acific Coast Society of Orthodontists Bulletin Summer 2018 - 66
Practice Management Diary
Old Wisdom Dies Hard
Dr. Jeffrey Nichelini
American Canyon, CA
The theory that developing wisdom teeth contribute to late lower incisor crowding has largely
been put to rest in the orthodontic community.
Despite the evidence to the contrary, however,
I continue to be amazed by the frequency with
which young adults presenting to my practice
for initial orthodontic treatment or retreatment
blame their wisdom teeth for their crooked lower
front teeth. Of course, I am happy to provide my
services to address patients' primary concerns,
but not without first clarifying that evidence
does not support the claim that their wisdom
teeth contributed to their condition.
It would be easy to simply ignore the subject, but
not making this clarification would be allowing
the propagation of a myth. In the era of evidencebased dentistry, allowing the propagation of this
type of myth works against the field's greater
goal of improving patient care through improved
decision-making.
Challenging Conventional Wisdom
Making a claim that challenges the historical
wisdom of the larger dental community within
which you practice, however, requires tricky diplomacy. Many patients who blame their wisdom
teeth for lower incisor crowding report their general dentist as the source of that information. To
avoid directly challenging the wisdom of a referring doctor, you can respond to a patient's asser-
66
tion with "possibly," which eliminates the risk of
making the referring dentist look bad. Following
that with a brief discussion of the distinction
between correlation and causality, and an explanation of alternative reasons for crowding, such
as late mandibular growth and soft tissue maturation, can effectively cast doubt on the myth
while establishing trust on the basis of your
knowledge and honesty.
Discussing the subject with general dentists can
be difficult. It is more comfortable to talk about
attractive modern subjects, like 3-D printing and
sleep apnea, instead of challenging conventional
wisdom. However, improving understanding and
dispelling myths of conventionally accepted dogmas may improve patient care and outcomes. If
we stop blaming third molars for late lower incisor crowding, perhaps fewer individuals will have
their third molars extracted. If we recognize that
other factors contribute to later lower incisor
crowding, perhaps patients would be inspired to
wear their retainers for longer periods of time.
Elements of today's conventional wisdom will
eventually become passé, and it is important to
keep our minds open to our patients' best interest.
If you would like more information on the management of third molars, Sanjivan Kandasamy gave
a nice presentation at the AAO in 2015; it is available to download on the AAO website.
PCSO Bulletin Summer 2018
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