Smartphone-based orthodontic monitoring: the big brother in our patient’s mouth

by Domenico Dalessandri, DDS, MS, PhD

Screen Shot 2016-03-11 at 11.06.09 AMNowadays almost all of us have a smartphone and we use it hundreds of times during the day checking incoming e-mails, surfing through the web and sharing our thoughts and pictures online within our social communities. This is the “permanently online” era and our patients ask for immediate information supply and assistance request satisfaction.

Since sometime orthodontists have used text messaging apps like WeChat or WhatsApp to communicate with their patients, to remind them the next visit, to solve an emergency or replying to a late doubt, or even checking the oral hygiene status or the cooperation level with removable appliances. There is a growing evidence in the literature showing the efficacy of these “App based” monitoring protocols in ameliorating oral hygiene and reducing treatment duration, bracket bond failure, and failed or late attendance [1-2].

Commercial interest regarding patient monitoring has also increased progressively and nowadays there are few apps especially designed for this purpose. In all these systems the orthodontist has his own dashboard on reserved area in the company website that can be used to invite patients to download the app in their smartphones and to visualize their smile pictures.

SmileTrackerTM (TP Orthodontics) also allows visualizing a time-lapse video, based on daily pictures taken by the patient during the monitoring, of the treatment progress. Furthermore this app has a rewards-based system in order to keep patients engaged throughout the monitoring and it also allows them to share their progresses through their own social profiles.

Dental Monitoring® allows patients to take smile pictures every 2 weeks in case of fixed orthodontic treatment or even every week for invisible aligners treatments. Doctors can also ask for a supplementary exam whenever they want, sending through their personal homepage a specific invitation that is forwarded by e-mail to the patient. This system requires doctors to send patient dental impressions before monitoring begins, because it utilizes a specific algorithm that allows calculating teeth movements based on pictures 3D matching and superimposition on the initial virtual models. For this reason patients are required to take 13 pictures for each exam from different angulations focusing on both single arches and on their position in occlusion. Three more pictures are required for patients treated with invisible aligners, in order to check each single aligner fit. This system, apart from calculating through the algorithm tooth by tooth displacement as mesial/distal, intrusion/extrusion, retraction/advancement, rotation, inclination and angulation variations, provides pictures observation by an orthodontist that looks at oral hygiene level, aligners fitting, possible presence of teeth abrasion, decays or brackets failure, sending a warning to the treating orthodontist in case of any unexpected event.

Could these systems become important tools allowing us to improve our treatments efficiency and quality? Is it credible that “virtual” appointments could in some occasions substitute the traditional “physical” appointments? Will our patients be available to be continuously controlled by this orthodontic “big brother”?

It is hard to foresee the future. The possibility for patients, especially if they live far from the orthodontic office, to save time and money by reducing the number of visits having the same, or even a better, accuracy in treatment progress control, can be universally recognized as positive factors fostering the diffusion of these systems.

Are we ready for this further step forward along the digitalization path of our beloved orthodontic specialty?

1: Zotti F, Dalessandri D, Salgarello S, Piancino M, Bonetti S, Visconti L, Paganelli C. Usefulness of an app in improving oral hygiene compliance in adolescent orthodontic patients. Angle Orthod. 2016;86:101-7.

2: Li X, Xu ZR, Tang N, Ye C, Zhu XL, Zhou T, Zhao ZH. Effect of intervention using a messaging app on compliance and duration of treatment in orthodontic patients. Clin Oral Investig. 2015 Dec 2. [Epub ahead of print]

Domenico Dalessandri qualified in Dentistry from the University of Brescia, Italy, where he received specialty training in Orthodontics. He obtained his PhD from the University of Torino discussing a thesis entitled “Cone Beam Computed Tomography: accuracy and reliability”. He received a research fellowship in “CBCT applications in Orthodontics” by the University of Trieste. Currently he is Adjunct Assistant Professor at the University of Brescia.

He has additional clinical research interests in: indirect bonding; self-ligating braces; use of mini implants and miniscrews; lingual orthodontics; Invisalign; cleft lip and palate; impacted teeth; 3D technology and virtual treatment planning; CAD-CAM; corticotomy and piezocision.

Simplifying Management of Satellite Offices

By Matthew Larson, DDS, MS

Matt LarsonIn the current economy, satellite offices are frequently utilized by orthodontists to increase their area of draw and patient base. Most orthodontists and consultants feel that the additional income offsets the additional overhead expense, but managing multiple office locations clearly requires more effort than maintaining only one location. However, current technology has helped make managing multiple locations easier. One dramatic example that most orthodontists now utilize is electronic charting, so that patient information is easily available at all office locations. Here are a few other tips and tricks to consider:

  • Centralized/Cloud-Based Documents: Most offices ensure that all patient information in their practice management software is either on a centralized server or cloud-based, but many offices are not as attentive to all of their supporting documents. Your satellite office should be able to run exactly like your primary office if desired. It is relatively easy with current technology to ensure all computers have access to centralized training manuals, patient handouts, and current projects. More limited access can be setup for the doctor and select staff to access more confidential information. Multiple methods can be used to achieve this, such as a shortcut to a shared document folder on the server (if a terminal server is used at the satellite office) or online cloud-based storage such as iCloud, Google Drive, or Dropbox. Please note that iCloud and Dropbox are not HIPAA compliant and Google Drive requires some adjustments to be HIPPA compliant, so these are not ideal solutions for PHI. The goal is that each practice location should have electronic resources in the same location for easy reference and there should be little to no effort to keep them synchronized.
  • Mileage tracking mobile apps: Deducting business mileage or tracking business miles on the company vehicle can provide a nice tax savings, but maintaining an accurate ledger to satisfy the IRS can be difficult. Multiple mobile apps are available to help keep an accurate log of business miles, such as Mileage Log+, MileagePad, Auto Miles, and Triplog. Some apps will automatically track when you are driving and then miles can be categorized later. Most allow you to export spreadsheets or expense reports for a nice end-of-year summary. Prices are generally under $10.
  • Remote locks and thermostats: I may be slightly biased since our practice is located in Wisconsin, but having a remote thermostat to ensure that heat is turned down when we are not at our office and that the office is warm when we arrive really helps staff morale at the start of the day! Also, there are coded locks available for your front door that allow you to remotely issue one-time use codes for contractors to access the building. Multiple permanent codes can also be set, which allows you to monitor who is entering your office. For example, cleaning staff can be given a unique code so you are aware of when they are onsite. These generally are a few hundred dollars to install, but avoiding extra trips to let in contractors or paying for additional heating/cooling bills can make it worth the expense.
  • Phone lines: Phone systems are a much larger topic, but it is worth at least briefly mentioning that having lines ring at only one location and going to voicemail if they are not answered is outdated. For offices with multiple locations, some type of VOIP system should be strongly considered, which allow lines to be answered and transferred independent of geography. Even with a traditional phone system, look into the additional features offered by the phone company. Generally, lines can be forwarded on certain days of the week and calls that are not answered in a certain amount of time can be forwarded to the other office (assuming the other office is staffed).

Overall, managing a satellite office can be less stressful using current technology, but some effort must be spent up front to design the correct systems and to implement them.

Is Your Website Mobile-Friendly?

Author: Dr. William D. Engilman

Mobile computing promises to change everything for consumers, from the way we pay our bills to the way we shop, plan, and commute. The wide array of mobile communications devices and the latest new mobile applications mean that it’s imperative for orthodontists to make sure their websites are ready for mobile devices.
Making Your Way on the Mobile Web
The mobile Web is here to stay. In the same way you look to the Web for valuable services, you also need to provide value for your potential customers.  Do you know how your existing website displays a mobile browser?  If not, you might be in for an unpleasant surprise! 
The mobile-friendliness of your Web page can either move you up or down in the mobile search engine rankings when people look for your services (but not necessarily you specifically) using a mobile browser.  Mobile browsers don’t always handle JavaScript, Flash or even cascaded style sheets (CSS) correctly. Sometimes they don’t handle them at all.

If your website has a lot of Flash animations, or makes heavy use of CSS, understand that the mobile user won’t find these helpful or attractive. In fact, these elements could actually drive mobile users away from your business.

You don’t have to redesign your website completely to accommodate mobile users, but rest assured, some changes are in order! Your web server can deliver information to your visitors based on how they view your site. Make a simple modification that allows your Web server to detect a mobile or traditional browser, and the server can issue one layout for visitors with desktop computers, and another layout for users with smartphones.

If you manage your own Web site, and you’re good with HTML and basic computer programming, you can modify your existing site relatively painlessly by setting up a “mirror” domain for mobile users, and adding a little bit of code on your main site that detects and responds to the type of browser a request for information is coming from.

If you have someone else design your website, let them know that you want to make your site mobile-friendly. These modifications are simple, and can even be tailored to deliver content to specific mobile devices if you want to add that level of detail. If this sounds complicated and/or expensive, here’s the best part: it’s not.

This small change will both improve your mobile search engine rankings and your customer service deliver at the same time.

Don’t dismiss your search engine position as unimportant. When someone is looking for a local orthodontist, you have a much better chance of making contact with the searcher if your practice is listed on the first page of the search engine results. Only dedicated searchers reach the second page of search results, and virtually no one at all sees Page 3.  If you’re listed on Page 4 of the local search results, new patients who are actively looking for your services will only see your competitors.

A mobile friendly website will be a big help to the mother who’s looking for your office phone number while she’s driving, or the new patient who’s not sure how to find your office.  It also preserves the function of your Web site for the user whose browser is prepared to take it all in.

What goes into making a mobile friendly page?  Mobile browsers are big on simplicity, so standard HTML and plain text are king. Forget long URLs, JavaScript, Flash animations, anchored images, scripts and all of the other things you may have added to your site to make it eye-catching.  Smartphones have decent data rates – 1 Mb/s or better, but a graphics-intensive Web site will deliver a quick beatdown to a mobile browser.

So, is your page mobile-friendly? The World Wide Web Consortium (W3C)’s mobileOK Checker will assess your website and tell you just how mobile-friendly your Web site really is (or isn’t). Visit:

Enter your website’s URL and the mobileOK Checker will rate your site in terms of critical, severe, medium and low failures in specific categories. The mobileOK Checker looks for standard HTML, page size, how much network support a visitor needs to view your page, and mobile-friendly page design.

If you’re worried that your site won’t look good after making these changes, think about this: mobile users (who use very small display screens) prefer fast, accurate information over aesthetics every time. Simple sites decrease the mobile browser’s download time and improve the mobile user’s experience.  In the end, meeting the user’s needs is what it’s all about.