Reprise:Very rapid orthodontic treatment

Year by year more propaganda is circulating among the laymen that it is quite possible and practicable to treat cases of malocclusion successfully and with dispatch within only a few weeks or several months. It is said that a retainer may then be supplied for a few weeks or a month, and then dispensed with; and it is explained that inasmuch as the teeth have been moved physiologically, it is unnecessary to use further mechanical retention. The impression is made upon the lay mind that the orthodontist who makes no claims to supply this extraordinarily high speed treatment in 2016 either is hopelessly antiquated in his methods and technic or deliberately draws out the treatment indefinitely for purposes best known to himself. Of course the orthodontist who does not make any claims for unusually rapid treatment is not in accord with either of these impressions which manifestly reflect upon his ability. However, until now he has paid very little attention to such claims, because he has, unfortunately, observed relapses of orthodontic cases treated by every known method, including in many instances the type of so-called physiological tooth movement, and he knows that there has been no secret formula discovered that is not well known to the average orthodontist of experience.

Probably the activating inspiration for so much effort having been made in the interest of so-called rapid treatment is the enormous amount of dillydallying with orthodontic cases which has been done in the past, for in many instances treatment of cases has extended over a long period of time, sometimes years. This has, no doubt, done the specialty a great deal of harm; for cases must be treated intelligently, consistently and thoroughly; the teeth must be placed in normal function with a reasonable degree of promptness if the natural forces of growth and development are to operate advantageously for the patient.

Stories concerning an unusual idea gain momentum in direct proportion to the number of times they are repeated, and they attract the attention of the American Journal of Orthodontics and Dentofacial Orthopedics , in as much as this JOURNAL, serves its subscribers and readers who are eager for orthodontic information and who are located in every civilized country. The JOURNAL publishes manuscripts of authors from many of these countries, and up to this time no material or manuscript has ever come under the scrutiny of its editorial staff which makes any such claims of efficacy and dispatch of treatment and rapidity of action as are being broadcast among the laymen at present. The seed apparently is being sown from sources which, if entirely sincere, are at least overzealous and perhaps oversold as to their own exceptional ability. The main trouble seems to be that enthusiasm over rapid treatment, especially among inexperienced men, is responsible for grossly exaggerated reports which, after being told a few times, become first increasingly exaggerated, then ridiculous. It is no new psychologic fact that an individual may develop such a burst of enthusiasm over an idea that he can, step by step, sell himself a scientific hypothesis which is only partially true, then by pondering over the hypothesis long enough and telling his story frequently enough actually believe it himself.

It is difficult for patients to reconcile themselves to a situation in which one practitioner in whom they have confidence explains that the probable duration of time which may be involved in successful correction of their case may be one or two years, and at the same time another operator in another locality will indicate that the duration of treatment under his very excellent care will be only two or three months’ time. There is plainly something wrong in these conflicting opinions.

For the most part, stories of speedy treatment (that of the spectacular kind) and of the ensuing results are not new. In fact the majority of orthodontists have heard informal tales for a number of years, and they listen to stories of voodoo treatment complacently, with an attitude, more or less of “important if true.”

A story is told about a golfer who was generally known to be in the mediocre class of players and who came in one day with a score of 72 strokes for 18 holes. With great enthusiasm, gusto and pride he told his colleagues in the locker room of the wonderful achievement. His friends, being somewhat astonished, set about checking this low score, and upon calling in his caddy of the day received the information that the golfer had inadvertently lost his pencil after playing 9 holes, and for this reason had been unable to count the strokes of the last 9 holes. Judging from current comment, orthodontists believe that in the hearsay regarding two- and three-month correction cases, someone has lost his pencil in figuring the actual time involved and has, possibly inadvertently, “failed to count all of the strokes.”

It should be remembered that all cases do not fall within the same category but offer a wide variability in the individual problems which are involved. For instance, the length of time required for treatment in any group of cases will vary, sometimes in a marked degree, and this has been found to be true even among children in the same family. Time is dependent also upon several factors entirely unrelated to appliances: the age of the child, the sequence of eruption of the teeth which must be in place before active treatment measures can be entirely discontinued, the growth and development of deficient muscles and osseous structures. There is also the very important factor of intermittent osseous growth in childhood, as brought out in Howard’s work at the Good Samaritan Clinic in Atlanta. He clearly establishes the fact that a child may be much more satisfactorily treated one year than the previous or the subsequent year, or vice versa, depending largely upon the growth spurts characteristic of childhood.

A case of malocclusion is usually believed to be corrected successfully after highly active treatment has been accomplished, the occlusion allowed to adjust and fix itself definitely to place in the process of mastication, and a period of retention observed, checked and double-checked until such time as there is no relapse. The duration of treatment for complete correction is usually estimated from the time the case is started until such time as a final check for relapse has been concluded. The actual time estimate of duration of treatment in cases is highly flexible, depending largely upon the type of yardstick chosen by the individual operator.

In checking over the published records elsewhere of the case reports of what are ostensibly supposed to be rapid treatment cases, it is found that if the time consumed in the first period of treatment is added to that of the second period of treatment, etc., the time consumed is no less than that consumed by thousands of other treated cases in which no particular claims for rapid treatment are made.

However, more wonderful things have happened authentically in the annals of scientific advancement than the proposed correction of average cases of malocclusion within two or three months’ time. It is our contention that the proof of the ultimate efficacy of this type of treatment should really be easy to establish if it is important. If there are operators who sincerely lay claim to the distinction of great success in this treatment (and by their own statements, there are), the proper, logical and most appreciative audience available is the orthodontic societies of the world. If one man or group of orthodontists is able consistently and successfully to correct malocclusion in two or three months, and to retain it without ifs and ands and buts, these operators should not boast and brag and ridicule but should prove the treatment to the world in no uncertain terms, in the interest of the science. This is customary in science, particularly in relation to human ills. To paraphrase a well known proverb, the orthodontic world as well as the public will soon make a beaten path to the door of those who can accomplish these results; furthermore, such men will undoubtedly go down in orthodontic history as having made the greatest single contribution to the work in its entire history up to now.

Until such time as proof is formally made without qualifying reservations or restrictions, this “gilding of the lily” to the laymen will be discounted by the majority of the orthodontists of the world as purely professional promotion and sales propaganda. Orthodontists at present are receiving the spectacular rapid treatment idea with a knowing wink and with the mental reservation that probably, on account of unbridled enthusiasm often coupled with unseasoned experience, the ardent advocates of this spectacular method have allowed their enthusiasm to carry them into the chaos of the clouds of reason. Such extremes can be made just as great a disadvantage to the advancement of orthodontics as can the so-called errors and mistakes of dillydallying with cases for an indefinite period of time, such as has obviously been done by some workers in the past.

Better cooperation among the members of the profession should result in greater harmony of thought, so that it would be impossible in the future for the ridiculous “believe it or not” conflicts of opinion to exist in orthodontics.

No doubt some good has been accomplished as a result of the rapid treatment propaganda because it focused attention upon the dillydallying methods of some practitioners of the past and will spur orthodontists to action in finishing up their cases with normal dispatch. However, grave harm is emerging from the idea of rapid treatment because, as in all new ideas and plans, somebody gets excited and carries the matter to a ridiculous state, and a resultant compensation movement follows, which colloquially means “back to earth.”

There is no unusual, extraordinary, or secret method for correction of a malocclusion other than the hard work and close application to detail, with a thorough understanding and knowledge of the fundamentals of the subject. Without these, relapse is the ghost that walks in the night, notwithstanding the variation in types of appliances or the time utilized.

Editor’s note: Dr H. C. Pollock (1884-1970) was one of the founders of the AJO-DO in 1915. He assisted the first Editor, Martin Dewey, as an Assistant and Associate Editor until 1931 when he was appointed Editor-in-Chief. He continued in that position until 1968 when he stepped down—after well over 5 decades of service to the Journal and the specialty.

This editorial was originally published in 1932 ( American Journal of Orthodontics and Oral Surgery 1932;18(11):1243-6). The current editor has made 4 changes as indicated by the underlined words:

  • 1.

    The word “Reprise” was added to the title. This word refers to something that is repeated.

  • 2.

    The year of “1932” was changed to “2016”—a mere 84 years between the original message and now.

  • 3.

    The name of the Journal containing the original editorial ( The International Journal of Orthodontia, Oral Surgery, and Radiography ) was altered to match the current name ( American Journal of Orthodontics and Dentofacial Orthopedics ).

  • 4.

    The term “orthodontia” was replaced by “orthodontics.”

I thought you might enjoy how messages of the past might have meaning in the present. It is up to the reader to determine whether this historical passage falls within the context of the present.

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Apr 4, 2017 | Posted by in Orthodontics | Comments Off on Reprise:Very rapid orthodontic treatment
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