Incorporating Orthodontics Into Your Practice

As an orthodontist, I recognize that certain complex orthodontic cases should be treated by a specialist in order to achieve the best possible outcome, but who says that the "best outcome" is always what's best for every patient? Oftentimes, a patient is simply looking for a solution for compromised esthetics, and this easily can and should be treated by the patient's general dentist.

Primary care dentists, including both general and pediatric dentists, can do specialty work when appropriately trained. For hundreds of years, general dentists have extracted teeth, fitted dentures, and performed root canals. Orthodontics was one of the only specialties largely untapped by primary care dentists because it was too complicated; however, this all changed about 20 years ago with the advent of using plastic to move teeth.

You want to make your practice more lucrative. Who doesn't? And you want to help people live happier and more fulfilled lives by improving their dental hygiene, function, and airways as well as the esthetics of their smiles. I commend you. All of that is very noble. There's only one problem-you know little to nothing about how to add orthodontics into your practice.

Orthodontics can be an extremely profitable addition to any general dental practice, but in order to maximize your profit, it's important to efficiently manage not just your chair time, but also your time spent in research and development as well as your time spent in operational planning and running the business side of this treatment offering.

Of the more than 200,000 practicing dentists in the United States, most have little to no formal education or training in orthodontics. Those who do seek out training often have to resort to expensive and time-consuming weekend courses. You learn on the job through trial and error, but any errors can be unfortunate and expensive for both patients and doctors. So how do you get started? In order to reduce your costs and the length of your trial-and-error period, you're going to need a mentor, role model, or service to provide coaching and support. You'll need to learn how to begin operations; what machines to buy (and not buy); how to train a competent dental assistant and treatment coordinator; how to maximize your time and revenue; how to provide treatment with various kinds of invisible aligners, indirect bonding (IDB) for brackets, and functional appliances; how to diagnose and treatment plan, how to upsell necessary services to your patients, and how to market your new menu of orthodontic services in a variety of ways.

When incorporating orthodontics into your practice, there is no one-size-fits-all plan. Each doctor will need to consider several aspects when making the decision and then create his or her own unique pathway. These aspects include patient demographics, competition from neighboring practices, and what your current patients are asking you to offer.

There are three primary categories for general practitioner orthodontics, and although I think it is wise for doctors to offer all three, it is sometimes better to concentrate on just one for an initial launch. These categories are clear aligners (both branded and unbranded), IDB straight-wire orthodontics, and Phase 1 functional appliances. A pediatric dentist should certainly start with Phase 1 appliances; however, a general dentist with a mostly older patient population should start with aligners, and a younger doctor with a mostly teenage demographic might want to start with straight wire.

In addition, every doctor should at least have an intraoral scanner and a panoramic x-ray machine before they start offering orthodontics. Beyond that, there is no significant additional cost to beginning to offer Phase 1 appliances or clear aligner therapy, unless you are offering Invisalign. The start-up investment for consumables for providing straight-wire orthodontics is around $2,000.

Like it or not, corporate dentistry is infiltrating the private dental space at an accelerated rate. With the changes to the health insurance marketplace during the past 10 years and the seemingly ever-increasing premiums, patients are flocking to lower-cost insurance programs and dental service organizations (DSOs).

Hygiene and pediatric patients are a gold mine for any orthodontic provider, and DSOs have an incredible abundance of them. However, the archaic, stepwise process of referring all of these potentially simple orthodontic cases to the in-house orthodontist often results in significant attrition and loss of production. By requiring that orthodontic consults be referred to the in-house orthodontist, a DSO could be losing valuable production and reducing the overall standard-of-care by failing to promptly address patients' concerns.

If you haven't considered adding orthodontics into your practice, then you need to. It's appropriate, it's fulfilling, it's lucrative, and you already know some of the basics. You aren't a brain surgeon who's trying to add orthodontics into your practice, you're a competent and highly successful dentist!

Amanda Wilson, DDS, MDS, is an orthodontist and the founder and chief executive officer of StraightSmile Solutions^®.