Back to the future

I discovered America in 1933, and many of the features we use and appreciate today were already in use then: eg, automobiles, commercial airlines, electric lights, telephones, radio, talking movies, skyscrapers, elevators and escalators, electric motors, local and general anesthesia, periapical and bitewing x-rays, edgewise orthodontic brackets, stainless steel orthodontic appliances and wires, and electricity-driven dental drills.

If an orthodontist had gone to sleep in 1933 and just awakened, I doubt that our Somnolent Orthodontist would be totally flummoxed by the current sights and sounds. He or she would be able to enter a car and likely drive it without too much trouble, since the brake, accelerator, and steering wheel are exactly where they were 82 years ago. Refrigerated air conditioning might delight our modern Rip Van Winkle, but he would certainly have known how to keep cool with an electric fan at a fraction of the cost we now have.

Our Somnolent Orthodontist might be impressed with the design and operation of modern orthodontic offices. Air-turbine hand pieces would probably be a thrilling discovery, but their use would not differ substantially from the belt-driven drill of old. The learning curve would be shallow and not dangerously challenging. Even the most sophisticated orthodontic technology that uses 3-dimensional computer scanning and printing, virtual occlusal setups, and robot-produced archwires would certainly be faster, but there would surely be understanding of the need for first-, second-, and third-order bends in archwires and the know-how to effect them. The idea of using removable retainers to move teeth would not seem altogether strange, either, since that was a standard part of orthodontic training. Although gold brackets and wires were the most commonly used appliances, our Somnolent Orthodontist would be familiar with stainless steel brackets, bands, and wires, since the Rocky Mountain Orthodontic Company introduced them, along with a stainless steel welder, that year.

No doubt computers, iPads, television, and antibiotics for infection control would excite a 1933 orthodontist. Then, the world was still 3 years away from a commercially available sulfanilamide, and penicillin would not find widespread use until 1942 during World War II. Clearly, much would prove astonishing in 2015, but I doubt that anything would be totally baffling. Certainly, iPhones would amaze and annoy as much as they do the rest of us today.

I rather imagine that the most delightful discovery for our sleepy colleague would be the ubiquity of orthodontic patients throughout society and the tremendous improvement in the dental IQ of the population. In 1933, orthodontic therapy reached only a small segment of the citizenry, and the faulty theory of focal infection supposedly caused by teeth and gums unnecessarily doomed many to edentulous mouths. Of course, the number of patients an orthodontist could care for would surprise our somnolent professional; how prefabricated appliances work and how bonding improves the delivery of a less painful and more pleasant orthodontic experience would be no mystery. Adapting to the modern techniques would probably cause little more trouble than it did for any of us back in the 1970s. I rather think the practice of assigning some of our traditional tasks to chairside assistants might give our time traveler pause, but, as with us, this transition would undoubtedly take place without much critical thought.

Rather than waking up 82 years forward of 1933, what if our Sleepy Orthodontist went to sleep in 1851 and awoke in 1933? Talk about surprise and astonishment—hardly anything of our modern era would have touched his or her life. The automobile would have completely perplexed our newly awakened orthodontic professional, since horse-powered vehicles, trains, and boats were the only forms of transportation in the mid-19th century. Imagine the terror and disbelief of soaring thousands of feet above the ground in an airplane or space capsule. The idea of hearing someone speak over a radio or television from hundreds or thousands of miles away would have bewildered our subject greatly. Flipping a switch to light up a room would certainly seem strange to someone accustomed to candles and kerosene lamps. Pictures that moved and talked would be almost incomprehensible, as would riding in an elevator or standing on an escalator or listening to recorded music. Having a tooth painlessly extracted or restored would have been almost unthinkable.

Alvin Toffler puts our modern era in perspective through his book Future Shock , which still ranks high on my list of influential books.

“It has been observed, for example, that if the last 50,000 years of man’s existence are divided into lifetimes of approximately 62 years each, there have been about 800 such lifetimes,” he wrote. “Of these 800, fully 650 were spent in caves. Only during the last seventy lifetimes has it been possible to communicate effectively from one lifetime to another—as writing made it possible to do. Only during the last six lifetimes did masses of men ever see a printed word. Only during the last four has it been possible to measure time with any precision. Only in the last two has anyone anywhere used an electric motor. And the overwhelming majority of all material goods we use in daily life today have been developed within the present, the 800th, lifetime.”

Seen from that vantage point, the orthodontic achievements of the past 82 years seem somewhat meager, and rather than congratulating ourselves and developing a colossal hubris about our professional accomplishments, which are certainly significant, laudable, and appreciated, we might dedicate ourselves personally and collectively to the development of even more remarkable theories and therapies.

Clayton Christensen, author of The Innovator’s Dilemma , says that most new products or ideas brought out each year are incremental improvements at best, while we still await transformational or disruptive ideas that fundamentally change the ways we do our work.

For me, the most transformational change in orthodontics would involve moving away from the reactive care mode that approves an error-prone “do first, think later” conduct. This clinically results in what I call the Napoleonic method of therapy; Napoleon counseled his generals, “On s’engage et puis on voit!” or, liberally translated, “Jump into the fray and see what happens!” We know how well that worked in Russia and Waterloo. Should we expect a better result from the placement of appliances before carefully considering and evaluating the patient’s needs?

Currently, our specialty seems enamored with a craft-based industrial model that emphasizes efficiency and productivity to the exclusion of exercising thoughtful planning and engagement of the patient intellectually, emotionally, and humanistically. This suggests nothing less than a sea change in values by orthodontists with an emphasis on patient-specific care.

Unfortunately, reactive, unscientific, dogmatic care protocols promoted by industry-sponsored thought leaders move the specialty away from evidence-based, scientifically sound practices that emphasize customized, patient-centered diagnosis, treatment planning, and therapy. Such prophets of foolishness would be powerless were it not for a genetic human flaw that keeps us yearning for a remedy against uncertainty. Orthodontic science seems ineffectual against such inherent fear. But absent the universal endorsement of such a bold, dynamic way of practicing, nothing stands in the way of each orthodontist taking the personal responsibility of delivering such treatment to patients.

Yet the question remains: Do we have the courage, patience, and devotion needed to share such a vision with our patients?

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on Back to the future
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