Why choosing for a doctor (orthodontist, dentist, surgeon) that are members of AOSF (Europe)
Why is it important to choose a doctor (orthodontist, dentist, surgeon) who is a member of the AOSF Europe?
AOFS doctors work toward reaching all goals of treatment while avoiding complications. These goals include functional occlusion, facial balance, periodontal health, TMJ health, airway improvement, long term stability, and patient satisfaction.
Patient treatment expectations –
Mutual patient and doctor satisfaction is reached when all treating practitioners understand the patient’s goal(s) of treatment and all are then able to work together toward achieving this result.
Epker and Fish(1) noted that the social-psychological evaluation is often neglected, leading to patient dissatisfaction despite an objectively favorable occlusal treatment result. This may indicate that the patient had motives for treatment beyond occlusal correction that were not identified by the practitioner prior to treatment. Proffit and White(2) recognized the importance of exploring a patient's motivation for treatment, pointing out that there is a difference between motivations and expectations and, stressing the need to consider them separately in the initial interview. Tucker(3) emphasized the need to define motivations for treatment when weighing the benefits of surgery versus orthodontic camouflage of mandibular deficiency.
The Treatment Motivation Survey (TMS) was developed and published by Arnett and Worley (4). The TMS consists of a comprehensive list of questions designed to assist the patient and doctor in arriving at conclusions about treatment expectations. With patient motivation and expectations mutually understood, the treatment plan can be accurately designed.
The first TMS section allows the clinician to uncover and document any changes that the patient may desire regarding the spatial orientation of the teeth. For example, a new orthodontic patient with a class II malocclusion might respond to the TMS with “make the upper front teeth shorter.” Had she not been asked directly, these concerns might not otherwise have been voiced. The doctor should consider this underlying desire when weighing non-surgical versus surgical orthodontic treatment. Bicuspid extractions with retraction of the maxillary incisors could certainly achieve an occlusion that is comparable to the one achieved with a surgical maxillary impaction. The resulting facial appearance, however, would be markedly different and may not satisfy the patients desire to show less upper incisor.
The second section of the TMS form asks the patient to describe any facial changes that they would find desirable concurrent with occlusal correction. Here the patient might confide in her orthodontist a secret wish ("since you asked...") that she has always wanted to have more lip fullness. While her doctor might not be able to satisfy the request completely, he or she would certainly want to think carefully before pursuing a treatment course that would call for significant incisor retraction, thus causing the lips to appear less full.
The third section is intended to identify any pain or discomfort symptoms the patient would like to alleviate. The breadth of questions within this section gives the patient an opportunity to identify problems from a list of head and neck complaints. The practitioner can then evaluate these within the context of potential resolution with treatment. If occlusal treatment will not definitely alleviate a pain symptom the patient should be informed prior to occlusal correction.
The fourth section reveals patient desires regarding obstructive sleep apnea treatment. When obstructive sleep apnea is present, advancement of the upper and lower jaws may be increased to assure cure of symptoms.
Perhaps the greatest value of using the TMS form during the patient interview is that it steers treatment in a mutually defined direction toward the goals of occlusal correction, improved facial appearance, TMJ symptomatic relief, and correction of obstructive sleep apnea and related medical issues. The TMS aids in treatment planning between occlusal correction methods; orthodontics alone, lower jaw surgery, upper jaw surgery or, upper and lower jaw surgery. When the TMS is used to define treatment objectives from the outset, the appropriate treatment is accomplished to the mutual satisfaction of the patient and doctor.
(1)Epker BN, Fish LC. Dentofacial deformities: integrated orthodontic and surgical correction. St. Louis, CV Mosby Co., 1986.
(2)Proffit WR, White RP. Surgical-orthodontic treatment. St. Louis, Mosby-Year Book Inc., 1991.
(3)Tucker MR. Orthognathic surgery versus orthodontic camouflage in the treatment of mandibular deficiency. J Oral Maxillofac Surg 1995;53:572-578.
(4)Arnett GW, Worley CM. The treatment motivation survey: Defining patient motivation for treatment. American Journal of Orthodontics and Dentofacial Orthopedics, March 1999;115(3)233-238.