Lithodontist - Door No. 2

I have been asked by several members of the Orthodontia Conference Program Committee to provide background on a project of mine that has some potentially intriguing aspects. While not typical of the daily work we do as orthodontists, it is nevertheless rooted, as it were, in the basic processes inherent in our specialty.

I welcome the invitation to make a more comprehensive presentation of the facts, which I think will clarify how accepted practice, extrapolated to several degrees of remove, has yielded results that are both astonishing to the less trained observer and extremely promising as a professional response to massive environmental pressures.

With your indulgence, let me preface my description of the current project with a brief allusion to its antecedent. A look at how the stratagem came into being will, I think, enhance understanding of the soundness of its potential in the larger scale.

While traveling in the Southwest, observing the various buttes, mesas, escarpments and other rock formations, something about their fundamental structure seemed oddly familiar, although I have never had formal training in geology or other earth sciences. It was only after comparing my observations with aerial photographs that I perceived a pattern that you will all recognize.

Here is a slide of a small mountain range in the Southwestern United States that is known variously as the Peabody Range or the Madre de Larmas. Below it I have inserted a standard frontal view of mature incisors and bicuspids from a typical male patient.

As you can see both the wear patterns, relative length (or height) and alignment are remarkably similar. Now, normal procedure in the case of a human patient would be to realign the teeth to improve their juxtaposition, and to file one or more teeth in order to prevent improper wear and present a more even, pleasing aspect.

As it happened, I have also been an admirer of very large art installations like those of Christo and others in his school. Released from the constraints of working within the oral cavity, and inspired by the freedom inherent in broader interventions, I determined to perform what amounts to exponential oral surgery on this mountain range.

As it was a little-known geological formation located in a remote corner of the country, the main barrier was simply logistical. With support from the Dental Arts Foundation, I was able to mount an expedition and within five months, reduce the apparent discrepancy between the heights of L1, in this case Murphy’s Peak, and its immediate companion B2 (Cripp’s Mountain).

I would have done more, but the local population filed an appeal claiming that the range was what they called Wassamattawichyu, and so protected under a little-used section of treaty regulations. In deference to their sensibilities, and to end a prolonged series of annoying mishaps on site, we terminated operations.

But the groundwork had been laid, as it were, and core principles substantiated. The findings from this expedition allowed us to successfully outline our much more ambitious current project, which is summarized in the next slides.

Here is a familiar topographic map overlaid with political boundaries. You will recognize it as a section of California between San Francisco and San Diego. With computer enhancement, rotated slightly to an oblique angle, the three-dimensional striations and ripples come to the fore. With increased contrast, we once again see a familiar pattern.

If we were to see such an alignment in daily practice we would recognize it at once as a severe case of malocclusion and, again, the course of management would be obvious. Please expand your vision enough to increase the scale further by many orders of magnitude. Because what you see before you is the complex of plate features that form what is commonly known as the San Andreas Fault.

crack in the earth showing Faultline from earthquake

My group knew correction was both desirable and possible, but we were also wary of initial hand-wringing by uninformed non-professionals. As a result, we took the liberty of dividing the overall intervention into discreet sub-projects, each with a modest and easily defensible objective. Seen as a whole, the overall goal becomes clear.

The San Andreas “malocclusion” threatens the region with catastrophic bruxism as the various misaligned plates grind on each other. The ripples from such strain would produce TMJ on a scale of many hundreds of miles and countless billions of dollars in damage.

Clearly, there is a need for tectonic prophylaxis in this situation. I am glad to say that we are approaching the critical point in realigning the entire line.

This picture shows one of the key formations with its “braces” of composite and high-tensile restraints. Each is anchored on a feature of proven stability. Adjustments are made every two weeks, calibrated to mutually enhance similar adjustment in other areas along the line of intervention.

heavy metal cables stretching on large framework against an open sky

Debridement of scree using heavy steel cables keeps adjoining areas smooth and free moving. This is essentially rock flossing, but funding is more forthcoming if other terms are employed. Regular views from chartered satellites show the overall effect and the trend is indeed promising.

This project is certainly ambitious in an engineering sense, altering rock on a scale that makes Mount Rushmore look like rinse and spit. It is also politically ambitious in the face of opposition from reflexive naysayers who would deny the public the benefit of scientific imagination. I regret to say that there are those within our own field who would limit our practice to reclining chairs and the mouths of adolescents.

We are not deterred. To paraphrase Archimedes, “Give me a place whereon to stand and I will make the whole world smile.”

Thank you.

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