Orthotown November 2022 - 49

treatment into a smooth, predictable method
to deliver the most time- and cost-effective
approach to early and adolescent care, and
in the end deliver a superior result with
lasting benefits?
The first step is to have an orderly way to
examine, educate and treat pediatric patients.
(The second step is treatment; the third is
Phase 2.) Some of the objections raised-and
rightly so-are that treating early leads to
long treatment times, extra cost and patient
burnout. Managing these objections can be
solved by involving protocols based on the
Treatment by Twelves philosophy of care
I described in a continuing education course
that was published in Orthotown in 2015.21
[Editor's note: To view this course, click the
link inside the digital edition of this article at
orthotown.com/magazine.] The takeaway
from the Treatment by Twelves philosophy
is that in addition to managing patients
during three key time points in a patient's
life, there are four elements of orthodontic
diagnosis, treatment and retention that
need to be constantly addressed during the
primary, transitional and adult dentition:
* Jaws and face.
* Teeth eruption.
* Influence of soft tissue and habits.
* Joint function.
Introduction to practice
The examination of pediatric patients
begins with the parent and child introduction
to the practice; the gathering and review of
pertinent medical and dental history; the
review of the findings; and a diagnosis and
treatment proposal.
In our combination pediatric and orthodontic
practice, the pediatric dentist and
team are well versed in screening patients to
come to the orthodontist. They use a protocol
for basic screening of potential patients
as described by McNamara,22
Fig. 1a
Fig. 1b
Fig. 2
Fig. 3
The office visit: Digital and laminated
measuring
palatal and incisor width (Figs. 1a and 1b),
and using marketing collateral designed by
the orthodontic practice to describe how the
two offices coordinate care.
Educating parents and patients in this
way allows for the pediatric dentist to
maintain communication and control of
the patients and eliminates the extra time
involved in referring patients to the office,
only to have them be told they should return
in six months.
presentation slides are used to describe the
key elements of the visit and to add a visual
component to the discussion to make sure
nothing is missed. These visuals help to
stay on point because of the tendency to
get distracted with other siblings or family
members or questions that take the discussion
to other topics. The new-patient coordinator
(NPC) informs the parent that the doctor
will evaluate the four previously mentioned
elements of orthodontics and arrive at a
diagnosis and treatment or recall plan. After
the introduction, the NPC asks if there are
any questions before taking the child.
Gathering records: The NPC allows the
parent to finish the patient's health history,
if not already completed online, and watch
a short video about orthodontics. The
doctor often will briefly peek in the room
to introduce himself and explain how the
exam will be conducted, emphasizing that
everyone will be able to view the results
on the TV monitor mounted on the wall.
The elements of the record gathering
are quite familiar to all and include:
Standard ABO photos: (Fig. 2) Because
of the small nature of pediatric patients,
parents often help team members obtain
photos by holding cheek retractors.
CBCT imaging: (Fig. 3) Natural head
posture, with instructions to touch teeth
together, close lips, relax and sit still.
The new-patient coordinator uploads
orthotown.com \\ NOVEMBER 2022 49
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Orthotown November 2022

Table of Contents for the Digital Edition of Orthotown November 2022
