by Rich Smith

D. Douglas Depew, DMD, MS, takes a hands-on approach to training assistants, whether human or canine

D. Douglas Depew, DMD, MS, takes a hands-on approach to training assistants, whether human or canine

Orthodontics has a lot going for it as a health care specialty. Compelling science, great technology, an enviably high rate of successful outcomes. But, as D. Douglas Depew, DMD, MS, points out, orthodontics is virtually the only field in which it is the norm to find clinical assistants performing essential treatment tasks without benefit of formal training.

Happily, that is changing. In more and more orthodontic offices across the country, assistants have taken and passed a course that equips them with the proper skills and knowledge about working in patients’ mouths. The course is offered via the Internet and at physical locations by the Academy of Orthodontic Assisting (AOA), the brainchild of Kennesaw, Ga, orthodontist Depew.

“The profession’s enthusiastic response to the Academy and what it offers tells me this is something that should have been put in place a lot sooner,” Depew says.

Met His Own Training Needs

Depew developed the AOA’s courseware in the mid-1990s to address his own employee-training needs.

“My practice had been growing at a clip of 30% a year for several years straight and I was hiring left and right, but was having an almost impossible time recruiting experienced assistants,” he remembers. “That put me in the position of having to train people from scratch, which was extremely time-consuming, frustrating, and usually not particularly effective. So, out of necessity, I sat down and tried to figure out an organized, efficient manner of training new hires.”



Depew Orthodontics


Kennesaw, Ga


D. Douglas Depew, DMD, MS



Years in practice:


Patients per day:


Starts per year:


Days worked per week:


Office square footage:

3,900 Depew Orthodontics; 1,300 AOA

Some 18 months later, a curriculum emerged that included study materials, audiovisuals, and—naturally—tests. Depew says, “It covered all the skills and knowledge necessary for someone to become a confident, motivated, valued orthodontic assistant.” His staff certainly thought this to be the case after completing the course. Buoyed by that initial success, Depew then offered the course to job-seekers and employees of other orthodontists in the area. The hearty response to that offer soon led him to obtain from the state of Georgia a certificate naming his fledgling AOA as a licensed private vocational school. In the summer of 1998, the first official class consisted of just three trainees. By 2001, some 200 individuals had graduated from the Academy. “Currently, we have hundreds of online enrollees in 12 countries. Since the AOA opened its doors, we’ve trained and awarded certificates to more than 1,200 graduates,” Depew says.

The AOA program—which later would garner the coveted endorsement of the AAO—started as a purely classroom-based program. Every Friday morning for 8 weeks, enrollees assembled at Depew’s practice to hear him or another instructor lecture, then spent the afternoon performing orthodontic work on specially designed dental mannequins, other students, and even real patients. Shortly thereafter, the course was enhanced for use in six other states and, more recently, adapted for the Internet. Additionally, an optional 2-day, hands-on course is offered at different locations across the country (St Louis University in Missouri and the University of Washington in Seattle have been among the recent hosts). In New Zealand and in the Australian state of Victoria, the hands-on course and the online program are required by law.

Depew’s Brace Bus picks up patients from their schools.

Experiments with Innovation

The AOA is a separate venture from Depew’s practice, yet the two are inextricably linked. “A nice thing about the relationship my practice has with the AOA is that I get first crack at the best students when I need to fill a vacancy on my staff,” he says. Depew serves as the AOA’s curriculum developer and chief spokesman, while day-to-day management is handled by a dedicated, full-time staff of three. Instruction is delivered by a team of assistants who work in other orthodontic practices.

Depew, who has been in practice for 18 years, differentiates his operation from other practices in the area by emphasizing his ready embrace of the latest techniques and appliances, especially those that maximize productivity and help keep costs down.

“I’m not afraid to experiment with innovation,” he says. “Innovations don’t always work out, but many times they do. A good example of innovation that has worked out is the side-delivery chair system. We used to have rear-delivery chairs. But by changing to side-delivery chairs, our access to instruments and supplies is much more efficient. It also helps us avoid back pain and back injury by eliminating that extreme twisting motion you have to do in order to reach things when they’re behind you.”

Academic Requirements

Prospective enrollees learn about the AOA through magazine advertising and trade-show marketing, but mostly through word-of-mouth networking, according to Depew.

And once they are made aware, the first question they ask is how much does it cost to enroll? Depew says that an individual can take the online version of the course for $1,200. Orthodontists, on the other hand, can save money by taking a subscription for $1,800, which then entitles as many as 12 members of a staff to unlimited online access.

Individuals new to orthodontic assisting often take several months to complete the course, while experienced assistants can wrap it up in a matter of a few weeks, Depew reports. “There are 14 online lessons, and they are based on the textbook I wrote for the program,” he says.

The title of the textbook is Orthodontic Assisting: Technique and Theory. Its lesson topics are the following: Oral and Dental Anatomy, What is Orthodontics, the Orthodontic Appliance, Archwire Selection, Headgears and Elastics, Secondary Appliances, Application of Orthodontic Appliances, Braces Removal and Positioning Retention, Diagnostic Records, Radiation and X-ray Safety, Orthodontic Models, Patient Management, Infection Control, and Professionalism in Orthodontics.

Depew indicates that a test is given at the end of each lesson. Enrollees must score a minimum of 75% to pass the course—an accomplishment that is formalized with the conferring of a certificate of completion.

AOA’s latest offering, Depews adds, is that, “As part of this year’s AAO (and hopefully future ones) we will be conducting several hands-on courses geared at improving clinical skills of orthodontic assistants. These will be similar in content to the 2-day hands-on course, but in a different and expanded format. Participants will be able to choose from among 13 hour-long exercises offered multiple times a day. We’re excited to be participating in this much-needed part of the annual meeting.”

For more information about these courses, see the AOA’s Web site at


Another example of beneficial innovation adopted by Depew is the iBraces appliance system. “We’re the first and biggest Georgia practice to be using iBraces,” he says. “We like iBraces because they are imperceptible like Invisalign, only more versatile. They’re also custom-made, which results in more efficient treatment, and glued to the lingual surface of the teeth.”

Efficiency is the name of the game in a busy practice like Depew’s. So is quality. Patient satisfaction, too. For those reasons, he has been building toward being a 100% digital office. “We’re almost fully there right now,” he says. “We’ve got digital pictures, digital x-rays, digital models, electronic charting, electronic scheduling. The only thing we can’t yet do is create and send e-mails to referring doctors right at chairside, but we’re expected to go live with that later this year.”

Got a Claw Deal

Viewed from the street, Depew’s office (which he owns) looks like a home. He designed it that way to give the place an inviting face and a nurturing appeal. Over the clinic area is a residential-style vaulted ceiling, which makes the eight-chair open bay seem especially open. Video monitors and game consoles for the kids are everywhere except in the basement, where Depew has set up a retainer-making lab plus a conference room and a generously sized staff lounge.

Despite all these outward signs of a vibrant practice, Depew did not always dream of a career in orthodontics. In his teens, he wanted to be a veterinarian, having grown up on a farm with animals all around. He even took pre-vet courses at the University of Georgia (from where he graduated magna cum laude in 1984).

For Depew, being a pet doctor would have been the cat’s meow—were it not for the fact that Depew discovered an aversion to cats’ meows while working a summer job in a vet clinic. Or, more accurately, it was an aversion to the nasty tempers that emerge in even the sweetest of kitties when the anesthesia wears off. Says Depew, “I’ve still got a few scars to prove it.” His career aspirations turned to dentistry and, in particular, orthodontics after sizing up the lifestyles and happiness quotient of a couple of family friends who practiced the specialty. “I definitely wanted to do something in the health professions, and orthodontics seemed like the best of all worlds,” he says.

Depew got his dental degree from the Medical College of Georgia, finishing at the top of his class in 1988. From there, he was accepted into Baylor University’s College of Dentistry for orthodontic residency training. He completed that program in 1990 and immediately entered private practice by purchasing the five-office orthodontic business of a doctor in Georgia’s Cobb County. Before a year had gone by, Depew divested himself of three of those offices. “They were really just the corners of offices occupied by dentists,” he says. “Sharing space with dentists was workable, but it did not fit well with the image I wanted to portray for my practice.” In 1995, Depew consolidated the operations of his remaining two locations within the four walls of his newly constructed building that looks like a house and has been the practice’s home ever since.

Depew is a big supporter of Canine Companions for Independence.

No Foaling Around

Even though his plans for a veterinary career ended up being tossed, Depew’s fondness for animals is as strong as ever. He and his staff are big supporters of Canine Companions for Independence, a nonprofit organization in Santa Rosa, Calif, that trains dogs to perform simple but important tasks such as opening cabinet doors or turning on lights for people with developmental or physical disabilities.

“I love dogs to begin with,” he says. “But it was Linda Reese, my partner in the AOA, who brought this group to my attention and suggested it was something we ought to get behind. At Canine Companions, they start training the dogs from the time they’re puppies, then carefully match them up with humans in need. The neat thing is that the people who receive the dogs are not asked to pay for them, which is remarkable because these are extremely valuable animals, given what they’ve been trained to do.”

Lately, Depew has increased his level of support for Canine Companions to include donating a portion of the proceeds from this year’s sales and engaging in cross-promotions. “If you think about it, what they do at Canine Companions is analogous to what we do at the AOA, so I’m understandably eager to help out,” he says.

Away from practice, Depew is an avid equestrian. He owns a 40-acre spread occupied by his half-dozen quarter horses. “My wife Vicki and I love to ride,” he says. (Vicki Depew, by the way, works in the practice with him as payroll manager. The couple have three children: Andrew, 21; Ashley, 18; and Ryan, 17.) “After a tough day in the office, nothing relaxes and refreshes the mind like saddling up and hitting the trail, getting close to nature on the back of a horse.” Depew tries to work things so that he can ride about twice per week. In the back of his mind is the notion that he would someday like to breed, train, and show horses for performance competitions known as cutting and reining. “We’ve already raised and trained three foals from one of our mares, bred to a cutting champion,” he says.

The Bus Stops Here

Being a friend of animals earns Depew Orthodontics a great deal of praise in the community, as does the practice’s reputation for things like on-time scheduling, computerized patient education, and excellent relationships with parents and patients. Helping strengthen those relationships is an unswerving devotion to customer convenience, as embodied by a service known as the Brace Bus.

The Brace Bus is a 2007 Hummer H2 sports utility vehicle, with chromed mag wheels and tinted windows plus a full package of extras, including LCD video screens and game consoles for the passengers, and an exterior emblazoned with graphics. Its purpose in life is to travel to local schools and pick up kids for their appointments at Depew Orthodontics.

The Brace Bus—driven by a nonclinical member of the staff whose only job is to pick up and drop off patients—is used by about 10 patients daily. The Brace Bus stops at specific schools on specific days, schools that have granted to Depew Orthodontics permission to make these pick-ups.

“This is a service genuinely appreciated by both the parents and the schools,” Depew explains. “Kennesaw is a suburb of Atlanta. Many parents who live here work in downtown Atlanta. For them, getting back here to pick up their child at school for an orthodontic appointment is a real hassle. The Brace Bus is meant to save parents from having to make that trip.

“And the schools like this service because we see to it that the kids are returned to their classes promptly—usually sooner than if the parents take them back. That’s because, typically, the parent who picks up their child from school for an orthodontic appointment will take him or her out to lunch afterward, go do errands or get in some shopping, and not make it back to school before the end of the school day.”

Young patients who take the Brace Bus are given appointments for the morning hours, when the schedule is often lightest. “The Brace Bus is a great way to fill those empty morning appointment slots,” Depew says.

Practice Builder

Unfortunately, the Hummer came with an unquenchable thirst for gasoline and, at today’s pump prices, it costs a pretty penny to drive. Compounding matters, Depew charges nothing for the pick-up service. Still, by at least one measure, the Brace Bus is anything but a financial burden. “The marketing value of it is enormous,” Depew asserts. “It’s a huge practice builder. First, it satisfies patients and parents, which encourages them to speak highly of us to their friends and relatives. Second, the Brace Bus helps generate new patients because it’s a mobile Depew Orthodontics billboard. With gigantic Depew decals all over it, you cannot possibly miss this thing heading on down the street. We get a fair share of inquiries just from people in other cars driving alongside us.”

In its own way, the AOA is a practice-builder too—and not only for Depew. “Many doctors who require their employees to take the AOA course insist they do so during the first few months after hiring, the probationary period,” he says. “They make retention as an employee contingent on passing the course before the end of their probationary period. In that way, the course serves as an excellent screening tool to help ensure that the people who are hired are motivated and fast learners. You can’t have a great practice without employees possessing those traits.”

Depew reveals that his ultimate goal with the AOA is to “develop a standard level of training that all orthodontic assistants will have in order to be able to work in the mouth. That’s going to be important not only for the sake of building and preserving consumer confidence in orthodontics generally but important specifically from the standpoint of the professionalism of the individual practice.”

Rich Smith is a contributing writer for Orthodontic Products. For more information, contact