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Diag and Treat Planning in Myofunctional Ortho

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Some considerations in treatment planning myofunctional orthodontics based on the patients' psychology as well a dental needs in the context of a multi-service orthodontic practice.

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Diag and Treat Planning in Myofunctional Ortho

  1. 1. Diagnosis and treatment planning in myofunctional orthodontics <ul><li>By </li></ul><ul><li>Dr. Barry Raphael </li></ul><ul><li>[email_address] </li></ul><ul><li>This presentation is part of a lecture given at Myofunctional Research Corporation </li></ul><ul><li>September 2011 </li></ul><ul><li>Comment: This describes my personal approach to treatment planning in a traditional orthodontic practice with a significant component of myofunctional treatment. These concepts may or may not apply in your practice, especially if you only provide myofunctional services. Also, when the public becomes aware of the value of myofunctional ortho and the benefits of prevention, this presentation will become obsolete. </li></ul>
  2. 2. Diagnosis <ul><li>Diagnosis </li></ul><ul><li>Is an Educational Process…. </li></ul><ul><li>The Doctor is Learning about the Patient </li></ul><ul><li>And </li></ul><ul><li>The Patient is Learning about the Doctor </li></ul><ul><ul><ul><ul><ul><li>Who we are </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>What we believe </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>What we are looking for </li></ul></ul></ul></ul></ul>
  3. 3. Parent’s Private-eye Sheet
  4. 4. Parent’s Private-eye Sheet <ul><li>“ There are many things about your child’s health that are important to know, but that I often don’t get to see at the office. Also, there are signs to look for that you may not have known were connected to your child’s teeth or health. By looking for and tracking these “signs and symptoms”, we can get a better handle on the problem and watch for resolution. </li></ul><ul><li>You don’t have to spend a lot of time with this, but don’t rush either. Watch for certain things at different times of day. Try not to let your child know they are being watched. You want to see the most natural behaviors. </li></ul><ul><li>Check off what you see. If you’re not sure, check it anyway and we’ll talk about it. Make comments if you want.” </li></ul>
  5. 5. While sitting around... <ul><li>While sitting around (watching TV, in the car), does your child: </li></ul><ul><li>put “things” in the mouth alot (toys, sleeves, pencils, fingernails, etc.) ______________________________ </li></ul><ul><li>lick or suck on the lips </li></ul><ul><li>have the lips apart, even a little </li></ul><ul><li>stick or dart the tongue out of the mouth </li></ul><ul><li>have the tongue resting between the teeth </li></ul><ul><li>lean the cheek on a hand </li></ul><ul><li>breath with his mouth open, even a little bit </li></ul><ul><li>make noises when breathing </li></ul><ul><li>have trouble sitting still </li></ul>
  6. 6. While talking... <ul><li>While talking , does your child: </li></ul><ul><li>talk very fast </li></ul><ul><li>talk very slowly </li></ul><ul><li>gasp for air </li></ul><ul><li>have a lisp </li></ul><ul><li>take speech lessons </li></ul>
  7. 7. During a meal <ul><li>During a meal, does your child: </li></ul><ul><li>gasp for air while eating </li></ul><ul><li>stick his tongue between his teeth when swallowing </li></ul><ul><li>stick the tongue out to meet the drinking glass </li></ul><ul><li>drink a lot while eating </li></ul><ul><li>make noises when chewing </li></ul><ul><li>eat sloppily </li></ul><ul><li>take a breath before drinking </li></ul><ul><li>puff the cheeks out when drinking </li></ul><ul><li>make the lips purse when swallowing </li></ul><ul><li>make the chin “crinkle” when swallowing </li></ul><ul><li>bob the head when swallowing </li></ul><ul><li>have trouble sitting still </li></ul>
  8. 8. While sleeping... <ul><li>While sleeping , does your child: </li></ul><ul><li>have the mouth open </li></ul><ul><li>snore </li></ul><ul><li>wet the bed </li></ul><ul><li>toss and turn </li></ul><ul><li>tilt the head back </li></ul><ul><li>wake up frequently </li></ul><ul><li>have frequent nightmares </li></ul><ul><li>have abnormal sleep issues </li></ul><ul><li>grind the teeth </li></ul><ul><li>have trouble waking up </li></ul><ul><li>wake with darker circles under eyes </li></ul>
  9. 9. The Process: Treatment Planning <ul><li>Principle 1: Select ALL the best treatments </li></ul>
  10. 10. <ul><li>Principle 2: Establish Cooperative Relationship </li></ul>I am at your Service Pleasant and Easy as Possible We share your Goals The Process: Treatment Planning
  11. 11. I know about STD and you don’t. If you don’t do as I ask, we’ll find another more painful way of doing it (ie: palate expander... Muwhaha...) Look how badly your face is growing The Process: Treatment Planning Principle 2a: Avoid Creating an Adversarial Relationship
  12. 12. <ul><li>Principle 3: Let the Patient Choose </li></ul><ul><li>Code of Ethics: Autonomy </li></ul><ul><li>Buy-in </li></ul><ul><li>Attitude Towards Treatment </li></ul>The Process: Treatment Planning
  13. 13. <ul><li>Code of Ethics: Autonomy </li></ul><ul><li>Patients have the right to choose for themselves among all the possible good treatments available, once they know the pros and cons of each. </li></ul><ul><li>Buy-in </li></ul><ul><li>Attitude Towards Treatment </li></ul>The Process: Treatment Planning Principle 3: Let the Patient Choose
  14. 14. <ul><li>Code of Ethics: Autonomy </li></ul><ul><li>Buy-in </li></ul><ul><li>Attitude Towards Treatment </li></ul>The Process: Treatment Planning Principle 3: Let the Patient Choose
  15. 15. <ul><li>Code of Ethics: Autonomy </li></ul><ul><li>Buy-in </li></ul><ul><li>Attitude Towards Treatment </li></ul><ul><li>What’s important </li></ul><ul><li>Family Dynamics </li></ul><ul><li>Preconceptions </li></ul>The Process: Treatment Planning Principle 3: Let the Patient Choose
  16. 16. <ul><li>Presenting…. </li></ul><ul><li>My Early Treatment Sequence </li></ul><ul><li>based upon the </li></ul><ul><li>Preconceptions of the </li></ul><ul><li>Patients and Parents. </li></ul><ul><li>(Drumroll please…) </li></ul>The Process: Treatment Planning
  17. 17. <ul><li>Preconception toward Trainers </li></ul><ul><li>&quot;Hmmm...makes sense&quot; </li></ul><ul><li>Gentler and more natural </li></ul><ul><li>Better hygiene (no stains) </li></ul><ul><li>May save money </li></ul><ul><li>Quiet in the house </li></ul>Parent The Process: Treatment Planning
  18. 18. Preconception toward Trainers <ul><li>Never heard of it before </li></ul><ul><li>Child won't do it </li></ul><ul><li>Child can't keep quiet </li></ul><ul><li>Child can't breath through nose </li></ul>The Process: Treatment Planning Parent
  19. 19. <ul><li>It’s not Braces </li></ul><ul><li>Don't have to wear to school </li></ul><ul><li>Can eat anything </li></ul><ul><li>Seems more comfortable </li></ul>Preconception toward Trainers The Process: Treatment Planning Patient
  20. 20. Preconception toward Trainers <ul><li>It’s not Braces </li></ul><ul><li>Their friends don't have this </li></ul><ul><li>They don't want to do the work </li></ul>The Process: Treatment Planning Patient
  21. 21. Let’s put it all together The Process: Treatment Planning
  22. 22. <ul><li>Trainers +/- BWS </li></ul><ul><li>if needed: Expanders </li></ul><ul><li>if needed: Braces </li></ul>Preconception toward Trainers The Process: Treatment Planning Parent Patient
  23. 23. Preconception toward Trainers <ul><li>Trainer ( 2-8 week test for cooperation) </li></ul><ul><li>then add BWS or Expander, </li></ul><ul><li>if needed: Braces </li></ul>The Process: Treatment Planning Parent Patient
  24. 24. Preconception toward Trainers <ul><li>BWS for 1 mo </li></ul><ul><li>add Trainer </li></ul><ul><li>rarely need Expander </li></ul><ul><li>if needed: Braces </li></ul>The Process: Treatment Planning Parent Patient
  25. 25. Preconception toward Trainers Traditional Methods: Expanders, Braces, etc (Well, you just can please ‘em all…) The Process: Treatment Planning Parent Patient
  26. 26. Trainers : Treatment Sequencing <ul><li>Initial Exam </li></ul><ul><li>Records </li></ul><ul><li>Consultation </li></ul><ul><li>Trainer Insertion </li></ul><ul><li>Trainer Check </li></ul><ul><li>Trainer Check </li></ul><ul><li>Activities </li></ul><ul><li>Activities </li></ul><ul><li>Trainer Check </li></ul><ul><li>Activities prn </li></ul><ul><li>Trainer Check prn </li></ul><ul><li>Ramp Down </li></ul>T4K only
  27. 27. <ul><li>Initial Exam </li></ul><ul><li>Records </li></ul><ul><li>Consultation </li></ul><ul><li>Spacers and Lab </li></ul><ul><li>BWS Insert </li></ul><ul><li>Adj BWS </li></ul><ul><li>Adj BWS </li></ul><ul><li>Insert Trainer </li></ul><ul><li>Trainer Check </li></ul><ul><li>BWS Adj and Trainer Check </li></ul><ul><li>BWS Adj and Trainer Check </li></ul><ul><li>D/C BWS and T4Khard </li></ul><ul><li>prn </li></ul><ul><li>Ramp Down </li></ul>Trainers : Treatment Sequencing BWS then T4K
  28. 28. <ul><li>Initial Exam </li></ul><ul><li>Records </li></ul><ul><li>Consultation </li></ul><ul><li>Insert T4Ksoft </li></ul><ul><li>Trainer Check </li></ul><ul><li>Activities </li></ul><ul><li>Trainer Check </li></ul><ul><li>Activities </li></ul><ul><li>Spacers and Lab </li></ul><ul><li>Band and BWS </li></ul><ul><li>Adj BWS </li></ul><ul><li>Trainer Check </li></ul><ul><li>Adj BWS </li></ul><ul><li>d/c BWS, T4Khard </li></ul><ul><li>Ramp Down </li></ul>Trainers : Treatment Sequencing T4K, then BWS
  29. 29. Fees and Arrangements <ul><li>The Orthodontic Model </li></ul><ul><li>Contract: One Fee for All Tx </li></ul><ul><li>Addt’l Fees Specified Ahead </li></ul>
  30. 30. <ul><li>Typical Expansion Phase I includes: </li></ul><ul><li>Impressions and insertion Bonded hyrax </li></ul><ul><li>Expansion checks </li></ul><ul><li>BO upper 2-2 </li></ul><ul><li>3-4 wire adjustments </li></ul><ul><li>Upper retainer </li></ul><ul><li>Lower Schwartz or Lower Fixed Lingual </li></ul><ul><li>Phase II records… </li></ul><ul><li>Fee: $2,500-3,300 all-inclusive </li></ul>Fees and Arrangements
  31. 31. Age related Fees and Arrangements
  32. 32. Coop related Fees and Arrangements
  33. 33. Coop related Contingency related Fees and Arrangements
  34. 34. Reward for Success Fees and Arrangements

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