Contemporary Orthodontics & Dentofacial Orthopedics
James
R. Waters,
DDS, MSD , PA
Board Certified Treatment for Children, Teens and Adults
“The Proof is in the Plaster”
Is your Orthodontist showing you
previous cases?
There are many styles of consultation/new patient protocols
Orthodontists use to discuss treatment with prospective patients. Some Orthodontists may simply look and tell
you braces are needed; some dentists now just include Invisalign as part of
their general dental care (along with cleanings, fillings and crowns) as if it
is as simple and predictable as a single filling. Others take specific records to better
evaluate the patient then give a treatment plan and cost. Still others take the records then schedule a
separate consultation after the records have been more thoroughly
reviewed. My feeling is that as the
Orthodontist becomes more experienced, he or she can give a better judgement of
the orthodontic needs in a single visit and save an appointment for both the
patient/parent and him/herself (though I usually do not) if the patient prefers
but they should never skip over a thorough explanation of the case with records
if requested.
So what is best? How
important are the orthodontic records in planning treatment? What questions should be asked to decide
between two or more Orthodontists? Can
your dentist just do the Braces or Invisalign?
There is no simple answer since every case is unique. In the past, it was standard to fully
evaluate a patient and their records (photos, radiographs and plaster models of
their teeth) prior to recommending any specific treatment. But in the advent of
the digital age, with more younger Orthodontists in the market place, and with
increased competition between professionals (including between the un-trained
general dentists and the specialist Orthodontists), we have seen a shift to the
“grab them while you can” mentality to get the patient into the practice first
then decide on treatment “as you go”.
This doesn’t mean the orthodontics won’t be effective or successful but
it may mean you (and/or your treating doctor) don’t know exactly what is going
to happen during treatment and it can lead to misdiagnoses and prolonged
treatments from insufficient planning and/or unrealistic expectations.
I prefer to see the patient for a single complimentary exam
just to determine if orthodontics is even necessary or if the patient is ready
for any treatment. If there is any question,
I will take a complimentary panoramic radiograph to screen the patient further. If treatment is warranted, I will give the
patient/parents a quick summary of why I believe treatment would benefit the
patient then I schedule full records (a separate 30 minute visit where another
radiograph, photos of the face, intra-oral photos and plaster models are
taken). Usually, I have time set aside
to take records after an exam but patients are not pressured into the
records.
A typical set of records for planning treatment includes plaster study
models, a cephalometric radiograph, a panoramic radiograph and full series of
extra and intra-oral photographs.
 |
| Plaster Study Models |
 |
| Cephalometric Radiograph |
 |
| Panoramic Radiograph |
 |
| Full Series of Extra and Intra-Oral Photographs |
Offices may attempt to draw patients in with “no fee
records” which always seems to mean either incomplete records or a higher
treatment fee; I believe in a modest and separate fee for the records ($250
presently) to offset the time to take and prepare records, for materials and for
the extended time it takes to review and plan treatment. Without a records fee, I believe the tendency
is to over-charge mild cases and under-charge difficult cases and it opens the
possibility of the doctor missing important but subtle issues that may be
present.
“Without a records fee, I believe the tendency is to over-charge mild
cases
and under-charge difficult cases”
After the records appointment, I set the patient/parents up
for a sit-down consultation where we review the records and the full treatment
plan. Most importantly I go over similar
cases I have already treated showing pictures and models of the “before and
after” while explaining similarities with the current case. I give copies of the records to the patient
following the consult along with a full copy of the treatment plan so if they
want to shop around, they can compare oranges to oranges and I reference my
website for reference if they have any questions about me or my treatments (www.bracesaustin.com) .
In fact, it seems more and more there is less effort to show
what an Orthodontist can offer through successfully treated cases. A picture is really worth so many words; even
in the iconic cartoon Simpson’s when Homer and Marge take
Lisa to the local Orthodontist, the doctor pulls out the
“The Big Book of British Smiles” to make the point for braces
referencing the all-too well-known stereotypical Socialized British dental care.
Unfortunately my specialty is not immune to salesmanship and
business management; both are fine as long as the sale can be backed up with
successful examples of previous and similar cases. Gone are the days that an Orthodontist hangs
a shingle, opens an office and is instantly successful; competition and costs
are far too great to ignore the business aspect of Orthodontics (or Dentistry
itself for that matter; refer to previous Blogs on the Costs of Dentistry). So I cannot fault my brothers and sisters too
much for if they are unsuccessful in practice, they won’t be able to help
anyone but that does not mean you cannot find thoughtful and skilled
Orthodontists for you and your family if you know what to expect.
In the past we would say “put the plaster on the table”
referring to the plaster models taken before and after orthodontic
treatment. The fact is that the best way
to assure your Orthodontist can provide you or your family with that perfect
Hollywood smile is to see that he or she has done it for others with the same
problems. And that doesn’t mean
reviewing pictures from patients treated by someone else; before and after
cases don’t mean much if the work was not performed by the Orthodontist you are
considering!
I make books of patients every few years as time permits so
that I can quickly reference before and after cases for anything as simple as
mild crowding and overbite to multiple missing teeth and even severe growth
anomalies requiring surgeries. In some
cases, I have case reports over 10 years to show growth, development, treatment
and stability (or relapse and re-treatment if necessary). After 20 years in dentistry and 15 years as
an Orthodontist, I have seen and treated most issues you could imagine (and
many you could not). I am proud of my
work and I always look forward to sharing cases; any good Board Certified
Orthodontist would feel the same (you can see some of my cases I used for books
at www.bracesaustin.com/smile-gallery).
“So what if I don’t
get to see before and after cases; should I look elsewhere?”
That is a question only you can answer; if the case is
obviously simple, records have been taken and the Orthodontist is experienced
with a good reputation (Board Certification is a big plus as well) then you are
likely fine. However if the bite is
significantly crowded, there is a shift in the jaw, there is joint pain, you
are waiting on teeth to erupt, or there is no room for future teeth to erupt
then you might consider a more thorough exam elsewhere before making a
decision.
So look for the evidence that your Orthodontist can treat
you and/or your family, ask to see results of similar cases, ask about
specialist training and ask friends and neighbors for their experiences; Check
to see if they are Board Certified specialists and when you visit the office,
watch how the staff behaves (are they proud of what they do; are they polite
and well trained?). Above all, remember that the proof is in the plaster!
If you have questions or comments concerning this or any
orthodontic question, please feel free to make a complimentary new-patient
appointment at either my Steiner Ranch location or my North-central Austin
location on West 35th street and MoPac.
Dr. James R. Waters
is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of
Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian
graduate from the prestigious Saint Louis University Orthodontic Program
receiving the J.P. Marshall award for clinical excellence in 2001. He holds a Bachelor’s Degree in Science,
Doctorate in Dental Surgery, a post-doctorate certificate in Advanced
Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics
and a Master of Science Degree in Orthodontics.
Dr. Waters and his wife of 20 years live in Austin, TX with their 4
children where he has a thriving, multi-faceted Specialist practice with
locations in Steiner Ranch and North-Central Austin. You can learn more about Dr. Waters at www.bracesaustin.com .
Central Austin
1814 W. 35th
Street
Austin, TX 78703
(512) 451-6457
Steiner Ranch
4302 N. Quinlan Park
Austin, TX 78732
(512) 266-8585
BracesAustin.com
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