JCO Survey of Referring Dentists

Responses to the JCO Survey of ReferringDentists offer orthodontists many clues aboutforming better relationships with GPs. The surveywas mailed on June 30, 2003, to an arbitrarysampling of 5,000 general dentists from theAmerican Dental Association list. Another mailingwas sent on Sept. 5, 2003, to 2,500 differentgeneral dentists. A total of 539 answers were received,for a response rate of 7.2% (Table 1).

It should be emphasized that because of thesmall sample size, this is more of an opinion pollthan a scientific survey. Our objective was toobtain dentists' views and comments about howand why they refer patients to particular orthodontistsand what kinds of communication theyfind valuable.


The respondents reported that the mostimportant factors in the GP-orthodontist relationshipwere the orthodontist's treatment results,their patients' satisfaction with their orthodontictreatment, and the orthodontist's reputation(Table 2). Good communication about mutualpatients before, during, and after treatment wasfairly close behind (when "very important" and"somewhat important" were combined).Convenient location of the orthodontist's officewas considered at least somewhat important by asizable majority. Whether the orthodontist offeredfree initial consultations and the dentist'sfriendship with the orthodontist were the leastimportant. Responses to the JCO OrthodonticPractice Studies have indicated, however, that theoffer of a free initial consultation is of someimportance to patients, and cultivating the friendshipof GPs certainly couldn't hurt.

Around three-quarters of the respondentsindicated that they would like the orthodontist torefer patients back to them for their periodic dentalcheck-ups (Table 3). Nearly as many encouragedstaff-to-staff relationships. The dentistswere about equally divided on whether theywould like to share their x-rays with the orthodontists or have the orthodontists take their own x-rays.

Respondents expressed a strong desire forwritten reports about their patients before andafter treatment, accompanied by patient photographs(Table 5). There was some interest inseeing photographs of patients' models, but relativelylittle interest in cephalometric tracings.

When asked how they would like to becommunicated with, a large majority of the dentistsfavored regular mail (Table 6). More thanhalf wanted telephone communication. It wasinteresting that fewer than 10% preferred e-mail.

Considering that there was at least someinterest shown by respondents to this survey inevery aspect of the GP-orthodontist relationship,it would be helpful for orthodontists to find outthe preferences of the dentists in their own areas.Toward that end, we offer a survey form thatcould be sent to those dentists (Fig. 1).

Dentist Comments ([table=4]Table 4[/img])

Many respondents to the JCO Survey ofReferring Dentists offered interesting comments,some of which are listed below:

  • Not enough orthodontists doing early orthopedicinterceptive treatment in my area.
  • Orthodontists must treat TMJ as well.
  • Why do some orthodontists not treat the secondmolars? I have seen braces off before thesecond molars are fully erupted.
  • It would be nice to be kept informed of treatmentso I could learn and better evaluate what isgoing on treatment-wise with the more advancedcases. Solely to better my understanding.
  • I do a moderate amount of orthodonticsmyself, and I am always interested in the diagnosisand treatment planning of my patients that Irefer. Our local orthodontist does a nice job ofsending an initial diagnosis letter, but it wouldalso be helpful for him to send a note at the end.
  • Orthodontists should be acutely aware ofocclusion and equilibration.
  • Orthodontists are extremely hard to convinceGPs know anything about ortho!
  • I never get any communications after the firsttreatment letter, and the letter is usually esoteric.
  • When further professional consultations areneeded (i.e., periodontist, oral surgeon), I want tobe included in the decision on where to refer thepatient.
  • Referrals to the general dentist are an importantpart of the relationship.
  • It would be nice to have orthodontists be moreaware of the periodontal status of the teeth.
  • Consult about cosmetic procedures and options.
  • Orthodontists rarely refer patients back forperiodic exams.
  • Referring to an orthodontist who gets alongwith teen-agers is a big deal!
  • I have found in 25 years of practice that abouthalf the female patients who have bicuspidsextracted and who wore headgear experienceTMJ problems starting in their 20s. I refer toorthodontists who allow the maxilla to developnaturally and bring the mandible forward tomatch it, and who expand or distalize rather thanextract.
  • If it is obvious that the patient is not keepingregular prophylaxis appointments, then a referralby the orthodontist would be helpful.
  • Orthodontists need to provide the general dentistwith written records and photos. A phoneconversation is a stress on my patient scheduleand has too much detail to remember accurately.
  • I expect my orthodontist to refer restorativepatients to me.
  • Communication is the key. The best orthodontistsutilize available technology to communicatewith me, photos included, with diagnostic evaluationand continual updates.
  • Wish all orthodontists understood more aboutthe function of the dentition and what it will looklike 10+ years after treatment.
  • I want bands and bonds to be as free of leaksas possible.
  • I want minimal invasion of brackets, wires,etc., into gum tissue.
  • Orthodontists should be willing to treat minortooth movements.
  • It is important that archwires be removed at thetime of prophylaxis so I can really scale and polishthe teeth.
  • I observe that most orthodontists give theimpression that they are too busy to send informationabout treatment to the general dentist. Itis important to us to be able answer questions bypatients or parents, which we cannot do withoutproper information. My feeling is if we take thetime for the referral, they should send informationto us before, during, and after treatment.
  • "Free" initial consultations for patients areattractive.
  • It is very important to get new patient referralsfrom an orthodontist.
  • I want enough information to understand treatmentand answer questions from patients or parents.
  • Orthodontists need to stress the need of periodiccheck-ups and prophies with the generaldentist.
  • I expect treatment to CR.
  • Every case is "comprehensive". I have had anumber of complaints, but have no avenue ofredress.
  • I see frequent root resorption and unadjustedocclusions.
  • Too many orthodontists (at least in our area)have expanded too much the duties of their assistants.
  • I do not refer to an orthodontist if my patientshave problems with excessive cement or resinnot cleaned off, wire problems, etc.
  • Having recently completed orthodontic treatmentmyself, I recognize the need for better communicationbetween the restoring dentist, periodontist,oral surgeon, and orthodontist. Morecommunication is necessary when implants andrestorative issues need to be addressed.
  • The orthodontists in my area are so busy theydon't seem to do much interceptive orthodonticson young kids. They seem to let a problem developlonger than I like to see.
  • Emphasizing routine dental cleanings andcheck-ups is critical!
  • Suggest patient-specific diagnostic records,not blanket prescriptions.
  • Lateral cephs are way overdone.
  • Fig. 1 Dentist preference survey form.


    Dr. Keim is Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


    Dr. Gottlieb is Senior Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.


    Dr. Nelson is Director and Research Consultant, Nelson Associates, Nederland, CO.


    Mr. Vogels is Managing Editor of the Journal of Clinical Orthodontics, 1828 Pearl St., Boulder, CO 80302.

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