I hear this is a common statement made by your adult patients when you have orthodontics in your treatment plan.
The envisioned scenario goes like this:
- You have spent much time and deep thought on an appropriate plan
- You’ve used the photos to see it
- You created a diagnostic wax up to demonstrate the possibilities
- You’re ready to discuss the steps for restoring their teeth and giving them what they asked for, that winning smile.
Now here we are at the first action step, getting the teeth in the right place. You paint the picture, you build the emotion, you feel the crescendo upon which all the other puzzle pieces rest. You speak the words, “I have a wonderful orthodontist I’d like you to see.”
On the lecture circuit it usually comes up in very big letters all-alone on the screen: “I WON’T DO ORTHO”
A statement heard so many times it is enough to give an orthodontist a complex that we are playing an evil part in a Harry Potter adventure. Creating villains that shred your cheeks, prevent you from eating any of your favorite foods and cause you to spend your leisure time trying to floss the four teeth you have chosen to save; what’s not fun about that?
WAIT A MINUTE! Isn’t everybody just trying to get healthy? Compared to dripping sweat on the treadmill, groaning through that last weight lift, and burning up your quads, braces sound like a cakewalk to me. With the fast growing market for ways to “looking younger” braces should be flying off the shelves. Inside of an hour you can look just like the gawky teenager you were when you were that gawky teenager.
OK I get it. Looking younger is relative, and all the way back to “teendom” is not exactly the target, gawky notwithstanding. No pain no gain only gets you so far when we are coaching our patients to their desired improvement in dental health, longevity and youthful appearance.
I’m pretty sure that most adults don’t want to ortho for one of two reasons: One, they don’t see the value relative to their desired outcome, or Two, they are visualizing full fixed appliances and wires. That first part is up to you … when you ask before you build the benefits most adults will decline your offer. The second part is something I know I can help with.
Traditional orthodontics is taught with full fixed appliances and continuous wires. It makes sense because this is the best way to have control over all the teeth. Like the preschool teacher who keeps the kids together on a walk by holding the loop on the rope so a straggler does not get away from her. (Like my son would do from time to time) Segmental mechanics, where fewer teeth, smaller appliances and less wire is used, can be just the thing when treating cases that require specific movements in specific areas.
Using a non-continuous wire will let me apply force in one area while maintaining or preventing movement in another area. This can be applied to correct a cant to upright tipped teeth, and to open the bite, to name just a few applications. Expand that thought to intrusion of the lower incisors, which is a very common need in worn dentition cases. If the lower incisors have super-erupted as they wore, and the VDO has not changed, we can focus our mechanics there and often forego those traditional full upper and lower appliances. TADS can serve us in segmented movements in a big way, particularly in intrusion of over erupted and worn teeth.
The thought of wearing full fixed appliances would give anyone pause. When you refer your patient to me with a request “evaluate for ortho” are you automatically thinking full fixed appliances? If I can clearly understand what it is you are after it might be possible to get the result without that. Do I absolutely need to fully correct the Class II molar and canine to Class I like I was taught? Can we both accept an asymmetry in the maxillary incisor gingival margins if the smile does not show them? Can we simply intrude the lower incisors to give you the needed restorative space? The result you hope to achieve answers those questions.
When we work to determine what orthodontic movements are really needed for THIS patient to get what they (and you) are after, we may be able to paint a different picture about putting their teeth in the right place than the one they automatically see – full fixed appliances and lots of wire. Perhaps a segmental mechanics approach can lead to a viable result. Who knows, maybe it can be done with something removable if we can talk about it.
SO – wait until they want the result that putting their teeth in the right place will give them, and then help them see that the possibilities for putting them there are very different today than they were when they were that teenager. You might be able to avoid the “I won’t do ortho” refrain from echoing through your office. And I can take off my witch’s hat and retire my wand.
(Editor note: Dr. Gary DeWood served as a co-author)
Donna J. Stenberg D.D.S., M.S., P.A. Spear Visiting Faculty and Contributing Author www.stenbergorthodontics.com
Gary DeWood, D.D.S., M.S., Spear Faculty and Contributing Author