Why orthodontic retention is more like the Vietnam War and not at all like the 1975 FA Cup.
In 1968 General Westmorland asked congress for an additional 260,000 US army personnel to assist in the already 200,000 soldiers present in Vietnam at the time. The American public finally realised that something was wrong and that despite the politicians saying otherwise they were not “winning the war”. Six years later in 1975 after the fall of Saigon, the Americans left with their tail between their legs and communism spread across the country. Meanwhile, in the same year, Alan Taylor took Westham to win the FA Cup 2:0 against Fulham.
Game theory is a unique life philosophy where there are considered two types of “games”. One being “finite” and the other “infinite”. Finite games have known rules, a set number of players and a time limit. Football is one such game. On the other hand, infinite games have no time limits, there can be multiple players and there are no such rules. Business is an example of this, so is raising a family or being in a relationship. Nobody in effect “wins” in business. There is no stopwatch that halts activities for one massive party at the end where champagne is opened. There is no cup for being a good dad or best wife. The problem arises when finite players meet infinite players at the same game. In the Vietnam War, the finite player was the US, thinking they could smash the opposition and destroy them. Whereas the infinite game thinking Viet Kong just fought a war of attrition, destroying American morale and resources. It happened similarly to the Soviets in Afghanistan.
Normal orthodontic stability usually requires the patients to wear a fixed and/or removable device for a set given time. In any social healthcare system retainer review appointments have time limits, (resources) similar to the Americans in Vietnam. Sometimes patients who need more of an occlusal review prior to or at the end of treatment are subject to a cursory static Intraoral examination without any mounted casts, etc. which would of course cause great problems with resources. An understanding of dynamic occlusal review is fundamental to stability and retention.
Modern orthodontics need the clinician and the patient to be of an infinite mindset. As it is not possible to fully articulate all cases, the patient should understand that there is a dynamic end to their treatment. In many cases, orthodontists cease to tell the patients that their teeth wouldn’t move. “They always move, nothing in nature is static”. When does growth stop? Growth is an enigma. If someone feels they understand it, they are duped. Informing patients that their teeth were very “content” where they were prior to treatment is sometimes important in making them appreciate the complexity of the human body.
Psychological stress can change the way teeth knit together; clenching and bruxism can move teeth and break retainers. Transient tongue thrusts can procline teeth cause crossbites whereas other habits can force open bites and deep bites to manifest. At best stability can be better in some cases than others but it is never really flawless.
The end is not after the match is over. It is bigger than that. It is not like in the 1975 FA Cup final, it doesn’t end just so. If the patient and the clinician understand this, the relationship between the two through issues and problems will be better. This is why an infinite game theory mindset is needed. If the patient and the clinician fully understand that dynamism is unavoidable, then there will always be tolerance and sympathy. If the patient is of a finite mindset, and that perfection itself is going to be perpetual, then any deviation from the norm is a catastrophe waiting to happen.
-Dr Raj Jabbal
Specialist Orthodontist
