Bill Klaproth: This is OMS Voices, an AAOMS podcast. I’m Bill Klaproth, and with me is Dr. Jim Baker, who is here to discuss the OMS and the orthodontist working together for the patient. Dr. Baker, thank you so much for being here. 

Dr. James Baker: Thanks for having me.

Bill Klaproth: Yeah, it’s great to see you. So, what is the relationship between AAOMS and an orthodontist? 

Dr. James Baker: Well, the orthodontist is the absolute expert in how to align the teeth and how to use the teeth to develop the facial structures, particularly in growing children. And the oral surgeon, or OMS, is the expert in how to align the patient’s bones and do various things surgically to help the orthodontists get a better result. People need to breathe, they need to chew, they need to talk. And so, working together, they can achieve a better result. 

Bill Klaproth: I was just going to say, so it sounds like that relationship is common and needed – the OMS and the orthodontist who often work hand in hand. 

Dr. James Baker: Communication is a huge part of that. Yes, we do. 

Bill Klaproth: All right, that sounds great. So then, can you tell us more about how a tooth extraction performed by an OMS would aid then in orthodontic treatment? 

Dr. James Baker: The common reason a tooth is removed is in cases of extreme crowding. The orthodontists like to start when the patients are young; they can do a lot to develop space. But occasionally the jaws are just inadequate to hold the teeth. And in those cases, they selectively remove a tooth to create space so that the whole thing can be unraveled and fit nicely. 

Bill Klaproth: Is that then where the orthodontist would refer to you to extract the tooth and then back to the orthodontist for the alignment or the straightening of the teeth or the following procedure? 

Dr. James Baker: That’s correct. The maintenance and the enclosure of that space is obviously a critically important thing to get that great smile. 

Bill Klaproth: So again, that relationship between the OMS and the orthodontist is very important. I would imagine then you do create relationships with orthodontists because there is this back and forth with patients all the time. 

Dr. James Baker: That is greatly to the patient’s benefit. 

Bill Klaproth: Absolutely. So, exposure and bond is a common procedure performed for orthodontic treatment. Can you explain to us what this procedure is? 

Dr. James Baker: So, you have a permanent tooth that doesn’t come in. In the beginning of my practice, it was almost always a canine tooth or cuspid in the upper jaw, which is the third tooth from the middle. And basically, the oral surgeon goes under the gum tissue, perhaps removes a little bone if there’s some over the tooth, and glues the orthodontic bracket to the tooth. And then you attach some type of device down to the braces that runs under the tissue, and the orthodontist pulls on that to bring the tooth in. 

Bill Klaproth: Does the OMS get involved in that? 

Dr. James Baker: Yes. The OMS does the surgical part, which is to go under the tissue, find the tooth, put the bracket on, and run the little attachment down to the orthodontic bracket. 

Bill Klaproth: For the orthodontist then to grab onto it. 

Dr. James Baker: In a certain direction and pull it gradually into the mouth. 

Bill Klaproth: OK. So then there are temporary anchorage devices, or TADs, and those are occasionally used for a short time during orthodontic treatment. Can you explain to us what those are? 

Dr. James Baker: TAD can be a very simple device. Think of it as a small screw that goes into the bone and provides extra – what the orthodontist calls – anchorage. The way they move teeth is they use other teeth to provide anchorage, or a solid spot, to move the other teeth. So if they need to pull teeth in a direction that they can’t achieve with the other teeth, then you have these small bone screws you can put in, and they attach various things to that to move the teeth. 

Bill Klaproth: Right, got it. So then how long does it take to perform a procedure to place a TAD? 

Dr. James Baker: A simple bone screw, five minutes, and a little numbing. The patients don’t require pain medicine. They really don’t require general anesthetic. It can be a more complicated process, which isn’t used a lot. But they make specific bone plates that can be placed to do really serious movement of sections of the teeth. 

Bill Klaproth: Right. So after the movement of the tooth is achieved, does the patient go back to you then to remove the TAD? 

Dr. James Baker: Yes. And it’s just a small tooth or screw removal device. Think of it as something very specific for that device. 

Bill Klaproth: So then you will remove that TAD and then... 

Dr. James Baker: Perhaps not even need numbing. They just come right out. 

Bill Klaproth: You basically just unscrew it then. Got it. So then, how does an OMS assist the orthodontist with questions related to pathology? Can you tell us about that?

Dr. James Baker: That’s a relatively new – within the last 10 years – thing that’s become much simpler. In the old days, you had to get together once every two or three weeks, look at X-rays, look at photographs. Now with the advent of digital everything, you can securely email radiographs, 3D images, photographs. So when the orthodontist sees something unusual or out of the ordinary, they can contact the oral surgeon. And we call it a curbside consult. It’s just, “Hey, what do you think about this?” And it’s all done, as I said, of necessity very securely with the medical records. 

Bill Klaproth: So this speeds up the process, then. 

Dr. James Baker: Yes, and it is very common now. 

Bill Klaproth: Which is a great benefit for the patient. 

Dr. James Baker: Commonly saves them a trip to the oral surgeon’s office. 

Bill Klaproth: Yeah. So, you were mentioning earlier about sending a child to the orthodontist. What age should a child see an orthodontist to begin care? 

Dr. James Baker: They like to screen them when they’re about 7 (years old), when there’s a mixture of still baby teeth and permanent teeth, and they can see if things are going to come in correctly. They can do a lot of things to prevent, for instance, an upper jaw cuspid from being impacted that would have been otherwise. So they like to see them at 7. It doesn’t mean anything’s going to happen. And then they will put them in what they call a recall system, where they see them every six months to a year, depending on how complex a situation they’re looking at. 

Bill Klaproth: Would you as an OMS then be called in if there is a situation that needs repair or some type of a procedure? Do you often see children 7, 8, 9, 10 years of age? 

Dr. James Baker: We do. And we have the anesthetic skill to manage those children, which is the other mission-critical part of that. 

Bill Klaproth: That is a very big part of it as well. So if something isn’t coming in right, that’s when you could be called in to remove something or place a TAD, so they can make sure that it’s coming in correctly. They’ll leverage the other teeth. Is that right? 

Dr. James Baker: Or there’s a lot of pathology in that age group. Just simple things. They’re not cancerous, but they’re things that will destroy the jaw or mutilate teeth. So you can intervene before those things get large and take care of them. 

Bill Klaproth: Yeah. So when it comes to numbing or localized numbing anesthesia, as you said before, I imagine that is a big concern for parents of any age child. 

Dr. James Baker: It’s a big concern. There are great oral pre-medication agents that you can either use to place numbing or commonly used to get an IV started so that you can put them to sleep. And we do perform general anesthesia on children in the office routinely. And that’s a specific care. 

Bill Klaproth: Absolutely. Well, Dr. Baker, thank you so much for your time. As we talk about the OMS and the orthodontist working together for the patient, is there anything else you want to add? 

Dr. James Baker: No, that was very concise and a good list of questions. 

Bill Klaproth: And I love it. And Dr. Baker, let me know that his wife is an orthodontist. You really are an expert. So, you really live this. 

Dr. James Baker: We do live this; our dinner conversations are incredibly boring. 

Bill Klaproth: Oh, my goodness. Well, Dr. Baker, thank you so much for your time. We appreciate it. 

Dr. James Baker: All right. Thanks for having me. 

Bill Klaproth: You bet. Once again, that is Dr. Jim Baker. And for more information and the full podcast library, please visit MyOMS.org. And if you found this podcast helpful, please share it on your social channels. We would appreciate that. And don’t forget to subscribe. 

Thanks for listening.