The Key Is Diagnosis

I usually enjoy reading letters to the editor, and chuckle over the generalist/specialist controversies. However, I have to question the editor`s decision to publish Dr. Keller`s letter; three columns is an excessive waste of paper unless you want to stimulate letter-writing.

Dec 1st, 1996

I usually enjoy reading letters to the editor, and chuckle over the generalist/specialist controversies. However, I have to question the editor`s decision to publish Dr. Keller`s letter; three columns is an excessive waste of paper unless you want to stimulate letter-writing.

I am a Diplomate of the American Board of Orthodontics and a university-trained orthodontist with 40 years` experience. I have taught undergraduate and post-graduate orthodontics for more than 30 years. I have to strongly disagree with Dr. Keller.

Extraction vs. non-extraction, fixed vs. removable, functional vs. headgear or patented vs. unpatented appliances is not the key issue. The key issue was, is and always will be differential diagnosis. Diagnosis determines the age to start treatment, the treatment objective to be achieved and the treatment procedures to be used.

The reason trained orthodontists in Dr. Keller`s community do not do early treatment is because they don`t see the patient until they are in full complement. The pedodontist cements the patient to the practice with a lingual arch. The generalist locks the patient in with the panacea of removable appliances as a way to avoid nasty, fixed appliances. In each situation, they usually try to lure and lull the parent by saying their technique will save the family money.

In dental school, they teach the KISS approach. In journalism,I thought they also taught that less is more.

Philip Bader, DDS, MS

Torrance, CA

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