Topics include early vs. late treatment and broken appointments.
1. What is your rationale for early or late treatment? lf you advocate early treatment, what do you find you accomplish at age 9 or earlier that you cannot accomplish in the full permanent dentition? If you advocate treatment in the permanent dentition, are you making any trade-offs-- for example, reduced treatment time, but more extractions?
A majority of respondents reported using early treatment very selectively. A representative comment: "I am doing fewer and fewer early treatments simply because with the increased use of direct-bond brackets, I find I need to have permanent teeth erupted to a stage that a great deal of clinical crown is exposed to place the brackets accurately."
A significant minority favored early treatment "to obtain a clearly advantageous change over a well-defined treatment period". Some preferred to wait until after age 9 to allow a rapid transition from Phase I to Phase II.
Reasons for early treatment mentioned most frequently:
Orthopedic problems-- maxillary constriction, maxillary deficiency, maxillary protrusion, mandibular deficiency Crossbites-- anterior and posterior, particularly with functional shifts Prevention or correction of lost arch length Oral habits preventing proper dental and/or skeletal development Prevention of trauma to protrusive maxillary incisors Additional comments:
"Cooperation with functional appliances or headgear is often better at about age 10, when the child is mature enough to understand and handle the appliance." "If treatment is postponed until the permanent teeth are fully erupted, I do believe that it might necessitate a greater percentage of extractions." "There is the danger of using up the insurance benefits in Phase I. Also, if Phase I has been 70-90 percent successful in resolving the malocclusion, often the parents will refuse to go ahead with Phase II." 2. What do you do to reduce the number of broken appointments, and how do you reschedule them?
Most of the practitioners reported a considerable problem with missed appointments, but few were optimistic about being able to effect a significant change. Many policies and strategies were employed, including:
Making the patient aware of the need for regular appointments by emphasizing the treatment delay caused by missed appointments Having a written appointment policy that is read to the patient and parents at the consultation, or including a section on appointments in the informed consent form Not rescheduling the patient immediately, but selecting a time convenient for the office to avoid disrupting the schedule for other patients
Informing the patient or parents that charges will be made for repeated missed appointments, starting at $10 Noting missed appointments in red on the treatment chart, and consulting with the patient and parents if more than two appointments are broken After a certain number of broken appointments (usually two or three), sending a letter-- perhaps a humorous one-- to the parents requesting their help in keeping treatment running smoothly Telephoning patients with long appointments the day before-- especially those with a history of missed appointments Separating out the records of patients who miss appointments until new appointments are made, and contacting them at the end of the week if they have not yet rescheduled Scheduling chronic delinquents at times that are hardest to fill (late morning or early afternoon) Rewarding patients who are not late and do not miss appointments with small gifts, cards, plaques, etc. JCO wishes to thank the following participants in this month's column:Dr. Iren M. Baker, Louisville, KYDr. Helen P. Delivanis, Louisville, KYDr. Philip M. Campbell, Huntsville, TX Dr. Ronald L. Gallerano, Houston, TX Dr. David B. Kennedy, Vancouver, BC Dr. Mladen M. Kuftinec, Louisville, KYDr. George W. Lundstedt, Lynnfield, MADr. Barry D. McNew, Greenville, TXDr. Kevin J. Showfety, Louisville, KYDr. Barton H. Tayer, Brookline, MA
