Dr. Joe Viviano joined Progressive Orthodontic Seminars almost 30 years ago. At that time, students didn't have nearly the amount of resources to help them learn orthodontics as they do today. In this interview, Dr. Viviano recounts how they used to get by without computers, and shares some expert tips that he has learned throughout his long orthodontic career.
ANDI SHULTZ: Hi, I'm here with Dr. Viviano. He's been a teacher with Progressive Orthodontic Seminars for the last 26 years and I'm going to ask a few questions today. So, Dr. Viviano, tell me what made you want to start learning orthodontics?
JOE VIVIANO: When we graduate from dental school, typically we don't have a lot of orthodontic education, and I didn't have any from UOP when I graduated in '83. When I started my practice, I started it from scratch and I had a few friends that were working in a large group practice. I started solo in that practice just building my own practice. One of the dentists in the practice was practicing orthodontics and he was using a technique called the Whitsett technique. I looked at what he was doing and it looked fairly easy to me at the time so I just started doing orthodontics, with no formal education at all. I just started doing it and would ask him questions and he would help me out. But when I got to the point where I needed to do some case finishing and actually idealize the bite and deband these people, they weren't coming out as good as I wanted them to. At that point I realized that I didn't have enough education. I started looking around and eventually found Progressive. I had taken a couple courses previously. Progressive wasn't the first course I took, but it was the last course that I took.
ANDI: And you took the course 30 years ago almost?
DR. VIVIANO: Almost 30 years ago.
ANDI: Okay, tell me about some of the early days at Progressive Ortho.
DR. VIVIANO: Some of the early days, well I was in a course called San Francisco #2, which was the third course that Don actually taught, and he would fly up for the weekend from here and we would meet at the Embassy Suites in South San Francisco. There was about 40 of us and what I remember mostly was the lack of all of the technical tools that we have now like the computer and those types of things to help us do the diagnosis. We didn't have any of those in the day. When we wanted to do a ceph tracing, we did a ceph tracing with a pen, a protractor, enormous ephah, a lightbox and some acetate paper, so it was somewhat archaic compared to what we do now. And then since I've been doing it for so long that question could just kind of go on and on. As the years went by obviously things got better and better and more technical until now today we've got the SmileStream software which is just fantastic and it will do so many things for you.
ANDI: No more protractors?
DR. VIVIANO: No more protractors. So I joke with the students a lot about in my day, like I'm the old guy that's on the block but it's kind of somewhat true because everything was by hand. We didn't even do model measures back in those days. That concept didn't even exist. Even when we started doing model measures, what we used to do is put the models on a scanner and once again take our protractor and draw our lines and do our model measure that way, so it was very hands-on back in those days.
ANDI: And one of the things that makes you unique in our group of POS instructors is the business of orthodontics class that you teach. It's now currently being offered online at SmileStream. What can you say about that class that would be helpful for current students or our graduates at POS?
DR. VIVIANO: One of the things that happens when you when you first decide to go into learning orthodontics or adding orthodontics into a GP practice is you are more focused on the mechanics. You're more focused on how do I put on the brackets, how do I put on the bands, how do I move these teeth around and then of course we have the software so you're learning some software as well. You tend to forget that that's only a small part of actually incorporating orthodontics into your office. The way that I say it is all of the other stuff that goes along with incorporating ortho into your office is what's going to slow you down. When you start to get slowed down, when you start to get to the point where you're not doing as many cases because your office is not running properly and integrating ortho. You don't do as many cases and the whole thing just kind of starts to slow down, not so much fall apart, but just it's not as productive as it could be or should be. What I did with this class is I tried to think of all of the aides, the tips, the helpful hints, the methods, the forms, pretty much everything that I could think of that I have either done myself or gotten from other instructors, or developed and kind of put them into one place outside of the mechanics so that you and your staff, because the staff is super important. Your assistants and your front desk are super important in the process because they're the first people that the patients are going meet anyway. So I tried to put all this into one particular spot called The Business of Ortho. You can go online and check it out before you decide to do anything with it. But I think the next question you're going to have for me is what is actually in it so I'll kind of wait on that.
ANDI: Yeah, well that was my next question. What's in the class and how would that benefit current students? What tips or tricks do you have to help them seamlessly integrate ortho into their practice?
DR. VIVIANO: Well like I said, I tried to think of, and this is not just sitting down for a few hours and trying to put together something, it's something that you gather over time and that has helped you out in your office and that when you sit down with a meeting of your own staff they think that these methods are helpful. So there's a long list of things that we try to do, but just to give you an example of a few of them. There's a section where we talk about how to structure your office software for proper orthodontic billing. Orthodontic billing is different than regular dental billing. It's an insurance as well so there's a section that works with your software and how to set it up so that you're more productive and it's easier for you to kind of keep track of these ortho patients. Then another thing that I think that they're going to find super helpful is I took every orthodontic procedure, and every procedure that was even semi related to ortho that you might be doing and we completely prefilled out the ADA claim forms with all of the numbers and everything so that all you have to do is literally put your patients name on that form and send it in. We also did that with the medical insurance which most offices don't do, but you can actually bill medical insurance for your temporomandibular joint issues, your sleep apnea, and if you can do Botox, or if you're doing Botox for migraine or TMD you can bill that via medical. So there's a section on billing all those things to medical and also the same thing we pre-made out the forms for you so that all you have to do is put your patient's name on there and you can send it in. I put in example narratives on first consults and what your assistant should say when they're asked questions by the patients and especially what your hygienists should be doing and should be saying so that they're talking to patients about ortho and they're finding ortho for you so that it makes it super easy for you when you go in. The patients are almost already kind of, for lack of a better term, pre-sold on the need for ortho or what ortho can do for them. There's a lot of other things in there but the last thing that I did when I was thinking about this was it's all fine and good to have this in one spot where you can actually give it to your staff and work with your staff, but what happens if you had any questions? What happens if you needed any help? What happens if you need anything like that, so what I did with the course is I added 30 days of phone or email consultation where either the dentist or any of his staff members, from front desk to assistants to hygienists, they can call my office and if they're having any problems we'll walk them through the process. If they're having a problem filling out a form, if they're having a problem with even really mechanics, whatever it takes to walk them through any of the difficulties that they're having, we'll do that.
ANDI: That's really helpful.
DR. VIVIANO: You know we'll see. We'll see how much time it takes me to do that or my staff so we'll see.
ANDI: Yeah, from my perspective talking to our students and our graduates every day on the phone, those are some of the big questions that we get that isn't really covered in the regular series. So it's great that you have this class to help them figure out the rest of the aspects of ortho that aren't strictly mechanics or finishing. I think that's going to be really helpful.
DR. VIVIANO: Yes, I'm hoping. I'm really hoping.
ANDI: Absolutely. Well thank you so much for your time today. Thank you guys for watching. If you're interested in that Business of Ortho class you can find it on SmileStream.
