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It’s Nice to Be Needed

And we'll have fun fun fun now that daddy took the t-bird away.

- Brian Wilson.  The Beach Boys.  1964 

Back in 1998, the year I completed my orthodontic program, I was at a family get-together in my brother’s back yard.   I cannot recall what the occasion was, but I clearly remember a conversation I had with my brother’s mother-in-law, a curiously contrary controlling family figurehead.   It went something like this,

“So Jim, I hear you’ve just finished your program.”

“That’s correct.   It’s surreal.”

“How long did that take?”

Counting swiftly on my fingers, I replied, “Fourteen years in total, but smart people can get it done in eleven to twelve, tops, these days,”  

“That’s a lot of school.”

‘Sure is.”

Must have been difficult.”

“Sure was.”

And then came the words that came forth from her mouth like daggers straight to my heart.

“I don’t think anyone really needs an orthodontist.”

Wow.  Nice.  Way to cut a guy off at the knees.  I remember my outrage, my indignation.  How could anyone say such a thing? 

Direct-to-Consumer prides itself on the elimination of regular visits to the orthodontist office.   In other words, I don’t think anyone really needs an orthodontist.  Son of a gun, my brother’s mother-in-law isn’t a contrarian, she’s a flipping soothsayer.  It’s hard to say what hurts more; the fourteen years of formal education or being home-schooled by a 70-year-old grandmother.  

To be clear (such painfully apropos verbiage), I am not a big supporter of orthodontic treatment that is overseen remotely by a dude or dudette over the internet.  It would be weird if I were.  Such processes may work some of the time, but even then, the jury is still out on this one.  University of Alabama’s football coach Paul “Bear” Bryant, was spot on when he famously uttered, “Offense sells tickets. Defense wins championships.”  In orthodontics, it’s not the cases that work out, it’s the cases that were heading south only to be saved from oblivion, that are the mark of the orthodontic specialist.  Even if home orthodontics can produce an acceptable result for a vast majority of cases, what about the person whose case is one that isn’t working out the way the algorithm predicted?  There is no one around to let him or her know treatment is not going well, let alone fix the problem.  Autonomous cars for the masses are a great idea too, unless you happen to be sitting in one as it wipes out.

At the same time, I’m torn.   The world is a technical place and advancements come at breakneck speed.   We live in a different world than our grandparents or even our parents. You can be for sure our grandkids will be dumbfounded when we tell them that we survived on only a 4G network, whatever that is.  Remember, it was Mr. Bill Gates, who allegedly predicted in 1981 "640K ought to be enough for anybody”.

As orthodontists, we must accept the new technologies that affect our little corner of the world.  We must become the leaders.   Direct-to Consumer orthodontics and venture capitalism are a marriage made in heaven.   Fast forward a scant number of years and few billion dollars later, the profession is reeling, retroactively trying to react to this onslaught.   Wouldn’t the picture differ if home aligner therapy was the brainchild of a couple of orthodontists?   Maybe.  Maybe not: many species eat their young.   At the very least, had an orthodontist developed Direct-to-Consumer orthodontics, the profession could have had a hand in the development and implementation instead of staring into the taillights of the Tesla proudly driven by business people brazenly flipping us the bird. 

I’m not a fan of Ben Burris, but I did read an article (or maybe a blog; its so hard to tell the difference these days) where he reflected on ‘the holier-than-thou’ attitude of the orthodontic profession.   His argument was that how could orthodontists lambaste Direct-to-Consumer orthodontic treatment for the relatively few associated cases that result in complication, reversible or otherwise, when orthodontists themselves supervise and treat cases with similar outcomes.   It hurts, but it’s a solid argument.   We all have cases that we are not proud of, with outcomes that fall short with the best of both intention and attention.   Humans are not machines. 

While the argument may be solid, I think Ben Burris is incorrect in his categorization of the profession.  When things are not working out, orthodontists let their patients know.  I do not love the expression, but ‘That is why we are paid the big bucks’ solidly applies here. This is the situation where traditional orthodontics cannot be beat.  A computer cannot tell a patient about gingival recession, inadequate torque or root resorption.  Yet.  Conversations with patients, or worse, parents of patients, regarding complication are not fun: they are an unpleasant task that are part of profession.  We sweat these conversations out.  They keep us awake at night.  We take it on the chin because that is what we are trained and ethically obligated to do for our patients.   I know of no orthodontist who does not take this obligation very, very seriously.    

It is what the fourteen years of fun, fun, fun were all about in the first place.

Jimmy P