Dr. Ting on How NOT to Get Fired by Your Ortho | JawCast #43
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- Опубліковано 6 сер 2024
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TiMe STamPs
0:00 Patient Doctor Etiquette+Problematic Patients
5:30 Warning signs for Orthodontists
6:58 Importance of Records+Nickel and Diming
12:50 Patients with A Lack of Respect
13:17 Why Ting doesn't like experimenting
14:40 Execution of the treatment
18:00 Stop Asking Questions+Trust Your Ortho
24:56 Not Responding to Long Emails+Losing Trust
28:40 Rons Red Flag Tax Clients
30:53 Never Burn Bridges
32:58 Patient Red Flag
33:35 Why Ting Stopped Taking Long Distance Patients
39:23 Transfering Ortho to Ortho
42:15 Having Respect+Getting The Boot
47:16 Gen Z More Disrespectful?
49:15 Leaving Bad Reviews
52:50 Weirdo Patients
55:39 !!! NO LOOKS MAXERS !!!
58:35 Airway already enough?
1:00:09 Are JawHacks patients problematic?
1:01:00 JawHacks Revolutionized The Ortho industry
1:04:34 Why Function should be priority over “Just straightening the teeth”+Patients cause the Change
1:05:15 Should you Fixate on The Side Effects of Expansion?
1:09:00 Expanding past 4-6 mm is murky water+Asymmetry
1:11:26 Mandibular advancement+MSDO
1:17:40 Problems with the Lack of Mandibular protraction options
1:21:50 When Extractions are necessary
1:23:40 Ting’s FME
1:28:00 Ting Failing to Split personal FME
1:32:00 Digital Work Changed the Minds of many people
1:33:06 Reviews
1:35:20 How To Be a Good Patient - Наука та технологія
The new JawHacks Discord is poppin off!! Join here: discord.gg/3WcG9caWAd
The link is broken already
I think I fixed it. Man, Discord links are a doozy.
Do you know any providers that do FME beside dr ting?
"stop asking questions + trust yout ortho" is the perfect way to end up with irreversible disabling health issues :)
Not if you're working with a JawHacks approved orthodontist.
Are there JawHacks approved Orthodontists in Germany? 😃
@@JawHacks This is a great sales line to prey on internet-poisoned people.
@@laughter95how is gaining more knowledge poisoning?
It's what happened to me!
I think the bottom line is we need more providers. Patients deserve value for their money too.
Yes, ultimately the law of supply and demand is governing this issue. And we have already seen top providers jack up costs due to increased work load of adult airway patients, especially internet weirdo ones like us.
Nope don’t agree with the Doctor. Patients have concerns and should not be dropped for questions.
Yeah this doctor is entitled af. Patients deserve to understand their treatment.
Also didn’t Ron say that you should always ask the MSE provider for their success rate?
@@PsychNautics Yes BEFORE the treatment starts.
Thanks for sharing your feelings. But if you want a doctor to treat you, you'll need to realize that their is a harsh reality beyond your feelings. That's the point of this video.
But the doctor (particularly a private one) does not owe you (legally) to help you if you ask impolitely. He can simply not take your money and drop you. Im sure if you ask nicely, and book consults and this and that they'd be happy to help.
Hey Ron. I've been to Dr ting for a consultation and so has my friend. He does not appreciate patients asking questions to be better informed. If you question his treatment plan, he gets mad. I simply asked him about facemask and he got extremely triggered. I was very respectful and did not push it further. I am now seeing Dr lipkin and ask him the same questions and he happily answers them.
What did you ask
Do you know any other providers that performs FME for sleep apnea?
How’s it going now? I’m from the same area and considering it
@@kanzaahmad5746 fme is a cookie cutter appliance. You want something customized for your own bone structure like a custom marpe
@@EZP2020 it’s going good. My sleep has improved by around 50%. I am probably going to get mma as well
If you can read between the lines, you can tell he's had plenty of patients who are unhappy with their results. Including me - I was a Ting patient and was unhappy with my result. He takes zero accountability and is trying to blame all his failures on his patients. He needs to grow up and take ownership.
What actually happened? Explain more cause I literally just saw him
@@luisislas2162update with you guys?
Yup. Same thing happened to me.
@@luisislas2162 I did MSE with surgical assist, and had serious complications, including damage to my nose and my occlusion. No improvement in my breathing but I needed follow up surgeries to address the complications. It was a nightmare
@@luisislas2162 I got MSE with Dr Ting and had serious complications which required additional surgeries to address. No improvement in my breathing.
Listening to this is so demoralising, as even the ‘good’ guys only want to treat the ignorant patients who just show up, shut and do what they’re told with a smile.
They just don’t want to be bombarded with a bunch of irrelevant questions.
Thanks again for all the MSE providers for doing their work.
Cool discussion. If you haven’t already, it would be cool to have a video on dental splints. There’s a lot of info/theories on the perfect bite supporting the maxilla and stopping it dropping. Preserves the cheek bone and forward growth, leading forward enough jaws to keep the air way open. That of course has its own downstream structural benefits.
Ron didn’t you say in previous videos that you should always ask the MSE provider for their success rate?
Haha yes, I am well aware of my role in contributing to this doctor/patient tension. And I want to help all to navigate through it too.
@@JawHacks Ron you’ve done nothing wrong
Love this channel
In terms of the primary focus of the video, I think that crazy unreasonable patients should definitely behave themselves and if they get fired, I don't really know what they expected. In terms of asking questions, maybe one too many questions, that is a bit of a grey area, especially when you are taking a lot of time from the office staff and orthodontist, and if you are asking very complicated questions. As a curious person myself, say I ask one question, am I lighting a fuse? If I ask two questions, is it going to cause an explosion? So it's like, I don't know what the solution is, in those situations it makes me wonder if better communication would prevent the bridge from burning.
________________________
Here's a personal story, if anyone is interested. I had an orthodontist in like, 2020, the plan was to have 8 of my teeth extracted, the idea was to pull the teeth inwards and then do an MMA for sleep apnea. Problem is, I could never breathe through my nose, my nose breathing got gradually worse as I got older and that seemed to coincide with my symptoms, and in my gut I felt like the problem was in the nose, which is why the first surgery I did was a nasal surgery, not understanding the actual problem, because the information simply did not exist at the time.
So given this backstory, around that time I saw Jawhacks and Dr. Ting's video on UA-cam. When I heard Dr. Ting explain about MSE, immediately I thought, this is it, this is the missing link, it all makes sense now. Of course back then, I knew nothing about evaluation, and evidently nobody else did either, at that time I did not know that my intermolar width was 30 mm, and I did not know that my aperture was 19 mm, the size of the average 3 year old. Anyway, my gut instinct knew this even though it was not measured, and so that is why it resonated. I didn't want to do an MMA if it was the wrong surgery, so I ended up becoming a very demanding patient all of a sudden. For me, I had recently become unable to work as the symptoms were too severe, later learning that I had moderate OSA (occlusion of the airway due to recessed jaws), as well as UARS (due to resistance/negative pressure, from the aperture and recessed jaws), however the airway resistance component I believe was causing the majority of symptoms. So, this wasn't a cosmetic thing, this was more like cancer like Dr. Ting described, at least for me, and so even though I would normally be a very normal, respectful patient, it was very important to me. I asked my Canadian surgeon and orthodontist at the time their thoughts on it, and they knew nothing about it, didn't think it would help with breathing, and didn't think that it was indicated, because my bite was okay. I looked to see, can I visit anyone in the USA to have this done, and due to COVID, I believed I could not, and really I am unsure whether it would have been successful anyway. So, I decided to go through with the treatment plan anyway.
Later on I think I had a point where I had some doubts and asked if my orthodontist would be willing to try the expansion if I could do it with a surgeon or something, and he said if I ever brought it up again he would fire me. Looking back, I wish I had let him fire me.
So later on I do the MMA, realize it didn't really help with the symptoms, still have brain fog, chronic headache, fatigue, orthostatic hypotension, cold hands/feet, etc. and I look into why that is and what went wrong in the evaluation, and I discover how abnormal my nasomaxillary complex is. So, that is the story of the undiagnosed severe transverse nasomaxillary hypoplasia. At this point my intermolar width is so narrow and my tongue so wide, that I cannot even fit my tongue between the molars, let alone on the roof of my palate. It is even causing me speech problems.
Well... here's hoping the FME outperforms the EASE and we can actually treat these breathing problems. Not just by one surgeon, but across the country for a reasonable price.
I have very similar symptoms to you, but what is an aperture?
@@lena990 The front of the nasal cavity that the expansion opens up. That's why expansion improves nasal breathing.
He is literally talking about cases of clear entitlement, verbal abuse and extreme demands, violation of their terms or lying. Patient's question are not the problem, he said that the problem comes in when patients ask the same question over and over, or question the treatment.
@@hkmorhsi I feel like some of these online people ask the same question over and over because of memory problems, but I don't know. I've run into a few people with questionionable mental capacity.
But I can't speak to the experiences of the office staff, I wasn't there, I can only speak to my experiences.
Thanks for sharing, and I hope you can continue to figure it out.
Can’t wait for Dr. GPT to decentralize medicine.
Way too stuck up.
Honestly yeah. It’s perfectly valid for a patient to vet a doctor and understand the treatment plan before starting treatments. Especially because many of these MSE patients got fucked over by orthodontists in the past which is why they’re even seeking treatment in first place.
Well you will have Dr. GPT quality and experience, good luck with that.
@@PsychNautics true, but it's not the random orthodontist's fault, I am pretty sure Ting and Ron are talking about more toxic and rude patients.
I'm sure software is going to do a great job installing a custom MARPE.
Thank you for opening up, both, and presenting your viewpoints :))
Asking questions and wanting to know more information before you decide to spend a lot of money is not unreasonable in my opinion. Especially when you get the run around form a variety of ¨specialists¨. It would be nice to have more compassion from these providers when we are dealing with a minefield of misinformation in a very high risk field. I´m hoping he´s referring to the most extreme cases and people are not satisfied no matter what you do.
This is helpful. I never know how to act in front of doctors. Sometimes I just ask questions because I think they expect me to... but that's like a few basic questions not this lol.
interesting choice of the term internet wierdo referring to those who request a specific treatment. i heard about this treatment from my friend, found your channel and got interested in the benefits, got a long distance consultation (because there are no local providers) who requested a sleep study and found that i actually have mild sleep apnea, now i am doing MSE to fix it. i guess it should have been more normal to randomly bump into this? you think the tooth fairy would have whispered something about it?
Relax, he needs to butter up Dr. Ting to get his exact thoughts out.
Don't get your panties in a bunch, I'm an internet weirdo too.
@guest3858 Did insurance cover your mse?
You are calling us Internet weirdos but in fact it's you who is educating us all. Yes, we are all paranoid because what the current orthodontics industry have done to us and is still doing to people like us (wisdom teeth mutilation). We want to be treated by the best doctors so we can function better and have better faces, is that wrong ? If asking questions is wrong isn't called being authoritarian taking advantage of the monopoly you have ? I understand being rude and having bad manners is a red flag but asking questions and clarifying the doubts beforehand in the consultation is never a bad idea.
Anyways, this video was useful as always. Thank you very much.
Glad you enjoyed it. Regarding internet weirdos, it takes one to know one 😇
Askin questions to clarify things politely is fine, especially in consults. Asking questions impolitely over the phone isn't fine.
@@nl5455 I Agree
Hey Ron. I wonder, does it make sense to book a chat with out when I live in Europe? I mean in regards to your contacts to the best doctors out there.
I kinda get what he’s saying but a good dr will always want their patients to ask questions
I’m sure he does get people acting inappropriate though
Thanks brother.
I think etiquette is key here, and the approach to etiquette is the line in the sand between a good patient and a problematic one, as opposed to patients entering potential treatment with ten tonne of their own research. Whether it was three different physios I had, one of whom had spoken with Mike yet saw no potential for myself in terms of mewing improvements, including the one I'm currently with, a tongue tie surgeon at my local general hospital who thought my narrow, asymmetrical, long face was totally fine because he possibly didn't have reference of orthotropic studies, a functional dentist using ALF who wholly dismissed Doctor Mew's offers to guide him through Biobloc but only ever gave his patients one routine example of an adult seeing progress, yet was confident in the ALF even in 24 year olds, I have had so many different experiences where each had their own degree of knowledge and opinion on things like mewing itself, success in adults, the need for a tongue tie, whether people just 'have' asymmetries or if they're an alert for a need for physical improvement.
At almost every stage of the way, until I realised I needed to keep to myself and quietly try to align the professional's abilities with my own goals, goals that might not be 100% understood or realised by said professional, I would have discussions that would end with myself not feeling as limited and at a dead end as the professionals thought. I can confidently say that I have been making skeletal improvements, even now when on the doorstep of 26, but this is only a recent occurrence for me, despite 3 years (since June 2020) of research, physiotherapy, attempted appliances and my own experimentation by myself. And it was all held up by a degree of polite disagreement on my end where I was following a personal intuition based on what I knew, say for example, Doctor Mew's many, many available teachings that, a professional, despite their lifetime of experience and study in their own field (say, orthodontics vs Orthotropics), might not know.
But never once was I rude, crass, dismissive or threatening, at most I'd simply walk away disagreeing with the conclusion I was offered, and continued in my pursuit for potential practice and approach that more aligned with my own rather optimistic goals. And that, whether it's in the improvement in my ability to swallow or breathe (thanks to strengthening the left side of my neck with my most recent physio in ways I wasn't able to realise with the first two) or a skeletal improvement in my palate and forward growth, I only achieved these things by politely finishing treatment if need be, or using treatment to my own ends, without kicking up a stink or looking for an endless argument with someone who hasn't yet had the proof that I might later be able to provide with their help, regardless of the difference in current opinion.
Very well said, thanks for sharing and best of luck with your health.
Hey I'm interested in talking to you about your experiences getting treatment. I'm having difficulty figuring out what treatment option to go foward with (I'm interested in biobloc as an adult but I might get mse if I cant find anybody or if its a better option).
What attempted appliances did you try by the way? Did you make a starecta splint?
i just wanted to add as someone who has had SFOT on my entire lower arch, it sounds worse than it is. My periodontist said its the easiest surgery he does. Took about 90 minutes, due to the tedious nature but recovery was unremarkable. Insurance covered most of it. Didn't miss a day of work. Its nothing like djs and much simpler than a marpe.
Thanks for sharing.
would hate to get canceled by my doctor, didn't even realize this was a possibility
Yeah, they are private practice owners. We are on their turf. It's important to remember that, and to keep the relationship positive.
Is there any providers Dr.ting recommends in the dfw Texas area. Every video I’ve seen staring him is amazing! Especially the older ones where he talked about correcting facial height! I just wish I knew someone near me who shares his philosophy and techniques. I desperately need an ortho who offers mse and will help me close my open bite while also correcting my lower jaw positioning!
I get the point of this discussion and don't necessarily disagree with the overall message. However, the "don't ask questions stfu and just do what I say" attitude is exactly why my jaw is fucked up.
Well some doctors are too stuck up, and some patients are too demanding or unstable, and make good doctors stress more when they are busy, as there is not many qualified MSE providers in the first place. Doctors also make very hard decision for our well being and make the experience as smooth as possible. They are also experts, even in new paradigms they still have extremely solid training and foundations to deal with, experienced ones like Ting or Newaz!
People that are not smart about their communication and appropriate engagement with their doctors, will make it worse for everyone else as stereotypes will arise. And ultimately, doctors have the ultimate say in it, although money is an incentive... it does not mean quality work or customer experience. People like Dr Ting should not be taken for granted! Nor should people informing us and keeping the dialogue going like Ron!
Thank you both.
Thank you for the thoughtful comment and kind words.
Ron, can Dr. Lipkin do an asymmetric expansion on purpose to correct a previous unilateral expansion?
Still a good jawcast, we get to know the mind of orthodontist. I think he's just your average orthodontist that treats people in a universal manner. Most clients expects an innovative orthodontist like a Liya Lipkin that can help with their bone development and breathing issues because those are real issues. Dr. Ting no disrespect but is going through the motions and making money which is fine. If you want a treatment from a doctor whose intentions isn't to make you look the way you want but get a treatment he thinks you should get then he's ok.
Does anyone know any other providers that offers FME?
1:09:50 can you explain what he meant when he said other suture seperation or fractures as a result of overexpansion?
Maybe he's referring to increased risk of asymmetry with over-expansion, idk.
@@shuikai272 he said that asymmetry is uncommon or rare in general though
Hi i have dental implant installates on lower 1st molar but now i need to expand lower jaw is it any way possible 😢😢😢😢😢😢 iwas so worried pls reply every one is saying after implant you can get expanderrrrr
At the time of releasing the video, I had the thought that Dr. Ting is rude, arrogant, entitled and with a huge god complex but now having consulted with several orthodontists , talking to many people and being more social in general I get where he's coming from.
He's talking about the people who are rude, arrogant, entitled and with a huge god complex not the general public. Most of you who whine and complain here (that includes me if you see my previous comment on this video) still needs to be mature about things and how the world functions in general.
Seems perfectly reasonable to me. Don’t be a dick, air out your questions in the consultation period, then choose to go ahead with the treatment or not and trust the doctor to see it through. Don’t do the treatment if you’re not confident or sure it’s exactly what you want/need.
Pretty good summary.
Hey Ron, my wisdom teeth are coming in pretty early, I’m 16. They haven’t notified me if they’re impacted or not, but if they are, I have heard of instances in which the wisdom teeth themselves correct their position. Should I get an MSE as a widening appliance or wait and see what will truly happen to those molars?
If you have crowding on your upper palate you should especially look into MSE. You could get MSE from a decent provider who also performs corticotomy on the midpalatal suture. It would be a way to increase your dental arch so there is enough space for your wisdom teeth, definitely avoid extractions, braces or any tooth-borne/non-miniscrew assisted rapid palatal expanders as you'll only damage your dental health and long-term health (especially if you do extractions). If you have done a recent dental x-ray you can look there to see if your wisdom teeth are impacted/in-general have enough space, if they're already impacted it would be difficult (albeit the best option) to save them. If they're not yet impacted and you expand you could probably make enough space just from transverse expansion. If they aren't impacted as seen from a dental x-ray and you don't have crowding on your upper palate and your family all have their wisdom teeth and didn't undergo extractions maybe your wisdom teeth have enough space for them as-is, is there any reason you assume they'll become impacted or don't have enough space?
@@user-03-gsa3 My dad still has his wisdom teeth, but my mom doesn’t. My palate isn’t exactly as big as I’d like it to be, there’s some small black triangles at the corner of my mouth when I smile. I had one tooth extraction when I was young. Mine are coming in pretty early so I suspected that they’ll probably be impacted, especially considering all the factors I listed before.
I would increase your bite force in anyway possible. That will keep your wisdom teeth from pushing against your other teeth
Hi jawHacks, I saw your videos about neck training. From what I know neck training can cause sleep apnea but I’m not sure why. Maybe because those who have been diagnosed with this do not mew 🤔 what do you think about that? Have you heard about neck training causing sleep apnea?
Neck training can cause sleep apnea in the same way obesity does. The thicker the neck (whether it's because of muscle or fat), the more It's likely to cause obstruction of the airways (especially when you're lying down on your back). If you have great facial development with jaws that grew forward at a nice angle around 90-110 degrees, then a thicker neck won't bother you unless you push it to the extremes. If you have bad facial development (jaws angled down, long face syndrome, recessed jaw, deviated septum, etc.), than you have to be careful.
yo i just called them yesterday !!
How did that go?
Dr. Ting is such a liar. I am suing him in small claims court because no, he doesn't give a refund when you fire him and transfer to a better doctor, like he claims @ 26:12 - PEOPLE! Save yourself the headache and choose someone better!
honestly just do it for your health and for your breathing and then accept the way you look from there, because no one is perfect.
totally agree w him not taking looksmaxxers. some of ppl have real function problems especially w sleep and need the already limited time these doctors have. the lookmaxxers need mental help
Re MSDO: a doctor should not impose his sense of aesthetic on his patients. If HE prefers long v shaped faces, its his right but its not legitimate to impose it on his patients
I mean that's his opinion, he's the professional after all. If he doesn't think it'll look good.. If you want to hire a doctor to try to help you with cosmetic goals, and you want somebody that just blindly agrees with whatever your opinion is whether it is right or wrong, personally I don't think that's a very good doctor. If you disagree, like okay, so now consult a few more for another opinion. If they all say the same thing, maybe they're right.
1 mm makes a huge difference. Imagine a 1 wide mm scar down your face, or 1 mm of eyeliner around your eyes, or 1 mm gaps between all your teeth. 🙄
These are horrible behavioral patterns from Dr Ting.
My theory on mandibular intermolar width right now (which could be wrong, it's a really complex topic) is thusly.
I believe there are 3 main variables that comprise the natural growth pattern for mandibular intermolar width.
1. Inclination of the teeth
2. Projection of the mandible (ANS/PNS, forward)
3. Width of the mandible, including TMJs
So, inclination, that is like, uprighting. Interesting thing to note, I looked at the inclination of mine, and the inclination of someone with a wide IMW (mine is not wide, mine is 26 mm), interestingly enough, my inclination is very tipped inwards whereas his was upright. So this seems to suggest that uprighting is following the natural growth pattern, and is "what should be done", if it's angled inwards like mine. I speculated I could get maybe 6 mm of widening by inclinating mine like his, so really that is quite a bit.
Projection, that can be like premolars and advance yes, but also, I believe something like the IMDO (that Dr. Paul does, but with that said, is this procedure good, can it be improved, I don't know, don't know much about it, because nobody even does it, just theoretically I think it follows the natural growth pattern better, you get more alveolar bone because of the intermolar aspect and distraction), the IMDO widens the intermolar width more than a BSSO I believe, because of the effect it has on the alveolar bone growth.
Width, appears to me that there is a variable factor for overall width of the entire mandible (including the joints), maybe the MSDO type surgery is natural too, I can't say for sure, but the width of the overall mandible including the joints does appear to be a variable in nature. So how do we replicate this in surgery? Midline and a TJR I guess? Hopefully we don't need to do that, I doubt anyone has ever even done it before.
So based on this theory, I think that the MSDO may be contrary to the natural growth pattern, and therefore a "bad practice" in human facial design?
For most people I don't see why you can't just upright the molars and expand a reasonable amount. If you're wanting 24 mm, 60 mm IMW, you want to break the record of widest jaw, then maybe you'll need to find some surgeon willing to do a TJR to widen that thing. Personally even if MSDO can be done to some degree, there's no way that it will yield the type of IMW increase that is needed for that type of expansion, right?? So then, you would need to widen the entire mandible including the TMJs, but good luck finding a surgeon who will do that.
Interesting take on this subject. Another thing I would like to point out regarding IMDO. So in one his videos, Paul discusses the reason for the underdeveloped mandible and how he sees the same shape and growth pattern in all his patients. That is the tongue being at the bottom. This results in the "V" like shape of the mandibular arch and outward inclination of the lower front teeth. In addition to performing outward tipping of the lower teeth as Dr. Ting mentions, such cases also require inward tipping of the lower front teeth from an AP standpoint because they are inclined outwards.
So this means that if we look at the patient from the side, their lower front teeth would be angled like this "/" but in reality they should be angled more like this "|"
The benefit of IMDO from what Paul says is that it actually widens the mandible as well as moving it more forward. I am unsure why everyone is so hesitant to talk about this procedure which could potentially result in a better outcome, be performed faster, and save the patient from undergoing any pre-molar extractions.
The most common issues with distraction osteogenesis for the mandible, according to oral surgeons, is that the results are unstable and it is less predictable. However, this is mostly referring to distraction as a whole and not specific to IMDO. I would love if Jawhacks could do some sort of video on this, bringing in some experienced oral surgeon and have them comment about IMDO, preferably tell them beforehand about the questions they will be asked so they do not give a generic answer of "I don't know what it is so I can't talk about it specifically" etc.
👏🏼
Dr. Ting is a brilliant person 👏
Thanks, JawHacks
How do y’all even live with an inter molar width of ~30mm? I have a 43mm and I still am having issues. God damn
Same