“May you growup to be righteous. May you growup to be true.”
Bob Dylan (Forever Young)
During my first few weeks of dental school, I took some time one afternoon to find the Department of Orthodontics to explore my interest in pursuing an orthodontic speciality training program after the completion of dental school. To my surprise, I did not find a Department of Orthodontics listed in the school directory. I learned eventually that orthodontic education and training took place in the Department of Developmental Biology. As a newly minted dental student I found this confusing, but years later the semantics became accurate and meaningful. Orthodontists have specific and intensive training in human growth and development for important reasons. The comprehensive understanding of normal human physiology, growth, and development is what arms us as clinicians to detect and correct that which is abnormal and problematic. An orthodontist is trained to possess profound expertise in skeletal, dental, and some aspects of psychological development.
Each day in my office, I am challenged to diagnose and treat developmental problems. Sometimes the cause of the problem may be abnormal growth of the mandible (lower jaw) or maxilla (upper jaw). Other times, unerupted, missing, or malpositioned teeth may be the primary cause for concern. It is not unusual to treat a seven year old child and a 65 year old adult in the same afternoon. You can imagine the variety and complex nature of the problems that fall within these parameters. Skeletal problems (problems of the jaws) many times require a different treatment approach than those of a purely dental nature (problems of the teeth). The seven year old child and 65 year old adult both require the same excellent standard of care, but meeting that standard requires a drastically different approach in treating and communicating to the patient. For instance, the primary psychological focus of treatment in a 65 year old is rendering treatment in a dignified way that does not interfere significantly with the patient’s lifestyle. For a seven year old, the primary focus may be alleviation of anxiety about the new office, exam chair, instruments, and appliances that the patient has never seen before.
Successful treatment begins with highly accurate diagnosis or discovery of the underlying problem. In order to understand the cause of orthodontic problems, orthodontists engage in extensive study of the normal pattern of growth of the dentition and facial skeleton. In addition, we focus on understanding psychological development in order to motivate and communicate with patients of diverse developmental statuses. The challenge of utilizing knowledge of development to improve confidence and quality of life is one of the most rewarding aspects of practicing orthodontics in my view. Despite Bob Dylan’s wishes in the aforementioned quotation, growth can sometimes be abnormal and causes functional and esthetic problems for people of all ages. Orthodontists are armed with sophisticated technology to identify these problems and work with the patient to select individualized, viable treatment options to improve quality of life by means of functional, esthetic and self-confidence enhancement “when the winds of changes shift.”
