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Orthodontic purgatory
Laurance Jerrold
Jacksonville, Fla
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is dened as having pain, bleeding, swelling, or whatever, or when the patient is at a stage of treatment
that places him or her in a precarious condition because
of the clinical realities of the case: eg, retracting canines
with nickel-titanium coil springs that are continually
active and might result in signicantly rotated or tipped
canines if the patient is not followed closely. Essentially,
we must rst stabilize the patient, and then we can then
terminate the relationship.
Although we have the absolute right, at virtually any
time, to discontinue active treatment, this is different
from terminating the doctor-patient relationship. Any
time that we decide that it is in the patient's best interest
to discontinue active treatment, we can do so. Some
common reasons for taking this action are the midtreatment development of signicant decalcications or
caries, root resorption, periodontal compromise of the
supporting hard-tissue or soft-tissue structures, temporomandibular joint dysfunction, and so on. Depending
on the clinical situation, we might decide that it is in
the patient's best interest to remove the appliances
and place him on observation to monitor the situation,
or to insert retainers and continue to monitor the clinical
situation. This decision is obviously based on the reason
that we decided to discontinue or suspend treatment. A
classic example is to provide a resting period upon the
discovery of root resorption. We could be planning to reinitiate treatment at some point or maybe not. The bottom line is that during this period of active treatment
discontinuation, the doctor-patient relationship is still
in existence.
As an aside, once you make the decision to discontinue or suspend active therapy for whatever the reason,
don't allow the patient to talk you out of that decision,
because if you do so and the case goes south, and the patient initiates a malpractice suit, you have just become a
witness against yourself. You knew what was right, you
recommended it to the patient, and then the patient
convinced you not to do what you knew was right.
Once you make the decision, stick to it. Sure, there might
be some exceptions to this rule, but let's adhere to the
generalities for now.
In the previous paragraphs, all decisions regarding
discontinuing or suspending a patient's active treatment were based on clinical parameters and not
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