Should a general dentist add straight-wire orthodontics to the practice?
Today, general dentists want to offer their patients the very best in dental health care, refer less to the specialist, grow their practices financially and become more and more competitive with corporate dental practices. Many dentists ask me for input about these issues because I have sustained a successful, thriving general practice for over 38 years. When I reflect on what has made the biggest, singular difference in my practice, there is no hesitation in my response.
Considering all the trends and fads and even the most fundamentally sound CE courses that I have taken over the last 40 years, traditional straight wire orthodontics is the one dental discipline that I learned, after dental school, that changed and continues to mold and influence my practice, my work and my life above all others.
I know this is a big claim and big words. Defending this paradigm is not something I can do in one short article. But I do at least want to touch on some of the highlights.
When I began doing comprehensive ortho in my practice, it began to influence every aspect of dental care and treatment planning I faced in my daily patient contacts and all my comprehensive and periodic exams. The following are some of the general practice scenarios that make my approach unique and different from dentists who don’t have orthodontics at their disposal.
I suggest orthodontics to every patient I examine, when indicated; even if they have gone years with crooked teeth, sometimes they just need to be told by their dentist that straightening their teeth is still an option. It is unbelievable just how many adults are unhappy with their crooked teeth but believe they missed their chance long ago. I have performed straight wire orthodontics for patients as old as 77 years of age. I never fail to be impressed when my hygienists or assistants will mention to a patient that has crooked lower teeth, “Doctor Williams can fix those; he does braces”, which opens a dialog between me and my patient resulting in comprehensive treatment or retreatment of an old relapsed ortho case.
With ortho in my tool bag, I have the option to offer my patients the service of correcting rotated and crowded teeth, which makes their homecare easier and more efficient. They begin to like what they see in the mirror and that motivates them to work even harder on oral hygiene, which in turn improves their compliance and prognosis. When patients like the way their teeth look, they become willing to have more frequent maintenance cleaning appointments (even if some of those appointments are not covered by insurance).
Often, teeth are decayed to such an extent that even though the tooth could be saved with root canal therapy, the resulting post core and crown are compromised because the margins are not just sub-gingival but are at or below the crest of the supporting bone. Orthodontic extrusion of such teeth allows the restoration to be completed without compromise. Moreover, the total cost of limited ortho, root canal therapy, post-core, and crown is less than the extraction, bone graft, implant, abutment, and crown which is the plan more commonly offered by the majority of GPs. My patients are excited to be offered an orthodontic-based alternative, avoiding an invasive, expensive, and long process of extraction and implant.
Many times, my patients have missing teeth that need to be replaced, but the adjacent teeth are severely tipped and/or super-erupted making the fixed bridge solution a compromise or impossible. With orthodontics in the mix, I am able to offer to upright the adjacent teeth and even intrude them when necessary, allowing me to do bridges with parallel abutments and avoiding endodontic procedures that would otherwise be required to accommodate over-prepping tipped and malaligned teeth. Some cases that do not have distal abutments because of long-gone missing posterior teeth can still have options of conventional bridgework by simply moving the most distal tooth back into a position that allows a bridge to be placed without implanting teeth. This is great in patients who have no implant options due to health histories that prohibit implants but want to avoid removable prosthetics.
Anterior diastemas, missing laterals, or peg laterals requiring crowns or veneers are issues I’m presented with from time to time. This problem is further complicated by the positions of the anterior teeth, which are arranged such that the cosmetic restoration of the anteriors is severely compromised. Using crowns or veneers alone, to resolve the uneven spaces, missing teeth, malaligned or rotated anterior teeth make the cosmetic result less than ideal, to say the least. With orthodontic intervention, the teeth can be aligned and properly spaced allowing me to obtain the best possible cosmetic result without compromise.
No other aspect of my family practice is influenced more by orthodontics, than my examination and treatment planning of children. With comprehensive straight wire orthodontics at hand, I am able to offer Phase I treatment to kids 4 through 9 years of age. Problems such as early space management, expansion of the arches, early concerns about esthetics and the child’s self-esteem can all be addressed. Early orthodontic intervention allows me to establish the best possible foundation for the coming Phase II comprehensive orthodontic treatment. Moreover, advocating this philosophy of early intervention, non-extraction orthodontics allows me to expand the arches early and distalize later, if necessary (instead of extracting 4 bicuspids at age 12 and up) resulting in great occlusions, bigger, broader smiles and good healthy airways.
I have found that even when my patients state that they cannot afford some of the treatment plans that I have recommended for them and their spouses, they will still come up with the necessary money to treat their children. My acceptance rate for children in comprehensive orthodontics has always been exceptional.
The Impact of Orthodontics on My General Practice—In Conclusion
In this article, I have only touched on a small sampling of the various ways orthodontics has influenced my approach to treatment in general practice.
The underlying benefit is that when I am able to offer more options than patients usually encounter, and can do those treatments without referrals to specialists, it builds confidence and trust; it creates a rapport with my patients that leads to more treatment acceptance and to many more word-of-mouth referrals than I ever would have had otherwise.
By offering comprehensive straight wire orthodontics in my practice, I have created new revenue streams, new referral bases, provided better comprehensive general care, and created a niche that very few corporate dental models are willing to get involved in. It sets our practice apart from the pack.
But the most important aspect of learning and providing straight wire orthodontics in my practice comes from the number of smiles that I am privileged to create daily. No other discipline changes smiles and lives as orthodontics does. It is, day in and day out, for almost 40 years, the most rewarding thing I do. I cannot imagine practicing without orthodontics in my practice and in my life. I hope that in teaching general practice straight wire orthodontics in my seminars, I can share the joy and excitement of adding this discipline to every dentist’s practice that I encounter.
Why on earth would you practice dentistry without orthodontics?
You can add orthodontics to your practice.
Expand your practice now. Offer your patients the care and dental team they love along with orthodontic solutions.
Join Dr. Williams in Dallas October 9 through 11, 2020, to take the Basic Straight Wire Orthodontics course. It’s perfect for general and pediatric dentists.
Learn more about the course and register.