Abstract
The phrase “physician, heal thyself” has Biblical origins. Simply stated, it advises correcting (y)ourself before correcting others. So, why such a profound thought for an Editorial. It is just that the orthodontic fraternity often finds itself at crossroads. The not so recent event was the transition from Begg/Edgewise to Pre-Adjusted Edgewise or Modified Edgewise as the purists prefer. Now, we have in our midst, “Clear Aligner Therapy” (CAT) and its many avatars which have been branded as “disruptive technology.” A recent systematic review reported that the use of clear aligners made no significant difference to treatment time compared with conventional appliances. 1
This Editorial is not about comparing fixed appliances and CAT. Eloquently stated, it is an orange and apple comparison. 2 This Editorial is about the orthodontist’s approach to treating patients. Not about orthodontic key opinion leaders (KoLs) who are a different league. But this is about orthodontists like you and me. Do we knowingly or unknowingly “sell” a particular mode of treatment though we claim we are professionally neutral? For example, do we send a subtle message about our preference when we answer questions about FAs and CAT. More importantly, does this transcend to other “gray areas” like self-ligating brackets, (the D philosophy) third molar impactions or borderline cases which may or may not need extractions which manifests itself in the post treatment axial inclination of the teeth. Are we clear as to what is the best line of treatment for the patient. Or do we conveniently hide behind the façade of patient requirement.
The biggest challenge for the orthodontist which has continued from time immemorial has been patient compliance? So now we link the two. CAT has no issues with compliance. So basically, the systematic review mentioned reports that the patients do wear these removable appliances. “Removable” is no longer an unparliamentary word in orthodontics as we were traditionally taught. While a visible improvement in the malocclusion is a definite motivation for appliance wear is an acceptable answer, especially for adults and adolescences, a recent entry by the world’s (biggest) aligner company to treat children between 6 and 10 with “first” align technology throws the logic of patient compliance, especially in children, out of the window. The list goes on: the compliance with oral hygiene, removable functional appliance wear, elastics, SLBs, extraction and the axial inclination of the incisors … did the patient want it “slightly” proclined or retroclined. So, the question is, is it about patient compliance or more worrisome, is the orthodontist’s pliant? So, next time the patient “refuses” extractions or any treatment plan proffered, physician, heal thyself. Is it comfortable for us that the patient has taken the said decision or is the orthodontist pliant. Anyone reminded of wag the dog?
Vox Populi Vox Dei may not be one hundred percent true especially in the field of medicine. As always, your opinion is most sought. Please pen your thoughts via a letter to the Editor. We also have a new email: editorjios@iosweb.net