Dear Dr Kamsiah,

Selamat Hari Raya Haji to you and your family. This has been a great day as I finally met someone (after two and half years of searching) who thinks like me on the issue of Malaysian Orthodontic Association trying to prevent General Dental practitioners from practicing orthodontics.

Dental services to the public have come to such a stage that with more and more specialists, they are starting to claim a piece of the pie which actually belongs to all.

Today orthodontists are claiming only they can treat orthodontic cases, tomorrow oral surgeons may say third molar surgery should only be done by them or worse still extractions are exclusively their area, endodontists will soon claim that root canal treatment is their specialty, periodontists claiming all gum treatment and scaling, pedodontists claiming children treatment can be only done by them and prosthodontists saying dentures, bridges and implants are solely their domain.

What will ultimately happen is inevitable, the general practitioner will not be able to practice orthodontics, peridontics, pedodontics, oral surgery and prosthodontics. What are we going to do next? Just examine patients and do referrals?

This is the beginning of the development of unfair and unethical professional practice of barring capable dental surgeons who have endeavored by studying on their own and seeking courses to upgrade and update themselves ultimately to help their own practices and the public at large. The Minister of Health and Health Ministry must take measures not to marginalize general dental practitioners.

There are hidden agenda’s in these backdoor lobbying and the best way is to open up the discussion and let’s hear what the general dental practitioners have to say about this. We have heard 114 orthodontist’s speak up, it’s about time the 500 plus general dental practitioners practicing orthodontics speak their minds. What will happen to their patients if every general dental practitioner was asked to stop orthodontic treatment? How much will the orthodontic equipment and material suppliers suffer in economic terms?

We have not only heard of lobbying in parliament but also intimidation of suppliers, even blackmail to prevent them from supplying general dental practitioners. The question now we can ask is how unethical are these practices against fellow dentist’s. Whatever reasons the orthodontist’s have we must take into consideration the microeconomic fallout on the general dental practitioner and the macroeconomic effect on the patient and suppliers.

There is plenty available for every general dental practitioner and orthodontist so let’s not argue and bicker on issues, we should find ways to better ourselves, help promote better dental health and bring foreign exchange into our country by providing dental care of high quality by dentists (regardless of their specializations) who observe ethical and moral standards.

Is it competition that makes orthodontists behave like this, well the root of the problem lies somewhere else but the general practitioners are mere scapegoats. Let us ask ourselves why are general dental practitioners having more patients than orthodontists – the answers are in better practice management, better human resource management, better financial management, use of modern technology and latest dental techniques, and the great desire to learn and acquire new knowledge on the part of general dentists. It’s not the cheaper price they charge, as there are general practitioners who charge comparable rates to orthodontists, but why do patients still like the general dental practitioners.

The general practitioner is a one stop center mall like practice, more approachable, who will handle all periodontal, conservatory work, radiography work, extraction work, laboratory requirements and if need be even implants combined with orthodontic treatment essentially multidisciplinary in their treatment and practice.

There will be always one or two general dental practitioners who will exceed and forget their limitations and try complex cases, but dire consequences, not as in life threatening. The best way is to educate the general dental practitioner of his or her limitations and not frighten the public about “dire consequences”.

Like you have said it is not rocket science now that everything is simplified, very little wire bending, sliding mechanics and very little pain. We have to stay away from alarmist attitudes of people with a fear of competition who indulge in aggressive treatment methods exceeding professional limitations, and who cannot find the middle path where there is the bulk of the work, happiness and wealth. Orthodontists who seek to legislate their practice to prevent others who are trained to do orthodontic work are basically insecure and greedy. As Gandhi says, “there is enough for everyone's needs, but not enough for a person's greed”.

The idea to deny general dental practitioners from practicing orthodontics is hitting below the belt. In retrospect, if I were to practice what I had learned I would still be doing silicate cements for anterior teeth, metallic amalgam filling, only plastic dentures and simple extractions. I did not learn esthetic dentistry, no composite veneers and layering technique then, no ceramic veneers too, then how did we learn all these and practice them now. I guess I am lucky that conservatory specialists and prosthodontists are not making a big fuss about what we practice.

The implants that we used to read about were blade vent type but look where are we now. Nowadays many general dental practitioners are getting to be quite good at doing implants; are we going to soon see implantologists stopping general dental practitioners from putting in implants to mouths of their patients? I had learned about lasers but now we can use them to enhance our treatment services.

Developments in dentistry that have taken place in the last few years are just too many and coming at too fast a pace for anyone to learn and master all. If we are to take our services to the next higher platform then, only we can advance ourselves. There are so many ways available, short courses if you are already practicing but have not specialised, read from online journals, read articles on esthetic dentistry, composite veneers, ceramic veneers, implants, botox ,dermal fillers and lasers online. There are also e-books available in all the subjects that interest you, in fact, you don’t have to leave your clinic to learn. The state of the dental knowledge and practice is so advanced compared to 15 years back.

We have regular talks by MDA, suppliers, study groups, privately organized hands on courses and private general practitioners who seek knowledge overseas but all these, unfortunately, are not recognized. Limited places for post graduation locally and internationally with high costs involved and lack of time have forced private general dental practitioners to resort to the short courses.

As professionals, let’s not suppress others but in stead let's find ways to help others to also come up and succeed in their practice as this is good for our people and solve the problem of shortage of dentists in our country. There seems to be many amongst us–the dog in the manger types– who believe they will remain supreme by keeping the art and science of dentistry to themselves. I will help anyone who genuinely seeks my help. I have plenty of journals and continuing education articles (in e-book form) to share with those who are willing to learn.

This is an art and science of making the patient happy and ultimately we derive pleasure out of their joy and happiness. This is the driving force which makes us excel and not by stepping on fellow general practitioners to stay on top. If there are some among the general dental practitioners who make mistakes, then there are laws to manage this. Every general dental practitioner and orthodontist should be liable for what he or she practices.

I believe debate on this issue will reveal the can of worms on both sides of the divide but things are being stirred up again to test the waters needing a unification of all general dental practitioners against unfair practices.

We must not let this be a precedent as it will ultimately curb the profession. The medical side too seems to be having the same problem as the dental side.

The Health Ministry—the DG of Health in particular cannot be siding with the MOA–must ensure the rights of the majority are not denied and general dental practitioners are not driven into a corner after all the years of service to the public because of these unfair trade practices not to mention unfair professional attitudes of the orthodontists in our country. MOA must be a cartel, as you say, to promote trade restrictive policies.

Actually it was the scab lands of northwestern America which were created by a series of massive floods during the last ice age. An enormous layer of ice a mile thick gouged out the depressions which would become the great lakes. As the glaciers began to melt, they formed a large inland sea held together by ice dams. Periodically the ice would collapse and billions of gallons of water would be released at once. The scab lands show the pattern of this mass of rushing water as it cut into soft bedrock, leaving harder rock exposed as large plateaus.

The grand canyon was also the work of running water, but the flow was much less and the canyon took millions of years to erode, unlike the scab lands which may have formed in as little as a week.

There is evidence that the flood mentioned in the bible was the formation of the black sea. Another ice dam held water back in the mediterranean sea and its collapse sent water rushing into the basin of what would eventually become the black sea. It is estimated the water advanced about 100 feet a day for many weeks. The people living on the shore of the original lake found they had to be constantly on the move to avoid drowning, which probably many of them did.

Unlike the earth, Mars is dead in terms of its geology. 4 billion years ago, Mars probably had liquid water and an atmosphere. Its iron core was still liquid and like the earth's, the magnetic field generated deflected charged solar particles. When the core cooled and solidified, the field shut down and the solar particles slowly stripped the Martian atmosphere of most of its gas and water vapor. The great canyon on Mars does not appear to be the result of erosion however. It is probably a section of the planet's crust which separated while Mars was still geologically active. With far less water, the earth would have had a very similar looking canyon when Africa separated from South America hundreds of millions of years ago.

I am a college professor, born in England but living and working in the USA, at Emory University in Atlanta. I was commissioned to write the article for the _Chronicle of Higher Education_, whose main readership is college professors and administrators. They were the people I had in mind as my audience, but I always try to write as clearly as possible, so that all readers can understand what I have to say. I believe high school students and undergraduates should think about the issue rather than assume that the system we have is somehow necessarily the right one. It's a question about which reasonable people can (and do) disagree.

Patrick Allitt

Advantages of Private High Academies for Children in South Dakota –