COVID-19 Education – Eladio DeLeon, Eser Tüfekçi

The pretreatment/posttreatment superimpositions (Figure 9) exhibit inhibition of maxillary growth, in combination with mandibular growth. Favorable differential growth of the jaws did decrease the maxillary posterior anchorage requirements. Contrary to what the oral surgeon predicted, there was no net change in the position of the maxillary central incisors-other than slight intrusion. The treatment did not “compromise the airway”, as the mandible grew forward!

It is easy, unfortunate, and often misguided for a non-orthodontic specialist to say something to a patient or parent that has no basis in fact. This case highlights such an example. It has become popular to suggest that extraction of teeth will compromise the airway and necessarily cause sleep apnea. The 2019 AAO white paper on this topic provides a fair synopsis of the current state of our understanding.

Many clinicians may have treated this patient differently. The case report is presented to illustrate one way and the rationale for this treatment approach. At the end of the day, we all want to achieve an esthetically pleasing and functional result, with the greatest chance for long-term stability. This plan was chosen because it also seemed to be the most predictable and time efficient, with a reasonable amount of patient compliance required and anticipated.

Figure 9: Pretreatment/Posttreatment Superimpositions

Education During COVID-19

Education of young orthodontists has been drastically impacted by COVID-19. Two people who are totally immersed in orthodontic education, Eladio DeLeon and Eser Tüfekçi, have shared their thoughts and their perspectives with the SAO News

Navigating through the COVID-19 Crisis and its impact on the Educational Process

Eladio DeLeon Jr.

Augusta University, The Dental College of Georgia Commissioner, Orthodontics Commission on Dental Accreditation

As I write this note, I am praying that our SAO colleagues, their families, and practice teams are all doing well. This coronavirus tragedy has become a generational-defining crisis that we will never forget. We, as a nation, have been asked to sacrifice and change our ways for the common good. The uncertainty of where this is heading is extremely concerning.

The coronavirus pandemic has had far-reaching consequences and sadly, it has brought our country and the world to a halt as we attempt to contain the spread and avoid the loss of lives. With no exception, the pandemic has affected educational systems universities. The interruption of the orthodontic educational process has been a major source of stress for all our students/ fellows/residents, as well as the program faculty who are all looking for guidance on how to deal with this crisis. Most, if not all programs, stopped their clinical activities in mid-March and there are still many more weeks or months before treatment of patients can resume. Despite the tremendous efforts of our faculty

worldwide, leading to the widespread closures of schools and to keep residents academically engaged during this time, there is considerable anxiety on how the loss of clinical time will impact the program’s compliance with the accreditation standards, the resident’s education, and graduation date.

This is when we must turn to the Commission on Dental Accreditation (CODA) for leadership and guidance. CODA serves the public and profession by developing and implementing accreditation standards that promote and monitor the continuous quality and improvement of dental education programs. CODA was established in 1975 and is nationally recognized by the United States Department of Education (USDE) as the sole agency to accredit dental and dental-related education programs. This interruption of the educational process has created an overwhelming and difficult challenge for CODA and since the start of this crisis, CODA has been collaborating with its stakeholders to seek solutions. The Commission recognizes that each educational program has an obligation and responsibility to ensure that its graduates of the Class of 2020 are competent and that the program complies with CODA’s Accreditation Standards.

Through the collaboration and assessment of this issue, CODA has decided that the Orthodontic Standards, as written, must be met. However, as a result of this crisis, CODA is allowing “temporary flexibility” in the accreditation standards to address the interruption of education resulting from COVID-19 for the Class of 2020. There are three areas of “temporary flexibility”: alternative assessment methods, modification/reduction of curriculum content or curriculum requirement, and program length.

Alternative assessment methods

Programs may determine the competency measures they will use, as long as they document that the graduates are competent. Clinical care is obviously preferred but alternative patient learning experiences such as scenario-based examination and simulations could be utilized. Programs can do whatever they feel is appropriate and defendable so long as they can ensure compliance and can provide documentation of these experiences.

Modification/reduction of Curriculum Content

Program-dictated requirements and/or CODA quantitative numbers

Eser Tüfekçi

Professor, Department of Orthodontics Virginia Commonwealth University

In this unprecedented time, our faculty, staff, and residents have organized quickly and put together a system to meet the educational and clinical demands of our residency program. I can proudly say that the quick adaptation to these trying times helped us continue to advance in most aspects of orthodontic education under dire circumstances. We moved right away to online teaching and it seems our residents are busier than ever as their days are filled with our usual classes and seminars in addition to lectures provided by many of our alumni, the American Association of Orthodontists, University of North Carolina Orthodontic Department, and the Angle Society, to name a few. To monitor treatment progress, even modify treatment when indicated (discontinue or change elastics, check tracking and start new aligner series) and to handle emergencies, based requirements may be modified or reduced as long as the program can document that the program continues to comply with the Accreditation Standards and ensure the competence of their graduates.

Program length

Programs must document how the residents/fellows were engaged in alternative activities such as distance learning, board case preparation, virtual patient visits, or other activities during the period of interruption as long as the program can ensure the competence of their graduates. The program must track overall program hours. As mentioned, programs ceased their clinical activities in mid-March but they were not closed since most programs continued didactic education. Consequently, there is no modification to the minimum 24 months and 3,700 scheduled hour requirement for the orthodontic programs, and there is no change in the minimum of twelve months for the Orthodontic Fellowship training programs in Craniofacial and Special Care Orthodontics.

In summary, it must be emphasized that CODA evaluates the educational program’s compliance with Accreditation Standards,

not the quality of each individual graduate. The “temporary flexibility” must result in comparable assessment and evaluation of the Class of 2020 residents to ensure that each resident is eligible for graduation from a CODA-accredited program. The program’s modifications to address the temporary flexibilities must be documented and reported to ensure the program complies with CODA Accreditation Standards.

As we recover, we know that there will be much change to every aspect of our life, but history has taught us that the hopelessness of this moment is temporary. We as a nation refuse to be defeated by impossible obstacles. We shall overcome this obstacle, and I’m wishing that all of you, as this threat is neutralized, will re-energize, pick up the pieces, and move on to an even better future.

Eladio DeLeon Jr.

teledentistry was implemented. Research activities continued if the study design allowed the resident to work remotely; however, clinical studies or research involving human interaction were all put on hold at this time.

We are lucky at VCU School of Dentistry as we had the virtual private network and other digital systems already in place for many years. Therefore, it was not a problem to remotely access Dolphin and Axium applications for patient care and continued treatment planning and analysis. Our residents have expressed their gratitude for the availability of the technology at our school as it has enabled us to hold our regular literature reviews, topical literature classes, and diagnosis and treatment planning seminars with Zoom without an interruption. While staying on track with the requirements of the residency program, our postgraduate students are in direct contact with all of their patients with regularly scheduled virtual orthodontic appointments. Although our residents know that they could certainly help their patients more in a clinical setting, they are confident that they are making the best out of the current situation. They all indicated that they miss working hands on with their patients.