Ep 83 - JCO Editor-in-Chief Dr. Neal Kravitz on AI, ethics, and the next generation of orthodontics

What does the editor-in-chief of the Journal of Clinical Orthodontics really think about orthodontic AI, corporate orthodontics, and research bias? Dr. Neal Kravitz pulls no punches in this candid conversation with Dr. Leon Klempner and Amy Epstein. A practicing orthodontist, educator, and past AAO Technology Committee chair, Dr. Kravitz shares why evidence-based orthodontics still needs room for clinical judgment, why overtreatment is the specialty's quiet problem, and why young orthodontists have more reasons for optimism than anxiety. Honest, direct, and deeply practical.

What You Will Learn In This Episode:

• How orthodontic AI is best used as a diagnostic and records automation tool rather than a replacement for clinical judgment, and why evidence-based orthodontics still requires the experienced eye of a trained specialist to catch what algorithms miss.

• Why research bias in orthodontic literature comes not only from industry-funded studies but also from reviewers and authors themselves, and how understanding this helps orthodontists read the Journal of Clinical Orthodontics and other publications more critically.

• How the philosophy of conservative orthodontic treatment planning and doing less rather than more protects young patients from iatrogenesis, and why this principle should guide practitioners from their very first cases in private practice orthodontics.

TIMESTAMPS: 

• 00:00 Introduction to orthodontic AI, corporate orthodontics, and specialty pressure with guest Dr. Neal Kravitz 

• 05:27 Dr. Kravitz explains how orthodontic AI supports diagnosis and records automation without replacing specialist judgment 

• 09:41 Discussion of underrepresented topics in the Journal of Clinical Orthodontics and what evidence-based orthodontics research needs more of 

• 14:29 Balancing evidence-based orthodontics with clinical experience and why residents need room to develop sound orthodontic treatment planning 

• 24:41 How research bias from companies, authors, and reviewers shapes what orthodontists read and how the JCO editor manages this challenge 

• 28:29 Advice for new graduates on private practice orthodontics, finding mentors, and navigating corporate orthodontics with confidence 

KEY TAKEAWAYS: 

• Orthodontic AI is a powerful adjunct tool for diagnostics and workflow automation. Still, it will not replace the clinical judgment that distinguishes a trained orthodontist from a general dentist who uses Invisalign treatment without oversight or expertise.

• Research bias is not limited to industry-sponsored studies. Reviewer bias and author bias are equally real, which means every orthodontist must approach the literature, including the Journal of Clinical Orthodontics, with informed skepticism and critical thinking.

• The philosophy of doing less protects patients. Dr. Kravitz argues that overtreatment, not under-treatment, has driven his most regrettable cases, and that conservative orthodontic care built around humility and honest self-evaluation defines what ethical practice looks like across an entire career.

EPISODE TRANSCRIPT

What follows is an AI-generated transcript. The transcript may contain errors and is not a substitute for watching the video.

Golden Age of Orthodontics Episode 83 Dr Neal Kravitz v1

(00:00:00) Dr. Leon Klempner: It should be of no surprise to you that our specialty is under pressure from corporate models, gp, competition, and ai. Uh, that in theory could replace some of our clinical judgment. Today jCO editor and all around good guy Neal Kravitz is our guest. Stay with me. Welcome to the Golden Age of Orthodontics.

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(00:01:10) Welcome to the Golden Age of Orthodontics. Fiona already know me. My name is Leon Klempner. I am a retired, proud board certified orthodontist. I'm also the director of orthodontics at Mount Sinai Hospital here in New York, part-time faculty at Harvard and Montefiore, and I am the new current president of the New York State Society of Orthodontists, as well as of course, the CEO of people in practice.

(00:01:36) I practiced for about 40 years on Long Island before. Co-founding people in practice with my partner, my daughter, my podcast host, Amy Epstein. Amy, welcome back. 

(00:01:47) Amy Epstein: Thank you. Always good to be here. This is always a really good episode. You'll be listening to this episode right ahead of the AAO. So, uh, as you're gearing up and making your plans, please include a visit to (00:02:00) People in Practice's booth, uh, on your list of places to visit.

(00:02:04) When you're on the show floor, we will be there. You will recognize us. Well, you can see our faces here, but uh, my dad's the six foot four white-haired guy. Hard to miss, hard to miss. It's really hard to miss. So, um, you should be able to find us. Uh, and it's always really fun when people recognize us from the podcast's.

(00:02:21) Kinda like a highlight for me. Feel famous for a hot second there. So, um, so we look forward to meeting with you. I'm Amy. Uh, and, and by way of background, I have an MBA in marketing in 25 years. Now I have to update my, my, uh, bio that, um, 25 years of marketing and public relations experience. We got together.

(00:02:43) To start people in practice to be able to offer that type of tried and true professional digital marketing and communications, um, services to the orthodontic industry. And so we've been doing that for a little while now and, uh, we really enjoy (00:03:00) working with orthodontists and working with one another. Um, and today we're very happy to have, uh, a distinguished guest.

(00:03:11) We have Dr. Neal Kravitz with us. If you don't know, he obviously, he's, he's a practicing orthodontist and, uh, you know, but he's the editor in chief of the JCO. He is an associate editor of the American Journal of Orthodontics and Dental Facial Orthopedics. Um, he serves on editorial boards like the Angle Orthodontist and seminars and orthodontics.

(00:03:33) He is also board certified on faculty at Harvard. Uh, the past chair of the AAO Committee on Technology. So he has a lot. Of, uh. Information to share with us on the topics that, um, my dad talked about at the top of the show in our intro about what's happening with the specialty. Um, you know, Dr. Kravitz has also been recognized, um, because he's been a recipient of the (00:04:00) aaos John Valentine Mercian Award and is known for his commitment.

(00:04:03) In clinical practice to being conservative, ethical, and offering affordable care. Um, so Neil, thank you so much for being here. We really appreciate it. 

(00:04:14) Dr. Neal Kravitz: Thank you. I'm excited. 

(00:04:16) Dr. Leon Klempner: All right. All right. Neil are ready. So lets start. I ready? Start off. Yeah. Yeah. Uh, first of all, let me, let me just, uh. Also state that Neil's a really nice guy, as I mentioned in the, in the opening, and he is extremely well respected for his authenticity and ethics.

(00:04:36) And so with that, my first question has to do with ai. So AI's permeating our lives on a daily basis and ortho's no exception. Um, we all have the benefit of. Doing a self-analysis or a CVM staging using ai, whereas, you know, in my day I used to take out tracing paper in that white (00:05:00) pencil and mark all the spots.

(00:05:01) So, you know, it's, it's been a delight. But as AI is getting better from your perspective. How are we going to differentiate ourselves from gps as more and more, um, vendors begin incorporating AI into things like treatment planning? So where, what do we do as a, as a specialty? 

(00:05:27) Dr. Neal Kravitz: Yeah. There's two parts to the ai.

(00:05:28) AI is the, is the topic in, in orthodontics and in medicine. I think, uh, I think the first part is. What I wanna see from ai, we're all talking about how AI can, uh, be used with Invisalign and, and treatment and maybe even making products. But what I really wanna see AI do, um, is two parts. One, diagnostics. I think you're gonna see it in hospitals with reading radiographs, uh, right away.

(00:05:56) I think treatment, planning and diagnosis, um, (00:06:00) AI needs to be helpful. Almost the way like Grammarly is helpful when you're typing an email. Which really is actually a, a, um, a small form of ai. Um, so I think, um, our ability to diagnose better, diagnose more accurately if we're between extractions versus a Herbst, we can kind of, um, uh, use what we have.

(00:06:20) I also wanna see AI in terms of records, automation. You know, I would love a day, this is my whole theory, and we, we always talk about products, but I would love a day where you can take yourself and it automatically goes to the insurance company. And it's, uh, the Salzman index is al already, um, computated.

(00:06:37) And, uh, the SEP is already traced for you, and there's, there's not somebody in a room paid by an insurance company to reject the surgical case. It is, it is just automated and it should be very easy to do all of that stuff right away. So I would like to, um, uh, you know, the, the records, the pretreatment, the authorization.

(00:06:55) In terms of separating from general dentists, I think this goes back (00:07:00) to maybe like the night tie wire argument, you know, you know, 50 years ago or so. I, I think we're always gonna be able to differentiate ourselves. AI is just an assisted tool. It will not replace doctors. But with that said, um, you need to incorporate it.

(00:07:16) I, I, I don't think, uh, this ability of, of not using it even as a journal editor, um, you know, you know, you can abuse ai, but you also can use it as a way to help you with, uh, with editing or uh, researching. So, um, I'm very pro ai, um, and I don't think, uh, we'll have any problem differentiating ourselves. It's not going to replace doctors.

(00:07:38) We're just simply, um, it's gonna be used as an adjunct. 

(00:07:41) Dr. Leon Klempner: So, you know, um, I gave a lecture at the AAO about two years ago entitled, you know, AI won't Replace You, but your competition using AI just might on on just a hundred percent. A hundred percent to make your point. But, you know, we had Joe Hogan on a couple months ago and, and I asked them this question (00:08:00) about the data that they're collecting over there.

(00:08:02) And, you know, in, in AI data is the king. 

(00:08:05) Dr. Neal Kravitz: Yeah. 

(00:08:05) Dr. Leon Klempner: And they've got. You know, 20 plus years of, of data and you know, in his eyes it's like AI can make things so much easier, but I'm concerned that, you know, you push a button and AI is gonna give you the treatment plan and you know, or the staging and all the things that, that, you know, we use in terms of our own clinical judgment.

(00:08:28) So. In the hands of like a gp, you know, it, it, it's gonna be, I'm worried that it's, it's, it could be abused in that manner and I, I don't really know how to deal with that. It 

(00:08:39) Dr. Neal Kravitz: could be we're already there. You're, you, you could put on, uh, brackets and put on a, a straight eye tie wire and let it ride. You can do Invisalign assist and never look at the case.

(00:08:48) Our clinical judgment, our ability to intercept and guide will always. Um, uh, be unique and superior. So I think, um, yes, of course it, but, you know, (00:09:00) people can, uh, abuse it, but I think it is gonna be just another tool that we use no different than, um, simply Googling, uh, the way, you know, we had, you know, so I, I think this is just, this is nothing that I'm too concerned about and I think the people that will abuse it.

(00:09:17) We'll be the non orthodontists. Mm-hmm. Um, and, um, I, I don't, I, I think the difference in care will always be there. 

(00:09:24) Amy Epstein: So let me ask you, because you have a unique vantage point here. You mentioned, well, your perspective, it comes together from your experience as an orthodontist, as as an editor, as an educator.

(00:09:36) Um, and I think you've published something like 200, you know, uh, papers. In your role at the JCO, you see what's coming through and what gets published and also what doesn't get published. What clinical topics or what questions do you think are, um, underrepresented in the literature? Essentially, I'm asking what topics (00:10:00) should be explored more deeply, um, through research that aren't currently being explored.

(00:10:07) Dr. Neal Kravitz: I, it's a, it's a great question. We are always kind of self-checking at the JCO. Uh, when, um, I took over the editorial ship from, from Bob Keim, who was an incredible editor for over 20 years, um, one of the things that I wanted to do and put my spin on it is I wanted the JCO to be a residence journal, and I, I really wanted someone who was in residency to be able to pick it up and read it front to back and say, I can apply.

(00:10:32) Everything that I'm learning, uh, to the clinic. I didn't want weird cases. I didn't want heroic cases. Mm-hmm. I didn't cases with 20 mini screws. Mm-hmm. Um, I, I, I reject those cases right away. I didn't want cases where people were naming things after themselves. Um, I wanted to, I kind of wanted to simplify it.

(00:10:49) I did want to emphasize Invisalign. Invisalign is a major part of clinical practice. So we went from maybe being mini screw focused a decade ago to now, you know, having a lot of aligner articles. But (00:11:00) if you're gonna publish an aligner article, uh, you better show your ClinCheck instructions. You better show your biomechanics.

(00:11:05) You can't just show before and after cases and show off your work. You need to walk me through why you thought about that attachment and what you were doing. Um, and we really are kind of hard on our authors, uh, because of that. Um. So I think what we are looking for, and it does change. I mean, now I, I would argue that I, I really am, I wanna see, uh, mark the expansion cases.

(00:11:28) Um, but I still kind of, I hate to say this, go back to basics. Um, I can't get enough of good old fashioned orthodontics. I have to ask orthodontists to publish those cases. Uh, I'm like, listen, uh, that's. You know, we have a lot of aligner cases, but you just did a beautiful case here. I wanna know how you did it.

(00:11:47) Um, we have some articles coming out on SAP positioning Tom Pitt's, uh, you know, smile arc protection position. I want authors to explain how they're doing it now and where they're applying it, because when I do it, you know, (00:12:00) sometimes I don't love the, the denture like aspect of the way the teeth look.

(00:12:04) They look a little toothy to me. Uh, and I love when someone does it correctly. So, um. We're always asking for hot topics, I guess right now, currently, I think Mark B would probably be up there with anything else. But to answer your question, um, really it's good sound biomechanics no matter what. So whether it's phase one biomechanics, whether it's Invisalign, biomechanics, whether it's just good old fashioned brackets and wires, uh, we can't get enough of those.

(00:12:30) Um, and that's what we want more of. So we went from, um, a, a. Having a journal that really tried to cover a lot to really trying to cover, uh, a residence curriculum. 

(00:12:43) Dr. Leon Klempner: And, you know, for me, um, when I think about the JCO and I've been subscribed to the JCO for, I don't know, 50 years I think almost, or whatever.

(00:12:53) So, you know, I go back a long way. I always looked to the JCO as what I (00:13:00) can practically use Yeah. In my hands, in my office. That's the value to me. I mean, I get the a JO and I read those articles and, you know, the studies and the, the mitochondria and uh, whatever. But, you know, the bottom line is that, you know, I'd, I'd look at the tips and, you know, the, you know, the, the little things that say, oh my God, you know, that's gonna save me so much time and 

(00:13:22) Dr. Neal Kravitz: Yeah.

(00:13:22) Dr. Leon Klempner: And whatever. So. 

(00:13:24) Dr. Neal Kravitz: It has to be graspable. It has to be easy to understand. You have to be able to read it in a sitting, you have to be able to, uh, memorize it there. There really, um, it is a journal that, that I wanted, uh, to be made for everyone. And, um, and we put a lot of effort into making these articles, uh, uh, beautiful to look at.

(00:13:42) Easy to read, uh, easy to just, uh, uh, graze through if you wanted to. Uh, we put some key summarizing keys in there. So, uh, we've included a digital aspect. So all those things, um. I mean, we are focused on it. 

(00:13:54) Mm-hmm. 

(00:13:55) Dr. Leon Klempner: Yep. So, uh, let me ask you this question. Uh, 'cause you and I are both (00:14:00) involved with a lot of, uh, ortho residents.

(00:14:02) We teach in, in a variety of different institutions and, and, you know, we pride ourselves on providing evidence-based cases and, and decision making, et cetera. Uh, but I think that my, my concern is that. Evidence-based, I think is very critical and important. But there's also an element of clinical experience and judgment as well that needs to get mixed into it.

(00:14:29) And I'm a little concerned that our residents are coming out without too much of that. And when that happens, I think innovation gets squelched and Yeah. And I'm wondering, you know, uh, how do you feel, uh, how do you feel that we should adapt to that balance between. Evidence-based, um, issues and. At the same time, open up to new ideas and trying new things and, and what works in your hands or my hands, et (00:15:00) cetera.

(00:15:00) Dr. Neal Kravitz: Yeah, I, I, I always tell the story that when I started my career, I would shake my head no. Uh, you know, I would always like disregard a maybe a patient's concern. Uh, that's not me. I couldn't be causing that, or that's never gonna work. And now I more go, maybe. Maybe that could work. I, I, I'm much more open as I have seen things.

(00:15:18) I think the way to be, uh, is to not be dogmatic. And I think it's very easy to form opinions, uh, very quickly when you don't know much. I mean, uh, think about, you said you've been pr, you know, you practiced for over 40 years, um, and how much. Better of an orthodontist. You were every five years or so, I love retreating my cases.

(00:15:38) I never charge to retreat my cases. And when patients are incredulous, when I present that to them and I, and I go, no, I, I really wanna do this. I'm a much better orthodontist now than I was when I treated you. And this will only take me six months to just touch it up and get it back to where I think I, I can do the quality of work that I wanna be doing.

(00:15:54) So I think, uh, you're right, uh, because, you know, you can, um, (00:16:00) you can, uh, have an article, uh, that, um, you know, we talked a little bit beforehand about Biasness. Yeah. You could, you could, you could be biased, uh, going into a new idea. And, um, you can not be open to what is out there. And the perfect example, we talked about this right now is, is expansion and airway.

(00:16:19) And it, it is hard for me 'cause there's a lot of research out there, uh, that says one thing, but. You know, we're, we're you, I guess the, the answer to this question is you have to know the research. You wanna make sure you're reading the correct research, but you still have to be open-minded because you're right there, there is, um, there's a lot of ways to do things correctly and, um, I don't think you can just follow.

(00:16:44) The journals, and in many ways, that's where the JCO uh, fits in. You know, I, I still don't want Harrell cases. I still don't want cases that in the, um, discussions, deviate from the, the, the A BO reading list. I, I wanna (00:17:00) make sure you know the material and you are following the rules. But there is that wiggle room of I wanna see a beautiful work.

(00:17:07) And there's a lot of ways to do sound ethical, beautiful work. Um, and I think both sides, people who are, uh, maybe a little cavalier, uh, and people who are a little rigid and only research focused or only evidence-based focused, that middle ground is where you need to be. And I think if you're doing that, you're practicing cautiously and conservatively and appropriately.

(00:17:28) And, um, you, when you do your heroic cases, you're doing them few and far between. That's fine. I'm fine with that. 

(00:17:33) Dr. Leon Klempner: Yeah. You know, I have, I had a classmate that once told me, this was like 20 years ago when I was, I was experimenting with, uh, twin block and some functional appliances and just to see what, what it can do, what it can't do.

(00:17:49) And, um, and my, uh, my classmate said to me, he said. I do everything exactly the way I was taught when we were in training. Yeah. And I said, and in my mind I (00:18:00) said, oh my God, this is, this is not a good day. 

(00:18:03) Dr. Neal Kravitz: How many times have you had a patient where you were like, you're gonna need teeth extracted, or you're, there's no way I can do this.

(00:18:08) I have this great case where. Was an Invisalign patient where we treated with class two elastics who had severe overjet. And the mom looked me in the face and said, my daughter will do everything she needs to do to get a great smile. And she did a case that really blew my mind. It wasn't me. I, I wasn't a great orthodontist.

(00:18:23) She was just an extraordinary patient. So, you know, listen, maybe maybe's the answer and, and I'm, I'm certainly open, uh, to doing things. So I listen, I, I know the research very well. Uh. But I try to be open-minded, um, to new ideas, um, and to new approaches. 

(00:18:40) Amy Epstein: Mm-hmm. Yeah, I mean, you have a very specific, um.

(00:18:44) Agenda's not the right word, but you know, uh, you decided that strategically you're going to make the J-C-O-A-A usable tool that residents can implement. Right. But you must, you know, there's heroic cases and there's cases where, you know, there people are naming things after themselves and yeah, there's all that, but there (00:19:00) you're seeing it all.

(00:19:00) Some of it goes through and, and gets published, but you're seeing it all. Has being the editor of the JCO influenced you? In terms of your own clinical practice based on all everything you're evaluating all the time, it's just a lot of, a lot of material. 

(00:19:15) Dr. Neal Kravitz: Yeah. No, I that's, that's actually great, right?

(00:19:17) 'cause I get access to it. I, I think what I would say is, um, maybe the reverse Okay. In the sense that the JCO is gonna be. Me, uh, I'm not saying I, I, uh, that is if you, that is, that is me on paper. Right. So what I mean by that is, um, I, it's not that I won't let some unique cases go by. Mm-hmm. Um, I have a case that I really am thinking about publishing where it is a phase one.

(00:19:46) So an Invisalign phase one case where they did class two correction, none of that has any benefit according to research. Mm-hmm. Right? Uh, this is too early, this is not the right treatment. This is all a temporary bite. Um. (00:20:00) But their case actually looked very good and it had some value, and I could justify if the authors appropriately, uh, mentioned the limitations that this should not be, uh, this should be done judiciously on the right kid who's going maybe through a, a social issue at school.

(00:20:16) Mm-hmm. That there is some value to know how to do this if you're doing this on every class, two. 8-year-old, you're, you're doing it for business. But I think there's some value here. But I, I would say what I try to do, and the only really way I know how to do this is to make the JCO kind of the way I would practice.

(00:20:36) But I try to again, be open-minded, uh, when I see some really good work that may deviate for me a little bit. Uh, I so it, it, it's really a lot of me in this journal and, um. Uh, so you're right, I do get access to all this type of stuff. I don't, I don't know if, if somebody's work that I read, um, changes my (00:21:00) experience, um, as a clinician.

(00:21:01) Um, but I definitely will say that, um, my experience, um, treating a case, uh, definitely has broaden in my, my applications of different types of orthodontic treatment. So, um, I'm still a little bit. It still a little bit rigid, but I've tried to be, again, open-minded. 

(00:21:17) Amy Epstein: Well, okay, so you have a treatment philosophy, and we talked about the ethics and, and, um, so is, are, is there something that, um, has shaped your philosophy Oh, yeah.

(00:21:28) That you can speak to? 

(00:21:29) Dr. Neal Kravitz: Oh yeah. Gosh, yeah. So I definitely have, uh, uh, you know, practice philosophies that I like to share. And the number one that I always say is, you know, um, you can achieve more by doing less. I, I think in my career, my greatest mistakes. My greatest heirs, um, my greatest, um, uh, times of iatrogenesis happened with good intentions where I overtreated kids.

(00:21:50) I, I, I never had a case that turned out poorly because I waited too long. Mm-hmm. It was cases where I started too early and did too much with great intentions. (00:22:00) Um, but I, I, I did not quite, uh, know what I needed to do. So I am a huge believer that, um, not just in orthodontics, but in dentistry and in medicine, we are overtreating.

(00:22:09) We are over medicalizing and, uh, particularly for young children, I like to do, uh, less so I'll, I'll say things like no permanent damage, no scarring of the teeth. If I have a patient. And I start to see early signs of root resorption or decalcification, the braces are immediately off and I'll transition them to Invisalign and I never charge for that and tell the parent, listen, your body is not responding well to brackets and wires.

(00:22:33) I need something different. Uh, and that's the cost of doing business. I never charge, and it's just part of it. So, um, I think. Orthodontist sometimes, and I, maybe it's the financial success we have sometimes do not look closely at their own mistakes and, and perhaps, uh, stand too far away from humility. And I think it causes them to make changes.

(00:22:57) Uh. Too late or sometimes not at (00:23:00) all. And I think it's very healthy. As my great friend Justin Hughes, a great orthodontist in Virginia says, yes, it's, we know it's good for you to both feel that you are the best orthodontist and the worst orthodontist in the same day. And if you're going through these emotions, you're, you're reflecting on your work.

(00:23:13) You're making changes quicker. Uh, the hardest thing about orthodontics is. Mistakes is that you had made those mistakes so many times before you were able to self-correct. Um, and I've had cases where parents were like, wow, this, this case turned out great and we did it so quickly. Boy, let me tell you about the cases where I, I I, I failed on.

(00:23:35) And um, so I think, uh, what I try to do is, um, is uh, learn from my mistakes. But many of those mistakes came with great intentions. Overtreatment, and I think that probably is true, uh, outside of orthodontics, uh, for other, uh, doctors and dentists as well. 

(00:23:54) Dr. Leon Klempner: So you and I align on probably 95% of, of issues (00:24:00) on the phase one, phase two, we're probably on operas end.

(00:24:03) So one day we should get another podcast going, going, you're gonna say 

(00:24:06) Dr. Neal Kravitz: sour cream and applesauce with the lact. So I, uh, for sour cream 

(00:24:11) Dr. Leon Klempner: too. Anyway, uh, anyway, uh, you know, um, here's another issue that, yeah. Comes up at, at least in my mind at least, is that we're seeing a lot of industry generated research, um, you know, aligner companies, for example, that publish their own research, um, uh, uh, regarding, you know, cases or decision making.

(00:24:33) But, so from, from your vantage point now you, I'm asking you to put your JCO, um, editor hat on now. Uh, how do we maintain independence and literature and avoid. Like the bias that could be shaping how orthodontists practice. Are there any guardrails, uh, against that? 

(00:24:53) Dr. Neal Kravitz: Yeah, listen, I, you know, it's hard, right?

(00:24:55) Every company is gonna do their own internal, uh, studies. Even 3M you know, (00:25:00) when you start looking at material sciences, I've, I've done research on, on composites, uh, for my angle, um, application, you know, 15 years ago, you know, they had internal research, which was very helpful by the way. Um, you know, I think.

(00:25:15) I think company bias is there. It's gonna be there. Um, but you know, I, I'll tell you that there's reviewer bias, that there is author bias. I think that's equally problematic. I, you know, I have trouble, you know, as an editor. Let's hear me out here. Let's, because you know, I, I can do this for every journal that I'm on the board for.

(00:25:35) If I want to reject your article and I'm being unethical, I can reject it by sending it to people that I know are gonna reject your article. And I know that goes on, like I know that happens. Uh, um, like I, I, you know, somebody can write an incredible article. Let's just talk about Invisalign for a second with an a beautiful Invisalign biomechanics.

(00:25:57) But if you send that article to someone who is (00:26:00) very, uh, rigid and very firmly against Invisalign, no matter. What the paper says, it's gonna be an immediate rejection, so you have to be very careful, uh, who you send people to. Now, I have a little bit of a unique problem. I, I am the editor for the a JO in charge of Invisalign research.

(00:26:17) There's only so many reviewers I have access to. So I can't keep sending them articles. I have to send them to other articles. And it's hard 'cause I, I can't keep hitting up the same reviewers, right? Mm-hmm. Uh, I have so many articles in the pipeline that I need to get reviewed, and I know some of these papers are being reviewed perhaps by a doctor who does not know or understand Invisalign and Invisalign research.

(00:26:41) So the bias is there from companies. Mm-hmm. The bias is there from the author. Right. The author has a, a motive. It's very easy to manipulate research if you're unethical. You know, I'll tell you, um, every two or three years I publish a major Invisalign study from my office. I have an employee who is paid, (00:27:00) um, to do my Invisalign research so people can't.

(00:27:03) Claim. My Invisalign is not blinded. My research is blinded. I painted. Now she's also a part-time nanny, so I get a little double dip for my, the seller. But I, I have an employee that I basically have as a research assistant to make sure I have blinded research, uh, 'cause I want these papers to get published.

(00:27:20) It's that important to me. But you're right, the bias is there and I think. I don't have an answer to your specific question other than I think you just have to be aware, but also be aware that it's not just from the companies. Every research paper you read, man, it's probably. Partially true. I hate to say that as someone who writes research, it's like even when I'm doing research, I'm even with my research assistant, I'm like, you can't get me on that.

(00:27:45) You have to. I can't see that data. Or like, I have to be careful that I don't go down that path. Don't, don't temp me down to look at things. Uh, otherwise things will start getting skewed. So it goes. Everybody could be guilty, uh, of it. (00:28:00) And you just have to be aware. And it's scary when you start thinking about it in terms of medicine too.

(00:28:04) You know, teeth aren't that important, but once you start going into the bigger world, I'm sure it's there. Yeah. In every research. 

(00:28:10) Amy Epstein: Yep. Well if you take all that one step further, it, you know, we have to talk about how all of this is shaping the next generation of orthodontists that are coming into the specialty and today with AI and corporate influence and biases and the research.

(00:28:29) Yep. What do you think matters most for a young orthodontist? Just getting going, um, to get right early on. 

(00:28:39) Dr. Neal Kravitz: Yeah, I, I think, listen, I would not worry, uh, first and foremost, I, I, I, I kind of chuckle a little bit when someone, uh, is, is anxious about, you know, it's, it's kind of like the, the climate change, uh, you know, anxiety.

(00:28:54) So I think, I think be aware of what's happening, but there's no, there's no reason, uh, (00:29:00) the sky is not falling down. Yes, there are corporations and yes, there are, um, there's AI and more dentists doing Invisalign and no orthodontists are not struggling at all. Uh, in my area there's nine orthodontists within about a.

(00:29:17) Three mile radius and we're all as busy as we wanna be. No one is struggling for patients. You get to have the life you want to live and you'll hate to talk about money, but you can make as much money as you wanna make, depending on how hard you wanna work, and everyone is doing fine. Um, so I think what I would tell orthodontists to do is to one.

(00:29:38) Choose a good mentor. Uh, it's very easy to become enamored, um, by the cool orthodontists. I call them like chachis, like Charles in charge, like, you know. Um, but that's not who you want. You want like an old school. Um, good ethical. Orthodontist and if you do work for A DSO or an OSO, fine, make sure one day a (00:30:00) week you can work for somebody.

(00:30:01) Uh, and if they pay half as much, that's fine. You're gonna learn so much. You know, my great failure is I started my career at A DSO and I learned a lot about business, but I had to relearn about, uh, clinical care, and I had to kind of almost like redo my career, uh, after a few years. So I, I'm, I was great at business, maybe not so great at orthodontics and, um, so I, I tell people, um, be humble.

(00:30:24) Be hardworking. Don't worry about growing too fast. Um, if you can be an independent orthodontist and have your own private practice, that's fantastic. If you can work for a doctor in private practice, that's great, but I would not worry about, um, uh, the corporate world or the artificial intelligence, or the changing landscapes.

(00:30:41) There's always gonna be something out there and you just adapt. You know, you just adapt to the rule set and everyone will be fine. 

(00:30:48) Amy Epstein: I like it because, uh, you know, I know from hearing from my dad talking to the residents and, you know, trying to make sure that they feel comfortable and confident as (00:31:00) they go out into treating patients in the world.

(00:31:02) And, uh, so it's nice to be able to hear from someone who has, uh, uh, likewise a positive outlook on what's to come. 

(00:31:11) Dr. Leon Klempner: Yeah. And I, and I think your point about mentor mentoring. Is really important. It could be really isolating for a new graduate to be dealing with complex cases on their own with nobody to bounce things off of.

(00:31:26) Yeah. I know. I got into teaching initially because of that. I practiced by myself and I, I, you know, I, I volunteered at the school just because I could be around some others and I could bring those, I'd bring the records in and say, well, you know, what do you think about this? What would you do here? You know, you, you need that type of thing in New York State.

(00:31:45) One of the initiatives that, that I'm working on right now is, is connecting up new graduates with experienced practitioners so they have a resources that they have somebody to talk to, not just about clinical stuff. Um, you know, how would you handle this (00:32:00) patient? A lot of the anxiety comes from, you know, patient management.

(00:32:05) Yeah. AI's not gonna help you that much 

(00:32:07) Dr. Neal Kravitz: on that way. I had a conversation with the graduating re uh, the residents at, at Harvard last week when I was up there. The, the, they'll be graduating next month. And I said, you know, in one month, um, a a a mother is gonna look you in the eyes and give, you, give over their child to you.

(00:32:22) Uh, you have to bat a thousand percent. You have to get this right. Uh, 'cause nobody needs orthodontics. So you cannot make mistakes. You cannot not in terms of not having a perfect occlusion, but I'm talking about iatrogenesis, you know, I'm talking about, you know, really, uh, erroring and, and so, um, yeah, I agree with you.

(00:32:41) And just to have a senior doctor there would've been so helpful for me, uh, just to slow me down. I think, I actually think that would've really been something that would've been so great. And I think to kind of sum up your point, Amy, and is that. I think just be a good clinician and the business side will, will be figured out.(00:33:00) 

(00:33:00) And I think, don't worry about the business. Even if the bills are incredible and they're incredible. They're incredible. You know, this, you know the, you know, when you write those initial checks, your hands are shaking. Now that's just a Tuesday. You get used to these numbers mm-hmm. Pretty quickly. So just, just do good work and you'll become fine at running a business.

(00:33:18) Uh, but don't be business focused when you come out. There's no need to. 

(00:33:22) Amy Epstein: Well, listen, thank you so much for all of your insight today. It's been a pleasure talking with you. I'm sure that our listeners are going to take a lot away from the conversation if they may have questions for you or, uh, would like to follow up, can they reach out to you in some way?

(00:33:36) Dr. Neal Kravitz: Yeah, I'm, I'm, I'm always available on, uh, on Facebook. You can, uh, just, just use Messenger and reach me. Mm-hmm. Um, I get. 10, uh, you know, uh, questions a day off from all over the country. I try to answer 'em as best I can. People show me their cases or just, just ask clinical questions. Uh, email's fine too. Uh, just my first and last name, Neal Kravitz, one [email protected].

(00:33:58) Amy Epstein: Very good. And 

(00:33:58) Dr. Neal Kravitz: I'm always here to help. (00:34:00) 

(00:34:00) Amy Epstein: I. Great. Well, thanks again for being here. Uh, it was a pleasure having you. Hope to see you again. Will you be at the a, a o? Will we see you there? I'll 

(00:34:06) Dr. Neal Kravitz: be at the ao. Yep. 

(00:34:07) Amy Epstein: I'll be here. Great. I look forward to meeting you there. 

(00:34:09) Dr. Leon Klempner: Stop by, stop by our booth 

(00:34:10) Amy Epstein: and say hello.

(00:34:10) Dr. Leon Klempner: You 

(00:34:11) Amy Epstein: very good. Yep. 

(00:34:12) Dr. Leon Klempner: Yes, thanks. Thank you. 

(00:34:14) Amy Epstein: You can subscribe or download other episodes of the Golden Age of Orthodontics on Apple Podcast, Spotify, SoundCloud. You YouTube if you'd like to see our faces, uh, or wherever you get your podcasts. And if you enjoyed it, we'd appreciate it. If you tell a colleague.

(00:34:27) For more information about people in practice, you can visit our [email protected], 

(00:34:33) Dr. Leon Klempner: or you can email me directly [email protected]. If you're looking for a good deal, we have partners. Uh, go to our [email protected] and remember, especially for our residents, for forward thinking orthodontists, it has never.

(00:34:51) Ever been a better time to be an orthodontist? We are currently in the Golden Age. Take advantage of it. Bye for now.(00:35:00) 

(00:35:05) Thank you for listening to the Golden Age of Orthodontics podcast. Subscribe to our podcast on YouTube, apple Podcasts, Spotify, or visit our [email protected].