THE EDITOR'S CORNER
The transient nature of orthodontic practice has tended to isolate orthodontists from the mainstream of dentistry and from general dentists with whom we ought to be strongly allied. Also, the orthodontist has rarely been aware of what has happened to his cases even as little as five years out of retention. As a result, the ills that have befallen orthodontic patients have often been ascribed to orthodontic treatment.
Whether any or all of these things are true, I believe that we are about to see a change that will end the isolation of orthodontists, that will keep them aware of what is happening to a much larger number of their cases following treatment and which will make post-treatment treatment a standard operating procedure in orthodontics.
I have felt that retention in orthodontics has been as much for the orthodontist's benefit as for the patient's and that the patient has not really benefited very much in terms of health, function or stability because of our retention effort. In too many instances, retention has been by the numbers, or because we didn't know what else to do, or for fear that some irregularity would occur or recur. I now believe that occlusal maintenance will replace or reinforce most of our present retention practices.
We all know that teeth are changing all the time. So, why pretend that we do not expect that to happen after our basic orthodontic tooth movement is completed? Why turn a patient out of our practices when what he really needs is maintenance of the occlusion that we have established? Why should we expect the general practitioner to pick up the occlusion at that point? He might be operating on a different occlusal scheme than we established. Or he may not be trained in occlusion. Or he may not wish to interfere in another dentist's case. Or the patient might prefer to have the orthodontist maintain his occlusion.
The key and maturing influence in the orthodontic specialty is occlusion. Once orthodontists accept the fact that mastery of occlusion-- dynamic, functioning occlusion-- is in their province for the patients that they treat; and that the orthodontist must finish his cases to a detailed functioning, healthy occlusion; then, it will follow that, since he knows that the occlusion will change with time, it is his responsibility to maintain the occlusion in a continuing healthy, functioning, comfortable condition. The orthodontist must know the relationship of occlusion to TMJ problems and be able to manage the occlusion to provide the patient with a functioning, trouble-free TMJ as far as possible.
If an orthodontist has this additional service in his armamentarium, he will have less concern in the foreseeable future with declining birth rates, increasing numbers of orthodontists, declining economy, inroads of pedodontists into orthodontics, clinics, closed panels, school nurse programs or anything else you can think of. He will have knowledge at a level at which he will not be replaced. We have taught auxiliaries to perform almost every mechanical task on orthodontics. We can conceivably have a computer print out a diagnosis and treatment plan. What the orthodontist has going for him over all the conceivable threats to his position is that he has the overall knowledge to coordinate the physical, physiological and psychological factors and this will be specifically enhanced by a thorough knowledge of occlusion and TMJ, function and health.
For most orthodontists these services and this concept of maintenance are entirely new. They represent great responsibilities in terms of knowledge, skill, time and effort. They are a new horizon in orthodontic practice, a new service for most orthodontic practices. Aside from broadening the scope of orthodontic service, it is the missing link between orthodontics and dentistry.
It is high time that there occur a detente between orthodontists and general dentists. The welfare of the people requires it and it is in our own self-interest. The future of orthodontics can be secured by the fact that we have a legitimate sphere of interest in occlusion to define and adopt as an orthodontic service.
