“The only thing people see when they see an individual is their face. You can hide every other part of your body, at least temporarily. You can't hide your face. I’ve done a lot maxillofacial prostheses. So, a scar, a birthmark, one eye out, or a missing nose, has made their life miserable. They're never able to achieve what they would have done with a normal appearance. So, what I see in orthodontics aesthetically is fantastic. What I see functionally needs some help.” spot has increased “x percentage” in the last whatever months. So, this study is the only sophisticated study that's ever been done on white spots. And then it was remarkable to see how there was one kid who got out of that study with very minimal white spots out of the 300 plus cases. They made a joke about the kid's mother because she was so demanding. She would rag on her kid until he would clean his teeth. The rest of the kids had white spots. Dr. Gordon Christensen: I would say wonderful. Being a prosthodontist, I often treat totally maimed people, and I get quite a few cleft palates and other kind of situations that are very physically and mentally debili-tating to the patient. I also have a degree in psychol-ogy, a person who has miserably crooked teeth and is going through orthodontics changes their whole life. The only thing people see when they see an individual is their face. You can hide every other part of your body, at least temporarily. You can't hide your face. I’ve done a lot of maxillofacial prostheses. So, a scar, a birthmark, one eye out, or a missing nose, has made their life miserable. They're never able to achieve what they would have done with a normal appearance. So, what I see in orthodontics aesthetically is fantastic. What I see functionally needs some help. Dr. Ed Gonzalez: We're really pushing toward structuring a new protocol in the American Orthodontics Society on teaching our members about occlusion as well as imple-menting Andrew’s six keys of occlusion with their orthodon-tics. We're evaluating their cases and specifically teaching these keys. It all is based on Andrews, but Roth, who came up with the functional portion of orthodontics, plays a major role as well. So, I feel that when we finally get this in place, we are going to have much less problems with occlusion because of the quality of the brackets and the ability for the straight wire appliance to put the teeth in the proper position. There's still a bit of a controversy out there about early treatment orthodontics as opposed to late treatment orthodontics. Using growth and stabilization early on when it is available. Can you comment on this? Dr. Ed Gonzalez: That's true. We see it often. In fact, on my treatment form, the very first thing after the date is a little box that says good, fair, poor on oral hygiene. I want to document what I'm seeing each visit and then have a consultation with the parents about what's going to happen when we take these braces off, and I surely should not be blamed for white spot lesions if, in fact, the child is doing a poor job of brushing or eating garbage. That's the way most teenagers are these days; all they eat is garbage. Dr. Gordon Christensen: Yes, that whole topic is prob-ably as pertinent as anything that could be discussed. Obviously, the earlier it's done, the more active is all the physiology and the movement is obviously faster. But then, the stability must be there as well. The matching a tooth size to skull size. That's a wide subject, Ed. Dr. Gordon Christensen: They do. They'll chew a Hershey candy bar and then go drink a soda to wash it down. And then not brush for one week. We saw plaque in our study, documented photographically, that started when the study began and had never been disturbed. Dr. Ed Gonzalez: No. It sure is. And being a pediatric dentist, and I do a tremendous amount of early treatment orthodontics, you get into the discussion of the fact that, oh, you're expanding the cuspids, that's not stable. Well, it's my opinion that, if you do it early enough and you expand the arches early, then the tooth erupts into bone that is there, so it is stable. And it's much more stable than trying to expand the cuspids in a 13-or 14-year-old. When you're expanding on a 7-or 8-year-old, it's a big difference. Dr. Christensen, I can't thank you enough for being a part of Orthodontic Smiles, you have shared a wealth of knowl-edge with us about both dentistry and orthodontics. Dr. Ed Gonzalez: Give me your evaluation in general, whether it be by a general dentist or orthodontist. How are we doing in providing a service in orthodontics to our patients? What kind of grade would you give us? 22 Winter 2019 JAOS
Journal of the American Orthodontic Society Winter 2019: Page 22
