Dr. Wheeler’s Formula for Successful Orthodontic Treatment

Getting your braces on is exciting, but getting them off is the best day ever!!! So you may be asking yourself, “How can I help my orthodontist help me get to that ‘best day ever,’ with the best result possible in the most efficient way available”? 

  

The answer is simple... 

Consistency and compliance.      

Let me elaborate…

You (the patient) are a significant variable that affects your treatment time. Your orthodontist may have the perfect diagnosis and treatment plan designed and prepared for you, but he cannot succeed without your cooperation. Some things you might be doing can sabotage your own treatment time.  These include 1) Missing, changing, or spreading out your appointments, 2) Arriving late to appointments so the chair-side technicians do not have sufficient time to perform all planned procedures, 3) Not getting other necessary procedures done in a timely manner (surgeries, extractions, restorative work, etc.), 4) Breaking or bending your wires or brackets between visits, or 5) Not following instructions regarding rubber band wearing, aligners, and oral hygiene. Consistently doing your part will not only help keep your treatment on schedule, it will give you the best final results too.

At the start of treatment, we gave you an estimated time of how long your braces would be on. This estimated time considers and assumes that you as a patient are being 100% consistent and compliant with what we have recommended for you to do. 

The intervals for adjustment visits we set up range from 3 to 8 weeks—although typically it’s every 6 weeks.  This interval is determined by the goals we have for that particular interval, and considers the bio-mechanical properties of the particular wires and ties we have selected for use.  We set up the following visit to coincide when the previous adjustment’s activation is about to “run out of gas”.  It has been proven scientifically that teeth move most efficiently under light, steady, and continuous forces.  If that application of a continuous force is ever interrupted, it takes a bit of time to get back into the “sweet spot” of efficient tooth movement.  We just don’t want an activation to ever “run out of gas”.  In fact, even just rescheduling an appointment just 1 week longer than ideal can easily add 3-4 weeks to your treatment time.  If you have been given rubber bands to wear—wearing them only 80% of the time causes the job to be done in twice the time, and wearing them only 50% of the time causes them to take 8 times as long for the treatment to be done.

Let me give you analogy.  Have you ever had to push a stalled car?  You might have noticed that it takes a little bit of strength and effort to get the car to start rolling; however, once it is rolling it is so much easier to push.  This is true with tooth movement as well.  All of what I am talking about occurs on the biological/physiological level within the supportive tissue around the roots of the teeth.  Once orthodontic treatment starts, special cells are recruited by the body to migrate around the root of the teeth and respond only to the stimuli of pressure…some remove old bone (osteoclasts), some make new bone (osteoblasts). When forces are added to the teeth in a consistent manner, this process works smoothly.  However, if these forces are interrupted by missing appointments, poor compliance with rubber band wear, or having broken appliances that need to be constantly repaired, then these cells get confused by the mixed signals they receive.  This, at a minimum causes a stop in the tooth movement (which takes a while to “get back up to speed”), but worse tends to cause the patient to experience an elevated level of tooth discomfort.  In rare cases, these cells get so confused they can actually start resorbing other hard tissue like tooth root structure, instead of remodeling bone.

Another important factor is to be consistent and compliant with your oral hygiene.  Keeping your teeth and gums free of bacteria-laden plaque keeps the supportive gum tissue strong and healthy.  If plaque is allowed to accumulate, then the gum tissues can get rather inflamed as they try to fight off the infection of the bacterial plaque.  Teeth simply do not move in areas of active inflammation.  To combat this you must be vigilant and consistent with your hygiene including, brushing and flossing twice or more times daily, and in seeing your family dentist regularly for thorough check-ups and cleanings (at least every 6 months or sooner, if advised to do so by your family dentist).  It’s a war against plaque!!

If you are in treatment now and are concerned by your prolonged treatment time, consider these three factors: Are you really doing your part and is there any room for improvement? Have you discussed your treatment progress with your orthodontist to see if anything has changed from his perspective? If you’re confident that both of you are doing your best, it may be that your body’s response to treatment is just slow.  Sometimes, it’s the individual’s biology that limits tooth movement to a slow pace. 

Also consider this as well…Not all orthodontists are the same.  Some are really focused and invested personally on making sure your treatment is complete.  Isn’t it comforting to know your orthodontist Dr. Wheeler has the integrity to finish the job he started, as opposed to one cutting corners just to say he finished “on time”?  Any treatment less that completed is unsuccessful treatment in my mind.

So to help your orthodontist help you get the most out of your treatment …be consistent and compliant with…

      1)     Making all your scheduled appointments

      2)     Making it to your appointments on time

      3)     Following all of our instructions regarding rubber band wear, aligner or appliance wear, and in following through with referrals for any adjunctive procedures (extractions, surgeries, etc)

      4)     Keeping your teeth clean through good oral hygiene practices

      5)     Making your treatment a team approach—having both the parent and patient—be active participants in the treatment.  Ask questions, be engaged in your investment of orthodontic care--come into the office, sit chairside for your child’s visit and not just sit in the car.

--- DocW

Content used with permission by Dr. Greg Jorgensen

http://www.gregjorgensen.com/blog

When Comparing Orthodontic Fees: Need To Compare Apples To Apples…

Let’s face it. Healthcare is expensive. Lasik surgery can cost $5000 or more for three short visits. A broken arm will cost you $7000 or more at the emergency room. Laser hair removal can cost even more than that! In today’s economy with incomes down and expenses up, it is not uncommon for families to price shop for everything. Is price shopping for orthodontics a good idea? How can some offices provide care for less? Does it really matter who puts on the braces?

Fees in my office are determined by what it costs us to provide the service. We have an accounting firm that keeps a close watch on our cash flow (we are a business after all) and about once a year we evaluate what we’re taking in (fees) and what we’re paying out (overhead). Our fees are about middle of the road for Stockton. Why are we higher than some but lower than others? Here are four variables that affect fees…

Perhaps the most visible difference between orthodontic offices is the physical facility and equipment. Our office is conveniently located, has lots of free parking, and the office and treatment areas are very open, bright, and inviting.  There is plenty of comfortable seating in our reception room. We utilize state-of-the-art in-house digital radiography and diagnostics and have 12 computers throughout the office to enhance treatment.  We have 6 comfortable treatment chairs to deliver our services, and have an on-site dental lab where we can make custom retainers and removable appliances with high-quality, quick turn-around capability.  Admittedly, we could straighten teeth with less, but each one is a gear in our “well-oiled-machine.” 

A second variable that affects our fees is the quality of the treatment we provide. I’ve been in practice for over 11 years now. Many of my team members have been with me most of that time. They are very talented and know what they are doing. They cost more than inexperienced technicians… and they are worth it.   We also use the most efficient braces available. We feature 3M Unitek brackets (both in traditional metal and clear).  They cost us a lot more than mail-order brackets from overseas or from recycled/refurbished ones here domestically. The proven quality, reliability, precision, and consistency provided by our brackets make the extra expense worth it. We also use the latest technology in wires. Wires, more than anything else, determine the position of teeth at the end of treatment. In fact, all our wires and brackets are individually packaged so they remain sterile until the moment we use them in the mouth.  It is impossible to hire the most talented staff, use the best brackets, provide the most efficient wires, and still charge the same as those who do not. Conversely, it is impossible to obtain our results without them. 

 

The third and perhaps biggest difference between treatment costs has to do with what is included in our fee. When price shopping, it is important to make sure that you compare “apples to apples”.  For example, when it appears that our fee for a first phase of treatment is higher, it turns out that our quote includes a lot more (i.e. an expander, upper and lower braces, and retainers while the competing office only recommended an expander or a space maintainer).  Our office includes the costs of the diagnostic records, including intra- and extra-oral photography, digital radiographs, and study models, as part of the treatment fee.  Our fees do not include hidden costs.  Some offices often charge extra fees for broken brackets, when an appointment needs to be rescheduled, or when the doctor needs to perform treatment planning and consulting.  Many offices also charge several hundreds of dollars for diagnostic records on top of the treatment fee. Others do not include retainers and retainer adjustment appointments in the pricing, and if they do often provide temporary or provisional retainers.  Some offices will continue charging monthly payment installments, if treatment takes longer than contracted for, and will do so until treatment is completed.  It is not uncommon in these offices to end up paying twice as much as was originally presented.   The take home message is that it is important to ask what is included in a proposed fee because apples and oranges rarely cost the same.

The fourth and final factor is one that is often overlooked is patient safety.  We pride ourselves on not merely meeting minimum standards but far exceeding them.  To keep us on the vanguard of patient safety, we keep ourselves constantly updated so we can implement new technology and techniques.  For example, we utilize steam sterilization in an autoclave of all our instruments and utilize category 4 sterilization bags.  Standard sterilization bags only measure if an adequate temperature was reached...but they don’t indicate if that heat was maintained long enough, if sufficient pressure was reached, or if the steam penetrated to the surface of the instruments. Category 4 sterilization bags have indicators to ensure that all four elements have been reached:  heat, time, pressure, penetration.

Choosing orthodontic care for yourself or for your child can be a life-changing decision. The quality of the result and treatment experience will not be the same just because the doctor has a license. We understand that orthodontic treatment is an investment for you or your child; we want to ensure the maximum return on your investment.  You may be able to find cheaper orthodontic care elsewhere, but you won’t find better treatment than Wheeler Orthodontics!  

Doc W

Content used with permission by Dr. Greg Jorgensen

http://www.gregjorgensen.com/blog

 

X-rays: An orthodontist's friend

Your child just had “X-rays” taken at the dentist last month. Why does the orthodontist need to take another one? In fact, why do orthodontists need X-rays at all?

X-rays, officially called radiographs, are images created when a beam of radiation passes through the body and hits a sensor (or a piece of film in older machines) on the other side. X-rays have the ability to create pictures revealing the differences in the densities of the tissues through which they pass. The “shadows” cast on the digital sensor or film allow doctors to see objects hidden by the skin and bone. The most common X-rays taken by general dentists are called bitewings. In a bitewing, the dentist gets a detailed picture of a small group of teeth that reveals the health of the enamel, inner canals, and roots. Enamel and fillings are dense and appear white in color on the radiograph. The bone around the teeth, the root canals, and decay are less dense and therefore appear darker. Dentists are trained to interpret the light and dark patterns so they can distinguish normal tissues from abnormal ones.

X-rays are essential in orthodontics for many reasons. First, orthodontists are also dentists and, although they are focused on different things, they share the responsibility of identifying pathologies if they are present. These include abscesses, tumors, and other things that are not necessarily directly related to straightening the teeth. Although rare, such pathologies are many times identified for the first time by orthodontists and lives can be saved as patients are referred for treatment.

The second reason orthodontists take X-rays is to help them diagnose and treat orthodontic problems. Orthodontic X-rays focus more on the position and form of the teeth and jaws than on individual teeth like bitewings. Orthodontists are especially interested in missing, extra, impacted, or misplaced teeth, and short, long, or misshaped roots. Problems with the jaws include bones that are too big, too small, asymmetrical (off center), too far apart, too close together, or misshapen. X-rays provide orthodontists with essential information that helps them determine where problems exist and the best way to correct them. The size, shape, and position of the teeth and bone in X-rays dictate if surgery or tooth extraction will be necessary.

Orthodontists also take X-rays during treatment so they can monitor how treatment is progressing. Not all effects of orthodontic treatment are visible to the naked eye. Although very rare, moving teeth in some individuals (about 2%) causes the roots to shorten. Orthodontists must check for this during treatment so they can determine if and how long tooth movement should continue. Sometimes orthodontists observe how the teeth are moving to help them finalize the treatment plan. I prefer not to remove permanent teeth if possible, so in many borderline crowding cases I will begin to align the teeth just to see how the teeth and bone respond. If the progress X-ray reveals that there is not enough bone to accommodate all of the teeth, I can always have some removed along the way.

After treatment, a final X-ray is taken to evaluate the outcome of treatment and make recommendations for other necessary procedures (i.e. wisdom teeth). Ideally then, I take one radiograph at the beginning of treatment, one after about six months, and one after the braces come off. Each of these X-rays exposes a patient to less radiation than they would receive taking a typical airplane flight. All dentists are taught to use the ALARA principle (As Little As Reasonably Achievable) when it comes to radiation. I am careful to take X-rays on my patients only when it is in their best interest, and I assume that my colleagues also do the same.

We are now using faster equipment, more sensitive films and sensors, better collimation, lead aprons, thyroid collars, and digital equipment (which greatly reduces the need for retakes) than ever before. These improvements have resulted in a 60% reduction in radiation exposure since I got my license in 1999. Today’s patients receive the equivalent of only one additional day’s worth of background radiation (from the sun) each time they get a pano.

Don’t be afraid to ask your orthodontist the reason for your next X-ray.

Doc W

Content used with permission by Dr. Greg Jorgensen

http://www.gregjorgensen.com/blog/2012/11/why-does-the-orthodontist-need-another-x-ray/