The Progressive Orthodontist

Dr. David Carter is a second-generation orthodontist who has managed to make room for a successful practice, lots of family time and to give back to the community. Dr. Ben Burris recently spoke with him about his early years in practice, his dedication to a balanced life, and the opportunities he’s had as a result of his career in orthodontics.

Burris: You are a second generation orthodontist. Tell us what this has meant to you.

Carter: Growing up, my father was an aeronautical engineer and changed careers. He went back to dental school at age 34 and finished orthodontics at the age of 40. Needless to say, I am grateful for him making that decision, especially with four kids in tow. I’m sure it was tough on him but looking back, it impacted all of us in the family in a positive way. His courage to change careers midstream and pursue what he loved gave the rest of us the courage to do the same. My older sister is an attorney who defends doctors (she also changed careers after originally being an RN and nurse consultant for a law firm), my brother is an anesthesiologist, and my younger sister was the smart one: she MARRIED a neurosurgeon! No telling what any of us would be doing or where we would be if it weren’t for him making that difficult decision that allowed him to better provide for his family.

Burris: What was the transition process like between father and son?

Carter: By the time I graduated from ortho school, my dad had already progressed through two careers and was basically winding things down. He was going to just sell the practice, but I said “Whoa! I want to take over.” The new direction re-energized him, and we both began trying to build the practice up to support two orthodontists. It was REALLY slow at first. I didn’t get a paycheck until my third month in practice because the money just wasn’t there. Good thing I was used to living off credit cards, like most dental students! Anyway, we continued to grow, and after 8 years we opened up a satellite office just across the river from Augusta, in North Augusta, SC. Now, you wouldn’t think driving 15 minutes across the river would be that big of a deal, but this satellite was a great investment. We basically got everyone in town coming to us and I think it was mostly because, in their eyes, we were making a commitment to their community by building there. After about 2 years in the satellite, I approached my dad and asked him if he’d like to retire. I made him an offer he couldn’t refuse. Our buyout hinged on me providing him an income until the day he and my mother pass away. Not to be morbid, but this way my siblings and I don’t have to worry about taking care of them financially in their golden years because the practice will be taking care of them. He still keeps his license current, does all the necessary CE, and sees the minimum number of patients to say he actually practices, so everything is legit from that standpoint. It keeps him interested in the profession, too. It is a great feeling to be able to provide for those who made everything possible for me!

Burris: Remembering your early days in orthodontics, and knowing what you know now, what advice would you offer residents and recent graduates?

Carter: Look for multiple ways to differentiate yourself from everyone else. There are so many things you can do. Lots of Invisalign – maybe even an Invisalign only practice, TAD’s, working with plastic surgeons more to address other facial issues that are presented to us every day, working more with ENT’s. Just do something differently. I’ve never been afraid to try new technology or new techniques. I am constantly looking for ways to provide better, faster and more comfortable treatment to outpatients and our patients see that commitment and believe that is a big reason for our success so I guess I’d also advise that young orthodontists not be afraid as well as striving to be different.

Burris: Give us some examples of the ways you’ve been able to practice differently.

Carter: I decided from the beginning that I would be around as much as possible when my kids were young. I missed out on a lot of time with my dad growing up and I wanted to do things differently. One thing I did was to adjust my schedule to work Monday-Wednesday, and then take off until the following Wednesday-Friday. It gave me TONS of time to be with my kids.

To do that, I worked smarter, not harder. The Damon brackets made a HUGE difference for my practice, making us MUCH more efficient. Ditto for Invisalign. There were a lot fewer emergencies with aligners. I am convinced that the integration of cutting edge technology and systems has allowed me to have an incredible practice AND be the family man I promised I would be.

Burris: Would you say that your family has been your driving force?

Carter: I have a very strong sense of family. I met the girl of my dreams at a wedding on Hilton Head Island, SC. We were both good friends of the girl getting married, and my dad thought I should be there even though I had college exams coming up the next week. Again…good call by my father! We were married my senior year of dental school, and have been blessed with two wonderful sons who are our greatest joys. Both are avid hunters and fishermen – hunting and fishing are really big social/family times here in the south.

My oldest, Brian, is a sophomore and on a golf scholarship at the University of Georgia (my alma mater – Go Dawgs!!!) and was named to the 2010 Southeastern Conference Freshmen Academic Honor Roll.

My youngest son, John, is a senior in high school and is being looked at for lacrosse in college. He’s an accomplished golfer in his own right but lacross is his love. I’m also happy to say that he wants to follow in my footsteps and pursue a career in dentistry.

Burris: Let’s talk a little more about how built your practice and those things you did differently.

Carter: When I joined my father in practice we obviously wanted to grow the business. We were using A-Company brackets at the time and asked our rep if there was a really big, efficient practice we could visit and learn from. He arranged for us to see this orthodontist in Spokane, Washington named Dwight Damon. We spent three days in Dr. Damon’s office just to see his business model and how he practiced. While we were there he and my father began discussing dad’s former career, and he wanted us to look at this prototype bracket he was working on. Yep. It was the ‘original’ Damon bracket.

Still the engineer, Dad immediately realized how low force/low friction could impact treatment. Damon arranged for us to be one of the original test practices and we went through the first few generations of Damon. We originally weren’t really sure WHY the teeth moved so rapidly and with much less discomfort, only that they DID.

I soon began speaking all over the world for Ormco (who bought A-Company) about the Damon brackets. I presented time-line photos of patients’ progress over their first few months of treatment and it was a VERY eye-opening experience!

I talked about the decreased chair time needed to change wires, as well as the length of time between appointments you could go before you saw full wire expression. We had measured the length of time it took to change an archwire and found that with traditional brackets, it took approximately seven minutes per archwire. With these new Damon brackets, it took about one minute. That much time saved simply CHANGING wires had a DRAMATIC effect on how much more time we could spend talking with patients or parents, and obviously increased the numbers of patients we could see in a day.

Remember that many dental schools and their associated orthodontic programs had closed their doors in the 1980′s and early 1990′s. The law of supply and demand was in full force. Many more patients wanted orthodontic treatment but there were not enough orthodontists graduating now to keep up with this demand. Damon brackets helped us solve that problem.

Burris: You’ve also been successful with Invisalign – specifically Invisalign Teen. Tell us how you’ve used this to promote your practice.

Carter: About two years ago, Invisalign came out with what I thought was a home run. The Teen product finally answered the question teenagers all over the country were asking: “Why can’t I get Invisalign?”

For years, Align would not let us use Invisalign if the second molars were not fully erupted. The Teen product allowed for control of these unerupted teeth. It also gave parents the ability to help monitor their teen’s progress (wear indicators), and also gave them the peace of mind that their child could lose up to six aligners and not be charged additional lab fees for lost appliances. BRILLIANT!

I jumped all over the idea and got on the fast track learning everything I could about how to treat with Invisalign. My new Invisalign rep came on board with me at the same time Teen came out. Together, we looked at how to brand our practice as THE Invisalign practice for our area. Social media, Google placement, Facebook ads, Twitter, TV ads, etc. We threw any idea we could out there to see what ‘stuck’ the best.

For us, it was a mix between TV ads and Google ads. Everything worked well, some just better than others. I was the youngest orthodontist in my area at the age of 48, and most of the other orthodontists around me don’t believe it works. They were certainly not interested in learning how to use Invisalign Teen. Guess what? What they don’t know actually helps me! We bring impacted cuspids into occlusion, do extraction cases, and close open bites. Is it harder than doing it with braces? Probably. But it’s what patients want. It’s become a huge part of our practice, has kept me and my staff invigorated, and the word of mouth referrals have been outstanding. We ARE the Invisalign Teen practice in our area.

Invisalign Teen has been a great tool to grow my practice. Through it I have access to a market that is untapped in my area so it is all mine. Remember what I said about being different? Invisalign Teen is a perfect example of this strategy in action!

Burris: We’ve worked together to establish the Smile for a Lifetime Foundation, which we’re both very proud of. Tell everyone how this evolved and about your experience as President.

Carter: Fortunately, you and I met at the Invisalign Summit a couple years ago. We are both EXTREMELY competitive in business, and I remember sitting down and just bouncing ideas off each other. A few months later, I was thinking about starting up a local non-profit to treat underserved kids in our area. Lo and behold, I read this orthodontic article about a Dr. Burris who had started a NATIONAL foundation for this exact cause.

I approached you about starting a chapter in my area, and it’s just continued to grow! I was probably the third or fourth chapter in the country, and still feel so fortunate to be able to give back to my community in this way. When I was asked to serve on the national board of directors, I really didn’t think I had the time. I had so much on my plate, having just opened my third office, and I’ve since opened a fourth.

You were very convincing, I agreed to serve, and within a month, I was chosen by the National Board of Directors as President. I prayed that if I served one year, God would send me two BIG national sponsors, as we needed money and visibility to get things off the ground.

I contacted my dear friend, Todd Blanton, at Ormco and told him about the Foundation. He was very interested and brought the company on board as national sponsor. At the same time, Televox came on board as our national media sponsor and helped us rebuild our website, host it, and produce our quarterly newsletter that goes out to thousands of orthodontist across the country. My prayer had been answered, and in a much bigger way than I could have ever dreamed.

My current prayer is that this Foundation will be endorsed by the AAO and be an answer to Access To Care issues. You gotta dream big, and pray even BIGGER!

Burris: With everything you’re involved in, do you have time for fun?

Carter: I love golf and to travel. I’ve had wonderful opportunities to speak about orthodontics around the world, and have been to a lot of places I never expected to see.
I’ve had the chance to play some of the most famous courses in the world, and actually got my handicap down to a 3.

Of course I also love to spend time with my wonderful family as I’ve already mentioned!

Burris: If you were given a “mulligan” off the golf course, what would you do differently?

Carter: I honestly can’t say I would do anything differently. God has a great plan for my life, and He’s used the experiences I’ve been through to mold me into a man who’ll get to spend eternity with Him one day. I’m still a work in progress!

Burris: Are there mistakes you’ve made that others might learn from?

Carter: Well, we all make mistakes. I regret that I never served in the military. During the recent anniversary of the 9-11 attack, I wondered what it would be like if everyone served a two year stint. I think it would give every American a little better sense of patriotism and discipline.

Burris: Looking back, are there any lessons you’ve learned from your kids?

Carter: Brian is 19, and learned to love my favorite sport, golf, at the age of 2 (Go figure…In Augusta, GA???) He got REALLY serious about it when he was around 13. To tell you how impressionable kids are at that age, he asked me during a tournament “Do you think I’m exceptional?” I thought for a while and told him “Not yet. But you’re very good.” I could see the light go out in his mind. He was totally deflated. I wanted to make sure he wasn’t getting a “big head” and it backfired.

He lost the tournament the next day but he still had the end of the year Players Championship the next week. I sat him down the night before and told him I was wrong. His work ethic was the best I had ever seen in a 13 year old, and his putting was always uncanny. Well, that’s all the spark he needed. He went out the next two days, was in second going into the final round, and shot his first under par score to win going away.

It’s amazing what an incredible effect we can have on the minds of children. In our profession, we have a tremendous opportunity and responsibility to encourage and build confidence in the kids we see in our practices and in our communities on a daily basis. What a gift!

David Carter is an exceptional man and orthodontist. His dedication to his family, his profession, to giving back and to making a difference is obvious to anyone who spends any time with him. Many thanks to David for all he does and will do for our specialty and for taking time to do this interview! Bravo, Dr. Carter!

Editor’s note: Under Dr. Carter’s leadership, Smile for a Lifetime Foundation has grown from a small, local foundation to a nationwide entity with more than 60 chapters in 40 states! Dr. Carter and s4L.org are changing thousands of lives for the better!