Disciplined Diagnostic Assessment
We have learned that what an orthodontist does or does not do can affect a patient for the rest of their lives either positively or negatively.
Is this diagnostic discipline widespread and a standard of care? Sadly, no it is not. Actually, orthodontics is considered the most demanding and difficult of all dental specialties that requires non-stop thinking and assessment initially and throughout the entire process. It takes time to properly assess the problem, care in developing an appropriate plan of care, and careful communication to enhance a functional understanding. It has often been said that dentistry is the largest medical specialty. In my opinion, orthodontics should be a medical specialty demanding more assessment and care than currently exists in the marketplace. Unfortunately, orthodontics is now treated as a commodity by some rather than a healthcare service of great importance.
We are now seeing the implementation of the corporate structure in medicine and dentistry. As corporations go, the business model is one of production. Several years ago I got caught up in that management style so I could spend more time seeing patients and let others manage the business of healthcare; meaning corporate management. Several of my colleagues had made the decision to move in that direction, so I followed suit.
It did not take me very long to realize that the doctor – patient relationship suffered along with the quality of care throughout the industry. The time the doctor had with each patient could be measured in seconds. A non- orthodontic specialist was achieving better results than the university trained specialist. Ah, the temptations in the market place are driven by the pressure to produce according to insurance mandates that says to the provider: “accept a lesser fee and make it up in volume.” This is impossible to do when one considers the need for a thorough diagnostic assessment and plan of care. We have learned that what an orthodontist does or does not do can affect a patient for the rest of their lives either positively or negatively.
This is where the Standard of Care comes in. We used to think that this term meant excellence. Far from it. It means nothing more than what everyone else is doing. Safe harbor perhaps for the doctor, but seldom in the best interest of the patient. I call it an area of accepted mediocrity. So rather than attempting to fit a patient into a corporate protocol of minimal standards hoping that the outcome will be a good one, I submit that each patient’s uniqueness and specific needs should be considered. Is a malocclusion strictly genetic? No. Is it strictly developmental? No. Is it strictly environmental? No. It is all of these. That is why we developed the concept of All Things Considered™.
- Concepts of oral volume
- Concepts of airway and the problems often associated with obstruction of airway (airway centric orthodontics)
- Facial growth
- Muscle spasm within the TMJ
- Postural compensation over time
- Position of the jaw joints: orthodontics predicated on establishing and maintaining optimal TMJ dynamics (begin with the end in mind).
Standard of Care or Beyond Standard of Care: You decide……
Minimal standard of care VS Comprehensive standard of care
The minimal standards of orthodontic diagnosis:
- Clinical examination
- Lateral cephalogram
- Panoramic view
Comprehensive standards of orthodontic and/or TMJ diagnosis:
- Clinical assessment including posture and range of opening
- Lateral cephalogram
- Panoramic view
- Cervical x-ray
- CBCT to assess TMJ and airway (we use the most advanced and safest imaging technology available). The
accuracy and safety are unparalleled in the industry. “Pediatric safe” according to the FDA.
- Non-invasive acoustic assessment of airways
- Scanning the dental arches for study models
Added to this list is the commitment that the doctor actually spends the time to properly evaluate the diagnostic records and arrive at an assessment, which will in turn determine a unique treatment plan rather than a corporate protocol where the same treatment plan applies to all patients. This should involve 2-3 hours of dedicated analysis by the doctor to arrive at the Diagnostic Assessment and Plan of Care. Of course there are common denominators that can be applied for base-line considerations; however, the patient’s unique requirements must be considered for long-term stability for the most optimal function, esthetics, and prevention of functional problems over time.
Diagnostic equipment used for proper diagnosis
Dr. J. Michael Dierkes, DDS, MS, NMD is a nationally recognized orthodontic specialist who has been creating beautiful smiles for over 30 years. His services have improved the lives of people from Roswell and the surrounding areas, including residents of Sandy Springs, Alpharetta, Marietta, and Atlanta. Whether you are an adult, a child, or a teenager, our knowledgeable staff is committed to helping you achieve the radiant, beautiful smile you deserve. Please call us today to schedule your initial consultation!