The October editorial points out that patients often receive insufficient information about their orthodontic treatment. The editor has touched on an important theme, which may be just the tip of the iceberg inherent to orthodontic professional standards of practice. We maintain here that defective information can result in unwarranted diagnostics, unnecessary treatments, and even health risks. The orthodontic standards of practice, although containing the main source of the problem, could, if slightly adapted, offer the solutions. To deliver proper information on treatment needs, sound scientific evidence and carefully estimated patient preferences are needed. In orthodontics, this task is extremely difficult, particularly because the concept of “normality” of dental occlusion is ambiguous.
The current orthodontic standards of practice are dominated by loosely defined concepts of disease that permit any deviation from the ideal dental occlusion to be considered “abnormal” and therefore seen as an acute or a potential health threat. However, more than 95% of the population do experience some deviation from an ideal occlusion; this could imply a potential need for treatment in 95% of the population. If taken literally, such concepts could produce devastating results. Indeed, current scientific studies do not show any substantial health risks from the majority of the variations of dental occlusion; for such cases, the studies even indicate that the medical or psychosocial benefit from orthodontic treatment is uncertain. Discrepancies between standards of practice and current sound scientific evidence may be a result of the so-called consensus syndrome: a form of political process where the majority vote of a panel of selected authorities determines the standard of care. The standard of practice might also reflect some interests that are in conflict with the medical interests or the private interests of the patients.
The standards of practice would probably need to be amended. First, apart from being guided by sound scientific evidence and bioethical principles, it is necessary to develop some specific indexes of treatment needs that would include, in addition to the dentofacial morphology, a number of specific complex social and patient-related factors. Second, more active involvement by the broader public and potential patients may be ensured through regular surveys about the public’s and the patients’ perceptions of dentofacial health and appearance. Third, some general aspects of current standards of practice should be deimplemented: eg, the routine use of cephalograms. Limiting the number of orthodontists should even be considered; this would permit reducing the apparent and auto-induced needs for orthodontic treatment. As with the law of supply and demand in economics, by reducing the number of orthodontists, there will be more “supply” of patients per orthodontist and their demand for patients will diminish, while their tendency (“auto-induction”) to broaden orthodontic treatment indications will be reduced. The orthodontic specialty might evolve as a pioneer in combating the modern medicine self-inducing overtreatment. The public will not fail to recognize this!