Dr. Hans De Bruyn has been a POS instructor for 20 years and is truly an expert when it comes to adult orthodontic treatment. In this interview, he discusses why age is not a limiting factor with orthodontics, the benefits of self-motivated patients, and his best tips for success with adult patients.
Click below to play the video or scroll down to read the full transcript.
IVETA MERKER: Hi everyone, I would like to welcome Dr. Hans De Bruyn who is teaching Seminar 8. He's visiting us from Belgium and we are so happy to have him here in sunny California. Welcome Hans.
DR. HANS DE BRUYN: Thank You Iveta. It's a pleasure to be here. Thank you for the invitation.
IVETA: Well it's our pleasure. Can you please tell us a little bit about yourself? How long have you been teaching for Progressive Orthodontic Seminars and also a little bit about your practice? How have you got started with orthodontics
DR. DE BRUYN: Sure. I've been teaching for POS for a long time now. It's close to 20 years I guess and we run an office in the north part of Belgium. It's a dual office so we have our own patients and we also treat patients on referrals. Referrals are for perio, ortho and TMJ so it's kind of a mixed office and orthodontics to us is just a tool. Orthodontics is not really a goal. We are not orthodontists, so we use orthodontics just as a tool to accomplish our goal which is restoring the function of a patient.
IVETA: In your opinion what would you think is the most common misconception about adult orthodontics?
DR. DE BRUYN: Well there's probably more than one misconception and one would be that some people say that on adult patients you cannot really do ortho. That's absolutely not the case. We have patients to prove that because our oldest ortho patient has 64 years of age, so that's not an issue. What could be an issue is some other problems related to general health but I don't think an age factor is an issue in adult orthodontics. There's many advantages you know in adult ortho because you can use the adult ortho as a tool to accomplish your ultimate goal which is to restore function and in fact we use ortho to improve the perio. We use ortho to improve the TMJ and eventually to put the teeth in the right position so that somebody can restore the teeth. So it's kind of a tool that has its place into the comprehensive treatment plan that's how we see it and that that's why I think that adult ortho has definitely gained its place into general dentistry.
IVETA: Well I would think in my personal opinion that the adults maybe they are just even more excited about having their teeth straightened and having all these things corrected.
DR. DE BRUYN: Yes, they do because let's say that you're treating a young child, then the parents walk in the office with the child, and the doctor and the parents look at the child, and they point at the child, and they say you're going to get braces. But an adult patient is self-motivated so they come into the office and they seek care for themselves. Self-motivation is a very powerful thing. They usually want to improve their smile, their aesthetics and this is one of the things that you can help them with.
IVETA: Yeah I was in my early thirties when I had braces and I just was so happy after I had that done so I just wanted to smile all the time.
DR. DE BRUYN: Yeah I can understand that.
IVETA: So what would you say the main benefits of adult orthodontic treatment are?
DR. DE BRUYN: Well the main benefits relate to two things. First of all, you have self-motivated patients and self-motivated patients come with a specific complaint and you can actually help them solve that complaint and turn it into something that they like. Usually it relates to aesthetics. So that's a very good thing. Another thing is that because of the adult ortho we are able to put the teeth in a position where the patient can actually clean them, because keep in mind sometimes teeth are so crowded that even the doctor cannot clean the teeth so if we put the teeth in a good position then everything is well aligned and the perio improves. You can put in nice restorative work because all the teeth are where they're supposed to be and of course then the result is that you have a more beautiful smile, so there is definitely a benefit to adult orthodontics.
IVETA: Right, so beautiful smile and healthy teeth.
DR. DE BRUYN: Here you go.
IVETA: What would you say the biggest limitations are in adult orthodontics?
DR. DE BRUYN: The first limitation is the name itself because you're treating adults and that's a limitation. You see, in kids we can work with growth. In adults there's no growth. And growth usually works to our advantage, not always but usually it does, and we can play with the growth but not with adults so that is a limiting factor. A second limit would be that because of the self-motivation of the patient they are very critical, very demanding so you'll have to spend more time on the treatment and you have to be very careful not making mistakes because there's very little, there's very few emergency exits here. I mean, if you treat adult patients it has to be right from the first time. Another limit would be you're limited in time because usually those patients have a certain timeframe within which you have to be done with the treatment and okay you can discuss that but the circumstances are usually more complex with an adult patient. And another limiting factor would be the dental history because maybe they have perio disease and that's a limiting factor. They can have missing teeth, restored teeth, accidents and endos on the teeth. So there's many things to consider. Things that you don't see in kids and those are all limiting factors. So there is limitations. And another thing I almost forgot that's very important is the medical history because a patient can be diabetic, can have heart disease, in females you can be confronted with osteoporosis and hormonal changes, so it's a different ballgame all the way.
IVETA: So can you tell me from your, from the years of your expertise can you please tell us what are some tips and tricks how to treat adult orthodontics?
DR. DE BRUYN: Right. This is kind of a hard one you kept the most difficult question for the last. First of all the patient comes in with a chief complaint and this is something you really have to look at. So my first tip would be when the patient comes in with a chief complaint don't ignore it. Put it on the table as item number one because that is the reason they consult you. And then a second thing would be that I know that you are on a time schedule if you treat an adult case but still don't go wild on the forces that you use. So more than kids I would urge everyone to use low forces in orthodontics to move to teeth around and then I would say avoid any movement of the teeth that you don't want. Avoid unwanted tooth movement that would be a very important rule. Rule number two would be don't forget rule number one.
IVETA: That's a good rule to remember. Hans you have developed this class Adult Ortho. How would you say this class complements the regular orthodontic series that Progressive Orthodontic Seminars teaches?
DR. DE BRUYN: Okay, that's an interesting question because my personal opinion is that orthodontics for growing children or orthodontics for adults in fact is a different ballgame. Not only from the patient perspective because the patient is self-motivated in adults, but also from the perspective of mechanics and materials that you use. A good example would be cervical headgear. I mean there's not many adults that want to walk around with a cervical headgear so there's many, many differences. As far as adult ortho is concerned, it much more relates to small surgery than with growing kids. Like the retrieval of an impacted tooth for example, that requires some surgery. Maybe there's wisdom teeth that you want to remove that requires surgery. Maybe there's an endo problem. So I mean if you treat adult patients with ortho you really need to have a helicopter view on things and key perspective of all the other parts of dentistry because you're going to need all those parts of dentistry in your comprehensive treatment plan and in your ortho. If I may I will give you another example. If you forcibly erupt one tooth and you put it in a more extruded position then you may want to do something with the soft tissue with the gums in the bone that requires a piece of surgery if you want to have a nice result. I call it soft-tissue high-speed hand piece and composite orthodontics and it fits into the treatment objective of adult cases. So there is a distinct difference between orthodontics for growing patients and orthodontics for adults that's for sure.
IVETA: Well I'm sure there are so many dentists around the world who can't wait to hear your seminar and thank you so much for spending time with us and enjoy your time in California.
DR. DE BRUYN: Thank you. I'm also very excited. I can't wait to be in front of the class.
Learn more about Dr. De Bruyn's Adult Ortho course here.