TOPIC (1) “Professionalism, has it become Old Fashion?”
This is a quote from a parent of a patient that was explaining to me her experience in another orthodontic office.
There was no professionalism, just a lot of high pressure sales pitches.
The personal relationship between the patient and parents with the orthodontist took a back seat to the workings and needs of the corporation. Furthermore, the orthodontist began advertising and promoting the practice under the name of the corporation. The trust relationship between the patient, the parents and the orthodontist started on a downhill slope. It is totally understandable why patients and parents began to trust the internet more than the orthodontist as their main source of information about orthodontic treatment. Almost daily I hear commits from individuals about what they had read in regard to orthodontic treatment on the internet. My concern is that they unquestionably believe every word of it even though some of the information is so wrong that it curls my toes and makes me wonder how we arrived here.
The internet is great; however, it is primarily an advertising and social media. You can post almost anything you desire on your website. It is not a factual based media, and yes the orthodontist, Dr. Whoever can make any claims he or she thinks might get patients to come to them for treatment and not be concerned about its factual nature. Remember there are no laws that require the information posted onto the internet to be factual and correct. Simply because it is on the internet does not make it a fact. Even when you “Google” orthodontic treatment, the information that Google brings up are websites established by either orthodontist or orthodontic companies.
The internet has become very important. Many people use it to get information about big ticket items that they purchase and yes, orthodontic treatment is included; therefore, it has become a necessity for orthodontist to have a website. The question is: How do you evaluate the accuracy and honesty of the information on a particular website. Remember the intent of the website is to get you to come to them for orthodontic treatment.
Listed below are ten items to help you evaluate orthodontist websites, and separate facts from high pressure sales pitches.
Suggestions in evaluating a website
1. Have they posted photos of cases that were treated by their office or instead photos that are furnished by some orthodontic company?
2. How many different offices do they have? If they have over two, why?
3. Be very concerned if it is claimed that they offer some superior or unique service not available elsewhere.
4. Be very, very concerned if the routine checkup appointments are over six weeks apart. They may claim that this is an advantage for you because you will not have to make as many trips to their office. Think about it. The less frequent they see their patients the more patients they can treat; therefore, the more income they will have. Perhaps it should be referred to as supervised neglect.
5. Take a hard look if they claim that the orthodontic appliances (brackets) that they use are superior to all other orthodontic appliances. Orthodontic appliances do not make a good orthodontist any more than pots and pans make a good chef.
6. If it is stated that they do not believe in the removal of permanent teeth, immediately shut down the website and try another.
7. Be especially concerned with the office that has a game room for the kids, taxi services, constant give-a-ways or any other service not directly related to orthodontics. Game rooms are clear indicators that they do not keep an on time schedule. Also, who do you thinks is paying for all this?
8. Has that orthodontist ever made any contribution to the field of orthodontics that has improved the profession?
9. After reviewing the website do you feel that the website has clearly shown and demonstrated that quality work is being done at their office or does it seem more like a commercial?
10. After reviewing the website do you know the fees for their orthodontic treatment, and how and to whom the fees are paid? Do they accept payment directly from your insurance company?
TOPIC (2) “The Truth about Maxillary Expansion”.
Transverse Maxillary deficiency is a skeletal problem which requires orthodontic treatment for correction. The rapid palatal expansion appliance (RPE) is most often the appliance employed to correct this skeletal problem.
Recently there has been a great deal of conversation in the world of orthodontic treatment regarding expansion of the maxillary arch. Claims are being made that it “Broadens the Face” and/or “Makes Room for Crowded Teeth.” Some of my orthodontic colleagues have been explaining maxillary expansion as the latest and greatest aid in orthodontic treatment. It is true that maxillary expansion is a useful aid in orthodontic treatment to correct the true transverse maxillary deficiency; however, claiming that it will broaden the face and make room for crowded teeth regardless of the degree of crowding is simply absurd. Also, the statement that it is a new treatment idea is without merit since maxillary expansion was first introduced by Dr. Angell in a paper to the dental community in 1860.
QUESTION: When is it appropriate to expand the maxillary arch?
The patient should have a true transverse maxillary deficiency. That is, the maxillary arch must be narrow when compared to other craniofacial features of the head and face and there is usually a posterior cross-bite. Cross-bite being defined as when the cusp tips of the mandibular posterior teeth do not occlude in the central fossa of the opposing maxillary posterior teeth. (Simply put: The mandibular arch is wider that the maxillary arch).
QUESTION: What are the proper orthodontic mechanics that should be employed?
The object is to get most of the expansion in the maxillary arch by opening the palatal mid-sagittal suture with as little tipping of the posterior teeth toward the cheek as possible. The appliance should be left in place for a period of 90 days after the expansion is completed to allow new bone to fill in the space created by the opening of the mid-sagittal suture, thereby creating stable expansion. Tipping of the teeth is very unstable and must be retained to maintain their abnormal tipped position.
The opening of the palatal mid-sagittal suture gives an actual increase in the horizontal width of the maxilla while tipping of the teeth only widens the distance between the tips of the crowns of the posterior teeth. So when one speaks of widening a narrow face it is nearly without merit since the average palatal mid-sagittal suture opening utilizing the present state of the art expansion appliance is only approximately 3mm. Certainly no one should claim that this small opening of the palatal mid-sagittal suture will widen the distance between the orbits of the eyes or widen the lower jaw or the forehead. With few exceptions expansion of the maxillary arch should be reserved for the correction of a posterior cross-bite due to a constricted maxillary arch.
The concept of maxillary expansion is also being falsely promoted as a procedure to make room for crowed teeth in the maxillary arch, even though there is no posterior crossbite nor is the maxillary arch narrow when compared to the other craniofacial features of the face. Also, the statement that extractions narrow the face is just as absurd as saying that expansion of the maxillary arch widens the face. Extractions afford anterior posterior room in the arch. Extractions have nothing to do with the width of the maxilla. If, however, extractions are preformed when extractions are not indicated the result is that the lips loose some anterior/posterior dental support which can produces an unpleasant profile, but extractions absolutely has no effect on the width of the face.
The bottom line is that the average increase in available maxillary arch space (opening of the palatal mid-sagittal suture) utilizing rapid palatal expansion is increased only by approximately 3mm, less than 1/3 of the width of a central incisor, and this is in the maxillary arch only, no increase in the mandibular arch space. Any other generated space is due to buccal tipping of the posterior teeth and flaring of the anterior teeth. Numerous researchers in the field of maxillary expansion have stated that expansion of the maxillary arch when it is done solely to make room for crowded teeth is without merit. Most of the space to align the crowded teeth in both arches is gained by putting a expansion force between the first molars and the cuspids resulting in the first molars moving distal; however, the major movement is the flaring forward of the anterior teeth. In many cases the posterior movement of the first molars blocks the normal eruption of the second molars, and excessive flaring of the anterior teeth often leads to periodontal disease later in life. In cases with moderately crowding of the teeth there can easily be 12mm of crowding (lack of arch space) in both the maxillary and mandibular arches. Even if we take 5mm, the upper limit of palatal mid-sagittal suture opening, there will still be an additional 7mm of space needed in the maxillary arch, and the total 12mm of arch space will be needed in the mandible.
FOOD FOR THOUGHT: If the maxillary arch is expanded to make room for crowded teeth in cases without a posterior crossbite and with good horizontal relation with the mandibular arch and other craniofacial features of the face, what happens in the mandibular arch? Would this not create horizontal disharmony between the posterior teeth in the maxilla and mandible? The answer is yes it would; however, the disharmony is made acceptable by the outwardly tipping of the posterior teeth along with forward flaring of the anterior teeth as was done in the maxillary arch followed by fix retainers to hold the teeth in their abnormal position.