THE EDITOR'S CORNER
Have you noticed that the Johnson & Johnson Company is aiming its TV commercials for baby powder and baby shampoo for use by the adult population? The significance of this should not be lost on orthodontists. Here is a multi-million dollar company two of whose major products have been traditionally tied to the infant and child population. Company officials have read their future in the statistics for population growth projected over the next 15 to 20 years and the growth trends based on known numbers. They know that their percentage of the baby market will have to go down in the presence of a significant decline in births in this country.
Orthodontics is a service that has been traditionally tied to the child population. The same numbers that the Johnson & Johnson people looked at are available to orthodontists. Reading them, orthodontists ought to come to the same conclusion. Future growth in orthodontics lies, to a considerable extent, in the adult population. There is, to be sure, a large unmet need in child orthodontics. The unmet needs of years past resides today in the adult population.
Apart from significant increases in third party insurance coverage, some of which we have already seen, it is not likely that orthodontics will soon be a major part of the third party health dollar. The cost factor has limited its inclusion in third party programs and will continue to do so in a tight economy. This may well be a blessing in disguise. Inclusion of orthodontics on a large scale in third party programs could easily result in a significant assault on orthodontic fees, merely on a basis of what such programs would or could afford for orthodontic treatment. This could not only affect the economics of orthodontic practice for the wrong reason, but also the standards and quality of care as well. Similarly, since it is not likely that orthodontic treatment for adults will soon be included in third party programs, emphasis on adult orthodontics may contribute to the preservation of private orthodontic practice in this country.
Another factor is the apparent increase in the amount of orthodontics for children that is being done by pedodontists and general practitioners which seems headed for further increase.
Whether or not an orthodontic practice has as yet experienced a decline in consultations, starts and/or income, the time has come to take a realistic look at the obvious and get into adult orthodontics. To do this, I believe that the orthodontist is going to have to reorient his practice administration and treatment procedures.
Treatment Procedures
The most important of these is in treatment itself. If we try to treat adults as we have been treating children, we are going to create untold havoc for our patients and ourselves. Older tissues and joints won't accommodate so well to the average present style of orthodontic treatment. We have been treating to a static Angle classification to produce a good set of interdigitated models. We then expected that some continued growth, some readjustment would "settle in" this occlusion so that it would continue to look reasonably good and achieve some stability before we dismissed the patient. Treatment of adults will have to include a thorough knowledge of occlusion and occlusal adjustment, and the TMJ and its relationship to occlusion. The orthodontist must become expert in these two areas. He must take courses, read books, form study clubs, study the patients in his practice.
Next, he must look to his diagnoses. The cases will be experiencing little or no growth. This may simplify diagnosis to some extent, but it places a new emphasis on careful diagnosis. The leeway of growth does not exist.
Treatment procedures will have to be more comfortable and efficient. It seems likely that, for a variety of reasons, the bonding of clear plastic brackets will be a way to go. Case finishing is going to be a whole new ballgame, with more precise techniques to well-delineated goals of occlusion; with proper methods of occlusal adjustment and the recognition of the need for long range recurring occlusal adjustment care as the province of the orthodontist.
Administrative Procedures
There has been a popular concept that you handle adults the same as children. Maybe so, when adults were an insignificant part of a practice, but we may find that a good deal of our practice administration needs to be altered to an adult level. While there may be someone other than the adult patient responsible for payment of the fee, office communications and educational procedures will not be directed at parents and letters and instructions must reflect that. There will need to be less negative input into the relationship and more supportive and understanding treatment. Changes will need to be made in methods of scheduling which are geared to children's schedules, to school hours, and to mothers transporting children. We will have to look into office design and decor. We will have to find out how adults feel about mixing with child patients in open bay operatories. We may have to go to semi privacy. We will have to find out how an adult reacts to an office with a decor geared to young children. We may have to make the decor somewhat more sophisticated and attractive and interesting to adults. Office location may need reevaluation. Heretofore it has been geared to the convenience of children coming by themselves from school.
So, just as we were becoming more proficient in the treatment and management of the child patient, events seem to be conspiring to force us to make some changes. But, I believe that nothing will be more important to the orthodontist than to recognize and accommodate to the conditions that exist.
Building an Adult Practice
How does one build an adult practice? First and foremost, recognize that adult orthodontics is different in many ways from child orthodontics, and master the art. Above all, study occlusion and TMJ and learn a proper system for understanding and treating both. Dismiss the concepts of static occlusion and orthodontics as a transient practice. Accept maintenance of occlusion and TMJ as the province of the orthodontist. Treat adults as adults and handle their practice administration on an adult level. Spend time educating adult patients about orthodontics. Get out into the community in ethical ways and spread the word about adult orthodontics.
Go to the general dentists and let them know that you are serious; that you have gone back to school, if you have, to learn more about treating adults; that you are more cognizant of the problems and solutions now and you want them to be, too; that you want to work more closely with them. Orthodontists must get into the mainstream of dentistry and make the general dentist realize that we are a knowledgeable and cooperating member of the dental team, that we are interested in his patient's welfare, and that we know what we are doing.
Future of Orthodontics
Child orthodontics remains and will remain the major portion of most orthodontic practices and we are not abandoning the field. In fact, new knowledge about occlusion and TMJ, which are essential for operating in the adult field, will have a very salutary effect on the quality of orthodontic results for children. This new approach to orthodontics will not only distinguish a practitioner capable of dealing with adult problems, but will become the standard for orthodontic treatment for everyone.
Get into adult orthodontics. Learn what you need to know, reorient your treatment and administrative procedures as need be, build the adult case load in your practice. It will have to make you a better orthodontist and one who is more secure.
