THE EDITOR'S CORNER
To Each His Own
Orthodontists tend to look upon the many technological and clinical advances of recent years as boons that have made their lives and those of their staff members easier, better, and less stressful, and their treatment faster. All that is certainly true, but it overlooks the idea that these advances provide equal benefits for patients. It is important to recognize this point and to make patients aware of the improvements being made on their behalf.
Bonding has been a multiple blessing for orthodontists. No more separations, fitting of bands, hammering bands into place, cementation, concern about decalcification under bands, and closure of interproximal spaces after band removal, all of which involved great amounts of time. But look at it from the patient's point of view. Elimination of painful or uncomfortable procedures in separation and in fitting and cementing. No more unsightly "metal mouth". Great savings of the patient's time. Patients ought to be made aware of the importance of bonding to their welfare.
For orthodontists, small brackets, ceramic brackets, tooth-colored wires, lingual appliances, and now Dr. Burstone's fiber-reinforced composite appliances (JCO, May 2000) may be marketing tools; some of these, such as self-ligating brackets, may even speed up treatment. But patients also benefit from the improved appearance and faster treatment. With innovations in wire technology, we move teeth faster and with lighter forces, but there is a reflected benefit to patients in less painful tooth movement and longer intervals between visits. We look upon longer appointment intervals as helpful to scheduling and as permitting us to see more patients. Let's not forget that patients' and parents' time is as important to them as ours is to us.
Computer imaging permits orthodontists to enhance a case presentation by altering the patient's face in anticipation of various effects of treatment. For patients, this tool can contribute substantially to their understanding of the objectives and potential results of proposed treatment. The scanning tool used in Dr. Sachdeva's recently reported system (JCO, April 2000) provides orthodontists with an accurate, three-dimensional computerized view of the patient's dentition for diagnosis, treatment planning, location and placement of brackets, and monitoring of treatment progress. While this may represent the cutting edge of technology in orthodontics, a side benefit is that it eliminates impression-taking for orthodontists and staff--and, more important, for patients.
We tend to look upon non-compliance appliances as a way to finish treatment in difficult patients, and as a means of reducing stress for doctor and staff. Actually, in cases in which these appliances do not compromise treatment results, they help patients just as much by eliminating the need for them to remember their part in treatment, or to be nagged about it by their parents and the orthodontic office. I have the feeling that even patients who seem to be cooperative are often operating at a relatively low level of cooperation; if so, these appliances can be beneficial in almost any case.
For orthodontists, fixed retainers are a surer way of protecting a treatment result against flagging cooperation and breakage or loss of appliances. For patients, fixed retainers are more comfortable and less of a problem in speech and hygiene than removable retainers, and they eliminate the family crises that removable wearers experience when their appliances are lost or broken.
Orthodontists have long been creative in offering installment-plan fee payment. This has not only improved case acceptance, but has given practices a relatively predictable stream of income. Of course, it has been a boon to patients as well, making orthodontic treatment affordable for a great many people. Now, with various fiscal intermediary plans from banks and companies such as Orthodontists Fee Plan, and with the acceptance of credit cards, both orthodontists and patients can benefit from automatic prepayment and payment.
Innovations that are of such great advantage to orthodontists often have a corollary benefit to patients. An effective case presentation would let them know about these advances before the fee is discussed.