Like many older orthodontists, I spent a number of years practicing general dentistry right after graduation from dental school, before returning for formal, accredited specialty training. The 1980s were a decade of general dentistry for me. My general practice was quite successful, and while I provided a full spectrum of dental care from pediatric dentistry to full-denture prosthodontics, I chose not to offer orthodontic care—unlike many general dentists of the time. My decision was based on the simple observation that I needed a lot more training than some weekend orthodontic classes before I would feel competent enough to deliver the high standard of care to which I have always held myself.
All of us who have left successful general dental practices to pursue formal training in orthodontics have had our own motivations for doing so. Many colleagues have told me they had simply “burned out” on routine restorative dentistry, perhaps not finding it challenging enough. I always found high-quality, full-mouth restorative dentistry to be plenty challenging, thank you very much. Talented general dentists who practice to the highest standards have always commanded my deepest respect and admiration.
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My motivation to specialize in orthodontics was the result of a much more specific and positive experience. It came in the form of a dedicated, young emergency-room nurse who illuminated any room she walked into like sunshine on a cloudy day. Her name was Cecilia—“Cissy” to those of us who knew her personally—and I am convinced that she was a saint on Earth. She had beautiful black hair, an attractive figure, enchanting eyes, and an endearing demeanor that caused everyone lucky enough to know her to essentially fall in love with her. She also had a face that was frighteningly ugly, to put it bluntly. As a result, sadly, she was shy and withdrawn. Cissy came from rural Mexico and was born with a complete unilateral cleft of the lip and palate. She did not receive any treatment as a baby or a young child; by the time her family moved to New Mexico, where my practice was located, she had only undergone surgical closure of the cleft, without any orthopedic or orthodontic care. Through her work as a nurse, she came to know our local plastic surgeons and oral and maxillofacial surgeon, who referred her to the one local orthodontist who treated cleft patients. Cissy came to me for her general dental needs, and I watched with utter fascination over the course of several years as that orthodontist and the team of surgeons treated her facial deformations. Like most cleft patients, Cissy was missing some upper anterior teeth, and it eventually fell to me to provide her final dental restoration. When I cemented her definitive fixed partial denture, I was struck by the overwhelming difference that the interdisciplinary cleft treatment—particularly the orthodontics and dentofacial orthopedics—had made in her facial appearance. While she did have residual scars, and the trained eye could always see the cleft repairs, Cissy’s final facial appearance could only be described as beautiful. It was at that moment, when I saw the look in her eyes and her radiant smile as she looked in the mirror, that I knew I had to become an orthodontist. I have lost track of Cissy over the intervening 30 or so years, but the last I heard, she had married and had a beautiful little daughter of her own. The personal gratification and immense sense of pride I derived from participating in her care were worth more to me than any monetary reward could ever be.
In this issue of JCO, Drs. Ribeiro, Lurentt, Pary, and Suedam from Brazil present a case that reminds me very much of the case that reshaped my career. They present, in fascinating detail, the treatment of an otherwise beautiful young lady whose face was pitifully deformed by a cleft. In reading their article and marveling at their illustrations, I was carried back to the time I spent in Cissy’s treatment. I am quite sure that the authors felt the same satisfaction and emotional gratification when they gave this otherwise beautiful patient a remarkably beautiful face. Who could ask for a more rewarding profession?
RGK
