When the patient is his own doctor …

Your housepainter, Fred, is almost a member of the family. He’s known you for more than 2 decades, after painting and wallpapering your then brand new home. You’ve always wanted to take care of Fred’s conspicuous malocclusion. Resolution of his crowding would not only enhance his appearance but would greatly simplify his home care. But Fred is a proud man, and has declined your treatment offers, regardless of your promise to make the fee very affordable. He says he never wants to be indebted to anyone. But he’s asked you twice about those “do-it-yourself braces” he saw on the Internet. A lengthy discussion with Fred on this topic is one you’ll have to take up with him later.

Mail-order orthodontics is not a new concept. Dr H.C. Pollock described the “mail-order orthodontist” in his 1941 editorial as a threat to patient vulnerability. Laboratory services had then arisen in which general dentists could submit diagnostic records to a laboratory and receive a preformed appliance with a treatment plan. In a subsequent editorial published in 1950, Dr Pollock compared laboratory-dictated treatment to “eyeglasses … ordered from mail-order catalogues,” and he concluded that “orthodontic devices made over the plaster model (via treatment plans devised by laboratories) are as far from the modern concept of orthodontic treatment as ‘mail-order eyeglasses’ are from the scientific correction of the eye … [and] this kind of promotion is not in step with the scientific problem in hand” (emphasis added).

Laboratory-dictated treatment is more common today than it was in the days of H.C. Pollock. But taken one step further, the opportunity for a patient to self-treat opens a whole new series of possible risks in tooth movement.

“Medicine is the science of uncertainty—the art of probability,” said Sir William Osler, founder of the Johns Hopkins School of Medicine, in the 19th century. This accurate observation remains pertinent today. Medical-dental treatment can involve an uncertain patient response that might require course correction as therapy proceeds. Also pertinent is the patient’s physical, emotional, and psychologic presentation when incorporating the “whole patient” into the plan. Consider how unpredictable treatment outcome and stability might be without professional supervision. When would the patient know that treatment modification is indicated? How would a patient discern between discomfort that is typical of tooth movement and a pathologic response? How would parafunction affect dental health as teeth are moved?

Other health care specialties have seen self-treatment modalities: home-based tooth bleaching, microdermabrasion, and even do-it yourself facelifts are examples. But the precision of an occlusion and the fragility of the oral structures present possible risks to those patients who self-treat in an unsupervised arena.

Recent statistics indicate that only 65% of adults see a dentist with regularity. Undiagnosed oral and dental pathology can be exacerbated if a patient engages in self-treatment. Unsupervised tooth movement conducted in the presence of undiagnosed inflammation can accelerate bone loss. Previously asymptomatic teeth with pulpal necrosis can also become symptomatic when moved. The list is open ended.

Dr Osler also said “A physician who treats himself has a fool for a patient,” but a patient acting as his own doctor might be even more dangerous. He would not know the damage he’s done.

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Dec 8, 2018 | Posted by in Orthodontics | Comments Off on When the patient is his own doctor …
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