retention In my last article, I began to cover the proper protocol when a patient's retention wasn’t effective and they are not satisfied with the treatment result. In this article, I will continue with this discussion and how to handle these issues with retention.

So, how is the GP relationship with orthodontists different from other GP/specialist relationship, and what does this have to do with how GPs handle issues with retention?

How GPs Handle Retention Issues:

  1. Orthodontic treatment is less referral-dependent than other specialty treatment. The American Association of Orthodontists (AAO), and many (if not most) individual orthodontists spend significant resources marketing directly to patients.  Orthodontic patients are more likely to be self-referred than patients in any other specialty.  When patients self-refer, communication between orthodontist and GP is likely to be perfunctory rather than collaborative, if it exists at all.  In fact, it is not at all uncommon for orthodontic patients to report that they do not have a regular dentist.  When an orthodontic patient is self-referred, or undergoes treatment when he/she has no regular dentist, by definition the GP has no relationship with the treating orthodontist, meaning that there has been no protocol established around how to handle post-treatment problems.
  2. Orthodontics is traditionally less integrated into general dentistry disciplines than are other dental specialties. This goes back a long way; orthodontics is the oldest of the dental specialties, and has been a specialty for over a hundred years.  Legend has it that Edward Angle, “the Father of Orthodontics” was disappointed in his efforts to have orthodontics classified as a medical specialty.  From the beginning, orthodontic treatment was considered to be largely separate and essentially unrelated to general dental treatment.  All that was required was that the patient had a dentition that was healthy and intact.  In keeping with this tradition, when the patient is finished with orthodontic treatment, the orthodontist is finished with the patient.  No other specialty requires life-long compliance with post-treatment recommendations without, for the most part, offering patients help or supervision.
  3. General dentists typically know less about orthodontics than other specialty disciplines. Some people may take offence at this pronouncement, and am quick to say that it is my personal opinion.  However, I think most dentists will agree that what they learned about ortho in dental school was paltry at best.  Further, the options open to general dentists to supplement what they know about ortho through CE are expensive and time-consuming, with questionable return on investment.  This contributes to GP’s reluctance to have anything to do with orthodontic treatment, including anything to do with retention.

Cheryl DeWood, DDS, is a Spear Contributing Author. 


Commenter's Profile Image James Craig
October 20th, 2014
Orthodontics with its tradition of ignoring atramatic occlusion, position of second molars, denial of these factors in head and neck pain, joint dysfunction has created countless restorative cases for generalists and prosthodontists.