You make the decision

Your neighbor’s daughter Susan returns to your office for your assessment. You have not seen her since she completed ninth grade, over 5 years ago, when you delivered a maxillary retainer that supports the pontics replacing her absent maxillary lateral incisors. Susan was to return to you thereafter to determine whether she was sufficiently mature to undergo implant therapy to replace her missing incisors. Her periodontist has now referred her back to you because her recent tomogram showed insufficient root divergence for implant placement.

During a discussion in which you disclose the need for retreatment via a short period of fixed appliance therapy, a tearful Susan relents to your recommendations with 2 conditions: that you use “Haste” ceramic brackets and a translucent composite archwire. She had seen advertisements proclaiming that the Haste appliance is the “most gentle, compassionate, yet rapid tooth-moving system—in full harmony with natural tissues.” The advertisements boasted of not only dental but also facial improvements. Susan wants no part of conventional archwires. She states that her friend has a “tooth-colored wire, and it looks great.” She tells you that a metallic wire is “social suicide.”

It is not unusual for patients to request specific products or materials for use in their therapies. To the delight of the supply companies and pharmaceutical manufacturers, patients often seek information about the products, materials, and drugs they are prescribed. The manufacturers of orthodontic products and materials have an understandable goal: to increase their sales and boost their profitability by educating the public about their products and services. The valuable fringe benefit to the orthodontic specialty is an increased awareness of the benefits of orthodontic therapy. The potential is a win-win situation.

Orthodontists are not alone in the present age of consumerism. Advertisements for prescription drugs to treat many maladies, including gastric reflux, impotence, and postmenopausal symptoms, flood our televisions, magazine pages, and laptops. The United States and New Zealand are the only 2 Western nations that permit “direct-to-consumer” advertising of prescription products and services. This practice involves dissemination of the product information via the lay media, but access to the product must be through a health care provider. The Food and Drug Administration has permitted such advertising since 1997. Some legislators and health care professionals have concerns about the wisdom of such a ruling for several reasons.

One concern about these advertisements is their accuracy. Comparisons between the advertised product and the conventional merchandise might be unsubstantiated by clinical evidence. The ethical principle of veracity (telling of truth) could thus be challenged. An example in the medical literature is the usefulness of full-body scanning for tumors in asymptomatic persons. In our arena, some newer bracket systems and esthetic aligner options might not provide the treatment advantages claimed by their manufacturers. In other instances, products can have questionable efficacy. For example, composite archwires or resorbable fixation plates might hold future promise for reliable clinical use, but insufficient evidence exists to permit replacement of classical materials with these products. Furthermore, investigational results can be contradictory or confusing to even seasoned practitioners. These issues can elevate the patient’s vulnerability during treatment.

The health professions have benefited from the continuing development of products and services by those in academic and commercial research. Although we will always value our patients’ input regarding the therapy they prefer, the ultimate decision of what defines appropriate treatment lies with us. This must remain a decision based on a sound history of the therapy’s efficacy rather than on the “bells and whistles” that can allure our patients and their families.

You should tell Susan that you will be happy to use esthetic materials for her treatment when possible, but your main concern is to deliver her therapy safely, efficiently, and predictably. The hope is that she will appreciate your candor.

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Apr 8, 2017 | Posted by in Orthodontics | Comments Off on You make the decision
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