Narrow the Chasm Between Specialists, Generalists

I read with much discontent the recent letter by orthodontist Dr. J. Franklin Whipps on the "Who Should Treat" issue. I continue to be at a loss why many orthodontists feel that they are the only dentists qualified to do orthodontics and what ethical issue does this view, in and of itself, raise? I know many general dentists, myself included, who incorporate comprehensive orthodontics into the general practice and whose completed cases are on a par with that of most orthodontic specialists. In

I read with much discontent the recent letter by orthodontist Dr. J. Franklin Whipps on the "Who Should Treat" issue. I continue to be at a loss why many orthodontists feel that they are the only dentists qualified to do orthodontics and what ethical issue does this view, in and of itself, raise? I know many general dentists, myself included, who incorporate comprehensive orthodontics into the general practice and whose completed cases are on a par with that of most orthodontic specialists. In fact, general dentists, competent in ortho, are perhaps more astute to caries and periodontal conditions, leading to better overall dental health.

Now that I have made these statements, let me be the first to admit that not all general dentists can become competent in ortho for a myriad of reasons. There are many, fine postgraduate courses available that encourage excellent orthodontic results. To imply that a general dentist, by nature of being a general dentist, is not competent to do orthodontics is complete arrogance on the part of the orthodontic specialist. In retrospect, I have seen many cases completed by the specialist that seemed to show little regard for the fundamentals of occlusion, esthetics of the facial profile and overall oral health. My reasons for entering orthodontic treatment was initiated by these observations and my desire for better treatment for my patients. Ethics was the major influence.

It is elitism that creates an unfortunate chasm between the specialist and generalist. General dentists will continue to do orthodontic treatment. Rather than be a part of the perceived problem, why doesn`t the American Association of Orthodontists become a part of the solution? Why not have the AAO offer postgraduate courses to the general dentists, or at least evaluate and give their seal of approval to existing courses? Why don`t more orthodontic specialists offer assistance to their referring general dentists? The specialist who has offered this service to me has seen his referrals from me increase several fold (yes, I still refer many cases out). What we need is a solution. I have offered two. Telling general dentists who complete full-mouth reconstructions, surgically remove teeth and perform molar endos that they cannot diagnose and treat malocclusion orthodontically is plain wrong. Look at some of the excellent orthodontics being completed by general dentists and not the occasional failure. We all know even the specialists occasionally fail. I wonder if Dr. Whipps would like general dentists to refer all their endos to endodontists, all their extractions to oral surgeons, all their dentures to prosthodontists, etc.

A third recommendation-why not have dental schools teach orthodontics at the undergraduate level? If they taught endo, operative and prosthetics like ortho, our graduates would, for the most part, be incapable and incompetent.

Gregory P. Heintschel, DDS

Findlay, OH

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