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The Essence of an Expert

It seems to come as a surprise to many orthodontic students and recent graduates that there may be some disagreement regarding the best ways--and times--to treat the wide variety of malocclusions that we see in day-today practice. In most dental schools, students are presented with very few options; instructors tend to preach that there is only one best way to do a crown, one best way to do a root canal, one best way to make a denture. Invariably, the best way is the way the instructor does it. After the young dentist has spent a couple of years in real-life practice, however, he or she comes to realize that there are actually multiple ways of doing practically any procedure, and that what is best depends as much on the individual operator's experience, skill, and clinical judgment as on some prescribed doctrine.

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The same holds true in orthodontics: there are many ways to treat practically any malocclusion, and deciding which way is best becomes a matter of personal preference. Of course, "personal preference" may also be subject to controversy. One school of thought argues that all clinical decisions should be made from an evidence-based standpoint, while an equally valid school of thought argues that experience-based decision making is more valid in day-to-day practice. As with most philosophical arguments, the truth lies somewhere in the middle, between the two polar opposites. My approach to any controversy in orthodontic decision making and treatment planning is to marshal all the pertinent evidence in the literature while exercising my own critical thinking skills and clinical judgment, derived from more than 30 years in practice.

I also strongly value, and still frequently seek, the views of experts in the field, whether through orthodontic journals, conventions, or proprietary courses. To qualify for consideration, I believe an orthodontic expert needs to meet three criteria: a strong background in the international scientific literature, paired with the ability to apply the information gleaned from that literature; a substantial, economically viable practice with at least several thousand of malocclusion; and an open mind--a willingness to change course in the light of new evidence, rather than mindlessly adhering to the dictates of any one treatment philosophy or orthodontic guru. Obviously, these criteria narrow the field of worthy experts to a select few.

One who easily satisfies all three qualifications is Dr. Jim McNamara. Dating back to the early days of my orthodontic training, I have read every paper that Dr. McNamara has written and attended many of his lectures. While I haven't agreed with everything he's ever said, I would find it difficult to debate him on any orthodontic topic. I had the good fortune to interview Dr. McNamara nearly a year ago at the annual meeting of the Pacific Coast Society of Orthodontists, where he was a featured speaker. That turned out to be one of the most productive, informative, and enjoyable times I've spent in my life as a dentist, orthodontist, and journalist. The interview (originally suggested by our Contributing Editor, Dr. Elliott Moskowitz) appears in this issue and next month's edition of JCO. Summarizing his entire career, Dr. McNamara addresses a number of topics, but all of them seem to circle back to one of the greatest controversies still facing our specialty: early treatment. To put it succinctly, his grasp of this subject is extraordinary. I don't recall any other American orthodontist who has combined such an extensive background in clinical research with such a long-established, highly successful private practice. I trust that you will gain as much from reading my interview with Dr. McNamara as I did from conducting it.


Dr. J. Daniel Subtelny, 1922-2014

The profession of orthodontics has lost one of its giants--one who possessed all the qualities of an expert I described above, and many more. Dr. J. Daniel Subtelny died peacefully in his sleep during the night of Sept. 17 at his home in Pittsford, New York. He was 92. Dan trained two of our Contributing Editors, Drs. John Graham and Sarah Shoaf, along with me and nearly 300 other orthodontists who now teach and practice all over the world. Dr. Graham's JCO column, "Hot Seat", is named after Dr. Subtelny's intimidating weekly seminar at the Department of Orthodontics in the University of Rochester's Eastman Institute for Oral Health. Dan founded that department in the mid-1950s and continued to lead and teach there until his dying day.

Dr. Subtelny's list of accomplishments would be too lengthy to publish in their entirety. He is the only orthodontist to date to receive the four highest honors of our profession: the Milo Hellman Research Award, the Louise Ada Jarabak Memorial International Orthodontic Teachers and Research Award, the ABO Albert H. Ketcham Memorial Award, and the James E. Brophy AAO Distinguished Service Award. He had a remarkable career as a professor, a researcher, a teacher, and an accomplished private practitioner who personally treated thousands of patients, many with debilitating craniofacial disorders. He was probably the world's leading authority on the orthodontic management of cleft lip and palate.

I'm sure I speak for Drs. Graham and Shoaf, for the hundreds of other orthodontists whom Dr. Subtelny trained, and for the tens of thousands of patients whose treatment he shaped when I say that Dan was our teacher, our mentor, our role model, and our friend. He will be missed terribly. Dan: Thank you so much for all you have given us.



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