THE EDITOR'S CORNER
Interprofessional relations is a neglected area with some very real and practical implications for orthodontists. We tend to stress administrative aspects such as methods of communication without actually succeeding in communicating. We try to keep general dentists informed of our diagnosis and treatment plans. We communicate referrals for caries and extractions. We do various things for the promotion of favorable relationships with other professionals and with other orthodontists for efficient administration and patient care, for image and practice promotion.
Our lines of communication run so often down a one-way street with no obvious effect that one can only conclude that something is missing from interprofessional relations and that the result has been an isolation of the orthodontist from other professionals.
More than mere isolation is the detrimental effect on the success of orthodontic treatment and the happiness and welfare of the orthodontic patient that stems from it. Let me cite a few examples.
1. Your patient is about to begin orthodontic treatment. You refer the patient to his family dentist for a caries check-up prior to placement of orthodontic bands. There is caries on the proximal surface of an upper bicuspid which the dentist treats and fills. However, there is also a space between the teeth next to the cavity. Obviously, to us, the tooth should be restored to its normal contour leaving the space to be closed orthodontically. What does the dentist do almost 100% of the time? He builds his filling proximally across the space to get a good, tight contact with the next tooth. What do you do now? Do you send the patient back to the dentist? Do you adjust the shape of the filling to restore the tooth contour, sometimes with great difficulty? Do you leave the filling the way it is, creating some mismatch of tooth material?
2. Your patient requires a jacket on an upper anterior tooth. You have carefully aligned the teeth and the occlusion is satisfactory. How often does the dentist make a jacket that is too bulky labiolingually? It must either protrude labially and spoil the appearance; or protrude lingually and disarrange the lower anterior teeth; or some of each. How often in making a post-treatment jacket does the dentist not completely fill the space mesiodistally, leaving a space which cannot be closed? How about those jackets placed before treatment, especially on mixed dentition patients? These are so often bulky in the mesiodistal as well as the labiolingual dimension. What do you do then?
3. Your patient is on retention and requires a crown on a molar. How often does the family dentist make the restoration, which almost always will interfere with the seating of the retainer, without making the necessary adjustment of the retainer or referring the patient immediately to you for that adjustment? Or does he not know or not think about the retainer which then just gets left out? Or, how often does he advise the patient not to wear the retainer?
4. How often have you had a family dentist notify you when he had completed all necessary treatment? Especially when you had removed one or more bands and referred the patient for caries with the expectancy that the patient would return as quickly as possible for replacement of appliances and the resumption of treatment. How often has three months gone by before the patient has returned?
5. How often have you had a general dentist place a space maintainer? How often have you had a general dentist place a space maintainer in a space that is approximately one-third of the original space?
6. How often have you had a general dentist communicate with you about the fate of lower third molars? How many times did he make one recommendation and you another?
7. How often have you had an oral surgeon confer with you with regard to the efficacy of his procedures in conjunction with orthodontic treatment? How often has one inquired about how long it is taking for impacted maxillary canines to erupt following his exposure procedures? Would as many bizarre surgical procedures be undertaken if oral surgeons were more aware of what the orthodontic treatment possibilities are and what results can be obtained in a given set of circumstances?
8. How often has a periodontist consulted with you concerning whether his treatment should be done before or after orthodontic treatment?
9. Have you ever had a reply or a communication from a family physician about a patient? Have you ever been called into a conference on a patient of yours in treatment who was placed in a Milwaukee brace?
We would say that there is something lacking in the education of other professionals. They do not have in mind or keep in mind all the needs of patients in orthodontic treatment. They are remiss in the amount and methods of communication with the orthodontist. Probably stemming from this lack of rapport is a very unfortunate negative aspect of interdental relations which is the predilection of many family dentists to ascribe all the ills that the dentition is heir to in its lifetime to orthodontic treatment. It is very small comfort to be able to pin someone's ears back occasionally and to be able to say, "Aha ! But that tooth never had a band on it." Whether the criticisms of orthodontic treatment are habitual or justified is almost aside from the point. This is not a way to run a coordinated profession dedicated to the health and welfare of the patient. It is a lack of communication that is causing the misunderstandings on both sides of the fence on this important question of short and long term side effects of orthodontic treatment.
If I think that orthodontists are more sinned against than sinning in the area of interprofessional relations, it would be wrong to leave the impression that we do not also contribute to the problem. We have a one-sided view of dentistry. We interfere with the family dentist's domain by covering his work area with appliances and resisting, rightly or wrongly, to uncover so that he can look occasionally. We have avoided making strong individual recommendations to the family dentist, preferring to live with difficult local situations rather than antagonize the dentist. We have been secretive about orthodontic treatment procedures and reticent about discussing problems in orthodontic treatment.
Dentistry owes it to the public to try to improve interprofessional relations. Group practice may be a way. Perhaps the most effective way is to get to the young dental student and teach him not only the generalities, but the practicalities of interprofessional relations and the higher horizons in patient care that could result from a new approach to a neglected problem. 
