Do you ever really consider patient comfort? I know you think you do but do the decisions you make during your daily routine support your self assessment? Let’s see. Here is a short checklist of the biggest patient comfort issues I see regularly in orthodontic offices.

Do you:

1) Use NOLAs when you bond? If you do, then be sure to use the clear tubing so you can see the blood picked up by the suction. Blood spilt by the archaic torture device we all love because it’s convenient for us and makes our lives easier. Patients hate them and there are easier ways to isolate.

2) Band molars? Put some seps in your own mouth for a couple days before you start defending this practice. Then put some bands in your mouth and take a pano. If you’re satisfied that the pain and the plaque trap and the overhang you create are justified by your desire not to fix the occasional broken molar bracket, well then, I have to say you’re still wrong. Plus you cannot complain about open margins or overhanging restorations from PCDs if you’re banding everything. And yes, sometimes you have to band a tooth with a crown or a large filling or one that constantly breaks but your default setting should be aligned with patient comfort not your convenience.

3) Bond or band all 7s even if they are well aligned? What?? You’re saying you don’t get on all the 7s Burris???

That’s exactly what I’m saying. I bond 7s when they need bonding. Sometimes that’s at the beginning and sometimes that’s during treatment. Why? Because bonding 7s is uncomfortable for the patients. Because having brackets on the 7s and a wire that far back is uncomfortable for the patient. Bands on the 7s are worse. I know saying this is heresy but I’ll stand behind what I said.

4) Refuse to go faster when you are doing a bond? Well, doctor, your patients hate sitting there in that NOLA or anything else for that long. Faster is better not only for reducing bond failure but it’s much better for patients.  Go faster doctor for the sake of your patient!

5) Allow assistants to remove glue with antiquated hand operated scraping instruments? Seriously? Try it on yourself.

6) Allow assistants to use a round bur and slow speed to remove glue. Again, seriously? Try it on yourself.

7) Allow assistants to remove glue with a high speed handpiece? Whether it is legal or illegal in your state is it really a good idea to delegate the wielding of a cutting tool turning 400,000 RPMs?? What would you want for yourself and for your kids? Who is less likely to make a mistake and minimize enamel removal? The doctor or the assistant? If you said they are equal or the assistants are better, then how can you oppose mid level providers running a handpiece or PCDs doing braces?

Well? How did you stack up on the patient comfort scale? Still think your choices are justified and you’ll do it the way that’s comfortable for you? Super. Pls send me your address so I can open up next to you… Taking great care of patients in things big and small is the best way to grow and maintain your practice. Times have changed. It’s time for our profession to do the same.

Post script: I wrote this piece a couple weeks ago and felt really good about how far I’d come and how well I’d explained the need for all of you to think patient comfort. However as I went to review and post it today, I realized I had omitted something. Something big! Now that I’ve recognized my own stubbornness and resistance to change, I must acknowledge my shortcomings when it comes to providing the most comfortable patient experience. I need to admit that I’ve ignored what many of you have been trying to tell me for years now… That I should be using intra-oral scanners instead of making impressions. Looking back in the context of writing this piece, I now see that have consistently defended and rationalized my anti-scanner position and I did it for the most base reason of all – that I didn’t want to part with the money to buy scanners. So let’s make this #8 and add it to the list.

8) Do you use intra-oral scanners or do you shove trays of goop down your patients’ throats and watch them squirm??

Looks like I’ve got some work to do to be as good at looking out for patient comfort as I thought I was.

PS: This does not mean that money is irrelevant or that you should buy stuff you can’t afford or don’t need.

3 thoughts on “Patient Comfort

  1. Excellent post. Thanks for sharing Ben. I completely agree that patient comfort should be of the utmost importance in a practice. I recently purchased a large practice where the senior doctor bands all first molars and oftentimes second bicupids and second molars. I’m moving the practice in the direction of bonding all teeth but I had a question. Since you bond all teeth, do you place bite turbos often? Do you get a lot of emergency calls regarding molar tubes being off? Just wondering and thank you for all the awesome information you provide so freely. It is truly so helpful for a new doc like myself.

    Also, I just signed up for MKS 2016. I’m really looking forward to it.

  2. Have you ever asked patients what they prefer? If so, you may want to rethink #8: Clinical use of a direct chairside oral scanner: an assessment of accuracy, time, and patient acceptance. Am J Orthod Dentofacial Orthop. 2014 Nov;146(5):673-82.

  3. Excellent post I agree pretty much all of your points. We still use the NOLA in my office and I would be very interested to learn your technique for doing a full initial two arch 6-6 bonding without using the NOLA. Thank you!

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