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Down with Dogma

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Down with Dogma

As I write this, the nation is winding down from aspirited presidential election. No matter which candidateyou chose to endorse, you had to endure the harsh accusationsand questionable criticisms from the other side.Now, I have never been content to be silent on any issueabout which I have strong feelings, but the very idea ofnarrow-minded partisanship has always baffled me. If acandidate's positions meet my own personal criteria forideological content, honesty of intent, and practicality ofimplementation, I am going to vote for that person, regardlessof party.

The same outlook applies to my clinical decision-makingprocess. Over the course of my orthodonticcareer, I have been intimately involved with three differentgraduate orthodontic programs: one on the East Coast,one in the mid-South, and one on the West Coast. Althoughaccreditation standards require that all programsin advanced orthodontic education offer more than justone treatment philosophy, in most cases the differencesare little more than variations on a common theme--forexample, using both .018" and .022" bracket slots. Mostprograms have a dominant treatment philosophy, primarilydefined by a particular appliance system.

This "dominant system" approach has many pragmaticadvantages: simplification of logistics in the clinic,ease of coordination among the faculty, and avoidance ofbaffling information overload for beginning students. Butthe approach has a fatal flaw, which can be summarizedin one word: Dogma. An online dictionary defines dogmaas "an authoritative principle, belief, or statement of ideasor opinion, especially one considered to be absolutelytrue". I learned early in life that there is no such thing asabsolute truth, and many 20th-century philosophers andscientists, from Dewey to Heisenberg, felt the same way.I would no more adhere to one exclusive treatment philosophyor appliance system than I would vote a straightparty ticket.

I trained in a program that placed a heavy emphasison equilibrium of muscular forces and employed suchappliances as functional bite blocks and lipbumpers. You can imagine my surprise when Iaccepted a faculty position in a program that heldto an extractionist philosophy and was told thatbite blocks and lip bumpers were not valid treatmentmodalities. This department relied heavilyon extractions and J-hook headgear. The programwith which I am currently affiliated teaches variousstraightwire modifications of the diagnosticand mechanical philosophies first expounded byCecil Steiner. Amazingly, however, when I comparethe cases presented by each of these orthodonticdepartments in the annual resident casedisplays at the AAO convention, they look muchthe same--all very good. I have concluded thatdogmatic adherence to any one clinical decision-makingprocess is, like partisan politics, a voluntarysurrender of one's critical thinking skills.

Since long before I took the reins as Editorof JCO, this journal has served as the primarymedium for the presentation of new orthodonticideas, new appliances, and new philosophies ofdiagnosis and treatment planning. As such, wehave been praised by some for treading new territory,and damned by others for violating a varietyof orthodontic dogmas. If that remains thecase, I will feel gratified about the direction ofthe journal. As a case in point, the current issuepresents some ideas for approaching such commonproblems as Class II malocclusions, ankylosedteeth, overerupted molars, and facial asymmetries.There are those who will find these ideaslogical and the techniques worthy of clinicaltrial. On the other hand, there are those who willsee them as infringements of more conservativedoctrines and therefore unworthy of consideration.

In orthodontics, as in politics, rather thanadhering blindly to habitual dogmatic approaches,I strongly encourage all our readers to exercisetheir own critical thinking faculties.


Editor in Chief, JCO. E-mail: rkeim@usc.edu

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