hey it's dr amanda with staightsmile smile solutions www.straightsmilesolutions.com and
today i'm going to be answering one of the questions that i got this week from
one of the doctors i connected with he asked me to write something so i
wrote a blog about handling non-compliance and orthodontic patients
like what do you do and inadvertently i mean the benefit of
using removables you know you know like um expanders
schwartz's different functional appliances
aligners is that you know it's healthy nothing can really go wrong
you know but they do have to wear them right same thing even if you're going to
be doing braces which is fixed at some point you're probably going to have to
have elastics and many patients to get a good outcome
so you're still going to have compliance so compliance is going to come
pretty much no matter what system you use so it's something you want to kind
of understand and for me up front i like to establish
expectations with both the parents and the patients it's a great idea if you
create a compliance contract um i have some
templates in my store on my website but it might be something you want to
custom make because i've seen some they look a little bit harsh
so but basically mostly just saying hey this is how this is going to work this
appliance in order for this to work we all have to collaborate
um you know little joey has to wear it 22 hours a day
here's how we're going to do it take them through the day what's going to
happen at lunch time you know what can you do as the doctor to make this
easier on the family because it brings stress into the family right
so usually the biggest hurdles are you know lunch time which you may not even
having this issue if most kids are studying at home this year this is like
perfect time to be doing you know removables but you know for me
sometimes it meant i'd buy the kid a retainer case on a string that she wears
around her neck or they can clip to their lunch box
just trying to find what that what that push point is you know to help them get
through the day so um or same thing you know you know
what do we do when they're supposed to be playing sports you know or
instruments like let's make sure that the
appliance gets taken out of the mouth and gets put away and then goes back in
the mouth but yeah establish expectations help to
walk the parents through the day um help them kind of tackle their
concerns that they might have throughout the day both the
you know the kids and the parents probably have some concerns but
ultimately i mean in general i like to have some type of three strikes role
where maybe not every you know i like to assume
kids are awesome kids you know but sometimes there's ones that just
aren't compliant and usually they're they're having issues at home too and at
school and and you know it's not only the it
doesn't manifest itself only as a behavioral thing
you know with the ortho it's it's everywhere so you know the parents do
appreciate your help with that but i like to say there's a three
strikes rule where after one or two three times that you know you're not
compliant then we have to really think about stop stopping the treatment
and doing something else which might mean let's say you had a
let's say you had elastics for example um let's say you
had a class two case uh you're a couple millimeters
class two you needed to correct with elastics it would probably take four
months patients just not wearing it or they're
only wearing it a few hours a day which is basically you're not going to do
anything you know you let them know the first
time you let them know the second time the third time you say okay well we have
two choices here you know we've given our three strikes
so we can either do some interproximal reduction which means you know grinding
on your teeth which you know are extractions we don't really
want to do that but that's an option we can just discontinue treatment you
can leave teeth or straight your bites a little off but
you know when you're older you can always go back and
get into some type of uh aligners or braces if that bothers you later and a
lot of times families are fine with that it takes the stress off of them
some other parents are going to ask you maybe to do something fixed there are
some fixed appliances like carriers or forces and stuff um
for the most part every time i've done those it's been like terrible
i mean the patient was pissed off the parents were pissed off even though they
asked for it because it you know it just disrupts life a lot
in terms of how you eat discomfort a breakage um
these type of kids that are getting it they're being forced to get it they
they're very angry um i personally i i've done some and i don't
think i would do it again i mostly just stick with removables and the kids can't
be compliant then then we got to do what we got to do so i
don't believe in medieval torture devices to try to get a bite
but anyways so that's the elastics thing um
but there are some ones you can do for distillation that you know like a
carrier and stuff that are not that bad you know so um definitely an option and
then the other option would be for something like a an expander you know if
they had a removable expander and then they wanted a fixed expander instead or
they had aligners and they wanted braces instead then the parents pay an upgrade
fee you know um and the upgrade fees should
be equivalent to the lab fee plus the ins you know the measurement and the
delivery fee so your chair time everything so i mean
you'd be charging easily between five and eight hundred dollars
for this change and treatment plan um parents need to pay for it you know
that's if that's what they're deciding to change
you know because they weren't compliant and also there's additional time and
treatment so you know that's pretty much how it
works but that's the main thing is just these type
of things are tend to be the ones where you get your most complaints
if you don't manage it right so you really just have to be
direct with the parent giving them options sometimes it might mean you
might need to give some money back okay because we're finishing treatment
early that's the right thing to do they're gonna be less likely to complain
not the whole thing but you know again on the front end
explaining to parents even when you get started hey here's how this is gonna
work okay um the first visit is has about this
much of a value because this is what we do the second visit has the most value
this is what we do the other visits are a little you know
a little bit less so if you decide to discontinue here at this month and you
know you might get 20 20 back or something
like that and usually parents are pretty cool about that so um
yeah that's it you know handling non-compliance but
also the main thing is is that you're especially if you're a gp or a pediatric
dentist you're doing ortho you can partner with the right parents and kids
that you want to if you're this kid's wiggling around in the chair
and jumping around or having behavioral issues it's not somebody you're going to
want to partner with partner with the kids that are well
behaved send the other ones to the specialists you know
as orthodontists we have to take everybody pretty much if they're really
bad we sent them to the university that's our that's our other one but
anyways all right thank you so much for listening