Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 27

Let's Talk About That

SR: Great question.
We all have had parents arrive with preconceived
ideas about a child's orthodontic treatment. The
clearest example is when the parent insists upon
non-extraction care regardless of the amount of
crowding or excessive facial protrusion that
might exist.
For example, when a parent is resistant to
extractions, a complete set of records is a great
educational tool. These include mounted study
and diagnostic models showing the amount of
expansion needed along with facial computer
visualizations. They will clearly show the effects
of excessive expansion on the facial balance and
the periodontal tissues. Showing this evidence
plus verbally sharing your vision or goals for
occlusion, facial balance and symmetry, smile
esthetics, and respect for the long-term health
of gum and bone tissue is helpful. The parent's
value system or preconceived notions may not
change, but at least you have presented what
you stand for.
Keep in mind that part of our responsibility to
our patients is to teach them, guide them, and
give them the benefits and consequences of a
particular approach. The time you spend may not
sway your parent, but they may share your tactic
and highly recommend you to others who share
your approach to orthodontic diagnosis and
treatment.
Pat, you and I have both practiced long enough to
see this happen many times over. And our commitment to clear goals has helped us to create
practices where patients and parents feel the
same way.
PT: For the past three years, you have been
acknowledged by the AJO/DO as one of its top
reviewers. In 2016, you reviewed the same number of articles as Kate Vig and only a few less
than Kevin O'Brien from the UK, which puts you
in special company. What type of articles do you

Winter 2017  PCSO Bulletin

most commonly review, and how does that complement your private practice and teaching
responsibilities?
SR: When I graduated from my orthodontic program, I was planning a small private practice and
a half-time teaching position. My passion was-
and still is- teaching, so reviewing articles is
pure pleasure.
The editors with whom I have had the pleasure
to volunteer ask me to review research papers
that have clinical implications. The topics range
from facial balance/symmetry, to effects of
extraction/non-extraction treatment on the face
and occlusion, to the effects of palatal expansion
on the face and airways- to name a few.
Reviewing these articles makes me a much
better clinician, as I must look critically at what
our colleagues are researching and what effect
that may have on all our practices, assuming we
practice evidence-based orthodontics. It also
makes me more conversant with my clients
when they introduce other approaches.
PT: Dr. Righellis, let's talk about the subject you
most commonly discuss in your lectures: treatment efficiency and excellence. Tell us about
what you think is most important in achieving
excellent clinical results?
SR: Achieving an optimal outcome with efficient
use of treatment visits has three components.
The first component is an accurate and complete
diagnosis. Do we really see everything we need
to know about the patient? Do we look at every
aspect of the occlusion, facial and smile symmetry, airway, jaw joints, gum and bone tissue? Do
we listen to the patient's chief concerns? For
example, are there occlusal wear facets on the
teeth, and can the wear patterns be related to
specific jaw movements? What about the health
of the jaw joints? Are there pops, clicks, or
crepitus? Do we ask the right questions about

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2017