Specialists In Orthodontics

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October 7, 2013

Two Truths and A Lie by Dr. John Dumas

Some of our Trivia Tuesday contestants have been asking me to give a few more details on the 2 Truths and a Lie that we posted last week for the trivia question so here it goes:

#1 – I have 3 US patents. True statement.  I do currently own 3 patents on orthodontic brackets that have been in the works for about 6 years.  I still have one patent pending and hope to have the bracket system to the market sometime soon!

#2 – I have a tattoo. For those who thought I had a tattoo….I’M SHOCKED!!!  No ink for me!

#3 – I survived a category 5 hurricane – also a true statement.  In 1992 while serving as a General Dentist in the United States Air Force, I was stationed in Homestead Florida with my wife when Hurricane Andrew rolled thru town.  The hurricane was originally categorized as a category 4 but later called a category 5…one of the most powerful storms to ever hit North America.

Dr. Dumas’ office after Hurricane Andrew

Sustained winds hit 175 mph with maximum winds thought to be over 200 mph.  It was so difficult to categorize because all of the monitoring devices were destroyed during the storm.  I was the disaster team Triage Chief at the time of the storm and my wife worked at the local hospital which was the only hospital south of Miami to stay open during the storm.  We rode out the hurricane (about 5 hours including the eye) in the hospital which was completely devastated by the storm.  24 babies were delivered while under emergency power due to the changes in atmospheric pressure, many of them named…..you guessed it….Andrew!

The dental clinic where Dr. Dumas worked after Hurrican Andrew.

The dental clinic at the base
where Dr. Dumas worked
after Hurricane Andrew

My role as the triage chief had little value as the Air Force base was almost completely wiped out and the local community had little to no medical capabilities.  Never did we simulate a disaster that came close to the scale of Hurricane Andrew!  South Florida was forever changed by the storm.

A typical suburb site after Hurricane Andrew

A typical suburb site after Hurricane Andrew

I returned 10 years later and much of the area looked just as it did after the storm.  What was once an important Air Force fighter base, now only houses DEA flights guarding the southern coast from illegal drugs and (ironically) hurricane chasers for the National weather center.

And now you know “The rest of the story”.

September 2, 2013

Fatherhood

First, I must apologize for the excessive time since my last post.   Second, this post will have nothing to do with orthodontics.  A lot has happened in my life since the last post.  On August 7th, my wife and I welcomed a new addition to our family.  Reese Elizabeth Groth was born at 10:12 PM.  She came into this world with a bang weighing in at a whopping 10 pounds, 1 ounce. 

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Any moms reading this will know that Kelly deserves some kind of labor and delivery medal of courage after delivering a baby of Reese’s size.  Today I am not going to write about braces, rubber bands, headgear, or anything else tooth related but rather would like to share ten insights that I have had in just a few weeks since becoming a father. 

1) When you think a baby has fallen asleep on your shoulder and it is safe to put her down, don’t do it!  Every time that I think that Reese is in a deep enough sleep to be put down she wakes up and looks at me with this playful grin that says “you wish I was sleeping, don’t you?”

2) When you hear that a diaper change is needed, don’t rush into it.  Wave two, or even three, is usually not far behind.  I learned this when I went through 4 diapers in the span of 5 minutes.

3) Babies are expensive.  I’ve known this for some time but one cannot simply grasp this concept until they experience it first hand.  Just like in dentistry, when you label something a “specialty” item it immediately becomes more expensive (as if they incorporate gold or precious gems into the plastics/fabrics that it is made of).  Piggy backing off of #2, as we go through diapers like a college football team goes through food at an all-you-can-eat buffet, I can’t help but see the dollars and cents ringing up.

4) Everyone has tips for solving those pesky issues that come up when you have a newborn.  Ranging from how to avoid her becoming a thumb sucker (and believe me, as an orthodontist, this is a very real concern of mine), to the best way to avoid diaper rash, or how to soothe a crabby baby. 

5) Walks and car rides truly are one of the best ways to lull a baby to sleep.  I am amazed at how quickly a grouchy child will quiet down when placed into a moving vehicle.  I say moving vehicle because as soon as that vehicle stops 

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they may begin to fuss again.  Babies can be very demanding.  A second best thing to a moving vehicle is a baby swing.  For any new parent out there we both highly recommend the MomaRoo.  It looks like something out of SciFi movie but is like the baby whisperer.  Reese likes the “Car Ride” or “Kangaroo” motion set on level 4.

6) When you have a baby no plans can be set in stone.  Even babies with the best schedule can destroy your best-laid plans.  I will admit, 

7) Regardless of all of the advice from books, family, friends, other parents, doctors, nurses, and even random strangers, you will do whatever you need to in order to comfort your child (including giving them a pacifier before they are 3 weeks old).however, that Kelly and I took Reese to her first Michigan tailgate last weekend.  We refused to let her disrupt one of our favorite Saturday traditions.  Reese was great the whole afternoon and slept very well that night.  It also helped that several of the couples that we tailgate with also have newborns.  It was quite the sight with our BOB stroller armada walking through Ann Arbor on our way to our tailgate destination.

8) Just because babies don’t have teeth doesn’t mean they can’t “bite.” I don’t know from experience but my wife and most moms can vouch for this.

9) Sleep is special.  I mean this in several different ways.  There are few things better than waking up to a happy baby who has slept for 5 straight hours, having Reese fall asleep on my shoulder/chest, or watching her smile while she sleeps.

10) Being a parent is going to be the greatest/hardest/most fun/most interesting/(insert your adjective here) journey of our lives. We both know that there are going to be bad days, great days, hard days, fun days, ups, downs, lots of lessons learned, and lots of diapers gone through and we excited about all of it! 

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Thanks for reading!

Dr. Groth (& Family)

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July 4, 2013

Founding Fathers

It’s the 4th of July, one of our favorite holidays in the United States.  Today we celebrate our nation’s birthday with patriotic outfits, fireworks, eating too much food, and hopefully spending time on a lake (if you live in Michigan).  I am sitting on a dock in northern Michigan enjoying a beautiful day with my wife and my family as I write this post.  The 4th of July is about more than bombs bursting in air, hot dog eating contests, and yelling “U-S-A, U-S-A” at any chance you get.  The 4th of July is a time to remember the founding fathers of our country, and in the spirit of the founding fathers, I am going to give a short history lesson of orthodontics.

           

            People have been moving, or attempting to move, teeth dating back to the time of the ancient Egyptians.  Skulls have been found that have evidence of attempted tooth movement with catgut and crude metal bands wrapped around teeth.  Ancient Greek Roman remains were found with appliances that were used to maintain spaces between the teeth, and gold wires to keep teeth bound together.  We don’t know much about their mechanisms other than that they were crude and probably very ineffective. 

 

It was not until Pierre Fauchard, a French dentist, published a book titled The Surgeon Dentist in 1778 that an orthodontic appliance was well documented.  Fauchard devoted an entire chapter of his book to an appliance known as the “Bandeau,” which was essentially a horseshoe made of gold that went around the teeth and was used to expand the arch.   Although very crude, a modification of the Bandeau is still used today.

 

Several men deserve the title of “Father of Modern Orthodontics.”  Norman Kingsley and J. N. Farrar wrote important texts outlining how teeth should fit together and how they can be fixed.  However, there is one man who is the true founding father of modern orthodontics.  In the early 1900s, Edward H. Angle came out with the classification system that we use today to describe how teeth fit together (the Angle Classification), and designed the orthodontic bracket that set the foundation for the orthodontic brackets that we use today.  Edward Angle also founded the first school of orthodontics, founded the American Society of Orthodontics (which eventually because the American Associations of Orthodontics), and also created the first orthodontic journal.  Because of Edward Angle’s achievements, orthodontics became the first recognized specialty of dentistry. 

 

Without Edward Angle who knows what orthodontics would be like today.  Maybe we would not have the amazing technologies that were built upon his inventions and maybe everyone would be walking around with crooked teeth and not so beautiful smiles!  So while everyone takes a moment today to thank the founding fathers of the USA, also take a moment to thank (or curse him if your teeth are sore) Edward Hartley Angle.  Without Dr. Angle you could possibly be enjoying corn on the cob, popcorn, and all sorts of hard candy on our nation’s birthday, but you would also not be on your way to a life with an amazing smile.

 

Thanks for reading!

 

Dr. Groth

 

 

June 7, 2013

Rubber Bands: Not Just Orthodontic Torture by Dr. Christian Groth

One of most unpopular aspects of orthodontic treatment is the rubber band. This tiny, innocent piece of rubber causes more headaches for patients, parents, assistants, and doctors than just about anything else we use. So what is the deal with rubber bands? What are they doing? Why do we ask some of you to wear them at night only, others for 18 hours per day, and some full time? Your questions will hopefully be answered below.

There are two basic types of rubber bands: those that move your teeth in a front to back direction, and those that move them up and down. If you have read the “Beginner’s Guide To Orthodontic Language” you should know that a Class II bite is one where the lower teeth are behind the upper teeth. The “Class II elastics” aim to bring the bottom teeth forward and upper teeth backward. Since the Class III bite is just the opposite, Class III elastics aim to bring the upper teeth forward and lower teeth backward. Check out the photos below for a visual representation of how the teeth are moving.

Class II Elastics

Class II Elastics move upper teeth back, lower teeth forward

Class III Elastics

Class III Elastics move upper teeth forward and lower teeth back

These are both front-to-back corrections. What about the up and down types of elastics?

Once the teeth are close to their correct position, we want to make sure that they fit together really well. In order to help this happen we will have patients wear “triangle” or “box” elastics. The typical triangle elastic hooks to one tooth on the top and two on the bottom in a – you guessed it – triangle fashion.

Triangle Elastics

Aiding vertical tooth movement with Triangle Elastics

On the other hand, box elastics hook up to two teeth up top and two teeth on the bottom.

Box Elastics

Aiding vertical tooth movement with Box Elastics

To be efficient we can have patients use “Class II triangle” elastics that help bring the lower teeth forward and the teeth together at the same time.

Now comes the time dilemma. Very often we ask people to wear their elastics full time or for 18 hours per day. When they take the liberty of wearing them a bit less, that patient is shocked their braces are taking longer than we anticipated! In general, when we ask a patient for full time elastic wear, we are looking for a sizable amount of bite correction. Wearing elastics is similar to pushing a big ball up a hill. If you push that ball consistently all day you will get to the top sooner than if you stop and let go of that ball for a while and let it roll back down the hill. When we need a small amount of correction, or have completed a large amount of correction and want to back off slightly, we will ask patients to wear their elastics for 18 hours (generally that is all the time except for school hours). If we want to hold the teeth where they are we will often simply ask for nighttime wear.

When we ask for a certain amount of rubber band wear we are doing so for a reason. We all understand that rubber bands are a pain in the rear, but they are a necessary evil for almost every orthodontic patient. Studies have shown that poor rubber band wear can extend treatment significantly. PLEASE wear your rubber bands as we ask because although we LOVE seeing our patients we would rather be checking your retainers (we will address that issue in another post), and not begging you to wear your rubber bands.

Thanks for reading,
~Christian Groth

May 14, 2013

New Toys by Dr. Christian Groth

Dr. Dumas and I just returned from the annual American Association of Orthodontics (AAO) conference in Philadelphia.  For those of us in Detroit we can equate this to the “auto show” of orthodontics.  The meeting brings together the orthodontic industry and leaders in the field for a four-day weekend of new product launches and informational lectures on the latest and greatest.  The AAO meeting is held every year at a different location during the first weekend of May.  I was fortunate enough to attend the meeting last year in Honolulu, where I presented my research and was actually PAID to attend! The meeting this year was held in the beautiful City of Brotherly Love, a place that I had never been before. Two of my very good college friends grew up around Philadelphia so I have heard for years how amazing the city is.  I must admit, we had a great time; our hotel was just around the corner from the Liberty Bell and Independence Hall.  There is something special about being in a place where you know a significant historical event has taken place.  I went for a morning run on Sunday and was thinking to myself that Ben Franklin very well may have walked down the very streets that I was running on (they were very old cobbled streets, which makes for precarious running). We did not get much time to explore the city because we spent the vast majority of our time at the Pennsylvania Convention Center either listening to intriguing lectures, or researching new and innovative products to bring back to the practice.

The buzz around the meeting was 3D scanner technology, 3D printing, and cloud computing.  Now, any of you who have spent time in the practice will know that we have been using 3D scanners in order to create our robotically-bent SureSmile wires for over 5 years.  Recently, we have utilized 3D printers to fabricate aligners to allowing patients to get out of braces sooner by fine detailing the teeth with our clear aligners at the end of treatment, or to treat those patients who may not have been as diligent with their retainer wear as they should have been. Two weeks ago we made the huge leap in converting our whole practice management software to the cloud.  During the conversion we threw Ortho2 (the software company) a curveball because for the first time they would not only be converting an office to the cloud, but also merging patient databases for 3 offices. For the past 18 years each office has had its own database, making it difficult to communicate between offices.  The conversion and merger allows us, for the first time, to have a single patient database across the entire practice. Our practice administrator, Laura Force, was instrumental in the conversion and merger. Without her we would have been like lost puppies. Laura was such a rock star that Ortho2 invited her to help explain the software to new and potential customers at the AAO meeting.

Converting our software to the cloud means a patient can call any office and be scheduled easily at the office of their choice. You may also notice new and different ways that we can communicate with you. Stay tuned for updates on our software conversation.  There are some innovative tools integrated that we will begin to use soon, one of them a morphing tool. The morph allows us to take the initial patient photos and all of the photos inbetween and create an animation of the transformation that we can email to you! For the doctors, the cloud means that we can effectively work from anywhere, checking patient files and images even if we are not in the patient’s home office that day, we are always just a click away.

The last piece in our digital puzzle has been our use of Invisalign.  We love the Invisalign product, as do our patients, but nobody loves the impression process. Because Invisalign is such a precise process and requires a high level of detail, we must take impressions with a more accurate material. This material, unfortunately, takes longer to harden than our normal material and results in a less than fun experience for the patient.

messy impression

We are excited to announce, that starting in a few weeks we will no longer need to take impressions for Invisalign!  We purchased three new iTero scanners at the AAO meeting that will allow us to scan a patient and submit the “digital” impression for Invisalign trays.  The scan is done with non-x-ray, visible light like a camera. It takes only about 12 minutes and the result is a more pleasant patient experience,   a quicker turnaround time, and better fitting Invisalign trays.

iTero scanner

Dr. Dumas and I are self-admitted orthodontic and technology nerds.  There is nothing more exciting for us than getting a new toy in the practice, especially one that will allow us to deliver a better patient experience. We are excited to offer this new service to our patients and hope that you all will enjoy it as well.

Thanks for reading and come see our new toys!


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T|D|R proudly providing braces, Invisalign, and orthodontics to Rochester Hills, Birmingham, Novi, Shelby, Lake Orion, Troy, Bloomfield, Royal Oak, Farmington Hills, Northville, Livonia, Walled Lake, and surrounding communities with a long list of straight teeth and happy smiles! An orthodontist receives two to three years of education beyond dental school and are the only ones allowed to call themselves “orthodontists”. Only orthodontists may be members of the American Board of Orthodontists.