I have decided to become an orthodontic quack and snake oil salesman!

I have decided to become an orthodontic quack and snake oil salesman!

I have always been interested in orthodontic developments that may not be considered to be mainstream. These are often promoted by practitioners who consider themselves to be “mavericks” or “great thinkers”. I have debated their techniques many times with them with limited success. So I have decided to join them and develop my own treatment and surround it by the “smoke and mirrors” used by the orthodontic quacks and snake oil salesmen. Continue reading

Is it better to use a fixed or removable appliance to correct a crossbite?: The final answer!

What is the best method of crossbite correction: The answer!

A few months ago I posted on the results of a trial of methods to correct anterior crossbites. Since then I have found several other papers from this trial and I have rewritten my original post to combine the findings into a single definitive post on the effectiveness of anterior crossbite correction.This new post is based on these four papers by Anna-Paulina Wiedel and Lars Bondemark. Continue reading

AcceleDent again. Cyclic vibration accelerates tooth movement; A clinical trial!

AcceleDent again. Cyclic vibration accelerates tooth movement; A clinical trial!

Earlier this year I posted about AcceleDent. This was a popular posting and was read 4,000 times. Since then several people suggested to me that I had not been critical enough of this new technology. I took this approach because they had developed a cautious approach to marketing and had not published the results of their trial.  However, the results of this trial have now been published and I would like to provide academic viewpoint on this piece of research.

Continue reading

Early Class II treatment. Part 2: Are we clinician scientists or barber surgeons?

Early Class II treatment. Part 2; Are we clinician scientists or barber surgeons?

This is the second part of my post from last week. This is concerned with  our presentation at the early treatment point/counterpoint discussion at the AAO conference 2015.

Jonathan Sandler started our session by discussing further data from the systematic review. He also pointed out that while the data suggested that  routine early treatment is not effective; it does not mean that early treatment is not indicated for any patient. There always will be patients whose problem is so severe and/or they are being teased so badly that treatment is clearly indicated. In these instances, clinical experience needs to combine with evidence and patient opinion. This led to my final sections which I shall outline below.   He also raised the question that if we ignore the evidence then we need to consider if we are clinician scientists or simply barber surgeons?

Evidence-based dentistry

The evidence-based care movement in dentistry has become firmly established. Nevertheless, there is a common misinterpretation that treatment decisions should be based solely on scientific evidence. This is not the case and  I have discussed this previously in this post.

graphic.001

Figure 1: the components of Evidence Based Care

We need to remember that evidence based care  has three main components and I have illustrated these in Figure 1. The best way to interpret this interaction is to consider that the initial stage of developing a treatment decision is based around a combination of evidence and clinical experience.  This is then followed by the essential step of outlining the possible treatments to our patients, along with any available evidence. As a result, they are in a position to take an informed decision on their care. In a situation where there is substantial evidence, it is likely that the evidence will outweigh clinical experience, because uncertainty is reduced. However, when there is limited evidence  clinical experience then carries more weight.

It is then clear to me that the most important component of this relationship is the information that we provide to our patients. If the evidence is high and uncertainty is low, we can provide evidence-based recommendations.  We certainly cannot ignore the evidence and we should not be saying to them “there is substantial evidence that we should treat you in a certain way, but I’m going to ignore it completely because of my clinical experience”.

I would also like to point out that when evidence is lacking, there is  nothing wrong with explaining to our patients that there is limited evidence, but our experience suggests that they should be treated in a certain way. Our patients will then have all the evidence required to make an informed decision as part of consent to treatment.

In the case of early class II treatment, the evidence is clear and we cannot ignore it if we are to ethically consent our patients to treatment.

Disappointment

4ea11990f48c1ccec23c0d45dde9e091In my final comments, in our counterpoint, I expressed disappointment that we were having this debate.  In this respect it is worth mentioning the comments of Dr David Sackett one of the founders of evidence-based medicine. In 1985 he spoke at the Moyers symposium and stated

 

“Orthodontics is behind such treatment modalities as acupuncture, hypnosis, homoeopathy and on a par with Scientology”.

He then attended the Moyers symposium again in 1994 when the early results of the class II studies were being presented He responded by saying.

“All orthodontists should look with pride on these trials, for they mark the entry of your profession into the ranks of the scientific health disciplines”.

At this point the United States was leading in clinical trials. But since then I wonder if there has been a lack of momentum and researchers from other countries are beginning to lead the way?

Finally, at the end of our presentation, my overall feeling was disappointment that in the face of so much evidence we were still debating early class II treatment. Indeed, Drs Dugoni and Oh suggested that this was a controversial area! I propose that it is not; we have the evidence on this clinical question. It is time to move on… or indeed, are we clinician scientists or barber surgeons?