Educate, Train and Quality Control
The problem of impacted canines, and definitely the 'non responders', is that they have not been treated with enough attention by the dental schools and orthodontists in general . This is how Dr. Adrian Becker concludes his article from 2010 on the 'Analysis of failure in the treatment of impacted canines':
From this platform, we issue a cri de coeur to encourage the teaching of this subject as a separate entity in
graduate orthodontic programs in which it is conspicuously absent at this time.(p 753) (1)
This is Dr. Becker in his January 2013 Bulletin:
In the preface to the first edition of my book which was published in 1998, I pointed out at the time that
there were virtually no graduate/postgraduate orthodontic specialty programs that included tooth impaction
in their curricula in any didactic or disciplined academic fashion. This situation has not changed in the 15
years since that time.
From this platform, we issue a cri de coeur to encourage the teaching of this subject as a separate entity in
graduate orthodontic programs in which it is conspicuously absent at this time.(p 753) (1)
This is Dr. Becker in his January 2013 Bulletin:
In the preface to the first edition of my book which was published in 1998, I pointed out at the time that
there were virtually no graduate/postgraduate orthodontic specialty programs that included tooth impaction
in their curricula in any didactic or disciplined academic fashion. This situation has not changed in the 15
years since that time.
Required reading!? a novel idea?
My main discovery in the process of my research, as a parent, into impacted canines, is the the ignorance of dental professionals on the subject. It is both heart breaking and infuriating. How can anyone be allowed to treat impacted canines without reading a book on the subject, taking a course, taking a test, proving themselves qualified? If you venture through 'the very long version of Sam's case' you will see that Sam has passed through the hands of dentists, orthodontists, oral surgeons, several professors at the University of San Francisco...and I, the mom, has to diagnose the resorption that is complicating my son's impacted canines! When the professors of endodontics and oral surgery are confronted with the term of PEIR (pre-eruptive intra-coronal resorption) they
are flustered and in denial.
My main discovery in the process of my research, as a parent, into impacted canines, is the the ignorance of dental professionals on the subject. It is both heart breaking and infuriating. How can anyone be allowed to treat impacted canines without reading a book on the subject, taking a course, taking a test, proving themselves qualified? If you venture through 'the very long version of Sam's case' you will see that Sam has passed through the hands of dentists, orthodontists, oral surgeons, several professors at the University of San Francisco...and I, the mom, has to diagnose the resorption that is complicating my son's impacted canines! When the professors of endodontics and oral surgery are confronted with the term of PEIR (pre-eruptive intra-coronal resorption) they
are flustered and in denial.
There are books on the subject of impacted canines, with chapters on 'Invasive Cervical Root resorption' and everything that can complicate a successful outcome, including PEIR.
With any kind of curiosity, anyone can find recent case studies and research around the world on all the potential problems you come up against, when dealing with impacted canines. How can the standard be set so low that ignorance of the kind of knowledge that can be looked up in a textbook is acceptable at a University Clinic! If you don't care to know, you can't diagnose, and you can't treat your patients. |
PEIR (se my special page under 'Copmplications') which is an unknown at UCSF is on the schedule at the dental school in Jordan. A study in children found the prevalence to be 8.1% (2). In the Bay Area, where there is no
knowledge of it, it is basically denied to exist, because you can't see, what you don't know. What I call the 'unicorn effect'.
knowledge of it, it is basically denied to exist, because you can't see, what you don't know. What I call the 'unicorn effect'.
Interpreting CBCTs
I expand on this on my special CBCT page. This new and very useful technique (around 2000) still is unregulated.
It takes training to know what there is to see, to be able to use the technique to best effect and ALARA (as low as allowable). Training is not keeping up with technology.
I expand on this on my special CBCT page. This new and very useful technique (around 2000) still is unregulated.
It takes training to know what there is to see, to be able to use the technique to best effect and ALARA (as low as allowable). Training is not keeping up with technology.
The Dissemination of Information
There are National and International Organizations and Journals set up for this purpose. The AAO has yearly conferences, The World Federation of Orthodontics have meetings every five years. There is a Harvard Society for the Advancement of Orthodontics. There is required continuing education. There is the INTERNET.
The non scientific attitude at UCSF
In my view, and from my experience throughout 'Sam's case', and as far as impacted canines goes, advancement of knowledge only works if the dental professional is interested enough, or cares enough, when they get that problem canine, to do the extra research. As you can tell, my 'research by mom' has far exceeded the interest of the UCSF 'dental team'.
See Sam's case: Sam's canines' condition was so rare that apparently the conclusion was that it could be disregarded. Reading Dr Janian's description of #6 as an 'artifical geometric shape, rather than a process the body creates' makes you wonder if he thinks Sam is an alien. (Well, I have to give him credit for bothering to look at an image, that seems to be more than what most will bother with); Dr Hosseini admits he doesn't understand the ethiology or cellular pathophysiology, and it is clear that he is not going to advance his knowledge even in view of an interesting case.
It is quite exasperating to find attitudes like that at a University.
There are National and International Organizations and Journals set up for this purpose. The AAO has yearly conferences, The World Federation of Orthodontics have meetings every five years. There is a Harvard Society for the Advancement of Orthodontics. There is required continuing education. There is the INTERNET.
The non scientific attitude at UCSF
In my view, and from my experience throughout 'Sam's case', and as far as impacted canines goes, advancement of knowledge only works if the dental professional is interested enough, or cares enough, when they get that problem canine, to do the extra research. As you can tell, my 'research by mom' has far exceeded the interest of the UCSF 'dental team'.
See Sam's case: Sam's canines' condition was so rare that apparently the conclusion was that it could be disregarded. Reading Dr Janian's description of #6 as an 'artifical geometric shape, rather than a process the body creates' makes you wonder if he thinks Sam is an alien. (Well, I have to give him credit for bothering to look at an image, that seems to be more than what most will bother with); Dr Hosseini admits he doesn't understand the ethiology or cellular pathophysiology, and it is clear that he is not going to advance his knowledge even in view of an interesting case.
It is quite exasperating to find attitudes like that at a University.
(1) Becker A, Chaushu G, Chaushu S. Analysis of failure in the treatment of impacted canines, Am J Orthod
Dentofacial Orthop.2010 Jun; 137(6): 743-54.
(2) Al-Batayneh* OB et al. Pre-eruptive intracoronal dentine radiolucencies in the permanent dentition of
Jordanian children. European Archives of Paediatric Dentistry, December 2013.
* Dr. Al-Batayneh is Assistant Professor in Pediatric Dentistry, Faculty of Dentistry, Jordan University of
Science & Technology.
Dentofacial Orthop.2010 Jun; 137(6): 743-54.
(2) Al-Batayneh* OB et al. Pre-eruptive intracoronal dentine radiolucencies in the permanent dentition of
Jordanian children. European Archives of Paediatric Dentistry, December 2013.
* Dr. Al-Batayneh is Assistant Professor in Pediatric Dentistry, Faculty of Dentistry, Jordan University of
Science & Technology.