Embrace Progress: Politics, Religion and… Yes, Orthodontics by Dr. Daniel Grob

Dentaltown Magazine

by Dr. Daniel Grob, DDS, MS, editorial director, Orthotown Magazine

If there has been one habit of civilized society—or, put another way, keeping peace among friends, family and professional colleagues—it has been to keep your personal thoughts to yourself. When we were younger, our parents told us that when we went to Uncle Bob’s house for Thanksgiving or a party hosted by the neighbor down the street, we should leave the discussion of politics and religion behind. There are so many other topics to bring up, so many comments and observations to mention, that we didn’t have to venture into someone else’s sacred or otherwise untouchable areas.

But differences of opinion are bound to come up even in the most mundane subjects—and more frequently in areas of contention—which means the challenge today is not about whether you have the right to express a contrary viewpoint, but how respectfully you should do so, especially in public forums.

Considering the alternatives

Social values typically were shared among cultures and societal groups. In a less mobile world—at least when and where I grew up, on the wrong side of the tracks—a sort of monolithic group could evolve where members could progress through their entire lives without coming into contact with members of other political or religious groups.

Which meant those groups could become stagnantly consistent. When a family who’s never been able to attend college has that first son or daughter who does, he or she graduates and steps out into society carrying not only a degree but also new, different thoughts and ideas that have been learned from interaction with others in this new environment, or thrust upon them by the institution.

The COVID-19 crisis has delivered yet another way to illustrate how divided our country is as a nation, and how opinionated everyone has become. Numerous comparisons are made to us “all being in this together.” But are we?

People take different sides about wearing face masks, staying home, businesses opening or not opening. Neither the committees that brief the press every day nor the reporters who ask the questions can hide their beliefs. Sometimes it’s difficult to believe anyone, because the facts or attempts at getting them are clouded with so much bias and innuendo.

Challenging knowledge bases

Lately, it’s become a more harrowing experience for an orthodontist to express thoughts and opinions about treatment plans, outcomes, patient management and the like. Too often on our message boards, threads related to genuine calls for assistance or proud postings of cases get torpedoed because of members who post brusque or rude comments about how the original poster’s ideas don’t mesh with their own.

I have many thoughts on this, so please read on.

Most of us are a product of our advanced training programs. In both dental and orthodontic schools, the department chairperson who makes the most noise typically gets to call the shots, which means that school becomes known for that department or is recognized as “the best” in that division or field. The departments we graduate from reflect these skill sets in ways we may not realize, and they influence our initial view of the profession and how we practice. Philosophies vary from department or program to another—some emphasize materials, others clinical treatment, still others a combination of everything. But your view toward orthodontics is shaped early on, and it’s up to you to continue to learn and grow and expose yourself to new things.

Like the first college student in a family learning that there are many other opinions to be respected outside of the particular neighborhood in which he or she grew up, orthodontists have been challenged by the advent of diagnostic devices and new treatment mechanics.

Developing new practices

In the early days of “put your plaster on the table,” we focused on tooth size discrepancies, mixed dentition analysis and the decision to extract or leave teeth in place. We know the story of Charles Tweed regretting his early non-tooth-removal treatment plans and returning with re-treated cases to display that almost entirely rejected the non-extraction approach.

After the rather rudimentary treatment planning we were able to achieve with plaster, a ruler and perhaps some photographs, our profession added the input of cephalometric analysis. This new X-ray device brought dozens of methods to analyze a patient’s facial proportions and gave us new reasons from which to base our decisions. Anyone who mattered invented his or her cephalometric analysis and claimed that the results of utilizing it would clarify the foggy diagnostic process and solve some treatment planning puzzles.

Heck, Dr. Sean Carlson—a world-renowned speaker on CBCT and futurist, to be sure—recently posted an article from the early years that showed just how many clinicians of the era were skeptical that this new device could help us in treatment planning.

My own bias centers on the utilization of articulators—those gadgets some of us used to analyze bites, occlusal planes and discrepancies within the TMJ. I can still remember the heated discussions between Roth and Rinchuse as they pointed and counterpointed the advantages and disadvantages of these contraptions. (I do still believe they are very useful, and they are responsible for my overall respect for treatment mechanics and stability.)

Which brings us to the current state of affairs in orthodontics.

Expanding the industry

Our profession is rapidly transitioning—from plaster to two-dimensional, to mechanical three-dimensional, to radiographic imaging of volumes within the skeleton and the effects of soft tissue. It’s no wonder some of us are struggling with the transition; many of us have not been trained in the diagnostic value of cone-beam imaging and the treatment planning decisions that come from it. Looking at oral and nasal volumes with teeth between the muscles and the air space is a totally different exercise from anything many of us have been taught. It’s no wonder that as I scan the message boards, I can see those who embrace these changes and those who resist.

It used to be just a question of “Do we extract or not?” Now, in addition to that decision, we need to ask if we are to distalize, advance, tip the occlusal plane, expand lateral or sagittal. Suggestions are made regarding airway health, muscle habits and tongue position and function. Some embrace the questions; some say it’s none of our business.

And of course, there is some capitalism mixed in with the new devices and techniques.

You see, with new diagnostic advances and devices comes the need to integrate them into one’s decision-making process, so what some clinicians are looking at to help them with that decision is not a “scam,” useless information or something outside the purview of our specialty.

I encourage all Townies to regularly check and contribute on the message boards with thought-provoking cases and questions, taking all of the new information into account.

We don’t want orthodontics to be a forbidden topic in mixed company—and be sure to share your opinions respectfully.

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