Lingual Orthodontics Solving Social Dilemma in Victims of Tragedy of Marriage in India

Dr. Rajesh Gadekar

www.lingualnews.com Vol 4 No. 1 February 2006

With the advancements in standard of living and longevity, which have occurred in modern human society, it is becoming more evident that dentistry has  to face (and accomplish), newer and tougher challenges from an ever increasing number of patients in all age groups. These challenges are also in the form of specific patient demands and requirements. The shrinking of our global village and the role played by mass media has also resulted in the ability to convey themes, messages, and images to a wider audience. As a result, it is not surprising that the changes in social psychology of every community in the world, including Asian and Indian communities, has been observed. Human psychology is changing in step with technological advances trying to attain highest individual performance in every field, including dentistry. The cutting edge of dentistry has provided new avenues for attaining not only a better prognosis but also more esthetically pleasing treatment outcomes. This has been accomplished through the concept of "Smile Designing" as a combined effort of Orthodontics, Prosthodontics, Periodontics, Dental implants, Oral surgical procedures, and adjunctive esthetic procedures like Bleaching and Plastic surgeries. The driving force for this approach has been the aging and increased life span of the general population which demands both health maintenance at a high level and a natural esthetically pleasing result. These factors have also influenced the orthodontic patient population. With an increasing trend of Adult Ortodontics, newer esthetic inventions and appliance concepts are brought forward. For example, clear plastic brackets, tooth colored ceramic brackets and most recently the family of removable clear tooth aligners (ex: Invisalign). The marketing success of the latter so called Invisible braces is really been welcomed by entire community of adult orthodontic patients with great enthusiasm.

The suggestion of "Instant Orthodontics" through smile designing by the placement of multiple laminate veneers and/or all ceramic crowns may be attractive due to the speed at which the results can be achieved, however, life long maintenance and future investment in treatment along with the controversy of tooth reduction are major concerns for adult patients undergoing aesthetic restorative smile design treatment and other treatments like bleaching. These and the high cost of such a treatment plan are the major reasons why adult patients still prefer the slower procedure of orthodontics
to correct their smile.
As far as the clinician is concerned, the problems of post operative sensitivity(though it has been reduced remarkably with self etching adhesives),pulpal changes, restorative failures, periodontal maintenance, high lab fees, difficult lab communication, need for a personalized lab approach, increase in Inventory, continuously changing concepts in adhesive dentistry, increasing investment in clinic, need to keep in touch with media for marketing & media associated problems, and medicolegal factors must all be taken into consideration.
Not surprisingly, the esthetic minded dentist has been in search of a middle solution. A significant part of this solution has been provided by Lingual Orthodontics which has answered the demand for such an approach. In Indian society the perspective and awareness of personal appearance and importance of an esthetic smile has tremendously increased in the medium and low socioeconomic strata along with high profile patients. A
non-specific example of this trend was seen in the analysis a typical orthodontic clinic patient pool in India, where 20% of the adult patients were those considered to be high profile patients, but 80% were female patients presenting with the Dental Handicap received as a result of Tragedy of marriage in India. The social explanation for this is that in Indian society a large emphasis is placed on the ability of each woman to become wed. This is so central as to be that the ultimate destiny and dream of each and every Indian girl since birth, is marriage. Women/girls with dental handicap as well as their parents are worried about their marriage settlements. Setllement of marriage in India is considered to be a most difficult task, which becomes even more difficult for the girls with Dental Handicap of proclinated and irregular anterior teeth. Physical beauty, especially of the face and smile, along with dowary, plays decisive roles in settlement of marriage. Due to low awareness, lack of availability of specialized dental treatments, and the inability to pay for a very involved dental treatment, girls in rural Indian society with such dental handicaps are less likely to undergo orthodontic treatment at younger ages. However, as soon as they become candidates for marriage (at or about age 20), and suffer the pain of rejection due to an ugly smile in their showing off ceremony, they have ugly smile in their showing off ceremony, they have suffered the Tragedy of marriage. These women develop
low self-images and inferiority complexes, as well as suffer from depression. Furthermore, it has been shown that following repeated marriage rejections they may be grasped with bipolar disorder and mania (1).

At this point parents begin seeking solutions to this problem. Quick fixes, although attractive from this standpoint, are often rejected since perspective patients are reluctant to commit to life long maintenance, they are relatively expensive, and may also be objectionable to the bride groom's side. Therefore, orthodontic treatment becomes an appropriate treatment option. However, conventional labial orthodontics performed on these "rejected" women poses a problem of its own. These women continue to circulate through society attending rituals and such (i.e. indirect showing off), and will be seen with what might be interpreted as unattractive orthodontic appliances. This may hinder their chances for a pending marriage since the parents of
such girls keep pending marriage proposals for possibly two seasons. In these instances Lingual Orthodontics has great potential in adult orthodontics in India.  In addition, both the parents as well as victims of the tragedy of marriage welcome and accept the so-called Invisible braces in spite of high cost. Ironically, this is due to the retaining of the marriage dowry which can now be redistributed as an investment to fund this treatment. They realize that with these invisible braces, while still under treatment they can move freely in society and search for any chance to get selected for marriage. Many parents take chances and succeed in getting settled a marriage with the promise to the bride groom's side or middle man of correcting the dental
handicap within 2 seasons. These candidates also prefer Lingual Orthodontics. The Lingual orthodontic approach can predictably finish the more dramatic aspects of active treatment within this speculated period. I have seen in my practice many girls after becoming married and as soon as they get settled in their new family or obtain financial stability, then present for orthodontic treatment. This has now become more expressed due to their personal as well as husband's concern about the handicap. In these instances, lingual orthodontics is the preferred treatment choice.

In summery,the magic of word invisible has really clicked in my practice and my adult patients to the extent that it has increasing my reputation as the
marriage settling doctor. These contributions ultimately give me peace, social status, job satisfaction together with satisfactory financial benefits from my profession in my Smile Designing practice implementing Lingual Orthodontics.

References
1. Gadekar Rajesh social aspect of cosmetic dentistry in rural society of
India-tragedy of marriage, journal of esthetic dentistry vol 2 no
10,Tokyo ,japan ,10 feb 1998

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Adult and Lingual Orthodontics
EDITORS:
Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc