As I’ve mentioned several times recently, I took over a practice that I own but haven’t run for many moons this summer. Overall the patients are in good shape but I’ve seen things I take for granted and this turn of events has given me an excellent opportunity to document simple things that may be of use to other orthodontists – especially those who are not long in the business and finding their way (I know you already know and probably won’t listen… but still). This young lady came in yesterday. She had been in treatment six months and presented thus:


Not only had her chief complaint been ignored, she only had upper braces on. This violates several tenets of pragmatic thinking in orthodontics, customer service fundamentals as well as many business principles. Let’s explore some things you should strive for in your practice:

  1. Ascertain and address the patient’s chief complaint as soon as possible
  2. Don’t make more work for yourself 
  3. Don’t make the patient suffer unduly
  4. Create a raving fan
  5. Advance treatment at every appointment like it’s a race to the largest wire you use
  6. The faster you progress treatment, the more compliant the patient will be
  7. Your patient is a walking, talking billboard for your practice

It’s a free country and you can do whatever you like in your practice but why would anyone do otherwise? What is the rationale for violating these basic tenets of business and practice? Why would this patient present in this state six months into treatment? I’m not certain but I can guess based on what I’ve seen and heard:

  1. Bonding one arch saves time (it doesn’t – it costs time)
  2. You can’t close space on small arch wires because the teeth may rotate (they may, slightly, but they will derotate just fine and the patient will be much happier)
  3. I can’t close space until I’m in large enough wires to run elastics to control overjet (well, maybe so but you can still close the space between the centrals even if you have to hold off of wholesale space closure).
  4. The office constantly runs behind and doesn’t have time to advance treatment at every appointment (this is very, very common based on the hundreds offices I’ve seen)
  5. The office doesn’t have control of the schedule and doesn’t have time to advance treatment (this is also very common and part of #4)
  6. The orthodontist/employee doesn’t give a darn because it’s not their practice and it’s too much work to treat the patients and the practice as they would if they were an owner (most owners assume this and I used to but the fact is that people who have never owned have no clue how to go about acting like an owner – they think they do – many times they think they know better than the owner). Also, if this were true then this kind of thing would never happen in an owner/operator practice and that’s just not the case any more than it is the case that all associate run practices suck. There are owners who suck and associates who suck AND there are associates who rock and owners who rock. Most of us fall somewhere in-between. We should all strive to learn and grow and improve what we do and how we help patients.
  7. The orthodontist looks at what they do as a job that is repetitive and boring and tiresome and forgets that, for most patients, this is their first experience in braces or Invisalign and it’s very exciting and very expensive and a big focus in their lives (we must treat patients like they are our family members every day, all day!)

So what did I do with this patient who was scheduled for a few minutes for an active? I bet you can guess:


She was very happy that I “finally started working on what she came here for” and I was happy to do so. Long story short, even if you start out in an 012 nit wire, put a frigging power chain 1-1 on cases like this. Hook it only to the mesial wings of the bracket and put an O tie on the distal wings. Skip a link in the middle of the chain if it’s too tight. See them back on a short interval if you’re worried about it. Whatever. Just do it! Your patients and your practice will thank you.

Patients are more important than the arbitrary rules we cling to as a speciality! We work for them.

5 thoughts on “Use Your Head!

  1. Excellent points! I’m not that far out and I’m still willing to listen and learn from my elders 😀

    I’m always telling my assistants (and even patients) that I’m ok with spaces in the upper arch before I can get to large enough wires to close them all, but I’m NOT ok (and neither are patients) with that space being between the centrals. Anywhere else, no problemo! I like to have them use powerthread underneath the wire upper 1-1.

  2. Excellent read!
    In some patients if you close a diastema too early they would be less cooperative with the remainder of the work as their front teeth now look good. I’d start early to correct at all corners of the mouth or even stage correcting the front teeth to the end as to make the patient feels that her/his long cooperation has paid off at the end! Happy Saturday 🙂

  3. Thanks for sharing. You really think that patients, on average, will be less cooperative when they see progress? That hasn’t been what we see at all when it comes to spaces or crowding or AP correction. The faster I go the more cooperative they patient is has been my experience. There are always outliers but I can’t get on board with your assessment for lots of reasons. Pls explain further if yo don’t mind.

  4. As stated Before Dr. Aymach has got some hang ups. He tries link things up that have nothing to do with one another as some proven game.

Comments are closed.