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Ectopic teeth in a smile and in orthodontics
For a patient whose teeth are ectopic - out of place - it is distressing.
A child will often say, “I don’t like my fangs.” And, if the teeth do not show up, are ectopic and unerupted, it is distressing to have spaces in your smile.
It is also distressing for you, wanting to be efficient and effective in helping create an even more beautiful smile. It is distressing in planning and carrying out your orthodontic mechanics in an often difficult situation with potential for negative sequelae.
A child will often say, “I don’t like my fangs.” And, if the teeth do not show up, are ectopic and unerupted, it is distressing to have spaces in your smile.
It is also distressing for you, wanting to be efficient and effective in helping create an even more beautiful smile. It is distressing in planning and carrying out your orthodontic mechanics in an often difficult situation with potential for negative sequelae.
IF, and that is, IF, you see the child early enough, there is a MOST HELPFUL answer to reducing the treatment time, the risk of sequelae, and improving the smile earlier on. It is simply, clearing the path of eruption.
While the scholarly articles about this topic are many, and great academics like Ericson and Kurol have written excellently, the bottom line is that the first and most important treatment/prevention is to clear the path.
As Fox and Fletcher wrote in the British Dental Journal, “ Late detection of palatal canines may have treatment implications for the patient and medico-legal implications for the dental practitioner.”
While it is rewarding to be thought of as the hero who helps a child have the most beautiful smile, it is no fun to be implicated in the parents’ and patient’s thoughts as someone who at worst, “harmed or worsened the smile,” and at best, “didn’t make it better, after all that ‘time and money.’"
While the scholarly articles about this topic are many, and great academics like Ericson and Kurol have written excellently, the bottom line is that the first and most important treatment/prevention is to clear the path.
As Fox and Fletcher wrote in the British Dental Journal, “ Late detection of palatal canines may have treatment implications for the patient and medico-legal implications for the dental practitioner.”
While it is rewarding to be thought of as the hero who helps a child have the most beautiful smile, it is no fun to be implicated in the parents’ and patient’s thoughts as someone who at worst, “harmed or worsened the smile,” and at best, “didn’t make it better, after all that ‘time and money.’"
Neither is it fun for the parent and patient to be unhappy with their smile, first and foremost, after orthodontic treatment, and neither is it fun for the parent and patient to be unhappy with the provider of orthodontic care.
Neither is it fun for the orthodontist to have a treatment plan extended by sometimes - yes - 2-3 years, working to aide eruption of the tooth/teeth, soothe the patient and parent as well as him/herself because everyone wants it to go quicker and easier.
Like all of your skills, surely you can learn to utilize, competently choose, plan and intermingle techniques necessary, including exposure, surgical attachment, orthodontic mechanics of wires, chain, forces, biomechanics including anchorage with TAD’s, appliances.
And, there will be patients who no one saw early enough to clear the path before the trajectory of the ectopic tooth/teeth was set and difficult.
And, there will be patients who BEFORE you even considered how to guide eruption and orthodontically reposition for that patient, there was damage to adjacent tooth roots, occurring as nature’s adverse trajectory triggered the resorption of other permanent tooth roots. And patients whose adverse position is such that the tooth cannot/should not be erupted due to risks.
As Jon Kurol states, “The correct development of a stable, functional, and aesthetically acceptable occlusion is an integral component of comprehensive oral health care for all paediatric dental patients.
It is the responsibility of the dentist to recognize, diagnose, and manage or refer abnormalities in the developing dentition.”
So what to do?
Prevent as often and as much as possible. Engage nature and natural eruption. Clear the path as early as is feasible and appropriate. Consider expansion if maxillary teeth are involved.
How to identify and diagnose aberrant eruption tracectories, ectopic teeth? Take a panoramic x-ray. Routine pano should be taken when any permanent tooth is erupting into the mouth. That is the time to initially identify possible aberrancies.
Neither is it fun for the orthodontist to have a treatment plan extended by sometimes - yes - 2-3 years, working to aide eruption of the tooth/teeth, soothe the patient and parent as well as him/herself because everyone wants it to go quicker and easier.
Like all of your skills, surely you can learn to utilize, competently choose, plan and intermingle techniques necessary, including exposure, surgical attachment, orthodontic mechanics of wires, chain, forces, biomechanics including anchorage with TAD’s, appliances.
And, there will be patients who no one saw early enough to clear the path before the trajectory of the ectopic tooth/teeth was set and difficult.
And, there will be patients who BEFORE you even considered how to guide eruption and orthodontically reposition for that patient, there was damage to adjacent tooth roots, occurring as nature’s adverse trajectory triggered the resorption of other permanent tooth roots. And patients whose adverse position is such that the tooth cannot/should not be erupted due to risks.
As Jon Kurol states, “The correct development of a stable, functional, and aesthetically acceptable occlusion is an integral component of comprehensive oral health care for all paediatric dental patients.
It is the responsibility of the dentist to recognize, diagnose, and manage or refer abnormalities in the developing dentition.”
So what to do?
Prevent as often and as much as possible. Engage nature and natural eruption. Clear the path as early as is feasible and appropriate. Consider expansion if maxillary teeth are involved.
How to identify and diagnose aberrant eruption tracectories, ectopic teeth? Take a panoramic x-ray. Routine pano should be taken when any permanent tooth is erupting into the mouth. That is the time to initially identify possible aberrancies.
Dental panoramic tomograms/ radiographs are widely taken in practice, but not often enough when permanent teeth are just beginning to erupt.
Look at the radiograph. Identify each and every permanent tooth’s presence and trajectory. Diagnose aberrancies. Inform the parent. Plan to manage or refer. Every single time.
Management at early transitional dentition may include: clearing the path, expansion, monitoring with progress films. Just don’t ignore the aberrancy! Instead, change a life!
Look at the radiograph. Identify each and every permanent tooth’s presence and trajectory. Diagnose aberrancies. Inform the parent. Plan to manage or refer. Every single time.
Management at early transitional dentition may include: clearing the path, expansion, monitoring with progress films. Just don’t ignore the aberrancy! Instead, change a life!
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© 2018 Dr Chris Baker
LEFT: Patient "Miss A" (see below for case explanation), displaying a right lateral openbite and forward tongue. © 2018 Dr Chris Baker
Funny how we call detailing the tooth alignment and the bite, “finishing”. Funny because it all starts from diagnosis. Actually it starts at the initial examination. What we do at the beginning makes our finishing time longer or shorter.
Here are three examples of finishing challenges that can become overwhelming, and how you can know of the facts, and handle the challenges better, from the start:
Facts and challenges like:
Patient Miss A may need lengthy and difficult anterior bite closure - how do you know?.
- ENT referral and treatments
- Tongue exercises that you prescribe
- Sublingual frenectomy
- Habit treatment
- Bite turbos, posterior biteplate, or other posterior intrusion therapies
- UAW or other molar positioning and incisor extrusion where appropriate
- TAD anchorage with posterior intrusion
- Lower full coverage splint following ortho treatment
And look at the concern typed onto the treatment plan for this patient, just above the signature line for the parent/patient:
Concern – Airway issues, habits and adverse tongue positions all contribute to adverse growth and continued adverse forces on teeth, with or without orthodontic treatment. Adam’s growth is vertical, which is made worse by mouth-breathing and low tongue position.
This may predispose him to an openbite. All treatment will be directed to improving these adversities, but longterm stability is lessened and risk of relapse is greater, depending on the success of the airway treatment, tongue position improvement and habit cessation.
OR
Vertical growth patterns are difficult to correct, and when corrected, often relapse, with a return of the open bite (space between upper and lower incisors, when the patient is biting on the posterior teeth.)
Even in the best-case scenario, openbites may relapse. Beginning treatment as soon as is feasible may help in longer-term stability. Compliance with elastic wear, if indicated, is important. All treatment is directed to improving the openbite pattern with as much stability as possible.
Annie’s tongue position is low and forward, and probably is contributing to the spacing of her teeth. Tongue training may be helpful, including CM circle and ball on retainers, and wear of her retainers as directed, will be critical, because the teeth often exhibit connective tissue memory/relapse without excellent retainer wear, due to the tendency of the tongue to remain forward and low throughout life.
Patient Mr. B may have later excessive mandibular growth, “outgrowing” your orthodontic treatment that attained a beautiful Class I, and the patient ends up Class III with open bite tendency. How do you know?
A patient and his mother presented for a recall orthodontic evaluation, and the mom said her dentist had asked her why we took the braces off, when he had 0 overbite and 0 overjet. A review of his final photographs at orthodontic completion showed a Class I occlusion with 3 mm overbite and 3 mm overjet. Indeed that was not the case any longer.
His treatment plan had listed the concern of possible excessive mandibular growth. He had a chin sling for nighttime wear prescribed for wear with his retainers, which had not been worn. Don’t we dislike these concerns expressing themselves in reality?
But - we don’t make the growth, and we are pleased to stress the concern at the diagnostic and retainer delivery stage. The patient compliance may not work to advantage. We hate that, of course.
Treatment during or throughout the original active phase, not just during what we call finishing may include:
- Class III Correctors - Motion or D2 appliances
- Chin Sling or Facemask wear
- Posterior intrusion therapies
Communication of growth progress to the parent is critical, throughout treatment. Keep them in the reality loop!
Patient Miss C may have difficulty attaining and maintaining adequate canine and/or posterior overbite. How do you know?
- Tongue exercises
- Blue Grass or other beads in palate
- Castillo-Morales circle in palate
- Crib on appliances
- Expansion therapy
We could similarly lay out the signs of future TMJD, of lack of eruption of an ectopic tooth, adding 2-3 years to a treatment time, of the complete dependence on the patient’s compliance if the occlusion is to be corrected, and on and on…
So, before you even consider putting appliances into a patient’s mouth, consider the findings - all of them. Do excellent diagnostics. Get all the information - about medical, airway and breathing, dental, skeletal, growth and finally dental findings. THEN put it together in a comprehensive treatment plan that you can share with the parent /patient, giving them the information they need to make good informed decisions about the treatment.
Then, pay the closest attention to your bracket placement. Bracket placement, though impossible to do perfectly, can make huge differences in finishing needs.
Keep everyone — parents, patient, your chart — in the loop. Be honest and open with the progress, OR LACK THEREOF. This will help you throughout the treatment. Your finishing will be more predictable, and could be a lot less surprising, a lot less difficult, and a lot less stressful for all.
- Identifying the existing risks, discrepancies, malpositions, and adverse trajectories of erupting or unerupted teeth begins your finishing.
- Making them part of your written treatment plan information for the parent/patient puts you all on the same page, reducing surprises and disappointments later.
- When you work these out, discover, document, and add the concerns to the treatment plan, and review with the parents/patient BEFORE you start, you will feel better, they will feel better, and even though the challenges are there for all of you, there is a better chance of working together with the realities.
Here are three examples of finishing challenges that can become overwhelming, and how you can know of the facts, and handle the challenges better, from the start:
Facts and challenges like:
Patient Miss A may need lengthy and difficult anterior bite closure - how do you know?.
- Signs and symptoms of airway and breathing limitations (bedwetting, ADD/ADHD, mouthbreathing, snoring, bruxism/grinding, enlarged tonsils, enlarged adenoids, dense turbinates and more).
- Vertical or dolichofacial growth and muscle patterns
- Forward and low tongue position, tongue habits, forward tongue swallow, difficulty with sibilant sounds and even generalized spacing between teeth
- Short sub-lingual frenum, which makes the tongue stay low and forward
- History of or current finger, thumb or pacifier habit
- Deficient overbite
- Protrusive incisors
- ENT referral and treatments
- Tongue exercises that you prescribe
- Sublingual frenectomy
- Habit treatment
- Bite turbos, posterior biteplate, or other posterior intrusion therapies
- UAW or other molar positioning and incisor extrusion where appropriate
- TAD anchorage with posterior intrusion
- Lower full coverage splint following ortho treatment
And look at the concern typed onto the treatment plan for this patient, just above the signature line for the parent/patient:
Concern – Airway issues, habits and adverse tongue positions all contribute to adverse growth and continued adverse forces on teeth, with or without orthodontic treatment. Adam’s growth is vertical, which is made worse by mouth-breathing and low tongue position.
This may predispose him to an openbite. All treatment will be directed to improving these adversities, but longterm stability is lessened and risk of relapse is greater, depending on the success of the airway treatment, tongue position improvement and habit cessation.
OR
Vertical growth patterns are difficult to correct, and when corrected, often relapse, with a return of the open bite (space between upper and lower incisors, when the patient is biting on the posterior teeth.)
Even in the best-case scenario, openbites may relapse. Beginning treatment as soon as is feasible may help in longer-term stability. Compliance with elastic wear, if indicated, is important. All treatment is directed to improving the openbite pattern with as much stability as possible.
Annie’s tongue position is low and forward, and probably is contributing to the spacing of her teeth. Tongue training may be helpful, including CM circle and ball on retainers, and wear of her retainers as directed, will be critical, because the teeth often exhibit connective tissue memory/relapse without excellent retainer wear, due to the tendency of the tongue to remain forward and low throughout life.
Patient Mr. B may have later excessive mandibular growth, “outgrowing” your orthodontic treatment that attained a beautiful Class I, and the patient ends up Class III with open bite tendency. How do you know?
- The patient has more than 4 total clinical deviations from the norm toward Class III, between Porion Location, Ramus-Xi position, Cranial Deflection and Molar Position.
- The patient presents with Angle Class I occlusion or Super Class I occlusion
- The patient has a brachyfacial growth and muscle pattern.
- The patient is skeletal Class III.
A patient and his mother presented for a recall orthodontic evaluation, and the mom said her dentist had asked her why we took the braces off, when he had 0 overbite and 0 overjet. A review of his final photographs at orthodontic completion showed a Class I occlusion with 3 mm overbite and 3 mm overjet. Indeed that was not the case any longer.
His treatment plan had listed the concern of possible excessive mandibular growth. He had a chin sling for nighttime wear prescribed for wear with his retainers, which had not been worn. Don’t we dislike these concerns expressing themselves in reality?
But - we don’t make the growth, and we are pleased to stress the concern at the diagnostic and retainer delivery stage. The patient compliance may not work to advantage. We hate that, of course.
Treatment during or throughout the original active phase, not just during what we call finishing may include:
- Class III Correctors - Motion or D2 appliances
- Chin Sling or Facemask wear
- Posterior intrusion therapies
Communication of growth progress to the parent is critical, throughout treatment. Keep them in the reality loop!
Patient Miss C may have difficulty attaining and maintaining adequate canine and/or posterior overbite. How do you know?
- Low and adverse tongue position
- Narrow palate, result of low tongue and cheek muscles strong without tongue balance
- possibly Class III tendency
- Tongue exercises
- Blue Grass or other beads in palate
- Castillo-Morales circle in palate
- Crib on appliances
- Expansion therapy
We could similarly lay out the signs of future TMJD, of lack of eruption of an ectopic tooth, adding 2-3 years to a treatment time, of the complete dependence on the patient’s compliance if the occlusion is to be corrected, and on and on…
So, before you even consider putting appliances into a patient’s mouth, consider the findings - all of them. Do excellent diagnostics. Get all the information - about medical, airway and breathing, dental, skeletal, growth and finally dental findings. THEN put it together in a comprehensive treatment plan that you can share with the parent /patient, giving them the information they need to make good informed decisions about the treatment.
Then, pay the closest attention to your bracket placement. Bracket placement, though impossible to do perfectly, can make huge differences in finishing needs.
Keep everyone — parents, patient, your chart — in the loop. Be honest and open with the progress, OR LACK THEREOF. This will help you throughout the treatment. Your finishing will be more predictable, and could be a lot less surprising, a lot less difficult, and a lot less stressful for all.
Patient "Mr B" (case discussion above), displaying zero overbite, zero overjet and excessive mandibular growth. © 2018 Dr Chris Baker
Patient "Miss C" (see above for case discussion) displaying an adverse tongue position. © 2018 Dr Chris Baker
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© 2018 Dr Chris Baker
The In-Treatment-Presenting Posterior Crossbite
Pickles can be sweet, tart, bitter, or sour.
“Dr. Chris, when do I get my braces off?”
“Let’s look,” I say to the pretty teenage girl in the orthodontic chair. She has worn her elastics well, kept her plaque under control, and wants to be finished with orthodontics.
Back to the beginning. The way it works is, an awful lot of young patients today want braces. Either their teeth and smile are not ‘Hollywood’ beautiful, OR all their friends have braces and they want them too.
No matter, the two questions asked by these young people are,
Two Q’s with easy answers. “As soon as you get your records done, give me a few days, your mom and I can conference - sit down and review what’s going on with your growth, bones and teeth, then as soon as it’s ok with your parents.”
And, “Yes.”
Not many months later, sometimes only 4 or 5, the Q is more difficult to answer:
“When do I get them off?”
I formulate the answer from two areas of information. The first, I pick up the chart, and study the original treatment plan, with time estimate, goals, and steps of treatment planned, as well as look at the original or most recent pano. The second, I give the assistant status notes. She is charting the information, as to alignment and spacing, overbite, overjet, all teeth erupted and accounted for, canine relationship and molar relationship.
And this pretty, sweet teenage girl is waiting expectantly for my answer, hoping it is some version of “Soon or very soon.” (She can always hope, can’t she?)
On our treatment plan, the time estimate is on the same page as the parent’s signature. That can help them, because the child or parent notices the signature and hopefully familiar page, when I say, “Our estimate was in February to May next year,” though the eager patient is disappointed, they handle the un-hoped-for answer better.
But - what if your estimated time is about now? And what about if the patient is looking pretty darn good? And what if, as you are calling off the status to the assistant, “alignment good, overbite 3, overjet 3, no spaces left, right molar and canine Class I, left molar” - UH OH!. You notice a lingual cross bite of the left six year molars.
Your mind races. “Where did that come from? She’s about done, she and her mother want the braces off, and we have a crossbite. In this case, perhaps the lower molar is kicked out buccally a bit….” It’s a crossbite. Or, you have done Class II correction and distalized upper molars in reference to lowers, and the lower arch width is wider “back there”. What to do??
What options are there?
Here are three for you:
Just sayin’.
Pickles can be sweet, tart, bitter, or sour.
“Dr. Chris, when do I get my braces off?”
“Let’s look,” I say to the pretty teenage girl in the orthodontic chair. She has worn her elastics well, kept her plaque under control, and wants to be finished with orthodontics.
Back to the beginning. The way it works is, an awful lot of young patients today want braces. Either their teeth and smile are not ‘Hollywood’ beautiful, OR all their friends have braces and they want them too.
No matter, the two questions asked by these young people are,
- “When can I get my braces?”, and
- “Do I get to pick colors?”
Two Q’s with easy answers. “As soon as you get your records done, give me a few days, your mom and I can conference - sit down and review what’s going on with your growth, bones and teeth, then as soon as it’s ok with your parents.”
And, “Yes.”
Not many months later, sometimes only 4 or 5, the Q is more difficult to answer:
“When do I get them off?”
I formulate the answer from two areas of information. The first, I pick up the chart, and study the original treatment plan, with time estimate, goals, and steps of treatment planned, as well as look at the original or most recent pano. The second, I give the assistant status notes. She is charting the information, as to alignment and spacing, overbite, overjet, all teeth erupted and accounted for, canine relationship and molar relationship.
And this pretty, sweet teenage girl is waiting expectantly for my answer, hoping it is some version of “Soon or very soon.” (She can always hope, can’t she?)
On our treatment plan, the time estimate is on the same page as the parent’s signature. That can help them, because the child or parent notices the signature and hopefully familiar page, when I say, “Our estimate was in February to May next year,” though the eager patient is disappointed, they handle the un-hoped-for answer better.
But - what if your estimated time is about now? And what about if the patient is looking pretty darn good? And what if, as you are calling off the status to the assistant, “alignment good, overbite 3, overjet 3, no spaces left, right molar and canine Class I, left molar” - UH OH!. You notice a lingual cross bite of the left six year molars.
Your mind races. “Where did that come from? She’s about done, she and her mother want the braces off, and we have a crossbite. In this case, perhaps the lower molar is kicked out buccally a bit….” It’s a crossbite. Or, you have done Class II correction and distalized upper molars in reference to lowers, and the lower arch width is wider “back there”. What to do??
What options are there?
Here are three for you:
- Cross elastics, from the lingual hook or cleat on the upper molar, to the buccal hook on the lower molar tube. Wear 24/7 and re-evaluate 2-3 weeks or more later. This is a good option if the patient is compliant (she wants to get her braces off, so she just may be,) if tipping the molars a bit will be acceptable in alignment and occlusion, and IF the cross bite is basically just the molars. It’s also when you have a labially positioned lower molar.
- NPE - Nitanium Palate Expander if the 4,5 or 7’s are also a bit edge to edge, cross bite or tendency, OR the upper 6 in cross bite needs a bit of rotation, the NPE can do that, along with some expansion, if you remove the arm of the expander. Watch closely so that the rotation and expansion are not overdone. See every 2-3 weeks. (You are getting mostly tipping, as with all of these corrections, so if you truly need expansive movement, gotta think RPE.)
- If the crossbite entails several teeth in the quadrant, this is an option. From our dear friend Dr. Larry White, turn a rectangular NiTi arch wire backward into the maxillary tubes. The curve of the wire can expand (tip) the teeth - careful again - check in a month, then in another if needed.
Just sayin’.
Images and text © 2018 Dr Chris Baker
Dr Chris Baker's book, "Your Child's Smile" (right) is an excellent guide for parents to help guide their children to optimal oral health.
- Published on
If you are a GP dentist or a Pediatric Dentist you take on the responsibility for your patients, of functioning as the “gate-keeper” or “dental home.”
You provide comprehensive and often extensive evaluations of your patients’ needs, and from there, along with the appropriate records, create a treatment plan addressing the various and varied needs of that patient. Those needs may cross into every area of dental care, and as well, cross into medical areas, where you request information and clearance from medical providers. And/or, you may refer TO medical providers, having found medical issues in your evaluation that should be addressed by a medical specialist.
In summary, you
A little side note - it is critical that you help the patient understand their findings and pathology, whether TMJD or decay. This is because if they do NOT understand it is their problem, it is all too easy for the patient to expect the dentist to "just fix it.”
There is NO “just fix it.”
There is only a team effort between medical provider AND patient where the provider evaluates, informs, guides, counsels, refers and treats the AREAS OF THAT PROVIDER’S EXPERTISE AND COMPETENCE; the PATIENT attends appointments, consents to evaluation, listens to the information, takes the time and energy and spends the money necessary to follow-up on referrals and treatments.
Do you see? It is not the provider who is responsible for ascertaining the completion of treatment in the face of all odds. (Read recent blog, “Way Too.”) It is not the provider who is responsible for providing the treatment if the patient is not compliant in attendance, following the guidance and instructions of the provider, including self-care, referral attendance, and so forth.
Which brings us to the fact that you as a generalist, gatekeeper, dental home, have the opportunity to study and learn any one or more of many topics, many dental specialty areas. Any and all treatment you provide in any area of dentistry, by law, must be at the level of what is expected of a specialist in that area. That goes for and includes, endodontics, surgery, prosthodontics, implants, orthodontics, periodontics, and pediatric dentistry.
And to have a full life, a resoundingly successful life and practice, and provide truly great care to your patients, you must choose and adapt to providing the areas of care in which you are interested, have fun, can be great, and continue learning and growing. In other words, keep growing and working in your areas of expertise. You will spend much less money on equipment, supplies, staff training, and learning curve time. If you instead, invest in equipment, staff training and learning curve time for you area of “specialization”, rather than all areas, it will cost you much less and you will be much more profitable.
Choose - Make it profitable. Your dental practice is your living. It is your source of income for you and your family.
Choose - Make it fun for you. Do what you enjoy the most, and consider delegating the rest. (Whether another doctor, or staff, you can delegate the rest.)
Choose - Find what you really love and get REALLY good at it. Your practice will be distinguished by the area in which you focus. What does your practice do that distinguishes you from the others?
Choose - and get FREE. An area of expertise and excellence in expertise gives you freedom. Get free of the stress of the parts you don’t like, free of spending the money on so many different courses, so many supplies, equipment, staff training, and learning curves where you aren’t making much or an money while you are learning. Free to discover a main mentor in your area of expertise-to-be. Free to become a mentor and possibly a teacher of your area of expertise. Free to enjoy life. Free to work ON your practice, and not just IN your practice.
Choose and change your life!
You provide comprehensive and often extensive evaluations of your patients’ needs, and from there, along with the appropriate records, create a treatment plan addressing the various and varied needs of that patient. Those needs may cross into every area of dental care, and as well, cross into medical areas, where you request information and clearance from medical providers. And/or, you may refer TO medical providers, having found medical issues in your evaluation that should be addressed by a medical specialist.
In summary, you
- identify findings of note
- inform the patient of your findings
- help the patient take ownership of these issues, problems, findings -
A little side note - it is critical that you help the patient understand their findings and pathology, whether TMJD or decay. This is because if they do NOT understand it is their problem, it is all too easy for the patient to expect the dentist to "just fix it.”
There is NO “just fix it.”
There is only a team effort between medical provider AND patient where the provider evaluates, informs, guides, counsels, refers and treats the AREAS OF THAT PROVIDER’S EXPERTISE AND COMPETENCE; the PATIENT attends appointments, consents to evaluation, listens to the information, takes the time and energy and spends the money necessary to follow-up on referrals and treatments.
Do you see? It is not the provider who is responsible for ascertaining the completion of treatment in the face of all odds. (Read recent blog, “Way Too.”) It is not the provider who is responsible for providing the treatment if the patient is not compliant in attendance, following the guidance and instructions of the provider, including self-care, referral attendance, and so forth.
- provide the appropriate referrals and information
- do NOT continue care if the patient does not follow up on referrals, compliance, payment, attendance of appointments.
- proceed with treatment IN THE AREAS of your expertise and comfort.
Which brings us to the fact that you as a generalist, gatekeeper, dental home, have the opportunity to study and learn any one or more of many topics, many dental specialty areas. Any and all treatment you provide in any area of dentistry, by law, must be at the level of what is expected of a specialist in that area. That goes for and includes, endodontics, surgery, prosthodontics, implants, orthodontics, periodontics, and pediatric dentistry.
And to have a full life, a resoundingly successful life and practice, and provide truly great care to your patients, you must choose and adapt to providing the areas of care in which you are interested, have fun, can be great, and continue learning and growing. In other words, keep growing and working in your areas of expertise. You will spend much less money on equipment, supplies, staff training, and learning curve time. If you instead, invest in equipment, staff training and learning curve time for you area of “specialization”, rather than all areas, it will cost you much less and you will be much more profitable.
Choose - Make it profitable. Your dental practice is your living. It is your source of income for you and your family.
Choose - Make it fun for you. Do what you enjoy the most, and consider delegating the rest. (Whether another doctor, or staff, you can delegate the rest.)
Choose - Find what you really love and get REALLY good at it. Your practice will be distinguished by the area in which you focus. What does your practice do that distinguishes you from the others?
Choose - and get FREE. An area of expertise and excellence in expertise gives you freedom. Get free of the stress of the parts you don’t like, free of spending the money on so many different courses, so many supplies, equipment, staff training, and learning curves where you aren’t making much or an money while you are learning. Free to discover a main mentor in your area of expertise-to-be. Free to become a mentor and possibly a teacher of your area of expertise. Free to enjoy life. Free to work ON your practice, and not just IN your practice.
Choose and change your life!
- Published on
Find the Joy in Your Everyday Practice Life : Part III
The Critical Elements
Critical element: Loving your patients and your patients’ parents
As your practice begins changing (because YOU are changing), you will find it easier and easier to love your patients. They will love you more. You will have created a love-fest.
And, by the way, you can learn to choose your patients. You will sense a patient who does not fit your GREAT practice, and help them with referral out. It’s amazing how easy it gets to say to a patient, “I do not believe I can meet your needs. I am not the right dentist for you.” And, less and less, do you need to say anything, because your patient population will begin to mirror and fit your joy, your great practice. It’s part of the magic of greatness and gratitude.
Your love and your great practice’s love will transform everything. You will be amazed how nice patients come “out of the woodwork.” They will flock to your practice because you and your staff are loving - kind, gracious, caring.
While you work on loving everyone, your practice is transforming before your eyes, and you need less (or no) marketing, practice management gurus, techniques, and formulas. You do need mutual support and love between yourself and your staff, patients, and yes, practice enhancers, those energetic, loving, caring people who help you and your staff in the transition, and beyond.
Critical element: Curiosity
It’s a new curiosity. Not the old gossipy-what’s-happening-around-town type of curiosity. This is a new curiosity about each person - staff, patient, visitor, and neighbor. This is a what-in-your-life-is-good sort of curiosity. It’s a magic curiosity.
All of a sudden you care. Why do you care about your assistant’s pregnancy? Because you love her and she is so happy. Your curiosity is more about how she is seeing this exciting change, and less about what are her symptoms, concerns, progress, and so on.
You care about a patient who shares with you that she is working to change her nutrition, and you care that that will reduce her oral illnesses as well.
You care about your neighbor dentist who wants to come talk and talk and talk, fussing about all his travails. You care and so you ask him, “What’s good in your day today?” And when, after his stunned silence, he answers, “Good patients coming today,” you respond, “Me too! Isn’t it wonderful?” And he grumps less and less.
You care. And somehow life turns in your favor. Not everything is perfect, but even the things that are not perfect, you see as opportunities to learn, to get strong. You know all is the way it is supposed to be. You feel it in your bones! It’s a new curiosity!
Critical element: Your "slight edge"
Author Jeff Olson named it “The Slight Edge”. It’s NOT a self-help gimmick or motivational tool. The Slight Edge is actually what you are doing every minute of every day. Your moment-to-moment actions are either the slight edge going to GREAT, or going to NOT-GREAT.
Your simple daily activities in your life are powerful. They may be powerful GREAT or powerful NOT-GREAT.
The ability to change the slight edge to positive and powerful, is already in you. If your actions are taking you down to NOT-GREAT, you can become aware of that and change your trajectory! As you realize how important it is to arrive for your day in gratitude, choose a healthy bite of food, hang out with people who support love and greatness, your beliefs and attitude will give you strength to make these positive powerful choices. Your tiny actions will build to GREAT results.
And this creates YOUR LIFE! which will never be the same again.
Read about Jeff Olson’s "Night of Despair" and "Day of Disgust" that brought him to realize he was on the slight edge going the wrong way, instead of toward a powerful, joyous life! It's in his book, "The Slight Edge."
The Critical Elements
Critical element: Loving your patients and your patients’ parents
As your practice begins changing (because YOU are changing), you will find it easier and easier to love your patients. They will love you more. You will have created a love-fest.
And, by the way, you can learn to choose your patients. You will sense a patient who does not fit your GREAT practice, and help them with referral out. It’s amazing how easy it gets to say to a patient, “I do not believe I can meet your needs. I am not the right dentist for you.” And, less and less, do you need to say anything, because your patient population will begin to mirror and fit your joy, your great practice. It’s part of the magic of greatness and gratitude.
Your love and your great practice’s love will transform everything. You will be amazed how nice patients come “out of the woodwork.” They will flock to your practice because you and your staff are loving - kind, gracious, caring.
While you work on loving everyone, your practice is transforming before your eyes, and you need less (or no) marketing, practice management gurus, techniques, and formulas. You do need mutual support and love between yourself and your staff, patients, and yes, practice enhancers, those energetic, loving, caring people who help you and your staff in the transition, and beyond.
Critical element: Curiosity
It’s a new curiosity. Not the old gossipy-what’s-happening-around-town type of curiosity. This is a new curiosity about each person - staff, patient, visitor, and neighbor. This is a what-in-your-life-is-good sort of curiosity. It’s a magic curiosity.
All of a sudden you care. Why do you care about your assistant’s pregnancy? Because you love her and she is so happy. Your curiosity is more about how she is seeing this exciting change, and less about what are her symptoms, concerns, progress, and so on.
You care about a patient who shares with you that she is working to change her nutrition, and you care that that will reduce her oral illnesses as well.
You care about your neighbor dentist who wants to come talk and talk and talk, fussing about all his travails. You care and so you ask him, “What’s good in your day today?” And when, after his stunned silence, he answers, “Good patients coming today,” you respond, “Me too! Isn’t it wonderful?” And he grumps less and less.
You care. And somehow life turns in your favor. Not everything is perfect, but even the things that are not perfect, you see as opportunities to learn, to get strong. You know all is the way it is supposed to be. You feel it in your bones! It’s a new curiosity!
Critical element: Your "slight edge"
Author Jeff Olson named it “The Slight Edge”. It’s NOT a self-help gimmick or motivational tool. The Slight Edge is actually what you are doing every minute of every day. Your moment-to-moment actions are either the slight edge going to GREAT, or going to NOT-GREAT.
Your simple daily activities in your life are powerful. They may be powerful GREAT or powerful NOT-GREAT.
The ability to change the slight edge to positive and powerful, is already in you. If your actions are taking you down to NOT-GREAT, you can become aware of that and change your trajectory! As you realize how important it is to arrive for your day in gratitude, choose a healthy bite of food, hang out with people who support love and greatness, your beliefs and attitude will give you strength to make these positive powerful choices. Your tiny actions will build to GREAT results.
And this creates YOUR LIFE! which will never be the same again.
Read about Jeff Olson’s "Night of Despair" and "Day of Disgust" that brought him to realize he was on the slight edge going the wrong way, instead of toward a powerful, joyous life! It's in his book, "The Slight Edge."
LEFT: Jeff Olson's excellent book, "The Slight Edge", gives excellent direction for life and business.
- Published on
As a dentist, you are a special kind of person.
Special because you went into dentistry to help others. Special because you have love to give. Now before you go and feel guilty because you hoped dentistry would make you a good living, let me say, “Congratulations."
You are also special because you want to take great care of yourself and your family.” Dentistry is what you do for a living! It should be a good living! You spend your time working hard and loving others. That’s the idea!
The most important thing is that you feel in your heart, a desire to serve, to love! If you aren’t interested in serving others, you might want to rethink being in dentistry.
Love is the whole thing. “All you need is love.” ~ the Beatles.
And, "love is all we’ve got.” ~ Kenny Rogers.
“Love your neighbor as yourself.” ~ the Bible.
Love is the answer - to any question; to any quandary; to life’s toughest times.
And, love is the answer to your success - as a spouse, as a dentist, as a parent, friend, as a soul.
"You can have everything in life you want, if you will just help other people get what they want." ~ Zig Ziglar.
You can’t teach an unhappy person to be full of love, even though it’s in there somewhere. But you can practice yourself, AND TEACH your people to consciously share love. When love is shared, it comes boomeranging back many-fold. What a deal!
The Southeastern Society of Pediatric Dentistry has long held its winter educational meeting in Atlanta, at the Buckhead Ritz-Carlton. I was "wowed" by a gentleman who helped me, when he smiled broadly and answered my “thank you” with, “It is my pleasure.”
It was his pleasure to help me. His pleasure to serve me. After that meeting, I began teaching my own office team as well as the seminar doctors the beautiful, easy, precious words to express love to those we serve: “It’s my pleasure.”
Lookie lookie!
Today, some 15 or more years later, our culture has adopted an ubiquitous colloquialism, “No problem.” While typically totally well-intentioned, it is actually not kind in its implication.
Think about it - when someone does something for me - serves me - then responds to my gratitude, “No problem,” the implication is basically, “It typically is a problem, but this time maybe it’s not such a problem.” or something related.
No matter - you have the incredible opportunity to demonstrate your love, by responding, not with a nod, not with a “you’re welcome,” but with, “It’s my pleasure!” When delivered genuinely with a smile, that struts your love stuff!
The tiny change of EVERY time someone says thank you, to respond, “It’s my pleasure,” has just elevated your client fulfillment system tremendously.
In dentistry, you went in to take care of people; to be good to people;…. for heaven’s sake, and then to imply it might have been a problem?
Strut your stuff! It pays great dividends back ‘at-cha.’ It’s what distinguishes your practice from the others.
Strut your stuff! Strut your love stuff!
It’s my pleasure!
Special because you went into dentistry to help others. Special because you have love to give. Now before you go and feel guilty because you hoped dentistry would make you a good living, let me say, “Congratulations."
You are also special because you want to take great care of yourself and your family.” Dentistry is what you do for a living! It should be a good living! You spend your time working hard and loving others. That’s the idea!
The most important thing is that you feel in your heart, a desire to serve, to love! If you aren’t interested in serving others, you might want to rethink being in dentistry.
Love is the whole thing. “All you need is love.” ~ the Beatles.
And, "love is all we’ve got.” ~ Kenny Rogers.
“Love your neighbor as yourself.” ~ the Bible.
Love is the answer - to any question; to any quandary; to life’s toughest times.
And, love is the answer to your success - as a spouse, as a dentist, as a parent, friend, as a soul.
"You can have everything in life you want, if you will just help other people get what they want." ~ Zig Ziglar.
You can’t teach an unhappy person to be full of love, even though it’s in there somewhere. But you can practice yourself, AND TEACH your people to consciously share love. When love is shared, it comes boomeranging back many-fold. What a deal!
The Southeastern Society of Pediatric Dentistry has long held its winter educational meeting in Atlanta, at the Buckhead Ritz-Carlton. I was "wowed" by a gentleman who helped me, when he smiled broadly and answered my “thank you” with, “It is my pleasure.”
It was his pleasure to help me. His pleasure to serve me. After that meeting, I began teaching my own office team as well as the seminar doctors the beautiful, easy, precious words to express love to those we serve: “It’s my pleasure.”
Lookie lookie!
Today, some 15 or more years later, our culture has adopted an ubiquitous colloquialism, “No problem.” While typically totally well-intentioned, it is actually not kind in its implication.
Think about it - when someone does something for me - serves me - then responds to my gratitude, “No problem,” the implication is basically, “It typically is a problem, but this time maybe it’s not such a problem.” or something related.
No matter - you have the incredible opportunity to demonstrate your love, by responding, not with a nod, not with a “you’re welcome,” but with, “It’s my pleasure!” When delivered genuinely with a smile, that struts your love stuff!
The tiny change of EVERY time someone says thank you, to respond, “It’s my pleasure,” has just elevated your client fulfillment system tremendously.
In dentistry, you went in to take care of people; to be good to people;…. for heaven’s sake, and then to imply it might have been a problem?
Strut your stuff! It pays great dividends back ‘at-cha.’ It’s what distinguishes your practice from the others.
Strut your stuff! Strut your love stuff!
It’s my pleasure!
Dr Chris Baker, teaching an ortho seminar in Dubai. Her teaching and seminar schedule for 2018 will be posted soon on: www.loveandorthodontics.com
- Published on
Against the backdrop of the mucosal tissues, the teeth, our target for treatment, stand out.
After diagnosis and treatment planning - normally the next step is the banding/ bracketing - of all available teeth. We pride ourselves in increasingly capable bracket placement, and work hard to be sure all brackets are placed as well as possible.
Our training and experience has taught us all about beautiful alignment. And occlusion.
After diagnosis and treatment planning - normally the next step is the banding/ bracketing - of all available teeth. We pride ourselves in increasingly capable bracket placement, and work hard to be sure all brackets are placed as well as possible.
Our training and experience has taught us all about beautiful alignment. And occlusion.
The question is, what should we do when we can’t have both, beautiful alignment AND occlusion?
Why can’t we always have both? Simply because the teeth in a human body don’t work like the teeth on a wax typodont or a plaster model.
Neither can the occlusion be changed as it can on models, by trimming the models, nor can the teeth necessarily be put into what we consider “ideal” alignment, as identified, for example, by the American Board of Orthodontics parameters for “ideal.”
“Wha??," you ask.
Ovoid arch forms
Ovoid arch forms, which, according to Ricketts, are found in 25 percent of the population, do not align to meet ABO criteria due to the greater curvatures and resulting positions of the teeth in alignment.
In an article by Kazuhito, A., and Will, L., the ovoid arch form is shown to be the arch form having the greatest variations among the examiners who are ranking them. (https://doi.org/10.1016/j.ajodo.2009.12.032)
Second molar prematurities
This may be the most common reason to consider carefully before bracketing 7’s. Second molars have a good chance of extrusion, when included in the archwire. And, if they extrude, voila! an iatrogenic prematurity, iatrogenic CR-CO discrepancy, and a risk introduced for future dysfunctional occlusion, need for RCT on a tooth that takes a pounding (and has no decay). We never want our orthodontic treatment to contribute to dysfunctional occlusion.
Here’s the real problem; the variable human body and variable tooth responses. Each body acts and reacts differently. Some folks can eat carbs/sugars all day and not get fat. Some cannot. Some people smoke and live to be 100 years old. Most do not. Why?
Some people can have a CR-CO slide and never have a symptom or problem. Many people have symptoms - craniofacial, neck and back pain, fractured molars, non-carious, non-vital molars needing RCT, gingival margin recession, especially in bi’s and molars and in the absence of perio disease, posterior crowns, abfractions, worn occlusal surfaces of posterior teeth?
Each human body reacts differently. And, adults are often not very adaptable. Our orthodontic treatment – mechanics – must be considered at risk of being etiologic (iatrogenically) in occlusal dysfunction.
So where does this leave us with those blessed second molars? It leaves us with a strong and careful consideration if they should be bracketed, or not. It just may be that the occlusion may be better without putting the 7’s into “harm’s way.” Even rotated, or malposed, are they quietly ok in the occlusion?
A patient may have MANY “CO” bites. Some patients are all over the map with their comfortable or uncomfortable bite. And some patients’ musculature and resulting joint movements will change the bite with the tiniest - and I do mean TINY - changes, like a new restoration with even tiny high spot. Consider that we never really know where a patient’s functional AND dysfunctional occlusion will be next. Keep that in mind when you consider bracketing those most-likely-to-extrude-7’s.
Which brings us to another reason not to bracket teeth:
The patient presents with signs and symptoms of dysfunctional occlusion.
Perhaps minor treatment, anterior alignment, with anchored posteriors is a consideration. Perhaps NO orthodontic treatment is the right choice. Neither you nor your patient want the situation to be worsened.
Don’t bracket a tooth just because it’s white.
Why can’t we always have both? Simply because the teeth in a human body don’t work like the teeth on a wax typodont or a plaster model.
Neither can the occlusion be changed as it can on models, by trimming the models, nor can the teeth necessarily be put into what we consider “ideal” alignment, as identified, for example, by the American Board of Orthodontics parameters for “ideal.”
“Wha??," you ask.
Ovoid arch forms
Ovoid arch forms, which, according to Ricketts, are found in 25 percent of the population, do not align to meet ABO criteria due to the greater curvatures and resulting positions of the teeth in alignment.
In an article by Kazuhito, A., and Will, L., the ovoid arch form is shown to be the arch form having the greatest variations among the examiners who are ranking them. (https://doi.org/10.1016/j.ajodo.2009.12.032)
Second molar prematurities
This may be the most common reason to consider carefully before bracketing 7’s. Second molars have a good chance of extrusion, when included in the archwire. And, if they extrude, voila! an iatrogenic prematurity, iatrogenic CR-CO discrepancy, and a risk introduced for future dysfunctional occlusion, need for RCT on a tooth that takes a pounding (and has no decay). We never want our orthodontic treatment to contribute to dysfunctional occlusion.
Here’s the real problem; the variable human body and variable tooth responses. Each body acts and reacts differently. Some folks can eat carbs/sugars all day and not get fat. Some cannot. Some people smoke and live to be 100 years old. Most do not. Why?
Some people can have a CR-CO slide and never have a symptom or problem. Many people have symptoms - craniofacial, neck and back pain, fractured molars, non-carious, non-vital molars needing RCT, gingival margin recession, especially in bi’s and molars and in the absence of perio disease, posterior crowns, abfractions, worn occlusal surfaces of posterior teeth?
Each human body reacts differently. And, adults are often not very adaptable. Our orthodontic treatment – mechanics – must be considered at risk of being etiologic (iatrogenically) in occlusal dysfunction.
So where does this leave us with those blessed second molars? It leaves us with a strong and careful consideration if they should be bracketed, or not. It just may be that the occlusion may be better without putting the 7’s into “harm’s way.” Even rotated, or malposed, are they quietly ok in the occlusion?
A patient may have MANY “CO” bites. Some patients are all over the map with their comfortable or uncomfortable bite. And some patients’ musculature and resulting joint movements will change the bite with the tiniest - and I do mean TINY - changes, like a new restoration with even tiny high spot. Consider that we never really know where a patient’s functional AND dysfunctional occlusion will be next. Keep that in mind when you consider bracketing those most-likely-to-extrude-7’s.
Which brings us to another reason not to bracket teeth:
The patient presents with signs and symptoms of dysfunctional occlusion.
Perhaps minor treatment, anterior alignment, with anchored posteriors is a consideration. Perhaps NO orthodontic treatment is the right choice. Neither you nor your patient want the situation to be worsened.
Don’t bracket a tooth just because it’s white.
- Published on
Dentists are attracted to their profession because they want to help others, and sometimes fall into the "approval addiction" trap.
We dentists are way too worried about people getting mad at us - people including our patients, our colleagues, our friends and family.
It’s our nature. Most people who are attracted to dental school are approval-addicted, and spend way too much time trying to please others.
Caring for ourselves first and foremost gives us the ability to care better for others. Caring for ourselves first and our family second makes us better dentists.
Seriously.
Because when we are at peace within, we present peace to all around us. Because when we feel good about “me”, we make others feel good about “you” AND about themselves. We emanate strength, love, surety.
When you learn to be happy with who you are, it frees you to pursue all you want to become. (And, the opposite is true. When you are fearful about whether you are “enough”, “good enough,” you are imprisoned and unable to pursue growth, change, and joy).
Approval addiction is an illness that keeps you from living life on your own terms. Pleasing others - you think - will help the others like you, want you to provide their orthodontic/dental care, love you. Nope. It’s the opposite.
Your working to please others is way too hard and doesn’t work. It’s borne of way too much fear. It’s the way you teach others you are a sucker. Oh sure, they may say how “nice” you are, and hang around to get what they want to get from you, but in the long run, the approval-addicted one is way too exhausted, way too confused, way too used, and your life is just way too hard.
Your life is way too valuable and potentially way too wonderful to keep being vulnerable to the fear that begets approval addiction.
As you live in the surety that you are indeed valuable, that you are indeed a love, that you bring incredible life to those around you, you can release the habit of being addicted to others’ approval.
Are you worried about what your staff thinks of you? What your patients think of you? What your colleagues think of you?
It’s time to decide - once and for all - that you are great the way you are, that you will keep growing and learning, that you will design your life, your practice, your each and every day, yourself.
“If you don’t, chances are you'll fall into those other people’s plans. And guess what they have planned for you? Not much.” ~ Jim Rohn
Once the other folks get what they want from you, they move on to work on someone else’s plan. And someone else moves into your life to try to plan your life.
Decide today. You are way too valuable, way too capable. Let others leave their future, their lives in others’ hands. Not you!!
It’s our nature. Most people who are attracted to dental school are approval-addicted, and spend way too much time trying to please others.
Caring for ourselves first and foremost gives us the ability to care better for others. Caring for ourselves first and our family second makes us better dentists.
Seriously.
Because when we are at peace within, we present peace to all around us. Because when we feel good about “me”, we make others feel good about “you” AND about themselves. We emanate strength, love, surety.
When you learn to be happy with who you are, it frees you to pursue all you want to become. (And, the opposite is true. When you are fearful about whether you are “enough”, “good enough,” you are imprisoned and unable to pursue growth, change, and joy).
Approval addiction is an illness that keeps you from living life on your own terms. Pleasing others - you think - will help the others like you, want you to provide their orthodontic/dental care, love you. Nope. It’s the opposite.
Your working to please others is way too hard and doesn’t work. It’s borne of way too much fear. It’s the way you teach others you are a sucker. Oh sure, they may say how “nice” you are, and hang around to get what they want to get from you, but in the long run, the approval-addicted one is way too exhausted, way too confused, way too used, and your life is just way too hard.
Your life is way too valuable and potentially way too wonderful to keep being vulnerable to the fear that begets approval addiction.
As you live in the surety that you are indeed valuable, that you are indeed a love, that you bring incredible life to those around you, you can release the habit of being addicted to others’ approval.
Are you worried about what your staff thinks of you? What your patients think of you? What your colleagues think of you?
It’s time to decide - once and for all - that you are great the way you are, that you will keep growing and learning, that you will design your life, your practice, your each and every day, yourself.
“If you don’t, chances are you'll fall into those other people’s plans. And guess what they have planned for you? Not much.” ~ Jim Rohn
Once the other folks get what they want from you, they move on to work on someone else’s plan. And someone else moves into your life to try to plan your life.
Decide today. You are way too valuable, way too capable. Let others leave their future, their lives in others’ hands. Not you!!
- Published on
Airway issues - sleep apnea - OSAS - have hit the “mainstream” in dentistry, first concerning the adult patient, and now the child patient.
I am thrilled!
Why? Because there are so many children we can help!
For more than 25 years, as a teacher of orthodontics and pediatric dentist treating children orthodontically, I have been a voice in the wilderness - and in teaching - about the airway issues in children and how they negatively impact cranio-facial growth and the child's entire well-being.
So many signs and symptoms that conventional wisdom and literature have attributed to genetics - like growth pattern, allergies, and so on - actually usually have a different etiology than we’ve been believing. Instead of mom having the “same” Class II retrognathic mandible, indeed, mom has the “same” forward head posture”, related to her airway/breathing issues.
I am thrilled!
Why? Because there are so many children we can help!
For more than 25 years, as a teacher of orthodontics and pediatric dentist treating children orthodontically, I have been a voice in the wilderness - and in teaching - about the airway issues in children and how they negatively impact cranio-facial growth and the child's entire well-being.
So many signs and symptoms that conventional wisdom and literature have attributed to genetics - like growth pattern, allergies, and so on - actually usually have a different etiology than we’ve been believing. Instead of mom having the “same” Class II retrognathic mandible, indeed, mom has the “same” forward head posture”, related to her airway/breathing issues.
Signs of poor breathing/airway dysfunction: mouth-breathing, narrow tipped-up nose, tired eyes with ptosis, openmouthed posture, dry lips, vertical growth. © 2000 Dr Chris Baker
Instead of Edwin having Class III brachyfacial growth which he “inherited” from Dad who looks the “same,” the child has a severe forward tongue position, with deep bite, forward mandibular positioning and Class III growth.
It is indeed the “same” as Dad - both Edwin and his dad spent early formative years with huge tonsils and inability to breathe nasally. Breathing is primary. We do what we must to breathe. Unknowingly posturing his mandible forward, bringing the tongue with it, due to the hyoid muscle attachments, allows Edwin, and allowed his father, to breathe through his mouth, bypassing his nose, and get the oxygen needed to survive.
So - Dad and Edwin grew similarly - Class III. The genetic etiology for this father and son pair has to do with tonsillar enlargement - and in Edwin’s case - is CHANGEABLE because he is still growing. Following removal of the tonsils and adenoids (adenoid tissue was enlarged as well), and expansion of his narrow palate, Edwin now breathes nasally. His Class III growth is diminishing (still habitual forward tongue.…).
As an early evangelist with this subject, having learned from Dr. Walter Doyle, I discovered that there was a huge volume of airway literature produced in the 1970’s, much of it led by Sten Linder-Aronson and Donald Woodside, Dudley Weider, Kenneth Nowak and colleagues, Donald Timms, and even Henri Petit.
They knew and published about what we think we are so smart to be “figuring out” now. Having been teaching and practicing this knowledge all these 25+ years, I am - yes - THRILLED - to see our “modern” thinking catching up to this body of knowledge.
It is indeed the “same” as Dad - both Edwin and his dad spent early formative years with huge tonsils and inability to breathe nasally. Breathing is primary. We do what we must to breathe. Unknowingly posturing his mandible forward, bringing the tongue with it, due to the hyoid muscle attachments, allows Edwin, and allowed his father, to breathe through his mouth, bypassing his nose, and get the oxygen needed to survive.
So - Dad and Edwin grew similarly - Class III. The genetic etiology for this father and son pair has to do with tonsillar enlargement - and in Edwin’s case - is CHANGEABLE because he is still growing. Following removal of the tonsils and adenoids (adenoid tissue was enlarged as well), and expansion of his narrow palate, Edwin now breathes nasally. His Class III growth is diminishing (still habitual forward tongue.…).
As an early evangelist with this subject, having learned from Dr. Walter Doyle, I discovered that there was a huge volume of airway literature produced in the 1970’s, much of it led by Sten Linder-Aronson and Donald Woodside, Dudley Weider, Kenneth Nowak and colleagues, Donald Timms, and even Henri Petit.
They knew and published about what we think we are so smart to be “figuring out” now. Having been teaching and practicing this knowledge all these 25+ years, I am - yes - THRILLED - to see our “modern” thinking catching up to this body of knowledge.
Five things your patient may exhibit
which could indicate airway issues:
While we could spend hours on this topic - and I do in teaching - for now let’s just look at five things your patients might exhibit to let you know they have an airway problem or may have an airway problem. Because - if your patient begins breathing nasally, their growth and development is changed - starting immediately. So the five things?
1. Enuresis - Bedwetting;
2. ADHD, ADD, behavioral problems, manic-depressive disorder of childhood, aggressive behavior;
3. Lowered IQ and Learning disabilities;
4. Restless sleep and daytime fatigue;
5. Bruxism - tooth grinding.
These all reduce a child’s quality of life - experience of life - to a life with difficulties, struggles, and are very often changeable, thus unncecessary.
And you can be the one to guide the life-transformation.
"Normal healthy cells
turn into malignant cells
simply in the presence
of lowered O2." ~ Otto Warburg
Three things you can do to improve the child’s chance of nasal breathing and his/her life
You - the child’s orthodontist, dentist, pediatric dentist, can help - a LOT!!
You can:
Nasal and sinus mucosa release nitric oxide,
a potent bronchodilator and vasodilator, hypotensive and it is bacteriostatic and virostatic.
There is more - so much more we can discuss about this topic.
Can you imagine, the lives you can change?
Can you imagine, how grateful the parents will be?
Can you imagine reducing the risk of adult sleep apnea in your now child patients?
Can you imagine, how wonderful for you?
Learn about the airway in children.
Contact me and I will be glad to help.
which could indicate airway issues:
While we could spend hours on this topic - and I do in teaching - for now let’s just look at five things your patients might exhibit to let you know they have an airway problem or may have an airway problem. Because - if your patient begins breathing nasally, their growth and development is changed - starting immediately. So the five things?
1. Enuresis - Bedwetting;
2. ADHD, ADD, behavioral problems, manic-depressive disorder of childhood, aggressive behavior;
3. Lowered IQ and Learning disabilities;
4. Restless sleep and daytime fatigue;
5. Bruxism - tooth grinding.
These all reduce a child’s quality of life - experience of life - to a life with difficulties, struggles, and are very often changeable, thus unncecessary.
And you can be the one to guide the life-transformation.
"Normal healthy cells
turn into malignant cells
simply in the presence
of lowered O2." ~ Otto Warburg
Three things you can do to improve the child’s chance of nasal breathing and his/her life
You - the child’s orthodontist, dentist, pediatric dentist, can help - a LOT!!
You can:
- Ask and discover the signs and symptoms.
- Refer to the ENT.
- Expand the arch to just short of buccal crossbite
Nasal and sinus mucosa release nitric oxide,
a potent bronchodilator and vasodilator, hypotensive and it is bacteriostatic and virostatic.
There is more - so much more we can discuss about this topic.
Can you imagine, the lives you can change?
Can you imagine, how grateful the parents will be?
Can you imagine reducing the risk of adult sleep apnea in your now child patients?
Can you imagine, how wonderful for you?
Learn about the airway in children.
Contact me and I will be glad to help.
Forward tongue position resulting from airway/habit dysfunction. Undermines a child’s beauty and causes abnormal craniofacial development. Image © 2016 Dr Chris Baker
- Published on
Part IV - How Can I Get There from Here?
How can you help your patients fall in love with your business?
How can you really manage your people/staff?
How can your practice/life/family/you be more fun?
How can you find peace?
Believe it or not, the answers to each of these questions are very similar. Perhaps the same.
The answer is - Ta Da……….. Drum Roll……….. Waiting……….
How can you really manage your people/staff?
How can your practice/life/family/you be more fun?
How can you find peace?
Believe it or not, the answers to each of these questions are very similar. Perhaps the same.
The answer is - Ta Da……….. Drum Roll……….. Waiting……….
...Systematize your practice!
Creating and defining a repeatable system allows your people - AND YOU - to spend your time and attention on getting the jobs done faster and smoother, while having more fun.
Structure is freedom. Freedom to do the necessary, redundant tasks while enjoying the people around you more. While getting the job done faster without as much frustration and challenge, and having more time for you, for your family, for your friends, for your fun. While focusing on your creativity - in or out of your practice.
The systematized structure communicates your vision of how you want things done. Your people have something to work with - direction, goals, habits, and constant improvement.
The system provides predictability to your patients, parents and staff. People like to know what to expect. People like certainty.
And when you encourage your folks to look for innovative ways to improve the system, it will indeed even get better. Way better. Nothing improves systems like people and their ideas as they perform the system tasks and realize how it could work better.
Looking for ways to improve on current systems should be encouraged - BUT - that doesn’t mean people go off willy-nilly and do it differently. It means your system has a line of communication to the person who will set up the innovation and quantification of it - the measure of it - to see what works and what doesn’t.
Back to your questions:
How can you help your patients fall in love with your business?
The system. The system gives your patients certainty and the meeting of their expectations each and every time. The system gives you and the staff more time to enjoy the patients and parents, and have fun with them. The system allows you to focus on love, not on fear (of business, of people being unhappy, of whether or not you can ‘do it’). The system allows you to fall in love with the patients and parents. Truly.
“There are two basic motivating forces: fear and love. When we are afraid, we pull back from life. When we are in love, we open to all that life has to offer with passion, excitement, and acceptance. We need to learn to love ourselves first, in all our glory and our imperfections. If we cannot love ourselves, we cannot fully open to our ability to love others or our potential to create. Evolution and all hopes for a better world rest in the fearlessness and open-hearted vision of people who embrace life.” ~ John Lennon
The system allows your true expertise to meet deep compassion and share it.
How can you really manage your people/staff?
The system. Managing people is impossible.
“Managing the system is possible and necessary to success.” ~ Michael E. Gerber
Picture this -- what if everyone on your team were focused every day on following/using the system you have created, and even making it better, instead of hanging out, playing it by ear (whatever that means), winging it, scratching their heads about what to do — or worse, coming to ask YOU?
How would that feel? How much would you like your system then?
How can your practice/life/family/you be more fun?
How can you find peace?
You can find peace in your systems. You can find time in your system, because things don’t take as long. Things go smoother. There are less questions, problems, challenges. You can remain calm and working, enjoying it more.
Structure is freedom. Freedom to do the necessary, redundant tasks while enjoying the people around you more. While getting the job done faster without as much frustration and challenge, and having more time for you, for your family, for your friends, for your fun. While focusing on your creativity - in or out of your practice.
The systematized structure communicates your vision of how you want things done. Your people have something to work with - direction, goals, habits, and constant improvement.
The system provides predictability to your patients, parents and staff. People like to know what to expect. People like certainty.
And when you encourage your folks to look for innovative ways to improve the system, it will indeed even get better. Way better. Nothing improves systems like people and their ideas as they perform the system tasks and realize how it could work better.
Looking for ways to improve on current systems should be encouraged - BUT - that doesn’t mean people go off willy-nilly and do it differently. It means your system has a line of communication to the person who will set up the innovation and quantification of it - the measure of it - to see what works and what doesn’t.
Back to your questions:
How can you help your patients fall in love with your business?
The system. The system gives your patients certainty and the meeting of their expectations each and every time. The system gives you and the staff more time to enjoy the patients and parents, and have fun with them. The system allows you to focus on love, not on fear (of business, of people being unhappy, of whether or not you can ‘do it’). The system allows you to fall in love with the patients and parents. Truly.
“There are two basic motivating forces: fear and love. When we are afraid, we pull back from life. When we are in love, we open to all that life has to offer with passion, excitement, and acceptance. We need to learn to love ourselves first, in all our glory and our imperfections. If we cannot love ourselves, we cannot fully open to our ability to love others or our potential to create. Evolution and all hopes for a better world rest in the fearlessness and open-hearted vision of people who embrace life.” ~ John Lennon
The system allows your true expertise to meet deep compassion and share it.
How can you really manage your people/staff?
The system. Managing people is impossible.
“Managing the system is possible and necessary to success.” ~ Michael E. Gerber
Picture this -- what if everyone on your team were focused every day on following/using the system you have created, and even making it better, instead of hanging out, playing it by ear (whatever that means), winging it, scratching their heads about what to do — or worse, coming to ask YOU?
How would that feel? How much would you like your system then?
How can your practice/life/family/you be more fun?
How can you find peace?
You can find peace in your systems. You can find time in your system, because things don’t take as long. Things go smoother. There are less questions, problems, challenges. You can remain calm and working, enjoying it more.
You can quit working through lunch. You can quit leaving two hours after the rest of the staff. You can have recharge time for yourself. Your life can be YOUR life.
It’s time.
Want help?
Contact me for information as to where to start.
It’s time.
Want help?
Contact me for information as to where to start.
RIGHT PHOTO: Dr. Chris Baker and Dr Luis Carriere chat following a 2017 Dubai seminar at which both of them taught.
