DR. NORDBERG'S TREATMENT PHILOSOPHY
My treatment philosophies are shaped by my training, life experiences, and ethics. These are a number of concepts that inform and guide my clinical practice of orthodontics.
Patient Autonomy has been described as “…The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.” [source: https://www.medicinenet.com/script/main/art.asp?articlekey=13551 ]. I do my best to inform my patients of their treatment choices and the tradeoffs of one type of treatment over another. I also try to include the option of “no treatment” so that patients and parents understand what they may miss out on in terms of growth and development or multi-disciplinary care. In the domain of orthodontics there may not be “one right way” to treat a patient but certain treatment options may be superior in certain circumstances. For example, a given patient may demonstrate an open-bite that might be better treated with Clear Aligners but the patient declines that course of action fearing they won’t be able to be diligent enough with aligner wear. My job is to help them understand the challenges of braces to treat the same condition and how very critical wearing elastics (rubber bands) will be if they choose to follow that treatment path. Another patient may suffer from severe crowding and decline extraction treatment. My job will be to educate the patient as to the potential insult that may occur to their periodontal tissues (recession and lack of bony support for example) and the heightened potential for orthodontic relapse following treatment. A third patient will present as an adult with a significant lower jaw growth deficiency. If that adult patient declines surgical treatment, my job is to help them understand what we can and cannot do with our other appliances and the tradeoffs therein. Ultimately, I see my job as an orthodontic specialist to partner with you on your orthodontic journey and help you make informed decisions about your own treatment and care.
The idea of Patient Autonomy incorporates a certain element of flexibility. Not every treatment scenario has one best solution, appliance, or timeline. Sometimes we can wait longer to treat a given patient and this may help patients and parents accommodate schedules, insurance benefits, or other constraints. Sometimes we can use one of any number of appliances to treat a given condition or even consider a limited phase of treatment. Not every patient has to finish with “textbook perfection”. We promise not to soothe our ego and “hold you hostage” to idealized treatment objectives but rather inform you of what we see and how much further we need to travel to obtain an excellent treatment result. If we can help our patients to understand the tradeoffs of various courses of treatment we can be flexible enough to accept their treatment decisions and help them work towards that chosen treatment objective.
My background as an engineer (software engineer) has given me a different mindset under the context of orthodontics. I constantly strive to ask myself “why” something is happening and “how” we can make it better in terms of efficiency and predictability. This can encompass things such as continued education training (above and beyond the numbers required by state licensure) and pushing the envelope of progressive treatment modalities (from surgical treatment, to TADs, to clear aligners, etc). Often that involves using customized orthodontic appliances such as Invisalign or Suresmile. Sometimes efficiency is as simple as knowing when to start treatment. If we can finish treatment faster by starting at a younger age then we will recommend this. In contrast, if waiting for teeth to erupt will result in a shorter treatment duration we will recommend this course of action. Our recommended treatment will always involve an aspect of efficiency. If clear aligners will result in faster treatment then we will tend to recommend this appliance. If braces will result in faster treatment we will tend to recommend that appliance. Our goal is to help our patients complete treatment in the most efficient manner possible.
Orthodontists spend 2 to 3 years in orthodontic residency learning about and attempting to treat patients to the highest ideals of the profession. These treatment ideals are rigorously tested in the American Board of Orthodontics clinical guidelines. As an orthodontist I attempt to combine those ideals with the ideals of dental esthetics in the ultimate goal to treat my patients to their most beautiful and functional smile.
Part of my engineering mindset involves focusing on a certain aspect of redundancy. I always want to have a backup plan if a tooth movement proves challenging or a patient appears to be uncompliant with a given treatment regimen. Once treatment is finished, I provide my patients multiple retention solutions so that if one is lost or broken they have another to rely on. Just like Boeing engineers ensure that their planes continue to move forward if a system should ever fail, I want to make sure my patients can move forward and arrive at their orthodontic destination and maintain those results satisfactorily.