LETTERS TO THE EDITOR What is the future of orthodontics ? To the Editor:
At this point in time, anyone in the limited practice of orthodontics would have to admit that the specialty is in serious trouble. With the number of general practitioners and pediatric dentists whb practice orthodontics increasing exponentially, the future of the specialty is questionable at best. An informal survey conducted recently in the Southwest indicated that 80% of the general practitioners polled do all of their own orthodontics, that is they refer nothing. In this-climate, one would expect members of the specialty to pull together and work toward its survival. If orthodontics is to survive as an independent special.ty, the entire profession must unite on behalf of the few dentists and dental students who have the integrity and fortitude to pursue formal graduate training in the specialty rather than relying on the quack motel programs so popular among the general practitioner/pedodontist orthodontic set. On surveying the fates of recent graduates, one has to doubt very seriously the intentions of established practitioners who seek out young "associates." Most "associateships" that are offered to graduating orthodontic residents can be regarded as nothing more than con jobs. One scam that has unfortunately become quite popular is for an established orthodontist with a declining practice to take on a current graduate on a "space rental" or "percentage of production" basis. In the contract, it is specified that the "employee" will have the option to purchase the practice in time. Also included in the contract is a covenant not to compete, specifying that if the "employee" leaves the service of the employer, he or she will not practice within a sizable area around any of the "employer's" offices for a period of several years. What this boils down to is a contract for indentured servitude. If the younger practitioner does not agree to the terms of sale set down by the senior practitioner, he is forced to pick up and move. Nowadays, there is nothing to move to. In the orthodontic market today, it is practically impossible for a recent graduate to open an office and expect to make even a subsistence living. The majority of recent graduates are struggling under a student loan debt of $40,000 to well over $80,000. Banks are unwilling to extend start-up loans under these circumstances. The younger orthodontists are over a very large barrel. Rather than extending a helping hand to their younger colleagues, many senior orthodontists see this set of circumstances as an opportunity to take unfair advantage of some very gifted people. If current graduates are not able to find acceptable employment within the specialty, they will have no choice but to join the ranks of the "supergeneralists." The students who are accepted into orthodontic graduate pro-
22A
grams are the very best that the entire profession has to offer. If they are not able to support their families in specialty practices, they will make excellent, aggressive generalists. If this crop of young talent is lost to our specialty, the specialty will have no future at all. Established practitioners are certainly within their rights to set the conditions of employment or the sale of their practices. If the specialty is to survive, these conditions must provide a decent, livable income for the employees. Noncompetition covenants should not be used as weapons to allow employers to dictate ridiculous practice sale prices. A realistic sale price is one that can provide the buyer a comfortable income while servicing the debt load. Anything more is simply an exercise in personal greed. Abuses of noncompetition covenants are simply cowardly expressions of territoriality. If the employment contract does not include a livable salary, it has no business including a noncompetition covenant. Now is the time for the specialty to pull together to help young graduates. It is not the time to eat our young. We must meet the challenge of overcoming personal greed and give recent graduates a well-deserved hand up. After all, they could have been general practitioners. and simply gone to a series of weekend orthodontic courses. Young graduates have been willing to make tremendous personal sacrifices to properly enter the orthodontic specialty. Are senior orthodontists willing to make personal sacrifices to 15reserve it? If they are not, the very future of the specialty is in doubt. Robert G. Kehn. DDS 1201 Grove NE Albuquerque, NM 87110
Comment on shear bond strength To the Editor:
At the expense of being repetitious, I would like to address the article "Shear Bond Strength of Four Orthodontic Systems" published in February 1990 issue of the AJODO. I was impressed and agree with some of the testing techniques employed by the authors. However, I would like to add some information to clarify the historic and clinical use of sealants. The article compared the mean shear bond of Saga sealant, Maximum Cure, Scotchbond-2, and Concise enamel bond. About 1968 I formulated Saga sealant to be used to prevent decalcifications in gingival areas of noncompliant bracket-bonded orthodontic patients and as a pit and fissure sealant. I called it NEWAD sealant. As Zachrisson noted, Saga (NEWAD) sealant demonstrated one half the unreacted methacyrate groups when compared with the Concise sealant and polymerized in thin films.
Vohtme 99 Number 5
NEWAD (Saga) sealant has also demonstrated good abrasion resistance and appeared to increase bond strength in vivo. In vitro shear bond strength tests, when testing plastic brackets, EPAC adhesive, and NEWAD (Saga) sealant, indicated an increase in bond strength as compared with EPAC adhesive when used alone. The acetone in NEWAD sealant decreases the effect of oxygen in inhibiting free radical polymerization. EPAC is an acrylic-based adhesive, whereas the unfilled resin primer (N.EWAD-Saga) is an epoxy-acrylate (BIS-GMA); hence th6 name EPAC. To be brief, NEWAD (Saga) sealant contributes to improved bond strength with EPAC or CONTACTO (for which it was formulated), and less so for Bondmor II (paste-paste sealant) (GOS) or Concise (paste-paste, sealant adhesives). Contacto, a no-mix adhesive, contains acrylates similar to EPAC, which facilitates bonding with NEWAD sealant. NEWAD sealant was distributed by General Orthodontic Supply in Europe under the name of Sage sealant. The tested Saga'sealant in the article is a copy of the original NEWAD sealant.
23A Letters to the editor
Although sealants are helpful in preventing decalcifications, one of the limiting problems is the toothbrushing force which abrades the sealant over a period of time. Subsequently, most sealants have to be reapplied after 6 months. In addition to sealants, rinsing with fluoride mouthwashes (e.g., Fluorigard) by the patient and con"stant monitoring of toothbrushing are essential to prevent decalcifications. George V. Newman, DDS West Orange, N.J.
REFERENCES 1. Newman GV. Bonding plastic orthodontic attachments to tooth enamel, J New Jersey D Soc, 1964;35:346. 2. Zachrisson BU. Heimgard E, Ruyter IE, Mjor IA. Problems with sealants for bracket bonding. AM J ORTIIOD 1979;75:641. 3. Rctief DH. The mechanical bond. lnt Dent J 1978;78:18. 4. Newman GV. A simple, economical bonding adhesive, J Clin Orthod 1980;14:273.
At this point in time, anyone in the limited practice of orthodontics would have to admit that the specialty is in serious trouble. With the number of general practitioners and pediatric dentists whb practice orthodontics increasing exponentially, the future of the specialty is questionable at best. An informal survey conducted recently in the Southwest indicated that 80% of the general practitioners polled do all of their own orthodontics, that is they refer nothing. In this-climate, one would expect members of the specialty to pull together and work toward its survival. If orthodontics is to survive as an independent special.ty, the entire profession must unite on behalf of the few dentists and dental students who have the integrity and fortitude to pursue formal graduate training in the specialty rather than relying on the quack motel programs so popular among the general practitioner/pedodontist orthodontic set. On surveying the fates of recent graduates, one has to doubt very seriously the intentions of established practitioners who seek out young "associates." Most "associateships" that are offered to graduating orthodontic residents can be regarded as nothing more than con jobs. One scam that has unfortunately become quite popular is for an established orthodontist with a declining practice to take on a current graduate on a "space rental" or "percentage of production" basis. In the contract, it is specified that the "employee" will have the option to purchase the practice in time. Also included in the contract is a covenant not to compete, specifying that if the "employee" leaves the service of the employer, he or she will not practice within a sizable area around any of the "employer's" offices for a period of several years. What this boils down to is a contract for indentured servitude. If the younger practitioner does not agree to the terms of sale set down by the senior practitioner, he is forced to pick up and move. Nowadays, there is nothing to move to. In the orthodontic market today, it is practically impossible for a recent graduate to open an office and expect to make even a subsistence living. The majority of recent graduates are struggling under a student loan debt of $40,000 to well over $80,000. Banks are unwilling to extend start-up loans under these circumstances. The younger orthodontists are over a very large barrel. Rather than extending a helping hand to their younger colleagues, many senior orthodontists see this set of circumstances as an opportunity to take unfair advantage of some very gifted people. If current graduates are not able to find acceptable employment within the specialty, they will have no choice but to join the ranks of the "supergeneralists." The students who are accepted into orthodontic graduate pro-
22A
grams are the very best that the entire profession has to offer. If they are not able to support their families in specialty practices, they will make excellent, aggressive generalists. If this crop of young talent is lost to our specialty, the specialty will have no future at all. Established practitioners are certainly within their rights to set the conditions of employment or the sale of their practices. If the specialty is to survive, these conditions must provide a decent, livable income for the employees. Noncompetition covenants should not be used as weapons to allow employers to dictate ridiculous practice sale prices. A realistic sale price is one that can provide the buyer a comfortable income while servicing the debt load. Anything more is simply an exercise in personal greed. Abuses of noncompetition covenants are simply cowardly expressions of territoriality. If the employment contract does not include a livable salary, it has no business including a noncompetition covenant. Now is the time for the specialty to pull together to help young graduates. It is not the time to eat our young. We must meet the challenge of overcoming personal greed and give recent graduates a well-deserved hand up. After all, they could have been general practitioners. and simply gone to a series of weekend orthodontic courses. Young graduates have been willing to make tremendous personal sacrifices to properly enter the orthodontic specialty. Are senior orthodontists willing to make personal sacrifices to 15reserve it? If they are not, the very future of the specialty is in doubt. Robert G. Kehn. DDS 1201 Grove NE Albuquerque, NM 87110
Comment on shear bond strength To the Editor:
At the expense of being repetitious, I would like to address the article "Shear Bond Strength of Four Orthodontic Systems" published in February 1990 issue of the AJODO. I was impressed and agree with some of the testing techniques employed by the authors. However, I would like to add some information to clarify the historic and clinical use of sealants. The article compared the mean shear bond of Saga sealant, Maximum Cure, Scotchbond-2, and Concise enamel bond. About 1968 I formulated Saga sealant to be used to prevent decalcifications in gingival areas of noncompliant bracket-bonded orthodontic patients and as a pit and fissure sealant. I called it NEWAD sealant. As Zachrisson noted, Saga (NEWAD) sealant demonstrated one half the unreacted methacyrate groups when compared with the Concise sealant and polymerized in thin films.
Vohtme 99 Number 5
NEWAD (Saga) sealant has also demonstrated good abrasion resistance and appeared to increase bond strength in vivo. In vitro shear bond strength tests, when testing plastic brackets, EPAC adhesive, and NEWAD (Saga) sealant, indicated an increase in bond strength as compared with EPAC adhesive when used alone. The acetone in NEWAD sealant decreases the effect of oxygen in inhibiting free radical polymerization. EPAC is an acrylic-based adhesive, whereas the unfilled resin primer (N.EWAD-Saga) is an epoxy-acrylate (BIS-GMA); hence th6 name EPAC. To be brief, NEWAD (Saga) sealant contributes to improved bond strength with EPAC or CONTACTO (for which it was formulated), and less so for Bondmor II (paste-paste sealant) (GOS) or Concise (paste-paste, sealant adhesives). Contacto, a no-mix adhesive, contains acrylates similar to EPAC, which facilitates bonding with NEWAD sealant. NEWAD sealant was distributed by General Orthodontic Supply in Europe under the name of Sage sealant. The tested Saga'sealant in the article is a copy of the original NEWAD sealant.
23A Letters to the editor
Although sealants are helpful in preventing decalcifications, one of the limiting problems is the toothbrushing force which abrades the sealant over a period of time. Subsequently, most sealants have to be reapplied after 6 months. In addition to sealants, rinsing with fluoride mouthwashes (e.g., Fluorigard) by the patient and con"stant monitoring of toothbrushing are essential to prevent decalcifications. George V. Newman, DDS West Orange, N.J.
REFERENCES 1. Newman GV. Bonding plastic orthodontic attachments to tooth enamel, J New Jersey D Soc, 1964;35:346. 2. Zachrisson BU. Heimgard E, Ruyter IE, Mjor IA. Problems with sealants for bracket bonding. AM J ORTIIOD 1979;75:641. 3. Rctief DH. The mechanical bond. lnt Dent J 1978;78:18. 4. Newman GV. A simple, economical bonding adhesive, J Clin Orthod 1980;14:273.
