Modern orthodontics at the crossroads

Lewis Carroll’s classic novel Alice in Wonderland has one of the most enduring heroines in English literature. Alice begins her adventures by falling down the Rabbit hole only to encounter uncertainty, absurdity, and unpredictable conversations and experiences.

Orthodontics at this time is also experiencing a “free fall” well into the “Rabbit Hole”. Much of Alice’s experiences mirror some of the orthodontic information being disseminated to the public, orthodontic specialty, dental profession at large, as well as to the medical profession. Such information, or rather misinformation is undermining orthodontics, dentistry’s first specialty, and far worse contributing to dubious treatment protocols for individual patients with at times, needless additional expense to the orthodontic patient or parents of younger patients.

The ability of individual orthodontists, orthodontic manufacturers, and cohorts of like- minded orthodontists and other dentists banded together in “homemade” specialties to make bold assertions (with little to no quality evidence to support such assertions) has been considerably enabled and enhanced. Such unsupported orthodontic assertions have been simply left unchecked, unchallenged, and unregulated. The orthodontic specialty, dental profession at large, regulatory state boards of dentistry as well as many global legal courts have either turned a “blind eye” and/or been rendered powerless to manage such irresponsible and unbridled dissemination of untruthful information. The smooth course of commerce regrettably trumps quality scientifically evidence based information all with the intention of “telling the public what they want to hear rather than what they need to hear.” Furthermore, it is the ultimate “snake oil” public and professional solicitation for additional patients in an orthodontic practice. The idea is to present such unsupported assertions and implying the superiority of the individual clinician espousing such foolishness while at the same time subtly (and at times more heavy handed) that other “Neanderthal” traditional orthodontists are simply not offering the “latest and best” techniques and overall orthodontic treatment to the public.

The dialogues found on the Internet including attractive orthodontist websites and even those more than occasionally found in professional dental and orthodontic publications have literally rivaled those found at “the Mad Hatter’s Tea Party.” Consider, for a moment (and hopefully not much longer) an article published in an ostensibly peer reviewed dental journal entitled Epigenetic Orthodontics – Facial and Airway Development . The author presents the Homeoblock appliance ( Fig. 1 ) which he asserts enables the “expression of unexpressed genes in adult patients” which is capable of altering craniofacial form and function. Clearly, this appliance is no more than a removable acrylic device with numerous springs capable of no more than tipping teeth. This is arguably an extreme example of ludicrous and impossible claims that are allowed to be disseminated to the dental profession and to the public with little to no consequences to those making such outrageous assertions.

Figure 1
The homeoblock appliance.

It appears that if something is said and/or written that it must be true. The time honored rules of scientific “engagement” demand that strong assertions require strong evidence. The public is not the only victim of such misinformation, but regrettably, so is the orthodontic specialty and dental profession at large. As such an example, the iconoclasts in the inexplicable continued extraction/nonextraction debate prefer to carry on this issue in an emotional rather than scientific environment. Every decade some statement is made condemning extraction strategies in orthodontics (in instances when they are clearly indicated) thereby giving license for orthodontists and sadly even some academic institutions as well to favor nonextraction strategies (in instances when they clearly should not) in an effort to appear to be “au courant” and politically correct. It has been the author’s opinion that extraction or nonextraction orthodontic treatment should not be a goal. They should be strategies used by the clinician to achieve esthetics, function, and stability.

The most recent meme condemns extraction strategies as causing a decrease in airway function ostensibly due to the retraction of incisors causing the tongue to retract and compromise the airway. The now classic study of over 5000 subjects who received orthodontic treatment (one half of this sample received extractions and the other half did not) clearly refutes such a nonsensical statement as there was an insignificant statistical difference between the 2 subject samples with respect to Obstructive Sleep Apnea post-treatment.

Orthodontics is replete with historical derivative “cookbook” teachings. Fig. 2 depicts 2 holiday makers (at a time long before tobacco awareness) who both received orthodontic treatment as youngsters. He was treated by the “I always extract philosophy” and she was treated with the “I never extract philosophy.” It is obvious that the facial esthetics of both individuals would have fared better if they were treated by the other’s orthodontist. The “ruining of faces” via orthodontic treatment is due to selecting a perfectly legitimate treatment strategy for the wrong patient.

Jan 9, 2020 | Posted by in Orthodontics | Comments Off on Modern orthodontics at the crossroads
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