Orthodontics for the General Practitioner
Raymond G.W. Kubisch, DDS, MSD
The addition of orthodontic services can provide added opportunity for the general dental practice. One of the most common ways that general practitioners begin to broaden their scope of treatment in this regard is to incorporate clear aligners as the method of delivery. When compared to using fixed appliances, the entry cost is small, and there are many continuing education offerings available to help equip the doctor to provide this service. Many regard this to be the safest method for the non-orthodontist to provide treatment.
Start Small, Then Expand
When starting out, it is advisable for practitioners to initially stick to alignment concerns primarily and avoid treating horizontal and transverse component malocclusions. A class II molar relationship case with upper anterior arch length deficiency and minimal lower arch crowding or a class III case with lower anterior crowding and adequate alignment in the upper anterior are examples of higher-risk situations that may require more experience to resolve successfully. When these patients start to respond to clear aligner treatment, the class II case is likely to show increasing overjet and the class III case is much more likely to end up in maxillary lingual crossbite in the anterior. Extremely deep vertical overbites also present additional risk. Laboratories that provide aligner services do not take responsibility for the diagnosis or the delivery of the orthodontic treatment; therefore, the prescription for treatment remains the full responsibility of the doctor.
The largest gap in knowledge leading to incomplete diagnosis is probably not associated with dental alignment issues but rather with an incomplete understanding of dental occlusion and function. This is an area in which all practitioners of dentistry—of any type—would be well to improve their understanding. Far too often, the perceived indication for orthodontic treatment is alignment alone and gives little if any consideration to how the teeth are supposed to work. However, there are many general practices that have accomplished a high level of understanding and are providing valuable and competent orthodontic treatment. They should be applauded for their recognition of the importance of orthodontics in the overall care of the dental patient.
Another approach to the integration of orthodontics into general practice, and one that may be more rewarding to some practitioners than providing orthodontic treatment themselves, is interdisciplinary collaboration. Although the concept is right under their noses, many dentists fail to recognize this opportunity to help their patients. Most general practices have patients who are suffering from dental attrition secondary to dental alignment and bite issues.
These patients are often lacking vertical clearance to restore given the continuing eruption of teeth that accompanies attrition resulting from malocclusion. They can become overlooked in a general practice and receive only maintenance treatment. These are the types of situations in which interdisciplinary treatment involving both the restorative dentist and the orthodontist can maximize the benefit to the patient.
Both restorative dentists and orthodontists spend years learning how to properly diagnose and comprehensively treat their patients, so it only makes sense for these two well-trained practitioners to team up in order to provide the highest quality treatment for the patient. Other specialists can also be included to provide a team approach to treatment planning and delivery.
To facilitate this, general practitioners should seek out orthodontists and other specialists who are interested in becoming part of the treatment team and then start looking for patients whom they can treatment plan together. Not only will this expand their practices, it will also enhance their reputations as doctors who desire only the best treatment for their patients.
About the Author
Raymond Kubisch, DDS, MSD, maintains a private practice in Santa Barbara, California, where he specializes in orthodontics and facial orthopedics for children and adults. He is also the founder and director of the Summit Dental Study Group.