CLINICAL EASE AND SHORTENED TREATMENT TIME
Comfort of the Orthodontist is as important as the comfort of the patient during the conduct of the treatment.
The INDIAN INSTITUTE OF ORTHODONTICS shows the way to achieve this through a two day short course announced in Ahmedabad as per their web site http://www.indianinstituteoforthodontics.com
The time taken to deliver the results is indeed very exciting. This opens up large possibilities for conducting Orthodontic treatment with little effort on the part of the Orthodontist. Fewer visits by the patient ensure their comfort with fewer visits to the Orthodontist. This is of great significance in this era of traffic jams and crowded streets.
Even the Orthodontist can now look forward to more free time for the family and will be in a position to take more patients. The advantage of the approach as presented in the course can make the life of the Orthodontist very comfortable particularly in the visiting practices which are the main stay of orthodontic patient care delivery for the new comers to the profession.
SIMPLEST PROCEDURE IN THE DENTAL CHAIR?
Placing and bonding an Orthodontic bracket on a tooth is the simplest procedure in dentistry. There are no complications even by the wildest imagination.
In India the visiting practice is the most popular way to practice Orthodontics. Newly qualified Orthodontists move from clinic to clinic and city to city attending to Orthodontic patients convinced for treatment by general dentists whose clinics offer orthodontic treatment among other modalities. The practice of Orthodontics is controlled by the general dentist.
It is highly recommended that the general dentist contribute to the Orthodontic treatment procedure by taking the responsibility of bonding the appliance for the Orthodontist. This will help save the time of the Orthodontist as well as increase the share of the dentist.
In the USA, appliances are bonded on the patients by 2nd assistants, who do not need certified qualifications to do the job. These are mostly school and college drop outs, with very low intelligence. Surely, dental graduates can be trained to bond the appliances for the Orthodontist.
FACULTY AUDIT
Orthodontic education in India cannot be de-linked from the recent exposure of large scale corruption in the Dental Council of India , the Government regulatory body for dental education in India.
It is a universal complaint from dental graduates that they are taught very little orthodontics at the graduate level. Is the faculty preserving it's knowledge only for the Post graduate level ?
The recent exposure of corruption centered around the Government permission to allow Post Graduates seats in private colleges irrespective of the availability of resources such as Faculty , equipment and patients.
Most, if not all,of the Faculty have acquired their experience by dubious means by merely lending their names to staff lists to meet the requirements of staff numbers in private colleges. This means they have not actually worked at their positions. Just eight years of such an experience qualifies the Faculty as Professor.
Some of these dubiously trained teachers have now risen to the ranks of Professors and Heads of Department, which are now trying to conduct PG courses in Orthodontics. The question is are these teachers qualified to teach what they are teaching to the students ?
To further elaborate, most of the faculty is basically trained in Begg's which was the ruling technique in most of the orthodontic departments in India, an exposure of one or two days, which includes time for entertainment and fellowship, in short courses, is hardly the training that can justify them to teach Pre adjusted edgewise and MBT to PG students.
The result is poorly trained students who know little more than sticking brackets and changing arch wires ,which rarely move beyond the 016” NiTi. This is resulting in treatments lasting for ever, with the patient's discontinuing in disgust.
So who is to blame ? Do we target Orthodontic course conducted by individuals or blame the East European and Russia trained Orthodontists or do we have the courage to look within.
How come no one asks “ WHEN AND WHERE DID YOU LEARN THE TECHNIQUE THAT YOU ARE TEACHING TO THE PGs ? “
Unfortunately, the economic interest drives the profession. The private dental college owners know that they have a goose which will continue to lay a Golden egg regularly, the dubious Faculty know that they have an extra source of income and the students know that they have bought themselves a fancy qualification / degree ,to now start it's economic exploitation in practice.
The faculty has found an easy way of covering it's deficiency of inadequate knowledge by changing track regularly to newly introduced hardware. It is fashionable to do the latest ( still unproven ) which is introduced at every yearly conference. Hardware has taken over the capability aspect. No one wants to know if the Torque values , as prescribed by MBT ,are good for the Indian population. It is even suggested that one particular fancy bracket removes the need for extraction in an Orthodontic case.
The overrated Indian Orthodontic faculty has yet to come up with something of value or something concrete. The so called best are busy quoting the foreign authors to impress the audiences.
The Faculty must answer the following :
- What technique were you trained in ?
- What technique are you teaching ?
- Where did you learn the technique that you are teaching ?
- What was the duration of the course ?
- How do you justify teaching something at the MDS level which you acquired over 2 0r 3 days ?
- Are you conversant with techniques such as pinching bands on molars with Peak pliers ( a requirement on an MDS program ) and making arch wires or are you an advocate of off the shelf ready to use orthodontic hardware ?
It is time the student's signing up for Orthodontic programs demand their money's worth and evaluate the faculty before enrolling.
STATE OF THE PROFESSION
The Orthodontic profession in India is well near 5000 strong, comprising qualified orthodontists and those from eastern European nation, whose qualification are yet to be recognized by the regulating authorities.
There are 92 Orthodontic programs in the country, taking it to the number one position in the world (reference WFO times Volume 15 no 1 2010 ) . There is, however, no reference available on the quality of the programs.
Orthodontic patient care is available throughout the country to the billion strong Indian population. Most Orthodontists are concentrated in the large cities, where they compete for the limited orthodontic care market.
The majority of the orthodontic patient care is provided by orthodontists on the move, who visit dental clinics periodically to take care of the orthodontic patients in the area.
The General Dental practitioner controls the orthodontic patient care market in India, directing and advising the patient for treatment for a monetary consideration. The Orthodontists feel obliged to pay in order to receive the reference. There is a growing competition amongst the orthodontists to offer higher kick back in the face of growing competition.
The loser in the deal is the patient. The Orthodontic patient is not generally referred to the better orthodontist, but to the one who offers a higher commission for the reference. To cover costs, the orthodontic patient has to shell out larger fees or may end up deprived of proper treatment. On the other hand, in order to make a decent profit, the patient is short changed and provided with compromised appliances and treatment.
The extensive and much glorified Orthodontic academic establishment has till date failed to provide a single thought process of value for the Indian orthodontic patient.
Almost the entire hardware for treatment is imported and there is a regular competition to sell the latest irrespective of the capability of the latest braces. The Indian orthodontist presents himself more as a salesman for braces than a technocrat.
With pre formed materials available in the market, the orthodontist's skill has taken a backseat. Gone are the days when orthodontists used to toil over a case making stainless steel bands for the patients and bending wires to suit the individual needs of the patient. It was precisely these skills that put the orthodontist in the highest paid bracket in dental care.
The private dental colleges charge the earth for a seat in an orthodontic program. This has resulted in a crop of orthodontists from very wealthy families, who do not care to put in the required hard work to take the profession forward. There is a visible absence of initiative on the part of most orthodontists. Talent has clearly taken the back seat in Indian Orthodontics.
INSTRUCTIONS TO THE PATIENT
The patient must choose the orthodontist carefully, find out the qualifications, experience, time devoted to each patient, time taken to complete a case . Find out about his training, Where did he learn the new technique that is being offered ? How much experience does he have with the technique?
Do not get impressed with full waiting rooms, this could mean that the orthodontist is just a show man, with poor work delivery. Be careful selecting your braces. You may be offered very fancy latest braces for a higher amount of money. Remember you are not there to purchase braces, It is important that you get good treatment and excellent results in a reasonable time frame. Fancy braces cost a lot of money with no special benefit to the patient, do not fall for the salesmanship.
You may need to have some teeth extracted for the purpose of the treatment. Some patients get scared of the suggestion and start treatment with orthodontists who offer to treat without extractions. This could just be a method of grabbing business. When after a long period of time, when results are not showing up , a case is made to extract. If extractions are necessary, then there is no need to waste treatment time. Remember you are also wasting your precious time traveling to the doctor and that also costs money. A good diagnosis must help establish the need or otherwise for extractions.
SELECTING AN ORTHODONTIC PROGRAM ?
There are now well over 92 orthodontic programs in India leading to the degree of MDS in orthodontics.
It is important that a right choice be made by the candidate in choosing the program. Most programs are very expensive and are staffed by faculty who have little to offer except that which appears in the text books which are mostly American.
There is almost no research or development in Orthodontics in India. Almost everything comes from the west and the Orthodontic establishment in India takes pride in blindly apeing the west. Even diagnostic standards compiled for the western population are used on Indian populations. Most of the pre adjusted hardware such as preformed arch wires and pre adjusted brackets are designed for western populations. The present system relies heavily on preformed hard ware with no attention being paid for developing skills like wire bending which was the major requirement for good orthodontics.
One must evaluate the economics of taking an Orthodontic program in a private dental college. Consider the fee charged to the return in private practice or the job market. Best way is to contact a fresh orthodontist and find out how he is doing. Do not get carried away by the glamour of the well established practitioner. As for the job market, it is drying up and a fresher should be prepared to work for a pittance.
Most new comers start with a bag in the hand visiting as many clinics as they can for the purpose of securing work. This is a clear invitation for exploitation by the General Dental Practitioner, who controls the orthodontic patient care market in India. The dental GP has been known to pit one new orthodontist against the other with the intent of makeing a higher profit on each reference. The visiting practice is totally unorganized and leads no where. The patient most times does not even know the name of the orthodontist. The patients are only aware of the dental clinic they are being treated in.
IS THERE AN ALTERNATIVE TO AN M.D.S. ?
Necessity is the mother of invention. Yes there is an alternative to a very expensive 3 year orthodontic program in a dental college. If you are going to practice orthodontics, it will be worth considering taking a private program. It will help you carry out a decent level of orthodontics. A large number of General Dentists have added Orthodontics to their practices in the USA. There are a large number of procedures in Preventive and interceptive orthodontics that can be easily handled by general dental practitioners. If you have the aptitude for Orthodontics and do not have the money to finance an orthodontic program, you should look for alternatives. Of course the degree will help you acquire a good job in a teaching institution, provided there are jobs available.
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