Q&A with Dr Geoffrey Hall

Interview with one of Australia’s leading educators of orthodontics – and die-hard advocate of imparting the lucrative trade to GPs.

By Danny Chan

One thing becomes clear when you speak to Dr Geoffrey Hall: he doesn’t mince his words. Especially when discussing issues close to his heart – like clinical orthodontics and orthodontic training – Dr Hall is not averse to making bold, and even controversial, claims. 

The Specialist Orthodontist is extremely candid about what he believes in, and what he doesn’t. For example, he openly counters the protective posture of those within specialist camps that preclude general dentists from learning or practising orthodontics. 

He charges that the majority of dentists would simply accept an aligner company’s algorithmic recommendations without any scrutiny.

The orthodontic educator tacitly questions the veracity of undergraduate and specialist programs, confident the short and long-form training courses offered by OrthoED, the training institute he founded, would enlighten even seasoned clinicians.

For over 30 years, the self-professed myth-busting orthodontist has treated more than 10,000 cases. Known for high profile roles such as specialist clinician, practice partner (MP Orthodontics), international lecturer (GAC/ORMCO) and founder/principal of teaching institute (OrthoED), he also holds little known credentials like orthodontic innovator and pioneering tech adopter. On the latter note, he was certified as the first Invisalign accredited orthodontist outside of North America.

In this two-part article, we chat with the straight-talking orthodontist, discussing everything from his training courses to passions and motivations. Of course, he also delivers unvarnished views of the industry – where it stands and where it is headed. 

Q: What led you to study orthodontics and made you so passionate about it?

After finishing dental training in 1983 at Melbourne University, there was a point in time when I became frustrated that whatever I did in general dentistry, somebody could do it better. 

Influenced by my brother, a rheumatologist who at the time was training at the Mayo Clinic, I went to the United States to undergo specialist orthodontic training at the University of Pennsylvania in 1988, becoming the first Aussie to do so.  

It was at the University where I had the opportunity to train with some of the greatest orthodontists in the world. At least once a month, I would be attending different courses, going around America being trained by – and making friends with – elite orthodontists such as Drs Vince Kokich, David Sarver, Ron Roncone Norm Cetlin and Dwight Damon, who developed the Damon bracket.

At the university, I was trained by the likes of Dr Brainerd “Barney” Swain, who invented the Siamese twin bracket, and my infamous chairman Dr Slick Vanarsdall.

One of the great things about going to America is that it gave me “the fire in the belly”. Even after completing the specialist orthodontic program, I used to visit the States every year and ended up bringing Invisalign, the Herbst appliance and micro implants to Australia. 

I really believe that one of the biggest problems of orthodontics is that my colleagues have kept it as a closed shop. They don’t teach GPs properly and everybody thinks that it’s too hard, when in fact, it’s not very hard at all, if you understand the correct principles.

Q: What made you decide to teach orthodontics?

The more I learned from these prominent orthodontists, the more I enjoyed being at the cutting edge of this branch of dentistry. As a result, I became an international lecturer and speaker for GAC (now owned by Dentsply) and eventually became the key opinion leader and international speaker for ORMCO.

During this period, I developed a genuine interest in teaching other dentists. I really believe that one of the biggest problems of orthodontics is that my colleagues have kept it as a closed shop. They don’t teach GPs properly and everybody thinks that it’s too hard, when in fact, it’s not very hard at all, if you understand the correct principles.

If someone were to sit down and explain orthodontics to you properly, you would quickly realise that it’s not rocket science. There are far more difficult areas in dentistry than orthodontics. But it has never been properly taught to GPs. 

Q: How did Smilefast and OrthoED come about?

When I first had the idea to develop an orthodontic training course for GPs, some general dentists and a couple of orthodontists were already teaching it in Australia. Unfortunately, most of them had a vested interest in what they were teaching. 

Some of these courses were run by dental labs and the training content was built around the use of appliances that they produced and sold. A lot of those appliances really aren’t needed at all.

Prior to setting up Smilefast as a short-term introductory course to orthodontics for GPs, I’ve already had several years of experience teaching orthodontists. 

Smilefast is a two-day course that gives general practitioners the ability to straighten teeth in 75% of adult orthodontic cases. The feedback was great and the dentists we trained were asking for more.

This led us to develop a 9-module, 2-year Mini Master’s Program. It was designed to equip graduate GPs with the skills to treat 95% of all orthodontic patients – without having to refer them to specialists. 

The idea with Smilefast and the OrthoED Mini Master’s was to provide a total program of orthodontic education, based on sound principals and good mentorship, which was lacking in the marketplace.

Q: You often talk about the need to rethink orthodontics and orthodontic training. Was there a turning point in your own understanding? 

My turning point came when I met Dr Rohit Sachdeva about 10 years ago. I consider him the brightest and most intelligent orthodontist alive today. It was Dr Sachdeva who taught me a fundamental principal that completely changed my thinking: with proper planning and proper risk management, 99% of patients can undergo orthodontic therapy with no surprises.

What I’ve learned from him, I would say not more than one per cent of orthodontists understand. I’ve since passed on a lot of these learnings to all of my dental clients. Based on what I call risk management, these principles take your orthodontic knowledge to a whole new level that protects you from unwanted problems.

What most orthodontists do, and that’s what we have been taught in universities, is that you put all your braces on and the teeth miraculously line up – but that’s only true in 70 per cent of cases. 

They can actually get worse in 30 per cent of the cases, and that has to do with what we call the bracket/wire geometry. We teach our course attendees about the difference between a consistent and inconsistent force system. In the inconsistent system, simply putting the brackets on the conventional way will result in teeth moving the wrong way.

Our job is to identify which cases fall into which category and once we do, we have to identify the mechanics to change from the inconsistent force system to a consistent one. 

Once this knowledge is learnt, orthodontic tooth movement and treatment can be very easy and predictable.

I was thinking this guy was full of garbage, basing his predictions on the initial photos and seeing some brackets. Photos of two to four months later showed that he was right with every prediction, in every case. 

Q: Tell us about your initial interaction with your mentor, Dr Rohit Sachdeva, and how you came to embrace his clinical methodologies?

When I first met Rohit about 10 years ago, he requested me to show him 10 cases that I was doing. I showed him the photos as well as the braces and wires. On two or three of those cases, he predicted that there would be certain problems and specified exactly what to expect.

I was thinking this guy was full of garbage, basing his predictions on the initial photos and seeing some brackets. Photos of two to four months later showed that he was right with every prediction, in every case. 

When I started doing my mentorship with Rohit, it felt like my first day in orthodontic school. My business partner Martin Poon, who joined Rohit’s program a year after me, felt exactly the same way.

Rohit trained under Charles Burstone, who is considered the father of orthodontic biomechanics. Rohit is an amazing thinker who managed to distil everything Charlie taught him and put into a methodical practical clinical approach. Those principles he has taught me over time are what we now deliver to our OrthoED students. 

The average treatment time for orthodontics is about two years. If you know what you’re doing and using the right force system – which is very easy to understand once you understand the principles – you can treat about 80% of cases in about 14 months. The reason it usually takes others two years is because treatment and tooth movement is out of control and they end up spending a lot of time fixing what should never have happened in the first place. 

Rohit’s principals requires not only proper planning at the beginning of the treatment, but also understanding the forces at work. It’s not about putting braces on every tooth but understanding what is going to happen, when it will happen  and why.

Q: What are the biggest myths in orthodontics?

Myth 1: The majority of orthodontic cases require extractions. In reality, about 80% of our patients are treated without extractions. 

Myth 2: With aligner therapy, all you need to do is put the case in to the aligner company and they will take care of the rest. 

If that is true, what’s the difference between a dentist-administered aligner treatment and that supplied from a company like Smile Club Direct? In probably 99% of cases, a system that completely relies on the technician for the set-up without any input from the dentist is likely to fail. I’ve never been involved in an aligner case where I have not modified it at least four times. 

The bottom line is, whether for aligner therapy or orthodontic treatment planning, you cannot depend on a one-size-fits-all system. Cookie cutters only work for cookies.

Q: What sort of resistance did you face because you tailored your training courses for GPs, and how did you overcome them?

I’ve received threatening letters from orthodontic bodies – one of them asked me to leave simply because I was teaching general dentists. It’s the only professional body that I know of that actually tells you not to teach other dentists. 

The training ethos of the ADA actually encourages specialists to mentor the general dentists and to help them. But I was told not to do that.

How did I deal with that? Unfortunately, with potential litigation and that stopped any further negativity. I used to get upset in the early days but now it’s like water off a duck’s back. My general feeling is if they are upset with me, I must be doing something right. 

Perhaps as a form of vindication, I’ve had specialist orthodontists attend my courses over the years – both Smilefast and the full-on orthodontic programs – and not one of them has been able to criticise my teaching or my courses but instead have been full of compliments. 

Q: What’s the future outlook for you and the profession?

I’ve probably got another five years of practice in me, and maybe eight to nine years of teaching before I say “enough is enough”. 

As for the profession, I remember the famous words of Dr David Penn, one of brightest dentists I’ve ever come across. 

He believes the future of a dentist is to become a mini specialist. A GP can be a mini specialist in two or more areas of specialty. You will end up in a practice with four to five dentists who cross-refer to each other. 

In 10 to 15 years’ time, if you wish to be a specialist orthodontist, you would have to be a really good specialist – treating the toughest of tough patients and you’re going to have to charge accordingly. That’s because increasingly, general dentists will be exposed to the work that used to fall under the domain of specialists. 

Unlike the old days when everyone did well, many more dentists will be joining our ranks (and performing orthodontics) in the future and it’s going to be tough for everyone.