Today on the Golden Age of Orthodontics, we’ll explore the controversial topic of early orthodontic treatment. Dr. Daniel Grob, a board-certified orthodontist with over 40 years of experience, discusses the benefits and challenges of early intervention. He emphasizes the importance of developing facial width and addressing oral habits in young patients.

Dr. Grob challenges traditional views on early treatment, arguing that cone beam X-rays have changed how orthodontists assess patients. He focuses on creating width for future development rather than just straightening teeth. Dr. Grob aims to complete phase one treatment in 15 months or less and phase two in 18 months or less.

The discussion covers the prevalence of oral habits like mouth breathing and nail biting in young patients seeking early treatment. Dr. Grob shares insights on educating parents and general dentists about the signs of maxillary deficiency and the benefits of early intervention.

The episode also addresses the marketing aspects of promoting early orthodontic treatment. Dr. Grob emphasizes the importance of building relationships with pediatric dentists and other specialists for referrals. The hosts discuss strategies for reaching parents directly through educational advertising. The conversation concludes with clinical advice for younger practitioners considering early treatment. 

IN THIS EPISODE: 

• (00:00) Intro: Early orthodontic treatment debate
• (02:28) Meet Dr. Daniel Grob
• (10:14) Cone beam X-rays changed approach to early treatment
• (14:47) Parent demand and concerns driving early ortho
• (16:49) Prevalence of oral habits in early treatment patients
• (24:42) Partnering with pediatric dentists for referrals
• (29:51) Evaluating transverse dimension and expansion needs
• (33:37) Compliance with Invisalign for young children
• (34:59) Resources to learn more about pediatric orthodontics
• (37:51) Closing thoughts and call for listener feedback

KEY TAKEAWAYS: 

• Early orthodontic treatment is about more than just straightening teeth. Dr. Grob’s focus is on developing facial width and balance, which can lead to better long-term outcomes. Using cone beam imaging has revolutionized how he approaches early treatment by allowing him to assess the transverse dimension more accurately.
• Oral habits play a significant role in malocclusions. Nearly half of the patients Dr. Grob sees for early treatment have some type of habit like mouth breathing or nail biting that impacts their dental development. Identifying and addressing these habits is crucial for successful early intervention.
• Partnering with pediatric dentists and educating parents about the benefits of early treatment has been key to Dr. Grob’s practice's success. By starting treatment between ages 6-9 when appropriate, we can often help avoid more complex interventions later on and simplify the overall orthodontic process for many patients.

RESOURCE LINKS

People + Practice  - Website 

Leon - Email

Amy - Email

People + Practice - Email

The Pediatric Orthodontist Facebook Group

KEYWORDS: orthodontics, golden age of orthodontics, early orthodontic treatment, pediatric orthodontics, transverse dimension, oral habits, cone beam x-rays, phase one treatment, facial balance, orthodontic practice growth, non-extraction orthodontics, orthodontic marketing, pediatric dentist partnerships, orthodontic education, orthodontic referrals, Invisalign for children, McNamara's transitional dentition, maxillary expansion, mandibular treatment, orthodontic case presentation, orthodontic compliance, orthodontic practice differentiation, orthodontic treatment planning, orthodontic patient education, orthodontic practice management, orthodontic treatment timing, orthodontic treatment outcomes

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[00:01:36] Intro-Outro: The future of orthodontics is evolving and changing every day, but although the way to achieve practice growth has changed, there's never been a better time to be an orthodontist. Let's get into the minds of industry leaders, forward-thinking, orthodontists and technology insiders to learn how they see the future of the orthodontic specialty.

[00:02:17] And now welcome to the Golden Age of Orthodontics with the co-founders of People and practice, Dr. Leon Klempner and Amy Epstein.

[00:02:54] And as usual, I'm joined by my partner, by my daughter and my [00:03:00] co-host. Amy Epstein. How you doing, Amy?

[00:03:21] Dr. Leon Klempner: dentists.

[00:03:42] Um, but we had like a little chat, um, before we, we, you know, are recording our podcast, just get to know each other, talk about topics, talk about what might be interesting for our listeners. And it was very inspiring to me because I have a 7-year-old as [00:04:00] you know, dad because she's your granddaughter. Um, and we're gonna talk about early ortho today.

[00:04:29] Discussion that we had with Dan. Um, and yeah, it was inspiring to me and I'm, I'm bringing my daughter in for a consult, um, because, you know, I think that she could, she could benefit from being seen and at least get some more information about whether or not it's the right time for her. So. You haven't seen her in a little bit, dad, but you know, she's getting real crowded down there.

[00:04:50] Dr. Leon Klempner: know. And, and, and, and it's a, this is a hot topic in ortho, you know, this has been bounced around for, you know, I've been around a long time and from the beginning this [00:05:00] has been, you know, volley back and forth in terms of, uh, value, no value, do it, don't do it. And people have pretty, they're pretty set in their ways I've found.

[00:05:34] We mm-hmm. You know, we have the residents for two or three years and, you know, it's a lot to just teach 'em how to. You know, treat a case with extraction, so,

[00:05:57] Um, but Dan is still in practice. Uh, he [00:06:00] has treated tens of thousands of patients and he's built his career around delivering thoughtful. Comprehensive care with a strong emphasis on early intervention. Uh, Dan actually, oh, he has a dual specialty, um, in both prosthodontics and orthodontics. Mm-hmm. Um, and he's spent his career not only transforming little smiles, but also big smiles, um, and educating like you do dad.

[00:06:46] And for those listening today, if you're interested in early ortho, you should go check out the pediatric orthodontist on Facebook and, uh, ask to be included in the group. Um, and if you, uh, look at your. You know, a couple years back of [00:07:00] Orthotown Magazine, we'll see his name because he was the editorial director for some number of years, and his monthly columns shaped conversations throughout, uh, about phase one care for, for a good number of years.

[00:07:17] Dr. Daniel Grob: Well, thank you for the nice introduction and I'm very, very happy to be here to spread, spread the word that I'm, uh, uh, working on perfecting and, and making a good experience that, that of, uh, early orthodontic care.

[00:07:52] Hmm. And what a, what a better dual specialty than prosthodontics and orthodontics so that you could treat all these adults. [00:08:00] And back then surgical orthodontics was coming into play. So we had a, we had a thriving practice in Wisconsin dealing with adult orthodontics oftentimes involving, uh, jaw surgery that kind of dried up when insurance benefits, uh, were cut back a little bit.

[00:08:46] Uh, so, so Dan, let me,

[00:09:07] But, you know, if I, when I do a literature search, um, and I, I look at the studies that were done that I. All of the studies other than let's say, um, instances where they have a large overjet and there might be some trauma or maybe if there's a, you know, deviation in terms of a crossbite. Those are typically the two areas that, that everybody agrees on.

[00:09:57] So let, let me give you a chance [00:10:00] to answer that question. So why so why, why would you choose early treatment if, according to whatever's been published, uh, you can get, uh, a similar result by doing it in one phase.

[00:10:25] I think DNI had something and, and I think at, I, I think the articles that, that you and I both are familiar with are comparing early treatment. With the same end goal. And I think, I think the end goal was taking someone from class two to class one or making the teeth straight. And I, and I personally think that the evolution of early treatment has led to a different end goal where we're looking more at the face balance as opposed to the dentition.[00:11:00]

[00:11:29] If you're using kind of a false premise for the end goal and, um, when they say, well, you can get the same result treating later, early, well, the results they're looking for sometimes involve serial extraction, sometimes involve taking out a couple of teeth, and I don't want to say that I get up every morning and, and promise the world that I'm not going to remove permanent teeth.

[00:12:12] I, I think he really got us looking at the, in, in the transverse dimension. So, um, my end goal now. Is to develop width to the face and to the smile. And I look at patients and I decide if I, if I need early treatment to create some width for the future, that's when I get involved. If I don't need early treatment.

[00:13:03] Uh, there, there, there's no doubt about it, that early treatment does add some time and some cost, but, um, the vast majority of the patients that I get involved with in early treatment, the, the parents are very happy. Hmm. And, uh, they, you know, they bring their second child and their third child and they know that this is the way we work and.

[00:13:44] It's, um, my, my goal, and I think it was mentioned in the last. Um, editorial that I wrote for Orthotown was I'm constantly working on trying to perfect phase one in 15 months or less, and phase two and [00:14:00] 18 months or less. And if you add that up, you might have two and a half, three years of treatment. Which isn't extraordinary.

[00:14:19] Amy Epstein: imagine, Dan, that, that, you know, there are others like me with, um. Little kids and, uh, concerns. So is, you know, how, how are you finding the sort of market in terms of the demand for early ortho?

[00:14:48] Dr. Daniel Grob: most of the parents and the beauty of orthodontics is. You know, the parents can look at their kids, smile and see if there's room or not.

[00:15:19] Some permanent teeth. I, I can honestly say that in the six or seven years that I've been in practice with, uh, with the pediatric dentist, I have signed a letter to take out four permanent teeth in less than a dozen times, and we've had hundreds of patients treated and I feel pretty comfortable that it doesn't necessarily.

[00:16:01] And I, and I think. And I think in, in the world of cosmetic orthodontics, we're very aware of the fact that the upper incisors should be upright to the floor, and that that provides the best bounce of light off of the front of the teeth. So we work very hard to develop width, and we work very hard to make sure that the central incisors are standing upright and straight when we're done.

[00:16:28] Dr. Leon Klempner: Mm-hmm. And I know, you know, I, I've heard you speak before in a, in, in conversations I've had with you, um, because we were aligned in so many different ways. But you, you introduced a few things that were, that I, I was not aware of, which, which was the significance of oral habits in terms of the developing dentition.

[00:16:49] Dr. Daniel Grob: Well, uh. In, in about two months, an in-office research project is going to be released in, in Orthotown, where we took three months of all [00:17:00] new patients, all recall patients, and all patients in between phase one and phase two, and we asked the parents and the patients to self-report.

[00:17:34] Well, we, we found that nail biting. Is even more prevalent in our practice than mouth breathing. And, and the, the, the total tabulation of the results will be available in Orthodon. But suffice it to say that almost half the patients that come in for early treatment have some type of a nasty habit, whether it be mouth breathing, nail biting, thumb sucking, uh, it goes on and on.

[00:18:33] All kinds of muscle imbalance, and part of the article that I'm working on this weekend and need to get into the Producers by the middle of July shows adults that come in with. Crazy dentitions. And when you probe them, you find that, uh, the same light, gentle pressure that we use to straighten teeth has been used to cause their malocclusion.

[00:19:12] Amy Epstein: Hmm. Yeah, that makes sense. You know. Our, um, so people in practice, something that we do at the start of any engagement with an OR orthodontist to try to help them market their practice is to understand what makes them different in their community, what their strong suit is, something that patients value that they can do consistently.

[00:19:58] I have, I have a treatment age, [00:20:00] a 10-year-old, and I have a 7-year-old. But no matter what I'm looking for, I know that this practice is good at this and this practice is good at, this seems to me that you have a very strong handle on what your differentiated positioning is in, in your market. First of all, I mean, it's.

[00:20:47] Dr. Daniel Grob: Well, we're very fortunate for one to have a pediatric dentist that we've worked with in a pediatric dental office staff that we've educated to, to explain to them the transverse dimension in habits. Hmm. When, [00:21:00] when the pediatric dentist staff goes out to the grade schools and talks about brushing teeth and fluoride and don't, don't eat candy, we follow up and, and we step in.

[00:21:32] In other words, early treatment is taking care of the first 12 permanent teeth that erupt. Uh, comprehensive treatment is taking care of the next 12 permanent teeth that erupt, you know, the buccal, the buccal segments. And then after the 12 year molars erupt, you're basically in into the adult dentition. I haven't really.

[00:22:10] 'cause I, I don't want to create a firestorm of, of early treatment and, and, and be known as someone that's wasting parents and kids' times. But, but I, I think, I think there are situations where, uh. We, we can start treating the six year olds and, uh, just getting a, a few teeth and start, start to expand. Like I said, I've, I've been very, I've never been an early adopter on pretty much anything, uh, in orthodontics.

[00:22:59] Every [00:23:00] day in my office is just so much simpler than the transverse deficient patient that shows up at 14 or 15 where the parent says, we've been waiting for all the teeth to come in. And you know the look of this patient, Leon. It's a narrow upper jaw flared incisors. Class two and you're, you're left with, okay, are we gonna do this surgically or are we gonna do this or that?

[00:23:44] And then I, then I'm left to explain to them that, well, we've, I have to start with width. So, you know, you're a little old for the conventional expander, so we might have to do. A Sarpy or, or like a surgically assisted type, uh, uh, expansion. Mm-hmm. And then [00:24:00] we're left with the protrusion. Uh mm-hmm. I, I feel pretty comfortable using herps appliances in, uh, when, when people reach double digits mm-hmm.

[00:24:31] Right. And there, and there are plenty of young kids that I pass on. It's, it's when they have enough maxillary with. And I feel that I can get it done in, in one, in one phase. Right.

[00:25:06] Um. And we, we work with a lot of practices that, you know, are not PETA ortho practices. And so, you know what, just as a, a thought for those listening, um, about. How to solve for, well, I waited, this is the parent talking. Well, I waited until all their permanent teeth came in, and now I'm, I'm in front of you.

[00:25:51] If you want to do, have those kids come early, like Dan's saying, and be able to make space younger to make it easier later, then you have [00:26:00] to reach those parents when their kids are seven and eight and or, or younger, and reach them with things that they can understand and identify about their children and give them a call to action that.

[00:26:35] So, um, from, from my perspective, I can see, or, and I can imagine many of our listeners are thinking, you know, I'd like to be able to do more of this, but how do I, how do I solve this issue?

[00:27:03] Um, so, you know, I'm, I, I don't visit the general dentists so much anymore because I have mm-hmm. Uh, access to the pediatric dentist. Right. And then sometimes those patients refer. And then we'll, we'll get a, a referral with a different general dentist, and then I will go out and visit like a lunch and learn.

[00:27:49] That's something to look for. So I, I show the, I show the general dentist and the staff that, you know, this is, this is your, you've got a box of disposable rulers that you can put [00:28:00] on your, uh, exam tray and take a tweezers and hold it up to the molars and see how, how wide the, the molar are. And that's, that's research, uh, from James McNamara, who is legendary.

[00:28:36] Mm-hmm. My first exam that I'm doing today after this podcast is on the, the child of an ear, nose, and throat surgeon who's been doing. Tonsil and adenoid work for me for the patients that we refer. So. Uh, it's, it's just, yeah, I mean, that's a

[00:29:12] You know, reaching out, this is what we do. But coupling that with reaching out to consumers, patients, parents directly, is the other side of that coin. So that they're seeing, they're hearing it from their doctors, their specialists, that seeing an orthodontist at this time is a good idea and they're doing their own research on their side confirming that this is a good decision for their.

[00:29:50] Dr. Leon Klempner: So, so Dan, I want to, I want to, in the short amount of time we have left, I'm looking at the clock and I wanna flip it back to some clinical stuff quickly towards the end.

[00:30:31] Yep. Um, then I remember it well. Yeah. That oftentimes we end up under, under expanding, so we need to expand to a normal lower arch. So that's just one thing that I, I find you don't need a cone beam in order to. To, you know, evaluate that. The other thing is that if I'm measuring the upper incisor and it's like 10 millimeters, 11 millimeters, or I have a bi maxillary protrusion, then I'm really questioning am I dealing, am I gonna try to treat [00:31:00] this, you know, non extraction.

[00:31:21] I don't know. I, I haven't been taught a lot. You know, how, how, how would you suggest that they get, get more knowledge or, um, advice that you might give them in terms of making those types of decisions?

[00:31:56] Uh, and, and he does, he treats the mandible first to [00:32:00] upright the lower and the lower buccal segment so that, uh, the curve of Wilson is not accentuated. I will agree that, uh, my failures in, in phase one early treatment have been because I have not paid enough attention to the mandible and parents. I, I have, I have never taken the approach of treating the mandible first just because.

[00:32:36] So, so we start with expanding and then when we, when we get to a point where the, the lingual cusps are almost on the buccal cusp of the lower, we either put brackets on the lower, or we do a removable device, or Invisalign, of course, really makes it easy. I mean, we've really, we've embraced Invisalign early treatment to a great extent.

[00:33:18] Uh, but, but you, I need to just

[00:33:33] Dr. Daniel Grob: Kayla. I hear Kayla. Yeah. I'm just curious. I mean, I have, I

[00:33:38] Dr. Daniel Grob: invisalign's own scientific research and, you know, they measure everything, including how much they Sure do.

[00:34:02] Mm-hmm. Because the amount of time that we spend with adults, um, trying to cover their tracks for, oh, I was, you know, I was in Vegas or Nashville this weekend, I forgot my aligners. Versus the kids that are really enthusiastic about making their smiles look great. Um, I, I, I think, uh, we've had a great result with, with, uh, even as young as, as the littles.

[00:34:26] Amy Epstein: Okay. Yes. Good to know.

[00:34:30] Amy Epstein: Very good.

[00:34:31] Amy Epstein: okay. Well, listen, thank you so much for taking the time to talk with us today for answering all my personal questions about my daughter, Kayla. Uh, if there any, well, it sounds like you,

[00:34:44] Amy Epstein: Yes. Well, I mean, yes, definitely. Yeah. Um. If our listeners are interested in learning more about early ortho, have questions for you, follow ups, can they reach out to you and if so, what's the best way?

[00:35:21] With all the, the case reports that, uh, that are sent in from other orthodontists that follow the, the page and myself, so that it's a resource for, uh, like you said, residents, uh, orthodontists patients, the, the. The website is available to anyone, the Facebook group, or is available only to members, and we're encouraging people on the Facebook group, the pediatric orthodontist, to upload photos, uh, before and after cases discuss the cases that I'm showing.

[00:36:19] That's great. Uh, what, what I do at the end of the cases that I show. Is I, I critique myself. Here's a case where, uh, we, we, we got our maxillary width to 34 millimeters. Our ultimate goal is 36. I think I could have upright the lower molars more, uh, things like that. Yeah, I mean, so, okay, great.

[00:36:43] You'll answer questions, things like that to visit the website. We know it's a work in progress, but they can learn more there. Um, and you know. That's one thing. So thank you again.

[00:36:54] Amy Epstein: Really appreciate your time. Looking forward to hearing more, um, and hope to have you on again in the [00:37:00] future.

[00:37:02] I, I love spreading the word.

[00:37:31] And about how we can help you bring that younger set to the practice for their exam and, uh, you know, educate those adults, the parents, uh, about early ortho. Visit our website@pplpractice.com

[00:37:59] Uh, do you do early [00:38:00] treatment? Um, if not, why not? If you do, what resources do you have? We can open up a, a discussion and, and share some information. I think it, it can only help all of us. And if you're looking for the best marketing company in the world, shoot me an email there as well and, and let's talk.

[00:38:36] Intro-Outro: Thank you for tuning in to the Golden Age of Orthodontics. Subscribe now on Apple Podcasts, Spotify. Or visit our website at the golden age of orthodontics.com for direct links to both the audio and video versions of this episode.