hey it's dr amanda with straight smile solutions straightsmastersolutions.com and today we're
going to talk about craniofacial teams this is the infographic i could find um i didn't want to put a
patient on there that had craniofacial needs but let's talk all about that what is a craniofacial
team when should you refer to a craniofacial team for ortho instead of keeping it in house
where are they what are they things like that how do you know if you need one and what's the benefit
so i first became acquainted with craniofacial teams when i was
a student at ucsf in san francisco they had a craniofacial team i volunteered there once a week
for a year or two before i went to ortho residency and it was absolutely fascinating for me
it was something i didn't know existed so at ucsf our craniofacial team granted this
was over 20 years ago um was composed of all different kinds of specialists
that met once a week for i think a full day um to see patients with all their needs so
um there was like a plastic surgeon there was an audiologist i believe there was an ophthalmologist
there was definitely a pediatric dentist there was an orthodontist and pretty definitely an omfs
um an oral mild oral myofacial surgeon i almost said omt maybe there's that too now but pretty
much just about everyone who would need to be in charge of making sure a child that had a defect a
syndrome or some type of growth issue with their head face mouth was taken care of quite often
these patients are syndromic patients or they have genetic issues it could be as simple and i
say simple because that's not simple as something like clefting um you know cleft lip cleft palate
um all the way into various very complicated syndromes which present with lots of different
facial issues smile you know and orthodontic issues um i know sometimes you see patients in
your office and you're like they look kind of funny kind of asymmetric but their teeth don't
look that hard you know it doesn't look that hard for me to fix well you don't want to take their
dental issues they're you don't want to treat their dentistry necessarily because it's probably
a heck of a lot more complicated than you think you know the bone often is different if you see
all kinds of asymmetries in their jaw and their bite you just you don't want to go there for
many different reasons a it's going to be much more difficult than you think b they often have
special needs and they need special a lot of sensory needs other things they need special
special kind of tlc special kind of care i'm saying this in the nicest way i can but see
if you start messing with it and you screw up you basically messing up with this patient permanently
and you're affecting this patient from getting the need later that is often fully covered by
medical insurance these craniofacial teams know how to use medical insurance to get the patient
everything they need so for example if you start moving the teeth the jaws and the asymmetry in the
face might get worse the patient may have more difficulty speaking functioning eating biting
and now you've permanently damaged this patient just because you wanted to try to help so you're
trying to be helpful but you're actually hurting the patient so that's why sometimes when i
work with some of my doctors in my consulting practice at straight smile solutions i go hey
pump the brakes i know you're thinking this isn't hard but it's a million times harder than you
think it is don't touch this patient refer this patient to a cranial facial team for treatment
now most of the craniofacial teens that i'm familiar with are at children's hospitals
or dental schools that have multi-disciplinary residencies um but there are some private
craniofacial clinics that are out there too as well you know you can give them lots of options
the best thing you can do for your patient is not touch them even if they want you to
refer them out perhaps they will come back to you and say it's okay for you to treat this patient
and that's great if that's if that's what they say but i would rather you be safe than sorry
because if you start messing with their bite their teeth like i said you could make their needs
so much worse and you could really damage them and you could also affect their ability to get
the surgeries that they need later maybe it's not surgeries maybe it's just ortho but just refer
them out if you need to you know it's the right thing to do even a lot of orthodontists refer
to craniofacial i certainly did a lot of times because my offices were just not equipped to meet
the full needs of these patients you know as even though i had experience because i knew that as i
moved the teeth other issues were going to come up they might i mean it might affect their hearing
their bite their ability to eat chew and swallow also a lot of these patients have sensory issues
and they need things done a certain special way and the team will be able to address these
issues and affect the orthodontics in a way or guide the orthodontics in a way that's best for
this patient's special needs and you may not be prepared for that so that's what craniofacial
team is and you'd be surprised how many times everything is fully covered what you know
why charge this patient when it's possible they could get everything covered for free because
they have some special needs now it is a very this is this is where the difficult issue comes up and
i'm going to give you my scripting on how i've handled it first of all of course i'm looking at
the medical history have they listed any things on there that you know syndromes other things i mean
um they're not marking anything and i and i suspect this patient's a craniofacial patient
and by the way a lot of times spectrum or autism spectrum disorders they fall within craniofacial
issues and i don't know which comes first the chicken or the egg um but i suspect there's
definitely a correlation because i see a lot of that so um you know they may have listed
you know spectrum disorder autism or whatever asperger's on the medical history but that's just
part of it you know what i mean there's probably something else it's possible that maybe they're
just not telling you maybe the patient doesn't know maybe the parents don't even know maybe they
just think the patient is is normal they don't even realize that there's an issue so this is how
i generally said it and i depending on the age of the patient i will either have the patient in the
room or take the parent aside and i don't think i've ever had a parent get upset before it depends
on how you handle it i mean obviously you want to get the patient away from other or the parent away
from other parents other patients take them in a consult room say hey i just want to talk to you i
have a few concerns done some measurements i've noticed that little johnny has a little bit of
a little bit of asymmetry some things are a little unbalanced in his face um orthodontics definitely
can help with some of these but sometimes it's outside the scope of what an orthodontist can do
i don't feel that comfortable treating him here right at the moment you know without him seeing
a specialist first to see if this is the right thing to do because i don't want to make certain
things worse you know and i'm concerned and i'm sensitive to this so i'm going to ask you to go
to visit a craniofacial team and then what you can do is you can go ahead and contact them help them
set up the appointment that's the best thing you can do because often these are at dental schools
and you know there's a lot of hoops to being seen at a dental school
um or a hospital you know making sure the patient gets scheduled making sure that you get a copy of
the records that you've taken you could definitely take records and send those ahead of time that is
the best thing you can do because sometimes they're going to see the records and be like
yeah definitely we want to see little johnny in here or they might say nah it's okay it's
not something we do here you know um help them set up the appointment send the records ahead of time
um help advocate for your patient you don't want to just abandon them hey here's a referral buy
you know that's not the right thing to do help advocate for your patient and then give them a
buzz in a month or two and follow up because it's possible that maybe it's fine you know and they're
like yeah cool you can still see them in your practice but nine times out of ten when i've done
this they were in the right spot i did the right thing and they stayed there and they were well
taken care of so and and like i said a lot of them could be fully covered by medical insurance um
by state funded insurances you know depending on what type of needs the patient has so
you really are helping this patient out get helping the patient get all
the care that they need so you're doing the right thing all right thanks so much