Orthodontic Treatment Without Ever Stepping Foot Into An Office?

adult braces

Who is a candidate-

  • Patients presenting with simple to moderate malocclusion cases. When choosing this method, personal information will be submitted on a website, and a starter kit will be provided which identifies if the patient is a suitable candidate.
  • Patient must be 12 years of age or older, and all permanent teeth must be erupted.
  • Patients who don’t want to physically see an orthodontist every 4-6 weeks for evaluation and adjustments.
  • Patients who are seeking orthodontic treatment at least 60% off traditional therapy.

Who isn’t a candidate-

  • Children under the age of 12 with mixed
  • Patients with a complex malocclusion and cases requiring surgery.
  • Patients with moderate to severe decay and/or periodontal disease.
  • Patient’s with dental implants. Although not impossible, each case will vary.
  • Patients who need constant in-person supervision.

What is at-home orthodontics?

  • A series of trays (aligners) are manufactured using a series of 3D printed models. These aligners are mailed to the patient over a period of months or all at once to guide the teeth into proper alignment gradually. Specific instructions are given as to when to advance to the next tray.
  • The trays (aligners) are clear and tight fitting. They must be worn continuously except for when eating, drinking, and practicing oral hygiene.
  • Although the patient won’t be physically seeing the orthodontist monthly, companies who offer treatment ensure that each patient is paired with a state licensed orthodontist or dentist who will evaluate their medical history, models and/or 3D scans, and photographs. Furthermore, these licensed professionals are available throughout treatment to assist the patient with any questions or problems.
  • Some dental insurance and FSA’s (Flexible Spending Account) will contribute to the cost.

Where do these treatments take place?    

  • Oddly enough, most if not all of the treatment happens in the privacy of the home. In some cases, the patient may have to visit a satellite office for a 3D scan of their teeth.

How does at-home orthodontics achieve straighter teeth?-

There are three steps to acquiring the perfect smile:

  1. The patient receives a starter kit in the mail which includes supplies to make an impression of their upper and lower teeth. The patient may also visit a satellite office, if they are close in proximity, for a 3D scan of their upper and lower teeth.
  2. After receiving the impressions and/or 3D scans, the manufacturer fabricates a series of aligners that are designed to move teeth gradually. These trays may be mailed all at once or every 4-6 weeks.
  3. When optimal results are achieved, the patient moves onto a maintenance phase where they will wear trays usually at night to keep teeth from shifting. Many times, these trays can double as bleaching trays so that the patient can whiten their teeth as well.

What are the concerns when choosing to use this method of straightening the teeth? The ADA (American Dental Association) and the AAO (American Association of Orthodontics) don’t seem to be in favor for several legitimate reasons. The absence of radiographs with this approach before and during treatment is very disturbing. X-rays are extremely necessary to evaluate bone level, decay, and abnormalities detected only on film. Furthermore, it’s difficult to predict the manner in which the bone will respond to movement of the teeth and the appropriate protocol if the patient’s teeth aren’t responding to treatment. The bottom line is that the consumer should consult with a dentist or orthodontist before considering orthodontics at home.

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Is Teledentistry Really a Thing?


Teledentistry is dental consultation, education, and treatment without the presence of a dentist using the aid of telecommunication and information technology. With dentistry being a hands-on process, how does teledentistry work without the patient physically being in a doctor’s presence?

Teledentistry began in the nineties by the U.S. Military to assist the troops stationed far from dental care. Digital images were captured during deployment in remote areas and transmitted to a dental specialist. These images were examined by a dentist and suggestions were given for the alleviation of pain. The patient would then be seen by a medic or surrounding dentist using the best available approach with limited supplies.

In the civilian world, teledentistry is becoming more popular because of some states in the U.S. passing legislation making it legal for specially trained hygienists and assistants to be supervised by a virtual dentist. Practicing in this manner is primarily being implemented to assist low-income families by creating access to affordable dental care while stressing preventative education. Teledentistry is also utilized throughout the world and even in third world countries where dental education and provision doesn’t usually exist.

With the passage of legislation, specially trained hygienists and assistants may provide basic therapy without a dentist’s direct or indirect supervision. Temporary clinics such as nursing homes, schools, or community centers are the setting for offering services such as prophylaxis, placement of temporary fillings, fluoride application, and other aid depending on the laws of the state. The provider of the assistance corresponds with the supervising dentist primarily by the internet. The interaction between the hygienist or assistant and virtual dentist consists of treatment planning and guidance throughout the appointment. Patients are referred to a participating dentist for more complex needs. While this type of delivery may be controversial, it can be very beneficial to those who otherwise wouldn’t have access to dental care as long as the provider operates within the laws of the state.

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Will Going Green in Your Dental Practice Put You in the Red?

recycle dental practice

Going green is here to stay, so how does this environmental movement transition into the dental office? Below are some suggestions to help without draining your bank account.

  1. Use non-aerosol products
  2. Take advantage of your energy providers energy savings programs
  3. Transition patient correspondence from mailed reminders to text messages or emails.
  4. Wear eco-friendly scrubs
  5. Use degradable plastic bags for patient bags
  6. Install programmable thermostats
  7. Use LED lighting where possible
  8. Caulk all office windows or apply weather stripping
  9. Consider using biodegradable supplies whenever possible
  10. Label recycle receptacles to encourage recycling
  11. Recycle all electronics (computers, batteries, computer parts, etc.)
  12. Recycle traditional x-ray lead foil and solutions
  13. Maintain air conditioning and heating filters
  14. Encourage turning lights off when the room is empty (restrooms)
  15. Use touchless faucets when possible and don’t leave them running while brushing or washing hands
  16. Deal with companies who support conserving energy
  17. Use fans to help circulate the air. However, practice caution when using fans in the operatory while creating aerosols.
  18. Consult with companies who support going green when building a new practice or remodeling an existing office.
  19. Utilize reusable products when possible
  20. Don’t become overwhelmed by trying to go green all at once. Incorporating sensible little changes on a continuous basis will contribute to making your office environmentally friendly.
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Things people say- Unusual requests and strange questions patients have presented over the years

2e1ax default entry nervous denta patient

Being a Dental Hygienist for nearly thirty years has afforded me many encounters with patients which can be awkward from time to time. Following are some of the most unusual requests and questions I’ve witnessed over the years.

  • Do you clean the instruments between patients? The answer is a resounding YES! Instruments are carefully transported to the sterilization area where they are placed in an ultrasonic cleaning device with an enzymatic cleaner. The ultrasonic action removes any debris on the instruments considering debris must be dislodged before the instruments can be sterilized The instruments are then placed in an autoclave where they are sterilized by pressurized steam.
  • Upon entering the operatory, I’ve had patients request: no x-rays, no scaling, no polishing, and no flossing. What??? My sarcastic self wants to ask why they’ve come in for an appointment. Instead, I regain my composure and ask why they are refusing the proposed treatment. If I identify what exactly they fear or dread, I can explain why each step of the appointment is necessary, and some parts of the procedure can sometimes be shortened while still providing thorough treatment.
  • I can’t lean back at all, so you’ll have to stand to clean my teeth. Again, my sarcastic self wants to tell them that it’s fine and I’ll stand on my head. After a few deep breaths, I inquire as to why they have to sit upright. There certainly are instances where a patient can’t lie flat, and that’s respected and honored. For the most part, if it isn’t a legitimate request, the reason for not wanting to lean back is fear and loss of control. Simply explaining to the patient that they are one of many patients treated daily and trying to treat them while they sit fully upright is detrimental to my long-term health. Some clinicians prefer to stand while providing treatment, but the patient is reclined. Treating patients fully upright can contribute to Musculoskeletal Disorders and end your career.
  • I just want a cleaning today. I don’t need to see the doctor- In most states, an examination by the doctor after a prophylaxis is the law. There are some states in which hygienists can open their own practice without a dentist ever being present. Also, some states allow for a patient of record to be seen without a dentist being present if they have received an exam within 12 months and are appointed for a regular prophy. For the most part, the patient must be examined by the doctor.

Some other funny things patients have said:

  • Upon handing the patient a sealed lip blam to use during the appointment they, in turn, ask me if I give the same one to the next patient. I smile and say, “No, this one is special for you to take home.”
  • “Where does the stuff go that you suction out of my mouth?” After a chuckle, I inform them that the “stuff” first goes through a filtration and separation system and the remainder goes down the drain just like it does at home when spitting in the sink.

 Patients can be the source of some unusual requests and questions, but it certainly makes the office more fun. Oh well, it’s all in a days work.

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Miss Manner's Rules for Proper Etiquette In and Out of the Operatory

root canal

Should you be concerned with etiquette in the operatory? Although it may seem to be a strange question, some clinicians aren’t even aware they’re violating the protocol of OSHA and HIPPA. Not all of the infractions listed below are HIPPA and OSHA requirements; they’re just plain rude. Here is a list of things to avoid in and out of the operatory:

  • Leave your cell phone OUT of the operatory. A patient in the chair DOES NOT want to witness your conversation or text message. Furthermore, the patient’s appointment time isn’t an opportunity to catch up on emails or social media. Smartphones have enabled us to have the world at our fingertips, and it’s tempting to engage with the phone instead of the patient since there can be plenty of downtime during the appointment. Try engaging with the patient instead and educate them, make them comfortable, or just let them vent.
  • Never blow your nose or cough in the presence of a patient. Excuse yourself and go to an area where you’ll have privacy. Even if the patient can’t see you, it’s not something anyone wants to hear, especially in a medical setting.
  • Never have a heated discussion with a team member in front of a patient. Leave any cross words or even a calm discussion for later when it can be addressed out of the operatory and in privacy.
  • Avoid conversations about religion or politics. Even if the conversation is agreeable, a patient in the next room may hear and find you being improper and unprofessional.
  • Avoid conversations about patients with team members unless in a closed room away from any observers. HIPPA violations are very real and can end in fines and jail time. Additionally, ignorance of HIPPA laws can’t be used as an excuse.
  • Pay special attention to the patient's personal information. When you have a chart in your possession, this information must be kept confidential. If anyone other than a team member gets access to another patient’s personal information, very serious consequences can ensue. HIPPA personnel will become involved and again, impose fines and in some cases, prison. These fines can be imposed per occurrence which means that you’re not facing one fine, but separate fines for each patient whose information is compromised. The front desk is a prime example of where opportunists might gather patient information. The reception area and front desk are very busy places with many things happening at once. Also, the communication in the front office includes credit card numbers, names, addresses, social security numbers, and insurance information.
  • Don’t eat or drink in the operatory or in front of a patient. Keeping food and drinks in the treatment room can cause them to become contaminated. With the use of high-speed and low-speed handpieces, particles enter the air and land everywhere. Even at the front desk where contamination may not occur, eating in the presence of the patient is rude.
  • Watch what you say outside of the office. It’s no surprise that people vent about the workplace. However, you never know who’s sitting in the next booth. Mixing in alcohol can also be a huge problem if it encourages you to talk louder and be more open. HIPPA exists outside of the dental office, and you absolutely can violate HIPPA guidelines and have to face the consequences.

Fun can still be had while treating patients, however, be sure to stay within reason of the rules and guidelines. The workplace will be safer and more pleasant for the team and the patients.

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