Dr. Cheryl DeWood continues her discussion about how long orthodontic retention should last.
2. When does the orthodontist’s responsibility for retention end?
This can vary a lot. As I said above, two years of retainer checks are built into my fee. That assumes, however, that a patient wears retainers as directed. If a patient does not wear retainers as directed, or does not come for retainer checks, I have a protocol for dismissing patients from my practice. When I dismiss a patient for non-compliance with retainers, I do so in a manner consistent with my legal responsibilities, of course, but it is also true that I do not feel responsible for a treatment result which a patient will not attempt to protect with appropriate retainer wear. On the other hand, if a compliant patient wants to continue to see me for retainer checks after two years, I am happy to do so, and I make my fee user-friendly to encourage them to do so. But what about the patient who would like to continue with the treating orthodontist but can’t? What about when people move? What happens to patients when an orthodontist retires?
3. What do I do with a patient whose orthodontist will not or cannot see him/her for retention?
You could refer the patient to the orthodontist with whom you work for management of retention. However, personally, I am reluctant to manage retention for a patient I did not treat myself. It is, frankly, professionally unsatisfying (managing retention is not at the challenging end of my skill set), and it is fraught with hazards. You don’t get any credit when the result someone else provided is good, and you don’t want to be a part of it if the result is bad. I feel it is necessary to take records for any new patient, even if that patient only wants to have existing retainers checked. This generates added expense that does little to further good will between me and the patient, especially when the patient correctly concludes that I am doing so primarily to protect myself from liability. While I am only speaking for myself, I think most orthodontists would agree with me. That puts a lot of patients in the position of having long-term retention recommended, but few orthodontists willing to supervise it. I think the solution is to have a plan for transitioning that responsibility to the general dentist. As with any of the specialty disciplines, general dentists need to decide how much they want to be involved with the orthodontic care of their patients. In this case, that means they need to decide whether they are willing to be responsible for retention.
Dr. Cheryl DeWood is an associate professor at Midwestern University Dental School in Phoenix AZ and a board certified orthodontist in private practice in Glendale AZ.