Diag and Treat Planning in Myofunctional Ortho

Diagnosis and treatment planning in myofunctional orthodontics

By Dr. Barry Raphael

[email protected]

This presentation is part of a lecture given at Myofunctional Research Corporation

September 2011

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.

mailto:[email protected]

Diagnosis

DiagnosisIs an Educational Process….

The Doctor is Learning about the Patient

And

The Patient is Learning about the Doctor•Who we are•What we believe•What we are looking for

Parent’s Private-eye Sheet

Parent’s Private-eye Sheet

“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.

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.

Check off what you see. If you’re not sure, check it anyway and we’ll talk about it. Make comments if you want.”

While sitting around...

While sitting around (watching TV, in the car), does your child:

put “things” in the mouth alot (toys, sleeves, pencils, fingernails, etc.) ______________________________• lick or suck on the lips• have the lips apart, even a little

stick or dart the tongue out of the mouth• have the tongue resting between the teeth• lean the cheek on a hand

breath with his mouth open, even a little bit• make noises when breathing• have trouble sitting still

While talking...

While talking, does your child: talk very fast

• talk very slowly • gasp for air

have a lisp• take speech lessons

During a meal

During a meal, does your child: gasp for air while eating

• stick his tongue between his teeth when swallowing• stick the tongue out to meet the drinking glass

drink a lot while eating• make noises when chewing• eat sloppily

take a breath before drinking• puff the cheeks out when drinking• make the lips purse when swallowing

make the chin “crinkle” when swallowing• bob the head when swallowing• have trouble sitting still

While sleeping...

While sleeping, does your child: have the mouth open

• snore• wet the bed

toss and turn• tilt the head back • wake up frequently

have frequent nightmares• have abnormal sleep issues• grind the teeth

have trouble waking up• wake with darker circles under eyes

The Process: Treatment Planning

Principle 1: Select ALL the best treatments

I am at your Service

Pleasant and Easy as Possible

We share your Goals


Principle 2: Establish Cooperative Relationship

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


Principle 2a: Avoid Creating an Adversarial Relationship

Principle 3: Let the Patient Choose

1.Code of Ethics: Autonomy

2.Buy-in

3.Attitude Towards Treatment


1.Code of Ethics: Autonomy• Patients have the right to choose for themselves among all

the possible good treatments available, once they know the pros and cons of each.

• Buy-in

• Attitude Towards Treatment



1.Code of Ethics: Autonomy

• Buy-in

• Attitude Towards Treatment



1.Code of Ethics: Autonomy2.Buy-in• Attitude Towards Treatment• What’s important• Family Dynamics• Preconceptions



Presenting….My Early Treatment Sequence

based upon thePreconceptions of thePatients and Parents.

(Drumroll please…)


Preconception toward Trainers

•"Hmmm...makes sense"•Gentler and more natural•Better hygiene (no stains)•May save money•Quiet in the house

Parent



•Never heard of it before

•Child won't do it

•Child can't keep quiet

•Child can't breath through nose


Parent

• It’s not Braces

•Don't have to wear to school

•Can eat anything

•Seems more comfortable

The Process: Treatment PlanningPreconception toward Trainers

Patient


• It’s not Braces

•Their friends don't have this

•They don't want to do the work


Patient

Let’s put it all together


1.Trainers +/- BWS

2.if needed: Expanders

3.if needed: Braces

The Process: Treatment PlanningPreconception toward Trainers

Parent Patient


•Trainer ( 2-8 week test for cooperation)

•then add BWS or Expander,

• if needed: Braces


Parent Patient



1.BWS for 1 mo

2.add Trainer

3.rarely need Expander

4.if needed: Braces

Parent Patient


Traditional Methods:

Expanders, Braces, etc(Well, you just can please ‘em all…)


Parent Patient

Trainers : Treatment Sequencing

Initial Exam

Records

Consultation

Trainer Insertion

Trainer Check

Trainer Check

T4K only

1.Activities

•Activities

•Trainer Check

•Activities prn

•Trainer Check prn

•Ramp Down

Initial Exam

Records

Consultation

Spacers and Lab

BWS Insert

Adj BWS

Adj BWS

Insert Trainer

1.Trainer Check

2.BWS Adj and Trainer Check

3. BWS Adj and Trainer Check

4.D/C BWS and T4Khard

5.prn

6.Ramp Down


BWS then T4K

Initial Exam

Records

Consultation

Insert T4Ksoft

Trainer Check

Activities

Trainer Check

Activities

1.Spacers and Lab

•Band and BWS

•Adj BWS

•Trainer Check

•Adj BWS

• d/c BWS, T4Khard

•Ramp Down


T4K, then BWS

Fees and Arrangements

The Orthodontic Model• Contract: One Fee for All Tx• Addt’l Fees Specified Ahead

Typical Expansion Phase I includes:

• Impressions and insertion Bonded hyrax• Expansion checks• BO upper 2-2• 3-4 wire adjustments• Upper retainer• Lower Schwartz or Lower Fixed Lingual• Phase II records…

Fee: $2,500-3,300 all-inclusive



Age related


Coop related


Coop relatedContingency

related


Reward for Success

Health & Medicine

Diag and Treat Planning in Myofunctional Ortho