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August's Tip: How to Run a Successful Orthodontic Practice Vol 2


By: Dr. Mark Paschen


This is the second in a series of articles outlining How to Run a Successful Orthodontic Practice.  Each team member has specific duties and responsibilities which will all contribute to the success of your practice (in terms of productivity and job satisfaction).  An orthodontic practice is very different, practice management-wise, than a general dentistry practice.  The first article, which appeared in the previous issue, centered on the receptionist.  This article will focus on your hygienist—listing her duties and describing some scripting as it pertains to your orthodontic patients. 

Hygienist: ( I refer to the hygienist as “she,” realizing there are many very good male hygienists).

The hygienist is an integral part of the orthodontic team, as she is responsible, many times, for the actual facilitating of getting your patient from the dental chair to the orthodontic evaluation.  After the dentist comes in for the “hygiene check” and determines that there is an orthodontic problem, the hygienist has 4 main responsibilities

  1. Schedule the patient for the orthodontic evaluation

  2. Discuss the importance of treatment and the benefits to the patient

  3. Give a testimonial as to the competence of the dentist

  4. Keep track of every patient that needs an orthodontic evaluation

The first responsibility is self-explanatory but not always accomplished.  “I don’t have my calendar with me,” “ We don’t have time to schedule, due to the soccer game,” are common excuses.  We do not charge for our orthodontic evaluations at my office, so fees are taken out of the equation.  We haven’t billed for an evaluation since 2010; my new patient evaluations have gone from 15 per month to over 25 per month.  You more than make-up for the lost production of not charging for the records by having a tremendous increase in patient flow.  You can’t start cases if you don’t get the patients in the door, and the best way to do that is not to charge for your evaluations.  I can’t stress this enough.

                A patient won’t do treatment unless they want to do treatment, and it is important to let them know how treatment will benefit them.  Your hygienist should go over the psychological implications of crooked teeth, consequences of a poor bite, airway issues, or TMD problems that may be expected by not doing treatment.  All of this needs to be “taught” to your hygienist and properly scripted.  This is done through in-office lunch-and-learns for your entire dental team (does your receptionist know what goes on during an orthodontic evaluation or adjustment appointment?).  Always keep in mindwhat your patient’s main concern was, if any (remember they need to want to do treatment).  I once had a patient with very crowded teeth and a Class II malocclusion whose main concern for seeking treatment was she wanted whiter teeth.  I explained to the patient first how light is reflected at different angles off of the teeth; and if she really wanted white teeth, she needed to get them straightened.  At that point, I had her full attention and then could continue talking about her orthodontic treatment.

                After the benefits are discussed, your hygienist should follow-up with testimonials.  She can’t do this unless she has first-hand proof of your expertise.  Put braces on her, her husband, her children, any of our team members, and any of their families.  Do this at no cost to them, as they will be your best marketers and give you the best testimonials.  Patients trust your hygienist, and their faith and trust in you will increase with a glowing testimonial from your hygienist.  “You will love working with Dr. Paschen.”  “Dr. Paschen is wonderful with children and treats his patients like family.”  “ You will love the results achieved by Dr. Paschen – look what he did for me.”  A truly honest testimonial cannot be given unless your team has experienced your expertise, first hand.

                The last thing your hygienist should do is keep track of all patients referred for an orthodontic evaluation through the hygiene department, including the patients that she was able to schedule.  Many times patients will get home and check their calendars and realize there is a conflict with their scheduled evaluation, and they will call to cancel.  They usually will not reschedule, stating they will call back (which usually does not happen), and they are then lost for another 6-12 months until they come back in for their regular cleaning.  The hygienist will give the list of patients needing an evaluation to an assistant (or she can follow-up herself) and at the end of each week, she will check to see if those patients have scheduled.  “ Dr. Paschen discovered a possible orthodontic problem while doing Jimmy’s exam.  He strongly recommends that Jimmy have an orthodontic evaluation to determine if any treatment is needed at this point.  As always, there is no charge for these evaluations, and there is no commitment to proceed with treatment.  Dr. Paschen will give his recommendations.  Let’s get that scheduled.”

                Before we started using this system and tracking our hygiene patients who were recommended for an orthodontic evaluation, only 63% of those referred patients actually came in for an evaluation ( they said they were going to call and never did, or they scheduled and then later cancelled).  Once we started tracking the patients who were referred and began following up with them, our percentage of patients referred and who actually came in for an evaluation climbed to 92%.  This increase is huge and has made a tremendous difference in the patient flow for our orthodontic practice. 

                I strongly recommend that every patient referred for an orthodontic evaluation also receive something in writing describing what will be done at the evaluation appointment, the time involved, the benefits of the evaluation, and that it is done at no charge.  Spouses who were not at the hygiene appointment may not have any idea why their child needs an orthodontic evaluation and will be hesitant to schedule anything, due to a lack of orthodontic knowledge and costs involved.  That is why giving a written sheet, explaining these things, is so important.  Peter Drucker, who was an American management consultant, once said, “…if it can be measured, it can be improved.”  This is so true when it comes to orthodontics in your practice.  You need to keep track of all of the numbers, from patients in the hygiene chair getting referred for an orthodontic evaluation, to the number of case starts per month.  In this way, you can make sure that your orthodontic practice is heading in the right direction.

                In the next issue, we will discuss the importance of the treatment coordinator.  You will see what duties she needs to perform, how to template a proper consultation, and the correct way to discuss fees which will lead to an increase in case acceptance of your treatment.


  1. Bettger F. How I raised myself from failure to success in selling.  1992. New York: Simon & Shuster.

  2. Paschen M. Trial and error at my own office and tracking all hygiene referrals for two years.

  3. Drucker PF. The effective executive. 2007. New York: Harper Business Essentials.

Dr. Mark Paschen graduated from the Marquette University School of Dentistry in 1983.  His “passion” has always been practice management, giving his patients extraordinary service.  After years of incorporating orthodontics into his general dentistry practice, his practice is now focused solely on orthodontics, TMD, and Sleep.  He credits much of the success of his practice to not only furthering his clinical skills, but also to his close attention to practice management implementation.  Dr. Paschen has lectured extensively in the United States and also in Sydney Australia.  He is a Senior Certified Orthodontic Instructor for the IAO. 

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