An Orthodontist's Data

One of the most challenging, yet at the same time, rewarding and enjoyable characteristics of orthodontics lies in being able to treat patients with seemingly similar presentations in a variety of ways. Nevertheless, one of the most frustrating features of present day orthodontics is the confusion arising from the conflicting differences of opinion that exist between members of the specialty. Every orthodontist must work to hone their clinical skills by keeping an open mind and using it to evaluate each patient in a clear, rational manner. Such evaluation requires exacting analysis based upon scientific knowledge and a keen clinical sense. I strongly believe that there is no magic formula that can be used to treat individual patients and that there never will be. A prudent orthodontist knows “what works”, “what works for a while” and “what doesn't work”. We need to know where we are and what we are doing in the “moment”.

Starting from the beginning of my orthodontic career, I have always been aware of thoughts in the back of my mind: “Why is it important to treat this case?”, “Why should I be doing this?” and “How should I do it?” Subsequently, my focus is squarely concentrated on the “What” I should do if I want to accomplish a particular objective. The above mantra has become the way of life for me with every step in the management of an orthodontic case. However, I have noticed certain factors that work against me and that impose limitations on treatment, such as deficient basal bone, abnormal growth pattern, imbalance of the skeletal components, asymmetries, variations of response, and muscle pressure due to a habit, to mention but a few.

In contemporary perspective, evidence-based patient management has become the cynosure of all eyes in medicine and dentistry. Many medical treatments, including drug therapeutics fall into this scheme but I find the complexity of orthodontic management hard to align with the concept of “one size fits all” at this moment. Most recently, for many medical and pharmaceutical treatments, it is now just becoming recognized that individual, and sometimes genetic, susceptibility should be considered and analyzed when formulating the most effective care strategy. Under the pervasive biological and mechanical limitations faced during orthodontic care, we should be equally (or perhaps even more) prepared to acknowledge that individual characteristics need to guide treatment decisions. It is naïve to think that “Clear evidence shows…” will ever be able to define a “best” treatment pathway for all patients.

At this moment, I assert that we need to move beyond the simplified “evidence-based” ideology that is being developed to define treatment decision-making. There are many individual, as of yet undefined, patient characteristics that potentially interfere with orthodontic treatment success. This does not mean that our evaluation should be cluttered with prejudice or personal adherence, but that, for now, we should act responsibly with our own patient ”data”. It also does not mean that we should ignore or discard the well-controlled scientific information that is published in our respected journals. To the contrary, we need to analyze it carefully, understand its strengths and limitations, and then use all of this information to build our own knowledge even further. I started my first fixed orthodontic appliance case in the year 2001 and that experience provided me with the momentum to think beyond. I humbly admit that my first case was a failure to the normal standards, but it showed me the path to record and assimilate my own patient's data. Since then, I reflect upon those details and try my best to excel in every orthodontic pursuit.

I intend to make a compelling case that all of us should be measuring and recording simple data about our own patients every day, because I believe that adding our own patients' data can reveal much more than even our great textbooks or standard operating procedures. Experience is useless without reflection and recapitulation of what we have done in the past. At the same time, we must accommodate and incorporate the most contemporary philosophies and new scientific evidence as it becomes available. We need to own our patients' therapeutic data to chart our own progress and work continuously to achieve further professional enlightenment.