Reticent Orthodontic Patients – What’s On Their Minds?

A consultation, a new referral, the elementary school child, the “whatever” teenager, the adult patient, what goes through their minds about orthodontics that they don’t vocalize to their practitioner for whatever reason.girl


What are the common concerns, worries and problems of these quiet and reticent orthodontic patients that may remain unspoken and lead to referral patients declining initial treatment, misunderstandings about adverse effects, unrealistic expectations or general poor patient rapport?

It’s true that patients are seen over a period years, but with increased competition, auxiliaries performing more procedures and time management appointment philosophies limiting time to really talk to a patient, opportunities to initiate a real patient/doctor dialogue may be missed. There are numerous studies on healthcare patient interactions linking perceived “good” communication and positive trust issues 1 as a major factor driving patient satisfaction, rather than other parameters of clinical treatment.

Reticent Orthodontic Patients – Great Expectations? 

Informed consent is one of the primary standards of care in healthcare. Usual orthodontic consent and treatment plan discussions center around final cosmetic and functionality aspects, possible risks and limitations of treatment, special case considerations as well as patient responsibilities for ensuring optimum treatment.
Unfortunately, it is not unusual for patients to sign medical and dental consent forms as a matter of routine behavior without reading them, understanding them, or asking any questions. This occurs even after participating in treatment discussions and responding negatively when asking about any questions. This can result in later misunderstanding especially for those patients who feel that questioning a dentist is “inappropriate” or they subscribe to the “dentist/doctor knows best” philosophy.

Meeting Expectations

Areas where adults, teenagers, children and parents may have difficulties in articulating their concerns, communicating adequately, are embarrassed, socially awkward or a myriad of other reasons, fall into some common categories.

  • Economic difficulties are a major concern of parents and adults undergoing treatment. Orthodontic treatment is a large investment of time and money.  Many patients do worry about the cost and may be hesitant to reveal certain personal details concerning family finances e.g., whether they should delay treatment until they save enough money; will it be worth it and so on.
    Making concrete, sympathetic and reasonable individualized payment arrangements helps to allay financial concerns, affect choosing an orthodontist and may open a dialogue making a difference in starting or rejecting treatment.  A sub economic issue concerns transportation problems associated with taking children out of school, missing work, driving the child to appointments etc. Coordinating appointments as best as possible with individual patient situations allows them to voice their concerns rather than bottling them up.
  • Pain issues may not be brought up prior to treatment. Children may be afraid to ask. Orthodontic advertising tends to minimize any references to pain.  Adults may “tough it out” without notifying the practitioner, but inwardly resent having pain. Being upfront, sympathetic and providing information on pain management encourages patients to be vocal about their pain so that this side effect of treatment is not “stuffed” and then comes out later as a misunderstanding.
  • Appearance issues with braces have become less of a problem with orthodontics becoming more popular and accepted. Colored rubber bands, shaped brackets, ceramic materials and Invisalign treatment have minimized some of the “metal mouth” caricatures, especially for the child. However, bullying of children with braces can remain a problem 2 and efforts on both the dentist and parent should be directed toward encouraging reporting of bullying.
  • Speech and diet concerns become an issue when patients experience real problems giving up foods that are detrimental to braces. Some patients may also experience speech problems with some appliances i.e., palatal expansion devices. Patients should be encouraged to report problems with maintaining dietary restrictions and feel empowered by dental staff to verbally report problems and seek advice without fear of “rebuke”.
  • Duration of treatment resentments may crop up at any point even though this parameter of treatment supposedly is universally understood as a core part of “having your teeth straightened”.  Patients may grow tired of the length of treatment and lose their commitment to hygiene, internally complain and resent treatment. Rather than asking perfunctory questions like, “How are you doing?” or “Any questions?” and exiting the operatory for the next patient, a better approach may be to periodically take a few minutes and encourage the patient to talk about themselves and have a real conversation.

Some Psychology

A New York Times blog 3 with supporting research about the difficulties of speaking up at the medical doctor’s office readily reflects the same dynamics regarding the dental practitioner. There is a well-known dynamic where people may feel vulnerable or intimidated in a medical/dental setting. The prospect of speaking up, viewed as complaining, or asserting their views for some patients represents a possibility for negative consequences impacting their care.

This dynamic along with the ones listed under the heading above have resulted in various recommendations 4 to improve patient/practitioner communication.

L.A.S.T. is an acronym outlining a four-point list that might be used by busy orthodontists to help their patients feel better about “opening up” and lead to better patient rapport.

  1. Listen: Take a few extra minutes to really connect with patients.
  1. Apologize: “I’m sorry, next time let’s try and communicate better concerning your worries about your child being teased while wearing braces”.
  1. Speak: Encourage patients to speak their mind without fear of judgement.
  1. Thank: Let patients know you appreciate it when they are vocal about their concerns.

Busy orthodontists need as much time as possible to devote toward direct patient care and communication. Manual cephalometric analysis and tracing are time consuming and one area where extra time can be freed up for important communication aspects of practice management including more time understanding reticent orthodontic patients. Computerized cephalometric analysis now allows for multiple analyses and cloud storage within seconds.


1: http://www.jyi.org/issue/trust-in-the-dentist-patient-relationship-a-review/

2: http://www.nymetroparents.com/article/why-are-some-kids-with-braces-bullied-and-how-to-boost-their-self-esteem

3:  http://well.blogs.nytimes.com/2012/05/31/afraid-to-speak-up-at-the-doctors-office/?_r=0

4: http://www.nature.com/bdj/journal/v187/n5/full/4800251a.html

Discover the advantages of online cephalometric analysis in this area of patient care and more at Cephx.

For more information please contact info@cephx.com or 1-800-992-1499

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Orthodontics – 2015 Summary

2016 already started, holding promises for another year of growth in the fields of dentistry and orthodontics. But it’s always important to look back to get an overview of trends and changes in the business, and conclude insights that may help us down the road.



According to a survey conducted in the USA on 2015, Orthodontists spend a weekly average of 30-40 hours  with patients This does not include time spent on practice management, staff recruitment and training, marketing and general business management, which most of it can outsourced.


The demand for orthodontics in the USA is comparatively higher than the rest of the world.
According to the WFO (World Federation of Orthodontists), in 2015 the number of orthodontist in USA is over 9,000. The European countries have additional 10,000 orthodontists (500 in Belgium, 350 in Czech, 200 in Denmark, 150 in Finland, 2500 in France, 3000 in Germany, 450 in Greece, 150 in Ireland, 1300 in Italy, 250 in Norway, 1100 in Poland, 300 in Sweden, 300 in Netherlands, and 1,200 in the UK). Due to lack of oral health awareness, lack of literacy, poor economic condition the demand for orthodontics in Asia is significantly lower compared to the rest of the world. Market research shows that only 1,500 orthodontists are working around Asia, leading to a low ratio to the large Asian population.



History demonstrates that during the past couple of decades it was normally children and teenagers were the main target patients of orthodontics. But now in 2015, this situation has changed for adult population – significantly more are concerned with correcting or improving the position of their teeth and correcting any malocclusion.

Recent study shows that over 1 million North Americans are taking orthodontics treatment by wearing braces in present days. 


The way forward for orthodontics is challenging yet promising bright. Challenges are primarily characterized with barriers for new entry, lack of awareness to new techniques and high cost of advanced treatments. For emerging markets, mainly around Asia, increasing demand for orthodontics is held back by less professional, with many of registered ones actually working in governmental hospitals.

Nevertheless, the bright future of Orthodontics is driven by new era of dental science, mainly clear aligners, rising dental aesthetic standards, rapid GDP growth in Asian markets and new technologies enabling less manpower for running Orthodontic practice, such as cloud services.Despite of greater competition, higher patient expectations, and increased legislative involvements, 5 years from now expect to see an increased usage trend of digital orthodontics including Laser technology, x-rays, White light, 3D printing, Intraoral Scanners, and Digital Photography which is expected to have the market size around $3.6 billion in the global dental market


Are you ready to attain excellence to brace yourselves for 2016?

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