THE READERS' CORNER

1. How often and for what reasons do you prescribe any of the following drugs or treatments?

Anti-inflammatory drugs and muscle relaxants

Only a few of the respondents said they prescribed these drugs routinely in their practices, but anti-inflammatory drugs were used occasionally by 51%, and muscle relaxants occasionally by 46%, mainly for TMJ-related problems. A little less than half of the orthodontists reported never prescribing either class of drugs.

Anti-sialogogues

These were not used at all by 65% of the practitioners. Another 24% used them occasionally and 11% routinely for bonding.

Pain medications

About three-fourths of the clinicians reported prescribing pain medications occasionally for their patients, but fewer than 5% did so routinely. Analgesics were prescribed both for TMJ pain and for the pain associated with orthodontic separators and banding.

Acupuncture and physical or osteopathic therapy

Only 9% of the respondents used acupuncture, and then only for TMJ patients. Physical therapy was at least sometimes prescribed by 37% of the clinicians, both for TMJ problems and for rehabilitation following orthognathic surgery.

Which of the following do you routinely prescribe?

Toothpaste

Toothpaste was prescribed by 71% of the practices. Most of these specified a fluoride-containing product, with 33% mentioning Crest and 40% not giving a brand recommendation.

Mouthrinse

Two-thirds of the offices recommended mouthrinses to their patients. Of these, one-third listed Colgate's Phos-Flur, one-third mentioned either ACT or Scope, and one-third did not identify a specific product.

Dental floss

Floss was prescribed by 71% of the respondents, with 28% of these recommending Super Floss, 25% listing no particular product, and the rest split among several different brands.

Manual toothbrush

A large majority (84%) of the practices recommended the use of manual toothbrushes. Oral-B was the most popular brand among these respondents (47%), followed by Butler (21%).

Electric toothbrush

Electric toothbrushes were prescribed by just under half of the respondents. Of these recommendations, nearly half went to the Interplak, followed by Braun (23%) and Oral-B (13%).

Irrigator

Only 36% of the orthodontists recommended oral irrigators, but the Water Pik was the choice of more than 80% of those.

Wax

Wax was prescribed by about three-fourths of the offices, who used a wide variety of products. Many clinicians reported using "generic" wax in their own packaging.

2. Do you currently have a video imaging system in your practice?

Only 20% of the respondents had imaging systems. Of the remaining practices, 18% planned to purchase one within the next year, and the rest said they would buy one "sometime" or "never".

Please indicate the system you own and your reasons for purchasing it.

One-third of the practices that had video imaging reported using the Quick Ceph system, primarily because of its ease of use. Many of those who were planning to buy a system in the near future also mentioned Quick Ceph. The remaining respondents used a variety of other products.

If you own a video imaging system, what do you use it for?

Virtually all of the offices used their systems for patient education and communication as well as for public relations and marketing. Only 58%, however, used them in diagnosis and treatment planning.

Specific comments included:

"For new patients at the initial exam, it makes it easier for the patient and parent to understand the orthodontic problem. It also conveys a high-tech image of your practice and sets your office apart."

"It improves communication in today's managed-care market. Using a 'smile bank', you can demo a post-treatment smile and profile--which may increase your treatment acceptance rate."

"We can put braces on the patient's initial photos to show them what they would look like with appliances on."

"Video imaging allows me to immediately show the patient images of their malocclusion, and they take a picture of this home with them. It is much easier for the patient to understand crossbites and the position of ectopically erupting or ankylosed teeth if they can see it on the screen."

"We use it for every new exam and send photo printouts with our consultation letters to the patient and referring dentist."

"We don't do a live demo to the patient because it is too time-consuming, but we do generate a printout of their photos along with the folder we give them."

Do you feel the system has increased your conversion rate of new starts?

Fully 82% of the video imaging users said the systems had boosted their conversion rates. Another 8% were unsure, and 10% felt their start rates had not been increased.

If you own a system, what advice would you give other orthodontists?

"Define your needs and goals prior to making a purchase. Find a system that fits your needs."

"Have a staff member totally committed and excited about learning the system. It takes a lot of time, effort, and patience to integrate smoothly and completely into the practice."

"Take the time necessary to learn how to take good intraoral pictures."

"Make sure installation and continuing support are good."

If you do not own or plan to purchase a system, what are your reasons?

Of the non-users, 53% reported that cost (currently $12,000-16,000) was their chief concern; 33% said they had no perceived need for such a system; and 10% said they did not understand video imaging and were unsure of its capabilities. Comments included:

"I would enjoy using one if the price were reduced."

"I don't want my patients to expect the exact result shown."

"I don't want to promise a result that cannot be achieved."

"I'm not yet convinced, but I won't say never."

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

Dr. Larry K. Aagesen, Rochester, MI

Dr. Robert Anderson, Fairfield, CA

Dr. John D. Block, San Bruno, CA

Drs. Ronald S. Branoff and James G. Gordon, Pikesville, MD

Dr. Joel F. Brodsky, Lakewood, CA

Dr. Kathleen M. Burr, South Windsor, CT

Dr. George M. Ciavola, Rutland, VT

Dr. Harold J. Cohen, Hanover, PA

Dr. David R. D'Aloisio, Sudbury, Ontario

Dr. Kerry C. Davirro, Pacific Palisades, CA

Dr. Frederick N. Dibbs, Reston, VA

Dr. Kenneth R. Diehl, Durham, NC

Dr. James B. Donaghey II, Mobile, AL

Dr. Sheldon Dorfman, Montreal, Quebec

Dr. Alan K. Fulks, Iron Mountain, MI

Dr. Michael J. Graham, Cullman, AL

Dr. James B. Gray, Cumming, GA

Drs. David B. and Frederick C. Hamer Jr., Charlottesville, VA

Dr. John F. Harrington, South Bend, IN

Dr. Gerard Kass, Waterbury, CT

Dr. Earle A. King, Wexford, PA

Dr. Causey C. Lee, Hialeah, FL

Dr. Justin J. Martin Jr., Canandaigua, NY

Drs. Joseph A. McCormick and Paul Carpinello, Lansdowne, PA

Dr. Barry D. McNew, Greenville, TX

Dr. Brian H. Miller, Newton Centre, MA

Dr. Wayne H. Minami, Waldorf, MD

Dr. Peter H. Nasser, Shreveport, LA

Dr. Robert G. Nowlin, Waco, TX

Dr. William P. O'gara, Reno, NV

Drs. Harry A. Osborne and Michael J. Bernard, North Canton, OH

Dr. David E. Paquette, Charlotte, NC

Drs. Vincent A. Parisi, Robert E. Doleva, and Emil O. Rosenast Jr., Wyomissing, PA

Dr. Thomas R. Pitts, Minden, NV

Dr. Paul T. Rasmussen, Schenectady, NY

Dr. Daniel F. Rentz, Pensacola, FL

Dr. William C. Richardson Jr., Lynchburg, VA

Dr. Hector Luis Rodriguez, Santo Domingo, Dominican Republic

Dr. Clark E. Schneekluth, Huntington Beach, CA

Dr. Gregory P. Scott, Lakeland, FL

Drs. Wayne O. Sletten and John F. Lawson, Albert Lea, MN

Dr. Dennis D. Sommers, Minot, ND

Dr. Fred L. Spradley, Fort Worth, TX

Dr. Buford J. Suffridge, North Little Rock, AR

Dr. Robert H. Thalgott, Las Vegas, NV

Dr. Jeffrey W. Vecere, Cape May Court House, NJ

Drs. W. Michael Wainwright and Philip G. Barer, Vancouver, BC

Drs. William Wallert and Alan Bagden, Springfield, VA

Dr. Danny Weiss, Memphis, TN

Dr. Bonnie D. Wheatley, Winchester, KY

Dr. Robert A. Winkler, Scottsdale, AZ

Drs. Barry F. Wood, Alan M. Patrignani, and Charles W. Kohout, Williamsville, NY