I’ve been thinking about the orthodontic fringe or quackery
I’ve been thinking about the orthodontic fringe or quackery.
This blog is about the concept of the orthodontic fringe and is a discussion on treatments that some do not consider to be mainstream orthodontics. When I first thought about this subject, I felt that it would be straightforward, however, defining the fringe is easier said than done. This is because there are rather blurred lines between accepted practice and what some would call the “fringe or quackery”. My first step, therefore, is to attempt to define these terms.
What is accepted orthodontic practice?
Perhaps the most logical definition is that this includes the treatments and concepts that most orthodontists practice or teach. These can easily be defined as
“treatment based on credible scientific evidence published in peer reviewed journals”.
In the absence of evidence this can include the views of physicians practicing in the relevant area and recommendations of “learned societies”.
What is “fringe or quackery”?
Definition of these treatments is more difficult because of the great diversity of orthodontic practice. I have looked for definitions and according to Wikipedia, we can consider that the quack
- 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…
- The orthodontic fringe
At this point I stopped and thought and it became clear to me that the fringe does not include the following “controversial” areas of our specialty.
- The extraction/non-extraction debate
- Functional appliance philosophies with world wide variation.
- Different bracket designs
It may then be easy for some to then conclude that the fringe may include
- Self ligating brackets claims in the face of scientific evidence
- Newly designed braces that provide fast treatment
- Extreme claims on facial growth modification and early treatment based upon variants of functional appliance and muscle training.
However, I would like to be open minded add a further definition of quackery and this is that
“the promoter of such a technique must know that they are mis-representing the risks and benefits of the services that they provide’.
If we consider this we then need to critically evaluate the evidence for both conventional and fringe treatments. While we have evidence underpinning some aspects of “acceptable’ orthodontic treatment, it is also well established that in many areas the level of this evidence is weak. When we look at the evidence for what we may feel is “fringe or quackery” based treatment, this is also weak. Indeed, in some areas the level of evidence is similar!
This confusing situation is compounded further when we remember that there are also highly respected practitioners who follow philosophies and make claims that are contrary to the evidence. A good example of this is self-ligation which continues to be promoted by key opinion leaders, in the face of research evidence that contradicts the claims. Yet, these “opinion leaders” are not criticized to the same degree as some of those who are considered to be on the fringe.
Is the problem solved?
In summary, the lack of evidence and the rather blurred lines makes it difficult for us to differentiate between accepted and fringe treatments. As a result, I propose that we can only classify as fringe those people who know that they are making claims contrary to the evidence that we have.
Importantly, when that evidence is absent, it is incumbent on the providers of both the fringe and conventional treatments to carry out the studies to obtain the evidence.
Until then each ‘side” cannot be critical of each other. It is time to work together….
Emeritus Professor of Orthodontics, University of Manchester, UK.