Date: Friday, October 05, 2007 11:12 PM
From: "ESCO automatic digest system" <LISTSERV@LISTSERV.UIC.EDU>
Subject: ESCO Digest - 1 Oct 2007 to 5 Oct 2007 (#2007-73)

There are 12 messages totalling 1444 lines in this issue.

Topics of the day:

1. Re: General/pediatric dentist-ortho communication
2. Re: General/pediatric dentist-ortho communication
3. Missed Initial Consultation Visits
4. Communication with dentists
5. Communication with referrals
6. Ortho communication and cone beam  question
7. Progress reports to referring dentists
8. Communication
10. General/pediatric dentist-ortho communication
11. Orthodontic DVD

Date: Friday, October 05, 2007 9:29 AM
From: Diane Johnson <DHMJDDS@AOL.COM>
Subject: Re: General/pediatric dentist-ortho communication

In our office, we are lucky enough to have a digital pan-ceph.  We always send a printed copy (on decent photo paper) of every panorex we take before, during, or after ortho to the dentist.  This also allows us to update our records of who the DDS is.  Sure is a lot of dentist-hopping going on in our area. We enclose the panx with the following letter:

Recently, we took an updated panoramic X-ray on our mutual patient, «PatientComName» «PatientLastName» . We have enclosed a copy for your records.

This X-ray was taken at no charge to the patient nor to the insurance company, so all benefits are still available for your office to use.

If you would like a copy of the digital file for your records, just e-mail Dr. XXX at  .

Thank you very much for all of your referrals. We are working hard to maintain the trust you have in our office. If there is anything else we can do to be of service to you, please let us know.

Beyond this, we really do not send much during treatment.  I'm not sure what the DDS would expect to get--they certainly don't care that we U/L 17X25 SS, PRT U 2-2, step up LR6, start cl 2 elas R&L ft.  They certainly never send us MO amalg #30 w/ Ind PC, MI Esthetix A2 #8. But you definitely do not want to only send them the bad stuff (so and so is not brushing, patient 2 is not cooperating, etc. etc.).  That will make it seem like only bad things happen in your office.  We rarely send a letter to the DDS about OH or cooperation unless we need the GP to actually do something, or unless things are soooo bad we are going to be debanding. On that subject, as a question to the group:  when do you decide to deband prematurely, either for financial, hygiene, or cooperation issues?  This is a very difficult area for us. Seems like once you see decalcification, it is already too late, but if we debanded routinely for poor OH, how many teenaged boys would still have braces?  Anyone's thoughts or protocols would be great.

Diane Johnson


Date: Friday, October 05, 2007 7:52 AM
From: Roy King <rkking@BELLSOUTH.NET>
Subject: Re: general/pediatric dentist-ortho communication

ESCO, I communicate every 6 months during treatment.

Roy King

Date: Thursday, October 04, 2007 8:08 PM
From: Gary Hirsh <Drummerdds@SAN.RR.COM>
Subject: Missed Initial Consultation Visits

Dear Members,

I am just curious to see if many or any of you have been experiencing 
a larger number of your new patients failing their Initial 
Consultations visits.
We are currently sending a letter and Health Hx by snail mail, 
calling them the day before (and rarely speaking to a person - just 
the voice mail) and sending E mail reminder messages. Even when I 
personally call them, a fair number will still fail the appointment.
  So, If you have found some very successful system to get the 
patient in your office on the first visit I, and I'm sure many of our 
members will really appreciate reading your replies.

Thanks in advance,
Gary Hirsh, DDS  San DIego

Date: Wednesday, October 03, 2007 4:55 AM
From: Utley3@AOL.COM <Utley3@AOL.COM>
Subject: communication with dentists


After the initial exam, we send a letter acknowledging/thanking for the referral, and include a summary of findings and tentative treatment plan.  After we take records, if any treatment request is sent, we include a copy of pan.  I don't routinely send progress reports or notify when braces are off.  I will often call or write a note to the dentist if the treatment plan requires coordination of ortho/restorative/perio...etc.  Should I be sending progress reports/pans?  Notifying when braces are off?  If anyone does, why?  

Kevin Utley
Cordova, TN


Date: Tuesday, October 02, 2007 2:09 AM
From: SCOTT SMORON <scottsmoron@COMCAST.NET>
Subject: Communication with referrals

I think your protocol is about standard.  Initial exam letter, recall
letters up until treatment (which also eventually says we are starting), a
post-treatment note later.  Never send in-treatment films unless
coordinating for cosmetics/implants/surgeries.

You can't make everyone happy.  I think the best question you could ask of
the referer is, "Is that what you normally receive from the other
orthodontists you refer to?"  If they say no, then why not try to meet
desire for more documents and possibly seal up a referral source to be 100%

I also have a question for the gallery.  If you are updating during
treatment, especially at the dentist's request, are they becoming
vicariously liable?  Shouldn't they be able to make certain judgments about
treatment from films?  If I was a GP I would keep myself out of if
I requested an endo, and then told the endo I wanted to see the films of the
fill or otherwise got involved in the details, aren't I increasing my
responsibility to the patient?  You might want to bring this topic up with
the dentist and tell the dentist that you would feel very comfortable
talking over the phone every few months about treatment progress (an
assistant could run a report on all patients, fax it over to the dentist,
and arrange a phone call to talk over the patients every 6 mos).  This might
satisfy the dentist while also addressing other issues.  Maybe meet

You mention this is a good referral source.  I would also ask the referer
what made them start referring to you in the first place and build from
there too.

And one final thought, I do get the rare call where someone calls me and
asks what's up with the patient.  Sometimes the patient is in recall.
Sometimes they are in-treatment.  The dentist starts asking me questions and
so I will typically say, "Yeah, I think I noted that in the letter I sent in
July."  Half the time they go, "Huh.  Let me see...yeah, it's here in the
folder.  Uh huh, uh huh [as they read], yeah, it's here.  Thanks.  So you're
thinking..."  The other half the time they go, "I don't see anything
here..." so I say, "Oh, I'm so sorry.  I have a digital copy of that
letter...would you like me to fax over a copy, e-mail it or mail it over?"
I have found out that some offices just throw out the letters I send.  The
kicker about the in-treatment patients is the fact that we call each office
asking for whatever bitewings and periapicals they have prior to braces
placement.  We ask them if their office if they want to take a full mouth
series prior to starting.  So if I have a copy of the x-rays, I know my
staff has done what I expect them to do to communicate.  So, when I get
these calls, typically the office I am dealing with has issues with patient
info and management and so I just try to be as accomodating as possible.
Your situation is a little different, but I would try and just see if you
can easily meet the dentists desires.  But you probably don't need to make
it routine.

My two cents.

Scott Smoron

Date: Tuesday, October 02, 2007 8:02 AM
Subject: ortho communication and cone beam question

Sounds like you are doing a good job. We send out a copy of all pans taken in our office to the GD. As I am a dinosaur and still taking silver halide pans, we use screens and film that allow us to have 2 films in the cassette at the same time. The duplicate is automatically sent to the GD with a standard form if there are no problems on the pan.

As a side note, at the most recent AAO in Seattle, one of the items that I noted was that the cone beam speakers did not seem to think that the definition was good enough to detect root resorption. My question is, are those of us who have jumped to cone beam now taking digital periapicals also? It would seem like this would still be a necessity to document the shape and length of the roots at the beginning and to check up on them periodically. Also, I take an update pan 6-9 months into full treatment. What are those of us with cone beams doing as a standard mid-treatment check on their patients? Are they taking a limited survey and periapicals? Thanks in advance for your replies.
Rob Kazmierski
Moorestown, NJ

Date: Tuesday, October 02, 2007 7:56 AM
From: Stanley M Sokolow <overbyte@EARTHLINK.NET>
Subject: Re: Progress reports to referring dentists


I would mark that doctor's patients' charts with a note in a prominent
spot that you'll see at each visit, saying to send progress reports to
him/her.   Ask the referrer what additional progress information he or
she would like to receive and how often, and say that you'd be happy to
provide it for all of his patients.

It would be a good routine in general to send a very short questionnaire
to all the referring doctors with your treatment plan letter, telling
them what feedback you normally provide and asking them to check
additional items on a list of things they want to receive and how
often.and which things they don't want to receive.  Make the list and
have a column to check for "yes" and one for "no,thanks" and one box at
the top to say "Just send your normal communications" so they can skip
the detail.   It's just one more burden and system to implement, but if
it's ticking off some doctors to the point they send referrals
elsewhere, it's worth the effort.   I think most referrers would be
satisfied with what you send, some would think it's too much information
for them to read (I've had that kind of complaint on occasion), and some
obviously want to stay in closer touch with what you're doing.   For
some doctors, just a card from you saying the patient started treatment
and one at the end of treatment would be adequate.

Stan Sokolow
Santa Cruz, CA

Date: Tuesday, October 02, 2007 3:01 AM
From: charles ruff <orthodmd@MAC.COM>
Subject: communication with dentists

I think you need to individualize things for certain referrers.
This would be something to discuss at lunch or you could generate a questionnaire that is sent around to everyone asking what there preferences are.
charlie ruff


Date: Monday, October 01, 2007 8:48 PM
From: Lively Orthodontics, P.A. <mdlively@BELLSOUTH.NET>

Hi All: I am trying to find the name of the company or individual that was marketing software for orthodontists for writing a business plan  I am  in the process of buying a building and converting it to an ortho office and I wanted to run a break-even analysis before committing to the project.   Does anyone own the software or remember the name of the company that wrote the spreadsheet?  Thanks in advance.

With warmest personal regards,


Date: Tuesday, October 02, 2007 5:40 PM
From: Mary K. Barkley, D.D.S. <mkatbark@COMCAST.NET>
Subject: communication with dentists

Dear Rob,
I do exactly what you do - my initial and final reports and panorexs
seems to be plenty for my general dentists save one (a lesser referrer
who likes to know when I've seen his patients for pre-treatment
recalls). 20 years ago, I  used to send lots more letters, and I have no
evidence that they were ever read.
Mary Barkley
Chelsea, Michigan

Date: Tuesday, October 02, 2007 5:58 AM
From: Scott Arbit <Scott@ARBITBRACES.COM>
Subject: Re: general/pediatric dentist-ortho communication

Good Morning Rob!

What you send is totally typical.  It is the standard of care.  You are dealing with a control freak who wants more information.  Some offices (not mine) have a mid treatment review with a pan in which they review progress and “on time” status with the family.  Then a letter can be generated for your control person.  Have you asked him exactly what he would like?  Hope his helps.

Scott Arbit


Date: Tuesday, October 02, 2007 3:21 AM
From: Athba Al-Misned <athaba@GMAIL.COM>
Subject: orthodontic DVD

Dear members

is there a way for understanding the theoretical part of orthodontics (from growth through mechanics till retention) by using DVDs or video tapes? for someone preparing to go for international examinations.