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science & practice 92nd EOS Congress6 thodontics versus STO systems. Conversely, it may be that differ- ing scientific, technical and ethi- cal ethos on managing the same problem is the source of the de- bate. Quick and easy? Commercialisation has mod- ified the provision of orthodon- tics in the UK. Indeed, there are now orthodontic brands with courses attached and a faculty of individuals who promote their particular product. Companies tend to boast that their product is the best with limited complica- tions and treatment being low risk, predictable and easy. Some- what surprisingly, courses are being run on how to convert pa- tients into orthodontic clients. There are books describing strat- egies on promoting and increas- ing revenue. They outline de- tailed strategies on attracting more patients than one’s local competitor— or is that colleague? Sounds more like capitalism than commercialism to many interested observers. The rapid development of STO has not escaped the venture (or some may say vulture) capitalists. In the same vein as DIY whitening and sports guards, one can now have one’s teeth straightened via online companies using products delivered by Her Majesty’s Royal Mail and so cut out the middleman (i.e. the den- tist). To my knowledge, STO has yet to make it on to the price list of Sa- mantha’s, a beauty salon in Peckham. What may cause fear and worry is that the provision of tooth movement set against a backdrop of a focus on increasing revenue and patient conversion may detract from the real reasons we are provid- ing the treatment. The risk and benefit of treatment must re- main balanced or be rebal- anced in favour of the patient. The best things in life are rarely quick, easy and without reflection. While learning or training, one gains stature from one’s mistakes and learns by way of osmosis from those of in- dividuals one hopes to emulate. Becoming an expert in many a field requires time, effort and experience. Orthodontics is a complicated discipline that is difficult to deliver optimally and efficiently. Treatment planning should be performed in person not only to appreciate the challenges the patient presents with but also to de- velop a lasting patient rapport. Equally important, patients need to be diligent during treatment and for- ever more for purposes of retention. Is it possible that a one- or two-day course with a treatment plan lasting half a year or less can provide equally optimal results to a specialist ortho- dontist utilising traditional means? In any case, placing a time limit on any treatment could be considered contentious. Patients ask me all the time ‘How long is this treatment go- ing to take Doc?’ I always reply ‘Ill tell you when its finished’. As such I am rarely wrong. Advertising cosmetic treat- ments the fair dinkum way The Australian health ministry recently examined the provision of cosmetic procedures and in particu- lar the modes of promoting the treat- ments. The working group found that advertising and promotion more of- ten than not focused on the benefits to the consumer, downplaying or not always mentioning risks. The group went on to identify advertising prac- tices that were not driven by medical need and where there was significant opportunity for financial gain by those promoting these. They identi- fied the need to regulate promotion and advertising ethically with fac- tual, easily understood information from a source that is independent of practitioners and promoters. This is unfortunately not always readily available. In some Australian juris- dictions, there are specific guidelines that need to be adhered to for promo- tion of cosmetic treatments and they specifically cover before and after treatment adverts, which we know in the UK is a popular practice among the cosmetically driven. This is com- monly one ideal, perfect case show- cased on the front end of the practice website with no mention of any prob- lems, either acute or chronic. Another aspect of the report detailed prohibi- tion of time-limited offers or inducing potential customers through free con- sultations for the purposes of treat- ment uptake. The latter is something that has seen STO promoted by way of voucher deals on the Internet or via smartphone applications. Others may consider such a practice as loss leading; one could ask who is losing and who is gaining and at what price? One important aspect of the re- port identified the wider social im- pact of cosmetic procedures in that people may become increasingly dis- satisfied with themselves and their appearance, culminating in deeper concerns for the person and reducing scope for individuality. Many dentists throughout the country may have a slipped contact here, a rotation there or a space distal to a canine who are unlikely to be waiting in earnest for the next voucher deal alert on their iPhones. Inducing misgivings or rais- ing concerns about the patient’s tooth position where the teeth are other- wise healthy and the patient presents with no concerns could be considered unethical and worryingly dishonour- able. Relapse of confidence In a recent publication from an indemnity provider, orthodontics was identified as an emerging area for claims against their clients. This is likely to be the tip of the iceberg, whose size will probably continually grow as more and more orthodontics is provided and the repercussions of which may only become apparent gradually in the future. In the now highly litigious arena of UK dentistry, the failure of ortho- dontic treatment against the back- drop of Montgomery v. Lanarkshire Health Board is likely to result in in- creased litigation. The movement of teeth into what the patient and the dentist feel is the correct position may be possible in the short term, but in the long term complications may arise owing to a variety of soft- and hard-tissue factors that cannot ac- commodate this new and supposedly “right” position. Indeed, orthodontics requires the appreciation of detail where symmetry and alignment are “king”, but long-term stability is the likely “empress”. Relapse of position is a common complaint and where pa- tients have paid handsomely for a re- sult they may have been happy with at the time of the cheque clearing, over time tiny tooth shuffles can re- sult in disproportionate and vehe- ment dissatisfaction. Where teeth are moved indiscriminately, recession in the labial segment is a complication difficult to explain and remedy in the high lip line of a conscientious and ambitious corporate female patient. Indeed, more haste, less speed may result in a case being etched longer in the memory of the patient and the cli- nician for the wrong reasons. Clear steps to business building A cornerstone of a successful business is the repeat customer who values the dentist and his or her ser- vice and returns with no qualms or misgivings about what the dentist feels should be provided. A success- ful business relies on patients return- ing in the long term owing to their positive experiences. Focusing on short-term gains without due consid- eration of quality or reliability of the treatment provided has potential re- percussions for patients, the business of dentistry and perception of the profession. AD © Alexis Photo/

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