Does your Ortho see you before adjustments/wire changes?

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#16 Post by **nvcarissa** » Fri Jul 21, 2006 12:08 am

My ortho always stops at the chair. In the beginning, instructions were in my chart and the tech just did the work, and often would make decisions on whether to figure-8 a lig or use a wire tie on a particularly stubborn tooth. But my ortho would ALWAYS check the work. As I got further on in treatment and my teeth were getting pretty well aligned, the tech would remove my ligs and the Ortho would then come over and check me and instruct the tech on what to do. I think in the beginning alignment phase, things may be a bit more cut and dried, but as treatment progresses and more expertise and tweaking is involved, the ortho becomes more hands on. For instance, he is the one who puts all the bends in my wires and places them in my brackets, but leaves the lig work to the tech. If I need a new bracket or some such hardware, the tech places it but the Ortho inspects the placement and adjusts if necessary before the special light to harden the glue is applied.

#17 Post by **fins** » Fri Jul 21, 2006 6:56 am

nvcarissa- I am getting the opposite, the tech put all the bends in the wire the last visit. The ortho never even checked anything after all the work was done. I think I had the most experienced tech in the office, so he must trust her but she's not an licensed ortho. Some of the techs in the office are learning on the job, and work with a more experienced tech. I think there's a bit of turnover too.

#18 Post by **jenfire** » Fri Jul 21, 2006 8:13 am

My orthodontist and the assistant both work on my teeth. The assistant does much of the "grunt" work--placing the wire, putting on ligatures, etc. The orthodontist checks her work and fixes anything as needed.

I do not have any problem with the assistant doing this work. I believe she is a capable and qualified person, and that is why the ortho gives her some additional responsibilities. I do believe there are some patients that do not approve of her having such responsibilities--personally, I think a lot of that attitude stems from patients' beliefs about the capabilities of young women (of course, I am baised because I have to face the same beliefs/stereotypes-- that only old white men can be professors engaged in serious scholarship).

#19 Post by **payoki** » Fri Jul 21, 2006 9:42 am

when I come in for an appointment my ortho takes a look of my progress and checks with his file and does all the work him self and during the work he and I talk, will mostly he does all the talking because I have my mouth stretched open. But I'm pretty satisfy with the attention I get.

#20 Post by **Kodius Champion** » Fri Jul 21, 2006 3:18 pm

He also told me, "BY LAW THE ORTHO HAS TO SEE YOU AT EVERY VISIT". I am in Canada so maybe that doesn't apply everywhere, but that is how it works here.

Is there anyone who knows where I can find the official statement of this?

#21 Post by **nvcarissa** » Sat Jul 22, 2006 10:33 am

I'm not in Canada, but in Nevada we have a Dental Board that sets the rules.

http://www.nvdentalboard.org/dentalpdfs ... nt%202.pdf

See page 9 as to what hygienists can do under supervision by the dentist.
I am assuming that since orthodontia is a specialty of dentistry, this applies to orthodontists as well.

#22 Post by **Pirate Wench** » Sat Jul 22, 2006 12:00 pm

I talked to my ortho about how some orthos don't even come and look at the patients. He said that seem to happen more in the USA in the "larger" offices. The assistant that was there and my ortho also said that after working as an assistant in the ortho office, the assistant starts to see what the ortho sees and can usually see where the treatment is going and what needs to be done next. Of course, he is very confident in his assistant and she is really good. That makes all the difference.

I know my ortho will continue to come and check how my progress is coming, but I think it is great that I have an assistant working on me that is able to predict what the ortho is going to do next!

#23 Post by **tkais** » Sun Jul 23, 2006 4:12 am

For me the assistants only remove the old ligs and take out my wire. The ortho checks the position of my teeth, makes any adjustments to my wire and instructs the assistant on any changes he wants when replacing my new ligs. I can ask questions anytime I don't have fingers in my mouth and everyone is more than willing to answer anything I ask.
Guess I have a pretty good ortho.

#24 Post by **SkyWolf** » Fri Jul 28, 2006 11:27 pm

I always see my ortho. Usually one of the assistants will ask me about my color selections. Then proceed to acquire my ligs and come back to take the old ones off. They almost never take my wires out. Once the ligs are off the ortho usually comes over and checks out my teeth. He then puts on the little 8's, wire ties, and makes any kinks in the wire that may need to be made. If I need a new wire he tells the assistant. Usually then he writes on my chart and the assistant applies my new stuff and I'm ready to head out again. I always see one of the two ortho's though not matter what.

#25 Post by **LondonLingual** » Sun Jul 30, 2006 4:22 am

Wow I just had to post here. I spent a while looking for my Ortho before deciding on one I really liked. My Ortho does absolutely everything herself and she is a very well renowned and experienced practitioner with a busy modern surgery. I have to agree with what many of you said. I would feel extremely angry if I had paid the amount of money I did pay for my treatment and my Ortho was not present for adjustments or available for questions.

I can't help wondering if Orthoâ€™s are over pricing their treatments if it truly is the case that the majority of the work can be done by their assistants. When I compare how much a dentist's time costs and then consider it only takes two further years of study to qualify as an Ortho I start to wonder.

I really think this shows us just how important Internet sites like this one really are. If we can have frank discussions about our treatment, what we pay and what we get for our money, then it can only help to empower patients and future patients.

The medical gaze is a phenomenon of which we all have experience. I am never ashamed to let a doctor know exactly how much I have researched whatever problem or procedure I may be subject to and I don't think anyone should be. Many of us will have studied for years in higher education and some may even hold doctorates in subjects unrelated to medical science. We are patients not idiots!

To conclude (this long old rant LOL) I would say you should never let your Ortho get away with not being there to answer a question or not doing any treatment themselves that you don't feel comfortable having an assistant do (such as deciding on what to do next in your treatment plan). I must say that I am feeling extra lucky now to have such a great Ortho who treats me herself, speaks to me with respect and is always ready to discuss anything I care to raise.

http://en.wikipedia.org/wiki/Medical_gaze

#26 Post by **ingyandbert** » Sun Jul 30, 2006 5:36 pm

My ortho ALWAYS checks me before the techs do anything. I'd have a real issue with any ortho that didn't do that. Your treatment is the orthos' responsibility -- not the tech's. Techs are not orthodontists. They should only operate under the supervision of the ortho and should NEVER be substituted for the ortho. I would have a serious discussion with your ortho and make it clear you expect him or her to examine you at each visit.