Breaking Down the Barriers to Interceptive Orthodontics: Dr. Shockley Wier's Phase 1 Consult Script

Posted by POS Course Adviser on 7/9/19 4:00 PM


One of the most valuable services I provide is orthodontic screenings for young patients.

Before kids get all their permanent teeth, an orthodontic screening can help me predict how teeth will erupt and how jaws will relate, and if there will be problems as they grow. Screening kids early helps me to better guide their growth to have better occlusion and long term health.

Unfortunately, some parents think of braces as a “teenager” thing. They may not understand  how two phase orthodontics can help their kids and don’t want to consider orthodontics on their young children. Instead of having a difficult consultation, inform your patients' families effectively. Practice discussing early intervention to parents. Look at these examples and get comfortable so you can do well in your next consult!


Dentist’s Protocol for Screening and Recommending Phase 1:

Doctor Dialogue Bubble

Doctor (or Staff Member):

Hi Sharon, nice to see you! We will be providing your daughter Sally a full dental screening before she goes to cleaning. We offer this complimentary service to every patient to make sure their dental health looks good or see any potential issues.

Now that she’s 7 years old, we’ll also provide a free 5 minute orthodontic screening too, to see how her jaws are growing and if orthodontics may be in her future or not.


Mom Script


Thanks doctor. I was wondering when she may need braces.

<After cleaning and screening>

Don't know how to screen for orthodontics yet?
Read POS’ Ultimate Orthodontic Screening Checklist 

Doctor Dialogue Bubble

After doing the orthodontic screening, it seems that Sally’s jaws are smaller and may not fit her permanent teeth once they come in in a few years. If we do nothing, her permanent teeth with become quite crowded.

(Adjust your results and conversation to what you have noticed in your screening - Early intervention can help patients with cross bites, inadequate space and those whom will develop certain AP discrepancies).

  Mom ScriptOh no! That sounds similar to how my teeth came in.

Doctor Dialogue BubbleYes, jaw size is often similar to one’s parents. If you don’t want Sally to have so much crowding, we can do something. We can use interceptive orthodontics to help Sally gain more space to improve the crowding that you experienced yourself.



Mom Script

How would the timing work?

Doctor Dialogue BubbleWe’d harness Sally’s growth spurt. Based on these x-rays, it looks like we should probably start next year. (Or whatever time frame you determined after doing a growth assessment).

We can monitor Sally’s growth to best time treatment. At your next appointment, we can see if she’s ready or wait further.

I would recommend addressing this early when her growth is right. After we've developed enough space with the first phase, we may maintain it with an appliance until all his permanent teeth are in. Later when Sally's probably in middle school, we would start the second phase of treatment to correct any rotated teeth, with full braces. Starting the first phase now, makes the second phase much  easier and gives her a better chance to avoid pulling teeth.

I’m happy to help with any questions to help you decide the best route for Sally.



Addressing Parent Objections:
Normally if you screen early, communicate with the parent confidently and provide clear advice to help his/her child, you will not have strong objections. However, here are some ways to address concerns. Prepare now, so you are confident in case the situation ever occurs.

Mom Script


  Interceptive orthodontics? Sally is too young to get braces now!  

What you could say: You’re right, Sally is young and she does not need to have braces right now. However, waiting for her to be older for orthodontics may risk us not getting the best finish or have more likelihood for her needing to have teeth pulled.

With two phase orthodontics, she won’t have full braces until the second phase, which may be when she’s in high school. In the first phase, she would wear an expander appliance to use her growth spurt to get her jaw to the proper size. She may have brackets on a few of teeth as that happens, but not full braces.

Mom Script

I don’t want to pay twice for braces. Don't sell me what she doesn’t need.

What you could say: I can appreciate you wanting to ensure Sally only gets the services she needs. Luckily breaking down Sally’s orthodontics in two phases often doesn’t affect the overall payment that much, maybe a couple hundred dollars.

If Sally waited to get orthodontics after all her permanent teeth erupted, it would probably cost around $5000. If Sally started orthodontics with two phases, we would charge $1500 for the first phase and $3700 in his second phase, and both can be spread out in installments.

Many patients even prefer having orthodontics in two phases since the payments are spread out over a longer period, and find that the extra $200 over 4 years is worth a better treatment.

I am not recommending this treatment because of a financial benefit. To be honest, if I had a daughter like Sally, I'd want her to have interceptive orthodontics to get every chance to avoid pulling teeth and for a perfect smile. 

Light bulb iconTip: Know how you want to bill your two phase orthodontics before you consult. Read this discussion to see how other dentists set up their Phase 1 billing.

Mom Script


Sally can wait. Everyone says that kids get ortho in middle or high school.

What you could say: Yes, many kids get braces in middle school or high school. There are many different case types and sometimes it’s better to wait til then. While Sally can wait to get braces in high school, she may not get the best finish and may have more need to pull teeth if we wait until then.

I understand that parents often think about orthodontics as a teenager thing. Unfortunately some dentists don’t screen kids to look at their options early, so not every parent knows.

Luckily for you, we did an early orthodontic screening. So you can decide if you want us to wait, or to help Sally line up her bones to have better success when she gets braces in high school.

Closing ScriptDoctor Consult With Mother and Daughter

I’d like to monitor Sally’s growth over the next appointments. When she hits her growth spurt, I’d like her to start using a rapid palatal expander to help her get the proper sized jaws for the teeth we can expect.

Starting orthodontics early can really help her for these reasons:

  1. I can use growth to make her bones line up better. The better the bones line up, the better the teeth line up.
  2. It makes it less likely that I’ll have to remove permanent teeth.
  3. Younger children typically cooperate better than older children.
  4. It’s less likely that she’ll be teased if we address potential issues now.

If you want to plan for this, I can have our front desk discuss your different payment options and we can note to look out for growth in our charts for the next appointment.


As a dentist, it’s our duty to consult patients on how they can have a healthy smile and prevent dental and facial issues.  Phase 1 treatment is a powerful tool and can fix the transverse, antero-posterior (AP) relationship, and crowding. If the Phase 1 results are perfect, Phase II can be much simpler and faster, sometimes just needing to fix some rotations. I encourage all dentists to do early orthodontic screenings and understand how to refer or treat interceptive orthodontic patients.

With a little practice, you’ll be able to answer parent’s questions with confidence. If you’d like to get more tips for working with young patients who have orthodontic needs, check out our Orthodontics for Children Series or Comprehensive Orthodontic Series.

Orthodontics for Children Course Learn More


Topics: Orthodontic Tips, POS Instructor Tips, Growth, Tips for Success, Mixed Dentition, Business of Orthodontics, Growth Management

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