A Boutique Practice Offering an At-Home Concierge and Retainers for Life

Alison Werner:              Welcome to the Orthodontic Products Podcast on the MEDQOR Podcast Network. I’m Alison Werner, your host, and chief editor of Orthodontic Products. My guest today is Dr. Deborah Solomon, an orthodontist in private practice with offices in Beverly Hills and Los Angeles. She has built a boutique practice that includes an at-home concierge service, and recently she implemented a Retainers for Life program in her practice. To learn more, I wanted to speak to her. Dr. Solomon, thank you for joining me.

Dr. Deborah Sol…:         Thank you for having me.

Alison Werner:              Well, let’s get started. I was reading your bio, and you actually spent the first part of your career as an active duty general dentist with the US Air Force, and then went on to do your specialty training in orthodontics. What did you take away from starting your dental career with the military?

Dr. Deborah Sol…:         I learned that you can go to work and have a ton of fun.

Alison Werner:              Excellent.

Dr. Deborah Sol…:         Yeah. One of the biggest takeaway I would say was the lessons that we learned from the officer training school, that’s where we learned how to delegate tasks and become actual real officers. And so, the best I would say was the obstacle courses and the solving exercises. Basically, one time I was in charge of guiding and safely transporting an injured soldier across the obstacles. We had to make sure to avoid certain really high electrical wires and bodies of water that were supposedly poisonous. It was so much fun. We had to guide 12 of us across the big thick wall. And so it was all about trying to think logically under high stress situations. And honestly, I think I implement it almost every single day at the office. It was a really good way to start my dental career. It was really fun.

Dr. Deborah Sol…:         The other thing I would say is, you are held at a really high standard clinically. At least our colonel, the chief of the squadron, was all about excellence in everything we do. And so we always made sure to go above and beyond. And always think of, what are ways to make things better? And never just accept status quo because that’s how we’ve always done it. It’s always try and get better. And I’ve implemented it ever since. Sometimes subconsciously. And then looking back, you were telling me about my career and I’m like, you know what, I actually do use it every day.

Alison Werner:              Was it always your goal to be a member of the military and to go to dental school, or did one happen first?

Dr. Deborah Sol…:         Not at all. I didn’t even know there was such a thing as the scholarship with the military, I knew nothing about soldiers in Army, or any of that. I grew up in France. I happened to be an American citizen born abroad, and so my mom is the American one in the story. And so when I came to dental school, this friend of mine was like, “Hey, there’s a fair for us. Why don’t we go downstairs and check it out?” And we went downstairs. And then she knew about the Air Force a little bit, so she started talking to the guy and asking all the right questions. I was just sitting next to the side. I’m like, I don’t know why I’m looking at someone with military outfit like this. I don’t know what’s going on. This is crazy. And then as he was explaining it, I was like, oh my God, this sounds amazing. And it’s been the gift that never stopped giving to me. It’s been an incredible journey.

Alison Werner:              Yeah. Do you feel like it set you up really well for when you made that transition to go to your specialty in orthodontics and then to set up your own practice?

Dr. Deborah Sol…:         Everything lined up perfectly. My father always jokes. He’s like, “You have more luck than brains.” This is insane how it all worked out so beautifully. Nothing was planned. I just go with the flow and it just works out.

Alison Werner:              What drew you to orthodontics? Because you did spend several years as a general dentist there?

Dr. Deborah Sol…:         Well, I think I had a little crush on my orthodontist growing up. And then all the girls in the office were just so fun, high energy. They always had a smile on their face, and they loved their work. That that’s how, at least, it seemed to me. And so I was like, hey, this is an amazing job. You get to make people beautiful and you get to have fun with it. And so in the back of my mind, it was always like, hey, why don’t I do that too? Then I started going to dental school and I’m presented with all this new information. Because I had zero dental background. My father’s not a dentist, my mother’s not. And then I was like, “I don’t know. I do like a lot of the crown press, and I love extractions.”

Dr. Deborah Sol…:         And I’m like, “Oh, I’m not sure.” It’s a big jump to just stick with one path. I like the variety of general dentistry and all that. But then in the military I really was like, okay, I need to be amazing at everything I do, and this is too much. So if I could just focus on something that I would truly love and do my whole in it, then I feel like I can do it better. So I decided to specialize.

Alison Werner:              Okay. You have offices in Los Angeles and Beverly Hills, and you have your own practice, Smile Health Orthodontics. What was the journey to setting up your own practice?

Dr. Deborah Sol…:         Same thing, I just go with the flow. I always had in the back of my mind, hey, maybe one day I’ll open my office. It was never, I have to open for sure. It was just like, oh, we’ll see how it goes. Let’s see how life is. I really liked my job at corporate. Great team, really good TC, excellent managers, good patients overall. Just really, really nice. But then COVID happened and I had too much time on my hand. So I decided, maybe I should do that. Because I had had to stay home for a month. And to me, that’s an incredible amount of time. And so I was like, you know what, I think maybe now was the time. And so I slowly put things together, and I had all that time. And so it just happened to be beautiful. Not a lot of thought, but I just go with the flow.

Alison Werner:              Did you buy an existing practice or were you an associate in a practice, or did you just start from scratch? You started from scratch.

Dr. Deborah Sol…:         From scratch. Completely. Yeah.

Alison Werner:              Which office came first, the Los Angeles one or the Beverly Hills one? I know they’re close together geographic.

Dr. Deborah Sol…:         Yeah. The Beverly Hills was the first one. There was this general dentist that was looking for… He’s a little bit on the older side, and so there was space for me. He’s like, “Hey, I have this open bay. I’m more than happy for you to get started there.” He was actually so gracious that he didn’t even want to accept rent until I actually got my first patient. So that was really nice of him. It really helped a lot, especially when you don’t know what you’re doing. You’re like, ah, what’s going on? And so I was very lucky to have that opportunity. And he saw my work, he saw what I could produce, and he started referring the patients that were in his practice. And then it really gave me the confidence that, okay, I can do it on my own.

Dr. Deborah Sol…:         Yes, I’m going to hire a treatment coordinator and all that. So believe it or not, my mother-in-law was my first TC. And my front desk and my everything. And then we had to hire an assistant, and then slowly I hired a treatment coordinator. And just everything fell together beautifully. It’s a work in progress, so every day we try to improve. But now we have a really nice group of people, and we love seeing our patients, and it’s just really nice. One of our patients found us through insurance, and so their pediatric dentist saw our work, because we were doing Brava by Brius, the ones on the lingual that’s pretty much… Really, it’s exactly what it says. It’s literally cutting the treatment time in half. And so he saw that work and he was shocked how we were able to correct that class two in 10 months. He had a massive full step class two.

Dr. Deborah Sol…:         And from day one we threw in the rubber band, he wore them like a champion. The teeth aligned beautifully. And so he was so impressed that he was like, “Hey, why don’t you join me? I expanded my office. I have three operatories. Why don’t you come with me to this Los Angeles location?” And they’re only 12 minutes away, but it’s so convenient to be located inside the pediatric office because the kids just go get a cleaning, come back to us to put the wire back on and all that. So now we have two locations.

Alison Werner:              Excellent. Well, as I mentioned in my intro, your practice includes an at-home concierge service. What does that involve, and why did you decide to build that out as an offering to your patients?

Dr. Deborah Sol…:         It all started during COVID. And so at some point… In Beverly Hills they were much stricter than in Los Angeles, and so we couldn’t practice in the Beverly Hills location. But all the Los Angeles locations, the dentists were able to see their patients, and the orthodontists kept seeing their patients. And so I was like, you know what? I have the iTero Flex, I’m totally movable. I also had the free dental unit that you could just carry in that suitcase. It’s pretty heavy, but it’s totally doable. You just have to make sure to go to the gym and work on those biceps.

Dr. Deborah Sol…:         But yeah, I’m fully portable. And so for these patients that were nervous to come to the office, and a lot of our concierge service patients are either immunocompromised patients or patients that have a lot of anxiety and they didn’t have a good experience for some reason in the past in a dental office. And so me and my assistant come. We don’t bring too many people, just two of us. We don’t wear an actual white lab coat or anything like that, we wear colorful disposable PPE. And we make it fun. And it’s a conversation that starts on the couch. And then once they’re comfortable, we start doing the iTero scan, talk to the whole family. Both parents are here or a sibling, and we start with a casual conversation. And then slowly, slowly, as the trust builds up, they’re in the comfort of their home. We go forward in doing the exam and seeing what options are best for them.

Alison Werner:              And then do you do their follow-up visits at home too, or are you also using remote monitoring as well?

Dr. Deborah Sol…:         It depends. The ones that sign up for the full concierge treatment for their entire treatment, we come to the follow-up at their house. But for the ones that choose to just do the consultation at home and then finish at the office, because now the trust was built, then they follow us at the office. The office is fun. The pediatric office, the way it’s set up, it has a princess room and there’s a LEGO room, and then there’s a travel room with a giant map of the world. It’s really cute. And even our adult patients love it. It’s fun.

Alison Werner:              Yeah. Well, because I haven’t come across that many orthodontists doing at home concierge, how does that look in terms of your schedule? And then, do you bill patients differently for that concierge service than you would in the practice?

Dr. Deborah Sol…:         Definitely. The concierge service is very, very expensive. The way you set it up, you have to make sure that when you close the office, the potential of revenue that you could have made during that period of time, it has to make sense. And so it’s really expensive. We do accept PPO insurance, so that helps cover a little bit, but it’s just definitely on the higher end. It has to make sense. Most Fridays I don’t like to work, I like to start the weekend early. And so those Fridays we can schedule the at-home visit if we need to, and then we go from there. We always have the time that we can carve out. If they need a different day, we will make sure that we have a month ahead scheduled, and then the rest of the staff stays and does admin work and whatnot, and then me and one of the staff will go to the house.

Alison Werner:              Okay. Okay. And then you mentioned that you’re using the iTero Flex and you have the portable dental unit. Are there any other technologies or products that make this doable that you rely on?

Dr. Deborah Sol…:         The best is when we do the clear aligners, we literally just set up the attachments on the second appointment when we come in to deliver the aligners, and then we do dental monitoring. And so it really avoids a lot of us traveling all the way there. That has been really, really helpful. If you do concierge, you’ve got to go with dental monitoring. And if they do regular traditional braces, you just hope and pray that they don’t break a lot of brackets.

Alison Werner:              True. But that’s the case even if you’re not doing at home.

Dr. Deborah Sol…:         Yeah.

Alison Werner:              Okay. Now, you recently, and the reason you came to my attention, is I saw that you were offering your patients a Retainers for Life program. And I’ve come across other orthodontists who have done this, but why did you decide to offer this program in your practice?

Dr. Deborah Sol…:         Okay. To me, I feel like Retainer for Life is like an insurance on your retainers. I don’t love the permanent retainers. Because as we know, it’s only holding the anterior surfaces together, and so the posterior can collapse. And so to me, it’s a removable retainer. I also don’t like the perio, that could be sometimes an issue with difficulty flossing under the wire and all that stuff. I highly recommend a removable retainer. However, a lot of times pets will chew them, they will lose it. They’ll leave it in the car when it’s hot and it gets distorted. And so to me, it’s like even I lost a few retainers. And I am pretty good about it, but it was the cleaning lady’s fault. But life happens. It’s always the cleaning lady’s fault. [inaudible].

Dr. Deborah Sol…:         And so you really need to have a backup. And so to me it’s like, okay, the minute you lose your retainer, just give us a call. You paid for the Retainer for Life program, you get one free set every single year no matter what, for 15 years. And so I think money-wise, it’s 1000% worth it for the patients. I want to make it affordable where… Because I really believe in it, I think everyone should do it. But at the same time, it has to be affordable. We charge a $700 upfront when they sign in for their orthodontic treatment. If they opt out of it, it’s totally fine. At the end when we’re done and we’re getting ready to deliver the first set of retainers, we offer them the option to sign up for it, but now it’ll be double the price. And so it’ll be 1,400.

Dr. Deborah Sol…:         Still an amazing value. You get one free set of clear retainers every single year for the next 15 years. If it happens to break more than once a year, they have a $50 copay per aligner. But the beauty is that they get to keep their 3D digitally printed models. And so if they bring them, get extra points. Because I don’t know if you’ve seen on our website, we launched recently the Patient Rewards Hub. And so we give patients points for brushing, for showing up to the appointment, for leaving Google reviews or Yelp reviews. And so we reward every positive behavior that we want them to do. Parents love it. They get to wear these rubber bands without having to fight with them. The kids are super into it.

Dr. Deborah Sol…:         And I have awesome stuff that for some reason they know exactly what the kids like. So they’re like, “Yeah, you need to start with LEGO.” They’re like, “Yeah, you need the mixes,” or something. I don’t even know what that is. And I guess Barbie dolls are still in style. It’s just nice. And when they come into the office, it’s like a big display in the front, behind the front desk they see a ton of toys and fun things. And I think it helps to bring in patients as well. It’s a win-win all around.

Alison Werner:              Yeah. With the Retainers for Life program, what is some of the specifics of implementing a program like that? Did anything change in your workflow? Or you mentioned the cost aspect, but was there anything else for you or staff?

Dr. Deborah Sol…:         Super easy. Treatment coordinators comes in, talks about the treatment options that they have available, and goes over the cost, down payment, monthly payments. We offer all that stuff. And then before they agree with everything that they decide to do, she presents the lifetime retainers. Because no patient starts treatment without understanding that you need to do retainers after. In my office we tell all our patients, first six months after treatment is done, the bone is still pliable. And so you could get relapse unless you wear the retainers all day, all night, except for eating and brushing. After the first six months, it’s okay to just wear it at night usually, but we’ll let them know when they’re actually ready to switch to just nighttime only. And so we explain how important it is to do retainers for life. And then once they know that, a lot of them buy into the program.

Alison Werner:              Yeah, I would imagine after that investment in orthodontic [inaudible]… It was actually interesting, I was talking to someone through work, and she mentioned that her 20-year-old daughter just paid for her own Invisalign after having brace… Or she had braces as a child, never wore her retainer. And now as an adult she’s having to pay for her own orthodontic treatment. And I said to her, I was like, “Well, make sure she wears that retainer.” She’s like, “Oh, she’s never not going to wear it.” Because now it’s her responsibility, and she saw that she wasted that money that her parents paid.

Dr. Deborah Sol…:         Yeah. And I think that’s a great way to present it to kids. Like, hey, now it’s time to be a grownup. You tried your little experiment without wearing retainers and look what happened.

Alison Werner:              Absolutely. Absolutely. You actually offer this program to patients who have completed treatment with another orthodontist. Why was that important to you to do?

Dr. Deborah Sol…:         I just feel everyone should have the opportunity to sign up for this insurance. It’s an amazing thing. And then for us as a practice, it just makes sense. Because they’ll see our practice, they’ll see how cool we are and the quality of treatment, and the different programs that we offer. Maybe they have a kid, maybe they have a cousin that they can refer to. So for us it’s a no-brainer.

Alison Werner:              Great. Okay. Switching gears a little bit, you talk a little bit about how you’re using the Brius. What new clinical technologies have you found most impactful? And if you want to talk more about that, or if there’s something else that you’ve found really interesting for yourself.

Dr. Deborah Sol…:         When I grew up… No, I’m kidding. In residency all we knew was Invisalign. And it’s a great company. I love their ClinChecks and all that stuff. I still work with them. I worked with 3M, and then I started working with uLab. And for me, uLab was a game changer because you get to do some trials, and so you don’t pay for the entire full session or anything like that. If you want, you could do just one or two, or whatever you want to do. You can set up your own case yourself. And that freedom, to me, was a game changer. And that’s why I really like submitting to uLab. For me, technology, that was really good. Brava by Brius, it’s such a genius. Dr. Mehdi is unbelievable. It’s an amazing appliance. It definitely can use some improvement, and I think they’re working on making it a little bit more comfortable for the patient.

Dr. Deborah Sol…:         But I’ve seen tremendous cases in my own practice with my own hands. It was unbelievable. The only thing you have to be ready for is just, kind of like aligners, you have to coach the patient and educate them and explain to them what’s going on in their mouth. And support them. Give them some peroxyl rinse, give them the little ortho dot, and whatever it takes to make their journey more tolerable and more enjoyable. I love offering the Propel. Oh my gosh, this has been a game changer for us. As soon as we started it, most of our patients on clear liners use it. And it just works. Whoever’s on Propel is just much more effective treatment for them. To me, Propel was a game changer. What else have we done?

Dr. Deborah Sol…:         And trials, we do the trials, it’s amazing. Parents come, because now we’re in the pediatric office a lot. And so these little kids come in, some of their teeth, their hygiene is not great. They’re not understanding that they really have to floss every night. And parents that have multiple kids, it’s difficult to really be on top of the hygiene for every kid. And so we offer them the options to do clear liners or to do traditional braces with an RPE. And parents don’t know if the kid is going to be good. And I have a five-year-old, honestly, every day I’m like, oh, this is something new I didn’t know about you. Or, you are [inaudible] so responsible, or you’re not so responsible. And so we give them the option to do a trial of a clear aligner that’s passive. We do it at cost because we have the 3D printer, the SprintRay. And so they can pick it up a day later or the next day.

Dr. Deborah Sol…:         And then we call the parents the following… Sometimes just three days, sometimes a week later and we’ll say, “Hey, how is so-and-so doing with the aligners? Are they losing it, or are they able to leave it on their teeth?” And based on the parents, most of the time they say, “Hey, he’s actually doing amazing and I’m shocked.” And so we go ahead and order a few aligners from uLab that actually have a prescription in them. We do four or five of them, and then we check them in the office. If the teeth are progressing well, we ask the kid again how he’s doing. If it’s good, then we order the whole case. If it’s not good, they have the option to switch to traditional braces, and that’s great. The other technology that we’re actually about to start using is LightForce. We’re going to bond a patient I think this week, and I’m really excited about it. I only heard good things about it, so I’ll let you know.

Alison Werner:              Great. Revisit. When you’re evaluating a technology or a clinical product, what goes into your decision-making?

Dr. Deborah Sol…:         I always imagine myself as the patient myself. And just meeting so many patients. At this point I’ve met, I don’t know, thousands and thousands of patients by now. And so just knowing how they try to decide which appliance is right for them and how they would feel the most. I feel if I was a patient, and let’s say the most important thing was to finish treatment in four months because I’m getting married in five months, then I want to have that available. And so Brava by Brius was offering that and it actually worked. They made it really accessible for me to try it. They were like, “Hey, we’re going to give you these three packages.” These three cases, packages. It was years ago. It was like two years ago I think. I don’t know when they came to the office. And so I was like, you know what, I’ll try it. Let’s see what happens.

Dr. Deborah Sol…:         And so I tried my two, three cases, and it was amazing. I was like, all right, I’m all in. And so then we offered it to pretty much whichever patient we thought was a good fit for them. Same thing with clear aligners. We offer everyone now a trial, because I feel like it really helps them with the decision-making. They’re like, “Hey, let’s try it. You have nothing to lose.” And then if not, then we switch to something more comfortable. I feel like as a patient I want to have all these options available, and so I’m able to provide it. Awesome.

Alison Werner:              With the trial that you’re offering patients, is that for both children and adults? If adults wanted to try it out and see how they would do?

Dr. Deborah Sol…:         First it was just for children. And then we realized, hey, why don’t we offer that to adults as well? And it just helps making the decision faster. It’s better for us.

Alison Werner:              That’s great. Yeah, I can imagine. Okay, as we talked about before, you practice in Los Angeles and have offices there and in Beverly Hills. And as you said, they’re about 12 minutes apart. I live in Los Angeles too, so I’m very familiar with the fact it’s a very saturated market. What has been key for you for carving out a niche for yourself?

Dr. Deborah Sol…:         It’s super saturated. And honestly, you just have to work really hard as far as referrals. And you have to have the budget to spend for marketing. It’s just no way around it. You have to play the Google game. You just have to constantly… But really, the bottom line is you have to provide excellent care and an excellent experience. If you do that, they will refer their friends, they will start their other kids there, and they will follow you. The way it happened with me, we offered the Brava by Brius, which is a new technology. A lot of orthodontists are afraid of change and they don’t like to change the flow of the clinic and all that. And I’m okay with risks and seeing where things are going. And so you just have to really find a way to differentiate yourself, a way to offer as many options as you can. And not just be like, oh, no, you can only do it with traditional braces.

Dr. Deborah Sol…:         Do you know how many times I heard patients come in, they went to another orthodontist and they told them, oh, I’m not a good candidate for clear liners? And then I finish their treatment in 12 months. Yes, it looked super scary. Yes, we had to explain to them they have to wear it all the time. But it works. If the patient is good and you teach them well, you coach them well, it works. You’ve got to put in the work, you’ve got to educate them, and then you’ll see amazing results. The Propel really helps as well. And CE is so important, continuing education. And so in one of these CE courses, this French dentist that I… Because I grew up in France, so I was like, oh, I really liked listening to him. He was saying that he had his patients eat with the aligners on, for those teeth that are really rotated in everything.

Dr. Deborah Sol…:         At first I was like, he’s completely nuts, what they do in France. Thank God I went to school in the US. But then I was like, you know what, one of these patients had a really severely rotated pre-molar. And I didn’t do traditional segmental in the back first. And as I’m looking at his tooth, I’m like, oh, how is it going to start rotating? Is it actually going to do it or not? And so I mentioned to him, “Hey, why don’t you start eating with it on, but promise me as soon as you’re done eating you go brush your teeth, brush the aligner to make sure you don’t get calcification or cavities.”

Dr. Deborah Sol…:         And then he did that and he actually loved eating with it on, believe it or not. And so the tooth actually rotated and it was almost 90 degrees. Yeah. I’ve been telling patients that have very, very crowded teeth and a lot of rotation and everything. I’m like, “Hey, why don’t you try eating with them on, it’s going to help speed up the process.” And some of them are like, “Ew, no, I don’t like that sensation. I tried it, it’s horrible.” But some actually did, and the treatment goes really fast.

Alison Werner:              Okay. So that CE of learning from doctors in different areas and how they’re doing it really has an impact.

Dr. Deborah Sol…:         It really helps you get some pearls sometimes, and it just makes the whole difference for some of our patients.

Alison Werner:              What excites you about the future of orthodontics?

Dr. Deborah Sol…:         It’s going to be amazing. The way things are going, there’s so much room for improvement, but we’re working hard. I can see every day, you go on Facebook groups for ortho, you go on all these CE courses. And thank God my mentors and the orthodontists that are being recognized and speakers are super smart. I think we’re going to make leaps and bounds in ortho, and it’s just going to keep getting better and better.

Alison Werner:              Great. Well, Dr. Solomon, thank you so much for joining me today. It’s been a pleasure talking to you.

Dr. Deborah Sol…:         Same. Thank you. Have a wonderful day.

Alison Werner:              Great, thank you. And to our listeners, be sure to subscribe to the MEDQOR Podcast Network to catch up on the newest episode of Orthodontic Products Podcast. And to keep up with the latest industry news, visit orthodonticproductsonline.com. Until next time, take care.