Too often a dentist, impatient to begin treatment, fails to stress the importance of the patient consulting a specialist. For instance, dentists often do not emphasize the functional objectives of tooth repositioning, and consequently may not motivate patients to seek orthodontic treatment that might prevent bone loss later in life.

In most instances when there are difficult spaces to restore, even a minor orthodontic intervention can make a tremendous difference in the final result. It is important to let the patient know what options he or she has and the degree of excellence that could be obtained with or without orthodontic treatment.

The next most important specialty to consider is periodontics. The control and correction of bone loss that could complicate the diagnosis or compromise the treatment results are obvious reasons to refer to a periodontist. In addition, the patient’s soft tissue needs to be observed during maximum smiling. Could tissue repositioning help create a more favorable tooth size relative to the patient’s face or smile? Would ridge augmentation help make a more realistic result? These, plus other questions regarding where and what type of margins to create are typical problems that could be more successfully solved with the aid of a periodontist skilled in cosmetic surgical techniques.

When there are questionable areas regarding periapical pathology, such as in teeth with deep, old restorations or periapical thickening, an endodontic consultation is in order. Previously placed ill- fitting crowns or endodontically questionable teeth could also seriously compromise the esthetic results unless you treat these areas, if necessary, before you begin.

Finally, oral surgery must be considered when facial deformities could also complicate maximum esthetic results. This may mean scheduling a consultation with a plastic surgeon as well.
The best way to communicate the advantages of obtaining specialty consultations is to let your patient know that you work with an excellent team consisting of orthodontists, periodontists, plastic surgeons, endodontists, and oral surgeons, and that your interest is in obtaining the best possible result based on their desires or preconceived images. You also need to stress that you are treating him or her as a whole person, not just treating the teeth. Finally, make sure you help your patient visualize the various options available.

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