DrBicuspid.com is pleased to present the next installment of Leaders in Dentistry, a series of interviews with researchers, practitioners, and opinion leaders who are influencing the practice of dentistry.
We spoke with John Buzzatto, DMD, president of the American Association of Orthodontists (AAO). Dr. Buzzatto attended the University of Pittsburgh School of Dental Medicine in 1978 and completed his orthodontic residency through the school's department of orthodontics in 1981.
He has dental offices in Allison Park and Bridgeville, PA, and is on the medical staff of both Allegheny General Hospital and Children's Hospital of Pittsburgh.
Dr. Buzzatto discussed the need to educate patients about orthodontists' unique qualifications and whether there has been an increase in adult orthodontic patients in recent times. He also reveals that affordable care and student debt are two of the biggest challenges orthodontists face today.
DrBicuspid.com: Earlier this year the AAO launched a multimillion dollar advertising campaign designed to educate the public about orthodontists. Why does the AAO feel it is important to educate the public about orthodontists' unique qualifications?
Dr. Buzzatto: One of the AAO's five critical issues is consumer awareness, and it was discovered from public focus groups a number of years ago that the public was not aware of our members' additional two to three years of training after dental school. Actually, the campaign began in 2006 with the theme "More Than a Smile," which was followed by the "Puzzle" campaign and the current theme, "My Life. My Smile. My Orthodontist." that began in January 2012.
The campaign put particular emphasis on the adult patients. Has there been a significant increase in adult orthodontic patients in recent times?
It has only been since January 2012 that the campaign began targeting adults, so it is a little early to see the effects of this strategy. However, we have been tracking adults (18 years and older) in treatment since 1989, and the results have held fairly steady, with about one patient in five being an adult. The most recent survey (2010) indicated that 66% of the adult patients that year were female. Most adults are interested in correcting a long-standing problem or one that occurred due to maturational changes. Also, the campaign helps adults understand that they, too, can benefit from orthodontic treatment. Healthy teeth can be moved at any age.
How has the advent of clear aligners and less conspicuous orthodontic appliances changed the practice of orthodontics?
Less visible orthodontic appliances have been around now for decades; clear aligners are simply another form of treatment that orthodontists can employ. Plastic brackets followed by ceramic brackets came to market in the 1970s, and direct bonding of brackets, which eliminated the need for each tooth to be encircled by a band, became commonplace in the 1980s. Even standard stainless steel appliances today are less noticeable than they were a decade ago. Lingual appliances are continually being perfected as well, for a totally aesthetic look.
— John Buzzatto, DMD
There was a time in the mid-20th century that it was rare to treat an adult patient. As we learned about the efficacy of treatment in adults, combined with less obvious appliance options, adults were open to the idea of orthodontic treatment.
Many times, parents or grandparents decide to have orthodontic treatment at the same time as their child. It is economical in terms of scheduling appointments and time away from work for the adult.
Some orthodontists have special arrangements at their offices for adult patients, such as providing a private space for these patients, and in some cases Internet access/Wi-Fi so that adult patients can keep in touch while waiting to see their orthodontist for an adjustment. Some orthodontists also offer evening and/or weekend hours to accommodate the needs of adult patients.
A recent study in the Journal of the American Dental Association reported that even though white-spot lesions are a common complication of orthodontic treatment their presence can result in a negative perception of the treating orthodontist by the patient's general dentist. What are your recommendations when it comes to dealing with these lesions?
White-spot lesions with the associated less-than-desirable oral hygiene continually perplex the orthodontic practice. Many products directed toward this concern -- such as fluoride rinses, extra-potent fluoride toothpastes, and powered toothbrushes -- are all adjuncts that may reduce the incidence of white-spot lesions, but only if the patient cooperates by using these products.
Some research on orthodontic informed consent has found low patient/parent recall and comprehension of treatment risks and expectations. How can dental practitioners improve orthodontic patient comprehension and recall?
This research extends into medicine as well, but a good starting point is an excellent informed consent brochure. I use the AAO's informed consent form and have found it quite useful as it covers a range of risks and limitations of orthodontic treatment. It also has an area for the signature of the patient/parent/guardian. I particularly focus on decalcification, including showing a photograph on the potentially devastating effects of decalcification. All oral instructions are reinforced with written instructions as well. Additionally, laminated instructions and videos are available from orthodontic vendors.
What exciting and useful new products and materials should orthodontists be aware of today?
Self-etching primers, hydrophilic adhesives, temporary anchorage devices, bone-anchored maxillary protraction devices, lingual appliances with robot-bent wires, and even the increased use of three-dimensional radiographic (cone-beam CT) technology are revolutionizing the specialty of orthodontics.
What are some of the key challenges orthodontists face today?
Affordable care: Federal and state governments continually add regulations and laws that impact not only orthodontists as healthcare providers but also as small business owners. For example, flexible spending accounts (FSAs) will be capped at $2,500 beginning January 1, 2013. FSAs allow the use of pretax dollars to pay for medical and dental care, which works very well for orthodontic treatment that may extend over two to three calendar years. Medical device taxes are also scheduled for implementation on January 1, 2013. Although orthodontic devices are not currently included, a ruling by the U.S. Department of Health and Human Services could easily change that.
Student debt: Many students are graduating from their orthodontic programs with a great deal of debt. The debt limits practice opportunities, including entering academia.