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Change: The Only Constant Benjamin Lund, Editor, Orthotown Magazine

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by Benjamin Lund, Editor, Orthotown Magazine

The orthodontic specialty has experienced much change in the last 10 years. Where does the profession go from here?

Nothing Stays the Same
Before my father passed away, he said, "Son, there is one thing in life you can depend on: Nothing ever stays the same." In my experience there is a great deal of truth in this admonition and as we look at the current world economic crisis, it seems to be affirmed in spades. But what about the orthodontics profession? Do we have a "crisis" on the horizon or is everything today going just fine? Perhaps it is a little of both? It might do us well to take a look at the term, "crisis."

According to Webster's, a crisis is a crucial stage or turning point in the course of something. It properly means the "ability to judge." Hippocrates said that all diseases had their periods, when the humors of the body ebbed and flowed like the tide of the sea. These tidal days he called critical days, and the tide itself a crisis, because it was on these days the physician could determine whether the disorder was taking a good or a bad turn.

Orthotown Magazine considered that it would be valuable to survey some of our Townies about the status of our profession to ascertain if it "was taking a good or a bad turn." The response was very prompt and the comments were varied but also significant. Our editor, Benjamin Lund, summarized the survey with some of the more meaningful responses both "good and bad." Read what resulted herein...

—Wm. Randol Womack, DDS
Editorial Director, Orthotown Magazine

I inherited large teeth. Having large teeth, I was destined to spend some time with an orthodontist to straighten out my crowding problem. For two years I was in and out of the office of my orthodontist, Dr. Tom Murphy. It felt like I wore those brackets and wires for eons but I'll always remember the relief I felt the day my braces came off. What sticks with me the most is how mature I looked - no more crooked teeth, no more metal mouth. It was all worth it!

Things have certainly changed since my visits with Dr. Murphy all those years ago, especially in the last 10 years. What used to take hours and several appointments to accomplish, orthodontists can now do in a 30-minute sitting. Thinking forward about the next year in the 21st century, Orthotown Magazine surveyed several Ortho Townies about how they view the changes they've experienced over the years, as well as the challenges they see moving forward. Knowing full well what these changes mean to you, the orthodontist, our goal is to focus our features and articles for 2009 on "the good, the bad and the ugly" of what the profession is facing in the year to come. Thus the purpose of our survey.

The survey questions addressed four major issues: 1. How is your practice different today vs. five and/or 10 years ago. 2. What technologies are you using today that you couldn't do without? 3. What are the biggest problems facing orthodontics today? 4. What change (good/bad) do you expect will happen in orthodontics in the next five years?

There were a few survey responses that mentioned the negative side of Invisalign with specific reference to general practitioners' increasing use of the product. However, many stated that this product has changed the focus of orthodontics for practitioners and patients alike. It has brought patients into the office who wouldn't have come if the only option were metal braces, and it's had major impact on ortho relapse patients who were lax in wearing their retainers, who want their teeth re-straightened but don't want to wear brackets and wires ever again.

Dr. Matthew Mayers, aka "like2drill," indicated in his survey answers that he cannot live without digital pictures and X-rays as they are "invaluable for patient and referral communication." In the column "The Digital Revolution" by Orthotown Editorial Director Dr. Wm. Randol Womack in the June 2008 issue of Orthotown Magazine, he emphasized how digital imaging has revolutionized communication with patients. You don't have to wait for film to be developed anymore, dark rooms have become obsolete and imaging is instantaneous.

Several technology-you-cannot-live-without-responses indicated that self-ligating brackets (part of Orthotown's November 2009 focus) have shortened office visits for changing wires and, according to Dr. Robert Kelleher of Folsom, California, they offer "better efficiency and less stress with controlling cases." This type of low-friction bracket has decreased chair time to change arches and has increased the interval between appointments.

Several other popular technology changes indicated by the survey results included temporary anchorage devices (TADs), non-compliance treatment, indirect bonding, robotic arch formation, computerized charting, digital imaging, the increase in the adult patient population and practice management software.

Of course, not all of the changes over the last decade have been a boon to the profession. The question of problems facing the profession included a reference to our increasingly litigious society, as evidenced by the survey comment made by Dr. Elliot Taynor of Port Jefferson Station, New York, "I practice more defensively. I advise, document and write everything I say and do."

The survey answers produced many other overarching concerns regarding the future of the orthodontic specialty. Dr. Mark McDonough of Pennington, New Jersey, wrote that the orthodontic specialty needs more people to go into teaching. "It is a very good way to stay current. More people should be involved. It's our future," says McDonough. Dr. Miki Kuftinec from the NYU orthodontic department speaks about this issue from direct experience, "We have fewer and fewer career and dedicated educators, [including] department heads, program directors, and full-time and part-time clinical faculty." In an e-mail, Dr. Kuftinec explains that the withering orthodontic educator crisis has been an ongoing issue for more than 20 years - primarily due to compensation issues and academic pressures. "When we hire new full-time faculty members and pay them $80,000 - that's only half of what they could get if they associate in a private office, and they'd work less in the office too," says Kuftinec. Orthotown Magazine is taking a look at this issue for future discussion in 2009.

The current economic downturn has mixed responses from two orthodontists. "Barring a depression, only good will come to the orthodontic specialty," says Dr. Taynor. "It will continue to be a requested and desired service for more than just the 'straight teeth' effect." And Dr. Kelleher says, "Economic pressures and an aging population will likely diminish demand for orthodontic care, however people's vanity is as strong or stronger than ever, so that continuing demand may not be a problem."

In his survey answers, Dr. Clark Colville of Seguin, Texas, expressed concern about lack of consumer awareness. "Who and what an orthodontist is would be the biggest challenge we (orthodontists) face today," says Dr. Colville. "I think the biggest problem is the debt burden new and young orthodontics carry, which forces them to practice with severe constraints and negative influences," says Dr. Ken Fischer of Villa Point, California. This sentiment, echoed by orthodontic resident, Dr. Matt Nondorf, is surely on the minds of other orthodontic residents as they enter the professional arena.

More than one of the respondents expressed concern about the current trend of general practitioners starting orthodontic treatment on their own patients. To quote one respondent, his main concern is, "Super GPs who believe they can treat everything with Invisalign, veneers, and implants." Another voiced his concerns about "misrepresentation by GPs."

On the other hand, respondents like Professor & Chairman of the Department of Orthodontics at the University of the Pacific Dr. Robert Boyd suggested that orthodontists and dentists need to work as a team and that orthodontists "would be better served if they would form study groups with other dentists in their areas to help them rather than just standing back and being negative that we do not get to do 100 percent of all orthodontic treatment."

While there does not seem to be an easy solution to these predicaments, they certainly seem to be influencing the outlook on where the profession is heading.

Many respondents indicated some positive things sure to come in the next five years. In regards to the rise in popularity of cone beam cephalometric tomography (CBCT), the consensus is clear as evidenced by the following survey answers:
  • "More mainstreaming of CBCT records as they come down in price. Standard of care and dose of radiation will have to be universally accepted. Related technologies may take advantage of the 3DCT."
  • "I think technology from a manufacturing standpoint will change the patient flow. Whether from digital impressions or CBCT."
  • "3D imaging will make the decision process easier on many challenging cases we treat."
  • And finally, Dr. Colville states, "I can see that, not too far in the future, the only physical record taken will be a 3D scan, and from that scan we will be able to order custom indirect bonding trays with a series of wires or clear removable aligners."
I realize the information presented here may be facts you already know. So rather than reciting a litany of that which you are fully aware, the conclusion is: The future of the orthodontic profession is in your hands.

So what can you do about it?

There are a lot of options. "Get involved," says Dr. Womack. "Join discussions in orthodontic study clubs and orthodontic societies. Become involved in your local dental society and/or your American Association of Orthodontics (AAO) Section organization. Attend your AAO Section meetings or the AAO International meeting. Communicate with your AAO delegates and/or trustees. Support the AAO's 'More Than Just A Smile' marketing campaign."

Perhaps it's time to become active in a forum where orthodontists, and only orthodontists, can express their honest opinions and get solid answers to their queries. It's time to connect with your colleagues and find ways to work through the issues your specialty is facing. For a profession that has given so much to its patients - be it hope or self-esteem or even simply revealing someone's true smile - it's about time someone gave back to you. I encourage you to join the discussions on the Orthotown.com message boards. Share treatment plans, ask questions, find out about the newest gadgets coming down the pipeline. Starting next year, you'll also be able to earn continuing education credits through our free CE program. Orthotown can be part of your future... as long as you start using it.
Orthotown Magazine
September 2025
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