Dr. Ed Gonzalez: No, that's true, but the American Orthodontics Society is primarily made up of general dentists and pediatric dentists. And I think we do a fantas-tic job of teaching very, very high-quality orthodontics to the general dentists. Dr. Gordon Christensen: Yes. When I was Dean of the Scottsdale Center, the Continuing Education Center in Arizona, for several years, and I recruited orthodontists who had the same feeling that I do to actually teach general dentists. And I actually visited some of the offices, and the quality of orthodontics done by general dentists and pediatric dentists was excellent. Dr. Ed Gonzalez: I got in a discussion this past week with an orthodontist who spoke at a recent Diplomate Confer-ence. We were there for our Diplomate's Conference, and at this meeting, we judge our Diplomates. To become a Diplo-mate, they must present 10 highly qualified cases that are reviewed by a minimum of three Diplomates, double blind. And the quality of those cases is just superb. And as the orthodontist was talking, he mentioned that the AAO, the American Association of Orthodontists, have eliminated the case presentation portion. amount and then getting down to finer instruments, and then finally re-fluoridating the surfaces of the teeth. But as far as cement, you know as well as I that many of these kids are highly cariogenic. They're eating cariogenic foods. We just finished a study of 315 orthodontic patients, looking at demineralization. We found almost none who had gone through orthodontics had remineralization. The so-called orthodontic white spots are a misnomer. They're orthodontic carious lesions which, as you know, continue to progress. We found in that study in a small religious town in Springville, Utah, involving some very fine orthodontists, that none of the so-called re-mineralizing agents truly worked. Not because they wouldn't work in a test tube. Here we go, back to in vivo/in vitro in a test tube, you could put amorphous calcium phosphate in the tube and it would somewhat appear to impregnate and go into the surface of extracted teeth. However, we found in our study of over 300 kids, that they first ate foods that were completely cariogenic. Many of them ate cereal as their primary food. This is hard for me to even believe or accept. For most of them, they're major food was cereal. And that was morning and evening. We followed them very closely. My wife, Dr. Rella, coordinated this study, and she is the ultimate researcher. She found that many of them would not even change their clothes. They'd come home, flop down in front of the TV, go to sleep after eating some cereal, without brushing their teeth. We found the average brushing of teeth in that orthodontic study was one time per week. And so, we found not even one of the agents had any major positive effect on what has been called remineralization. Tooth wear makes it look like it had remineralized, when in fact, it had just worn off the little microscopic specula sticking out. The only product that had some statistical value is an old product, PreviDent 5000 from Colgate. Dr. Ed Gonzalez: How about varnishes? Dr. Gordon Christensen: I can't really accept that real-ity. We have a new medical school starting in Utah, and I hear they're not going to have cadaver dissection. They're going to be taught primarily by virtual meth-ods. This frustrates me. We learn by doing! Dr. Ed Gonzalez: Well, let's talk a little bit about orthodontic products. I think that there are some things that you can help us with. Gosh, in orthodontics, we use cement. And I'm sure you've evaluated them. Dr. Gordon Christensen: Let's talk about the negative and positive. A lot of the cements, you know better than I, if they're not adequately strong, they release primarily on second molars since it's hard to keep a dry field back there to adequately get light cure perpendicu-lar to the surface of the resin, and then of course it's hidden under wires and brackets. We see many patients coming from orthodontists’ offices where the resin cement is still left on the teeth. I don't mean in small quantities. I'm sure you know as well as I, we will see big cement pimples all around the mouth. I've asked groups of general dentists quite often, "How many of you see resin cement remaining on the teeth when they come back from an orthodontist?" and every hand will go up and there will be laughter throughout the group. This needs to be corrected. Taking off those cement pimples involves several very simple techniques. We should be taking off the gross Dr. Gordon Christensen: Varnishes had an effect, but they had to be placed far more routinely than is now promoted. I can't remember the exact number of break-downs. There were about seven or eight different sections in the study. The only one that had any statistical posi-tive significance was PreviDent 5000. Dr. Ed Gonzalez: Because God knows we see so much poor oral hygiene amongst our orthodontic patients. It's just frus-trating sometimes. Dr. Gordon Christensen: Ed, we had a very, very sophisticated grid system and 25,000 photographs, so the computer was very capable of showing this white www.orthodontics.com Winter 2019 21
Journal of the American Orthodontic Society Winter 2019: Page 21
