Topics of the day:

1. Re: Untangling efficacy of differing treatment
2. Re: Untangling efficacy of differing treatment
3. JCO March 2005
4. ESCO - The Electronic Study Club for Orthodontics


Date: Sat, 26 Mar 2005 13:22:17 -0500
Subject: Re: ESCO Digest - 10 Mar 2005 to 22 Mar 2005 (#2005-16)
To: "The Electronic Study Club for Orthodontics" <ESCO@LISTSERV.UIC.EDU>

Dear Mrs. Vredenburg

My name is Laurance Jerrold and I am the Dean and Program Director of the post graduate orthodontic program here at Jacksonville University. Let me start off by saying that I am by training an orthodontist, an attorney and a bioethicist. As for your dilemma, I wish I had a good answer for you but i'm afraid I don't. Orthodontics is highly subjective. We all view esthetics differently. depending upon the subjective analysis of your daughter's soft tissue drape (nose, lips, chin, etc) and what the goals are for facial change, if any, may greatly affect one's diagnosis of the problem and hence the proposed treatment plan. As to her hard tisue problems ( teeth and supporting structures) depending upon the treatment goals, and where one was trained, meaning what kind of gizmos or widgets he or she likes using, you may indded encounter a variety of viable treatment alternatives. It's really not that important that we agree on how to solve your daughter's problem; what is important is that you and your doctor agree as to what the problems are, what realistic goals can be achieved, and then let the doc do his or her thing. As long as you have found someone whom you can communicate with, feel a certain degree of trust with, and essentially feel comfortable with, go with that person. Most of us are more than capable. If you want tosend me your daughter's records, I'll be happy to review them and get back to you my (your 7th) opinion. I'm attaching a little something that you should read. It should help you decide on which doctor to choose.

Laurance Jerrold DDS, JD
(904) 256-7852

(Please see the attached MS Word file.)

Date: Sat, 26 Mar 2005 20:50:13 EST
Subject: Re: ESCO Digest - 22 Mar 2005 to 25 Mar 2005 (#2005-17)

Response to Dr. Madsen's note:

It is not often that a communication from a prospective patient or parent of a patient appears in the ESCO files.  When it does, it sometimes presents an opportunity for all of us to reflect about why, what, and how we do things in clinical orthodontic practice.  Such is the case with the letter from Ms. Vredenburg concerning differing treatment options offered.

I was pleased to see the responses from our orthodontic colleagues.  Drs. Madsen, Vlock, and Utley, although approaching Ms. Vredenburg's concerns from different perspectives, all "hit the nail on the head".  

What we do on a daily basis is difficult.  Creating accurate data bases for our prospective patients (developing problems lists in our diagnosis) and formulating meaningful and appropriate orthodontic treatment plans for individual patients with arguably problems chiefly of variation rather than pathology present life-long challenges to the orthodontic clinician.  It is understandable, that reasonable, but different treatment options are often present for each patient.  It takes a considerable degree of critical thinking for what might be considered the most "ideal" option to distill from our study of the patient and diagnostic records.  And on occasion, the most "ideal" treatment option might not be appropriate for that patient in question for a variety of reasons which mainly focus upon risk/benefit/patient management/cost factors.

Dr. Madsen mentions some of the problems associated with the treatment formulating process, and I could not agree with him more.   Regrettably, there is still not enough evidence based information for us to rely upon in many instances, and when available, there is frequently other information to suggest an opposite position on any given matter.  In this regard, we can simply "curse the darkness", or continue to hone our skills in doing better research.  The latter option seems to be the trend in both our orthodontic residency programs and peer reviewed publications.  Neither system is perfect, however, we remain committed to improving both so that graduating orthodontic residents and colleagues at large develop required critical thinking skills enabling them to separate the "gold from the dross" in our orthodontic literature and marketing claims of orthodontic manufacturers; And to a great extent, our peer reviewed publications reflect such a discerning professional posture.  

When it is all said and done, at least we should agree upon one thing;  That it "ain't all about gadgets or gizmology".  If it was, then we would probably not be having this conversation. 

Elliott M. Moskowitz, D.D.S.,M.Sd
New York, NY

Subject: JCO March 2005
Date: Tue, 29 Mar 2005 11:04:16 -0700
From: "Wendy Osterman" <>

JCO March 2005 issue.
Open the attached PDF for the current Journal of Clinical Orthodontics table of contents. The Editor's Corner ("If the Staff Ain't Happy...") and other articles are accessible at .

JCO Staff
Journal of Clinical Orthodontics



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