Orthodontist for 40 years-Ask Me Anything

[sonakshi]

what to do if some one is having poking wire.

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[DrJeff]

what to do if some one is having poking wire.

While not an orthodontist for 40 yrs as the OP is, I have been married to an orthodontist for 20 yrs and have heard this conversation on the phone COUNTLESS times over the years....

What my wife does when a wire is poking a patient and they call after hours.... #1, try and snip it with a pair of nail or cuticle clippers if they feel comfortable doing so... #2 if they can't snip it, find that envelope of wax that they give to each and every patient at some point and put a little over the end of the wire poking the patient, and then they'll see the patient the next day and/or when ever the patient can get into the office at their convenience. Or #3, if the patient lives close to our house (our house is about 20 miles from the nearer of my wife's 2 offices), then many times she's had the patient over and she'll snip the wire often while the patient is sitting at our kitchen table (my wife always keeps a clean set or 2 of basic ortho instruments and a box of gloves for minor such emergencies at our house)

And occasionally as a GP, if I see an ortho patient with a protruding wire where I can see it's caused some soft tissue trauma, I'll gladly snip it myself (or more often just trim off the offending end with a high-speed handpiece and a fine grit diamond finishing flame shaped bur)

The simple truth is that if there's a wire poking a patient, the vast majority of patients (or more often Mom's of patients) will wait until the next day (if it's after hours when they're informed of the poking wire) and call my wife's office and they'll get them in ASAP and take care of it for them. Just a part of the practice of orthodontics

 

[Str82th]

Thanks for your time @JawJock47!

What do you consider the most important orthodontic-related skills or knowledge for GPs to have?
What are the biggest mistakes GPs make regarding orthodontic treatment or referral?

It's been a while since you asked, so I'll offer a reply.

It seems that most GPs believe they should wait until all deciduous teeth are rzfoliated and the permanent teeth in place before referring to an orthodontist. Often, when all the permanent teeth are in, the peak velocity of growth has passed.

Girls peak around age 12, boys around age 14.

If treatment requires functional appliances, it would be advantageous to begin treatment before that peak of growth, in order to help direct growth.

Most patients who you suspect would need ortho should be referred around age 7-8 for evaluation. Most orthodontists don't charge for consults.

If you see a crossbite causing a functional shift in a patient, refer. A functional shift can behave like a functional appliance, and can cause asymmetric growth.

One of the greatest mistakes GPs make in treating ortho cases, in my opinion, is poor diagnosis and treatment planning, failure to control the vertical dimension and failure to treat to CR=CO. In many cases the GP will be satisfied when the "social six" (upper canine to canine) are aligned. That's a disservice to the patient, who likely doesn't know any better.

 

[2TH MVR]

I'll add the indiscriminate extraction of primary canines thinking this will magically make more room and help that patient. Extracting primary canines causes loss of arch length. As Sr82th said ... send these patients in when they are around 8-9-10 yrs of age. At that time .... expansion and molar distalization procedures can be done to PREVENT upper cuspid impactions and future perm teeth extractions. Orthodontists aren't miracle workers. We need SPACE to work with. GP's don't like bicuspid extractions ....... then.....send those patients in earlier for Phase 1 interceptive treatment.

 

[predent94]

My son just recently showed me this site, what an awesome resource for student in today's era! I won't say when I was a pre-dent, but there certainly wasn't SDN 🙂

I owned a private orthodontic practice for 20+ yrs, have worked for a corporate dental company, and am also teach in a ortho residency program. My goal here is just to pay forward some of the help I received along the way. Ask my anything and everything!

Hi, thanks so much for the informative Q&A. I wanted to ask what advice do you have for someone applying after having worked as a GP for 2 years? I have a pretty low rank and GPA as I never thought of specializing while I was in dental school, but I've been working with an orthodontist and am very very interested in the field. Is there any way to offset that or do you think it is simply not possible to get accepted without the competitive stats?

 

[Afp0731]

Well I had 7 children and only 1 chose the dental route, and even he is a nontraditional dental student now. In fact, he was so interested in medicine at first he went all the way through the MCAT and getting accepted to his "dream" medical school, only to turn around and take the DAT and now go to dental school. I think in his experience, he got sick of every MD telling him to do dentistry or something else. I have tried hard to not pressure any of my kids to do anything they didn't want to, just emphasized the importance of being a professional at something-but deep down im laughing at his experience and conclusions.

I didn't come from a health related family-both my parents were immigrants. I went to UL and majored in Biology and really just saw dentistry as a fascinating growing field and here I am still pluggin away into my 70s!

Oh wow do you have another son who is almost done with medical school right now? I also graduated from UL in biology!

 

[InformMe123]

Do the orthos at corporate chain or multi-doctor office settings put on the brackets and other manual work etc. or are there assitants?

 

[8_man]

Do the orthos at corporate chain or multi-doctor office settings put on the brackets and other manual work etc. or are there assitants?

Assistants for sure, because it's all about production speed at low cost

 

[2TH MVR]

Do the orthos at corporate chain or multi-doctor office settings put on the brackets and other manual work etc. or are there assitants?

I work 3 days at a Corp chain. The most important step in orthodontics, besides diagnosing the case properly, is placing the braces in the appropriate positions. In my private practice .... I place ALL of the braces. In Corp .... the assts will place the brackets and remove the residual flash. I then come over and position as necessary. The assts then light cure the braces. It's actually pretty efficient.

 

[jda02624]

I work at a corporate office and I place all brackets, position them, and cure them (I tack them, assistants do the final curing which takes several minutes). I remove all adhesive with a hand piece at debond as well. There are some things that you can delegate, but bracket placement is extremely important in the success of an ortho case (with proper diagnosis, of course).

 

[sierra128]

When considering residency programs, what are some key factors for deciding on a program? Looking back, would you have picked a 3yr vs a 2yr program? Thank you!

 

[2TH MVR]

2yr since less cost and real education starts after residency.
3yr for MS if you end goal someday is academics.

Seems like most programs are going 3 yrs.

 

[sb_ort]

My son just recently showed me this site, what an awesome resource for student in today's era! I won't say when I was a pre-dent, but there certainly wasn't SDN 🙂

I owned a private orthodontic practice for 20+ yrs, have worked for a corporate dental company, and am also teach in a ortho residency program. My goal here is just to pay forward some of the help I received along the way. Ask my anything and everything!

Hello.
It's been a while but I figured it's worth a shot.
Did you prefer Reusable or Disposable surgical instruments?
Which disposable surgical instruments / tools are used by Dentists and Orthodontists?

Thank you