THE READERS' CORNER
Topics are retention and meeting with parents.
1. What is your preferred retainer for the nonextraction patient?
More than 80% of the respondents preferred a Hawley-type retainer for the maxilla. About one-third of these said they used a wraparound design with no wires crossing the occlusion. However, virtually every clinician mentioned individual design variations.
For the mandible, the respondents were almost evenly split between removable and fixed retainers. More than 70% of the removable retainers involved a "spring retainer" design from canine to canine, with many practitioners extending a lingual flange to the first molars. Hawley-type retainers were recommended by about one-fourth of the removable appliance users. The leading fixed appliance was the bonded 3-3; 4-4 and 5-5 retainers were occasionally mentioned, and several readers suggested Zachrisson-type spiral-wire retainers.
Retention regimes also varied considerably, with the most common one involving one year of full-time wear followed by a year of night-time wear. Some prescribed the removable retainer at night until the third molars had erupted or the patient went to college. Indefinite retention was often mentioned, especially with occasional wear (such as once a week) for adult patients.
What is your preferred retainer for the extraction patient?
About three-fourths of the readers reported using the same retainers and retention regimes for extraction patients as for their nonextraction patients. Those who varied their protocols tended to use more wraparound retainers in the maxilla to eliminate wires crossing the extraction sites. In the mandible, the principal difference involved extending both removable and fixed retainers posterior to the extraction sites.
How frequent are your retainer visits?
Virtually all of the clinicians said they progressively increased the length of time between retention visits. Examples included: four weeks, six weeks, eight weeks, three months, six months, one year; monthly for three months, then quarterly; two weeks, one month, three months, six months.
Is retention included in your usual fee? If not, how much do you normally charge?
Retention was included in the fee for 88% of the respondents. Of the remainder, some charged a per-visit fee of about $30, and others had a fixed price ranging from the cost of the retainer (around $140) up to $700.
Specific comments included:
2. How often do you normally meet with patients' parents or guardians?
While 53% of the clinicians reported meeting frequently with parents during treatment, 47% said they seldom met with parents. Virtually all of the respondents reported meeting at least occasionally with parents after treatment.
What particular occasions call for a meeting ?
Poor cooperation with oral hygiene, headgear, or elastics was the most common occasion for a meeting. Regular six-month progress reports were mentioned by nearly half of the practitioners. A change in the treatment plan was the third most common factor, with the need for fiberotomy or third-molar extractions occasionally mentioned.
Does the patient's chart reflect these meetings?
Almost all of the clinicians noted parent meetings on their patients' charts. About one-third simply noted the date, but the rest entered specific notes about what was discussed and recommended.
Do you prefer to have a staff member handle these meetings? Why or why not?
More than 70 percent of the doctors preferred to handle the meetings themselves. They felt it was important for the parents to be able to talk directly to them, and for them to know what was said. Some of the readers had staff members handle routine conferences, while they dealt with those involving problems.
Do you find it more difficult to schedule meetings with fathers than with mothers, and why?
The clinicians unanimously found it more difficult to schedule meetings with fathers. The main reasons were thought to be the fathers' work schedules and commuting distances.
How do you meet with divorced parents?
Most of the readers preferred to meet with both parents together. If this were not possible, most said they met primarily with the financially responsible parent, but encouraged the other to come at least once so as to understand the treatment being recommended. In many cases, both parents were sent copies of all correspondence and financial information. Some clinicians required both parents to sign consent forms before starting treatment. Telephone calls to the absent parents were also frequently mentioned as a means of communication.
Do you have any methods for improving parents' attendance at meetings?
About half the respondents answered "no" . Strategies used by the others included scheduling the meetings at times convenient for the parents, such as 8 a.m., lunchtime, and after 4 p.m., and confirming the appointment with a letter or call.
What do you do about parents who never come to the office?
Many of the orthodontists reported sending letters to inform these parents of their children's progress and problems. Others sent copies of their patients' six-month progress report cards. Several doctors said they attempted to call the parents in the evening, when they were more likely to be at home.
Do you encourage or discourage parents or guardians from entering the treatment area?
More than 75% of the clinicians discouraged parents from entering the operatory. They felt this would add another distraction to a busy schedule and disrupt the traffic flow in the treatment area. Some thought the children might "perform" for their parents, making the staff's job more difficult.
Do you think that parental influence can improve the cooperation of child patients?
More than 90% of the respondents believed that parents can improve the cooperation of their children, and they tried to take advantage of this whenever possible. Parental influence was considered particularly important in difficult cases.
The following are representative comments:
JCO wishes to thank the following contributors to this month's column:
Drs. Samuel Ackerman and Alan R. Weber, Cincinnati, OH
Dr. Andrew Alexander, Tampa, FL
Associates in Orthodontics, Burlington, VT
Dr. Paul Batastini, Cherry Hill, NJ
Dr. Eldon D. Bills, Flagstaff, AZ
Boise Orthodontic Associates, Boise, ID
Dr. Roger L. Bumgarner, Castle Rock, CO
Dr. Carl C. Casperson, Bloomington, MN
Dr. Lynn Dettenmayer, Sarasota, FL
Dr. James A. Evans, Rapid City, SD
Dr. Melvin M. Feldman, Rutherford, NJ
Dr. Vacharee B. Fell, Culver City, CA
Dr. Leonard Goddard, Chatham, NJ
Dr. Kenneth R. Greenbaum, Salem, OR
Dr. Ormond Grimes, Jr., Gadsden, AL
Dr. David C. Hamilton, Jr., Hickory, NC
Dr. Douglas W. Hom, La Puente, CA
Dr. Charles W. Houghton, Roanoke, VA
Dr. Thomas J. Huerter, Blair, NE
Dr. William Hyman, Montebello, CA
Dr. Jay C. Kaltman, Plantation, FL
Dr. Earle A. King, Wexford, PA
Dr. Robert A. Kobylarz, Utica, MI
Dr. David G. Lehman, Elkhart, IN
Dr. W. Bonham Magness, Houston, TX
Dr. R.T. McDaniel, Springfield, IL
Dr. Edward M. Morin, Worcester, MA
Dr. James A. Morrish, Jr., Bradenton, FL
Dr. Peter H. Nasser, Shreveport, LA
Dr. Richard E. Offerman, Waukesha, WI
Dr. Thomas G. Robinson, Sault Ste. Marie, MI
Dr. George Schudy, Houston, TX
Dr. R. Neil Schultz, McMinnville, TN
Dr. Stephen Scola, Smithtown, NY
Dr. John R. Shaw, Cazenovia, NY
Dr. Darrell G. Smith, Roy, UT
Dr. Robert E. Sutter, Lodi, CA
Dr. Michael D. Switkes, Jacksonville, FL
Dr. Robert J. Tacy, Sunnyvale, CA
Dr. Thomas P. Weirich, Oklahoma City, OK
Dr. Charles D. Welch, Jr., Florence, SC
Dr. Peter D. Wendell, Wiliamsburg, VA
Dr. Richard J. Woterman, Cincinnati, OH
Dr. Robert T. Workinger, Marshfield, WI
