Is the orthodontic fringe quackery?
My recent post on the airway and orthodontics at the 2023 AAO Congress resulted in a lively discussion. This has led me to revisit a post that I wrote in 2015 on orthodontic quackery. There have been many developments since then. Here is my update.
Accepted orthodontic practice
An excellent place to start this discussion is to consider the definition of evidence-based medicine. This is the classic definition.
” EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”
However, this is rather basic and does not always align with the contemporary concept of evidence-based care. As a result, I would like to add that we may include the views of practising physicians and the recommendations of learned societies, but only when high-level research evidence is absent.
Furthermore, it is essential that when this evidence is not available, we must not make claims for treatment that we cannot substantiate.
Importantly, these definitions enable clinicians to develop new ideas and treatments that can be tested using appropriate research methods. In orthodontics, this is usually RCTs but does not exclude other approaches where randomisation is impossible.
We now need to consider what a clinician should do if they develop a new treatment method or philosophy. Importantly, there is nothing wrong with them sharing preliminary findings. Nevertheless, they should not make claims for the treatment without more robust scientific evidence. It, therefore, follows that they should carry out further research. This is an ethical way to practice.
It is patently wrong to make claims in the absence of evidence.
The fringe and quackery.
Undoubtedly, orthodontists have developed treatment methods using empirical knowledge and research methods over an extended period. However, we are now in an era in which we should study the effects of most treatments using high-level research. But if this is not done and the promoters of the treatment make extreme claims, can we consider this to be quackery?
We can define a quack as someone who
- Promises benefits from treatment that cannot be reasonably expected to occur.
- Recommends against conventional therapies that are helpful.
- Promotes potentially harmful therapies
- Promotes magical thinking.
- Empties patients’ bank accounts.
It is also essential to consider that the quackery practitioner promotes techniques knowing that they are misrepresenting the risks and benefits of their treatment.
So what is orthodontic quackery?
At this point, defining orthodontic quackery is complex. This is because many treatments have developed over time as standard clinical practice. This includes using pre-adjusted fixed appliances, the extraction/non-extraction debate and the definitions of the need for orthodontic treatment. Examples of innovations honed by research are TADS, the effects and indications for functional appliances and the early treatment of Class II and III malocclusions.
I would now like to consider what we can classify as orthodontic quackery. This ever-lengthening list must include
- orthodontic treatment for TMD,
- our old friend self-ligating brackets that develop bone and avoid extractions.,
- any method of increasing the rate of tooth movement, particularly vibration, magic lights and MOPs,
- extreme claims about the effects of functional appliances and myofunctional orthodontic treatment in growing mandibles.
- The use of the Carriere appliance to change the skeletal pattern and modify airways.
- The orthodontists who claim to treat a high percentage of cases non-extraction.
- Orthodontic treatment to cure breathing disorders.
Now I have revisited orthodontic quackery; my original conclusion is still valid.
“The lack of evidence for some treatments and the blurred lines between others make it difficult to differentiate between accepted and fringe/quackery treatments. As a result, we can only classify quacks as those who know they are making claims contrary to our evidence”.
This means that those who ignore published high-level research findings or recommendations made by our specialist societies on treatments are simply orthodontic quacks.
Emeritus Professor of Orthodontics, University of Manchester, UK.