Orthodontics is very much an art as well as a science. The styles of treatment varying from one orthodontist to another can be very confusing. Oftentimes there is no “right” answer because a successful orthodontic outcome depends on the skill of a practitioner utilizing a particular method. When orthodontists cannot even agree then what is a consumer of healthcare to think?

I’ll try to break this down into what I consider are the 3 major areas to consider when deciding on an orthodontist and an orthodontic treatment plan: ART, EXPERIENCE AND SCIENCE

ART:
Smiles are not one size fits all. David Letterman’s smile looks good on him but Beyonce or Julia Roberts have smiles that light up the screen in a different way. The best smile must take into account what nature gives us to work with. As an orthodontist I have to consider aging, gender, race, bone structure, and even how much the upper lip curls during a hearty laugh. Orthodontics must be personalized.

EXPERIENCE:
I have over 22 years of experience as a dentist. After dental school I attended an intensive one-year General Practice Residency to gain depth of experience in all areas of dentistry including pediatrics and operating room work. I then practiced as a general dentist with an emphasis in surgery for 11 years. My orthodontic residency at Ohio State was a 3 year Masters level program. Orthodontics is my specialty. If considering orthodontics by a general dentist please realize that orthodontics will be one skill amongst many and will likely have been learned at a weekend seminar.

THE SCIENCE of ORTHODONTIC CONTROVERSY:
Which brings us to the last topic: the scientific basis of orthodontics. I rely heavily on art and experience but I consider the bedrock of my orthodontic practice to be what is called evidence based care. All healthcare exhibits some level of uncertainty but if I rely on what the best and brightest tell us in the scientific literature then we should be one step ahead toward a great outcome.

Who really needs orthodontic treatment?
This is such a troublesome question that this is what I did my research and thesis on at Ohio State. I use a set of criteria called the Index of Orthodontic Treatment Need to help make this decision. It takes into account not only the esthetics of the smile but also health issues such as potential for excessive wear, gum disease, jaw joint problems and trauma. This Index of Need is what we will accomplish and discuss at the evaluation appointment.

What is growth modification?
Most people associate orthodontics with crooked teeth. However, a disharmony between the sizes of the jaws is a common problems. If the lower jaw is too short for the upper jaw, then the top teeth stick out. If the lower jaw is too large, then an underbite results. A great goal of the orthodontic profession is to influence these undesirable growth patterns in a favorable way. Unfortunately, the science tells us that we can affect the timing of the growth but not the total growth in any significant, reliable way. The body is genetically programmed to grow to a certain endpoint. I believe that the use of growth modification should be limited to correcting damaging malocclusions and whenever possible should be combined with comprehensive therapy in a single phase rather than as a separate early phase.

When is early treatment indicated?
There are strong opinions both ways in the orthodontic community. The strongest evidence I have seen comes from the University of North Carolina and the University of Florida. Their very good studies showed that early orthodontic treatment, (ages 6 to 11), results in a noticeably improved smile at that age but at the risk of more appointments, more time away from school, greater cost and the orthodontic outcome at age 15 is not signicantly better than when compared with patients who went through a single later phase of treatment. In my practice I strive to treat patients like my own children. This means as often as possible treatment in a single phase starting at about the time the last baby teeth are lost. The exceptions when I will recommend early treatment are:
1) crossbites that may damage the teeth or cause growth problems;
2) permanent tooth eruption problems; and
3) managing the extra space from the baby molars to help align moderately crowded anterior teeth.
It is normal for children to go through an “ugly duckling” stage as they lose baby teeth and gain permanent teeth. If I recommend early treatment, I want the parents to be comfortable that the decision is based on achievable objectives and is not a convenience or economics issue.

Extractions: This is another area of strong opinions and controversy. I will make every effort to avoid the extraction of permanent teeth. However, extractions are often the right thing to do depending on objectives. The avoidance of extraction of teeth at all costs is often inappropriately labeled “conservative treatment”. In fact, the extraction of teeth may be the most conservative treatment if your goals include protecting the gum tissue from recession, a stable end result and the most pleasing esthetics. The Fall 2008 newsletter covers this topic more in depth.

If I could sum up my treatment philosophy in one line it would be:

Do the right thing at the right time for the greatest benefit with the least cost and risk.