Australasian Dentist Magazine May June 2021

Category 134 Australasian Dentist and unfortunately is not raised often enough by practice principals. I actually did address this in a previous article that I wrote in a previous edition of Australasian Dentist. In order to summarise the most important points of that article: In this day and age,many practitioners are learning orthodontics and starting cases in a general dental practice – and whilst they may not own the practice they are imposing a significant liability to the practice principal, who is usually unaware of these potential issues. I personally think it is excellent that dentists learn about orthodontics, from a diagnostic point of view and even how to perform treatment – but everyone must have their eyes fully open as to the possible consequences of commencing orthodontics in a general dental practice where the practice owner is not equipped for orthodontics, or doesn’t have the knowledge, expertise or possibly the passion to continue a patients ongoing treatment. Orthodontics has many nuances which are different to those in general dentistry. These “orthodontic nuances” include: a. Patients in treatment for an extended period, anywhere from six months to 3 or 4 years or possibly beyond. b. Once active orthodontic treatment is finished, these patients still require monitoring of their retention phase of therapy which should be for a minimum of a further two years after completion of active treatment. c. Patients who may have paid in full for their treatment or prior to finishing active orthodontic therapy – hence their payments do not relate to the actual treatment (work) performed. This is a unique situation in dentistry, as all other dental procedure’s payment usually equates to the work performed – but this is not generally true with orthodontics. d. There are significant extra expenses for a practice to incorporate and integrate conventional orthodontics – EG brackets and possibly specific individual patient brackets , arch wires, special orthodontic pliers ,orthodontic bands etc and the question becomes who should pay for these items and does the usual % commission need to be adjusted ? e. If an assistant dentist uses a hygienist in the form of an orthodontic auxiliary (to help increase their own income), the hygienist is now no longer an income producer for the practice owner – and should be remunerated by the assistant. f. Who takes on the responsibility of the patients continuing orthodontic care? g. Orthodontics requires a thorough diagnosis and treatment plan – and who is responsible if the new treating practitioner feels uncomfortable with the initial treatment plan adopted by the departing dental practitioner, the mechanics utilised or the finishing that will be required? A very detailed agreement between the practice principal and the assistant dentist is required, outlining the terms of employment. With regards to orthodontic treatment remuneration, this should be based on work performed rather than payment on receipts. This would mean that when a patient finishes active treatment, there still is a further two years of retention that is required, and using the Australian Society of Orthodontists (ASO) guidelines, 20% of the total fee would be allocated to the retention phase of therapy. In addition, this would allow a fair adjustment for those patients who have paid in full at the beginning of treatment with the assistant dentist having been paid for the total treatment yet has not performed that amount of work! In addition, this agreement should specify exactly who is responsible for the ongoing care of that patient, and from an ethical and moral point of view it should be the initial practitioner, and hence it should be their responsibility to maintain treatment for all orthodontic patients until their ultimate completion-and if not, some form of remedy /remuneration to the practice principal needs to be in place. u u What is the position of the upper incisors. u What is the position of the lower incisors. AsIteachallofmystudentsinthecourse, itisabsolutelyessential from a medico-legal point of view to have a lateral cephalometric radiograph for each and every patient, not too dissimilar to an OPG. Having said that, most cephalometric analysis can be done purely by “eyeballing” the lateral cephalometric radiograph – but a thorough understanding of cephalometrics is important medico- legally. Even more importantly is to understand the limitations of a cephalometric analysis, as once you understand its limitations, you will understand why we do not rely on this as much as we do on our clinical evaluation and/or clinical judgement. Once again, the training and knowledge from a good course and having a good mentor is essential for you to understand the pros and cons of the cephalometric analysis, but I can assure you that once it is all boiled down, it is not very difficult at all. Let’s get rid of all the smoke and mirrors that have been used traditionally in this area – and make everyone understand how easy cephalometrics can be, once it’s fully understood. v v v Q6 Dear Geoff, I am bringing an assistant dentist into my practice and he mentioned he is doing a lot of orthodontics. Could you please give me some advice of how I can bring him in and allow him to do orthodontics in my practice however I worry if he decides to get up and leave in the future and how can I reduce the risk of issues? Dr VV South Australia Response 6 This is an interesting question – one that has been raised previously columnists