Business Unusual

Neal D. Kravitz, DDS, MS, tends to bite off a lot of work during his 6-day workweek, but he can chew it comfortably. Combining the latest technology with a distinctly old-school dedication to hard work has allowed Kravitz to regularly pull in almost 700 starts per year to his two offices in South Riding, Va, and White Plains, Md.

With many clinicians dialing down to 4 or even 3 days per week, the energetic Kravitz has no interest in following suit. Busy adults seeking treatment, and parents who want their children to miss fewer school hours, have responded and made Kravitz Orthodontics a thriving practice. “The biggest difference is our availability,” says Kravitz, who sees around 85 patients per day during appointments that range from early morning to as late as 8 at night. “One model is that you work Monday to Wednesday, or Monday to Thursday, from 9 to 4 or 10 to 4, and then you go golfing. That is not the model at our office. Our model is, ‘We are always there for you.’ “

Drawing Patients from All Over

South Riding and White Plains have relatively modest populations of 15,000 and 5,000, respectively, but Kravitz’s added availability serves to attract out-of-town patients who bypass local practitioners to nab those coveted Saturday time slots. The office motto is enshrined on a sign in the waiting room and says simply: “Our time is not more important than yours.” A line underneath the sentence could easily read: And we mean it.

Before school, before work, late evenings, and weekends are all fair game for appointments, and all patients have Kravitz’s cell phone number for urgent matters. If a patient has a wire poking him and is leaving on vacation the next day, a quick meeting will resolve the matter. It’s not surprising that word of this exceptional service has spread quickly. “We get people from all over the state of Virginia, and outside the state,” says Kravitz, whose South Riding office attracts the majority of his patients. “If you don’t have to miss work, and you can come in on a Saturday, you are happy with that. If your child does not have to miss school, except for long appointments, again all the better. I have changed the equation, and now you don’t need to have a doctor that is close to you.”

When asked how he manages to take a vacation, Kravitz chuckles and acknowledges that he gets the question a lot from parents who are often in awe of his work ethic. The short answer is that vacations are an undeniable rarity if you intend to run two successful offices. While other businesses are struggling, the Columbia-educated Kravitz takes pride in making the office payroll, and far from laying people off, has given raises for exceptional work.

Parents are able to see this work firsthand, thanks to an office design that goes beyond the open-bay setup now found in many modern offices. Kravitz’s office is open in the sense that everything can be seen from the waiting room. “I am proud of my standards of care, and parents can watch us work, similar to an open kitchen at a restaurant,” Kravitz says. “Parents are appreciative that they are able to watch their child from the waiting room, or come back into the treatment bay and sit next to their child during the procedure. We do also have two private rooms for our adults and for children who need a quiet space.”

The office as a whole is centered on a classroom, with two half-circle consulting rooms separated by an accordion door that opens to create a large learning center. Kravitz uses the space for in-house lecturing to doctors for CE credits, hosting PTA meetings, or providing community service events such as the biannual CPR certification for South Riding parents and adolescents.

Kravitz admits that the open design puts additional pressure on him and his staff to be perfect in every appointment. However, he welcomes the attention and takes pride in the details. Kravitz is fond of saying, “When you are great, everything matters.” The theme runs throughout the practice, with the tone set by Kravitz and his trusty office manager, Theresa Balintfy. Balintfy is the business coordinator and crucial patient liaison whose primary function is case acceptance and financial supervision.

Balintfy and Kravitz meet each morning to review daily and monthly goals, as well as to discuss individual patients who are in treatment or have had recent consultations. “The manager and I know at every moment of every day our daily goals, daily expenses, growth, and overhead,” Kravitz says. “Balintfy is without a doubt the vena cava. It is because of meticulous organization that we are able to hire the best possible staff, provide the highest quality service at an affordable fee, and use the best possible materials.”

Kravitz and his office manager, Theresa Balintfy, meet each morning to review daily and monthly goals.

Ahead of the Curve, Behind the Teeth

Going a step beyond aesthetic ceramic braces, Kravitz prefers iBraces from 3M Unitek. While he also uses Invisalign, he believes that clear aligners are best suited for minor malocclusions.

At Kravitz Orthodontics, the behind-the-teeth custom iBraces—desired by patients and occasionally feared by orthodontists—are far more than a sideshow. Instead, Kravitz says he completes more lingual cases than any orthodontist in the country.

Becoming proficient at the lingual way of doing things took 6 to 9 months for Kravitz and his staff members, a process that involved new ways of working and different expectations. “The ergonomics eventually get a lot easier, but it does take time, because it really is a different technique,” Kravitz explains. “You are dealing with different products, and there are different expectations as to how teeth will move.”

For adults who would rather not advertise their orthodontic treatment and/or choose not to wear removable aligners, the lingual option has been tremendously successful. “We really wanted to invest ourselves in a treatment that had the invisibility of clear aligners, but would not compromise the quality of results,” Kravitz says. “We can do lingual braces now and get fantastic results in a completely invisible way.”

Kravitz further explains that lingual braces involve a different bracket with different subtleties. For example, on a regular buccal bracket, the wire goes in horizontally on the x axis, and right into the slot. The wire for lingual braces seats vertically in the anterior teeth. “The benefit of the iBraces is that you have a custom wire with a custom bracket, which is very closely adherent to the tooth,” Kravitz says. “The wire incorporates all the prescribed tooth movements, so you really have the invisibility of no braces, even more so than the Invisalign, because there is nothing on the outside of the teeth. You essentially have the custom brackets of Insignia [Ormco] with the customized wires of SureSmile [OraMetrix], which really allows for efficient treatment.”

The familiar worries about eating, speaking, and keeping lingual appliances clean have not been a serious problem for patients at Kravitz Orthodontics, a fact attributable to a thorough educational effort on the part of staff members. Kravitz has used iBraces to successfully treat public speakers, professional athletes, cheerleaders, musicians, and television anchors—all without problems. Even adults with a past history of mild to severe periodontal disease have done well.

Lingual appointments typically are a little bit longer than their labial counterparts, but Kravitz says all of those challenges get easier with time and experience. Long procedures, such as bondings, debondings, and appliance insertions, are typically scheduled for 7 AM to 2 PM, while staff members ensure that most shorter appointments take place in the afternoon and evenings.

With some patients coming from as far as 3 to 5 hours away, completing multiple tasks is essential. Far from simply “getting through the day’s schedule,” Kravitz believes in doing more at each visit to reduce the overall number of patient visits. “If a patient comes in with a broken bracket, we perform all necessary repositions at that time,” Kravitz says. “If a patient has a wire poke or loose wire, we take care of the next appointment when possible. And not all orthodontic malocclusions are created equal. More challenging occlusions, or poorly compliant patients, are seen in the morning for longer appointments.”

The field of computer-aided design/computer-aided manufacturing (CAD/CAM) has revolutionized orthodontics, and Kravitz is convinced this evolution will only continue. With all the specialized technology, Kravitz still keeps costs down with efficient office processes and sheer volume. “Lingual braces may be a little bit more expensive,” Kravitz acknowledges. “However, at our office, because of our expertise and our large number of lingual braces, we actually keep our fees low and accept all insurances. Our lingual fees are comparable to many orthodontists’ labial fees.”

Always Teaching

As a faculty member at the University of Maryland and Washington Hospital Center, and a regular on the speaking circuit, Kravitz enjoys teaching, an endeavor he loves almost as much as being in the clinic. “When I am out there teaching, I am smiling from ear to ear,” says Kravitz, who shares his wisdom all over the country and occasionally outside of it. “There may certainly be a time to travel more, when certain things are in order, but right now teaching is the theme of my life. As orthodontists, we are constantly teaching and guiding our patients.”

When he teaches, Kravitz emphasizes that orthodontics is no place for rigid beliefs. “Orthodontics is a religion, and many orthodontists believe that if you don’t share their religion you are doing it wrong,” muses Kravitz with tongue firmly in cheek. “A lot of orthodontists are creatures of habit, and it is the reason that some are still using braces from the 1970s. I believe you must commit yourself to staying at the forefront. That is why I continue to teach, read, and learn.

“I am constantly being asked to beta test, and just because you test something does not mean you have to like everything or use everything,” continues Kravitz, who usually teaches twice per month at orthodontic residencies, study clubs, or society meetings. “There are many times during the day where I may pull out one of those tricks that are oldies but goodies, but you can’t fall into a comfort zone. You can’t shy away from advancements in the field. Everything we do is evidence-based, and we incorporate advancements immediately.”

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Greg Thompson is a contributing writer for Orthodontic Products. For more information, contact