THE READERS' CORNER

This month's topics are bicuspid extractions and "professional courtesy".

1. What are your opinions on the effectiveness of extracting second bicuspids vs. first bicuspids? What percentage of your active cases would you say is in each category?

While the clinicians reported a wide variety of opinions, many felt mandibular second bicuspid extractions were most effective in adolescent patients that met some or all of these criteria: moderate skeletal Class II pattern, straight profile, mild-to-moderate mandibular crowding, upright lower incisors, full-step Class II molar relationship, little remaining growth potential, possible problems with headgear cooperation, and open-bite tendency requiring more posterior extraction.

When mandibular second bicuspids were extracted, it was most commonly in combination with maxillary first bicuspids. Those who favored extracting lower second bicuspids believed the ability to advance the molars without over-retracting the incisors outweighed any potential difficulties--including leveling deep bites, obtaining good contact between the first bicuspid and molar, maintaining root parallelism, and keeping extraction spaces closed.

The reported frequency of second bicuspid extractions ranged from 1% to 85%, but a large group of orthodontists said between 15% and 20% of their extraction cases involved second bicuspids.

Some representative comments:

"I try to avoid second bicuspid extractions in adults due to opening of the extraction sites."

"In cases with Class III molars and mild anterior crossbite, where the patient refuses surgery, I will extract the maxillary second bicuspids and the mandibular first bicuspids."

"Maxillary second bicuspid extraction is good in the presurgical stages of a Class II orthognathic case, combined with mandibular first bicuspids."

"Extraction of second bicuspids is indicated when there is not a need for maximum anchorage to retract the anterior teeth--in other words, when about half of the width of the first bicuspids is necessary to align the teeth."

2. To whom do you extend "professional courtesy", and how much of a discount do you give?

There was fairly uniform agreement about giving professional courtesy to referring dentists and their families. A 100% discount was by far the most common, although cost (overhead rate) and 20% discounts were also mentioned.

Beyond that point, the respondents split into two even groups. Some specified exactly who received professional courtesy and listed exact discounts. Others determined discounts on a case-by-case basis.

Assistants from other dentists' offices frequently received a discount, usually about 20%. If the staff member was from a referring dentist's office, particularly a regular referral source, the courtesy was almost universal and more often 50%.

Families of the orthodontist's own staff almost always received a discount, most commonly 20%, sometimes 50%, and occasionally 100%. Few respondents extended professional courtesy to physicians and other non-dental professionals, and then with only a 20% discount.

Comments included:

"Professional courtesy is sometimes extended to religious groups, students at schools for the blind, orphanage children, etc."

"I used to extend professional courtesy to physicians, but feel that it was a one-way street and have now discontinued this practice."

"I give a 20% reduction for multiple family members under treatment."

"There is no charge to our employees after one year of employment."

"We give a 100% discount to full-time employees and 50% to part-time employees."

JCO wishes to thank the following contributors to this month's column:

Dr. John P. Anderson, Atascadero, CA

Dr. James E. Bradley, Silver Spring, MD

Dr. Douglas S. Cameron, Bellevue, WA

Dr. J.P. Devin, Laramie, WY

Dr. James K. Economides, Albuquerque, NM

Dr. A. James Felli, Corning, NY

Dr. Miller W. Gibbons, Wilson, NC

Dr. Herbert J. Gordon, Chicago, IL

Dr. Hubert E. Kiser, Bluefield, WV

Dr. Harold Levin, Reseda, CA

Drs. Otto E. Minshall and George B. Wedell, Kenosha, WI

Dr. Jerome S. Schechter, Allen, TX

Dr. Louis D. Schultz, Houston, TX

Dr. Joseph H. Seipp, Baltimore, MD

Dr. Ronald R. Snell, Sonora, CA

Dr. Lloyd B. Swiedom, Houston, TX

Dr. Charles W. Weathers, Waco, TX