THE READERS' CORNER
The topics are staff training and second molar extraction.
1. How do you handle operatory staff training?
Virtually all the respondents reported using a combination of several different techniques. Direct instruction by the doctor or other staff members was used by more than 80% of the respondents. More than 75% used on-the-job training, often in conjunction with direct instruction. Staff meetings, cited by 60%, were a popular means of disseminating information. Although training manuals were used by 60% of the readers, they received mixed reviews. Outside courses were used regularly by 40% of the offices, and textbooks and videotapes each by about 25% .
Most practices had similar training techniques for new and current staff, except that typodont instruction was used by nearly 50% for new employees, but by only 20% for current employees.
If you use in-house instructional material, how was it prepared?
Nearly 75% of the respondents used in-house instructional material, but methods of preparation varied widely. Training manuals were often produced by the orthodontist alone or by the orthodontist and senior staff members. Many offices said this was a long-term process, with new items added periodically to their manuals. Some mentioned that incorporating ideas gleaned from other practices was a good way to update the training manual.
If you use outside material, whose material do you use?
A wide variety of products were mentioned. The only one that seemed to be widely used was Welcome to the World of Orthodontics by Dr. James Reynolds.
What courses or meetings have your staff members attended in the past year?
The majority of the readers had sent their staff members to one meeting during the previous year. Most often it was a local meeting with a practice management theme.
What do you estimate to be the cost of training an operatory assistant in time and materials?
About half of the respondents were not sure what it cost them to train a new assistant. The other half had responses ranging from $300 to $10,000; the consensus seemed to be that it cost $2,000-3,000 and took about three months. Some offices added that it really took at least six months to get a new assistant working at full efficiency.
Do you monitor the results of your training?
Very few practices had any formal monitoring process, relying instead on the doctor's, the staff's, and often the patients' observations about how a new employee was performing. Periodic reviews were reported by some offices, particularly at three- and six-month intervals.
What plans do you have for improving or intensifying training?
More than two-thirds of the readers said they were satisfied with their current programs and planned no major changes. Those who did envision making changes most often mentioned using more formal evaluations and more staff meetings.
Specific comments included:
2. In what percentage of cases do you extract second molars? What are your indications and contraindications ?
The respondents to this question fit into two distinct groups. More than 25% said they never took out maxillary second molars unless they were carious or severely compromised (e.g., impacted, malformed). This group took out second molars in only 1-2% of their cases.
The remaining 75% of the clinicians were more likely to extract second molars, but still in only 5-10% of their cases. Their indications included a Class II, division 1 malocclusion with a normal-to-high mandibular plane angle; a good profile; an acceptable lower arch; mild maxillary crowding; well-formed and well-positioned maxillary third molars; and the expectation of good cooperation with headgear or intraoral appliances. Their contraindications included poor third molar crown size, shape, and position; bimaxillary protrusion; a poor record of cooperation; and severe enough crowding that bicuspid extractions would shorten treatment time.
More than 90% of the readers reported never electively extracting mandibular second molars; only 5% said they used the technique routinely. In general, the respondents removed lower second molars only when there was distinct pathology, severe caries, or significant impaction.
Most clinicians said they were unable to distalize the mandibular first molars significantly and found that only about 10% of the lower third molars erupted acceptably. In contrast, they felt that about half of the upper third molars were likely to erupt into a satisfactory position after second molar extractions.
At what age do you typically remove second molars?
The most common age for second molar extraction was the early teens. A few clinicians advocated early extraction (10-12 years old), and others recommended waiting until age 16, particularly for male patients.
There was general agreement that control of third molar position was required in most second molar extraction cases. Many readers said this added six to 12 months to treatment time. The third molar evaluation was either incorporated into the normal full treatment or added as a partial treatment phase after the third molars had fully erupted.
Comments included:
JCO wishes to thank the following contributors to this month's column:
Dr. Cyrus M. Alizadeh, Chesterfield, MO
American Dental Group, Sterling Heights, MI
Dr. Stephen K. Bailie, Indianapolis, IN
Dr. Barry Briss, Chelmsford, MA
Dr. Stephen Chu, Carrollton, TX
Dr. Jerry Clark, Greensboro, NC
Dr. Ronald B. Cooper, Mount Pleasant, SC
Dr. Arnold G. Greene, Lake Worth, FL
Dr. John H. Ferguson, Milledgeville, GA
Dr. Lamont R. Gholston, Louisville, KY
Dr. Edward M. Goldman, Westminster, MD
Dr. Michael A. Harrison, Sumter, SC
Dr. Ross G. Kaplan, Salem, OR
Dr. Joseph J. Kincaid, Moultrie, GA
Dr. Mark D. Knoll, Bellmore, NY
Dr. Michael A. Miroue, El Cajon, CA
Dr. Harry Newman, Freeport, NY
Dr. Charles W. Nichol, Dallas, TX
Drs. George Payne, Delmar Mobley, and Brian Payne, Santa Rosa, CA
Dr. Peter I. Pfaffenbach, Schenectady, NY
Dr. J. Scott Pinkard, Marquette, MI
Dr. Robert H. Rappaport, Longmeadow, MA
Dr. E. Stephens Reed, Jr., College Park, GA
Dr. Jeffrey Sessions, Lake Oswego, OR
Dr. Bruce J. Snyder, San Mateo, CA
Dr. Joseph L. Tabourne, Somerset, NJ
Drs. Robert L. Tanner and Jeanne L. McDonald, South Portland, ME
Drs. Thomas L. Thompson and George B. Clarke, Jr., Fresno, CA
Dr. Mark E. Thomson, Plattsburgh, NY
Dr. Ronald G. Tietz, San Antonio, TX
Dr. Scott Tyler, Birmingham, MI
Dr. James L. Wetzel, Jr., Casper, WY
Drs. John White and Leroy H. Kulis, Kent, OH
