A rush to judgment with a very critical nature is smoldering in dentistry over the neglect of duty and responsibility of orthodontists to tender and render air way analysis and intervention at pre-school ages.
Admittedly, this age has not received orthodontic attention, not because of neglect of duty or ignorance of causative factors such as mouth breathing, but because effective, efficient and economic recovery from treatment can best be guided when first molars and permanent incisors have completed root development and the child intellectually understands, owns the problem and is willing to be coached. (“no wine before it’s time”) Just as important to the equation is active growth for something good to happen. This fire needs to be quenched by those who struck the match that lit rifts of drought stricken brush strewn across health care.
A wise axiom should be applied “you don’t know what you don’t know” which we see repeatedly in the medical community as they fail again and again with trial and error “cures” often enough with our loved ones who continue to suffer from unknown causes. Another wise saying taught long ago is “which is worse, to be taught wrong or never learn at all”?. Honest introspection proves all of us have been taught wrong and we know we don’t know what needs to be learned until the awkward advance of knowledge alerts us. Learning is infinite not finite. We have way too much of one side insulting and accusing another of some impropriety, of one side a perpetrator of wrong, the other the victim, one side a greedy capitalist causing poverty to the other. We need statesmen not protesters to advance dentistry’s perimeter to higher ground not a circular firing squad. I believe it is my duty as a conscientious orthodontist objector to respond – one, by the way, who as a preschooler was tongue tied, stuttered with speech dysfunction, mouth breathed and drooled with low forward tongue posture, a tongue thrusting swallowing pattern, anterior open bite and bilateral posterior cross bite with tonsil and adenoid problems. I was embarrassed to eat a sandwich in front of anyone because all the contents fell out on my chin. I had two contacts on the distal marginal ridges of my first molars on one side, no other teeth close to touching. Just to ice the cake, my orthodontic hero is my father who did everything he knew to get his kid’s teeth to fit, close his mouth, correct his tongue habit, get tonsils and adenoids out, and constantly remind me “mouth closed breathe thru nose”. In my 52 years of orthodontic practice and 26 years of teaching orthodontics to GP residents, I have encountered only two cases worse than I was. But you ought to see me now and that is exactly why I wanted to become an orthodontist who cares a lot about kids like I was.
So maybe I’m qualified to address an issue that needs not the slings and arrows of conflict, but the olive branch of brotherhood, of leaning from past mistaken knowledge or lack thereof and our attention turned towards a better future for our patients. The pre-school child first needs observant and educated parents, a pediatrician, a pediatric ENT, a pedodontist, maybe a myofunctional therapists and breathing coach long before an orthodontist ever gets an opportunity to see a patient still demonstrating the effects of airway issues. To me timing is everything and too much long term early treatment can burn a kid out just when we need their greatest motivation and compliance. There is no special bridle to strap on the horse to lead them to drink from the fountain of knowledge. The horse must trust you and respond to the reins. I sure wouldn’t pick up a stone and throw it at my father. He was an airway orthodontist before WWII.
Whoa Nelly! John B, Harrison DDS, MSc