X-rays were discovered in 1895, closely followed in 1898 by the discovery of the radioactive properties of radium. Almost immediately, a flood of medical products were introduced, marketed, and purported to cure just about any ailment that existed. For the consumer market, companies and products were branded with terms related to radiation, because it was believed not only that radiation produced positive effects, but also that such branding increased sales. Various forms of radiation sources were added to drinking water, elixirs, lipstick, suppositories, jock straps, and toothpaste, to name only a few. Curiously, even products that contained no source of radiation whatsoever—eg, soap, whiskey, golf balls, playing cards—were marketed with names that contained the words x-rays , radium , or radiation . This was done simply because the belief that radiation was good for you was so strong that such advertising, although false, was effective in driving sales. Even the comic book hero Superman, the champion of truth, justice, and the American Way, used his superpower of x-ray vision in a positive way to fight crime. This enthusiasm for radiation lasted for over 50 years but eventually dissipated because, over time, science sorted things out, and it became known and accepted that radiation could be useful in specific, carefully controlled applications, but was also dangerous in many other ways. The important things here are what science provided and what the public believed.

Now what does this have to do with pitching speed? As I walked through the exhibit hall at the recent session of the AAO, I studied the displays to see what words and concepts were being pitched, and I scanned the speakers’ titles in a similar way. Upon doing so, it became quite clear that in contemporary orthodontics many products and strategies are being touted as speeding up treatment. This claim is also a broad theme on the Internet, with nearly all the synonyms of “speed” being invoked to imply that treatment time can be shortened if certain brackets, wires, elastics, appliances, strategies, or adjunctive therapies are used. Given all this information, and in a whimsical moment, one could wonder the following: if a practitioner adopted all the devices and strategies that are fast, could the teeth be moved at the speed of light, and thus could the treatment end before it even begins?

Seriously, the quest to shorten treatment time is an important and serious endeavor that could greatly benefit patients and practitioners alike. If one could completely understand tooth movement and control the mechanics as efficiently as possible, prediction of treatment time would be a trivial exercise, at least theoretically. ¹

1 This is to say that if one could control for all the variations associated with tooth movement, prediction of outcome, and time, treatment could be perfect. Unfortunately, for the whole process of treatment to be perfect, one must also control for the variations added to the treatment process by the patient; this is a formidable problem.

Anyway, regarding the evaluation of new devices and strategies that are suggested to have bases in science, such an endeavor should be encouraged through the process of research and development. As was the case with radiation, science will eventually sort things out to determine whether new methods are fanciful phenomena or useful and efficient methods of treatment.

On the other hand, some approaches out there on the Internet claim that the speed of orthodontic treatment can be dramatically changed. Such descriptions of orthodontic treatment are usually categorized by time (ie, a number of months, number of weeks, or even “instant orthodontics”) or by limited procedures (closing a “gap” or treating only the “social 6”). The associated information that is made available to the public claims fast treatment, no need for extractions, and quality outcomes. Testimonials are not unusual. What is bad about this situation is that some approaches could be dangerous, ²

2 Actually, one procedure available to the public through the Internet would be considered malpractice if performed by a dentist.

the amount of treatment performed could be limited, and the quality of outcome could be compromised…all by design.

To make a point, there is a classic scene in the 1998 movie There’s Something About Mary , involving a hitchhiker (Harland Williams) and Ted (Ben Stiller), where the hitchhiker is pitching a new product and its competitive virtues. The hitchhiker believes that a product called “7-minute Abs” would sell a lot better than an existing product called “8-minute Abs.” He was so sure of this that his product would be guaranteed, and if someone complained, he would send that person “the extra minute.” Obviously a spoof, but life continues to imitate art, so that there are now programs offered on the internet for 6-, 5-, 4-, 3-, 2-, and 1-minute abs. At least no one has dreamed up “instant abs,” suggesting that no one actually believes you can get great abdominal muscles just by thinking about it; some work is necessary if something worthwhile is to be accomplished.

Obviously, in some instances, the desires for speed and quality can be conflicting goals. In one direction, quality could be lost if speed is the goal. In another direction, speed could be lost if quality is the goal. Are such tradeoffs always and in all ways necessary? Maybe not.

Sometimes, for a high quality result, a certain amount of time is absolutely necessary (as in pregnancy, for example); these sorts of limits need to be admitted, and orthodontists will need to continue to be patient. Beyond that, focus is important; practitioners who decide that quality is the overriding goal will develop accordingly. They will know what quality looks like, they will learn how to achieve it, and, as a by-product of developing expertise, they will get better at motivating patients and faster at achieving the desired end. In this sense, speed is a by-product of high aspiration and achieving clinical excellence. Quality is the required commitment.

If speed is the overriding goal, the practitioner might remain average in terms of knowledge and skills, might seek a compromise of quality, and might embrace the gadget, gimmick, or trick that promises the most. Unfortunately, these practitioners will probably be disappointed in the end. They will probably also come to know that the speed of treatment will not seem such an accomplishment if the patient needs to be retreated.

Of course, one must not forget the public in this high-minded discussion. People need to be educated on the matters at hand, fully informed by practitioners as to the practitioner’s abilities, the options of treatment, and the consequences of their decisions, and then allowed to make an informed choice that represents their own blend of speed, cost, and quality.

Rolf G. Behrents

“Give them quality. That’s the best kind of advertising.”