THE EDITOR'S CORNER
The growing rate of divorce in the United States is becoming a serious problem in orthodontic practices. The National Institute of Mental Health estimates that 45% of children born this year will live in a one-parent household at some time before they reach age of 18. In some places today as many as two-thirds of children under 18 are estimated to have divorced parents. Add to this one more statistic, that 46% of children under 18 have mothers who work, and you get some measure of the change that has occurred in parenting.
Psychologists seem agreed that divorce has a devastating affect on young children. It undermines their self-esteem and leaves them with deep feelings of guilt, fear, and anger. It may manifest itself in dropping out on the one hand or anti-social behavior on the other. Frequently these children lose confidence in themselves and interest in their lives and engage in behavior which is damaging to their future. Their school grades and behavior deteriorate and, what is important especially for the orthodontist, their interest in and cooperation with their orthodontic treatment evaporates.
The need and/or desire of mothers to work also changes parenting and the extent of parental obligations to children. Many employed women cannot get time off to deliver children to the orthodontic office, creating another kind of poor cooperation (in keeping appointments). This may even have implications for orthodontists about office hours and practice locations. More orthodontists may consider starting at 7 A.M. when parents can deliver children to the office and then to school. And more orthodontists might consider locations adjacent to or convenient to schools so that the children can get to the office on their own.
With divorced parents and working mothers, no one is "minding the store". Children are more on their own and supervision of their orthodontic cooperation at home declines or disappears. The combination of lessened interest on the part of parents and lessened supervision of children in their formative years is certainly sowing the seeds of psychological problems for a percentage of such children now and in the future. Some children may survive these conditions, some may have a rough time until they reach 18 or 20 and may be more or less out of the house anyway, some will have persistent psychological problems for life.
As the number of children of divorce and of working mothers increases, an increasing number of children in orthodontic practices are becoming victims of this receding parenting along with their orthodontist, who is also an unwitting victim. The orthodontist is faced with the serious problem of growing numbers of indifferent or antagonistic patients. He is increasingly stressed and frustrated by poor cooperation on the part of a large and growing percentage of his practice. He cannot achieve the result he plans for and in time he may acquire a large number of patients in limbo and past their estimated completion date with no successful end in sight.
The orthodontist's role is not that of a surrogate parent. It would be foolish to think that such a relationship could exist on a once a month basis anyway. The orthodontist's role is not that of a psychologist, although psychology is extensively involved in an orthodontist/patient relationship. The orthodontist's role is not that of a judge. It is not up to him to try to decide who was right and who was wrong. The orthodontist's role is not that of a party to a family's problems, although the problems may be affecting his work. The role of the orthodontist is that of a friend who is supportive of and caring about his patient's welfare; and his role is that of a counselor, but only as a counselor within his sphere of expertise. This does not mean that the orthodontist may not suggest psychological help for the child.
The orthodontist's first effort in eliciting patient cooperation is with the patient, routinely. All patients must know exactly why they are having orthodontic treatment and there must be some transference so that the orthodontist's goals become the patient's goals. This requires a good deal of initial and ongoing patient education, and a sense on the patient's part that the doctor and the staff and the whole office really care whether he reaches those goals. This same effort must be made with parents, including divorced and single parents. They have to know that more is involved on their part than paying the bill and more is involved on the orthodontist's part than straightening teeth.
Above all, the orthodontist's approach should try to avoid being negative. A truly caring approach for the welfare of the child and the success of his orthodontic treatment should dominate over the threat of a poor result, prolonged treatment, additional fee, and parental punishment. While everyone involved must understand--and preferably early in the game--that all of these are possible, they must also understand that unsuccessful treatment is damaging to the orthodontist's self esteem as well and that this negative consequence is not erased by additional fees or assignment of blame.
