Orthodontics is just another phase of dentistry. True, but it is the most different phase in many mays than all the others. Typically the dentist has a one dimensional mindset – because of the nature of business. Patients have a singular problem that needs to be solved quickly and efficiently. To do this, the dentist needs to be focused on that problem. It is very effective and for a dentist to be successful he must be efficient. Even the way the teeth are considered – tooth # 8 or tooth # 21, etc. keeps the focus on a single tooth.
In orthodontics you think in terms of quadrants – upper left quadrant for example is maxillary left central distally to the last molar; lower right quadrant starts with the mandibular right central and so on. Teeth are considered in terms of semetry – the upper threes are the cuspids – the lower twos are the laterals, etc., so when you are talking about a particular tooth in orthodontics you are referring to that tooth in relationship to its antimere (the same tooth on the opposite side of the arch). It becomes even clearer when you consider the orthodontic numbering system in graphic form –
which is more a position in the arch than a specific tooth. If you were referring to the upper 2’s, it would be the lateral incisors, or it could be the cuspids substituted for the laterals – completely different teeth but in each situation you would be referring to the same space in the arch.
When filling out a treatment chart (I’ll get to this later) use this system to keep you focused in the right direction. It’s actually very similar to what you have been doing but with the lens fully open. Get comfortable talking this system with your assistants and others doing ortho so you keep the proper mindset. You will soon notice the benefits.
It’s well known that orthodontists take the best records in the health field. The orthodontic dentist should be no different. Cephalometric and Panorex X-Rays, beginning facial and intraoral photographs and study models – the dentist must restrain himself from using stone models – white plaster only and they should be sent out to a professional laboratory for trimming and sculpture. Of course, the model sculpture laboratory must be furnished with impressions that include not only teeth but the supporting structures all the way to the reflection. Orthodontics is not just moving teeth but also reshaping bone (the most important part of all) – if the bones are not lined up, the teeth can’t get lined up. Without accurate study models you could make a mistake in diagnosis. Everything is tied together.
You must have patient records that you are proud to show to patients and parents, others doing orthodontics and orthodontists. If you have to make excuses about your records, you need to try harder.
The orthodontic patient in the operatory is unique in the dental office. It’s not necessary to have a special room or chair for the orthodontic patient – nice but not necessary. There are requirements that must be met however to be efficient with completion of treatment. Each appointment must be maximized for the time spent. Tasks need to be accomplished in a routine and orderly fashion. The work routine is of special importance in orthodontics. Try to do things the same way every time. Attempt to place your patients on a routine pathway so nothing is overlooked along the way. If you do things the same way every time you should get better at it and also quicker. Make brackets and archwires the standard treatment so you are not tempted to do partial treatment with removables or some other inefficient device.
The necessary paraphernalia must be present at the chair before the patient sits down. The beginning study models, an equipment tray and the patient’s orthodontic treatment chart are the minimum requirements. The orthodontic treatment chart must be separate from the dental chart. At the top is the patient information – name, age, dentist if other than you. Special situations such as missing teeth, allergies, etc. go top right corner in RED. Molar band and preformed archwires sizes can be noted there also for the future reference if needed. Each procedure should be recorded, in abbreviation form, at each appointment. This should start with the date and be in a specific color (blue). The next entry should be what you plan to do next appointment and in how many weeks (example 6-1, six weeks for one 15 minutes segment). This should be in a different color (Red). The assistant knows how to read the treatment card so when the patient arrives the appropriate materials are on hand at the chair. This is done to save you time and get you up to speed with each patient as soon as you are ready to work. Also present are the patient study models (which you should look at each appointment because it is impossible to remember everything about every patient) and the equipment tray which allows you to immediately start work no matter what you have to do. The equipment tray (there are three or four always ready on hand) should contain 1)explorer, 2)mouth mirror, 3)small cutter pliers, 4)ligature director, 5)scaler, 6)and ligature wire in neat bundle. Any additional pliers etc. will be present on the table since the assistant read the treatment card before the patient arrived and placed them next to the study models.
The secret to efficient and excellent orthodontics is good communication and good assistants. In most states the assistants are permitted to place and remove archwires, size bands, prepare teeth for bonding, mix cement, clean cement from the bands and caronal portion of the tooth and so on. The assistants should be well trained and utilized to the fullest. There are procedures you do not want to delegate – the main one is that you make all decisions. You are the first to examine the patient and inspect all archwires out of the mouth before they are tied in. You are also the last to examine the patient before they leave no matter what procedure has been done.
Orthodontics can be the most rewarding addition to your practice you have ever done. It can be mentally stimulating, financially rewarding and a tremendous service to your patients. With a well organized plan it will be even better.