Magic game: the madness of a crowd

You ask me to say what you should consider particularly important to avoid. My answer is this: a mass crowd.

Lucius Seneca

Orthodontics is an individual sport. Just as in chess, you are one on one with the opponent – the malocclusion. You have 32 pieces at the start and you finish each case sacrificing some of the figures. Each match takes a precise calculation, a steady concentration throughout the process, and decisive actions taken at the right time.

But what if someone tells you that chess could be played as a team sport? That all the figures could somehow remain on the board all the time, the strategy should not be thought through, and the movements of the figures might not be well-respected? What if someone insists on this? What if someone concocts a heavy advertising campaign to support such view and invests a few millions in it?

If you are a chess player, you will certainly denounce such claims as a rubbish. However, if you are a lay person inundated with such statements on a daily basis, your perception of chess might once become distorted.

The world of orthodontics and dentistry has been drastically changed over the past decades. Perhaps only a few young specialists know that advertising by dentists had been prohibited by many state dental practice acts and, according to the American Dental Association, considered a breach of professional ethics up until the mid 1970s. This, of course, is a world away from the present day situation when big manufacturers dictate the rules of how orthodontics should be played and corporate practices are turning the treatment process into a mass production.

The ultimate and perhaps the most problematic outcome of this contemporary paradigm is the fact that the individual practitioner is becoming inevitably ousted to the outskirts of the orthodontic landscape. Who is taken the central place then? An appliance, a concept, or just some catchy hard-sell slogan. And since these all are non-human entities, they are easily soon become beyond-human, super-human, magical.

Here are the lines by James Vaden published in the AJO-DO over 20 year ago:

“If a casual observer were to go through an orthodontist’s mail for a month or so, that observer would think that orthodontics is pure magic. Every day brochures are received touting some new widget that is going to “revolutionize” treatment so that the doctor can spend more time on the “business” of the practice.

Many are swayed by this hype, and some remain forever caught up in the euphoria of the “magic” of orthodontics and the appliance “de jour.” But on the other side of the coin, one could ask a few questions: Has service to the patient been improved with all this magic? Is treatment time shorter? Is the treatment easier on the patient and doctor? And is the treatment result better and more stable?”

I think these all are still germane questions. 

If we look at the recent studies on the currently most glamorised orthodontic technologies, self-ligation and aligners, we are going to see that neither of them give us additional efficacy. On the contrary, both provide evidently inferior results compared to the conventional fixed appliances. 

What if we then look at the day-to-day trenches of big corporate practices? I can’t help citing here a few passages from a wonderful book by Dr. Norman Wahl, The Golden Age of Orthodontics. Here are the comments of different orthodontists who have worked under the so-called dental service organisations:

“They asked me, “Would you have a problem seeing 80 to 100 patients a day?” I say, “No problem.” But the back of my mind says, “How the hell are you going to do that, newbie? Is the quality compromised? Do you get in the sevens? What mechanics are used to be so efficient? Do they cherry-pick cases and send the hard cases away?

I have worked at almost every office. Nobody else bonds sevens, the hygiene is terrible, and nobody seems to care, and they slop adhesive all over the teeth without cleaning it up.”

“Lack of instruments and supplies. They always run out of brackets, bands, and wires. All the cutters are very dull.”

“Patients pay a lot for the mediocre customer service. They charge extra for broken brackets, for treatment extension, no shows, etc.”

“The next day I looked at some more cases. They were so bad that I had to go home and take a shower.”

These are very sad comments. At the same time, they also resemble my own – however very brief – experience with the corporate dental world in Russia.

It seems that Andrew’s invention of the preajusted appliance in 1970s turned to be a blessing in disguise. This event, combined with the new advertising policy of the same decade, opened a pandora box of slipshod orthodontics worldwide. Everything became so easy, accessible, attractive. People started worshiping magic chessboards and forgot about the actual grandmasters. This trend amplified by the modern-day digital marketing capacities has almost lead us to the point of a perfect storm that seems ready to wipe out the very foundations of orthodontic specialty.

Shelter from the storm?

It is not easy to find a way out. The only thing I know for certain – we have to stand against the magic cult. We have to ignore “magic chessboards” – whether these are some allegedly superior appliances, heavily advertised dental chains, or one-size-fits-all treatment solutions. It might look like a difficult task required a lot of education, investment and people involved. 

But if we look at the core of the issue – the solution actually requires only two counterparts to get in touch. A skilled enthusiastic clinician and a discriminate patient. My deep belief is that building a strong, trustworthy relationship on this ground level could be an antidote to the madness of a crowded ostentatious orthodontic market.

Could a corporate practice provide the same level of care a small diligent private practice can offer? Could the appliance “de jour” substitute a creative mind of a skilled and experienced clinician? 

We have to be never tired of nourishing and advancing the patient-doctor relationship. Such meaningful bond is what an individual practitioner could juxtapose to the insatiable Goliath of the corporate world. 

If this relationship is to be flourished, the art and science of orthodontics is to be preserved. If not, we might get drown into the muddy waters of advertising illusions. And an intellectual game of orthodontics will be forever replaced with a magic show.

One comment

  1. “Orthodontics is an individual sport”, Hmm.It can be OR it can be a team sport.!!
    You can easily see and treat to a high standard,over 100 pts.a day ,within 8 hrs.
    This just needs some experience,good systems in place,very well trained and motivated staff and a large investment of organisational time and input by the orthodontist.
    The orthodontist is the final arbiter in terms of quality assurance;thus dont blame “corporate”or any other body if standards drop.
    One of the great features of the ability we have to design our practices and service delivery as we see fit.


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