We greatly appreciate that orthodontic research on patient decision aids has finally appeared in the world’s leading orthodontic journal, the AJO-DO . Decision aids have already been adopted and used for years in other fields of medicine. However, this randomized controlled trial of a patient decision aid for orthodontics contains, in our opinion, 2 serious flaws.

First and most importantly, the authors neither cited nor discussed a previous study on a patient decision aid for fixed orthodontic appliances that had a diametrically opposite result to their study. Whereas the former found a significant decrease in decisional conflict in patients receiving decision aids, Parker et al found no significant reduction in decisional conflict between the group using the decision aid and the control group. The quality of the study of Parker et al would without doubt have benefited from a discussion of the results of Marshman et al and would probably explain the contradictory results and push forward the development of decision aids in orthodontics.

Second, Parker et al neither presented nor gave details about the content of the decision aid itself. For instance, they did not explicitly state which risks from fixed orthodontic appliances were listed in the decision aid and how they were presented, as absolute or relative risks. The quality of the information and the format of its presentation may have crucial impacts on patients’ understanding of decision aids.

Both studies would profit from a more detailed and critical generation and presentation of their information and the way this information is presented to the patients (images vs text) because those 2 factors strongly influence understanding and consequently a patient’s decisional capacity.