If you have a patient that is over the estimated treatment time and the end is nowhere in sight, it’s time to do something about it. Whether it’s a compliance issue, a bracket position issue or it’s just one of those cases that isn’t going like you want it to, a braces vacation is a great idea and much better than doing the same thing over and over while expecting a different result. Generally, if I’m taking over a practice then anyone who has had braces on for 30 months or close is going to get a braces vacation – meaning that I’ll take the braces off (all their braces) and leave them off for 8 weeks to allow things to settle, to get hygiene under control, to let gingival swelling go down and to allow the patient to get a checkup and cleaning. In my practice on patients we started, I hope to recognize problems earlier than that and generally can tell there is a problem by the 10-12 month mark so I like to do the braces vacation at that point if necessary. I use very specific scripting in these cases to get across why I’m doing what I’m doing and how it benefits the patient.
I’ll generally address mom in front of the patient and say, “Mom, little Johnny’s case is not going as I would like it to and is taking longer than we thought. Luckily I’ve learned how to handle these cases and instead of just doing the same thing over and over and hoping for the best we are going to make a change! I’m going to give Johnny a Braces Vacation! That way he can go get a cleaning and a checkup from the dentist and we can let those gums settle down. I know you remind him to brush and floss but kids will be kids and the braces have been on a while so I want to be sure he doesn’t get cavities or gum disease. Taking the braces off and putting them back on is a lot more work for me but Johnny is worth it and I want to make sure he gets a great smile. Just to be clear, this is on me and there is no additional charge. Any questions?”
There rarely are. Occasionally mom will worry about the teeth going back to being crooked but I assure her they will not move much in that short a time. A thorough explanation of what I’m doing, a smile and some enthusiasm go a long way in making mom comfortable. I make it clear that I’ll do whatever it takes to get a great result.
When Johnny comes back in 8 weeks you’ll often be surprised by how much better his teeth look. Sometimes mom doesn’t even want the braces back on and I’m fine with that as long as we discuss what I see before we make that decision. These cases that drag on and on wear everyone out – not just you!
I’ll also do a braces vacation/smile preview at any time I feel hygiene is out of control to the point that the gums are too swollen for the patient to recover on their own. I’ll remove braces in those cases and be careful not to Piss Momma Off! I will take the braces off in these cases ONCE and only after repeated warnings and documentation and removal of the wires. Once I put the braces back on, if there is still a chronic hygiene issue we will remove braces for good and part ways. Moms rarely have an issue with that because we are very methodical and thorough.
I know most orthodontists believe that removing and replacing braces is a huge deal. It’s not once you’ve done it a few thousand times and get your acumen and speed up. What’s that? You haven’t done it that many times and it’s a big deal to you? Super. That’s all the more reason to act in the best interests of your patient and do a braces vacation when needed! It’s a great way for you to get more experienced and your patients will thank you.