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.
Once a new form of treatment is developed, it tends to gain popularity, and we are swept up in a wave of enthusiasm. However, all waves subside, and after a few years of generating income, the treatment’s popularity declines.
I qualified as a specialist orthodontist in 1986, and these are the waves of orthodontic quackery I can still remember.
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”.
Emeritus Professor of Orthodontics, University of Manchester, UK.
Excellent history lesson! Functional appliances should make the list too.
I think emac is being a bit severe about functional appliances.
All Eastman orthodontic graduates of the 70’s and 80’s will remember Professor Mill’s Functional Appliance criteria: Class two dental bases (but not too much), normal or reduced vertical relationships (and definitely not ‘high angle’) long dental bases, no crowding, slight spacing, E’s present, 5’s unerupted, 7’s unerupted and an actively growing patient. In these circumstances, functional appliances are a good way of achieving class two inter-arch traction and reducing the overjet thereby.
The ‘problem’ of function appliances which maybe emac has in mind, is the over inflated claims made for them – for example, the idea that ‘alteration of the functional matrix’ (if there was such a thing) could make the direction and amount of mandibular growth something an orthodontist could change. As I heard said, when I was an orthodontic postgrad, ‘just can’t be done doctor’.
Richard:
Our medical colleagues appear to agree that the old functional matrix hypothesis was not complete. Please see this article for further details;
Singh GD. Craniofacial endotype of obstructive sleep apnea: Spatial matrix hypothesis. Sleep Breath. 2026;30(2):106. doi: 10.1007/s11325-026-03656-5.
Functional appliances addressed many more dental compensations for skeletal issues than a class 2 correction.
Yes, even mandibular advancement in a bionator for a year or two may not affect mandibular growth (unless it prevents lip entrapment or a tongue thrusting habit) but the appliances were designed to facilitate compensation and thus reduce the necessity of fixed appliances. Very common desire in European dental care environment in the early 80’s.
Sorry, do not agree! I have used hundreds of Twin Blocks with excellent success. Didn’t get everybody right, of course. The success of any orthodontic appliance is directly proportional to the orthodontic equation E=R. Effort = Result, and Twin Blocks have worked wonders for all patients who followed the protocol. Those that didn’t, well, we tried to use fixed brackets and intermaxillary elastics. Some worked, but most didn’t, because if a patient doesn’t co-operate wearing a Twin Block, they will probably also not wear intermaxillary elastics. I have never lost any sleep over an uncooperative patient because I learnt very early in my orthodontic journey, and it’s been 44 years this year, that you can’t please all of the people all of the time, so they kept their partially unresolved overjets, and I kept on having great sleeps. It’s not up to me! It’s always up to them.
Thank you so much for this post. We have been in the profession for the same length of time, and I truly identify with every word.
RIGHT ON !!!!
A few comments, Kevin:
• Orthodontic treatment for TMD and other “diseases”.
Could you please define what “orthodontic treatment” you are referring to? Are you saying that TMD is not a recognized medical disorder that is often successfully treated by general dentists using, say, oral orthotics as a phase I treatment followed by orthodontic finishing in phase II in some cases?
• All my treatment is non-extraction.
Are you saying that orthodontic specialists do not refer their patients to oral surgeons for the extraction of healthy wisdom teeth, whether symptomatic, asymptomatic or partially erupted as part of the orthodontic treatment plan?
• Airway “We will know more in two years or so”.
“Airway” is not a disease or condition that needs treatment. It needs to be defined since the upper airway varies markedly from the lower airway. For example, allergic sinusitis may be present in the upper airway unrelated to, say, bronchiectasis further distally. But, why the foreboding, magical “two years or so”? Do you know something that you’re not disclosing or just playing the boogey man?
“a new treatment. Which has been adopted by the non-critical or gullible members of our specialty”.
Thank you for being the self-appointed gatekeeper of the holy grail of orthodontics.
“In the words of Jimi Hendrix, “And so castles made of sand fall in the sea eventually”.
I didn’t know Jimi Hendrix was a scientifically accepted scholar of orthodontics. Is that where you derived your inspiration from for this?
Wow! Comments are a little bit arrogant and a little bit sarcastic. Good to know you treat all your patients non-extraction prof Singh. Angle also tried it about 120 years ago, and then Tweed came along and fixed them all up with his famous 100 cases. Now, don’t misunderstand me. I also treat many of my cases non-extraction, but all of them, like you say? I don’t think I could or would want to! I should send you some of my crowded cases, and then two years or longer later, I would like to see the plaster that you put on the table and the Cephalogram at deband. Maybe you can distalize upper and lower sixes and sevens 4-5 mm. I’ve never been able or willing, quite frankly, to do that. In my 44-year career, I have completed almost 12,000 cases, and I’ve started my retirement, so I’ve seen it all. I wish you well in the non-extraction treatment of your patients. I, for one, if I had to start over again, would not consider doing that.
Spot on Kevin! I became an Orthodontic Specialist about the same time as you in 1986, and have live through all this nonsense until 2010 when I retired through ill health. A brilliant summary of all the Fads we were faced with! You didn’t mention “Orthotropics” for some reason?? Is that STILL going???
I agree 100%.
Thank you for documenting all these marketing schemes.
Those who bought in should, as specialists in this profession, reflect on either their training programs or on whatever processes their decisions to promote were based. and perhaps be more skeptical going forward.
Unfortunately, IMO, in most every case you can bet it comes down the principle most illustrated by the phrase “follow the money….not the programs.
Regarding the comment on functional appliances, and that they be included, I disagree.
They are effective but require exceptional cooperation.
Excellent post – thank you Kevin!
I need to repost this on a few general dentistry forums.
Thank you for the lecture, also for this post.
Sometimes I think you speak from my heart.Everything you said is soo true. They think they are different, to make us we have missed something, or worst, we don’t understand.
Careful with that expander, Eugene.
Now look-a look, a-look-a yonder, what’s that I see?
A great big stone wall stands there ahead of me.
But I’ve got my pride.
And I’ll move on aside.
And keep on pushin’.
(“Keep On Pushing”,1964 by The Impressions)
Of course Dr. Samson quotes a song!
The fundamental failures remain the same:
1) Failure to diagnose (either from lack of knowledge or lack of effort/time)
2) Failure to learn (thinking that knowledge is static and that we learned it all in 2-3 years of training)
3) The temptation of the quick solution (there is no panacea for the face – no one Class II corrector to rule them all, no magic bracket, no special plastic, and no one treatment planning tool including that not every retrognathic person with 15mm overjet has OSA)
That all being said – learning is hard. Beware those selling a “patented” solution. Be open to those who share and dialogue with nothing to gain.