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Topics this month include non-compliance appliances and fee-payment options.

1. Do you use non-compliance appliances?

Seventy percent of the clinicians reportedthat they "sometimes" used non-compliance devices;8% "always" used them, and 3% "never"used them.

Under what circumstances do you use non-complianceappliances?

Replies of the clinicians who used thesedevices were evenly distributed among "actualnon-compliance", "anticipated non-compliance",and "lagging treatment", with most respondentsindicating that they used them in all three categoriesof patients.

Which non-compliance appliances do you use?

Most clinicians reported using more thanone appliance. The two most frequently listedwere the Forsus (a fatigue-resistant device fromUnitek) and the Herbst. Other devices, in decreasingorder of usage, were the Hilgers Pendulum,Jasper Jumper, Jones Jig, MARA, and ClassII Corrector. Also mentioned were the MandibularProtrusion Appliance, the Williams maxillarySeries 2000, the Eureka Spring, a Nance archwith Sentalloy distalizing springs, a fixed anteriorbiteplane, and a tied-in lip bumper.

What problems have you encountered using non-complianceappliances?

Multiple problems were listed by mostrespondents, with only 5% reporting no complicationsat all. By far the most common problemwas breakage, followed by excessive anchorageloss (usually expressed as flaring of the lowerincisors) and tissue impingement. Less frequentlymentioned difficulties included loose-fittingappliances, incomplete correction, patient discomfort,emergency visits, loss of function,relapse, displacement of the condyle from thefossa, and speech and oral hygiene problems.

How often do you use Class II non-complianceappliances such as the Herbst or Jasper Jumperwith no control of forward movement of thelower incisors?

Again, the majority of clinicians checkedmore than one response, but the most prevalentanswer was "never", indicating a focused awarenessof the position of the lower incisors. Thiswas closely followed by "sometimes"; only 10%indicated that they "always" used these deviceswithout any extra control over the lower incisors.

How do you control anchorage loss when usingnon-compliance appliances?

The mechanism most frequently mentionedwas a heavy, stable archwire in an aligned arch.This was generally used in combination withother mechanics, the most common being aNance arch or facial root torque on the lowerincisor brackets. Other alternatives listed werelingual arches, cinched-back archwires, transpalatalarches, Class II elastics, and second molarbanding.

Do you find that patients prefer non-complianceappliances compared to headgear or elastics?Why or why not?

Three-quarters of the respondents reportedthat their patients preferred non-complianceappliances over headgear and elastics. The usualreasoning centered around the reduced need forpatient responsibility and for lectures from theorthodontist. Many other clinicians commentedthat patients did not like wearing headgear, andthat non-compliance devices were a more acceptablealternative. Another point mentioned wasthat wearing non-compliance appliances tendedto make treatment faster and more predictable.

The clinicians whose patients did not prefernon-compliance appliances said they thought thedevices performed no better than headgear orelastics, that patients looked belligerent withtheir jaws being constantly positioned forward,that the appliances were bulky and difficult toclean, and that if they were used in a Class IIIvector, they were constantly forcing the condyledistally in the fossa.

2. What fee-payment options do you offer?

All the respondents used multiple fee-paymentoptions, with a relatively even distributionamong monthly in-office payments, monthlycredit-card payments, third-party finance companies,and full payment in advance. Slightly feweroffices used preauthorized monthly bank debitsystems and preauthorized monthly credit-cardpayments.

If you collect fees in-house, do you send bills? Ifso, do you bill only delinquents?

Two-thirds of the respondents did not sendbills for fees collected in-house. Of those whosent bills, two-thirds mailed them only to delinquentaccounts.

If you use a credit-card payment system, whatpercentage are you typically charged for credit-cardfee payment?

Credit-card fee percentages varied from 0%to 3.5%, with most in the range of 2.2-2.8%. Afew clinicians were charged a set fee of a littlemore than 1.5%, plus 21 cents per swipe of acard.

What percentage of your patients use credit-cardpayment?

There was a wide range of responses, withan average of approximately 22%. Several cliniciansreported that more than 35% of their patientspaid by credit card, but these were balancedby those reporting fewer than 5% credit-cardpayers.

What is your average monthly cost for using acredit-card payment system?

Again, the responses varied widely, from$25 to $2,100. The average monthly expense,however, was in the vicinity of $180-200.

If you use a third-party finance company, whichcompany do you use?

Ninety-two percent of the clinicians reportedusing Orthodontists Fee Plan. A few otherssaid they used OCB or Wells Fargo as their third-partyfinance companies.

What percentage of your patients use third-partyfinancing?

The most common responses were between5% and 11%, with a low of less than 1% and ahigh of 50%.

What are the advantages to the doctor of third-partyfinancing?

The prime advantage appeared to be gettingthe complete fee up front, thus avoiding the needfor billing or for turning patients over to a collectionagency. Third-party financing was consideredparticularly helpful when dealing withfinancially at-risk patients. Another frequentlymentioned benefit was that the clinician couldfinish a case early without considering the effecton fee collection. Tangential remarks includedthe observations that prepayment by third-partyfinance companies increased cash flow andimproved the morale of the business office, andthat more patients could be offered treatment.

What are the advantages to the patient of third-partyfinancing?

The major advantages cited were the optionsof an extended payout period (as long asfive years), flexible payment plans, and no downpayment. The convenience of third-party financingfor both doctor and patient was also emphasized.

Do you offer a discount for full payment inadvance, and if so, how much?

With the exception of one respondent, allthe clinicians offered at least a 5% discount forfull payment in advance. Nineteen percent of therespondents provided a 7% discount, and 15%offered 10%.

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

Dr. Len Ackermann, Anoka, MN

Drs. Michael S. Apton and Joshua H. Rothenberg, Stony Brook, NY

Dr. Robert A. Bard, Gurnee, IL

Dr. Anthony E. Bisconti, Youngstown, OH

Dr. John J. Brady, West Hazleton, PA

Dr. Douglas M. Brown, Claremont, CA

Dr. Bruce D. Burns, Kernersville, NC

Dr. Steven Cheng, Schaumburg, IL

Drs. Dominic A. Colarusso and M. Kurtz Dietzer, Hamburg, NY

Drs. Edward A. Cronauer and Rosie Angelakis, Pembroke Pines, FL

Drs. Richard M. Dunn and John X. Cordoba, Lake Mary, FL

Drs. James Frugé and André Frugé, Baton Rouge, LA

Dr. Peter Galgano, Camarillo, CA

Dr. Jeffrey S. Genecov, Plano, TX

Dr. Joseph P. Giordano, Andover, MA

Dr. Ernest J. Goodson, Fayetteville, NC

Dr. David C. Hamilton, Jr., Hickory, NC

Drs. Todd Hamilton and Steven Austin, Lincolnton, NC

Dr. David J. Hibl, Louisville, CO

Drs. Gregory R. Hoeltzel and Richard J. Nissen, St. Louis, MO

Dr. Erik W. Hrabowy, Columbus, OH

Dr. Stephen B. Ingram, Lebanon, PA

Drs. Christopher Kesling and Thomas R. Rocke, Westville, IN

Dr. John S. Konegni, Lakewood, CO

Dr. Richard G. Lord, Champaign, IL

Dr. George W. Lundstedt, North Reading, MA

Dr. Scott S. Masunaga, Honolulu, HI

Dr. Gil C. McAdams, Apple Valley, CA

Dr. Nancy A. McNamara, Bordentown, NJ

Dr. Mark J. Mills, Colorado Springs, CO

Dr. Orrin D. Mitchell, Jacksonville, FL

Dr. L. Owen Nichols, Greenbrae, CA

Dr. Bradley Nirenblatt, North Charleston, SC

Dr. John F. Oliver, Brownwood, TX

Dr. Ronald L. Otto, Roseville, CA

Dr. Mario E. Paz, Beverly Hills, CA

Dr. Norman J. Pokley, Caro, MI

Dr. Patrick M. Redmond, Rochester, NH

Drs. Eric J. Reitz and Gary J. Yanniello, Bethel Park, PA

Dr. Kendra J. Remington, Guilford, CT

Drs. Cliff H. Running and E.H. Todd Hellwig, Scottsdale, AZ

Dr. Sigrid C. Schwartz, Kokomo, IN

Dr. Siobhan M. Sheehan, Duxbury, MA

Dr. John M. Sparaga, Anchorage, AK

Dr. Terence C. Sullivan, Mill Creek, WA

Dr. T. Barrett Trotter, Augusta, GA

Dr. David W. Warren, Miami, FL

Dr. David L. Wells, Sylvania, OH

Dr. John C. White, Aurora, OH

Dr. Robert E. Williams, Baltimore, MD

Dr. Janice J. Wilmot, Lilburn, GA

Dr. William Wood, Red Bank, NJ

Dr. William L. Wright, Jackson, MI

Dr. David W. Zemke, Minneapolis, MN


Dr. Sheridan is an Associate Editor ofbthe Journal of Clinical Orthodontics and a Professor of Orthodontics, Louisiana State University School of Dentistry, 1100 Florida Ave., New Orleans, LA 70119.

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