“The Fool’s Golden” Proportion

Or should the title be the Golden Proportion for all us fools who have listened to cosmetic experts? If you have been practicing for a while you would have experienced the reference to this pillar of cosmetic training that seemed to dictate the ideal relative proportions of the upper anterior teeth.

I used to cringe hearing it, and was relieved to read an article in the spring issue of the Journal of Cosmetic Dentistry that agreed with my repulsion.

In his article “Keeping It Real!: Mystifying Beauty”, the author Iran Ahmad described in essence how smile design by cosmetic experts has been destroyed by using this misapplication of a Greek scholar’s non-dental theory. If you are like me, you would often pick up cosmetic dental journals and articles mailed from porcelain dental labs to see smiles that were somehow ‘not right’.

Even though patients have flocked to cosmetic dentists for their expertise it seems their trust has often been betrayed. As the author states, perfection does not equal esthetics, and the obsession with getting every tooth dimensionally sized to honor a dead Greek geek has been foolish. The hundreds of thousands of veneers designed with philosophical foundation are now obsolete. Will cosmetic dentists and their labs be sending out notices of a factory recall? Not likely.

It takes a lot of gumption to write an article that questions the beliefs of fellow professionals, but I don’t think the author will be sitting alone in the convention cafeteria. He will be able to enjoy his meal with the author of another article in the same journal (Jason J. Kim) that essentially stated porcelain veneers are often too white to have a chance at looking natural.

Maybe those of us who are a little sloppy in our measurements and simply eye-ball with thumb and finger are the new real-life experts in Un-Cosmetic Dentistry. Maybe we will have our day in the sunshine sooner than others would have dreamed.

Are my Roots Straight Enough Yet?

It was interesting to read that the American Board of Orthodontists does not have special requirements for the facio-lingual inclination of roots (and my spell check won’t let me even type it without a hyphen). On the other hand “general root parallelism is required, and points are deducted…” (Am J Orthd Dentofacial Orthop 2012;142:139). This same article was discussing the use of cone beam technology to access the root positions of the teeth.

A few journal issues ago a different author revealed that the need to have roots parallel for stability was a myth. In the real world it is nice to simply be able to keep the roots within the bone and gums, and have the part that is covered with enamel stick out without attracting attention. When a layperson (your patient) doesn’t like something it doesn’t matter how many points you get from the rule books.

Being the person that quietly questions the commandments of the dental niches, I always felt there was something odd about the center of rotation theory. Rather than believing the ‘2/3 down the root’ idea, I proposed an alternative concept where a lateral force applied to the tooth would cause the tooth to effectively fulcrum off the alveolar crest. Proof for this theory which I called the ‘alternative center of rotation theory’ or ‘Z spot’ for obvious reasons.

Proof or support for my idea came in another article which tested the various energy within a periodontal ligament with applied force. The researchers found a higher force in the ‘Z spot’ although they did not seem to make the connection. Pleasured by this data I emailed one of my orthodontic gurus who responded that it could have some merit.

Rather than discuss the possible abuse potential of extended treatment times needed due to the difficultly in moving roots, and the radiation exposure that could kill off some of our clients, I am going to relax and have a cigarette and leave that to the reader to ponder.

The Magic Mandibular Growth Pill

As I am doing a routine dental check-up on one of my young patients, I feel her despair. I also am biting my tongue, as the orthodontist her father decided to take her to is using the magic Herbst appliance to grow her deficient mandible. In my mind, I am thinking things that I could not say without risking a slander lawsuit.

The orthodontic journals still contain articles where the authors are proclaiming stimulation of mandibular growth, when most authorities agree that it is not what really is happening. An orthodontist friend came across a patient who was in a Herbst for a prolonged period of time. The patient had severe deterioration of the TMJ but repeated requests for radiograph evidence were ignored. Are we trying to keep something secret?

If we use facial analysis and determine that a deficient mandible is the cause of a ’bad bite’ what options should dentists offer? If a patient is a teen are we really allowing children to be tortured by convincing the parent orthodontics is the cure, when often it only gives the impression of a correction. Posturing the mandible forward is an unnatural state and doctors use certain techniques they may be venturing into voodoo science.

Decades ago my cousin fell asleep at the wheel and was ejected from his vehicle. His left leg was hanging by a thread, but they pieced it together rather than amputating. The bone fragments healed, but the damaged leg ended up three quarters of an inch shorter than the unaffected side. He could have had it surgically lengthened but instead he either walks with a limp or wears a shoe that corrects the discrepancy with a thicker heel.

These compromises are similar to what we can offer in dentistry for a deficient mandible. We can offer a surgical advancement (high risk-text book results- but numbness and death are compromises), correct any anterior alignment concerns (cosmetic ortho -compromises), dabble with ‘camouflage’ treatment (compromises) or even pretend to grow the mandible with appliances.

If the mandible cannot be stimulated to grow, then this treatment is as silly as charging my cousin $8,000 to teach him to correct his gait with an uplifted heel (walk on your tip toes if you want to be taller Mr. Tom Cruise).

The limited post-orthodontic supervision time may serve to protect the orthodontic practitioner from legal responsibility and from seeing the truth that the treatment often falls short of the claims. It is one thing to say you can do something, another to lie when you know you can’t and another to fool yourself into thinking you can do it even when the science says it doesn’t work.

With all the stink about general dentists doing ‘shorter term braces’ I simply shake my head. The ones making the most fuss are often doing things that are using outdated techniques that need to be put in a museum. I see an ad for an upcoming convention where periodontists and orthodontists are getting together…why are they excluding the best referral source they have on the planet?

When Orthodontists Attack – Part One

If you read my book ‘Confessions of a Former Cosmetic Dentist’ you would quickly pick up the message that I had a bad attitude related to both cosmetic dentistry and orthodontics. Why would a small time general dentist try to make a stink about the purists and the experts? The real reason was the ADA sat back and allowed a group of doctors to systematically attempt to destroy my practice after I began offering ’shorter term orthodontics.’ It made me question the whole dental profession and the closer I looked the more problems I discovered…I felt they were in no position to cast stones. The experience that I had apparently is not an isolated event, but some dental associations allow disputes to spin out of control and others try to nip turf wars in the bud.

I really had no idea that orthodontists in my area would feel threatened by cosmetic orthodontics, since they had a long list of referring dentists (including myself). My niche is simply people who want to have straighter teeth in a shorter amount of time, usually for a lower fee. My background training was described in another article, but the point here is even in an area where orthodontists are in short supply, they can resort to unsavory tactics to undermine your reputation.

The personalities involved attempted to blackball my practice in what I was told was a coordinated effort. Rather than lie quiet and let them have their way with me, I decided to expose the foolishness recently by posting a ‘Dentist Crime Stoppers Reward for $10,000.’ The levels of arrogance of my attackers combined with their passive-aggressiveness were almost humorous. The attacks were inspiring and gave me a bigger purpose, to lobby for a worthy niche between traditional orthodontics and cosmetic dentistry. I chose to dig in and fight. The Achilles heels of both orthodontic and cosmetic dogma are easy targets, and it is clear that many patients are being mistreated by members of these camps due to twisted ideas that do not hold up under scrutiny.

When I read a specialty journal article that suggested orthodontists should report general dentists to the licensing body for aggressive marketing practices I had to laugh. Besides a possible Guinness Record for the most expensive tooth, I would surely win a second for most marketing complaints for a dentist. The surest way to dry up referrals is to report a general dentist to the marketing authorities. If orthodontists do the math, they will see that it is only their loss. Once a battle is initiated there is no going back but in the end this in-fighting will take the dental profession to a better place. Patients will have another alternative in any brand of STO that has as much merit as all the other choices that are currently promoted by heavily funded groups.

When I recently interviewed Dr. Clifton Georgaklis, who may have been the first to publish the concept of ‘six months cosmetic orthodontic treatment’, he described experiencing a few of the same issues and simply said it was best to ignore it. That’s not what I’m choosing to do.

Time to end Animal Cruelty in the Dental Profession?

Reading a recent article in my favorite orthodontic journal I was shocked to see graphic photos of a dog’s skull dissected to the bone. I wondered if this experiment was really justified. If the dental profession is truly concerned about its public image then the animal studies better have some massive benefits besides giving authors a chance to say their work has been published. It would be a touchy subject…but similar to an endodontist I like touching nerves.

The study was investigating the effect of a couple types of orthodontic implants (TADS) on the jaw bone and comparing inserting them with and without pre-drilled pilot holes. The original article is titled ‘Microdamage of the cortical bone during mini-implant insertion with self-drilling and self-tapping techniques: A randomized controlled trial’ – ((Am J Orthod Dentofacial Orthop 2012; 141:538-46). I never can keep the two types straight, but the scientists made this article unforgettable.

Many readers including PETA would have likely suggested the whole group of researchers from Connecticut and Indiana should be put on trial. Their null hypothesis was that neither technique of implant insertion would have an effect on cracking of the bone. My concern was one or more dogs (hounds as they were referred to in the study) were rounded up, tortured and killed for science. After going back and skimming the whole article I discovered twelve of man’s best friends were slaughtered for this experiment.

We may have all been irritated by a neighbor’s dog barking through the night and thought ‘if he doesn’t shut up I’m gonna kill him.’ In this case the motivation was simply to test a hypothesis with little real world benefit. Pamela Anderson who likely doesn’t read dental journals would be steaming up in her red bathing suit if she could understand the perversity behind our profession’s ‘Mengelish’ experiments.

The researchers were not studying if TAD’s caused cancer or other serious complications. They were not studying a relationship to anything related to clinical performance, which we are easily capable of doing on humans, perhaps with compensation. It was a study that was not thought through. People (or dental students) willingly participate in studies all the time and this one could have easily been completed on a few fresh pig heads while their loins roasted in the oven. Many experiments do not have to be done on live animals (who are usually used as pets).

Being a loose cannon you’d think I would run to the groups who are dedicated to animal protection and serve up some humans.  Impossible. It was only a few weeks ago on a mountain weekend getaway when my wife pulled me into a store for ‘a look’. She wanted to give me a fashion show and in the end I was pulling out my credit card for a sheared beaver…the third fur in the last 12 months. Within that same time I picked up some thick silvery baby seal boots in a Quebec City snowstorm. My wife would also remind me of the time I pushed her pug into the trunk of my new BMW for a short drive to the vet, rather than have his hair contaminate my plush interior. A splash of red paint or critical comment or risk of such leaked atrocities could be argued would keep most sane folks off the keypad.

Hypocritical as it is to now write about this, I also enjoyed a tender beef steak on the weekend. We all break rules of some kind but it may even give me more inspiration to dissect this topic as I come clean about my own transgressions. While I am splitting hairs on this theme, I still encourage you to consider the risk-reward of animal studies and not simply look at this as a black/white issue or worry we can’t talk about it because it will tarnish the profession’s image.

Aware that dentists can be painted with good or bad strokes by each other, the public or the media the profession seems to bite its cheek and tolerate some unusual activity. It is also possible to ‘get away’ with things because we talk in jargon and may be able to fool laypersons as easily as a computer geek talks us into an extended warranty and a few extra gigs. We even fool ourselves and build massive educational cults based on conjecture and the rants of gurus who have sprung from dark places. The animal rights consultants likely didn’t see through the jibber jabber of the groups plea for the death penalties of the animals that should have been spared.

Our profession attracts certain types of intelligent people that enjoy inflicting pain. As children we all do stupid things to small animals and sometimes each other. Two brothers once sadistically tortured me, tying me up and roasting me over a hot gas furnace. They later grew up to become ‘almost normal’ health professionals and they sometimes laugh in reminisce (while I wait for the right moment to extract revenge).

True psychopaths are a small statistical part of any group but we still need to use caution to avoid entertaining activities that could be misconstrued. The researchers in this group may not have been aroused by their exploits (like the recent body part-mailing killer recently captured in a worldwide manhunt). They may not have even aware that their study was of little value. The true value may have been to simply highlight the fact that many animals are suffering at the hands of scientists fixated on finding answers to questions that can be uncovered differently or don’t really matter in the real world.

In dental school I can still recall how one of our elderly clinical instructors paused over a few of us and our slack jaw dento-forms in the back row of operative class. He wondered why I was wearing black leather pants in the clinic…did I own a motorcycle? (No). Then he described doing physiology tests in dental school on live dogs which were later killed. It was obvious that although years had passed and he felt it was a useful learning tool, he was uneasy about it. Like this study in the orthodontic journal, and others going on right now across the world, in some of the cases we don’t have to keep doing this to animals to know the truth.

The dental profession is advancing at light speed with the help of motivated individuals, manufacturers and the needs/wants of the public. Perhaps it is time for researchers to re-think what animal interest groups would say to ensure studies do not cross the line into blatant animal cruelty. The profession needs to watch its step.

Michael Zuk dds

original article – all rights reserved


Are you ready when the media calls?

When I bought the John Lennon molar at auction last November it was like being out in the ocean on a surf board and seeing the chance to ride the one perfect wave. There may be times that you choose to let a big opportunity roll by and for example let a more prominent surfer grab the big one. I would say, get in there and go for it.

In my case I had already written a book and there was a section on celebrity smiles so there was a way to work that into the news stories. The odd news of buying John Lennon’s tooth was simply too unusual for the media to resist. I had the gut feeling that it was one of those experiences that would looked on by some as ‘disgusting’ and by others like Dr. Howard Farran as ‘the smartest marketing idea ever’.

In my case the celebrity association got the wheels rolling, but behind the scenes I was shooting out press releases to all the big players. I had taken a course about publicity the year prior and it helped prepare me for this ride. I totally ignored the negative commentary, except from Bill O’Reilly. Any time you can get kicked by someone with his position, it’s worth it. I wrote a short book to document some of the fun called ‘John Lennon Tooth’, appeared in a celebrity DNA documentary and continue to milk the story. Locally a magazine just featured me as a local celebrity and a two page feature, cover listing and with 30,000 distribution. I could have said, no thanks, but why not? There are pocket books that help you prepare for working with the press.

Charity is also an angle that easily attracts attention, so a ‘free dental day’ is an idea (I wrote a book or five/six, one called ‘Pro Bono Dental’ available on Blurb.com sold without markup, if interested in some ideas). Being the rebel or someone who is willing to speak out against the mainstream experts can be another angle (I keep an eye on Dr. Oz and his dental experts). New innovations are also considered of interest to the media.

Today a friend is being visited by the media and I simply gave her a few words of advice…keep it simple, repeat the same basic message and don’t talk using too many brands. We all do many things but being known for a something unique keeps constant focus. You can and should work at being a celebrity in your area, and if you are not feeling worthy then take some steps to become what you want to be.