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Several years ago, I wrote an editorial that reflected that orthodontics was considered the ‘Number 1 profession’ in the USA. Despite the challenges we have all faced in the past few years, I certainly still firmly hold this view.
The reason I find orthodontics so interesting is that each and every patient encounter is a step into the unknown. We deal with variation, rarely disease, and as such our decisions are not binary, but more nuanced and cerebral, from the initial diagnosis and treatment planning to the decisions made at every visit. It is always a very pleasant surprise when seeing patients, and comparing the current situation with that 6 weeks ago, to see that various clinical parameters have improved. A small reduction in overjet or overbite, a diminishing extraction space or an improvement in sagittal relationship or the interdigitation in the buccal segments is positive affirmation that whatever clinical treatment was performed at the last visit, was indeed the correct thing to do. We can then pat ourselves on the back and reflect on how good we are at our jobs.
However, far more can be learned when treatment does not go according to plan. If the overjet or overbite has increased, or perhaps the canine relationship has deteriorated, then this is an undeniable proof that whatever clinical ministrations were applied at the last visit were not necessarily in the patient's best interest.
It is incumbent upon our trainees to be able to identify what they did to make the malocclusion worse, and to make a note not to perform that particular intervention again in such a case. This, of course, requires diligent recording of each and every case with photographic evidence.
Isn't it wonderful that on a visit-by-visit basis, by correct reflection on the clinical measurements and records, we have confirmation that treatment is moving in the right direction, or conversely, set the alarm bells blaring, suggesting we need to choose a different path. Every single patient episode presents a unique opportunity to learn more about clinical movement of teeth and the overall management of both malocclusions and patients.
Review clinics are also equally fascinating because photographs from the previous year or two can be studied. Where judicious inactivity or perhaps extractions were recommended, we can instantly confirm whether the right or wrong decision was made, and once again an invaluable opportunity to learn about case management is provided.
To be able to pass on the value of appropriate decision-making to the next generation of trainees is a privilege. We can provide evidence of what works, and why it works, and how quickly it works. Equally we can show them what doesn't work and offer reasons for this deterioration, by virtue of the photographic documentation.
I've been intrigued by why and how teeth move for the past 40 years. I know that I've managed to pass on this fascination to many of the trainees with whom I've had the privilege to work. I now rely on them to do all the ‘heavy lifting’ and keep me up to speed as the old man in the department. It is now up to this next generation of orthodontists to ensure that the love of the ‘Number 1 profession’ continues. As for me, it has been a privilege and a pleasure for my entire career.
A fascinating 3 hours spent placing magnets, last month.