Facebook based orthodontics
Facebook based orthodontics
A couple of posts ago Mark Wertheimer did a great post on professionalism. In this post he mentioned some of the effects of social media. This has led me to think about a new form of evidence “Facebook based orthodontics”.
As regular readers of this blog know, I publicise my posts using several Facebook groups. I also reply to comments that people make about the posts. Some of these discussions are quite heated. These are on the role of evidence vs personal experience or beliefs that are not founded on science. Unfortunately, these spiral on a slow descent to insults and eventually people accuse me of being prehistoric or a conspirator who wants to maintain the status quo.
Occasionally, I wonder whether I should be having these discussions. I feel that I should do this to challenge the false statements, snake oil and the unfounded hopes and dreams of these practitioners. I think that this is necessary to protect our patients and also address the claims that may subtly start to influence practice via social media. This may be called “Facebook based orthodontics”.
Examples of “Facebook based orthodontics”
I would like to explore this concept by looking at a post in the excellent orthodontic pearls Facebook group. This is a forum in which orthodontists post up clinical hints etc. In a recent posting, an orthodontist put up a panoramic radiograph. He pointed out that it had been taken and read by a general practitioner who told the patient that there was not much to worry about. This is the radiograph.
No other clinical information was provided. The poster made the point that he did not want to receive treatment plans.
When I looked at the radiograph, I tended to agree with the primary care dentist. I was a little concerned with the potentially enlarged follicle of the upper right canine and perhaps submerging lower primary molars. Nevertheless, if this was my patient I would try and palpate the permanent canines. If I could not feel them buccally, I would remove the primary canines and observe. Some may feel that this approach is cautious, but I think that this would be a sensible initial plan. However, the Facebook orthodontists had other ideas. I did an analysis of the responses that they made.
What did they suggest?
They suggested the following treatment plans;
- CBCT now x 4
- Extract primary canines x11
- Extract primary canines and lower deciduous molars and fit lingual arch/lip bumper/nance etc x4
- Rapid Maxillary expansion x4
- “This looks like maxillary hypoplasia, address with expansion, then the magic will flow”!
- Headgear x 2
- Keep under close review x 3
All these options were suggested from one panoramic radiograph!
There are also other examples on other groups. For example, people comment on clear extraction cases with phrases such as
- “non exo all the way”
- “all day PSL treatment to develop the arches”
- “non ext, I like to shoot from the rough”…whatever that means..
Why does this bother me?
While I tend to see the funny side of these strange phrases and diagnosis using one radiograph. There is an important issue here. This is the effect of this approach on the readers of these posts.
If I return to the Facebook diagnosis and plans from the panoramic film. I was certain about my initial plan, but as the number of alternative plans grew, I began to doubt myself. I wondered if I was missing something or my plan was wrong. So I looked at the radiograph again and I decided to stick with my plan. However, I am an experienced orthodontist and I have treated many similar cases. But what is the possible outcome for an inexperienced specialist or a GDP looking at all these alternatives? Would I ignore the Facebook orthodontic warriors, or would I note their suggestions and start to change my practice? This change may contradict scientific evidence, particularly if I do not read research papers and only listen to the Gurus at conferences?
I also wonder if this causes some of the changes that we are seeing in practice with younger orthodontists being very engaged with social media. Perhaps, this is why the younger orthodontists proposed less extractions than the older group in the paper that I discussed last week. This may be conjecture, but it could potentially true.
What can we do?
As usual, we can educate. We should use more social media to widely disseminate research findings. I cannot help thinking that the monthly journal, hidden behind paywalls, will soon have its day and research findings will be circulated via social media at no cost to the reader. The orthodontic programmes could also warn their students that Facebook, Wikipedia or other social media are not good sources of clinical evidence.
Secondly, the Facebook Orthodontic Warriors should be more responsible and moderate their responses. They may think that they are orthodontic superstars, but they need to realise the effects of their statements.
I would also like to add a new lowest level of evidence to the pyramid of scientific evidence. This could be called “Facebook based orthodontics”.
Emeritus Professor of Orthodontics, University of Manchester, UK.