Spring 2001 Presentation Summary:

"SIS = Steal Ideas Shamelessly"— Dr. White humbly introduced his lecture with these three words. At this lecture, he shared his collection of useful clinical ideas and concepts, ranging from motivation to mechanotherapy that could be immediately implemented to daily orthodontic practice.

Special Recipe

To handle multiple oral ulcer lesions, Dr. White recommended a home-made recipe mixing Tetracycline syrup (60ml) with Benadryl Elixir (60ml), and Parenteral Kenalog 40mg (1ml). An oral rinse with 1 teaspoon of liquid for 10 to15 minutes can be very effective.

New Paradigm in Orthodontic Motivation

"Never try to teach a pig to sing. It wastes your time and annoys the pig." (see Dr. White’s JCO editorial).

According to Dr. White’s new paradigm of motivation, clinicians should understand the concepts of "orthodontic sensitivity threshold" and "genetic control of behavior" that we can’t change.

Poorly compliant orthodontic patients have a low tolerance for discomfort (low sensitivity threshold). They display 4.5 times less toothbrush force as well as difficult dental behavior compared to non-complaint patients.

Interestingly enough, low sensitivity threshold patients will not tolerate wool sweaters, tight clothes or shoes, labels in shirts, food without right texture, repetitive sounds, and social lights.

Besides understanding classic primary motivational technique using humanism (e.g., magic button technique), psychoanalysis (e.g., self-esteem measurement), and behaviorism (e.g., reinforcements and punishment), recognizing low-sensitivity-threshold patients helps when dealing with motivational problem in daily practice.

While this understanding is helpful, in the final analysis, the theme of motivation remains: "People need reminding more than teaching."

Pain Reducing Technique in Orthodontic Patients

Dr. White suggested the following tips to reduce pain in orthodontic patients:

(1) Use segmented forces when possible

(2) Protect maxillary molar anchorage (Dr. White showed the simple way of making chairside Nance appliance using two wires bent from molars and Triad on palate with ?? light cure.)

(3) Limit the use of compliance appliances such as headgear

(4) Elastics are better than removable appliances

(5) Use continuous force (e.g., NiTi springs)

(6) Use strategic extraction to properly relate the maxillary and mandibular dentitions (ref: Dr. Creekmore’s article: "Where teeth should be positioned in the face and jaws and how to get them there." J Clin Orthod 30:586-608, 1998.)

(7) Use brackets with the largest intrabracket and interbracket distances (e.g., Uni-Twin brackets)

(8) Lower appliance forces whenever and however possible

(9) Use the most resilient wires possible (e.g., Cu NiTi wires)

(10) Use bands less frequently and use a dentometer to measure the right size when doing bands

(11) Use bonded attachments whenever possible and an indirect bonding technique when possible

(12) Use the simplest mechanics for orthodontic patients.

Dr. White’s hierarchy of simple mechanics includes Mulligan’s mechanics, compressed coils, Jones jigs, Hilger’s palatal expander (intra-arch mechanics), Class II/III elastics, Jasper Jumper, MPA, and Churro Jumper (inter-arch mechanics).

Clinical Use of the Churro Jumper

Dr. White enthusiastically introduced the Churro Jumper, named taken from a Mexican cinnamon twist, that is modified from the MPA (Mandibular Protraction Appliance, so called "Brazilian Herbst"). See the article in the Jounal of Clinical Orthodontics 32:731–745, 1998 and the article on the protraction appliance in the same journal, 29:319–336, 1995.

The Churro Jumper furnishes orthodontists with an effective and inexpensive alternative force system for the anteroposterior correction of Class II and Class III malocclusions. The appliance is easily fabricated with materials commonly found in orthodontic offices and does not require any laboratory construction.

The jumper (a coil spring made from 15 to 20 circles of .030-inch stainless steel wire) attaches to the maxillary molars by a pin passes first through a circle on the distal end of the jumper and then through the distal end of the headgear tube. The mesial end of the Churro Jumper is an open circle that is placed over the mandibular archwire, against the canine bracket, and squeezed shut with a How plier. In Class II malocclusion, the Churro jumper functions more like the Jasper Jumper (see Fig. 1).

Many Tips

Dr. White shared lots of clinical pearls and tips in between lectures. Here are some of the examples. He suggested using a palm -size mirror (made by Summit ortho supply) instead of small mouth mirror to look at the entire arch. He recommended the Sonicare toothbrush for low sensitivity threshold patients. To reduce pain, new NSAIAs such as Celebra or Vioxx are believed to be better than traditional analgesics, which may stop bone metabolism. Benzocaine lubrication (Brace-Relief) can be used in separator elastics and inside removable appliances. Overlay wires made of .036 stainless steel on molars can be used for posterior bite opening. Half of the arch wire (made by Highland metal) can be flipped for expansion to correct unilateral crossbite in 6-8 weeks.

At the end of lecture, Dr. White handed out copies of rulers and arch forms that can be reproduced in transparencies for immediate use in practice.

His lecture was informative and entertaining. Indeed, the audience seemed to have enjoyed it very much.

Editor’s Note: Dr. White claims no financial interests on the products that were introduced in his lecture.

Previous Article             

Top of the Page

Copyright © 1999 - 2006 Pacific Coast Society of Orthodontists. All Rights Reserved.

Please review our legal notices and privacy policy.

Created by WebResults.