Is the Specialty of Orthodontics Dying?

Has anyone else heard that the specialty of orthodontics is dying?

I was speaking to my local orthodontists, and they introduced me to this idea: Clear aligners have changed everything. Whether you love them or not, you can’t deny that they are the wave of the future (if not already the wave of the present). At the very least, they are not disappearing anytime soon. 

Why would clear aligners kill the specialty of orthodontics? Quite simply, because in the majority of cases, technology has advanced to the point that you no longer need your local orthodontist to complete the case. In other words, advanced software has made it so that you — the general dentist — can treat most cases.

To describe the technique simply, the general dentist can take all impressions and records. You submit the case. The manufacturer’s team of orthodontists and technicians evaluate and treatment plan the case. They manufacture the needed trays. Then, finally, you deliver the clear aligners to your patient. All orthodontic considerations have been addressed by the manufacturer’s orthodontists and technicians using their software. What is missing from the scenario? Your local orthodontist.

One of the cornerstones of a dental practice is that only the doctor can diagnose each case. But that does not mean that you have to diagnose alone. What if you had a team of orthodontists diagnosing along with you? Let’s assume for a moment that this team of orthodontists knows more about orthodontics than you do. Additionally, the team members use a computer database containing hundreds of thousands of completed cases (maybe even over a million). This is the kind of support that enables you to complete many cases yourself.

Remember, these are the same steps your orthodontist performs when he or she uses clear aligners.

It is no secret that general dentists already perform more orthodontic procedures than ever before. Not only are clear aligners being used, but other, relatively fast orthodontic techniques are available to the general dentist as well. In short, those who choose to treat orthodontic cases have several options. You may not like some of those techniques, but there is no questioning that they have simplified orthodontic treatment for the general dentist.

How do patients feel about all of this? Well, I’ll let you in on a little-known secret: Patients don’t like to wear braces, so the acceptance rate for clear aligners is quite high. As for the final result, I have heard that the vast majority of patients are satisfied with the final outcome. Not everyone, but the vast majority. Of course, any orthodontist can tell you this is the same for conventional braces placed by a specialist.

It’s ironic, isn’t it, that the first recognized dental specialty may be the first to become obsolete?

Another point to consider. For those of you who use CAD/CAM to make crowns, you’ve already eliminated the role of the dental lab tech. Now orthodontists. Who’s next?


Andy Alas, DDS

The ABCs of a Successful Dental Practice (Part 1 of 3)

Unless you graduated with a finance, accounting or human resources degree, the operations and financial requirements required to run a successful business in today’s economy may seem daunting to you. You are not alone. I believe that the dental school curriculums have failed the “business dentist,” and way too many excellent clinicians have suffered as a result thereof. 

There are myriad systems, processes and strategies required to run a successful business. During part 1 of this blog series, I have taken the opportunity to provide a snapshot of the ABCs of a successful dental practice.

Analytics: Never underestimate analytics. If you are not evaluating your numbers on a monthly basis, you are undervaluing your career investment and probably leaving $500,000 to $1,500,000 on the table.

Business: Knowledge is power, and you owe it to yourself to take the time to increase your business acumen. For example, do you know what key performance indicators (KPIs) should be monitored on a monthly basis? If not, take the time and learn so you are equipped with the necessary information for the balance of your career.

Consultant: More than 90 percent of dentists could reap substantial benefits if they hired a mentor/dental analyst who has “walked in their shoes” as a clinician and business owner. Choose wisely, as your return on investment should net you 10 times their fees.

Dental hygiene: In the average general practice, the hygienist should account for 25–33 percent of your daily production.

Demographics: A well-prepared demographics study incorporates your patient’s average age, income, the number of children per household and your patient’s education level. It also incorporates the number of homeowners, apartment-dwellers, the location of the competition, and estimated five- and 10-year growth by carrier route.

Embezzlement: Don’t think it can’t happen to you. Do you have a foolproof system to ensure your day sheets are equal to your deposits? In the banking business, the teller doesn’t go home until he or she balances to the penny. How about looking into the backgrounds your front office personnel who are responsible for your money?

First impressions: More than 90 percent of new patients will formulate an opinion based upon their first impression. Is your office in order? Do you inspect your office weekly? Do you check out the windows, ceiling tiles, restrooms, uniforms, employee hygiene, dental lights, baseboards, floors, plants, etc.? I recommend that next week, you take a few minutes to lay in each dental chair and ask yourself, “What does the patient see?” Are there improvements that can be made? Maybe you and your team can develop a list at your next monthly meeting.

Growth: Conservatively, your business should be growing 5–8 percent per year. If you are not, then get help. You need a diagnosis by someone other than yourself to develop a business treatment plan before it is too late. Turn to an expert who has walked in your shoes

Handoffs: For continuity of care, it is imperative that your entire team understands the importance of mastering patient “handoffs,” or a transfer of responsibility to convert the case for the patient’s and team’s benefit. Just like a football team that practices the “down and out,” your personnel should master the “handoff” or transfer of information from one team member to the next. If you don’t know how to perfect this communication technique, then get help. If you want to operate at the highest level while providing the highest level of customer service, it is imperative that this responsibility is cohesively shared by all.

Intraoral cameras: If you and your dental hygienist are not using intraoral cameras with big-screen monitors on every patient, you are doing yourself, your team and the patient a disservice. When you incorporate intraoral cameras on a regular basis, your case acceptance will soar. Intraoral cameras, large screen monitors, co-diagnosis (“What do you see on the screen, Mrs. Jones?”) and printed color pictures of the patient’s dentition (your recommendations) will move more dentistry than the best clinical treatment you can ever provide. The visual component elicits emotion, and emotion is how the consumer/patient makes his or her buying decision. There are more than 40 uses for the intraoral camera.

Stay tuned for next month’s part 2, in which I will look at additional tips that can be incorporated as a checklist of how to improve your dental practice/business. Change is inevitable. It can be logical or forced. I have seen way too many colleagues fail to heed the above recommendations while continuing to resist change, ultimately committed to doing the same thing over and over expecting a different outcome. It is OK to seek guidance from experts in the “business of dentistry” and from those who have “walked in your shoes.” After all, we don’t hesitate to enroll in clinical continuing education programs.

A comprehensive knowledge of every aspect of your business is paramount. The business clinician who can master excellent business and clinical skills will always have a place providing wonderful dental care with reduced stress and a balanced lifestyle.



Duke Aldridge DDS, MBA, MAGD

The Importance of an Accurate Dental Claim Form

The claim form (dental or medical) is a legal document, just like any document presented to a bank, a court or a mortgage company. It is vitally important that the doctor who provides the treatment, and the person who prepares the claim form to submit to the carrier for reimbursement, understands the claim form must accurately represent who received the care, who provided the care, the services provided using the most accurate code currently available from the CDT or ICD-10, and the fee that will be accepted as payment in full for the services provided … as well as several other things.

The bottom line is that everything on that claim form must be accurate. Having dealt with several questions from doctors and their business staffs, the one question that always sends chills up my spine is: “How can we get around this?” They question this as if there are shortcuts or some mystical way to be reimbursed more than is possible given the policy’s restrictions and limitations. Reimbursement for treatment provided hinges on the condition being treated and the coding that best describes the service provided, nothing else … certainly not what the carrier will reimburse. The doctor and staff need to completely and thoroughly understand the codes and how they are to be applied. The team must also realize that just because a code exists to describe a service provided, it may not be paid by the carrier due to limitations and restrictions established by that specific plan.

Ignorance is no excuse; ask a dentist who is also a convicted felon about the ignorance defense. Code for what you do, no more and no less. Do it accurately using the best code to describe the service provided and report the fee that represents what you will accept as payment in full for the service provided. This practice policy will protect and defend you every time.

Roy S. Shelburne, DDS

Interested in learning more about coding? Register for the Dental to Medical Cross Coding Webinar Series, available for purchase in the AGD Online Learning Center.

A Triage Training Exercise

We were abruptly awoken from our sleep in the middle of the night. We were needed near the front — and fast. Our mobile dental clinics were designed to be packed up and moved in less than 30 minutes, and we were soon on the road. My dental assistant driving, I was navigating us to our destination of the Field Ambulance hospital.

Attack helicopters and A10 Warthog tactical attack planes were circling overhead in the distance, firing on the enemy as we rumbled over and around rolling, sandy hills. Then we heard a series of bang-puff sounds, like the sound a bag of flour makes when it hits the floor and releases all of its contents. We looked at each other with that knowing fear and immediately put on our gas masks.

We arrived at our destination, and our fears were confirmed. The enemy, losing the battle, deployed chemical weapons in desperation. We were ordered to get into our safety environmental suits, which we did without hesitation. We were briefed about what had happened and what we were to do, but we already knew what our roles would be.

Earlier that year, we had received training on what we would do in a chemical warfare environment. With our extensive general medical knowledge and expertise in the orofacial region, I was to be deployed outside the surgical tents, receiving the incoming soldiers and civilians (collateral damage), and be in charge of triage. I would be the primary dentist deciding who we could save now, who could safely wait while more urgent injuries were cared for and who we would be unable to save. The sweat of anticipation and fear built up rapidly across my forehead.

We did not have to wait long before they came in waves. At first, it was primarily soldiers who came in. The damage was ghastly. But our roles were critically important, and you just focused on the role, knowing that you were saving lives. We injected narcotic pain killers in those who were in great pain. No sooner than we would clear the area of the injured to be treated when more arrived. Eventually, as the hours wore on, some civilian victims caught in the battle, made it to our field hospital, and we treated all who came.

Six hours later, the flow of incoming people stopped. It was “over” for now. We went to the decontamination area, where we undressed, showered, cleaned and put on fresh clothes. Exhausted, thirsty and hungry, we made our way over to the command center for our debrief.

In the weeks after Iraq had invaded Kuwait, and a growing fear that the world would intervene in what was later known as the First Gulf War, we were busily preparing for the worst. Everyone knew how Iraq and Iran had used chemical weapons in the recent past, sometimes on their own people. We did not want to be caught unaware.

The story above describes a practical training exercise, a very realistic one. The images of those hours haunted my thoughts and my dreams for months afterward, and in my case, no one was really hurt. It was all amazing makeup, props and acting. But we performed well, and if the real thing had happened, we would have been ready to do our best to save as many people as possible. I am thankful and grateful this scenario never came to be.

To this day, in Canada, in the United States and around the world, our defense organizations work hard to prepare their personnel to be able to ensure we continue to be free. In the past, millions of men and women have fought and paid the ultimate sacrifice so that we may enjoy the freedoms we have today. In Canada, on Remembrance Day, at the 11th hour of the 11th day of the 11th month, we will remember them.

May the scenario told above never happen. May we continue to enjoy our freedom. And let us all show our gratitude that we live in a perfectly imperfect democracy that works hard to ensure we remain free.

Larry Stanleigh, BSc, MSc, DDS, FICD, FADI, FACD, FPFA

Comments on the Growth of Corporate Dentistry

Lately, I am finding that many of my friends and colleagues are starting to feel the breath of corporate dentistry on their backs. They are beginning to believe that the growth of corporate dentistry and group practices may suffocate their small businesses.

Allow me to give another perspective. Let me start by saying that I am a solo practitioner who runs a fee-for-service practice in a saturated dental market just outside the Washington, D.C., area. Just as I was graduating dental school, it seemed to be a “golden” time in dentistry — a time where the majority of dentists were making a fortune from doing cosmetic and other elective procedures. There was hardly a concern about how much things cost and more about how quickly one could get in. When I started my business around 2000, the “.com industry” was beginning to collapse, and then the attacks of Sept. 11, 2001, happened. Let’s not forget about the housing bubble that shortly after popped and left the economy in ruin, not to mention the impact it had on the overall tone of the community: utter despair.

Through those horribly difficult times, my business continued to grow. Not just mine, but many others. When we see empty chairs, it is difficult not to stress about it and get deflated. Just remember that these feelings are not productive and will not instill change. We cannot control anything outside of our own actions, so why put so much energy into negative things you cannot control? Instead, redirect and refocus. What are things your team can do to generate new patients and increase production? Look at your team’s conversion on case acceptance and focus on the existing patients in your practice and how your team can create opportunities toward gaining that production.

Corporate dentistry is as present as another option for the public. I do not feel threatened by the presence of corporate dentistry. In fact, since corporate dentistry’s business philosophies and models are completely different than mine, I don’t see corporate dentistry as competition for the type of patients whom I am trying to attract. People seek our office for the quality of care we uniquely provide them and for our expertise in our state-of-the-art facility.

If you feel like you are losing patients to big companies and becoming intimidated by the millions put into advertising, my advice is to continue to work with integrity, find ways to “sharpen the saw” and stay true to your personal mission. There will always be ups and downs in the economy, but what happens in business is a direct reflection of you.



Pamela Marzban, DDS, FAGD

Set Ground Rules in Your Practice

We recently had an issue with a team member that brought this idea to the forefront, but it’s certainly worth sharing, especially for you young associates as you transition into partner/ownership roles in your practices.

When we begin our careers straight out of dental school, we are mighty “green.” We’re just trying to learn how to properly diagnose, treat and navigate molar canals, section roots, etc. Leadership, conflict resolution, systemization, rules — these are totally foreign to us. And, at least in my experience, these were some of the hardest concepts to grasp as I moved into my partnership role, but ones that are absolutely, unequivocally necessary for health of the team, the day-to-day running of the practice so I don’t pull my hair out when I get home at night.

With these concepts comes a necessity to dictate your own terms: “This is how I want my crown prep set up to look”; “This is the rule on vacations days and requests”; and “These are the options for patient financing.”

These are all examples of ways in which you will be required to dictate terms (there are too many to name them all). This, however, does not equate to a dictatorship, though some staff members and patients might disagree. And the drama begins!

Especially in a large office or multi-location practice, you cannot function without clear policies and procedures in place. You can’t get around it. You also cannot let others dictate those terms for you, i.e., assistants saying, “I’m not working past 2 p.m. when my kid is in summer camp,” or “I’m not paying for that crown upfront; I’ll pay you $10 a month.” These are practice killers! But it takes some courage to be firm and confident in your selection, presentation of, long-term adherence to these policies and procedures. It’s the only way you’ll stay sane and still make a living.

It’s a fine line to walk, but as you move along in your practice life, you must acquire, develop or magically gain the ability to set the ground rules in a way that not only exudes confidence in yourself, but also elicits a sense of comfort among your staff and patients. You go about setting these rules to make their lives easier, not harder. It just takes time to transition the flow of your staff and patients to be system-driven. And that’s OK. Find the patients and team members that truly want to be on that path with you. As for the rest of them — sorry, but you’re better off without them. And you’ll have less hair-pulling and headaches.

So dictate your terms. And know your staff and patients respect a confident doctor and team members who have a set of clear policies, procedures and rules they follow. I questioned the very notion as we move in this direction, and it’s been eye-opening to see what a difference it makes. Cheers!

Donald Murry III, DMD