I think the ad was completely fine.

I have had this argument on SDN many times before: I am not (for the hundredth time) saying that you are not "allowed" to do anything you want as a GP, but arguing that your work will be at the same level is preposterous. I know that if I ever need teeth extracted, I'm going to an oral surgeon. This is not to say my general dentist could not do a nice job, but I want the person with the most training and the most ability to deal with a complication, completing the work. This is the same reason I would never go to a "dental therapist", but would want a dentist to do a restoration in my mouth.

 

[54807]

ha, I am clearly outnumbered!

I just don't like it and don't think it should be a direct to consumer advertisement. It's not a business, it's in theory health care. But I imagine direct to GP advertising along these lines have failed and weekend ortho courses will continue to grow. So maybe this is the next step in protecting patients.

I bet I will change my mind as I see more of this shoddy dentistry that most of you have brought forth...

Is the underlying goal to protect the patient or the orthodontists' fantastic profession?

I'm still 1 year from finishing dschool so my real world experience is nothing and I may have no perspective on this.

 

[texas_dds]

just because you CAN doesn't mean you SHOULD in many tough cases
remember all providers are subject to the same standard of care in court.

 

[gryffindor]

just because you CAN doesn't mean you SHOULD in many tough cases
remember all providers are subject to the same standard of care in court.

"Standard of care in court" is just another empty threat, similar to the "dentist shortage due to boomers retiring." I would bet that such a small number of cases actually go to court, the threat of standard of care is almost nil for a GP to go ahead and delve into cases they have little knowledge to treat.

 

[ZeroCool]

who cares if the orthodontists want to advertise; it's a free market. On another note, general practitioners fulfill 50% (http://www.jdentaled.org/cgi/content/full/71/12/1549) of all orthodontic treatment in the US. If anybody thinks that ortho is out of the scope of general dentistry than they're on crack. Granted most dentists don't get much training leaving dental school; I can't imagine it is that difficult to learn how to treat a class I occlusion with minor crowding. As Howard Farran likes to say about ortho "anybody can do ortho, it's just rubber bands and glue". Don't believe specialists when they scare you into believing that doing molar endo, ortho, or implants are out of the scope of a practicing GP; It's all a turf war. Why do you think endodontists are beginning to learn implant placement even though they had no formal training from dental school? It's all about money. 😎

 

[bsmcga0]

problem is, most people don't know, they say my dentist is my orthodontist.
On a side note, I have completed several cases recently treated by GP

 

[WharfRat]

Ortho is a lot more than rubber bands and glue. I'm at the end of my first year of residency and still have a lot to learn. I don't know how someone could do it in weekend courses. It baffles me.

 

[ZeroCool]

...and i partially agree with you. There are complicated cases in every field of dentistry that should be referred out to a specialist if the dentist doesn't have the knowledge; however, most GPs don't go to a weekend course for ortho and begin treating complicated Class III malocclusions. Most start with very easy Class I minor crowding cases and work their way towards more complicated cases. Most GPs take extended ortho courses that last several years or they take enough CE's and get assistance from their local orthodontist to sufficiently treat patients.

 

[charlestweed]

I wouldn't worry too much about more and more GPs doing ortho treatments. There are enough patients for all of us. Just look at the teenagers at your church…more than 50% of them wear braces.

When Invisalign first came out, many of us orthodontists were concerned that it would hurt our profession. Ten years later, orthodontists are still doing very well even when many of the GPs are doing Invisalign. I don't even do invisalign in my office b/c I don't feel right about charging my patients a ton of money and not being able to give them a satisfactory result.

 

[CanuckDDS]

Again, having practiced as a GP for 4 years before specializing- it was part of my informed consent to tell ppl that there is someone better at treating condition A (whatever it is). But if they are comfortable with you as the DDS doing it then it is their choice to get Tx done at the GP's office. I used to tell ppl this all the time before I took out their wizzies, the OMFS guys down the street are "better" than me at doing this, but some ppl are confident in their GP and if that is the case that is fine- go for it, but don't SELL it. And don't sell yourself as "the best person for the job", because it is not true.

Most ortho cases I have seen from the GP's around me here have been terrible, in fact one of the GP's who does ortho once told me that it is "cookie cutter" BUT he sent his own kid to the Orthodontist to have treatment done!!!

As an aside, most specialists don't enjoy getting $hit cases dumped on them. Like when GP's take out easy upper wizzie's and then refer ppl (after they've done the uppers) to OMFS for DA impacted lower wizzies. That is a stupid money grab which makes the GP an extra 10 grand a year but the surgeon they are referring to thinks they are an idiot.

 

[ZeroCool]

Canuck:
"As an aside, most specialists don't enjoy getting $hit cases dumped on them. Like when GP's take out easy upper wizzie's and then refer ppl (after they've done the uppers) to OMFS for DA impacted lower wizzies. That is a stupid money grab which makes the GP an extra 10 grand a year but the surgeon they are referring to thinks they are an idiot."

I would agree with most of what you stated; however, why is there any problem with referring the lower impacted/difficult wisdom teeth? The GP is giving his business to the specialist so i'm confused at what the problem is? The purpose of specialist is to handle the crap that the GPs can't handle or doesn't want to do. I'm completely astonished how any specialist in their right mind thinks a GP shouldn't have extracted the easy wisdom teeth or completed the easy anterior endo before referring the patient to a specialist for the more difficult treatment. This entire thread all revolves around the bottom line (money). It doesn't make any sense for a GP to save the easy treatment for his specialist buddies if he can competently do them himself.

I do agree that a GP shouldn't be doing procedures that he can't competently complete (successfully).

There are specialists out there that are worse in their specialty than General practitioners; however, i do agree there are more GPs doing poor work (only because there happen to be 150,000 GPs and 15,000 orthos).

 

[WharfRat]

I don't mind other dentists doing ortho, I only mind if they do a disservice to patients. I was just trying to say that there is so much more to ortho than what appears at the start. Even simple looking cases can be very difficult to treat. And my only response to the whole doing what you can for the patient and referring what you can't, is why would you put a patient through 2 extractions in your office and then send them to the oral surgeon for 2 more, when they could have all 4 out at one time at the OMS office. It would be like lining up the front teeth so they look nice and straight and then sending them to the orthodontist to finish and detail. There is plenty of work to go around, this isn't about a turf war for me.

 

[CanuckDDS]

Canuck:
"As an aside, most specialists don't enjoy getting $hit cases dumped on them. Like when GP's take out easy upper wizzie's and then refer ppl (after they've done the uppers) to OMFS for DA impacted lower wizzies. That is a stupid money grab which makes the GP an extra 10 grand a year but the surgeon they are referring to thinks they are an idiot."

I would agree with most of what you stated; however, why is there any problem with referring the lower impacted/difficult wisdom teeth? The GP is giving his business to the specialist so i'm confused at what the problem is? The purpose of specialist is to handle the crap that the GPs can't handle or doesn't want to do. I'm completely astonished how any specialist in their right mind thinks a GP shouldn't have extracted the easy wisdom teeth or completed the easy anterior endo before referring the patient to a specialist for the more difficult treatment. This entire thread all revolves around the bottom line (money). It doesn't make any sense for a GP to save the easy treatment for his specialist buddies if he can competently do them himself.

I do agree that a GP shouldn't be doing procedures that he can't competently complete (successfully).

There are specialists out there that are worse in their specialty than General practitioners; however, i do agree there are more GPs doing poor work (only because there happen to be 150,000 GPs and 15,000 orthos).

If you want to talk about dentistry as "health care" there is definitely a problem with taking out uppers and referring off lowers- you are DOUBLING the number of your patient's surgical procedures. Instead of having one surgery, your patients get to have two, two rounds of analgesics, more time off school/work etc.- sounds like fun doesn't it? This isn't true for your endo analogy though...

"The purpose of the specialist is to handle the crap..." Listen to yourself, that sounds silly doesn't it? Why would anyone want to be a specialist then? Specialists are ppl too, we don't always want to do "crap". It is actually quite nice to do an easy Lefort/BSSO every now and again.

The GP is "giving his business". Patient's are not business, they are not commodities to be "given". I know dentistry is a business, but professional courtesy dictates allowing a specialist to make some "easy cash" as well. That way they'll be there to bail you out when you push a palatal root into the antrum, and tell your patient's that "it wasn't his/her fault, these things happen, no you shouldn't litigate". I know this is a confusing business model, but you can do very well and still treat ppl nicely (patients and colleagues), you may not get as big a house as that cardio-thoracic surgeon on your street but I think he/she deserves it- don't you?

 

[CanuckDDS]

what warf said.

 

[ZeroCool]

We seem to repeating the same concept in different words; a lot of this conversation comes down to semantics. I agree that dentistry is a unique profession that operates a hybrid business model (business/medical). Patients should never be treated as a commodity and It's a shame that it tends to occur.

Our disagreements tend to revolve around the same few things:common courtesy referrals, competency, professional ethics. Before I begin, I think my previous posts were paraphrased in a manner that changed my original intent. Sorry for my colloquial approach with words (such as "crap") but i think it's obvious what my intent was.

I agree that in certain situations (medically compromised, etc) patients shouldn't be subjected to multiple surgeries such as extractions; however, many oral surgeons schedule multiple surgeries to accomodate complex extractions. In my opinion, I feel that the general dentist (for the most part) is the best person to accomodate all of the patient's necessary treatment. The GP has established a relationship with the patient and provides the vision for the final outcome. It is very common to have disconnect between GP and specialists about acceptable results (responsibility could be from either party).

A professional courtesy referral is laughable. I understand your intent in regards to quality of care and general respect but still... It is not the GP's job to make certain that the specialist can make easy money. Specialists aren't entitled to easy money because of their extended training (referring to your cardio/thoracic analogy).

There is a time and place for a specialist. They serve a valuable role in dentistry; however, what is wrong with the specialists serving as an adjunct to the GP when he feels cases are out of his skill level or if it's within the patients best interest (complicated case)? Specialists fully knew that their livelihood relied upon GP referrals; so why is it specialists seem to be encroaching into the GP business model to dictate what he is "adequately" trained to do?

I think this is a great debate... I hope we can keep it civil and educational. I value everyones' opinion. Please don't infer that i'm trying to push an agenda and I certainly don't think that my opinion is better than other people in this forum. It's nice to share these view points with other dentists/dental students that have had differing experiences within the field.

 

[Jyaki]

There is a time and place for a specialist. They serve a valuable role in dentistry; however, what is wrong with the specialists serving as an adjunct to the GP when he feels cases are out of his skill level or if it's within the patients best interest (complicated case)? Specialists fully knew that their livelihood relied upon GP referrals; so why is it specialists seem to be encroaching into the GP business model to dictate what he is "adequately" trained to do?

I think that a lot GPs fail to realize that they need specialists just as much as specialists need the GPs. As someone stated earier, not all cases are as easy as they may appear. What happens when one of these cases blows up in your face? Patient is getting frustrated, you're getting frustrated, your office isn't as well equipped as the specialist's to handle it, you're staff that is trained 90% for crown & bridge work and 10% ortho isn't skilled to handle it...what do you do? How do you tell the patient that you're unable to complete the treatment? What happens when the frustrated patient seeks a specialist for an opinion? What would you want the specialist to say to the patient? A good relationship with a specialist can have a significant impact on how these situations are handled.

 

[ZeroCool]

jyaki... I completely agree. Well trained GPs should still be allowed to perform "specialty related" treatment within their skill level (Novice or advanced cases). Specialists serve a valuable role in the dental community but it doesn't mean their opinion or treatment is always adequate/correct.

 

[WharfRat]

I think the main concern I have with the ortho thing, is really how competent do you think you are doing ortho with your dental school training? Even with years of weekend and CE orthodontic courses, do you think that compares to 2-3 years of full-time ortho education and 100% dedication after training? I know after 3 years of ortho training, I wouldn't feel that comfortable doing restorative work. I could still do it, and probably at a "standard of care" level, but wouldn't the patient be better off receiving that treatment at a dentist who does it routinely? I don't think specialists are just an adjunct to the dentist. I would send my family and would go myself to a specialist if I needed it (and no I don't think if someone is a specialist they are automatically good at what they do). Just like if I needed a crown or bridge or filling (etc) I would go to a dentist. I wouldn't go to my family physician for a cardiac exam, I'd go to a cardiologist. I wouldn't want my ER doc to read my xray (even though they can), I'd want a radiologist. Again, I don't want to say that nobody but orthodontists can do ortho, I just think that they need to be aware of everything that they are taking on, and treat the patient right. I have a lot of dentist friends who are doing ortho, and I take the time to talk to them about their cases. But again, I am just finishing up my first year so I'm just a novice.
Anyway, the commercial although aimed somewhat at GPs and Peds doing ortho, is also aimed at the companies like Damon (Ormco) and Invisalign that advertise direct to the public.

 

[Jyaki]

Specialists serve a valuable role in the dental community but it doesn't mean their opinion or treatment is always adequate/correct.

I'm not sure what you mean by this statement?
I have no problem with GPs doing orthodontic treatment. I do have a problem when they never refer but then will send their kids to the specialist for treatment. If they're not good enough to treat their own kids, what makes them good enough to treat other people's children?

 

[CanuckDDS]

Laughable??...
A discourteous referral is laughable... it is a money grab if you do half a case of wizzies and dump your patient when the going gets tough. Your patient's will see right through this and they will realize that it was a money grab. The guy I worked for (as a GP) did this all the time, his patients thought he was an idiot.

It is like when a GP tries for an hour and a half to get out a tooth but doesn't have the skills to finish it off, raises a hamburger flap, leaves half a tooth in and puts in a panic call to his OMFS buddy (who typically says "sure send him right over, I'll take care of it"). This scenario is fine, until the dentist charges the person for the extraction (that they didn't finish) b/c it was important chair time that was used up. You would agree that is not fair to the patient I hope? But it is a good business model.

Training, amount of work put into training, and difficulty of occupation should absolutely be in direct correlation with moneys earned. A cardio-thoracic surgeon should make way more money than me, I hope they would anyhow, they've put in their time. How would you like it if a dental hygienist made more money than you as a dentist? (Doesn't seem plausible, but I think you'd be bitter no?)

Specialists encroaching on a GP's business model? Back to business eh...
I think that providing the BEST service possible while still making a comfortable living is the best "business model".
I believe that specialists are considered "experts" in their field no? It is absolutely up to the experts to put forth the standards of who is "adequately trained" and not. Why not just allow anyone to fill cavities then? (I'm sure a tool and die tech could, they have great hands)

I need some Zofran.

We seem to repeating the same concept in different words; a lot of this conversation comes down to semantics. I agree that dentistry is a unique profession that operates a hybrid business model (business/medical). Patients should never be treated as a commodity and It's a shame that it tends to occur.

Our disagreements tend to revolve around the same few things:common courtesy referrals, competency, professional ethics. Before I begin, I think my previous posts were paraphrased in a manner that changed my original intent. Sorry for my colloquial approach with words (such as "crap") but i think it's obvious what my intent was.

I agree that in certain situations (medically compromised, etc) patients shouldn't be subjected to multiple surgeries such as extractions; however, many oral surgeons schedule multiple surgeries to accomodate complex extractions. In my opinion, I feel that the general dentist (for the most part) is the best person to accomodate all of the patient's necessary treatment. The GP has established a relationship with the patient and provides the vision for the final outcome. It is very common to have disconnect between GP and specialists about acceptable results (responsibility could be from either party).

A professional courtesy referral is laughable. I understand your intent in regards to quality of care and general respect but still... It is not the GP's job to make certain that the specialist can make easy money. Specialists aren't entitled to easy money because of their extended training (referring to your cardio/thoracic analogy).

There is a time and place for a specialist. They serve a valuable role in dentistry; however, what is wrong with the specialists serving as an adjunct to the GP when he feels cases are out of his skill level or if it's within the patients best interest (complicated case)? Specialists fully knew that their livelihood relied upon GP referrals; so why is it specialists seem to be encroaching into the GP business model to dictate what he is "adequately" trained to do?

I think this is a great debate... I hope we can keep it civil and educational. I value everyones' opinion. Please don't infer that i'm trying to push an agenda and I certainly don't think that my opinion is better than other people in this forum. It's nice to share these view points with other dentists/dental students that have had differing experiences within the field.

 

[runfast520]

I have a case where the gp got frustrated, told the patient he was moving away and to go to an orthodontist, of course he didn't move away, haha

 

[cobalt31]

Training, amount of work put into training, and difficulty of occupation should absolutely be in direct correlation with moneys earned.

I think the 33 yr old PhD postdoc in my lab making 35k/yr would agree. However, demand for services and saturation of the market does play a role, as well as business savvy.

 

[aphistis]

So I think we're all in agreement here that no general dentist should ever do more to a patient than organize referrals.





🙄

 

[Jyaki]

🙄

 

[aphistis]

Laughable??...
A discourteous referral is laughable... it is a money grab if you do half a case of wizzies and dump your patient when the going gets tough. Your patient's will see right through this and they will realize that it was a money grab. The guy I worked for (as a GP) did this all the time, his patients thought he was an idiot.

It is like when a GP tries for an hour and a half to get out a tooth but doesn't have the skills to finish it off, raises a hamburger flap, leaves half a tooth in and puts in a panic call to his OMFS buddy (who typically says "sure send him right over, I'll take care of it"). This scenario is fine, until the dentist charges the person for the extraction (that they didn't finish) b/c it was important chair time that was used up. You would agree that is not fair to the patient I hope? But it is a good business model.

Training, amount of work put into training, and difficulty of occupation should absolutely be in direct correlation with moneys earned. A cardio-thoracic surgeon should make way more money than me, I hope they would anyhow, they've put in their time. How would you like it if a dental hygienist made more money than you as a dentist? (Doesn't seem plausible, but I think you'd be bitter no?)

Specialists encroaching on a GP's business model? Back to business eh...
I think that providing the BEST service possible while still making a comfortable living is the best "business model".
I believe that specialists are considered "experts" in their field no? It is absolutely up to the experts to put forth the standards of who is "adequately trained" and not. Why not just allow anyone to fill cavities then? (I'm sure a tool and die tech could, they have great hands)

I need some Zofran.

Just make sure the chief of anesthesiology for a major academic center gives you that Zofran. I'd hate for you to make yourself a hypocrite by letting anyone other than the most qualified specialist in your state start an IV.

 

[mike3kgt]

What is odd about this video is that they chose models to show off the best and brightest cases an orthodontist does and then one of their models has a canted smile, a left side buccal corridor defect, and disharmonious gingival architecture. (see pics below)

She probably requires a referral to a periodontist to correct her gingival asymmetry and a referral to a prosthodontist or a general dentist to correct the buccal corridor defect.

Remember, it's a team effort. The doc that I used to work for required any patients he sent to the orthodontist to have a consultation with him prior to debanding to approve the esthetics and [especially] occlusion. They had an excellent working relationship and the specialist knew that if he did not follow through with this request, he would no longer be seeing referrals from this particular doc.

So if you all are getting into it because of specialized ortho vs. gp ortho what about prostho and gp? What if the ACP brought out a video like this comparing prostho vs. gp, would that be appropriate?

 

[CanuckDDS]

Just make sure the chief of anesthesiology for a major academic center gives you that Zofran. I'd hate for you to make yourself a hypocrite by letting anyone other than the most qualified specialist in your state start an IV.

Well played aphistis, well played.

Not what i'm saying though, I hope I didn't come across as hating on Gp's. Maybe I did, but that wasn't my intent. I was commenting on the attitude that a specialist is someone you should dump your crap on. I think dentistry is the only health care related field that sort of attitude is prevalent. I feel kinda bad for prosthodontists....

 

[charlestweed]

What is odd about this video is that they chose models to show off the best and brightest cases an orthodontist does and then one of their models has a canted smile, a left side buccal corridor defect, and disharmonious gingival architecture. (see pics below)

She probably requires a referral to a periodontist to correct her gingival asymmetry and a referral to a prosthodontist or a general dentist to correct the buccal corridor defect.

Remember, it's a team effort. The doc that I used to work for required any patients he sent to the orthodontist to have a consultation with him prior to debanding to approve the esthetics and [especially] occlusion. They had an excellent working relationship and the specialist knew that if he did not follow through with this request, he would no longer be seeing referrals from this particular doc.

So if you all are getting into it because of specialized ortho vs. gp ortho what about prostho and gp? What if the ACP brought out a video like this comparing prostho vs. gp, would that be appropriate?

Wow! I feel sorry for the orthodontist who works with your former boss. We, specialists, need GP referrals. But if I have to ask the dentist’s permission to remove every of his patient’s braces, then I don’t need his referral. I am a practicing orthodontist….not his student.

Our goal is to get a perfect occlusion on every patient but sometimes it is not possible to accomplish such goal because of poor patient’s compliance (poor elastic wear, no shows, poor oral hygiene), patient’s growth, patient’s decline to have jaw surgery, pre-existing short root problem etc. When these things happen, I write a letter to the referring GP.

PS. I don’t think gingivectomy alone can fix that canted smile…she would need Le Fort I osteotomy and mandibular BSSO surgery. I think her orthodontist did a good job.

 

[WharfRat]

Wow! I feel sorry for the orthodontist who works with your former boss. We, specialists, need GP referrals. But if I have to ask the dentist’s permission to remove every of his patient’s braces, then I don’t need his referral. I am a practicing orthodontist….not his student.

Our goal is to get a perfect occlusion on every patient but sometimes it is not possible to accomplish such goal because of poor patient’s compliance (poor elastic wear, no shows, poor oral hygiene), patient’s growth, patient’s decline to have jaw surgery, pre-existing short root problem etc. When these things happen, I write a letter to the referring GP.

PS. I don’t think gingivectomy alone can fix that canted smile…she would need Le Fort I osteotomy and mandibular BSSO surgery. I think her orthodontist did a good job.



I'm with Tweed 100% on this one.

 

[aphistis]

Well played aphistis, well played.

Not what i'm saying though, I hope I didn't come across as hating on Gp's. Maybe I did, but that wasn't my intent. I was commenting on the attitude that a specialist is someone you should dump your crap on. I think dentistry is the only health care related field that sort of attitude is prevalent. I feel kinda bad for prosthodontists....

I understand and appreciate the sentiment, because I'm sure it does happen a lot. Not always, though, and not from all general dentists. Cheers.

 

[Istr8nthem]

Wow! I feel sorry for the orthodontist who works with your former boss. We, specialists, need GP referrals. But if I have to ask the dentist’s permission to remove every of his patient’s braces, then I don’t need his referral. I am a practicing orthodontist….not his student.

Our goal is to get a perfect occlusion on every patient but sometimes it is not possible to accomplish such goal because of poor patient’s compliance (poor elastic wear, no shows, poor oral hygiene), patient’s growth, patient’s decline to have jaw surgery, pre-existing short root problem etc. When these things happen, I write a letter to the referring GP.

PS. I don’t think gingivectomy alone can fix that canted smile…she would need Le Fort I osteotomy and mandibular BSSO surgery. I think her orthodontist did a good job.



I'm with Tweed 100% on this one.

Ditto for me too! A very demanding referring dentist is just like a very demanding patient... sometimes they are not worth the hassle.

As an orthodontist, you are the occlusion specialist, you are responsible for creating the very best occlusion possible and like tweed said, sometimes that is not possible with certain individuals. Every case cannot look like a typodont, there is a person attached who often does not follow instructions. Writing a letter to the GP is great practice and shows good two-way communication. Having a GP demand to see ALL patients referred to a specialist to seek approval prior to treatment completion is not good practice! Does this same dentist ask the endodontist he refers his calcified canals and retreats to to send the patient back to him with working length X-rays prior to completing the endo?? Does he want to be present for all third molar exo's, orthognathic surgeries, etc to make sure they are done "correctly" as well?!? Sorry for the rant, but I have dealt with similar referring dentists and it is simply not worth it.... they are the smartest people they know and nothing is going to change that.

 

[aphistis]

Ditto for me too! A very demanding referring dentist is just like a very demanding patient... sometimes they are not worth the hassle.

As an orthodontist, you are the occlusion specialist, you are responsible for creating the very best occlusion possible and like tweed said, sometimes that is not possible with certain individuals. Every case cannot look like a typodont, there is a person attached who often does not follow instructions. Writing a letter to the GP is great practice and shows good two-way communication. Having a GP demand to see ALL patients referred to a specialist to seek approval prior to treatment completion is not good practice! Does this same dentist ask the endodontist he refers his calcified canals and retreats to to send the patient back to him with working length X-rays prior to completing the endo?? Does he want to be present for all third molar exo's, orthognathic surgeries, etc to make sure they are done "correctly" as well?!? Sorry for the rant, but I have dealt with similar referring dentists and it is simply not worth it.... they are the smartest people they know and nothing is going to change that.

I agree with this. By referring a patient to a particular specialist, I'm implicitly endorsing that doctor's clinical judgment. This prior-approval business from the referring GP is not appropriate.

 

[gryffindor]

Remember, it's a team effort. The doc that I used to work for required any patients he sent to the orthodontist to have a consultation with him prior to debanding to approve the esthetics and [especially] occlusion. They had an excellent working relationship and the specialist knew that if he did not follow through with this request, he would no longer be seeing referrals from this particular doc.

This is really weird. Why was he referring to this ortho if he didn't trust the orthodontist's work?

 

[mike3kgt]

Wow! I feel sorry for the orthodontist who works with your former boss. We, specialists, need GP referrals. But if I have to ask the dentist’s permission to remove every of his patient’s braces, then I don’t need his referral. I am a practicing orthodontist….not his student.

Our goal is to get a perfect occlusion on every patient but sometimes it is not possible to accomplish such goal because of poor patient’s compliance (poor elastic wear, no shows, poor oral hygiene), patient’s growth, patient’s decline to have jaw surgery, pre-existing short root problem etc. When these things happen, I write a letter to the referring GP.

PS. I don’t think gingivectomy alone can fix that canted smile…she would need Le Fort I osteotomy and mandibular BSSO surgery. I think her orthodontist did a good job.

As a dentist, you are judged by whom you refer to. It is terribly silly and naive to compare comprehensive adolescent or adult ortho checks before debanding to checking working length (endo referrals) or flap design during exodontia (OS referrals). As a part of a aesthetic and/or restorative ortho referral the referring orthodontist prefered to have a second pair of eyes (from my former boss) to verify that the patient's expectations will be met and will be attainable after debanding.

Many times I saw the photos or patient during a check and the senior doc would make a note and call the orthodontist. He actually enjoyed these phone calls and preferred to have his checks prior to debanding to avoid any issues with the patients. He never felt like it was "asking for permission."

A majority of the time this was during adult ortho or in the case of interceptive ortho prior to restorative (think creating space for missing lateral implants). If a restorative dentist refers a patient to an orthodontist to have comprehensive ortho for restorative purpose, it is essentially asking that orthodontist to act as "technician" in that particular step of the treatment plan. If there is an inadequate result and compromises the definitive treatment, it falls upon the restoring dentist and not the referral. Very much similar if a referral goes to the periodontist for an implant placement and comes back too anteriorly placed and would severely compromise the esthetic result. The surgical aspect could be perfect (no mobility, no infection, osseointegration) but ultimately the case would fail from an esthetic point of view and it would be the restoring dentist fixing things up or getting sued. There are times when it is impossible to get teeth exactly where they need to be or an implant where it needs to be, but many people just fall back and tell you to just "use a custom abutment" or "he'll do a canteliever off your canine" instead of an implant.

You are missing the point of what I am trying to say in the previous post. A restorative doctor should not be dictating how you should do your treatment or how to do your job just the same way he/she should not be telling a fellow oral surgeon what flap to elevate or a periodontist what type of bone graft to use.

There's a reason why orthodontists tend to be the most highly selected or highest ranking people in their classes... there is a significant amount of things to think about when doing ortho and not just straightening teeth. You have to be an excellent expert treatment planner and know how to just tweak here or there to get that perfect result.

And yes, for the aformentioned reasons, I really never plan on doing nor do not advocate comprehensive GP ortho. Stick to resin & porcelain, not wires.

 

[Cold Front]

Like all specialties of dentistry, orthodontics has undergone considerable development and improvement in treatment techniques over the past four decades. Over the years, orthodontic treatment has become easier and more efficient to carry out, allowing greater numbers of patients to receive treatment. The introduction of Invisalign and Orthocap systems were a big leap, even the conventional braces embraced new materials and superelastic wires that deliver light, continuous forces, changed less often, and often with minimal patient discomfort. It won't be long until the next set of systems or materials make ortho more easier for all dentists, not just GPs (just like Implants).

In today's advertisement driven world, patients will start asking about latest treatments, and they will always start with their GPs. The same GP's who have access to latest technological advances in imaging, radiographical analysis, diagnostic models, and can acquire treatment techniques (there are tons of hands-on courses out there, taught by ex-ortho program directors).

Ortho will grow in the GP direction, fo sho.

 

[Istr8nthem]

As a dentist, you are judged by whom you refer to. It is terribly silly and naive to compare comprehensive adolescent or adult ortho checks before debanding to checking working length (endo referrals) or flap design during exodontia (OS referrals). As a part of a aesthetic and/or restorative ortho referral the referring orthodontist prefered to have a second pair of eyes (from my former boss) to verify that the patient's expectations will be met and will be attainable after debanding.

Many times I saw the photos or patient during a check and the senior doc would make a note and call the orthodontist. He actually enjoyed these phone calls and preferred to have his checks prior to debanding to avoid any issues with the patients. He never felt like it was "asking for permission."

A majority of the time this was during adult ortho or in the case of interceptive ortho prior to restorative (think creating space for missing lateral implants). If a restorative dentist refers a patient to an orthodontist to have comprehensive ortho for restorative purpose, it is essentially asking that orthodontist to act as "technician" in that particular step of the treatment plan. If there is an inadequate result and compromises the definitive treatment, it falls upon the restoring dentist and not the referral. Very much similar if a referral goes to the periodontist for an implant placement and comes back too anteriorly placed and would severely compromise the esthetic result. The surgical aspect could be perfect (no mobility, no infection, osseointegration) but ultimately the case would fail from an esthetic point of view and it would be the restoring dentist fixing things up or getting sued. There are times when it is impossible to get teeth exactly where they need to be or an implant where it needs to be, but many people just fall back and tell you to just "use a custom abutment" or "he'll do a canteliever off your canine" instead of an implant.

You are missing the point of what I am trying to say in the previous post. A restorative doctor should not be dictating how you should do your treatment or how to do your job just the same way he/she should not be telling a fellow oral surgeon what flap to elevate or a periodontist what type of bone graft to use.

There's a reason why orthodontists tend to be the most highly selected or highest ranking people in their classes... there is a significant amount of things to think about when doing ortho and not just straightening teeth. You have to be an excellent expert treatment planner and know how to just tweak here or there to get that perfect result.

And yes, for the aformentioned reasons, I really never plan on doing nor do not advocate comprehensive GP ortho. Stick to resin & porcelain, not wires.

I completely understand that it is crucial to have a direct line of communication between the GP and specialist especially for major interdisciplinary cases. I am in constant contact with prosth and referring GP's about cases in which we plan on doing implants, etc. The implants are often placed prior to taken fixed ortho appliances off and the GP can then tell me if there needs to be more/less room for their final restoration.

My intention was not to make light of the importance of GP/specialist communication, it was simply to comment on your experience with a senior GP who was asking that he "check" the occlusion on EVERY referral that he sent to ortho. This can be terrible unsettling for the specialist to feel as though their hand is being held. Most GP's I deal with are excellent dentists and they let me know right from the beginning what they would like done and there is continuous communication throughout the treatment to make sure our interdisciplinary cases run very smoothly, but there is NO reason that they should ever want to see EVERY patient I debond. I can't even count the number of times I have had a pt referred with small/peg laterals, and there was no instruction from the GP as to what he would like to be done, often because it is not completely noticeable until WE, the orthodontists do our bolton analysis and determine there is a tooth size discrepancy and then refer the pt back to the GP to have lateral build-ups done and the GP gets restorative work they never new was coming (usually puts a big smile on their face)- easy money/easy restoration!

I hope I am more clear as to my reason for my response before.