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Virtual Orthodontics with Labbe Family Orthodontics

Orthodontists offices are getting ready to reopen. In the meantime, they’re putting copious precautions in place, and even practicing “drive-by dentistry!”

We spoke to Dr. Stephen Labbe about how they’ve handled things with their offices closed, how virtual visits work, and how they will put extra safety precautions in place as they reopen.

You can watch the interview below. For more information on Labbe Family Orthodontics, visit their website or Facebook page.



Podcast Version:

Catch past episodes of our podcast and video interviews here.

Janet Jefferson (01:36):
Welcome to Third Floor Views, where we at Chesapeake Family Life talk about health, education and living with kids. I’m your host. Janet Jefferson here with us today is Dr. Stephen Labbe from Labbe family orthodontics. Thank you for being here. Dr. Labbe originally from the new England area has been living and practicing in Maryland for over 30 years. He lives in Annapolis with his wife and two children, and when he’s not creating beautiful and healthy smiles, he’s managing four location practices with 30 employees. Let’s jump right in. So Dr. Labbe, while the pandemic has impacted everyone, small businesses have really been hit the hardest. So first off, how are you and your family and your work family doing right now?

Dr. Stephen Labbe (02:35):
Hi, Janet. Thank you for having me, my wife and I love your publication. It’s so community oriented and it’s my honor to get to talk to you today. So thank you. We’re all doing well. I have an 18 and a 20 year old home. My son’s finished his finals first semester freshmen at University of Tampa. And you know, the online learning was a challenge for everyone, but my daughter just finished her last final yesterday, so they’re both happy and we’re healthy. So that’s all good.

Janet Jefferson (03:07):
Yeah. That’s a big deal. Yeah, I’m sure doing finals and finishing, especially for freshmen their first semester, that could be really tough doing that online, but everyone’s healthy and that’s really what matters. How about your work team? How are they holding up? I know that this has been challenging for everyone sort of mentally and emotionally. And so, you haven’t been operating like you used to. So how is your work team doing?

Dr. Stephen Labbe (03:32):
The work team is doing well, but it’s been, as you said, challenging and frustrating for everyone. A lot of confusion, but communication is key. And I think that throughout this, I’ve tried to communicate with the team at first how we were going to handle employment most everyone, but a handful of people that helped with some answering of telephones for emergencies and such. Well, let’s say when we first closed, it was only going to be for two weeks, right. Mandate. So, you know, what are we going to do with two weeks worth of patients, which soon became much longer, right? So most of the staff hadn’t seen each other in a while. We started having Zoom meetings to tell them how we were going to approach this. And the information was taken from Zoom meetings and webinars of large accounting firms that we were following. And we would communicate that information to the patients, to our practice, to our staff members via the Zoom meetings in those do meetings sort of became Zoom happy hours, but it was great to see everyone online and you know, just to see how they were interacting after not having been with each other was a pleasure because they really do love each other. And you know, it’s more than just a workplace. It’s really a family.

Janet Jefferson (05:03):
Yeah, definitely. I think we’re all feeling that right now is really missing that, that community and missing each other and having those interactions. And so Zoom does sort of fill a bit of a void, but it’s not quite the same. So let’s go back in time a little bit. Can you tell us a little bit about how you decided to close? Cause you were sort of one of the earlier businesses decide to close. So what was happening during that and how did you make that decision?

Dr. Stephen Labbe (05:29):
So my wife, Stacy and I were traveling at Laguna beach, California for a dental meeting the week of March 13th. And we returned on the 15th and we were putting a plan together as what this week was going to look like because the talk had started to become Coronavirus oriented. And we were starting to put measures in place, like take away the coffee station, take all the magazines out, put signs up on how to properly and trying to do everything we could to focus on. This, we knew, was going to be the new norm. And we worked that next day, March 16th was a Monday. My first day back to work was a 12 noon to 7:00 PM day. And at around two o’clock I happened to check my email to find out that one of the speakers at the conference that I just had been to had tested positive for Coronavirus. So all of a sudden it was here. I walked out to my car, sat there and I just thought now this email said, you’ve been possibly exposed. I personally know that I was talking to the gentlemen, he signed autographed, his book. We were right on top of each other. So I called the office and they said, Dr. Labbe, where are you? And I said, I’m in the parking lot. Why are you in the parking lot? I said, because I’m going to self quarantine, this has happened. And I explained it to them. So they canceled the patients and we went home and for the rest of the day started planning of what those next two weeks were going to look like. And by the next day, when we heard that the Governor was closing down, we then started planning, that everybody was going to be closing.

Janet Jefferson (07:18):
That’s crazy. But luckily you’re healthy. Right.

Dr. Stephen Labbe (07:22):
Yes. We ended up after the initial five days, there were no symptoms. And then 14 days later, I started coming in with one other, a dental assistant, starting to see the emergencies that were calling in with a broken bracket or a poky wire. And interestingly enough, the recommendation was try not to have them in the office if it’s at all possible. So they would pull up and I put on the gown, a shield, the mask, come out there and they rolled the window down and I’d reach in and clip the wire and off they would go within a minute, we had fixed the problem and they had never even entered the office. So we didn’t have a lot of cleaning up to do what you know.

Janet Jefferson (08:07):
Right, right. Literal drive by dentistry. So how, I mean, since you are in the medical profession, you are always aware of how germs are spread and making sure that you’re protecting yourself. Have you found a lack of protective equipment or do you feel like you’ve been pretty well stocked and that hasn’t really been a problem?

Dr. Stephen Labbe (08:29):
No, it was a problem. Fortunately with four locations, we have a pretty good stock as it is, you know, having practice for 30 years, I’ve lived through AIDS and SARS and different things. And they’ve always trained us to say, the patient will only communicate a certain amount. They fill out the medical questionnaire. They may or may not be honest. They may not know that they have something and to treat each patient as though they have an infectious disease. So, you know, for years you wear a mask, protective goggles, gloves, hand-washing all the basics, but now they’ve added stuff like putting a shield in front of your mask and they’ve improved the mask. We’ve always had a level three mask, which is a nice surgical mask protective, but now they have an N95 and KN95 masks, which are filtered even more. So those things that we hadn’t, you know, the things that we introduced were hard to get. And I had a team of staff members working diligently to find these different PPE, personal protective equipment, that we needed for whenever we’re going to reopen. And again it’s one of those unknowns. We had no idea when we were going to reopen, but we decided to try to be as prepared as we could for what that day was going to be thinking. Maybe it’s middle of May, maybe it’s June 1st. And then when Governor Hogan said May 7th, that was a little bit of a shock, but you know, we scrambled, we didn’t open right away because we weren’t prepared as we were still getting the supplies that were difficult to answer your question to get. But eventually we had everything we needed. We had sneeze guards up at the front desk and we started this week seeing a patient per hour plus one new patient in the morning and one new patient in the afternoon. So this week I worked seeing approximately eight to 12 patients per the whole day. So there may be one or two patients in a 4,200 square foot office at one time. And we had the parents waiting in the parking lot.

Janet Jefferson (10:47):
How would that be different say from what you were doing three months ago, how many patients would you see on an average day?

Dr. Stephen Labbe (10:55):
You know, a traditional orthodontic office works in an open bay. I’ve got an island with six chairs around it. The adult area has another two chairs. I have a couple of consult rooms. So, in my practice, our office with four locations, we could see 65 patients in a day. There are some practices, see 200 patients in a day. Wow. But to go from even what we were doing, 65 to seeing eight patients is a big, big difference. And come June 1st, we’ll probably see half of what we did before. So this was sort of a soft opening, sort of a trial sort of see how the patients feel, make sure we have all our ducks in line and then come June 1st, we’ll have four assistants working instead of just the two I had working with me this week.

Janet Jefferson (11:50):
Okay. And what are some other adaptations you guys have done to be ready for June 1st? So what is that going to look like? So other than cutting back on number of patients and having sort of an in between number of personnel, what are some other things that maybe have changed?

Dr. Stephen Labbe (12:07):
So in addition to the layout of the room, it is sort of an open room. And as I said, we had six chairs around an open bay. So the idea is if we work in chair, one, three and five, you’ve got three people spread out with 10 feet in between each instead of having using six chairs, we’re doing three chairs. So there’s distancing. When they drive up, we have implemented through our software management system, Dolphin, Call My Orthodontist. So they download an app to their phone, which virtually puts the practice in the palm of their hand. What they can do is they can access all the forms that we put online, the health questionnaires, the pre screenings. They can check their appointments, they can check their balance. They can look and see pretty much anything that we were doing face to face, now they have it in the palm of their hand. So they drive into the office and they let us know they’re here. And then we have the parent and the patient into the vestibule area where we take their temperature. That’s something new. We wouldn’t have to do that before. And they answer the prescreening questions and if they are healthy, they’re allowed into the clinic and the parent goes back into the car. So there’s really no reception area, any longer it’s there. And we have certain chairs that they can sit in separated, but so like the virtual world. And another thing that we implemented was, there were a lot of webinars that were, that we watched during this downtime and trying to learn. And let me back up a second and say that tele dentistry has been out there for a few years now, but somebody like myself really didn’t move in that direction. And this pandemic really was a kick in the pants to say, this is something that you can utilize so that you can communicate with your patients. If it’s a new patient, they have the company we ended up going with dental monitoring has something called Smile Mate, which is a virtual consultation. So you take some pictures of your teeth, you send it in. I look at them analyze what I can tell by pictures. And then we have one of these meetings and we just discuss your treatment as though you were in the office. And it really allows us to determine if you’re a candidate for Invisalign clear aligner therapy or for braces and what your level of interest is. And then when the office reopens, you come in and get full set of records and we get started you on whatever treatment best fits your case.

Janet Jefferson (14:56):
Do you feel like that virtual interaction is an acceptable replacement for being in person? Or is it just because it’s preliminary, it can sort of get the ball rolling in a safer way. Are you happy with how that that sort of virtual transition has gone?

Dr. Stephen Labbe (15:13):
That’s a great question. It’s going to take some adjusting for everyone, but I think that whether you, the consumer’s mindset or our patient of today is different than when I started, the patients want ease of access. You know, they want convenience. And for certain patients, this is exactly what they’re looking for. And, you know, it’s interesting that you say, is it the same? It’s not the same from a personal, you know, but you know, from a scientific approach, some of the artificial intelligence that this company uses to determine, let’s say for a clear aligner patient for Invisalign, if they’re wearing an aligner and they’re supposed to change after a set amount of time, seven, 10 or 14 days, when they come in to see us after say eight weeks, we’ll look at their aligners and we’ll determine if they’re ready to move on to the next aligner. How did they do with the batch that we gave them while they were away from the office now in an eight week period, that’s two months, they’d send us pictures. Let’s see if it’s even twice a month, then it’d be four touches in the time where we had in person one touch. So, you know, it’s less personal, but in the long run, it may even work out better in terms of tracking their case. Now with braces, it’d be a little different. They can still start sending in patient pictures of their teeth and we can check how their hygiene looks. You know, what’s the health of their teeth and their gums. Is there anything broken, but they still have to come in to get an adjustment so that the dental monitoring, the teledentistry dentistry, virtual tracking of the patient, it works better in my mind for the clear aligner therapy, because you can give them more aligners that they just switch out and they don’t have to come back in for a new scan until they’ve completed that batch of aligners, but with the braces patients with fixed appliances, they have to come in at some point, even though it’s nice to see where they are along the way, it’s not going to say office visits like it would in the other. But what I want to see in the long run with either is if it’s going to help efficiency in terms of, if we say that your treatment is going to take this much time to that, it would finish on time because you are being more diligent compliance wise because you know, you’re sending photos of your teeth to me twice a month. Whereas before you were only coming in to see me after two months, right? What can happen in that two months where you might have gotten off the track, but having to touch base, even if it’s virtually with an email or a phone call that we’ve looked at your pictures twice in a month, instead of once in two months, right? Maybe you’ll have higher accountability of your patients and a better tracking. And you’re case we’ll finish on time with less what we call refinements or fine tuning.

Janet Jefferson (18:32):
I wonder too, if it, so since you have fewer patients coming into the office for social distancing and safety reasons, I wonder if some of these virtual interactions can also make up for that lack of patients. And, you know, I think about, Oh, small business, you really need to make sure that you’re maintaining the same number of clients. So then you could support your staff and make sure that they can stay employed. So hearing that you’re going to have to cut down your patients in the chairs, potentially 10%, you know, that that’s a lot or cut it all the way. Right. Cut it all the way back. Like, so you’ve only seen maybe 10% of what you were seeing. So I’m wondering if virtual interface can sort of make up for one of those gaps. So even though you’re not seeing as many people in person, that’s okay, as long as you can make up for it virtually. And do you think that is going to happen?

Dr. Stephen Labbe (19:24):
No, I feel like that’s going to happen. That’s what we’re hoping. That’s what we’re banking on. We have two staff members who have been identified as DMC, and they’re right now, all they’re doing is analyzing the pictures that are coming in, bringing them to my attention, we discuss it. And then they get back to those patients. So we’re trying to keep in touch with all the patients that we hadn’t been able to in eight weeks, and then identify the ones that can go out a little further versus the ones that have to be seen right away.

Janet Jefferson (19:59):
That’s great. It sounds like you’re able to really catch up with patients more and make sure that their needs are being met, whether they like it or not.

Dr. Stephen Labbe (20:10):
Right. There are some that are going to love it. And there’s some we’re going to want to come in right away. But we had a soft opening this week, just as a trial to see how everything would go. Just seeing one patient per hour, June 1st, we’re going to, instead of only having one chair running, we’re going to have four chairs running and we’re going to do it. I’m going to work from 7:30 to 7:30. So not only are we seeing less patients, but in order to get to a certain number, I have to, instead of work eight hours, I’m going to work 12 hours. And I’m going to do that with my associate alternating every other day. So if I work the long shift on Monday and Wednesday, he’ll work the long shift on Tuesday and Thursday, and then we’ll have a regular Friday and then calculate how many patients we’re going to see during that week. Our teams will rotate. We’ll have three teams and they’ll rotate an early shift and a late shift on the long day and a regular shift on the regular day. And I will flip flop so we don’t burn out, but we’re planning to do that for the month of June. We’ll see where we are. Hopefully we can go back to regular hours, come July. If we’ve sort of caught up with all the patients that we hadn’t gotten to see to your point, you know, the new norm is not going to allow us to work. Like we used to so longer days is one way that we can make up a little for that.

Janet Jefferson (21:40):
Right. Well, I mean, in terms of a patient that could possibly be a good thing, cause then like, Oh, I have a, a longer range of time that I can choose from though. I wonder too, is it going to be more challenging to make an appointment? Are you going to have fewer time slots open to accommodate patients for maybe whatever their peak time is or whatever your typical peak time is? They might just be assigned a time. How do you think that’s going to work in terms of scheduling? Are you going to have flexibility with scheduling or is it sort of first come first serve, we’ll see how it goes.

Dr. Stephen Labbe (22:14):
A hundred patients, at least a hundred patients that were on a list that had something broken, you know, wow, broke a wire, they broke a bracket, they lost a retainer. So those were the patients that we saw during the soft opening this week and next week to try to get most of those patients taken care of. So the June 1st, when we open it’s on the patients from March and April, that hadn’t been seen. So they’ve been working diligently this week. And last week, the minute we found out when we were able to reopen again, we just started scheduling patients. Cause we didn’t want to have to schedule, schedule just guessing when we’re going to be open, that’s a lot of work and then have to do it over again. Right. So right now that’s what we’re working on. Getting everybody scheduled.

Janet Jefferson (23:02):
Well, it sounds really promising. It sounds like virtual orthodontics could be a really positive thing for patients being able to move through the process a little bit more efficiently and having that better outcome because of a higher accountability. And it sounds like when you do see people in person that you’re really well prepared for it. So that’s great news. Is there anything that you’re asking of your patients say, okay, when you do come in person, I expect you to have XYZ or, you know, please don’t come. If you have these issues or what are you hoping your patients are going to be doing when they do come into the office?

Dr. Stephen Labbe (23:39):
Well, one of the things that we took away was our toothbrush station. So we have disposable and toothpaste available for all the patients. The old way was they would come in and sign in and brush right away, sit in the reception area and be called back into the clinic. And now that we don’t, you know, we’re not allowing any brushing, cause there’s a lot of splatter. We’re asking them to do that at home. And then, you know, when we scheduled their appointment, there’s six questions that they have to answer. Do you have a cough? Do you have a fever? Have you traveled? You know, making sure that they’re not sick to spread it. They, if they have answered yes to any of those questions, then we ask that we reschedule them for 14 days. But then the day they’re here they go and get the temperature taken. They go through the same questions again, just to make sure that, you know, from the time we scheduled them until the time they arrived, nothing happened. And you know, it’s still no to all of those questions, right? So basically, you know, healthy and if their teeth are clean, that’s one less thing they have to do. Then when they come in, they walk to the back, they have a mask or they’re provided with a mask in the office at all times, except for when I’m working on their teeth, they rinse with a 1% hydrogen peroxide rinse. And it’s just something, that’s one of these recommendations that we learned online that it’s supposed to clean them out out and reduce the risk of germs while our assistants and our doctors are working on them so that they’re seated in the chair and we start their appointment.

Janet Jefferson (25:25):

Dr. Stephen Labbe (25:26):
So orthodontics though, is that people should know is there’s a lot less aerosol. So what is the aerosol when we talk and when we breathe, air comes out of our mouth, carbon dioxide and particles. But if you went in for a cleaning, say from your hygienist and she had a Cavitron or something that’s spraying air and water, and you took an image of that, it would be everywhere. So the orthodontist, what we have to do is we have to limit our aerosol procedures, which are any time we use a high speed handpiece, whether it’s the trim and size alleges, I’ll go in between and reduce the width of the teeth to create space and crowded cases, to specific rooms that’s the only thing going on in that room is one patient in one chair and nobody around them. So our main clinic that had the six chairs, but we’re only using three separated out, that’s just normal visits where you would have a patient getting new aligners or changing an arch wire or putting some sort of activation to an appliance that they’re wearing. So very little aerosol going on during that procedure.

Janet Jefferson (26:44):
Yeah. That makes sense.

Dr. Stephen Labbe (26:45):
Other than the regular breathing.

Janet Jefferson (26:47):
Right. Right. Have you, are you going to have to change your cleaning practices dramatically because of this?

Dr. Stephen Labbe (26:54):
Yes, we definitely, it’s interesting that one of the things that we had before this, we could change the mask at every single patient. We would change our mask, but now, because masks are in demand, what they’re saying we do is wear the shield over it. And, you know, you’ll change your mask. Say you see a few patients at the end of the morning, put a new mask on, or if it becomes soiled, put a new mask on, but we have like belt and suspenders. So there are multiple layers. So instead of just having a mask, somebody might have on a N95 mask, which is very, very protective, but also expensive and hard to come by. So you put a level one mask over top of that to protect the mask. And you put a shield over that to protect the patient and the doctor and the staff, and you have all of these layers. So then when you, when you’re questioned about how do you recycle this stuff? So you take your level one mask off that you can, they’re much more available, throw that away. And there are techniques to deal with the masks, the n95 masks where you take a Tupperware container and you put it over top of the mask and just take off the ear loops. And it sits in there. So it never got touched by hands. So there’s, there’s new equipment that we have to to have, including Tupperware. These are bizarre times.

Janet Jefferson (28:31):
Well, last question. Is there anything that you want to sort of tell your patients or just our families out there that they should remember, should they call just as frequently to come into the office or to, should they, if they’re worried about something or are you suggesting, you know, they contact you in a different way. Anything about your procedures or sort of last sort of things that you want families to know?

Dr. Stephen Labbe (28:58):
I would just say that safety is of utmost importance, because as I said, when we were told we could open on the 7th of May, it was a shocker and a lot of people still haven’t opened yet. And I think that’s important because you only open when you feel you’re ready. And I feel like we’ve put all the safety measures that we can in place. And then like our staff and our patients and our personal safety is the most important thing. So to know that when you come in for your visit, we’re going to do everything we possibly can to keep you safe. And as far as contacting us, I’d like everyone to download that my orthodontist apps, you can communicate with the office that way. We have, seemysmile@labbefamilyortho, that we have an email, we have a regular phone numbers, 410-267-7300 is our main line. And on there, you can either leave a message or push for the emergency number and that’s me. And I will either answer or call you right back. It shoots to my cell phone. So there’s many ways to reach us, but know that we are, we have a system in place where we’re taking the patients that their appointments were on March 16th and 17th and 18th. And we’re rescheduling those for June 1st, 2nd, and 3rd and so on. And then anybody that had an emergency type of visit with a drive by that we talked about and their bracket is off, or a wire is clipped. We’re trying to get them in this week and next week as well as early June. So we have plenty of systems in place, reach out to us if you feel the need, but we will definitely be contacting you if you haven’t already been rescheduled very soon.

Janet Jefferson (30:52):
Oh, that makes sense. And then use your use the virtual platforms that you have brushed your teeth at home and bring a mask, right? That those are the other sort of things that you’re asking your patients. Well, it sounds like a really solid plan and hopefully things will go really smoothly, both for, for your team and, and for the patients. Thank you so much Dr. Labbe for being here with us today, to answer all of our questions about how things have changed with COVID-19. Thank you to all of our viewers and listeners. We love to hear your thoughts, comments, and questions. If you enjoyed what you heard today, check out more at thirdfloorviews.com. I’m Janet Jefferson. This is Third Floor Views. Thank you for listening.


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