Enlightenment In Orthodontics : Entropy, Evolution & Information

WARNING: This Blog Post Will Make You THINK!

We start the new year with a mind-provoking, philosophical Guest Blog post by Prof. Dr Anmol Kalha, Professor Emeritus, Distinguished Professor and Advisor / CIDS, Associate Director & Advisor / Max Health Care, and Chief Architect and Cofounder of Smart Health.ai. He is also widely known among his contemporaries as The Orthodontic Philosopher. 

“Dare to understand : one age cannot conclude a pact that would prevent succeeding ages from extending their insights, increasing their knowledge and purging their errors.” ~ Immanuel Kant

An end of the year invitation to write this blog leads to an introspective reflection of orthodontics conceptually in the process of challenge and transformation.

The “Age of the Adult” heralds a new challenge for a specialty traditionally committed to studying growth & development, the quintessentially elusive mandibular growth and a panoply of appliances devised for this purpose. Adults may not grow but faces age and the consequential change in the craniofacial skeleton and support has marked aesthetic outcomes. A compromised occlusion adds to the challenge of adult orthodontics. Yet our beliefs and thoughts remain focused on brackets, wires, and adjuncts with endless debates on virtues of new appliances or interventions that are a marketing success and capture your imagination, but the claims remain unfounded.

Is there hope for orthodontic enlightenment in 2019 and beyond?.. Entropy; the second law of thermodynamics states that in a closed system, entropy or disorder never decreases. Is Orthodontics a closed system rooted in a possible need to create the best mechanical or technological answer to moving teeth?.. Are we still engaged in the battle of “prescriptions and brackets” ?.. Has orthodontic education accepted the changes around us or is it still rooted in the past of the status quo, comfort zones and the familiar focus on skills and techniques?.. If we continue to be a closed system, structure and organization will decrease and so will the ability to accomplish optimal outcomes both in terms of time as well as aesthetics. The specialty will descend into grey monotony and stay there.

Optimism and evolution would be based on the fact that all failures are due to insufficient knowledge, and that knowledge will be infinitely far from complete, and that all problems are solvable. An evolved specialty will not be afraid to innovate; it would have a strong base of criticism and the most important knowledge is the ability to detect and eliminate errors. Information is the key to reducing entropy and disorder. The imperatives of an orthodontic case need to change. The movement of teeth will necessarily bring about a change in “craniofacial skeletonization”, and the changes affect the middle third and shape of the face, not just the profile. The discovery of the largest and newest organ of the human body; the Interstitium – which consists of fluid-filled spaces in the body’s connective tissue, including in the skin’s dermis – brings a new learning that as we move teeth, there is consequent change in craniofacial skeletonization and a shift in facial volume due to gravity. This brings into sharp focus the need to bring in the study of facial aging and clinical facial analysis to augment and replace conventional imaging and treatment planning . The need to control orthodontic tooth movement accurately also brings in the issues of bracket design, prescription and technique. 

The fact that OTM is a biological event involving a cascade of cell messaging needs to be integrated into our orthodontic thinking because we live in an age where chronic diseases are a part of humanity and so are autoimmune disorders with a host of  medications being routinely prescribed for the patient. Should we debate the magic of Self-Ligation in arch development or should we look at the fact that a control on the bacterial load in the mouth of a compromised health may actually favor the health of the patient, or that reducing the forces that may favor treatment of patients prone to root resorption may actually warrant a use of self-ligated systems?

Is Orthodontics a closed system rooted in a possible need to create the best mechanical or technological answer to moving teeth?.. Are we still engaged in the battle of “prescriptions and brackets” ?.. Has orthodontic education accepted the changes around us or is it still rooted in the past of the status quo, comfort zones and the familiar focus on skills and techniques?

The biggest challenge today is Non-Ionizing Radiation and some sources comment on it being the New Tobacco of this century implicated in a host of cell mutations with unpleasant outcomes attributable to RFER. The effect of cell phone usage on the release of heavy metal ions in the mouth is well-researched. The oral environment degrades the best of metal appliances, so should potential patients and children be offered only ceramic brackets? This is a discussion between doctor and parent/patient that needs to be broached.

As the digital era intrudes on our thoughts and practice, the ability to shift to predictive rather than reactive treatment strategies requires a new level of thought and skill enhancement. Aligners and customized appliances all provide the advantage of removing uncertainty in appliance therapy and predictable outcome. The business of orthodontics for once has changed the entire landscape of clinical orthodontics. “Direct to Consumer” advertising has built an inherent global demand for Invisalign and consequently the social and aesthetic forms of orthodontic care, and central to this is another controversy about the fact that the appliances are central to the business of orthodontics and the treatment itself is priced around the appliance. Can we transform to charging a fee for the treatment rather than the appliance? after all, the appliance is only a means to the end!

The future will be steeped in how we manage it. In the words of Stephen Pinker:

“Energy channeled by knowledge is the elixir with which we will stave off Entropy.” 

From his latest book: Enlightenment Now: The Case for Reason, Science, Humanism, and Progress.

Let’s look forward to 2019 with optimism and enlightenment.

About the Guest Author:

Prof. Dr. Anmol Kalha is Professor Emeritus, Distinguished Professor and Advisor / CIDS, Associate Director & Advisor / Max Health Care, and Chief Architect and Cofounder of Smart Health.ai. 

With a 40-year diverse and checkered global experience in Orthodontics, Oral Health Sciences, Health Care Administration, National Health Care policy, and International Research and Consultancy, he has lectured in over 46 countries around the globe and has published extensively, serving on the editorial board of key journals, EBD UK , EAPD and several others . He has a key clinical practice in Delhi with a focus on adults , aesthetics, sleep medicine. He was recently invited to speak at the prestigious International Orthodontic Symposium in Prague, Delivered the Indian Orthodontic Society Oration 2017 , Selected for the Outstanding Professor  award by the IOS 2018, and received a lifetime achievement award in military dentistry from the FDI-SFDS. He has a royal decoration from Oman for distinguished services. An avid reader, writer and keen golfer, he is currently a distinguished Professor and advisor to a prestigious institution in southern India, and is also the cofounder of Smart Health; an initiative on Health Analytics and Artificial Intelligence.