It was after a Tweed course in Tucson Arizona, June 2019. We were sitting with a group of young American orthodontists at some Mexican place in the downtown enjoying our tacos and discussing some of the common issues which all young specialists are facing across the globe. Then out of the blue one colleague asked me – “Is this true that the Russians always lie?”
Frankly, I was quite happy she brought this up. I then went to great lengths explaining the structure of Russian language and its history, partially admitting and partially denying her notion. Firstly, it is really super-hard to state something precise in a language which doesn’t have articles. Secondly, when it comes to holding a discussion about orthodontics in Russian we are stepping into an even more troublesome waters due to the confusion in terms and the lack of basic orthodontic knowledge among the senior generation of clinicians. Furthermore, the communist propaganda which had been butchering the language for a number of decades also left a significant heritage we are still grappling with.
Despite all these predispositions which could make the language pretty vague and therefore create prejudices towards the particular group of people, I don’t think that dishonesty should be regarded as a national trait. At the end of the day, people are free to change their current language to the one they are more comfortable with. And this is what I am now witnessing among the younger generation of orthodontists around myself. I guess the transition to English is a natural and inevitable process we should take for granted.
However, are we immune to deceit using English?
Of course, it is naive to think so. Yes, the Russians were historically very innovative in concocting various deceptions such as, for example, Potemkin villages. However, over the past century, in my view, they fell behind pretty significantly. I guess this has a lot to do with incredible advances in marketing in the West which probably the Russians have not yet completely adopted.
Let’s get the focus back to orthodontics. In their AJO-DO guest editorial from 2010, Kevin O’Brien and Jonathan Sandler quite reasonably stated the following:
“Our specialty is often unwilling to accept the results of well-conducted, scientifically valid trials of common treatment methods but enthusiastically embraces treatment methods that have not been clinically tested to a level of evidence that withstands scientific scrutiny but are perhaps beautifully described and illustrated in marketing brochures.”
This conclusion resonates with an even more despairing statement Lysle Johnston articulated in his lecture at the Angle Society meeting two years ago:
“Orthodontists nowadays don’t really read journals, but they do read brochures and printing materials from the companies.”
So have we really entered the post-scientific era where the companies are allowed to freely manipulate the data without facing the consequences? And if so, perhaps it is just alright to be slightly economical with the truth? Why should we really be reading anything more than Instagram feed? No one dies from orthodontics and everyone likes glossy pictures…
Two years ago, I published a post titled On reading where I would briefly review the main orthodontic journals and state that going back to the literature is probably the best way to resist the digital overload of nonsensical information.
However, it was only later I stumbled upon a neat and concise explanation on why reading the literature could not be substituted for anything else. I actually found it in a book which I first read at the age of eleven in Russian, but gave it a second round last year in English. It is a classic dystopian novel, Fahrenheit 451, written by an American author, Ray Bradbury, in just nine days in 1953.
In the beginning of the second part, a protagonist called Montag, a fireman who burns books, is talking to a retired English professor, Faber.
“We have everything we need to be happy, but we aren’t happy. Something’s missing. I looked around. The only thing I positively knew was gone was the books I’d burned in ten or twelve years.” – starts Montag.
Faber then replies that it is not books that Montag was missing, but the three things that come along with them. I can’t stop feeling that these are the exact three things we are missing in orthodontics today.
Probably the trade-off for quantity over quality is one of the most ubiquitous trends of the culture we now live in. “The good writers touch life often. The mediocre ones run a quick hand over her. The bad ones rape her and leave her for the flies.” – states Faber. It’s pretty much the same with orthodontics if I just think of how many raped non-extracton occlusions I have seen over the past year.
2. Time to think
“A TV rushes you on so quickly to its own conclusions your mind hasn’t time to protest.” – carries on Faber. So does the social media. Moreover, the trend of speeding everything up has recently pretty intensely permeated the whole filed of orthodontics – the use of orthodontic vibrators, micro-osteoperforation, ‘frictionless’ brackets, etc. In reality, however, all these supposedly effective methods for speeding up the treatment turn to be effective only for squandering research and patients’ money.
3. The right to carry out actions based on what we learn from the interaction of the first two
I can’t help feeling Faber was talking here about evidence-based orthodontics! And now I have closely come to…
The most beautiful thing in orthodontics
Last week, a colleague of mine asked me – “What is one single thing you enjoy about orthodontics the most?”
It was pretty easy because I already had had the idea for quite some time.
I replied – “Certainty.”
I then ranted on how uncertain and frustrated I was during my first year in clinical practice and how later I would read dozens and dozens of books and research papers and carried out actions based on what I learned. And every year my results would get slightly better and I would become slightly more certain.
And I can’t think of anything more beautiful in orthodontics than this feeling of peacefulness when you see a new patient and know the scientific basis for the issue through and through and see pretty much the final result in your head. This is what I call certainty.
Of course, I am not certain 100% about all of my cases. Moreover, there are some cases I can’t wrap my mind around at all – these are the cases I typically deny treating. However, there are definitely a lot of topics in orthodontics which have been very thoroughly researched and are now pretty safe places we shouldn’t be worried about much. These is just a handful of examples:
- All expansion relapses to a degree
- No brackets are superior
- We cannot grow mandibles
Of course, we can talk a lot about the responsibilities we have to our patients and the meaning we have to pass to our younger colleagues. However, being less pompous, certainty is first of all a cure for our own self. And to get it we first have to have high-quality reads and enough time to digest them.
If I only could be as certain in everything else in my life as in the fact that we cannot grow the mandibles, I’d be the happiest person in the world.
I wish you an absolute peace of mind in all you do. I am sorry for such a long text.