We interviewed veteran orthodontics specialist DR CATHERINE LEE just after being awarded Global Australian GameChanger 2023 by Advance The Global Australian Network (supported by the Australian government). She talks about her wide-ranging experience and the importance of early and correct intervention, especially for jaw and teeth alignment. She also discusses the promise and potential dangers of the AI revolution in orthodontic treatments, including clear aligners. Plus her humanitarian work, which focuses on dental facial orthopaedic and cleft palate surgery.
As a US-trained specialist you could have made your career anywhere – why Singapore?
I left New York with every intention of joining my previous team in Sydney. On a stopover in Singapore, I met up with some of the leading surgeons in my field and was headhunted to come and work here. It worked out well, as you can see! I made that commitment, and now I feel quite permanently rooted here.
I still go back to teach at my alma maters, Adelaide University and NY University; specifically on the subjects I think they need help with. An extension of this is accepting medical school interns to spend a few months working with me. I feel the need to pass on what I know.
How would you describe your approach to orthodontics?
It combines early intervention with minimal invasiveness. I don’t have a cookie-cutter approach – each case is different and needs to be carefully assessed and properly diagnosed. With children, I like to look at their age and take advantage of growth patterns to correct any discrepancies.
Minimal invasiveness also includes never removing a tooth unnecessarily – and that includes wisdom teeth. Removal may seem the easier option in a challenging case; in fact, it can be more difficult, more time-consuming and more costly.
What is an example of a challenging case?
Not uncommonly, there may be a growth discrepancy between the upper and the lower jaw. Either one may have failed to develop in time with the other. Though it may look as though the teeth themselves are sticking out, it’s actually a fault with the jaw. That’s our forte – dental facial orthopaedic work. We have a limited window of opportunity; ideally, it should be corrected between the ages of seven and 11 to utilise a child’s growth potential, otherwise it can require jaw surgery later to correct the discrepancies. Correct diagnosis is crucial in these cases.
Who are your typical patients?
People of all ages, literally. Treating kids is fun – they listen well, and they like to be rewarded. For an adult patient, orthodontic changes can be slower and more difficult to effect. Unlike children, their tissues have stopped growing, their bones have hardened and adaptation is slower. But I like treating adults, too, and we’ve achieved some incredibly gratifying results.
Some of the adults who come to me think they’re a lost cause, and it’s not just about looks. In some cases, they’re unable to eat properly, have been enduring chronic joint pain and may even suffer from psychological problems. For them, orthodontic treatment can be a life-changing experience.
A recent case of mine was an adult woman who’d already undergone five years of unsuccessful orthodontics treatment. It took us two to three years to undo the damage and treat her correctly, but we got there in the end!
A possibly unusual aspect of my work is treating older people – into their 80s and even 90s. It can be challenging, but I do whatever I can to help them to retain all their teeth and not have them pulled. Teeth are so important to ensure proper nutrition and stave off getting older and weaker.
What’s new in your practice?
We continue to move to the rapidly advancing world of 3D technology. I use cone beam 3D CT radiological scanning for more accurate diagnosis; imaging technology such as 3D intra-oral scanners that have made moulds unnecessary; 3D software technology to plan the treatment; and finally the production of clear aligners that effectively move teeth without braces. This technology has been making steady and significant progress over the past 20 or more years.
However, clear aligners aren’t right for all cases; they’re a tool, like any other braces. Sometimes it’s possible to do a hybrid of metal and clear braces. Being resourceful and able to think out of the box is fun for me, and my patients like it!
I now sit on the board of ClearCorrect, a Swiss-based implant company that is number one in the world. As one of their global advisers, I test new products and provide feedback on them.
How is the increasing use of AI (artificial intelligence) in medicine affecting your field?
It’s having a tremendous effect; AI is undoubtedly revolutionising dentistry and is a game-changer in one of my own particular specialties, digital orthodontics. Clear aligner orthodontic treatment programmes are increasingly incorporating cutting edge AI algorithms in their software.
One result, however, is that orthodontic products are no longer reserved only for use by trained specialists. AI has made clear aligners accessible to practitioners who are not well-versed in orthodontics; this has pushed the prices down, and the quality of care has suffered; as orthodontists, we have started to see complications from this.
Human input remains critical. While AI can aid in diagnosis, planning and treatment, it takes a qualified, experienced and empathic human being to ensure a safe, smooth and effective treatment experience. We have to negotiate a potential minefield that may include conflicts, unexpected or difficult situations, personal and cultural preferences, and considerations such as socio-economic backgrounds and ethics.
Tell us a little more about your involvement with the Cleft Care Indonesia Foundation (CCIF).
More than 16 years after we started it all, CCIF is run by a group of international volunteers and four full-time local staff. Its main objective is to locate underprivileged, untreated cleft children (needing cleft lip or cleft palate surgery) from city slums, small villages and remote areas of East and Central Java, and then to support them throughout their growing years with the necessary surgeries, together with educational, nutritional and other related programmes.
In my current role as patron and medical care director, I go there twice a year to assess performance, give advice and so on. Fundraising is of course vital for this work to continue, and anyone who feels moved to contribute in some way can find out more on the website, cleftcareindonesia.org.
When you do have some free time, what do you like to do?
More of the above! Although I enjoy visiting different countries, I’m not the kind of person to go and sit on a beach. When I travel, it’s as part of a multi-disciplinary team providing care for cleft-lip, cleft-palate and cranio-facial patients in various parts of Asia-Pacific.
I love these trips, because they’re always such a meaningful experience. Each person I meet helps to give me a deeper understanding of the local culture and way of life. You could say that work is my true passion.
- Born in Malaysia and grew up largely in Adelaide, Australia.
- Studied Dentistry in Adelaide, followed by postgraduate training at New York University (NYU), including being selected for a fellowship with a worldrenowned cleft and craniofacial team.
- Has practiced in Sydney, New York City and Singapore, arriving here in 2001 and starting a specialist practice in 2002.
- First Dentist appointed as visiting consultant in Singapore General Hospital’s Department of Plastic Surgery, and National University Hospital of Singapore.
- Founder of charity Cleft Care Indonesia Foundation (cleftcareindonesia.org).
- Ongoing charity work for Hainan Smile in China and the NY-based Smile Train (smiletrain.org), which carries out cleft palate surgery and provides funding and training for local doctors in 87 countries.
- Accolades: Australian Distinguished Alumni Award nomination 2021, University of Adelaide; Global Australian GameChanger 2023; Global Australian Awards 2023, finalist. Read more on this here.
This article first appeared in the October 2023 edition of Expat Living. You can purchase the latest issue or subscribe, so you never miss a copy!
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