Sie sind auf Seite 1von 7

Public Relations and Contemporary

Treatment Concepts
ROBERT M. RICKETTS, D.D.S., M.S.

As I look around our orthodontic standing and goodwill” ; or another, “to


societies, I realize that my contempo¬ evaluate public (dentists’) attitudes,
raries, or men even younger, are now identify procedures with the public
the main torch bearers and that the (dentists’) interest, and execute pro¬
future of orthodontics will be decided grams of action to earn understanding
by what we prescribe and practice to¬ and acceptance (by the dentist)”.
day. Many new leaders must emerge Professional relations are now at the
from among us. lowest I’ve seen in my career. One
The tempo is fast today, and all of eminent general dentist told me, “Com¬
society is accelerated. Our methods of munication between orthodontist and
communication have quickened. Scien¬ dentist is at the lowest possible level.”
tific knowledge of orthodontics and I feel compelled to express some ideas
techniques have been developed re¬ and observations. It’s time to bring
markably. The demands for our services certain problems to attention, some of
have never been greater, but our gen¬ which you may not know or may not
eration is faced with problems never like to hear.
before experienced. Our greatest cur¬ Why the problem? First, let’s put
rent problem is public relations. ourselves in the position of the general
Now, what is meant by public rela¬ dentist in order to understand what’s
tions for orthodontists? First it includes happened. Until recently, most but —
relations with the lay public. However,
our relationships with the rest of den¬

not all general dentists were loath to
look at occlusion. We still are told by
tistry and other disciplines may be more patients, referred by their friends, that
important. Perhaps a more appropriate their dentists never looked at their bite
label would be “public and professional or mentioned orthodontic attention.
relations.” The whole subject of public The average dental practice was charac¬
relations was developed by commercial terized by partial dentures or fixed
firms for better business practices. Hu¬ bridges. Dentists tended to look at
man relations is basic to public rela¬ teeth only with the mouth open, seek¬
tions. We tend to forget that, as special¬ ing caries. Interest in occlusion was
ists, we rely on dentists for referrals. limited to the use of marking paper for
This makes the general dentist truly high spots at the time of carving
our customer. restorations. Ultimately many dental
Some quotes on public relations practices developed a higher frequency
which appeared in an edition of the of full upper and lower artificial re¬
Los Angeles Times might be useful. placements. Dentures seemed to be the
Public relations is “a function of an love of the older fellows in dentistry
organization expressed in practices, because their practices mature also.
which serves the public (dentists’) in¬ Occlusion finally became a problem,
terest, and communicated to the public but then only for the purpose of sta¬
(dentist) to secure its (his) under- bility of artificial teeth. Dentists have
tended to transpose that stabilized arti¬
Read before the Angle Society, New
ficial denture concept to the natural
Orleans, October, 1967. teeth when the subject of occlusion has

321
322 Ricketts October, 1968

come up. During a lecture in 1964, I in and get out in the shortest time.”
canvassed the senior students at a lead¬ The extraction of teeth was often
ing dental school and about one half deemed necessary as a compromise for
were graduating with the idea that the stability and esthetics. But, the general
“balance” prosthetic occlusion was ideal dentist has never become “sold” on this
for the natural teeth. In fact, some idea or need and those orthodontists
orthodontists accept this idea. who have championed this cause have
not convinced the general dentists on
Meanwhile, the orthodontists in the
first half of the twentieth century prided its merits. Also, the general dentist has
themselves as the masters of occlusion. observed the young graduate in ortho¬
The emphasis was on a full comple¬ dontics, in only a few short years, over¬
ment of teeth in normal occlusion, and run with patients and enjoying an
the master of all was Angle, after whom abundant financial success. He was
this society is named. naturally envious. The young ortho¬
dontist, blown up with success far in
But in the past two decades the tenor excess of his skill and education, often
of the usual dental practice has assumed a superior attitude. This was
changed. Many general dentists have resented and the result was a chasm
become more sophisticated. They have between the specialty and general den¬
become more interested in occlusion. tistry. The dentist began to snipe with
High-speed cutting instruments, routine some justification.
anesthesia, and improved impression Another confusing factor to the den¬
techniques have extended efficiency and tist and the public was also present.
possibilities. The articulator has been When I was an assistant staff member
perfected for the purpose of mouth in the late forties, our orthodontic de¬
rehabilitation with fixed precision. De¬ partment’s policy was to tell patients
velopments in periodontics and endo¬ not to return until all teeth had erupted.
dontics have changed the dentist’s Public pressure for orthodontics was a
attitude to one of preserving the factor in postponement to the perma¬
teeth in harmonious function. He has nent dentition level. But also, ortho¬
become interested in the dynamics of dontists became more interested in
functional occlusion as a preventive of creating alignment to suit their sub¬
oral disease and a promotion of dental jective preferences rather than perfect¬
longevity. ing normal functional occlusion to suit
It is rather ironic that his shift toward the individual need. Those with a
occlusal concepts occurred when the strong background in biology trusted
emphasis on occlusion shifted away the finishing of a case to “settling” or
from the mainstream of orthodontic to nondescript nebulous forces. Finish¬
practice. Interest during this past two ing by the mechanically-disciplined was
decades in orthodontics became cen¬ left to the positioner. The best ortho¬
tered on esthetics. The objectives for a dontist was often considered the man
straight profile and putting anterior who could do it quickest or get the
teeth “over the ridge” or upright over teeth back the farthest.
the bone overshadowed occlusal perfec¬ Cephalometries played its part in
tion. Research in the thirties had sug¬ tempting the orthodontist to treat to a
gested the limitation of orthodontics to pragmatic standard rather than to the
alveolar bone, so early treatment be¬ biological needs or demands of occlu¬
came unpopular. In addition, for the sion on an individual basis. Many
sake of expedience, a trend developed orthodontists in both camps came to
to wait until the orthodontist could “get rely too heavily on nature either to close
Vol. 38, No. 4 Concepts 323

up extraction spaces or for the patient Whether I’ve liked it or not, I have
to grow out of created protrusions. become a spokesman for orthodontics
The general dentist, looking at ortho¬ and protectorate for orthodontists
dontics, had reason to be confused or among many disciplines in dentistry as
skeptical because he could see the wide well as medicine. I have represented
division in practices. He began to doubt orthodontics on panels before the largest
the profoundness of the profession as a bodies of practicing dentists in the
whole. country. It is not uncommon to hear it
said that the orthodontist doesn’t know
Now, I’m proud to be an ortho¬
dontist. I’m proud of this society and anything about occlusion. The dentists’
ideas concerning occlusion relate to a
I’m proud of the reputation that its
static terminal hinge axis registration
members enjoy the world over as
and prematurity of contacts. Our ap¬
leaders, scholars and clinicians. Ortho¬
dontics has given me the opportunity proach is on a longitudinal basis.
to help my fellow man and an oppor¬ We need strong spokesmen and we
tunity for a full life. It is my first love, must enjoin as many enlightened ortho¬
outside of my family. Orthodontics is dontists as possible to speak out. This
creative, and it pays well in financial is a bigger job than one local society
rewards and even greater in personal can accomplish. It is true that many
satisfaction; it has been more than men have established excellent relations,
worth the price I paid to learn even but most have not done nearly as good
though that price was exorbitantly high. a job as they may think.
This is why I have defended ortho¬ Maybe you think you don’t have
dontists without exception every time problems, but I’m speaking for the
our profession has been criticized
often even against my own personal
— orthodontic profession as a whole when
I say that we do have problems. I never
welfare. realized how poorly orthodontics was
As an organized force of the specialty considered by some dentists until the
and as an intellectual body, we have a summer of 1965, when I was one of the
task before us. As a body, this organiza¬ lecturers at the Berkshire Conference in
tion has not recognized the challenge. Massachusetts.
Too many members have sat with com¬ In that particular group were some
placency and smug satisfaction, taking two hundred periodontists and general
the fruits of orthodontics without dentists from all over the country. The
“plowing back” anything. One ortho¬ orthodontists and the whole field of
dontist stated, “I don’t know of a more orthodontics were fair game. Each
cocky, pompous, dogmatic, egocentric essayist before me knowingly or un¬
and self-satisfied group in orthodontics.” wittingly took broadside shots at the
Another excellent clinician, in describ¬ orthodontist. The situation was so ex¬
ing the reputation of his local- group, tensive that individuals and personali¬
remarked, “I don’t know of a bigger ties were involved beyond practical
bunch of snobs than the Angle Society. problems. I was deeply concerned at
They are supposed to be the leaders of many of the things confided to me by
orthodontics and all they have done in some of the clinicians and participants.
recent years is to play politics. They It appeared that the climate had grown
have done more to promote bad pro¬ from envy, jealousy, malice and ridicule
fessional relations than any other group. to hate— mostly because orthodontics
They not only look down on dentists, and dentistry had failed to communi¬
but on the rest of us orthodontists.” cate. A recent periodontal meeting was
324 Ricketts October, 1968

attended by about eighty people. The and muscle as static and fixed struc¬
subject for three days was adult ortho¬ tures.
dontics and not a single orthodontist Another mature West Coast dentist
was on the program. remarked : “I’m very reluctant to send
I have learned that the most im¬ any child to certain orthodontists and,
portant factor in communication is to if I do, I could just as well remove
listen. Let’s listen to the voices heard. four first bicuspids before I send him,
Please try not to become irate or de¬ because they always come out for some
fensive, but seek an empathy with their reason anyway. Then, when I get the
position. patient back, the occlusion is terrible
A New England periodontist after the and I must apologize to the parent,
Berkshire Conference stated, “You are spot-grind or treat periodontal prob¬
the first orthodontist I have ever heard lems caused by the treatment in the
of who knows anything about the sub¬ first place.” I later approached the
ject of occlusion and is willing to talk orthodontist about whom the dentist
about it. The orthodontists in my area was referring and he stated he had
won’t even talk to me about occlusion.” excellent relations with the dentists in
his area, which proves he worked under
This is the image of the orthodontist an illusion.
from a dentist in the Northwest: “He
is high-priced, secretive, and possesses From a California pedodontist: “I
an untouchable attitude. He won’t lis¬ pleaded with orthodontists in my area
ten to anyone outside his field and he to do something for the seven-year-olds
has departed from dentistry. He doesn’t with p-otrusions. The parents were told

care a hang for occlusion all he thinks
or talks is esthetics. He cares even less
that nothing could be done until all the
teeth had erupted. The child would
about periodontal disease. He keeps encounter an accident and the mother
himself aloof and above practical prob¬ would come to me in tears. When the
lems in dentistry. He is hardly ever front teeth are fractured because they
seen at regular dental meetings. I just ‘stuck out,’ the orthodontist doesn’t
can’t talk to orthodontists.” —
have to treat them I do! So, I started
doing the orthodontics myself. I’ve
A New Orleans dentist’s opinion is:
found that I can do it at that age. Tell
“You orthodontists sit in a terrific spot.
me, why couldn’t the orthodontist do
We find the patient, motivate him, tie
it”?
him with a ribbon and hand him to you
on a platter. If you do a good job, I put this predicament directly to an
you’re great. If you do a bad job, I’m orthodontist in that area who held the
the man who sent the patient to you, viewpoint that waiting for the perma¬
and I’m responsible. I have to verify nent teeth was necessary, and he said,
your results as correct. When I get the “It’s all right to let the pedodontists
patient back, I almost always must fiddle with the kids. I’ll get them to
equilibrate his occlusion. Don’t forget treat later, anyway, and I can’t clutter
the patient is my charge for the rest of up my office with a lot of problems for
his life.” But a little later this same five or six years when I can wait and
dentist asked, “If the occlusion was do it in two years.”
right, why do you need retainers”? Three out of four of my patients pre¬
This further stresses the need for com¬ sent for consultation before all the
munication by his orthodontic col¬ permanent teeth have erupted and have
leagues to him on the forces of occlu¬ always done so. I will ask you all a
sion. The general dentist thinks of bone question : Who is best prepared to diag-
Vol. 38, No. 4 Concepts 325

nose and treat the deciduous and mixed periodontics, endodontics and prosthe¬
dentition, the pedodontist or the ortho¬ tics, and said, “Well, if the orthodon¬
dontist? One thing appears increasingly tists can make mistakes, why shouldn’t

evident today it’s going to be treated
by someone. Is it going to be a bite
the dentist be permitted the same
opportunity to learn on the public”?
plate, a promiscuous headgear, a re¬ My answer, of course, was a standard
movable appliance, or the best sophisti¬ one: “If the orthodontist, even with his
cated total approach? Is it any wonder special training, gets into trouble, just
that the pedodontist is moving into the what do you think the man with no
field of orthodontics as rapidly as he training will do”?
can when orthodontists have tradi¬ A well-disciplined Los Angeles den¬
tionally, as a group, turned their backs tist called on the phone one day seeking
on deciduous or mixed problems. They a different orthodontist. In his own
have taken over the diagnosis. I have words: “I want someone else because
been impressed with some courses in I’m tired of my patients coming back
“Preventative Orthodontics,” and per¬ with their mouths looking as puckered-
haps we should embrace them. up as the hind end of an old hen.” The
I gave a talk to an entire dental orthodontist to whom he referred
audience at a dental school which I proudly claims to extract in about
had entitled Objectives of Orthodontics seventy-five percent of his patients.
in Light of Present Possibilities. As an Other broadside accusations and re¬
introduction, one dentist facetiously re¬ marks are standard and historical.
named my lecture Objections to Ortho¬
1. Orthodontics, with fixed appli¬
dontics in Light of Periodontal Destruc¬
ances, causes root resorption and
tion. destroys supporting bone.
All this is not just happening, it has
2. Orthodontic appliances produce
occurred. One Ohio orthodontist ex¬
damage to the attachment appa¬
claimed, “You know, community fluori¬
ratus.
dation has really made a difference in
my practice and all the general dentists 3. Bands and arches are unsightly
say the same thing.” Some years ago and dirty.
another Ohio dentist remarked, “I’m 4. Children complain of too much
getting into orthodontics before it is too pain.
late. I think it is a good racket and they 5. Orthodontics causes caries.
are going to eventually wipe out caries 6. Orthodontics creates traumatic
and all we’ll have left is orthodontics.” occlusion and causes temporo¬
He is now an orthodontist, but his moti¬ mandibular joint disease.
vation is interesting. There is fear
These represent the voices and the
among some dentists that they may
accusations mentioned frequently about
have nothing to do in the future. Gen¬ orthodontists and orthodontic treat¬
eral dentists all over the country have
ment. Is it any w'onder that the unin¬
started doing orthodontics with no
formed dentist looks for a cheaper,
training whatsoever. All this while
easier way, free of bands or archwires,
competent orthodontists are being ma¬
and looks desperately with hope at even
ligned and doing nothing about it.
a promise of a better method? Is it any
An educator once assailed me when I wonder that removable appliances
expressed the notion that the general attract general practitioners in den¬
dentist should stay away from ortho¬ tistry? Is it any wonder that dentists
dontics. He likened orthodontics to find courage to go ahead with radical
326 Ricketts October, 1968

expansion for years when a Milwaukee tion in Washington, D.C., believes the
dentist insists that they do so because orthodontist, like other technicians such
they know more about it than ortho¬ as engineers, has the highest degree of
dontists? technical skill which equips him to do
things himself; but he knows little of
Profile of the Orthodontist human relations or how to work through
The following is abstracted from a other people. The running of an office
study conducted for the A.A.O. by requires wearing two hats: the first is
James R. Hanson & Associates. I will the manager and the second is the
also mention the result of my personal operating executive. This means a total
inquiry in human relations from read¬ conceptual skill, not just technical com¬
ing and courses. The purpose of the petence. It requires a ruthless self-
study was to describe the orthodontist’s discipline because the total job is not
image, identify the problem and offer glamorous and most are not interested
solutions. The study by Hanson was in it, but want only to be left alone
broad coverage rather than specific. It
suggested that flexible, long-range pro¬

with what does interest him straighten¬
ing teeth, at the chair.
grams were indicated. It showed that
the minority fault must be considered Thus, three skills are needed for the
contemporary dentist and orthodontist,
— not just the majority. Fifty-two ortho¬
dontists were studied. Published ortho¬ only one of which we learn in school.
dontic literature and educational films The first is technical, the second con-
were analyzed. Discussions from twenty ceptive, and the third, human relations.
periodicals concerning what was said Technical work should be no problem
about orthodontists were investigated. with training. The conceptual skills of
Close-range observations were made of coordinating auxiliary personnel and
orthodontists at a national meeting. planning can also be appraised with
cold logic and planning. The third
According to Hanson, “Against the
area— human relations, actually is
backdrop of the extremes of those who
psychological. The manual skills and
are bom with affluence and those who
artistic imagination that made the
depend on the welfare state for se¬
orthodontist previously successful now
curity, the firm finds most orthodontists
in the middle where they must work
provide him with no tools or natural
and compete for security. The ortho¬ inclinations in human relations. This
dontist’s specializing places him almost frequently results in exasperating ex¬
in a sellers market and he arrives at periences. Human relations, in the end,
financial independence early. is the most difficult part. The same cold,
calculated input that works in tech¬
“By the time he starts practice, he is nique does not always produce the same
scientifically bent and his long years of result when dealing with human rela¬
training help him to retain the image tions.
of a student. His job of updating ideas
is commendable, but he has done a Going back to the profile study . . .
poor job of getting due credit for his “the orthodontist as a whole, and the
research. These three personal qualities dentist as well, seems to lack the
of science, continued pursuit of knowl¬ genuine good-will effort. His business
edge, and built-in need for personal skills are weak. He is not seen regularly
security limit him as a business at dental meetings. The young ortho¬
manager.” dontist feels he is a cut above the gen¬
Nathan Bailey, Dean of the Ameri¬ eral practitioner or above his own
can University of Business Administra- customer.” Please keep in mind that I
Vol. 38, No. 4 Concepts 327

am quoting studies and I warned that The study thus expressed three main
you may not like it. needs: (1) the orthodontist should
“The default of good-will is the most stand right in the eyes of the public and
serious relation problem. There is re¬ dentists, (2) he must devote more time
luctance on the part of many general to being understood or to defend his
dentists to refer patients and voices position, and (3) these forces demand
from these ranks assail orthodontists as stronger leadership.
a “closed shop” and a barrier to dental The members of the orthodontic
education. The orthodontist may fail to societies are disunited within their
acknowledge referrals, make no effort ranks. Splinter groups in dentistry are
to inform dentists on progress, and emerging into a federation under the
claim no credit for return.” name of orthodontics and are supported
strongly by the A.D.A.
Orthodontics and the whole profes¬
sion of dentistry is in a world of change.
Professionals in the field of human
There is a question whether the entire relations looking from the outside into
the specialty of orthodontics wonder if
professional rank and file is yet aware
the orthodontists are not too tightly
of this change. In dentistry, twenty-
three per cent insist they are not work¬
corseted to their code of ethics. If
better ambassadors are to emerge, more
ing to desired capacity; about forty per
liberal interpretations of the code must
cent of American dentists claim to have
be available to free him as a spokesman
more than they can handle.
and to spare him the jealousy or con¬
Dental care for the masses is upon us demnation on the part of his fellows.
by government, union and other group There is a big problem in evaluation of
insurance plans. The clamor is heard problems from the “bottom up” or “top
for more prevention and less care. The down.” Orthodontists evaluate from the
demands will swell from one million “top down,” or from perfection. Den¬
orthodontic patients yearly to manyfold tists’ views are characteristically from
figures if all seek care who need it. The the bottom up, or anything that will
question is, will the general practitioner work reasonably in good function.
in dentistry assume orthodontic treat¬ 984 Monument St.
ment to fill his appointment book? Pacific Palisades, Calif. 90272

Das könnte Ihnen auch gefallen