THE EDITOR'S CORNER
It is the contention of many periodontists and prosthodontists that it is they who see our orthodontic cases as adults and that it is they who inherit the whirlwind of destructive forces set in motion years earlier through our orthodontic treatment. Our cure, they are saying, is often no better than the disease and perhaps worse. Whether the allegation is true or not--and it is all too easy to blame orthodontic treatment for all the ills that the dentition is heir to--it discloses a distressing lack of communication, if not antagonism, among dentists.
Generalists and specialists have access to each others literature, but there is no meeting place. On those occasions when meeting may occur because a group of dental specialists may be involved in the treatment of an adult, it is already too late. This is pointed out in an excellent article by Dr. Herbert Fine, the concluding installment of which is in this issue of JCO. It is usually the prosthodontist who calls the tune and the others are more or less delivering adjunctive treatment to the prosthetic reconstruction. Dr. Fine demonstrates that there are times when the orthodontist can "spoil" the prosthetic plan unwittingly by carrying his treatment to a point at which the dentition is satisfactory to the patient without further prosthetic reconstruction. We must also recognize that there are times when the orthodontist, doggedly pursuing in an adult treatment standards he has set for children, really does spoil a prosthetic solution or unnecessarily prolongs treatment time, discomfort and expense.
By training and attitude we have become too channelized. What we need you could call the power of vertical thinking. What we do now is horizontal thinking. We operate on one level, devoting our lives to a specialized body of knowledge to the exclusion of other knowledge in the same profession. Without devoting less time to the specialized knowledge, we need to incorporate that knowledge into a comprehensive understanding of dentistry at a sophisticated specialty level.
There are various ways of trying to accomplish this. The most obvious one is to conceive of a program of postgraduate dental education that is truly continuing and comprehensive. A second way lies in group practice. When we hear that group practice is the way of the future, it is generally from government or insurance groups advocating it as possibly a more economical way of delivering dental care and as an easier way to control quality and performance. I am referring to vertical groups, teaming up one or more generalist, periodontist, prosthodontist and orthodontist in a single group practice. It may take practices like that to be able to fulfill all the constraints of common knowledge, coordinated effort and continuity of treatment that may be required to treat an adult dentition properly and assess the influence of orthodontic treatment on the life and health of the dentition.
Additional unifying media could be created by interdisciplinary meetings or workshops and interdisciplinary study clubs. Somewhere the glue is missing from general dental meetings and postgraduate dental education. There is an urgency about developing some of these ways of supplying the glue, of overcoming the narrowness of our channels of specialization, the meagerness of our channels of communication and the 100% transient nature of specialized practice. We need a common meeting ground for all of us in dentistry. If we don't avail ourselves of those that we perceive, I believe that we leave the mission of dentistry unfulfilled.
I have mentioned integrated postgraduate dental education, vertical group practice, interdisciplinary meetings and workshops, and interdisciplinary study clubs as potential common meeting ground. Of these, only one is simple and immediately achievable. This is the interdisciplinary study club and we should begin there. I would also suggest occlusion as a unifying theme for the start of such study club activity.
One obvious approach for getting such a program under way would be for an existing orthodontic study club to divert its attention to a study of occlusion and invite dentists from the other disciplines in dentistry to participate. I hope that one or more of the dedicated orthodontic study clubs may be inspired to undertake this project and that they may keep the rest of us informed by reporting their activities and findings from time to time in JCO.
