I just returned from the International Association of Orthodontics meeting and was mesmerized by the keynote speaker, Dr. Timothy Bromage. Dr. Bromage is a professor at NYU College of Dentistry who studies paleontology to learn about human evolution. He spoke about the complexity of human beings and how this complexity impacts the way we should treat disease.
Think about what you learned in grammar school about the biology of a human. We are made up of cells and organs that create systems, like the respiratory or cardiac system. In essence, we are composed of systems within systems which are interconnected, adaptive and have diversity. A change in one system, no matter how small, will have impact on the whole system. For example, if you break your foot, you may begin to tilt when you walk which may then cause your back to hurt. Or if allergies lead to prolonged your nasal congestion you will begin breathing through your mouth which leads to more cavities and crowded teeth.
Why is this important? Because the earlier you can identify a change in the way the system should work and help to correct the change, the better a prognosis for health and proper development of the system. Dr. Bromage, however, believes that we often get to solving a problem too late; and therefore, we are reactive rather than proactive. He specifically spoke of recognizing changes in infants and young children that may affect the way they develop and intervening immediately rather than taking a wait and see approach. The concept is that the longer you wait to make a correction, the less likely you will be able to return the system to normal, instead you will need to settle for adaptation.
So the message is clear: identify as early as possible and intervene to guide the system back to the more normal range. It is why we should identify and treat the 2 year old that has big tonsils and is breathing through their mouth before it has an impact on the way their face grows which leads to crowded teeth. It is why some specially trained optometrists do vision therapy in children to help strengthen eye muscles instead of just giving glasses. It is why speech therapy should be started the moment a child doesn’t meet the traditional milestones of speech.
I would like to suggest the term “Proactive Prevention” that seeks to be like the old investigator, Columbo, who was forever questioning. I suggest we all search for small changes in children and be curious about how that change will cause an adaptation that will ultimately affect the way our children grow. In the past, it may have been seen as overreaction, but instead it is Proactive Prevention.