1. Case selection
Select the right cases to treat with aesthetic orthodontics, also known as cosmetic orthodontics or short term orthodontics (STO).
Comprehensive orthodontics aims at getting as close to the ideal relations in terms of angle class, root torque (angulation), overjet, overbite and midline corrections. It is the gold standard in orthodontics.
As a result of growth of aesthetic orthodontics especially in the US and UK, many patients ask for aesthetic orthodontic treatments or systems. However, not everyone is suitable due to patient expectations (the most difficult thing is sometimes to say ‘No”) or the severity of the malocclusion. There can be underlying skeletal problems that require a comprehensive, or even a surgical approach.
If a patient does not want comprehensive ortho and is suitable for aesthetic ortho, provided you can solve the patient’s cosmetic concerns and the patient understands the implications of your treatment plan (to gain informed consent!), aesthetic orthodontics can be an acceptable and defendable treatment.
Remember even comprehensive orthodontics may only offer a camouflage of underlying problems if a patient does not want to have orthognathic surgery. So even comprehensive ortho may be a “compromise”. The phrase ‘compromised treatment’ is meant in comparison to the ideal treatment possible. What orthodontists/dentists may classify ‘as a compromise’ may from the patients perspective be a great result and in no means ‘a compromise’. This is proven by patients who have had aesthetic orthodontics and see their new smile for the first time, who become very emotional and extremely happy with the outcome.
A lot of orthodontic treatment is carried out by general dentists in the UK. Unfortunately most dental students do not get much encouragement whilst studying to treat patients with orthodontics. Some orthodontic treatments needs to be undertaken by a specialist, just like some root treatments require a specialist endodontist. Some extractions need to be referred to a maxillofacial surgeon. Some restorative work requires a prosthodontist. Some patients require treatment by a periodontologist. However, the majority of these treatments are undertaken by general dentists (GDPs).
This is such an important topic that I would recommend all dentists to study this subject in depth.
Make sure you understand all the patient’s concerns, which of these absolutely must be corrected and which ones are not essential. Do not assume to know what the patient thinks, ask the question ‘is there anything else you would like to change’ and keep going until the patient has no more concerns to be addressed. Write out a full problem list and again list the ones that you will correct and the ones you will not want or be able to correct.
Clinical skills are important and dentists are already doing CPD and improving their dentistry, but the one thing I see that is often left out is the quality of the communication.
Mentors like Ashley Latter, Jane Lelean and other communication experts can open your mind to why patients may or may not want to proceed with a treatment plan even if you as a dentist know this is “right” for the patient and the clinically recommended treatment plan. Ashley Latter says ‘you don’t know what you don’t know’. Just like patients don’t know what they don’t know, dentists don’t know what they don’t know (what they are missing).
It will make a massive positive impact on your professional (and personal!) life if you can get this right and it will greatly reduce the risk of patient complaints and litigation.
Take excellent photographs, so you know what the starting point was. Go on photography courses and bring your staff along so that this task can be delegated to staff members. It makes the dental nurses’ work much more interesting and let’s the dentist keep his dental focus.
Good photos make a good portfolio. This is important for any dentist, associate or principal. You want to be able to show good before and after photos.
Back up your photos – no excuses! This may involve on-site and off-site (cloud) storage.
Make sure you have appropriate tools to do the job. Working with loupes would improve most aspects of dentistry and orthodontics are no exception. What you do after the ortho can be just as important! If patients need and want further treatment to achieve their ideal result, then they may also need cosmetic bonding, veneers or teeth whitening.
Using the right materials and techniques together will create the best result cosmetically and in terms of longevity. With the modern composites we can now achieve results that were previously only thought possible with ceramic restorations and even those have developed greatly in recent years.
Go on courses to learn the right techniques, you will be amazed at how much it will change the way you work and help you to enjoy dentistry again!
5. Keep learning
Keep improving your understanding and skills. There are companies where you can keep improving your orthodontics knowledge from theory, to consent (ESAO, European Association of Aesthetics Orthodontics, BOS British Orthodontics Society to name a few), and hand-on courses for both aesthetic orthodontics to comprehensive orthodontics.
My hope is to bring together what sometimes seems to be two opposing camps: the general dentists (GDPs) and the orthodontic specialist community. My experience however is that there are specialists that are in favour of GDPs carrying out orthodontics with the appropriate training.
Get involved in other areas of dentistry such as occlusion studies. Everything we do in dentistry is somehow connected. If we make crowns that are to high or not well designed we may be changing the occlusion, articulation or function of the complex that is the TMJ, muscles, teeth and soft tissues.
We are fortunate that there are so many talented teachers and mentors in the UK or you can look abroad for training courses.
Remember that all dentists are in some way colleagues and what is good for dentists is ultimately good for patients (and this works the other way around as well). Have a win-win attitude towards your colleagues and your patients!
If you want a positive perception and the respect of the general public and dental/medical colleagues, then we have to keep the bigger picture in mind. Work together, we can all score more ‘points’ that way.
Dr Jan Einfeldt – www.staplehurstdentalpractice.co.uk
If you need guidance or inspiration speak to colleagues or contact me on: [email protected]