Medicine: Orthodontics Without Borders
Egyptian mummies have been discovered with crude metal bands around their teeth, and gold wire binds the teeth of a skeleton unearthed in a Roman tomb. Hippocrates and Aristotle both pondered how to align crooked teeth, and first-century medical encyclopedist Aurelius Cornelius Celsus suggested that finger pressure may be the answer.
Straight teeth, it seems, have concerned us for a very long time. The practice, techniques and materials have changed over the millennia—and changed most rapidly of all in the past few decades with new cements, ceramics and computer-aided design and manufacture. So, too, has the approach to dentistry’s first specialty—orthodontics.
“Orthodontic practice and research, like other dental and medical specialty, has become global,” says orthodontist Stella Chaushu, orthodontics chair at the Hebrew University–Hadassah School of Dental Medicine founded by the Alpha Omega fraternities. “Although our department and its work are known worldwide, a few years ago we decided it was time to truly put ourselves on the map, and thus lay a firm basis for future international research collaborations and professional exchanges. This was a key incentive in opening our 36-year-old postgraduate orthodontic program to international students.”
Dental school dean Dr. Adam Stabholz, a long-time supporter of collaboration among dental schools worldwide and initiator of the Alliance for Oral Health Across Borders, threw his full support behind the International Postgraduate Orthodontic Program, known as IPOP. Last year, five dentists from Poland, Bulgaria, Greece and Romania joined seven Israeli dentists to embark on three rigorous years of specialization that combine training in clinical orthodontics with research for a master’s thesis.
“I was thrilled to be accepted,” says Dr. Georgia Kotantoula, the daughter and sister of dentists, whose home is three hours outside of Athens. “Good orthodontic care is needed in Greece as everywhere else, and I wanted a higher-level training than that available at home…. We are now a quarter of the way through [the program], and it is giving me even more than I expected.”
The curriculum used in IPOP is built from the school’s longtime postgraduate orthodontic specialization, adjusted to ERASMUS (EuRopean Community Action Scheme for the Mobility of University Students) requirements, both theoretical and clinical. “We translated all of the Hebrew teaching material into English,” notes Dr. Chaushu.
As in the original syllabus, specialization at Hadassah “focuses not only on clinical orthodontics but also on research,” Dr. Chaushu adds, “so each resident graduates qualified not just for clinical practice, but also [able] to drive orthodontics education and to help lead the specialty.”
British-born clinical orthodontist Tom Weinberger is one of 20 dental school faculty members, all of them well known in both practice and academia, who teach in the international program. Dr. Weinberger trains students “in a specific orthodontic technique,” he says, ”one of several taught in the course,” lecturing in English after more than 30 years of teaching at the school in Hebrew.
“Many orthodontic specializations limit themselves to teaching one or two of the discipline’s basic techniques,” Dr. Weinberger adds, “but the Hadassah faculty is diverse and brings to the classroom a wide range of philosophies and approaches. Together, we give the residents more tools for their toolbox and a far broader perspective.”
Dr. Weinberger’s broad perspective is one of the program’s main attractions, says orthodontist Miri Haisraeli-Shalish, herself a graduate of Hadassah’s dental school and today director of IPOP.
Orthodontics is widely perceived as an elective aesthetic treatment, but it also has important applications in treating conditions that affect the health of the mouth—for example, functional deviation of the jaw, which affects chewing and biting.
“Our department,” notes Dr. Haisraeli-Shalish, “has subspecialty clinics for cleft lip and palate; orthognathic surgery to correct conditions of the jaw and face related to structure, growth and sleep apnea; impacted teeth; special needs patients; early treatment; adult orthodontics; and treatment of multidisciplinary cases. An orthodontics program where you can study so many different fields under one roof is rare.”
The department’s hospital and university parentage is, in large part, responsible for this, she continues. “These connections enable the broadest clinical and academic interdisciplinary teaching and consultation with dentistry’s top specialists, which benefits residents, patients and faculty.”
Dr. Kotantoula has recently been assigned the first of some 60 patients in whose treatment she will be involved. Patient treatment is one of the program’s four modules; the others are clinical and hands-on laboratory training, clinical orthodontics and clinical research.
“My patient is a 14-year-old girl with severely protruding front teeth,” she says. “Developing her treatment program is a challenge, but I have support and guidance from my teachers and supervisors. I also have access to experts throughout the dental school and even the medical school.”
All the international students are fluent in English, and a crash course in basic Hebrew at the start of the course has given them phrases such as “Please open your mouth!” and “Wider please!” along with the more usual “Shalom” and “Boker tov.” The Israeli students, the dental assistants and supervisors help out with language as necessary.
The international program requires residents to live in Jerusalem for three years, and the course ensures that the visiting students see the country and learn something of its history and culture. “We plan special events linked with festivals and national holidays, but the Israeli students in the international course have made our job easier,” says Dr. Haisraeli-Shalish. “They have become a close-knit group, with the Israelis inviting foreign students home on weekends and holidays.”
Dr. Inness Golbert is one of the Israeli students. “As well as what we are gaining from the program professionally, it is giving us a wonderful cultural window,” she says. “We have become acquainted with a very exciting group of people with whom we’ve become good friends.”
Dr. golbert notes the high ra-tio of professors to residents, which is especially important when learning new treatment techniques; the extensive experience provided in diagnosis, treatment planning, orthodontic therapy and patient management under different circumstances; and the program’s interdisciplinary emphasis, which encourages students to learn a range of approaches and to choose which works best in any given situation. All this gives IPOP participants the confidence they need to compete in today’s competitive dental services market.
“We are very happy with the way the first year of the program is going, and with the students selected,” says Dr. Haisraeli-Shalish. “We are looking ahead with confidence to 2014 and our second international course.”