THE EDITOR'S CORNER

EUGENE L. GOTTLIEB DDS

In deciding about treatment of orthodontic cases in the past I used to indulge myself in what was then a popular fantasy and consider--"What would I do for this case if it were my child?" And, on case presentation the parents would learn what I would do for the case "if it were my child". If it were my child, at least in those days, there was virtually no condition that would not be treated. Shoemakers' children may get no shoes, but orthodontists' children get orthodontic treatment.

Well, I have long since given up on this approach to orthodontic diagnosis and case presentation. I now ask myself a different question--"Can I do enough good for this child to warrant the expenditure of time, effort and discomfort on the patient's part; the possible wear and tear on the teeth; the time, effort, aggravation and money on the parents' part; and the time and effort on my part?" If the answer to that question is "Yes", then I have a substantial basis for recommending treatment.

There are cases to which the answer may be "No" and for which treatment should possibly not be recommended.

A case with otherwise acceptable occlusion with irregular lower anterior teeth. The only conceivable job you could do is to straighten the lower anterior teeth and to keep them straight. If you straighten them only to have them become irregular again in this case, you have done nothing. You have done worse than nothing.

A case of a 14-year old boy with a mild Class II malocclusion--say less than half a cusp--a marked overbite, a borderline protrusion, no other irregularities. Is it worthwhile to extract teeth to correct the problems that he has? If you don't extract, will your technique make him more protrusive?

A case with a perfect occlusion and a marked bimaxillary dental protrusion. Can your technique accomplish enough improvement to warrant the treatment? How have bimaxillary retractions been working out in your hands? Have you looked to see?

A case with a bimaxillary dental protrusion with marked crowding and irregularity in both arches. It has already been treated by another orthodontist. There are marked root resorptions. Do you risk further wear and tear to the teeth? Are you sure that you will succeed where someone else has failed?

A case of a 50-year old with a Class III malocclusion, with irregular upper and lower anterior teeth. The patient is referred by the dentist who is beginning to see loosening of the anterior teeth. Can you make it worse ?

So, there are various kinds of orthodontic cases about which the orthodontist may have reservations strong enough to cause him to recommend no treatment in spite of the presence of an obvious orthodontic problem.

Now comes an even harder question for you. Suppose in each of these cases the patient and/or parents want to have treatment in spite of your reservations. If you go ahead and treat under these circumstances, is it enough for you to inform the patient and parents fully about your reservations on treatment? Does that take you of the hook? No sir! That puts you right on the hook. You are undertaking a case that you think cannot or should not be treated by you. It won't do you a particle of good to remind the patient and parents later on that you really didn't want to take the case in the first place. They forget. It doesn't do any good to show them a carbon copy of your letter carefully explaining the pitfalls. The only fact that remains clear is that you did undertake the case and once you did, it is no different than any other case.

The answer is really very clear. If you feel that you are not going to accomplish enough good for the patient to warrant the expenditure of time, effort and discomfort on the patient's part; the possible wear and tear on the teeth; the time, effort, aggravation and money on the parents' part; and the time and effort on your part, don't undertake to treat the case.

Journal of Clinical Orthodonics

THE EDITOR'S CORNER

DR. EUGENE L. GOTTLIEB DDS

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