Let’s look at the waves of orthodontic quackery?

Last week, I gave a lecture at the European Orthodontic Conference in Dublin. One of the topics I addressed was orthodontic quackery. I think this section was well received, so I decided to turn it into a short blog post. It includes my comments on the waves of “special” treatments I have encountered over the past 40 years.

The quackery checklist.

I would like to start with my impressions of how a fringe treatment can be developed. 

The first step is to develop a new disease that we can to treat. This can relate to any orthodontic problem or new treatment. They then invent a new diagnostic method that is difficult for people to understand. For example, a new or obscure cephalometric analysis.

It is then a good idea to devise a new name for the treatment. I recently came across the term orthopneumodynamics! The next step is to form a new club of special people to deliver this treatment. I recall that “Damon Doctors” were a clique that provided this special treatment.

The next tactic is to criticise others. For example, refer to other orthodontists as “conventional” or ask them to open their minds to the new way. The final step is to dismiss research evidence and offer to engage others in debate, where they download a massive reference dump of poor-quality research.

Waves of quackery.

Orthodontic treatment for TMD and other “diseases”.

In the mid-1980s, the gurus promoted mounting study casts for every patient. This was part of their philosophy of treating patients towards what they felt was a perfect occlusion. They hope that this would prevent and cure all TMD disorders.

All my treatment is non-extraction.

The next wave occurred in the early 1990s. There was a movement to treat all our patients without extractions. We were then presented with multiple case reports and conference presentations showcasing heroic non-extraction treatments. Some of these patients looked excellent, with nice, wide smiles; others had rictus grins with overexpanded arches. This trend lasted for a few years and has recently been revitalised by the increasing use of all manner of expanders.

Self-ligation

This was the first tsunami from a supply company. These brackets became popular in 1996. The market leader was Ormco, which provided Damon brackets. They made several claims about these brackets. The most common “benefits” were reduced treatment time, arch development, and less pain than with conventional brackets. They ran a high-profile campaign, and many orthodontists became self-ligating providers. Unfortunately, the claims did not withstand scientific scrutiny, and several trials reported that they were no different from conventional appliances. They rapidly lost popularity.

Orthodontic vibration and magic lights.

I have grouped these together because they were promoted at the same time in 2009. The KOLs and companies claimed that these devices reduced treatment time, but there was no evidence to support this. It was, therefore, no surprise that people stopped using them a few years later.

Trauma

This is more recent. The theory behind this treatment was that trauma induced Regional Acceleratory Phenomenon. A team from NYU published a paper in the AJO. I wrote a blog post about this, which generated a lot of discussion. After several other studies and systematic reviews showed that this technique did not yield a meaningful reduction in overall treatment time, the treatment wave declined.

Airway

This is our latest wave.  There is currently a heated debate about the airway and orthodontics. Airway orthodontists seem to be increasing in number, and treatment is being promoted. History may be repeating itself.  We will know more in two years or so. 

I suspect that by then someone will have developed a new treatment. Which has been adopted by the non-critical or gullible members of our specialty. However, most orthodontists will ride this wave and continue to practise ethically. Perhaps I should not worry.

In the words of Jimi Hendrix, “And so castles made of sand fall in the sea eventually”.