Tag Archive for: Orthodontics

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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Increased Demand for CBCT

During the past months the dental market has been buzzing about CBCT Scanners and Ceph images. This is mainly due to the increased demand for CBCT scanners, and the superior imaging quality yet lower radiation doses it delivers. Initially, this new technology was only used to evaluate jaw bones (for implants or surgery), but quickly advanced to panoramic and Cephalometric imaging capabilities CBCT


What is CBCT (Cone Beam Computed Tomography Scanners)?

A medical imaging technique where the x-rays are divergent, forming a cone. The 3D technology and panoramic imaging enables very high resolution pictures, yet through low radiation. Cone-Beam Computed Tomography (CBCT) is a new technology which is dedicated to imaging change from a two dimensional to a three dimensional capability and has created a revolution as it enables substantial improvement in operative and surgical procedures.
Some of the advantages of this new technology include: more rapid acquisition of data, shorter examination time, reduced image distortion, and best of all – one quarter to one fifth of the price of the standard CT machine. In addition, during the last decade manufacturers were able to produce small enough machines to be used inside dentals offices.

According to recently conducted research (*Transparency Market Research), the Global cone beam computed Tomography (CBCT) market expected to reach US$ 960.8 million in 2023. This demonstrates a clear high demand from clinics, and provides an increased incentive for further technology development and improvements. There are currently various leading manufacturers, but overall the demand for CBCT is sometimes said difficult to fulfill.

What about radiation??

Zero x-rays carry zero radiation! But, that’s almost impossible when treating patients these days. Saying that, the average radiation exposure for individual, panoramic and Cephalometric images have decreased. This is mainly due to improved protocol and procedures established for both clinicians and patients. It is also due to advancements in technological solutions such as the CBCT scanners. Comparison with patient dose reported for maxillofacial imaging by conventional CT (approximately 2000 mSv) indicates that CBCT provides **substantial dose reductions of between 98.5% and 76.2%.

What are common uses for Dental Cone-Beam CT?

The technology is normally used for treatment planning of orthodontic issues. These include surgical teeth implantation planning and placement, disorders diagnostics, tumor detection and treatments, pain locations, reconstructive surgery, and Cephalometric analysis.
Depending on the procedure type the patient is normally required by the practitioner to sit in an exam chair, while the scanner is used. Afterwards, once the results are ready, they will be discussed with the patient and proceed to the proper treatment.

Regardless of the technology used at dental clinics, CephX still provides the prime analysis and reports with the highest accuracy and substantially lower processing time. CephX is a fully-featured cloud system, where you can create patient records, upload X-Ray and profile photos, and be sure you can always access past records, photos and analyses as they are stored, secured and backed-up daily!

CephX online cephalometric trace & analysis is available at https://cephx.com/

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

Read more about Interview with Dr. Greenfield – Non extraction technique

Interview with Dr. Greenfield – Non extraction technique

Dr. Greenfield is the author of “Nonextraction Orthodontics, 98.5% Nonextraction Therapy using Coordinated Arch Development®“, a textbook that has been published in four different languages, and is now in its 2nd edition, with over 1,100 pages and 7,000 images.

During the making of his textbook Dr. Greenfield made extensive use of CephX.com services to get unbiased Cephalometric analyses, and through that we came to learn about his 98.5% nonextraction treatment philosophy entitled; “Coordinated Arch Development®.”


Dr. Greenfield was invited to present his philosophy at the 1996, 2003, 2004 and 2005 scientific sessions of the American Association of Orthodontics, and was asked to defend his Nonextraction approach at numerous sessions, including:

  • The 1992 and 2002 College of Diplomates of the American Board of Orthodontics annual sessions
  • The 1993 Southern Association of Orthodontists’ annual session
  • The 1998 Northeastern Society of Orthodontists’ annual meeting
  • The 1999 American Academy of Pediatric Dentistry annual session
  • The 2001 Japanese Orthodontic Society Annual session.



Let’s start with your background information

I am a graduate with honors from Howard University College of Dentistry in 1971.  After receiving my Master of Science in Orthodontics from Boston University in 1973, I continued as a Clinical Instructor until 1976.  In 1984 I became a Diplomate of the American Board of Orthodontics and was invited to exhibit my board cases at the A.A.O. meeting that same year.

How and when did you develop your NON-extraction technique?

“Coordinated Arch Development®“ is a nonextraction philosophy more than a technique.   Its roots were formed in the early 1940’s from the work of my mentor Dr. Norman Cetlin, arguably one of the greatest orthodontic clinicians in the modern era.  The Tweed extraction philosophy was very popular at the time and consequently Cetlin’s early efforts were overshadowed.   In the 1970’s and 1980’s, long term nonextraction cases were exhibited at the AAO meetings which aroused great interest in the philosophy. Cases 25 years out of retention were also submitted to the University of Michigan for evaluation of the technique’s long term stability.

Please explain “Coordinated Arch Development®” philosophy

Achieving long term stability requires controlled upper and lower 1st molar movements, simultaneously, in all three planes.  Light continuous forces of similar magnitude are utilized to “coordinate” these movements.  The final orientation of the molars creates occlusal forces through the long axes with the absence of deflective contacts during function.  The molars are placed well within cancellous bone and the “neutral zone” to enhance their compatibility with the periodontium and soft tissue envelope.  The resultant position of the anterior segment provides proper incisal guidance and maximizes facial and dental aesthetics. nextortho-sample1
nextortho-sample3 nextortho-sample2a

What has changed in the industry since the book was written?

The pendulum has definitely swung towards a nonextraction treatment approach the last several years.   People want a full radiant smile rather than seeing dark corridors at the corners of a smile.   However, there is high quality nonextraction treatment and there is quick nonextraction treatment.   The new generation of orthodontists must lean towards quality in this delicate balance.   The Doctor must remember that the treatment decisions they make today will impact the patient’s health for the rest of their life.   Throughout the Textbook, the principles for attaining long term stability for their patients are explained in vivid detail, and must never be compromised for the sake of “efficiency.”

What can you tell us about the book writing process?

The writing of the Textbook took approximately 4 years.   Without the encouragement of my wife, the project would never have been completed.   She typed and proof read the entire manuscript while I compiled long term records on my patients.  In fact, my youngest daughter whose a graphic artist, designed the cover – it truly was a family effort.   I had 3 contributing editors write 3 chapters in the textbook, and CephX , under the expert direction of Danny Abraham, traced every cephalometric x-ray in the textbook.  CephX unbiased data not only made my job easier, but it contributed greatly to the success of the publication.   We also included 10 cases  from my study club in Japan.   I specifically chose Japanese cases since they are considered to be among the most difficult nonextraction cases in the world.  It was my way of confirming the versatility of this philosophy no matter how difficult the case. nextortho

When and where was the book distributed thus far?

The textbook has been published in four different languages, and is distributed throughout the world. It is available in hard copy (Amazon), and in digital (Downloadable) format.  The information contained in the Textbook is NOT available anywhere else, so Doctors that have purchased the Textbook are very appreciative of its content.  I constantly receive hundreds of emails from Doctors around the world thanking me for sharing this information – it has prevented the unnecessary extraction of teeth in thousands of children and adults.

My ultimate goal is to create optimum LONG TERM function and radiant smiles for our patients worldwide.

Can you share with us feedback you received about it?

The feedback has been extremely positive – beyond my wildest imagination.  Doctors have emailed me thousands of photos of their cases treated successfully with the information contained within the textbook.   Many Doctors wished they had this knowledge earlier in their career.  In fact, my Japanese study club recently won 1st place for their case presentation at the American Association of Orthodontists Annual session.

Do you plan to publish a follow up book to extend the technique?

The textbook is now in its 2nd edition and still very popular.   The Chinese publication has just been released in December, 2015.

Instead of publishing a 3rd edition, we have now expanded our FREE WEBSITE, NEXTORTHO.COM to include VIDEOS of all the techniques in the textbook, and 100 nonextraction cases illustrated in vivid detail in our “library of cases.”  By making the website FREE, we have made the “Coordinated Arch Development®” nonextraction philosophy accessible to students and clinicians in every country.   This will expedite my goal of preventing unnecessary extractions in children worldwide.

How do you feel about CephX – how relevant is the online tool for the industry – what is the added value you see in Cephx to the industry

The value of CephX to me as a clinician, author and researcher is extremely valuable for different reasons.   First, it removes all bias from my cephalometric measurements.   This is very important in the minds of Doctors who purchase my Textbook.  If I traced the X-ray, they may be concerned that the measurements were skewed in my favor.

The tracings are performed by a well-trained 3rd party who does it all day long.   Thus the quality of the tracings and measurements are consistently excellent.   Our diagnoses & treatment plans are certainly enhanced by their quality & consistency.

CephX has all the popular cephalometric analyses on their website.   Therefore, the Doctor can refer to any of the analyses for a specific measurement to aid his diagnosis – how important is that!   In fact, Doctors who purchased my textbook were allowed to contact CephX to gain access to any of my case measurements if they wanted to view their favorite analysis online.   Finally, I cannot say enough about the excellent support of CephX I received for the past 15 years.   Anytime there was an issue, it was resolved the same day in a courteous and professional manner via email.

The Doctor does not have to train a staff member to perform this task, nor train another staff member should the original employee leave the office.   This is a real time saver in a busy office.

An author or researcher can focus on their research rather than worry about the accuracy of their tracings.   Placing this task in the hands of an expert improves the overall quality of the final product.

Finally, CephX may not have invented cephalometric tracing, but CephX certainly defines it.

Dr. Greenfield’s textbook is available at www.nextortho.com

CephX online cephalometric trace & analysis is available at https://cephx.com/

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

Read more about Increased Demand for CBCT

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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