March 12, 2023
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When my youngest brother was a baby, I remember him wearing shoes with a bar attaching them.  I was amazed that despite this devise, he was able to rapidly move to wherever he wanted, which was usually towards some sort of trouble.

In the 80’s, I decided to learn more about orthodontics. Less than 10 years into practice, I was noticing people in their late 20’s and 30’s who had orthodontics as teenagers were experiencing relapse.  I wanted to know why.  And of course, I learned nearly ZERO in dental school about orthodontics or TMJ.

So, I took a 3-year long course in Orthodontics, Dental-facial Orthopedics and TMJ.  It was there that I met Dr. Earl Bergerson, who taught part of the course.

An orthodontist, Dr. Bergerson spent his professional life studying growth and its relationship to orthodontics and orthodontics and its relationship to orthopedics and bone growth.  Both of my children and many of my patents benefitted from his growth guidance appliances, which I used throughout my career.  These appliances are now part of a program called “Healthy Start”.

What my brother experienced with his shoe-appliance, and I experienced with the “Occlusoguide” growth-guidance appliances, is that it’s fairly predictable to move bones while a child is growing.  Guided bone growth, or orthopedics, is challenging at best once natural growth has stopped.

Orthopedics is moving bones, while orthodontics is moving teeth.  Sometimes, when you move teeth, the bone comes along for the ride, even in adults who are done growing.  Sometimes it doesn’t.  Wouldn’t it be nice to be able to predict when that would occur?

And, I found out why many of my post-orthodontic patients were experiencing relapse.  It was either a failure to properly diagnose, poor case selection, or failure to move the roots of the teeth into a harmonious position relative to the bone, musclesand bite forces.

Case selection, doing the right thing on the right patient, is one of the more challenging things to teach and learn in health care.  It requires a ‘big picture’ thinking as well as experience.  And, as the doctor-patient relationship matters, even AI isn’t a total solution.

We know, that for many people with sleep apnea and other breathing disorders, the shape of their jaws is a contributing factor.  Narrow jaws do not allow for proper sinus function nor space for the tongue.  The result can be mouth breathing and a tongue that has nowhere else to go but back into the throat during sleep.

While oral appliances to advance the lower jaw during the night can work to treat sleep apnea, the holy grail would be to somehow permanently change the shape of the jaws (and even the sinuses) to remedy structural problems.  And, because adult, non-surgical, growth guidance has  yet to be proven in double blind, randomized studies, the only way to do this predictablyhas been with surgery.

Surgery of the jaws is a complex and expensive process that most people would like to avoid if at all possible.  Hence, there have been many ‘devices’ invented to help facilitate and guide adult jaw expansion.  To my knowledge, none of these adult orthopedic expansion devices are routinely taught in post-graduate orthodontic programs in U.S. dental schools.

The challenge then is, if one wants to learn about these new ‘devices’, one has to go to a course where it is taught.  Such courses rarely give the dentist-student the opportunity to dohands-on diagnose, evaluate live patients, treat them, deal with complications, and see the final results in actual patients, under the supervision of experts.   Rather, the dentist-students are left on their own to implement what might have been taught in a one or two-day course.

Let’s say that adult growth can be accomplished using some type of oral appliance.  Would every patient be a candidate?  Orwould it more likely be patients with particular phenotypes?  Would there be structural and other medical considerations?   Of course, there would.  “Patient selection” is one of the most difficult parts of diagnosis and treatment to learn and often comes with “clinical experience.”  It’s why we call health care application, PRACTICE.  Indeed, practice counts.

Last week, the airwaves and internet were abuzz with stories of a “dental device” that caused irreversible harm to a patient.  The image of this woman’s teeth protruding from her mouth is enough to scare anyone.  This might present a real challenge to all dentists, as people often look at the picture and the headlines and then fill in the rest on their own.  Any dental device might now be thought to result in the disfigurement that the woman in this story experienced.


Photos from KHN

And of course, it didn’t take long for LAWYERS to smell the blood in the water.

The real threat to dentists of this unfortunate story is not from the lawyers.  It’s the imprint it might have on Physicians who are involved in sleep and patients who are looking for a more comfortable alternative to CPAPs.

Don’t assume your referrers or your potential patients have not seen this or know the difference between your sleep appliances and the potential disfiguring “Dental Device” of the story.

This is the time to be proactive and educate your referrers and potential patients about the differences between the appliances you use and others, including the ones available on the internet or in the drug store.

Such an educational opportunity should be incorporated into every website, patient conversation, blogs, and everywhere and anywhere possible.

Good news!

This month’s Coffee With The Coach webinar covers this exact topic.  REGISTER HERE!

Want to learn how to communicate issues such as the DENTAL DEVICE DEBACLE to referring doctors and potential patients?  This webinar will give you ammunition and a delivery system to help encourage referrals and prospect conversion.


To your excellent reputation and success,


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Dr. Michael Goldberg is one of the leading educators on dental practice management in the United States.

Michael ran and sold a prestigious group practice in Manhattan and has been on Faculty at Columbia University and New York-Presbyterian Medical Center for 30 years including Director of the GPR program and Director of the course on Practice Management.

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