Orthodontics can be a hidden art and it’s often perceived by non-orthodontists as a secret language. Most undergraduates know a something about it, but not much, similar to knowing a few key phrases. “good morning”, “where is the bus stop?” and “two beers please”. That’s where it ends. After graduation it used to be kept (mostly) to the confines of those who had been through, what the New Scientist once called, “the years of crawling subservience under the gaze of the white coated moguls that control our great teaching hospitals”. Then, when deemed to be fluent in the language, the specialists with their M.Orths, headed off to their own planet in the Orthodontic universe to fiercely guard their patch and occasionally share a few simple phrases of ortho speak with their referring dentists.
Times have changed and with the relentless march of a thousand aligner systems everyone has a phrase book – or at least they think they do. Or could it be that they have the dodgy Hungarian Phrase Books?
I am not looking to fan the flames of the GDP v Specialist debate, there’s way too much of that about, rather to present Professor O’Brien’s last two blog posts for your consideration because I think they are both worth a read. I find him to be readable, thought provoking and that sometimes rare thing someone constantly questions what he does and WHY he does it.
A thinking about Orthodontics blogpost. In its entirety.
This is a short blog post to read just before the weekend, or just after if you are in Australia! I have just attended a major symposium in the UK and I was asked to give a major lecture. The preparation of this took some thought. During the meeting I listened to some great presentations and this got me thinking about orthodontics. I have been working as an academic orthodontist and research since 1986, spent a large amount of time researching clinical matters, I have trained too many people for me to remember and spoken at many major orthodontic conferences. But what do I know about orthodontics? Here is a list of my academic knowledge and opinion.
This is a precursor to a more thoughtful blog post that I am going to post next week, so here we go. You may not agree with me..
- Malocclusion is caused by a combination of genetic and environmental factors
- There are many ways to treat particular malocclusions.
- Evidence based orthodontics is a combination of clinical experience, patient opinion and scientific research. The proportions of influence of these factors varies according to our level of scientific evidence.
- Arch form and dimensions should generally be accepted
- Functional appliances and other bits of plastic, pistons and springs do not change or influence facial growth. They tip teeth.
- To my knowledge there is no high quality scientific proof that orthodontics, extractions, appliances, expansion, myofunctional orthodontics influence breathing, posture, academic attainment, sleep disordered breathing etc
- Class I molar non extraction treatment is very easy
- I wish that I knew how to intercept malocclusion…
- Extraction of permanent teeth is required for the treatment of some malocclusion..but treatment mechanics are as important as the extraction decision
- You can only “drive” upper molars 2 mm distally
- Temporary Anchorage devices are better than other anchorage reinforcement method by about 2mm
- Wire and bracket properties do not influence the efficiency of alignment
- None of the new developments that are supposed to speed up orthodontic treatment seem to work; according to new trials..
- There is no such thing as non-compliance treatment
- I simply do not understand clear aligner systems
- Self Ligating brackets do not have any advantages over conventional brackets. The self ligating practitioner should explain this to their patients.
- The alternative orthodontist should explain to their patients that there treatment is not mainstream.
- The General Dental Practitioner who has been on a short course to learn speedy orthodontics should explain to their patients the limitations of their training and knowledge
- There has been and there continues to be great high quality research being done in orthodontics and don’t tell me that our evidence base is weak!
- Nearly all orthodontic treatment relapses to a degree and this is probably caused by ageing and we cannot stop time…………….
That’s about it, does anyone want to add to the list?
Now here’s the second one:
Should we practice evidence-based orthodontics?
This is a basic point and a good place to start. It has been pointed out to me several times that orthodontics is different to other part of dentistry because it is more of an art than a science. Furthermore, it is difficult for us to do harm because the harms that we may cause are usually minor, for example, decalcification and root resorption. It is, therefore, not necessary for us to practice evidence based care.
I must disagree with this sentiment. This is because we need to practice ethically by ensuring that our treatment is based on evidence, when it is available. We also need to inform our patients of all the potential risks and benefits of treatment. To this end we should be particularly careful of making statements that are not based on good research evidence. I can think of the following examples, the proposed benefits of non-extraction treatment, methods of speeding up treatment and orthodontics that is provided to reduce sleep disordered breathing in children.