Research & Reviews: A Journal of Dentistry

ISSN: 2230-8008(online), ISSN: 2348-9561(print)

Volume 7, Issue 2
www.stmjournals.com

Clinical Practice Management in Orthodontics: An

Overview
Rohit Kulshrestha*, Ragni Tandon, Shrish Srivastava, Abhishek Singh
Department of Orthodontics and Dentofacial Orthopedics, Saraswati Dental College,
Lucknow, Uttar Pradesh, India

Abstract
The traditional education of a dentist has placed greater emphasis on developing highly
competent diagnostician or clinicians and has often left a noticeable void in the area of
practice management. As dentistry enters the 21st century, it faces an ever changing
population and concepts. Orthodontic observes are minor businesses, not only among
orthodontic providers, but with all other health care providers as well. Competition within the
arena comes from general dentists performing orthodontics, too many orthodontists and too
limited patients. Also, very few barriers to entry into the orthodontic field exist, as all
graduates of accredited dental schools can practice orthodontics. The passive approach for
growing an orthodontic practice will no longer does. One common scenario is that many
orthodontists aren’t confident about how to approach and succeed in the very thing they may
need most. This article will assist the post-graduates and the practicing orthodontists in
managing their clinical practice and any problems which they face in day to day practice.

Keywords: Practice management, ethics, fees, education, orthodontics

*Author for Correspondence E-mail: kulrohit@gmail.com

INTRODUCTION Mayerson initiated that the marketing

There are some doctors who have good
technical skills, but display poor chair side
manners, or where the office looks good, but
the staff is not friendly and does not seems to
care about the patients. This is mainly because
of the doctor’s lack of basic training and
knowledge in the principles of customer
service and practice management. It is possible
that many of the today’s orthodontists are
learning to become great diagnosticians,
excellent wire benders, and motivated
researchers, while never being taught the
fundamental communication, financial, and
management skills needed to run high-quality
service oriented practices [1]. In today’s day
and age good clinical skills alone does not
ensure successful practice. Most clinicians will
agree that today’s environment is more hostile
and it is difficult to break into the ever so
competitive dental market [2]. Little or no
emphasis is placed on helping the young
orthodontic practitioner to avoid mistakes or
educating these doctors on the basic principles
that should be employed in any practice,
whether starting from scratch or taking over
the practice of a senior orthodontist.
emphasis in orthodontics has been internal [3].
Keeping patients and families informed about
treatment progress, showing courtesy and
concern to all, running your schedule on time,
and paying prompt attention to emergencies
are all cost effective ways to create an
atmosphere in which the practice will grow.
Everyone is also engaged in some form of
marketing to referral sources [4]. Being a
capable orthodontist does not assure the
orthodontist of financial success. Creating a
genuine feeling or pride in the office on the
part of both doctor and staff, will help
establish a magnetic field that attract patients
and referring dentists [5]. This article will help
the newly passed out graduate and practicing
orthodontist in managing his/her clinic and
solving any problems which arise in daily
practice.
ORTHODONTIC CLINIC DESIGN
The ambience and design of the clinic is an
important factor in the success of any practice.
The reception room and reception desk make
an immediate impact on the new patient’s
entry into the practice. A warm atmosphere

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Dental Practice Management
and decor go a long way toward establishing a
comfort zone for both parents and patients,
who are often anxious about the initial
examination [6]. The examination room is
usually the next step in the orientation process
(Figure 1).
Fig. 1: Examination Room.
It is advantageous to locate it near the front
desk, so it will be convenient for
administrative functions such as private
financial discussions, mini-consultations, and
short, private doctor-staff conferences. When
placed nearer to the operatory, it can be used
as an overflow room for retainer checks,
emergencies, or impressions [7].
Some consultants prefer the more intimate
atmosphere of a smaller consultation area,
especially if a dental chair is not needed to
handle operatory overflow. When such a room
is properly designed, visual aids can still be
placed within comfortable reach [8]. A stool
that slides easily on an acrylic floor mat allows
the treatment coordinator or the orthodontist to
get to any items or props that are needed.
Another design trick for smaller rooms is to
create a feeling of space with mirrors,
windows, and colour selection [9]. Controlling
sound transmission around and within
consultation rooms should also be a high
priority. Most consultants agree that the first
three or four minutes of any new relationship
are critical to its success [10]. You cannot rely
on the patient’s ability to judge your skill and
quality of care. An exceptional office
environment and a warm, caring staff are
fundamental if you want to improve your case
acceptance rate [11].
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Kulshrestha et al.
Fig. 2: Floor Plan for a 1000 square foot
office.
Less than the minimum 8 linear feet for the
area would be quite cramped, but more than
the ideal 12' would be required only in special
situations (Figure 2). The difference depends
primarily upon the following points [12]:
 The need for more unloading and
packaging space
 Whether a double sink is used
 The size of the ultrasound unit
 The size, type, and number of sterilization
units
Some orthodontists may want extra counter
space for such items as an anti-rust bath, a cold
sterilizer, or a bead sterilizer floor plan [13].
The importance of a good lighting
environment is evident in the statistic that 85%
of the information we acquire is visual [14].
Three factors must be considered in any
discussion of orthodontic operatory lighting as
the laws of physics, the physiology of the eye
and how it accommodates to fatigue, and the
technology of products currently available
[15]. For the flooring ceramic tiles are
preferred in the sense that there is a layer on
the surface which makes it waterproof and
impervious to staining, the only disadvantage
being scratching away of the surface which
normally doesn’t happen with bare foot [16].
ETHICS
One feature that distinguishes dentistry from
the other occupations is the consumer’s trust
that a dentist gives advice on the best interests
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Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561(print)
of the individual/patients. We should strive to
promote ethics in orthodontics and make it
part of our daily practice [17, 18]. According
to Dr. Geller, if payments are behind and there
is no response or efforts to discuss the
situation the parents need to be informed they
are part of the team helping to render care to
their children, their absence from the office
and the communication process would conflict
with their desire to continue treatment [19–
21].
According to Dr. Birdwell it is ethical to offer
a less-than-ideal treatment because of finances,
as long as the limited treatment leaves the
patient in a better dental health. Dr. Dietzer's
view is that if a patient can't afford a fee for a
two-arch treatment and there is no health
compromise with one arch only then one arch
treatment can be done. According to Dr.
Yurfest a patient who wants less treatment for
a smaller fee is entitled to the care as long as
they are told all the facts [22, 23].
THE NEW PATIENT PROCESS
In an orthodontic practice, the “new patient” is
the lifeblood of the practice. Regardless of the
biomechanics used for orthodontic movement
of the teeth, a constant flow of new patients
seeking treatment is essential not only to
replace existing patients who have completed
treatment, but also to add to the growth of the
practice through increased active patients [24].
Since, Dr. Edward Angle and his
wife/assistant, Anna, opened the first
orthodontic practice in 1906; the process of
managing the new patient has changed
immensely [25].
The importance of the new patient phone call
is such that needs to be conducted by someone
who can make this call a top priority in their
schedule without any distractions. This call
can typically take 5-8 minutes to complete, so
orthodontic staff members need to support
each other in handling any other phone calls
appropriately [26]. Assigning a specific person
or persons, to be available to take these initial
patient contact telephone calls is essential.
They should undergo detailed training and be
able to discuss a wide variety of possible
questions on the basis of sound knowledge of
the practice, the activities, and all advantages
RRJoD (2016) 7-17 © STM Journals 2016. All Rights Reserved
offered. The next contact that usually takes
place is the “confirmation call” which is made
to the new patient or parent of an adolescent
child. This call is so much more than
confirming the day and time of the
appointment as it provides an opportunity to
verbally express the excitement to meet the
new patient/parent at the upcoming
appointment [27]. This also is a great time to
ask if the patient or parent has any questions
about the office location or length of time for
the appointment, as well as highlight what will
take place during the initial consultation.
Although the initial examination had
previously been a short screening appointment
to assess orthodontic needs and treatment
recommendations, at present the initial
examination is far more complex [28]. With
many choices currently available in selecting
an orthodontic practice, patients and parents
alike tend to look at three key areas in helping
them make their final decision:
 Personal interaction
 Operational excellence
 Product quality
An operation of excellence should be a
standard in the practice, not only in
orthodontic treatment biomechanics and
finished results, but also in all areas of
operating an orthodontic practice. Patients
understanding of excellence will be judged by
two strong factors [29]:
 Time: seeing a patient on time for
appointments, spending quality time with
a patient beyond their teeth, and finishing
treatment on time
 Money: providing clear communication
about fees and services, establishing high-
value for orthodontic benefits and offering
easy and flexible ways to make payments
The taking of a digital panoramic film and
digital photographs on the new patient can
greatly enhance and support the diagnostic
findings and treatment recommendations for
the orthodontic needs of the patient. The use of
these visual tools as part of the examination
can increase the rate of treatment acceptance
as it creates more value of the practice. Often,
it can also eliminate the need for additional
appointments. The doctor can then perform the
examination and become more acquainted
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Dental Practice Management
with the patient and parent. Once the
orthodontist notes the clinical findings and
discusses the treatment recommendations, the
remainder of the examination can be focused
on walking the patient through the steps in
getting starting with treatments along with fee
presentation and scheduling the appropriate
appointments. The goal is to ensure that they
see the benefits of selecting this practice for
their orthodontic needs. Ideally, the goal is to
have the patient and parent so greatly
impressed by the professional and personal
office that they have no hesitation in
proceeding with treatment [30].
CONSENT
A discussion of informed consent in the
context of ‘Orthodontics and the Law’ is
important because substantial litigation has
been generated in this area of the law. While
an independent claim may infrequently occur,
lack of informed consent is commonly added
to claims of dental negligence or malpractice
[31].
The informed consent doctrine created a new
health care provider-patient relationship that
involves continued reliance on the health care
provider's unique knowledge and skill, but
places an emphasis on the decision-making
role of the patient. The patient is no longer a
passive party in the provider-patient
relationship, but rather, an active participant in
health care delivery who is jointly responsible
for the outcomes of care.
The action against a health care provider for
failure to obtain informed consent generally
must establish that the defendant had a duty to
disclose sufficient information about the
proposed treatment plan to obtain the patient's
informed consent, that the defendant breached
that duty, and that the defendant's breach was
the cause of injury suffered by the patient. A
duty to obtain the patient's informed consent
will arise during the course of a health care
provider-patient relationship when a danger or
risk attaches to a treatment plan that may
influence the decision whether to proceed with
the treatment [32].
The requirement to disclose in general terms
the treatment or course of treatment is not
interpreted to include a requirement to disclose
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Kulshrestha et al.
the risks of treatment. However, a duty does
exist to speak truthfully when responding to a
specific question posed by a patient
concerning the risks of the contemplated
treatment. This statute has been interpreted to
apply to dentists.
FEES
It is one of the most controversial topics as far
as orthodontist and patients are concerned.
Nothing comes free and it is also applicable to
our profession [33]. Like any other enterprise,
an orthodontic practice can be deemed
economically successful only if it is profitable.
In today's competitive environment that mean
paying attention to both ends of the economic
equation: cost and fee. The customary way to
set fee has been to ask two or three colleagues
in the same general area what they are
charging, then adjust the going rate depending
on relative experience, competitiveness and
other factors [34]. Starting orthodontists tend
to set their fees lower in an effort to bring new
patients into the practice. The problem with
this approach is that without an in depth
knowledge of the baseline expenses of the
practice, a downward spiral can be started,
eventually taking the practice below its
breakeven point [35].
In most of the developing and developed
countries cost of dental cot and the health care
services are rising sharply. Orthodontists are
often puzzled, when patients and public
complain of high costs or orthodontic care.
Post payment plans method of payment was
first introduced in 1930s by local dental
practitioners in Pennsylvania and Michigan
(USA) [36]. It is also known as budget
payment plan. The patients borrows money
from a bank of financial company to pay the
orthodontists fee at the time when the
agreement to receive care is made. The patient
then repays the loan with specified interest
amount to that bank in budget amount. This
concept was developed with the idea of
providing orthodontic care to large segment or
population and was utilized by the people of
middle income rather than the lower income.
Orthodontists who permit instalments in
payment of bill tend to lose interest on the
credit as well as run a default payment. The
first dental personal loan plans were instituted
by National City Bank of New York in
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Research & Reviews: A Journal of Dentistry
Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561(print)
January 1929, followed by Bank of America.
In 1935 the first dental society plan was
established in recognition of the professions
interest in promoting and helping control
personal loans for dental care.
Salary is defined as amount paid to the dentist
whatever the treatment assigned to him
regardless of whether the patient utilizes or
not. It is very common form of mode finance
in orthodontic dental fee in developing
countries like India. In USA, North Carolina
established the first state dental division in
1918 and many stated followed the suit. Many
programmes were instituted, financed and
administered by state and local communities
[37]. There are various public programmes
currently available, they are as under:
1) Medicare
2) Medicaid
Medicare: It removed financial barriers for
hospital and physician services for person aged
65 and above. Medicare has two parts hospital
insurance, voluntary supplemental medical
insurance. Medicare addresses the problems of
old age, where we see high health care needs
with low income. It was brought into action
because voluntary health insurance system was
unable to provide adequate coverage above the
age of 65 years. Dental segment of Medicare is
limited to those services hospitalization for
their treatment, usually surgical treatment, so
this mode of financial care is of very limited
use as far as orthodontic care payment is
concern.
Medicaid: It was established in the year 1965
by Title xlx of the Social Security Act, jointly
funded by the federal and state governments of
USA. It provides medical and health related
services to America's poorest people under
category or parents and children the disabled
and elderly.
RELATION WITH GENERAL
DENTIST
Most orthodontic practices seem to go through
predictable stages of:
Getting started
Reaching the point of survival
Growth
Productive years
Decline
RRJoD (2016) 7-17 © STM Journals 2016. All Rights Reserved
The decline stage usually starts about 20 years
into the average practitioner's life cycle, and
may reach a point where the owner-
orthodontist has trouble making ends meet.
One reason for decline may be failure to add
new general dentist referral sources to
maintain the loyalty of existing referrers [38].
With much of today's marketing emphasis
placed on patients and parents, dentists can be
overlooked. To be sure, a patient-centred
practice that offers superior service can expect
a significant number of its patients to refer
other family members and friends. It is also
essential to provide a high level of care, or else
these internal marketing efforts will be quickly
forgotten.
Still, the average orthodontic practice receives
52% of its referrals from other dentists. Many
offices depend on five or six general dentists
for the bulk of their referrals, thereby placing
much of their long-term growth potential in
the hands of a relatively small group of
professionals [39]. If any of these dentists
experience decline, or decides not to continue
to refer patients, the result could be substantial
reduction in new starts for the orthodontist. In
addition, many orthodontists believe that as
they and their practices age, it becomes more
difficult to maintain referral relationship with
younger general dentists.
There are several popular methods of
establishing relationships with general
dentists, including lunch meetings, office to
office events, and gifts. As these techniques
become more common, however, it becomes
more difficult to differentiate any one practice
from all the others. The orthodontist should
encourage the general practitioners to invite
their own staff to at least one special program
per year. The staff members will appreciate the
recognition, and it will broaden the exposure
of the practice. This meeting can be scheduled
around a calendar event such as Valentine’s
Day or a topic such as practice management.
Keep the cost equal to the dinner expense to
boost attendance [40].
WASTE MANAGEMENT/OSHA
REGULATION
Orthodontists are exposed to a wide variety of
microorganisms in orthodontic office by
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Dental Practice Management
contaminated instruments, inhalation of
aerosols or via percutaneous injuries with arch
wires, ligature wires, band materials and other
sharp cutting instruments (Figure 3).
Fig. 3: Chain of Infection.
Instrument processing is done to prepare
contaminated instruments for reuse while
keeping instrument damage to a minimum.
The following steps are undertaken41,
 Holding (presoaking)
 Pre-cleaning
 Corrosion control drying and lubrication
 Packaging
 Sterilization
 Sterilization monitoring
 Handling processed instruments
 Instrument protection
Instrument sterility should be maintained until
the sterilized packs, pouches or cassettes are
opened for use at chair side.
Drying and Cooling: Packs, pouches or
cassettes sterilized in the autoclave must be
allowed to dry before use. If they are still wet
they may gather microorganisms when used
from the pouches wrapper [42].
Storage: Sterile packages should be stored in
dry areas away from sun light. Instrument
packages should be checked for tears after
drying and just before use. If sterile packages
become wet or are torn they become infected.
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Kulshrestha et al.
“First in-first out” system of instrument
rotation should be followed. Metal instruments
can be stored maximum for a time of 1 month
[43].
Health care workers are at risk for exposure to
and possible transmission of several vaccine
preventable diseases such as hepatitis B virus
(HBV), influenza, rubella, measles etc., and
therefore they should be vaccinated. Hands
must be washed before wearing the gloves and
after removal of gloves. Gloves are meant for
single use. Re use of gloves increases infection
risks to dental personal and to the patient.
When gloves are torn, cut or punctured during
the dental procedures, they should be
immediately replaced. Gloves should be stored
in a cool dark place [44].
Protective eyewear is indicated, not only to
protect physical injury, but also to prevent
infection from aerosol (Figure 4).
Contaminated protective eyewear should be
washed thoroughly with soap and water, rinsed
well and sterilizes, if possible or disinfected in
an agent that does not damage eyeglasses.
Protective eyewear for the patient should be
used to avoid accidently dropped instruments,
chemical splashes and any other foreign object
injury [45].
Fig. 4: Protective Eyewear.
Waterline asepsis: The dental unit water
supply system (DUWS) are contaminated with
micro-organisms in the form of a bio film
coating inside of the water line in its stagnant
areas due to retraction of water when negative
pressure is built up upon switching off the
system, thus contaminating the incoming water
through hand pieces and air-water syringes.
Flushing water through dental unit waterlines
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Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561(print)
for 20 seconds reduces the concentration of
microbes in the water. A filter can be placed
into the water line of the hand piece and the
three ways [46].
Drawers should be made of impervious
materials and be easily removable for cleaning
and disinfection. All employees must be
knowledgeable of occupational safety and
health administration (OSHA) regulations
concerning blood borne pathogens, hazardous
materials and safe use of chemicals in the
laboratory and the environmental protection
agency dealing with both work place exposure
levels to chemicals, heat and radiation and for
discharge and final treatment of waste material
[47].
SATELLITE/GROUP PRACTICE
The development of satellite/group practices is
a popular method of used by dentist to cope
with this increased competition. Multiple
office locations, a new source of patients
become available who would otherwise not get
treatment done from the orthodontist’s main
office [48, 49].
A 2003 study of specialty orthodontic
practices published in the Journal of Clinical
Orthodontics (JCO) rated the opening of a
satellite location to be the best practice
building method available. The same study
reported 32% of orthodontists operated
satellite practices, with the highest net income
orthodontists more commonly maintaining
satellite locations [50]. These numbers indicate
a belief that satellite practices expand a patient
base and increase profit, although there is little
evidence in the orthodontic or business
literature to support this notion. Sullivan
encourages orthodontists to follow industry
principles in managing their practices, which
include reducing the number of employees,
streamlining processes, and reducing space
necessary to conduct business as a means to
improve profit margins.
There is a possibility the satellite office may
hurt the production of the main office, as
patients and dentists may be hesitant to refer or
select an orthodontist who is available only at
certain times. A practitioner choosing to open
a second office must sacrifice family time,
RRJoD (2016) 7-17 © STM Journals 2016. All Rights Reserved
hobbies, or time spent either working at or
promoting the main office. Opening of a
second clinic will increase costs, the question
is whether the increased income will be more
than the cost of investment. Rent, new
equipment and supplies, advertising, and
additional staff are the main reasons for
increased costs. Managing many clinics,
travelling between the clinics, purchase of
materials and maintenance of records is a
difficult thing to do and it can personally take
a toll on the orthodontist [51]. The
management of additional staff or even a part-
time associate can also act to increase the
stress levels of the orthodontist. The available
orthodontic literature notes the popularity of
satellite practices as a way to build a practice,
but the bigger question is whether satellite
practices are associated with increased
financial success for the practitioner.
PREVENTING LOSES
One out of every six dentists will be
embezzled during their careers. Despite the
fact that most embezzlement losses run into
the thousands and some into the hundreds of
thousands most practices never implement the
safeguards necessary to prevent this loss.
Three strategies discussed below can help
prevent the practice from hiring a potential
embezzler. Why do so many orthodontist fall
prey to embezzlers. Many learn only to
practice and leave the management duties to
front desk staffers without establishing any
internal controls or periodic review. An even
greater problem, however is the tendency for
doctors to shortcut the hiring process by
failing to test prospective employee integrity
and do basic background and reference checks.
Results, it is very common for dentists to hire
serial embezzlers and other poorly qualified
candidate for front desk positions [53].
Use integrity testing as part of the interview
process. These pre-packaged tests should be
given to all front desk applicants to screen for
organizational delinquent behaviours including
a tendency toward stealing sabotage substance
abuse absenteeism, lying, unreliability
immaturity or insubordination.
1. Perform reference checks with the three
most recent employers.
2. Consider back ground checks.
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Dental Practice Management
Ten steps to protect the practice when firing
an employee: Firing a staff member is such a
traumatic experience that many doctors
neglect to attend to the necessary end of
employment details. Unfortunately this neglect
can prove quite costly. Following the 10 step
checklist set forth below can protect your
practice against loss whenever this distasteful
situation arises [53].
Reclaim any office keys and building passes
from the terminated employee.
1. Change the office locks.
2. Revoke the employees computer access
and change password.
3. Change the burglar alarm code.
4. Revoke any check writing or other
financial authority.
5. Recover any practice credit cards or phone
cards.
6. Have the employee remove all personal
belongings from the office and return all
cell phones pagers.
7. If the employees has the power to order
supplies by phone, notify suppliers that it
is revoked.
8. Finalize all payroll and benefit details.
Give the employee the last pay check.
Although a few states have no law
governing how quickly doctors must pay
employees who quit most require that an
employee receives the final pay check by
the next regular payday.
9. If severance pay will be provided, consider
having the employee sign a release form to
protect your practice from liability.
RETIREMENT
The orthodontist has no idea of the amount of
savings he would need to retire. In 1999; JCO
retirement survey, 92.9% of the responding
orthodontist felt they were going to “afford a
comfortable retirement”. Yet other studies
show that fewer than 15% of practicing
orthodontist will have $4 million or more in
assets at retirement [26].
Financial experts say you need 70–90% of
your pre- retirement income for a “comfortable
retirement”. Working on a daily basis with
orthodontists who, for one reason or another,
are not prepared to retire. “Divorce”, “poor
investments”, “poor planning”, “limited
saving” and “enjoy life philosophy" are, but a
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Kulshrestha et al.
few of the reasons for why orthodontists are
not able to hang up their pliers and ride off
into sunset [54].
It assumes that you plan to continue to fund
your retirement plan to the maximum and that
your investments are moderately aggressive,
but by no means speculative.
STRATEGIES
1. Plan ahead, plan ahead, plan ahead!
Decide when to retire, to your
calculations, and determine what you need
to save and invest, annually.
2. Seek professional assistance, if you do not
already have competent professionals
working on your behalf, and then seek
them out in the arenas of accounting, law,
management, investment, and transition.
Develop a team committed to helping you
reach your goals.
3. Work the plan, monitor your numbers
monthly and discuss them quarterly, semi-
annually or at least annually.
4. Maximize peak earning years. The peak
earning years are usually seven to 20 years
into practice. It is of paramount
importance to make, save, and invest as
much as you can during those years. Use
professionals to help you install the
business systems that can maximize your
income.
5. Develop both personal and practice
budgets. Creating and sticking to a budget
can free up additional investment funds.
6. Increase practice income. Develop a
marketing plan, increase fees, improve
clinical efficiency, and increase
collections.
7. Reduce practice expenses. Make sure
you’re not over staffed, use strategic
purchasing strategies, control your
inventory, track your numbers, and stop
whim spending.
8. Spend less than you make. It sounds
simple, but many orthodontists who make
plenty of money have developed spending
habits that don’t provide the additional
funds needed to properly invest in their
retirement. This may hurt a bit, but the
long-term results are worth it.
9. Determine the investment rate of return
needed to reach your goals. You might
need to adjust your comfort level for
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Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561(print)
investment risk and restructure your
portfolio to increase the projected rate of
return on your investments.
10. Don’t be greedy. Once the desired
retirement portfolio balances, readjust the
rate of return by reducing the risks of
investments.
11. Don’t make foolish investment mistake.
Orthodontics will provide sufficient
income to retire comfortably if you don’t
make ill-advised investments in “get-rich-
quick” schemes such as restaurants and
speculative land deals. Slow and steady
wins the race.
12. Plan to work longer. If it becomes
apparent that you will not be able to meet
your savings and investment goals by the
retirement age you desire, you may need
to work longer.
13. Make sure to sell the most valuable asset
your practice. Properly plan for its
transition to ensure the return you deserve.
In other words, start planning for the last
day you will practice on the first day you
begin to practice. From purely business
standpoint, the optimum transition time as
12–15 years into practice.
14. Protect the loved ones. Make sure things
have been taken care of to properly protect
you family. A “family security portfolio”
can be invaluable to your survivors should
tragedy befall. It can be in form of a three-
ring binder, an according portfolio, or a
simple. Make sure you include copies of
every important document and also note
where the originals are stored.
Always know the value of your practice. If
you have never had a comprehensive practice
valuation performed, you are missing out on
an important tool both for protecting your
family and for improving your practice
performance and profitability.
In addition, a practice coverage agreement- a
group of orthodontists who will continue to
run your practice in case of death or disability-
is critical. The value of your practice decreases
quickly and dramatically if you are unable to
operate it. The longer it can be kept running,
the better the chances that your loved ones will
be able to sell it and reap benefits of your
years of hard work [55].
RRJoD (2016) 7-17 © STM Journals 2016. All Rights Reserved
CONCLUSION
The success in an orthodontic office does not
entirely lie on one factor, but a number of
factors. It’s a team effort in association with a
number of other factors like site planning,
office design, patient incentive and motivation,
fixing the fee structure, finding right partners
which are usually ignored by orthodontist
while setting up a clinic or while practicing.
Orthodontic office design is the basic step to
ensure success in practice. As it is rightly said
first impression is the best impression, site
planning and office designing is a primary
objective before building an office the
orthodontist must conduct some research
before buying the land. Any site should be
used to the fullest extent possible but over
purchasing may force the orthodontist to
become a developer of the excess land. In this
competitive world when awareness about
orthodontic treatment is on the rise patient
drop outs also quite high, so to maintain a
good rapport with the patient and continuous
and uninterrupted treatment orthodontist have
taken patient incentive in am more serious
manner. To increase the cliental patient
motivation is also important to change
consultation drop-ins into regular patients, one
needs to motivate the patient in a positive
manner abut orthodontic treatment. A very
challenging question arises in the start of
orthodontic practice, whether the fees are
right. In this cut throat competition where
every dentist is decreasing his fees in order to
woo the patients to its clinic, fixing a fee and
then maintaining it is in itself a challenging
job. While deciding the fees he has to
undertake a market survey to know what
orthodontists are charging. While fixing a fee
he should cover his expenses and profit.
After a long practice the orthodontist wants
time for his family and friends which he thinks
has been neglected due to his busy schedule.
Aright associate or a partner can reduce the
burden to quite an extent and an orthodontist
can keep the clinic open as well as enjoy
vacation leaving the clinic to his partner.
Failed partnerships are becoming the order of
the day. A careful planning and a sensible
decision can avoid losses. After a long and
successful practice it is time to retire and stop
working. A very peculiar question arises
Page 15
Dental Practice Management
whether to sell the practice or not. Ethically it
is advised to sell the practice to a good
orthodontist under some conditions that new
orthodontist will look after the old patients
also. At the end of the day it is worthwhile to
mention and plan for your retirement. A
practice is called a successful practice if the
orthodontist has planned well in advance for
his retirement. Some major policies are to be
bought like life insurance policy, disability
insurance, liability insurance, home insurance,
health insurance etc just as treatment goals are
critical in successful orthodontic cases,
specific quantitative financial retirement goals
are pre requisite for successful comfortable
retirement. In the end it can be concluded that
managing a practice is an art in itself which
everybody has to master it so as to lead a
comfortable satisfied life.
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Cite this Article
Kulshrestha et al. Clinical Practice
Management in Orthodontics: An
Overview. Research and Reviews:
Journal of Dentistry. 2016; 7(2): 7–17p.
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