When I finished residency in 2004 I bought a tiny little practice in Jonesboro, Arkansas. I was scared to death and my wife and I were happy to live in Arkansas instead of the East Coast where I grew up for several reasons – most of them had to do with being terrified of going broke and finding a practice that I could afford to buy and a seller who would finance it.

Now, this practice was no gem. It was as old school as they get. Straight Tweed, 14 inch wire segments, turrets for hand crafting archwires, bands on all the teeth from the canines to the second molars and “stick on brackets” only on the incisors! Sounds fun right? Well luckily for me, the residency program I attended was terribly backwards and I was equipped to handle the practice and the mechanics!

Anyway the reason I tell you this is so you know that to debond the cases of the selling orthodontist, I had to remove a bunch of bands and all those bands left a lot of band space and that band space had to be closed. To close band space for patients without having multiple partial deband appointments, I handmade my very own upper and lower wrap around Hawleys. I would place upper and lower bonded retainers, remove the braces, deliver the Hawley and remove the interdental acrylic as needed and then progressively cinch the retainer down to close the space. A Herculean effort to say the least and one that didn’t always work out. The most common problem was the appearance of a tiny space between the maxillary lateral and canine. When this happened I would see it coming from across the room and would immediately drop to my knees and pray to all that was holy that the patient wouldn’t see the issue.

Of course the patients ALWAYS saw the issue and would aggressively share their displeasure with the rookie orthodontist that had recently been thrust upon them. Of course I would fiddle with the retainer and try to convince them they were happy but it almost never worked and the patient, rightly so, demanded satisfaction. Most demanded braces be reapplied so I would begrudgingly put the braces back on (no bands this time of course) and unhappily treat the issues and the case, again, to completion. I’m sure none of you have these issues but if you do there is an easier way. I just wish someone had told me 11 years ago!

These days when a patient has an issue or a space or a tooth that moves within the first couple months following debond, I point it out to them before they get a chance whenever possible. The conversations come in a few different flavors and go something like this:

 

Scenario 1

A happy retainer patient walks in the door for a 10 week retainer check and I see an issue:

Me: What’s that? What’s going on with your teeth? One of them moved?

Patient: What? Where? I haven’t noticed anything?

Me (handing the patient a mirror and pointing at the offending tooth): Right there. It’s moved! Have you been wearing your retainers? Do we need to put braces back on and fix that? I can do it right now and it won’t cost you a dime?

Patient: Wait. You can barely see that plus I bet if I wear my retainer more it will be fine. I don’t want braces back on.

Me: I don’t know… We should probably put braces back on now and be sure. I want it perfect.

Patient: Sorry doc, no way. It’s fine. Settle down. I’ll just wear my retainer more.

Me: Ok, have it your way… But you better wear that retainer more or I’m gonna insist on putting braces back on you!

 

Scenario 2

Unhappy patient comes in before the scheduled 10 week retainer visit:

Patient: This isn’t right. My tooth moved, I don’t like it. I spent a bunch of time and money on this and the darn things aren’t right. You need to fix this!!

Me: Absolutely. I see exactly what you are talking about. Let’s fix it. Sit down here and let’s put your braces back on. I won’t charge you a dime. I want it to be right. Let’s do this! (And I hold my hand up to high five the patient).

Patient (deflated a little and looking concerned and not interested in a high five): Um wait. Can’t you just fix it with the retainer?

Me: Well if you haven’t been wearing your retainer like we discussed, you can try wearing it all the time for a couple weeks and see if that pushes the teeth back in place but otherwise, no, it takes braces to move teeth. Retainers just hold them in place.

Patient: Well, I guess I could wear the retainers a bit more. I really don’t want braces back on.

Me: Well that works for me if that’s what you want. Let’s try it for two weeks and check again. If your teeth look good, great! If not we can slap braces on you again, no problem at all!

Patient: I bet it will be fine. Thanks though.

 

Scenario 3

This one is the same as Scenario 2 except in the ending.

Patient: I think I want braces back on.

Me (smiling and truly happy to render good service): Fantastic. Thanks for letting me make it right. Do you have time to put the braces on right now?

 

I can tell you from vast experience that very few people want their braces back on when the issue is handled this way. When I used to try to avoid addressing the issue or deny the patient their due, things didn’t work out nearly as well for either of us. Patients spend a lot of money and time on our services. We owe it to our patients to do what we can to make them happy. Reapplying braces occasionally and being happy about it is a small price to pay. We can choose our attitude. The funny thing is that when you offer to do the right thing immediately and you’re happy to do so, life is pretty easy and people feel heard and satisfied.

Try this scripting for yourself. It will work if you proceed with a cheerful heart and a grateful attitude. It’s a privilege to do what we do and nothing is better than making people smile!  Satisfaction guaranteed!

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