cheryl dewoodIn my last post I began discussing how to transfer retention for patients treated outside your referral network. In the absence of an established relationship with the treating orthodontist or GP, transferring retention for patients who were treated outside your referral network typically poses greater challenges.

I suggest you have a discussion regarding retention with post-ortho patients who are new to your practice and existing patients who are post-ortho with someone outside your referral network. Discussing the issue of retention pro-actively helps achieve the following:

  • It reinforces the importance of retention to maintain orthodontic results. We have all seen patients whose opinion seems to be that retention is not all that important. It is a common perception that after a certain period of time, retainer wear is no longer necessary because the teeth become ‘set’ in their post-treatment positions and relapse will not occur. Similarly, it is commonly believed that removal of third molars reduces or eliminates the need for continued retention. Another misconception is that stability of tooth position in growing patients can be assumed after growth is complete. While we would like to believe that all of these misconceptions have already been dispelled as part of a patient’s instruction regarding retainer wear, we know that it is either not always the case, or the patient’s understanding has faded with time. When I was in general practice I encouraged patients to bring their removable retainers with them for their recall appointments. It’s my belief that this not only serves to reinforce the need for continued retainer wear; it also breaks wearing retainers ‘forever’ into more manageable chunks of time if patients know I’m going to be checking the fit every six months or so.
  • It provides you with an opportunity to enumerate the benefits the patient obtained through orthodontic treatment, which further reinforces retainer compliance. Many, if not most, patients are aware only of the esthetic improvement that resulted from their orthodontic treatment. Additional benefits of easier hygiene, better occlusion, enhanced restorative results, among others, may have also been obtained. When that is the case, the patient’s interest in maintaining the treatment result may be enhanced by being made aware that these additional benefits exist.
  • It establishes that monitoring retention is an actual service, meriting an actual fee. As with any other service that we provide, if we provide it at no fee we invite patients to perceive that it has no value. When a patient requests an appointment specifically for a “retainer check”, it is my opinion that an office visit fee is indicated and appropriate. On the other hand, when the retainer check occurs at a recall appointment, I consider it covered in my fee for a periodic exam. This was perceived as a significant “value-added” by most of my patients.
  • It helps prevent orthodontic retainer 'emergencies'. If you are checking retainers at routine recall appointments, you can observe how they are holding up. This reinforces that retainers don’t last forever, and helps you avoid having your first conversation about what will happen when a retainer breaks after it breaks, (or comes unbonded, or gets lost).

You may be of the opinion that your patient’s compliance with retainer wear is not your responsibility. While that is certainly true, the consequences can often be your problem; consider, for example, how misaligned lower incisors can complicate an upper anterior restorative case. At the very least, helping a patient maintain a nice orthodontic treatment result demonstrates your interest in their best interest.

In my next post, I will discuss some strategies for the problem retainer cases: the poor treatment outcome, the orthodontist who views your efforts as interference, and others.

Cheryl DeWood is a Spear Contributing Author.