The new standard of care in orthodontics: Part 1

Diagnosis and treatment advances have improved the quality of dentistry and saved or prolonged permanent dentitions for millions of individuals.

Such changes in the standards of care, evidence-based treatment protocols only come about as a result of enormous dedication, time, research and practice and are passed on via education for new dentists who become knowledgeable and skillful practitioners.

The term minimal intervention (Mount & Ngo, 2000) is relatively new in dentistry and has been introduced to suggest to the profession that it is time for change not only in operative dentistry but all specialties. Regardless of which phase of dentistry, treatment should begin with identification and elimination of disease first and foremost and with surgical and more invasive considerations not only as a last resort but with the removal of as little natural bone and tooth structure as possible. Orthodontics must acknowledge the primacy of prevention first and foremost as well.

Society demands a great deal from doctors who are responsible for maintaining and improving the health and welfare of patients. The practice of orthodontics requires a tremendous amount of education, dedication and knowledge —from four years of college to four years of dental school to residency and sometimes fellowship training. In addition, orthodontists must complete continuing education credits every year in different aspects of medicine, dentistry, ethics, etc. The stress and strain of studying and training to become a doctor cannot be diminished; however, the satisfaction it delivers when a patient has a successful outcome makes it worth every bit of its demanding commitment.

The orthodontist is trained to deliver the absolute best care, and make no mistake, we know what we’re up against; the public expects unconditional expertise and the best from us. Errors in judgment, diagnosis and skill are not tolerated. We must think and think clearly to establish an accurate diagnosis and implement a protocol that has the best chance for a positive outcome. For this, we turn to peer-reviewed seminars, studies, training workshops and mentorship after completion of our residencies. It is a profession that places high demands for excellence and expects quality assurance from all practitioners.

So, given the high level of commitment required and the time involved to become an orthodontist, no one is in a better position to determine treatment options than the clinician. We not only look for reproducible studies that give us a high degree of confidence in what we do, we also self-police.

All doctors in all specialties should be held to high standards of excellence in education as well as clinical performance. Yet, that no longer seems to be the case, which sets a very dangerous precedent in this country going forward.

It appears completely logical that orthodontists themselves, both individually and as a group, set the standard of care, and that goes for the health insurance commitment as well.

Health insurance companies have been able to take over control of orthodontics through contracted arrangements with doctors. When a doctor agrees to “participate” with a health insurance company and becomes a provider, he or she also becomes obligated to the terms and limitations set forth by the insurance company, which is not in the health-care business but rather in the “keep the premium dollars” business.

That means insurance companies have a vested interest in keeping down the costs of care in order to maximize the profits. The insurance company/orthodontist relationship can become controversial, contentious and argumentative as a result. The doctor, by contrast, must hold to his “oath” for providing the best possible care while also adhering to the theory of doing no harm.

Note: This article was published in Ortho Tribune U.S. Edition, Vol. 8, Nos. 5/6, Fall 2013 issue. The reference is available from the publisher.