October 2, 2020
by Dr. Bruce Freeman, Director of Patient Experience, dentalcorp
In my 28 years practicing and lecturing internationally on orthodontics, I have seen tremendous outcomes and great failures – mine included! In celebration of National Orthodontic Health Month, I’d like to share a few of my key learnings in the field to help you deliver the ultimate ortho experience.
As dental professionals, we speak our own clinical language that is foreign to patients. It is essential that we communicate in a clear and jargon-free manner, while not only listening to our patients, but hearing the subtleties of what they are saying. Interestingly, many patients seeking orthodontic treatment may initially present wanting straighter teeth, but through a careful and lengthy consultation, it is often revealed that they really desire changes to their facial appearance. Patients often struggle to put their motivation behind seeking treatment into words, as it is sometimes more of a feeling.
Careful questioning to help the patient reach their own conclusion is critical, or the treatment plan will never properly address why the patient is seeking care. Allow the patient time to think about how they feel about their appearance, as this will allow for the development of the best, personalized treatment plan that may require facial reconstruction and not just the alignment of the teeth they thought they wanted. Without unearthing all the details about a case, the final result could be a clinical success but, in the patient’s eyes, a resounding failure.
I often joke that whoever coined the expression, the devil is in the details was probably an orthodontist, because a case may look simple at the start, but it is the hidden, often mysterious elements that make the difference between success and failure. The success of orthodontic treatment rests in learning how to make the myriad of details coalesce into the right plan, or the treatment will quickly go sideways and leave you with a very unhappy patient.
As dental professionals, there is always plenty of room to learn and improve. Pool and Ericsson were the first to write about the 10,000 hours required to achieve mastery of a skill in their book Peak, which studies the science of expertise and purposeful practice. For instance, if you play tennis only twice weekly and you want to improve, you may think you just need to practice an extra two days a week. While that may be fine in theory, you will still find yourself smacking balls into the net. If you focused on the details of every aspect of the game, from the first serve to the last overhead smash, you would start to notice a great improvement. If you practice a skill for four hours a week, whether it be a sport or a dental procedure, you will need to work every day of every week, of every month, for 52 years to achieve the 10, 000 hours thought to be required to become an expert.
I am part of a study group with members from across the world. Together we have over 100 years of collective experience. We see different details of every case and are constantly learning from each other. We periodically get stumped and never hesitate to seek out the expertise of others. It is crucial to exercise humility in our profession and not let our egos get in the way of optimal patient care.
Do-it-yourself aligners have become a popular alternative among consumers in recent years; however, they are no substitute for true orthodontic treatment. I lecture about virtual surgical planning, and this is where the old axiom, measure twice, cut once really comes to life. In my office, we have three orthodontists, all with different training. We continually read and study about every aspect of orthodontics from materials to clinical concepts, to ensure we can provide the best outcome possible for our patients. Every patient’s surgical reconstruction is planned in 3D with our team, the oral and maxillofacial surgeon, and an engineer. It really does take a village to accomplish great things!
With direct-to-consumer aligners, there is no evaluation of the tissue and bone support holding the teeth, nor does the bite seem to be much of a concern. So, why bother with all those pesky details? You would never build your expensive dream house without first surveying the land, as you would not want to risk your family home sink into what you later discovered was swampland. When I lecture about orthodontics at university programs, I remind young residents that every orthodontic case is essentially a full-mouth reconstruction, just without the porcelain. This helps put things into perspective about do-it-yourself healthcare. More often than not, with DIY aligners, patients seek treatment wanting orthodontics, and upon completion, wind up needing it.
The goal is to understand what is being offered to patients and educate ourselves on the products, so we can help curate the information and educate our patients. We should examine our own current systems to see how we can continue to offer exceptional care, while recognizing the limitations patients have to accessing it. There are many general practitioners that undertake many procedures with a high-level of safety and proficiency. But like all of us, they know their limits, continue to educate themselves, triage cases appropriately, and know when to refer the patient to someone with more experience. We all strive to understand what “great” looks like, and that is not just about a clinical result, but how the patient perceives the experience they have under our care.
We all work in dentistry to help our patients achieve their goal of a healthy smile, and orthodontic treatment is just one of the many ways we can do this. From a lengthy consultation through to the diagnostic and treatment planning phases, we should endeavor to provide a personalized plan that addresses why the patient sought care in the first place so we can provide the best possible Patient Experience.
About the Author
Dr. Bruce Freeman is the Director of Patient Experience for dentalcorp, helping dentists across Canada achieve clinical success that results in the best experience for their patients.
Bruce is an international lecturer on clinical orthodontics, facial pain, patient experience, and virtual surgical planning. He is the co-director of the Facial Pain Unit at Mount Sinai Hospital. He further directs the Wellness Program for dental residents at Mount Sinai Hospital, emphasizing how self-care leads to the best patient care.
Bruce is an honours graduate of the University of Toronto. He completed the Advanced Education in General Dentistry program at the Eastman Dental Center in Rochester and returned to the University of Toronto to complete his diploma in orthodontics and his Master of Science degree in temporomandibular disorders and orofacial pain. He is also a certified yoga instructor with additional training in breathing techniques, meditation, and trauma informed movement. He can be reached at email@example.com.
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