Please introduce yourself
The ‘elevator pitch’ would be: orthodontist, teacher, husband and father to three. More formally: Jonathan Sandler, a Consultant Orthodontist at the Chesterfield Royal Hospital NHS Foundation Trust for the last 25 years. Immediate Past-President of the Angle Society of Europe, contributing editor to the Journal of Clinical Orthodontics and Examiner for the European Board of Orthodontics.
Congratulations on your election to the role of President of the British Orthodontic Society. What does this role entail?
As President of the BOS, I am Chairman of the Board of Trustees. It is my job to manage Board meetings and to ensure that the BOS fulfills its charitable functions. It is an honorary role which is significantly time-consuming and carries considerable responsibility. I hold this office for a three year period until the end of 2020.
Why did you decide to become an orthodontist?
After graduating I first had a shot at maxillofacial surgery both in the UK and the USA but decided this was not going to be my goal and then tried general practice for a couple of years and decided this also was not for me. I decided at that stage to take my well deserved ‘gap year’ and ended up on a beach in Greece teaching windsurfing. My friend Kevin O’Brien completely disapproved of this dissolute lifestyle and used to send me the ‘situations vacant’ section of the BDJ every month. He circled an advert for an opportunity to try orthodontics at the Eastman Dental Hospital in London.
The Eastman has been a formative place for many in the profession. For me it was doubly so, as in addition to carrying out my orthodontic training there, it was where I met Alison Murray, my wife, and a fellow orthodontist. After a brief try at specialist orthodontic practice on the Swiss/German border I returned to the UK to do my Senior Registrar training at The Royal London Hospital in the East End, and at Southend General Hospital where I had the opportunity to work with David DiBiase, an inspirational clinician, and Bob Lee a superb organiser and course director. I was the longest serving Senior Registrar in the land when I finally secured a Consultant post at Chesterfield Royal Hospital and the rest is history.
I have absolutely no doubt that maintaining a healthy and vibrant district general hospital orthodontic service providing high-quality clinical training and led by Consultants will keep the orthodontic training in the UK second to none. I am concerned about the current shortfall in Consultant orthodontists and working together with my fellow BOS trustees, we are looking at ways to promote a more flexible approach to training, in order to ensure we have enough consultants for the future.
What type of orthodontic cases do you most enjoy working on and why is this?
Working in a hospital, I mainly see complex cases and a considerable proportion of my patients require multidisciplinary treatment. This can vary between the provision of multiple bridges or implants with my restorative colleague of 20 years, Ian Harris, to delivering the jaw surgery required to fix the handicapping malocclusions we encounter. This orthognathic treatment is provided by three most obliging maxfacs surgeons, Messrs Doyle, Orr, and Opie. It has been a privilege and a pleasure to work with these guys producing the great results that they do on a weekly basis.
Multidisciplinary cases involve a long and challenging treatment for both patient and clinicians but they can be extremely rewarding because of the life-changing facial changes that can be achieved. Truthfully, I enjoy all the cases that I get to treat and I get a great deal of fulfillment from teaching. I work with my trainees and enjoy seeing them transform from a general dentist who has little or no knowledge about orthodontics to highly trained and incredibly skilled diagnosticians and clinicians able to succeed at national and international levels. It is a pleasure to play a part in that transformation.
What do you consider to be the most significant advance in orthodontics over the last ten years that has contributed to the outcomes for your patients?
I would say Temporary Anchorage Devices (TADs) have produced the biggest change. They have almost completely replaced headgear as a method of anchorage supplementation and have significantly enhanced the many tooth movements that we can achieve efficiently and effectively. I have undertaken research in the field of microscrews resulting in a PhD in 2014 and I believe them to be a significantly safer and much more acceptable device for patients.
Can you describe a case that you were particularly proud of?
One case I will always remember was that of a young girl who had some orthodontic issues but because of her severe epilepsy was being badly bullied at school. The patient’s treatment was routine and involved having teeth extracted, followed by straightening with fixed braces. I can safely say that for her the treatment was life changing. She succeeded academically, obtaining Batchelor’s and Masters degrees and funded her studies with a successful modeling career. She went on to become a ‘beauty queen,’ taking the title of Miss United Kingdom in 2006. To see the transformation from one of life’s ‘victims’ to a confident, successful professional young woman was very gratifying. She attributed much of her success to smile given to her by orthodontics and she used her fame to promote the power of orthodontics to change lives. You can read about her here.
What approach do you take working with adult patients?
It is important for the clinician to listen to the patient and to understand the specific concerns that they would like addressed. The consultation is after all the meeting of two experts. You are the expert in the provision of clinical solutions but the patient is also an expert in their own condition. My approach is to establish a positive relationship from the outset as the clinician and patient need to be working together to achieve the desired goal. The endpoint of treatment must be absolutely clear and agreed upon by both parties before the orthodontic journey begins.
In a recent BOS survey, it was reported that the number of adult patients seeking orthodontic treatment continues to rise. What advice would you give to those considering treatment?
Traditionally, patients were usually referred out of their dental practice for their treatment, either to an orthodontist or to a dentist with additional training. Nowadays, many more dentists are providing brace treatment in-house, so adult patients are not always exposed to all of the options that a fully trained orthodontist might be able to offer. My advice would be to check out the experience and skills of your treatment provider. Our guide to adult orthodontics sets out the key considerations for patients: We have also made a video featuring Professor Tim Newton, a leading psychologist which can be viewed here.
If you are unsure about the advice you are getting, do not hesitate to seek a second opinion.
From a patient’s perspective, how does the BOS support adult patients thinking about undertaking orthodontic treatment?
In addition to the leaflet and video mentioned above, we have produced an extensive array of patient information leaflets (PILs). Most hospital departments and many practices give our PILs out to patients – more than 500,000 annually – and they are available for download from our website. These are being updated currently and I hope that we will soon have them in our app. We get a regular flow of enquiries from members of the public and will always do our best to advise and support. For patients with complex problems, our orthognathic resource has proved to be extremely popular.
You were a Membership of Orthodontics examiner for over 10 years and have been training orthodontists for over 25 years. Could you describe the additional training orthodontists undertake after they qualify as a dentist? Is it difficult to become a specialist orthodontist?
The training pathway from dentist to orthodontic specialist is very challenging, and rightly so. In most situations, this involves a 3-year full-time course or equivalent to learn all the necessary skills. Specialist training requires a comprehensive understanding of growth and development of the jaws and the face, allowing us to visualise and work in three dimensions and confidently predict how the face and jaws will respond to our ministrations, often over a number of years.
Is it possible to receive aligner treatment without visiting a dental professional?
It’s certainly possible, but not desirable. The BOS has produced a statement on this issue urging caution and I am concerned for patients who are being encouraged to think they can have acceptable treatment without seeing a dentist. In my view, a dentist has to be the first port of call in every case not only to ensure optimum dental health but to ensure all the treatment options are fully explained before embarking on a course of orthodontic treatment.
Is the landscape for provision of orthodontics changing?
Yes, in terms of both NHS and private provision. In the private sector, there is a significant growth in the provision of aligners as well as short-term systems. In NHS orthodontics, which is largely geared to under 18s, NHS England has restructured the way that contracts for orthodontic treatment are delivered, with all providers having to go through a rigorous procurement process. The BOS is concerned about the impact on ongoing patient care when an orthodontic provider loses their contract. We issued a release earlier this year highlighting that procurement of orthodontic services risks putting high quality and sustainable patient care at risk.
How do you feel about the growth in adult orthodontics?
I am delighted at the growth in interest in the orthodontic specialty. Your blog is a perfect illustration of the way that patients are researching their options and wanting to understand more about treatment. This is to be welcomed. Would-be patients need to pick their clinician carefully and feel confident in their skills. Orthodontics is more than aligning teeth, it should also be about creating harmony in the jaws and the bite. This cannot always be achieved through the use of a short-term orthodontic treatment and patients need to be made aware of what is and isn’t possible.
Conversely, clinicians need to decide whether a proposed course of treatment is within their expertise and whether all possible alternative treatments have been fully explained to the patient. Only then can informed consent be obtained. Nearly 2500 years ago we were reminded by Socrates that ‘ethical principles are the essence of humanity’. In this ‘post-truth’ era we do well to constantly remind ourselves of this guiding principle.
Reflecting on your career, what has been the most rewarding role you have undertaken?
Chairing the 8th International Orthodontic Conference in London in 2015 has been my most challenging yet rewarding role! Assembling a panoply of international speakers at Excel, for an audience of 6000 from all over the globe and laying on social events in the most spectacular settings, such as ‘the finest dining hall in Europe’ at the Royal Naval College, Greenwich and dining with dinosaurs at the Natural History Museum was a truly spectacular experience. It offered the wonderful experience of leading a truly amazing team of devoted specialists that comprised the conference committee, who all worked tirelessly over 9 years to the single goal of running the best orthodontic conference the world has ever seen. And we did it!
A huge thank you to Prof Sandler for taking part in this interview. If you would like to be featured in a future ‘a coffee with..’ or would like to support my blog or to work with me please do get in touch.