dr amanda with straight smile solutions straightsmilesolutions.com and today
we're going to make another phase one interceptive ortho video and by phase
one interceptive i mean early treatment it's not comprehensive treatment it's done on younger kids
usually phase one is age seven to nine however today we're gonna be talking about pre-phase one
or early early intervention and this is not really a thing this is what i call it
um it's a bit different than what isn't tradition traditionally done at least in the us
in orthodontics and it's not even something we learned at all about in orthodontic residency
it's something that i kind of fell upon a little bit edgy a little bit different only because
perhaps the area where i was practicing which was west coast um there tends to be a little bit more
um open-minded people asking for alternative therapies maybe not wanting things like surgeries
or premolar extractions people concerned about airways and a lot of people are very aware of
aberrant growth both parents physicians and you know the medical and dental community in general
so let's talk about what we can see i'm just assuming this patient this is not my patient
this is a stock image that i bought but it's always the best because i like to be open-minded
with what i see and it's a great way for me to point things out and educate you what i see
so looking at this patient what i wanted to show you is that you can take an average four or five
for a five-year-old guessing this patient is four or five most likely maybe even six um and could
be as young as three and you could just grab one picture you don't have to take impressions
you don't have to have the whole series of ortho photos with mirrors you don't even have to have
a panoramic x-ray i don't care in a patient this young you know but what i want you to do
is to start screening your two three four five and six year olds if you are a general dentist or if
you are a pediatric dentist i want you to start to screen them every single two through six year old
in your practice why i want you to look for things that are correctable now obviously the severe
situations there's going to be some it might be five percent 10 in your practice maybe you'll be
treat them maybe you'll refer them out there's problem with orthodontist is that we tend to get
kind of stuck in our ways and i'll be honest i was one of those where if the patient wasn't seven you
know i'm not saying i do this now but the patient wasn't at least seven i would say oh it's too
early you know tell them to reschedule if i see a five-year-old or a four-year-old on my practice
schedule which now i realize is a huge mistake because i didn't even realize that there were
ways that there was interventions that you could do this young now the other issue is that you
cannot bill insurance for the most of it most of the time insurance is not going to pay for this so
a lot of parents come in just assuming insurance is going to pay for well they're not
so very rarely you can try sometimes if there's an active habit or space maintainer issue then you
could build that so for habit intervention there is a code for that it's a removable appliance i
think it's d8210 fixed might be d8220 i might be flipping those though sometimes insurance
will cover if there is an oral habit like thumb sucking pacifier use but i strongly recommend
that you get that pre-authorized because a lot of times it just doesn't get paid for
also you are using the patient's orthodontic coverage which often has you know a max of
a thousand fifteen hundred two thousand five 2500 um if you're using it at age three or four
you might exhaust it and they may not realize they're gonna have to pay in full for their braces
later and sometimes we need two phases of braces this is like a pre-phase this basically turns the
ortho into three stages or three phases that means the patient's gonna have to pay three times so if
you use the insurance now whether it get exhausted all or not you're not gonna have it later and that
can get parents very upset i'm just warning you about that so i strongly recommend if you
if you even if you are able to get it covered that you almost you know have the parents sign that
they realize they're exhausting their insurance benefits and that they will need additional
treatment later so that is the risk that they take but i've just seen it you know fly in my face
before when you know even i've done phase one and so now i have something called a phase one consent
form and this is even before that this is like pre-orthodontic you know this is early phase one
so no guarantee if you start things now that you're not gonna have to have two more phases
later phase one and phase and comprehensive or phase two later so just wanted to say that okay
so what do i see here let's get back to this and this is not obviously like i mentioned there's
gonna be five or ten percent that have severe issues i'm talking about over jets more than
eight to ten millimeters um i'm talking about severe crowding you know in um just constrictive
arches vaulted arches skeletal malformations basically talking about skeletal malformation
severe ones those are gonna need a little bit more than what i'm talking about you're gonna have to
get a little more aggressive with your treatment this is a minor issue but remember i love to tell
you what i love to play like a party game this is like an orthodontic nerd party game but you know
on cousins and family members and stuff when you go to parties people always come up hey can you
take a look at my kid and sometimes they're two three you know i can predict the future
most of the most of the time as to what this patient's going to look like when they're 13
with their teeth are they going to need braces and they need one face are they going to need
two phases are they going to need three phases and i think it's a really great thing for you to
prepare the parents for because they don't know right so they're looking at this they may think
oh this is totally normal but it's not okay so what do i see here that concerns me first of all
the main thing that concerns me is the deep bite okay remember deep bytes will always get worse
they do not get better okay this is something that always gets worse over time so it is
something that needs that must be treated now if you've heard me talk about deep bites before i'm
probably repeating myself but i want to tell you a personal story because it's a there's a reason why
this is so important to me so deep bites run in my family or vertical issues um as do diastemas as
you can see here so this is probably what my wreck i can show you pictures of me you know smiling
this is basically what i look like and i was always there was no crowding you know there wasn't
any major malocclusion major constriction anything like that it was just a deep bite it was my so i
went all through you know and a diastema but that was considered cosmetic at the time so you know my
parents it's not that finances were a huge issue but they were told by every pediatric dentist
and even orthodontist i believe yes orthodontist um that it wasn't necessary for me to have
orthodontics even though i really really wanted it like from age eight on begged my parents for it
but what was actually happening is that because of my deep bite which kept getting worse the
bottom teeth are hitting the roof of the mouth and they're biting up on the gum of the top of eight
and nine or the upper ones and causing um bone loss causing tissue trauma it's very uncomfortable
and over time it gets worse and you actually damage the roots to those teeth of those permanent
teeth so once i get to be about 17 finally an orthodontist who is a friend of the family's like
whoa this is bad you know she needs to come in and get started well by then i was going to college i
was not happy about this you know so it was not fun and i was i was angry to be honest that i
should have had this treated when i was younger so i just want to point this out this deep bite
will get worse you can spot it on a two three four five year old and you can definitely get started
with treatment there are options from a variety of different companies and if you watch my phase
one playlist from my youtube channel which is not youtube in general but if you go to youtube and
put in straight smile solutions in the search bar you'll get my youtube channel and you might be on
it right now if you're watching this and then you scroll down on the homepage and there's playlists
right where you click the playlist button and i have i think about 12 playlists and one of them is
phase one interceptive watch that playlist click through the stuff that interests you because we go
into all these different appliances that are out there there are many different companies that sell
appliances price point in the us starts at about 42 dollars on appliances they're not expensive
it's something that could be very affordable what to dentist charge that is the price to the dentist
so obviously that's for the appliance itself it is a class two medical device it isn't something
you can purchase as a parent yourself um the great news is you don't have to take impressions
or molds or scans these are stock so they come in a couple different sizes but there's a size for
a two to four year old there's a size to a four to six year old except et cetera um some of them
the some of the companies have warranties if you have a bite through some don't so for the doctor
you need to keep that in mind because some of the companies the products aren't as good of quality
as other products some come with warranties some don't so ultimately i think you have to
figure your lab fee is going to be more like about 150 when all is done if you use a more expensive
company or use a cheaper company name multiple appliances but regardless some of the companies
are going to require you to take a course some are gonna require you do memberships some don't
so watch all my videos i'm not gonna promote any because i really don't care what you use the
ultimate thing is that you're using one and taking care of these kiddos that should be taken care of
so again these appliances they're only worn at night and when home i recommend four hours a day
when home it can take some time to get used to them you don't have to be stressed out you know
i usually recommend you get started initially by wearing this it's just we call it a tooth pillow
you know and and it also can be used to help to reduce thumb sucking or pacifier sucking or
other issues other oral habits you know finger biting things like that they start off using
it while they watch a cartoon then they proceed to a movie then they proceed to trying to wear
it maybe during books you know um they can use it during gaming things like that and then they
start wearing it at night time and it might fall out initially or you might even come fall out for
the next few months my daughter had one i remember it would fall out if i when i go put her to bed
you know if it was out later when i went to bed i would just plunk it back in her mouth it was
really easy and you know she'd take it and someone should when she woke up in the morning it would be
missing would be in the sheets somewhere and we'd usually find it sometimes it would stay in and and
we did you know there'd be a sticker or reward you know we'd celebrate that but ultimately it takes
time these are a marathon not a sprint so you're gonna have to wear them for at least a year or two
you know every night as well as a few hours during the day they don't need to wear it at school
and over time the bite will improve over jets overbites crossbites a lot of stuff real passively
real slow but it can really help a more severe case getting get an age you know a leg up
which will prevent more severe orthodontic issues later and it also can improve airway it can
improve the way they feel the way they breathe there's a lot of other positive benefits that
come for using these appliances because you are getting the bite the right size and shape that
it should be so the patients can breathe and sleep well at night and it also eliminates a
lot of habits which can cause misshaping of the arches and of the mouth and of the face
so hopefully that was helpful so the answer would be yes i would go ahead and start this patient now
or at least i give the parents an option like i said pull out that crystal ball let them know
what to expect i would tell a patient like this um i mean obviously i can't really see the sides
but you know for the most part patients probably a little bit class two div tooie
tiny bit class two deep bite i would tell the parents you know um she'll probably have that
gap when she gets older that's not a medical problem but the deep bite is a medical problem
we're gonna have to correct it with either braces or aligners or we can get started right now
earlier and get the harder problems out of the way you know and then later it might not be a big deal
that we maybe don't even have to do braces or aligners later maybe can't make promises all i
can tell you is it's only going to help you know whether it helps 10 20 50 100 not sure you know
everybody reacts differently and a lot of parents are willing to invest a couple hundred dollars
you know out of pocket into helping their kid look better feel better what's what's the risk there's
really no risk so not all parents will do it but at least you've created awareness let them know
that there is a problem that they definitely want to keep their ortho insurance and they
probably going to want to have anything like this is going to want to have at least a phase
one when they're seven eight or nine so if you don't get started now all right thanks so much