January 25, 2021

How to win an orthodontic patient? An ultimate guide to cashing in.

This is a guest post by Alex Ditmarov, who is a Russian specialist orthodontist. I thought that this was an interesting viewpoint and he nicely covers some of the problems of our orthodontic specialty. Have fun spotting the KOL/fringe orthodontists!

I came across this when he posted it up on several orthodontic Facebook groups. This resulted in him getting excluded from Orthopreneurs which is a USA based Facebook group. This group is mostly populated by KOLs who praise each other for what they do. He joins good company. He published this previously on his excellent blog.

Introduction

In the competitive field of orthodontics it is imperative to develop a proper marketing strategy to succeed financially. After all, we are all in this to make some cash, not to waste our precious time on tracing cephs, bending wires and understanding all those boring research papers, right?

Being the number-one marketing guru in orthodontics, I’d like to give 10 powerful tips and tricks to my devoted followers. Please read them at least three times, then highlight the ones you find the most important and next implement this new knowledge into your practice. If done correctly and with enthusiasm, these great life-changing hints will bring you not just thousands, but millions of dollars.

Non-extraction

Advertise yourself as a 100% non-extraction orthodontist. This is a very lucrative statement. No one wants to have teeth taken out, so give your customers what they truly want! Of course, this way you will be constantly damaging the periodontium but this is only a plus: make a referral arrangement with a periodontist and create an additional cashflow. Moreover, no need to waste time on studying complicated biomechanics. Absolute win-win!

Superior appliances

Stick to one brand/type of brackets and claim it is the best on the market. Invent some fictional properties of these brackets: state that they work 2 times faster than conventional, cause no discomfort, or even cure bed-wetting. And yes, always use a word “conventional” when talking about others. Then use ecstatic epithets while talking about yourself.

Ecstatic language

Always use such words as awesome, gorgeous, great, tremendous, life-changing, etc. This to show your patients you have a heart of gold. Example: Look how great your gorgeous teeth look after our life-changing non-extraction treatment! Now you have to see an incredible periodontist. Have an awesome day! 

Confusing titles

Use confusing abbreviations. This will add some charm to your persona and help you to stand out from the crowd. Everyone is bored with mundane DMDs, PhDs. Use something innovate and meaningless: MICCMO, AIAOMT, FIAPA, etc.

X-rays to worry moms

X-rays are great toosl to cause anxiety and confusion! Scan every child indiscriminately from the age of four and then state to the parents the kid needs treatment. Advocate your claims by pointing on the permanent dental follicles and saying there is no room for them. The earlier you take the x-ray the more frightening the permanent follicles will look in the kid’s jaws.

Become friends with airways

Breathing is a huge trend today. Tell the parents that without an orthodontic expander the child will inevitably develop a serious breathing issue. Use a term “mouth breather”, it sells really well: “Have you ever seen Johnny with his mouth open? He is a mouth breather! Needs an expander urgently!”

Become a disciple

Become a member of a school of thought. There is a plethora of ever-emerging pseudo-scientific movements in orthodontics. Just pick one and worship the leader. It helps to solve many troubles: next time the parent asks you what the benefit of a first phase treatment was, if the child still needs a comprehensive second phase, just answer: I am a disciple of mr. X, it is just the way we do things.

Myofunctional exercises

Oblige patients to do myofunctional exercises. No one does them, so it is a great way to protect yourself in case of a poor result. The patient’s teeth stuck out of the mouth and no occlusion at all? C’mon! It wasn’t you who didn’t  do the exercises!

Be above others

Advertise yourself as an expert in a particular area and claim to be the number one in it. As you have probably spotted, the number-one position in orthodontic marketing is taken already, so be creative and make up something for yourself.

Just do it

Now you are loaded with invaluable new knowledge. We have come to the last and the most important step – go and put the knowledge into practice! Start with social media: regularly post some of the claims above to your social media accounts: use Facebook, Instagram, and TikTok. Thousands of practitioners are doing this already! What are your waiting for?! Join the army of charlatans now!

Please note: it is a tongue-in-cheek blog post to illustrate the most notorious modern-day trends in orthodontic marketing. The author doesnt think it is good to delude the patients and is a big believer in evidence-based orthodontics. 

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Have your say!

  1. Avatar

    This was really hilarious to read but unfortunately it is very much true.
    But as in any field of dentistry, it’s not that the best ( most knowledgeable) orthodontist is the most popular or the wealthiest one.

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    Dear Alex,
    Clearly this is sound guidance but unfortunately out of date and limited in scope!

    In Australia we have moved on with some Ausrralian practitioners showing the way forward where paediatricians and psychiatrists are failing.

    I am talking about the important role orthodontics plays in ADHD treatment.

    These pioneers don’t go far enough in my personal opinion. I have looked through my records and many older patients are missing some teeth, older patients are less likely to have had expansion, and dementia is more common in older patients.
    The association is clear!
    The area of Neuro-orthodontic development is the future. Neuropsychiatry has had it too good for too long.
    The world is your oyster and it’s not just about straightening the pearls.

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      Paul – your script would fit nicely within the upcoming “Orthodontic Comics” mini-series.

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        Actually I’m not an orthodontist Gerry but that’s the thing with our sun kings of progress. They are so clever they can teach mere GPS like me anything in just a weekend or two.

        They swallow all knowledge, digest it with their superior wisdom then regurgitate the lot down our baby bird like throats while we skwark about their genius.

        All is for the best, in the best of all possible worlds.

  3. Avatar

    Unfortunately, this is a real situation. Lots of orthodontists depend upon these mentioned points. But I believe that sooner or later the skilled orthodontist will have the increased income because simply the patient will be inforced to search the one who can fix his or her bad orthodontic treatment result.
    So, my message to everyone, don’t be worried about the cash, just work professionally.

  4. Avatar

    For over a century it has been reported in top-tier medical and dental literature that transverse and/or sagittal maxillary hypoplasia will reliably persist beyond the deciduous/early mixed-dentition (Bishara, Gianelli, McNamara, EA Bogue, et al); and furthermore, are/will often become, associated with various respiratory health-related co-morbidities such as inattention, OSA persistence after adenoiectomy(JCSM 2020), what might explain the general reluctance on the part of many, many orthodontists for delaying definitive Dx/Tx until the late mixed/early permanent dentition?

    Please advise

    Kevin Boyd
    Pediatric Dentist
    Chicago

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      Quite the example of using a lot of prophecy and scary words to say that something terrible is going to happen unless a parent consents to your treatment plan.

  5. Avatar

    LOve love love……. If I had a sense of humor I would have written this! Compliments to the author!

  6. Avatar

    This is terrific satire, unfortunately those that need to see it are unlikely to be on this group! It saddens me when someone posts a few pictures on a dental facebook group and invites treatment plans….and then the madness ensues….no proper diagnosis required, just a ‘blinkered’ quick-fix….. informed consent? What’s that?

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    I would be interested to hear more about the use of early x-rays and their merit, or otherwise. Thank you!

  8. Avatar

    😂😂😂 I had a smile on my face the whole way through.

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    I laughed and wanted to cry at the same time. Great post in that it describes the realities unfortunately. Perception is reality and so much more true now than ever. I believe we all would like to believe that science, quality care with patient first mentality will prevail but I’m not at all optimistic.
    In my community I have both a Damon practice and an Airway practice and I see that nothing but Damon and elastics are needed anymore and other techniques such as functionals are “old school”. I had a parent in my reception area who asked me an interesting question. He said “Doc I have a question for you ,we had another opinion and the doctor came out and said: “you’ll never live to see your daughters graduation” …he was told that just by looking at him sitting there he had apnea and needed treatment or he wouldn’t live long ! “What was that about?”

    Charisma is a nebulous thing but one that can sway public sentiment much more than quoting a high quality scientific paper at least in my community. I mostly feel quixotic in my attempts to educate in consults since, simply stated ,most people don’t care. If your treatment looks more complex or might me a month or two longer in treatment time estimate you will frequently find the patient going elsewhere.

    I attended an in office course for Lingual which I used only briefly. I learned way more about how to sell than I did about mechanics and it was eye opening. An example is how the office staff would build up the doctor incredibly well from the call forward. When the Doctor came in the room the entire family would jump to their feet with a huge smile for the opportunity to be in the same room with the celebrity that had been manufactured by his staff.

    The above is the reality of practicing Orthodontics these days thinking that we can drive it out with science is ,in my opinion, a lost cause.

    Please don’t stop trying, it’s heartening.

  10. Avatar

    Alex Ditmarov did not mention another very important field for getting new patients.IN Germany some Orthodontisst tell parents that they treat children with a holistic method.and that they are not only locking at teeth but on the whole person. On every tooth is hanging a whole person. Every tooth,they say, is related to a special organ. for example the upper first bicuspids are related to allergies ore the wisedomteeth are related to the sexual organs. So what can you do better for your child and its livelong heath : let the teeth be corrected but you should nerver use braces,we can do everything without them just with removable apliances.

    • Avatar

      I guess in Germany the method of extracting second molars to give some space for the wisdom teeth to erupt is very popular 😉

  11. Avatar

    Again,

    What might explain the general reluctance on the part of many, many orthodontists for delaying definitive Dx/Tx until the late mixed/early permanent dentition?

    Please advise

    Kevin Boyd
    Pediatric Dentist
    Chicago

    • Avatar

      Hi Kevin – no one else has attempted to answer you, so here goes!!, in precis:
      – I don’t believe that dx is delayed (AAO recommends first ortho exam at 6 yo)
      – re definitive tx: many potential reasons for delay:
      – psychological readiness
      – anchorage potential (what teeth do we have to work with?)
      – belief that expanding to fit all teeth does not necessarily satisfy orthodontic need,
      constitute successful orthodontic treatment, nor does it necessarily improve oxygenation of the blood and all associated benefits in the short or the long term (if definitive tx is defined as purely expansion, then absolutely, the maxillae will split much easier in younger patients!)
      – retention until Phase II (most studies show a Phase II will be required for majority)
      – high potential for relapse of any gain made in Phase 1 (early tx, early intervention, mixed dentition tx etc) due to either issues w retention and / or continued growth pattern
      – burnout if we continue through to a Phase II without pause
      – financial loss for patient
      – increased iatrogenic potential due to longer tx times (phase I and Phase II)
      – relative success of single phase of adolescent / adult tx
      – yes, patients may absolutely benefit from an early intervention, but not all, and not most. I would think that is why many orthos, as you say, will delay definitive treatment until patients may be definitively treated – we can only do that once most of their permanent dentition is erupted.
      – No doubt what so ever that patients should be evaluated at an early age, to identify those -that will surely benefit from “early” intervention, to be determined based on the individual needs
      – Guess the difference in approach to treatment time will then be influenced on what the clinician believes in terms of their ability to influence growth and development in both the short and in the long term, to ensure that the benefit to the patient outweighs the risk.
      – I cant speak for all orthos, but the factors above often contribute to decision making in terms of timing of treatment “when the hay is ripe, and each season is different”

    • Avatar

      Dear Kevin
      One of the reasons behind MY reluctance to start treatments like expansion for cases that in my opinion seems unsuitable for early treatment comes back to my rudimentary knowledge about the difference between efficiency and efficacy.
      One treatment can be effective for a child at the age of 4 or 6 but may not be efficient as the treatment may have to be continued in some form for years to come. In the place that I work, Brisbane, most people are not blessed with the patience of saints and don’t have infinite financial resources and after few years they will give up ….

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      The main reason for what you feel is reluctance is the absence of evidence that most interceptive forms of treatment benefit the patient. In other words orthodontists are mostly practicing evidence based orthodontics.

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        Thank you for your observation Prof.

        While ‘Evidence-Based’ is certainly the most robust form of data in terms of driving best clinical practices, it is also the least available; and these data weren’t even at all readily available until after WW II thanks to the UK’s Archie Cochrane, MD (known best for having invented the meta-analysis and inspired the Cochrane Collaboration database) who’d designed one of the first ever RCT’s (Vit. C vs Vit. B12) whilst serving as a prison doctor in Nazi concentration camps. So Dr. O’Brien, as you are likely aware that data derived from controlled ‘observational’ trials (i.e., non-RCT’s) were really all that would have been available to guide best clinical practices before WW II, to declare now that ‘….orthodontists are mostly practicing evidence based orthodontics.’, seems to imply that maybe EH Angle and other esteemed pre-WW II orthodontists were maybe just getting lucky per their successes?

        Back in the late1970’s I used to be a barman in a Soho pub near to the Great Marlborough Street in London which was close to where Dr. John Snow had performed one of the most useful ‘observational’ trials in recorded history. Through systematic mapping of where cholera cases seemed to have been aggregating in around the Broad Street public water pump, Dr. Snow had eventually convinced the London health authorities that cholera was actually caused by a water-borne, rather than by an airborne pathogen which had been the prevailing belief before then. My point sir is that I think you are doing a public disservice by proclaiming that data derived from observational studies are worthless and have no place in orthodontic discourse or practice…..history is certainly not on your side.

        Please consider, if after she’d had her tonsils and adenoids surgically removed 6-12 months previous, your 4-5 year old granddaughter (now living in Chicago) was being evaluated by her pediatrician, ENT and Sleep Medicine physician for post-surgical recurrent apnea(based upon overnight polysomnography(PSG sleep study), Dx:ADD/ADHD and habitual mouth-breathing, snoring, night terrors and nightly bedwetting. If her team of physicians had referred her to a pediatric dentist who was also an appointed dental consultant in their tertiary care children’s hospital Dept of Sleep Medicine, might you object to a collaborative deciduous dentition Tx plan for addressing the following: crowded deciduous incisors, tight bilateral posterior buccal segments (w/no posterior crossbite), deep/narrow palatal vault, retrognathic mandible/distal step primary second molars, class II cuspids, 100%+ excess overbite and 6 mm excessive overjet? And just to clarify, this particular pediatric dentist had clearly explained to her parents that the recommended dentofacial orthopedic Tx plan was being proposed as strategy for resolving specific hypoplastic malocclusion/structural phenotypes only, but might or mightn’t, result in mitigation of all or even some of his systemic health co-morbidities.

        • Avatar

          Thanks for the history of evidence based care. You missed out the latest developments in which all evidence is considered and rated for its quality. As a result, I stand by my statement. You can always find the one miracle case that treatment appeared to cure a problem, but this is not evidenced based care and may lead down the path to quackery.

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            Dear Prof O’Brien

            Thanks for your pointing out what you’d thought I’d missed out on regarding the usefulness of all evidence….very helpful. Your usage of the terms ‘miracle’ and ‘quackery’, however seemed maybe a bit fear mongering….how easy it is to fall into one’s own trap.

            And I would really like to know what you might think about the hypothetical ‘grandchild’ scenario question that I’d previously posed to you sir.

            Kind Regards

            Kev

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            I would ask the dentist what evidence they had that the orthodontic treatment fir a five year old was effective? If they could not give me any I would recommend to my children that they do not have treatment at such an early age

  12. Avatar

    Thank you VV and sep for your thoughtful replies.

    The current official AAO policy, as was discussed in 1990 at a house of delegates meeting(excerpt below), clearly stated that ‘a child’s first orthodontic examination should be performed at the first recognition of the existence of an orthodontic problem, but no later than age 7.’ ‘At the first recognition of an orthodontic problem’ ….at first recognition by whom I’d like to ask VV?

    This is my point VV, your interpretation was – ‘I don’t believe that dx is delayed (AAO recommends first ortho exam at 6 yo)’. Albeit sincere, I think your posted inaccuracy here might occasionally pose health consequences to at least some children for whom you have maybe decided to delay Dx/Tx. Imagine you are a pediatric developmental ophthalmologist who’d recently diagnosed a 3-4 year old with myopia, amblyopia or some other uncorrected refractive error, and then advised the parent to delay corrective intervention until needed to pass a driving test at age 15 for fear of ‘inefficiency of Tx, – lack of psychological readiness, – burnout if we continue through to a Phase II (subsequent glasses or contacts) without pause, – financial loss for patient (parent), etc., well, maybe you do not agree with this analogy, if so, I think you should maybe take your self and your art a bit more seriously sir.

    As stated previously, transverse and sagittal hypoplastic phenotypes of either or both arches are: 1. easily recognized between 2-5 years of age; 2. reliably persistent beyond (will never self correct); and 3. also sometimes associated with increased risk for development of systemic health co-morbidities. As Pediatric Behavior Guidance and Child Development training were not likely part of your residency training(?), you might not be comfortable with the management of child-parental anxiety/fear associated with very early orthodontic/dentofacial orthopedic intervention. Should that possibly be another reason (not on your posted list) for your reluctance, please consider performing at least validated risk assessment and then maybe refer to a colleague who might not share your understandable reluctance.

    Kind Regards

    Kev

    Excerpt from AAO HOD mtg.:

    First Orthodontic Examination
    21-90A H – May 9, 1990
    Readopted as amended May 7, 2012
    RESOLVED, that it be the policy of the Association that a child’s first orthodontic examination
    should be performed at the first recognition of the existence of an orthodontic problem, but no
    later than age 7. Such first examination may occur anytime.
    RESOLVED, that this Association recognizes there are many instances wherein correction of
    problems such as congenital anomalies, transverse, anteroposterior or vertical discrepancies can
    improve the child’s growth and development potential.

    • Avatar

      As Dani said before, this is an example of fear-mongering. What is “transverse hypoplastic phenotype”? Probably it is an ophthalmologic term? I’ve just finished a consultation with a patient who was advised to use a FAGGA appliance to open her extraction spaces. It took me an hour to calm her down and explain that her orthodontic treatment was done correctly and not every Kevin online is equally trustworthy.

    • Avatar

      Kevin,

      Are you ever going to publish any of your work/cases?

      You’ve been orthodontically treating very, very young children for many years now…you must have something to show for this by now other than your opinion.

      • Avatar

        Thank you Nicky for your curiosity about our data. We are in the process of retrospectively analyzing data gathered over the past several years who were initially referred to us for assessment prior to the age of 71 months. Overseeing our protocol development and its execution is a prof. from a very prestigious medical school who has been instrumental in changing how pain management protocols in many US healthcare systems are over reliant upon opiates as a ‘first choice’ analgesic. If you might want to know more Nicky about why this particular research design strategy might apply to to how early childhood malocclusion-SRBD co-morbidity might be best managed, please let me know ([email protected]) and I will gladly elaborate.

        Inclusion criteria/indications for Tx will include skeletal hypoplasia (under-development) and/or transverse(width) and/sagittal(anterior-posterior) phenotypes (traits) in either or both arches; the aforementioned are orthodontic terms Alex. Many of these kids also presented with sleep-related breathing disorder (SRBD) co-morbidities (behavioral traits). While not as robust as a prospective RCT Nicky, I am hopeful that after peer-review of the final manuscript and hoped for publication, you will read the final paper and offer your constructive input. And btw Nicky, the bibliography might very well contain few references pertaining to observational reports within med-dent journals that predate the EBM era.

        • Avatar

          Probably it is the term in the world of general dentists practising orthodontics, but in orthodontics we usually talk about transverse/sagittal/vertical dimensions and discrepancies. We also have a lot of research we rely on and we don’t invent new diseases and seed panic. At least, those of us who don’t want to look as the protagonist of the blog post.

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          Kevin

          Have you published the protocol?

          That would be a great start to either get some constructive input/critique before you go down the long road of data collection or at least help with the transparency of your study.

          • Avatar

            Thanks Nicky for your constructive input.

            If you send your personal email address to mine ([email protected]) I will gladly share our proposed protocol details accordingly when completed. We have thus far identified 53 patients who’d begun their orthodontic Tx (T1) in our practice sometime between 2016-2020 when they were then under the age of 71 months old; we are only now up to the letter ‘G’ in the alphabet and are optimistic to have an N=100+/-. Most of these children had been referred by Sleep Medicine physicians, pediatricians, ENT’s, pediatric dentists, GDP’s and even a few ABO orthodontists(!), and other pediatric HCP’s who were concerned about possible health risks often associated with persistent ECM-SRBD co-morbidity. One hypothesis Nicky we will be testing is that the etiology of Dx: pediatric sleep disordered breathing (p-SRBD), has specific structural/morphological components besides enlarged adenoids and/or tonsils, deviated septum and nasal polyps, etc., that might influence naso-respiratory competence (i.e., gradual nasal disuse) during early childhood. Specific malocclusion traits such as maxillary and/or mandibular retrusion and/or transverse deficiency, hyperdivergent skeletal growth sensitivity and/or deep/narrow palatal vaults, are all examples of phenotypes being investigated. As you know, any useful hypothesis must of course be first testable, but also must be refutable. So, as many contributors to this esteemed forum will likely be delighted should we fail to find robust support for our hypothesis, regardless of outcome, we think our retrospective trial will serve as a useful endeavor to this forum in particular….regardless of our outcome.

            I appreciate your interest Nicky

            Kev

  13. Avatar

    I don’t know which is funnier, the article or the comments.
    Seriously though,
    Thanks to all my wonderful and varied orthodontic colleagues for making me laugh and smile and keeping me sane when the horizons are dark and gloomy.
    Big love to you all and keep doing what you all do….
    Contributing.

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