January 06, 2020

New Year Hopes and Dreams for orthodontics.

Since I started my orthodontic blog, I have used the first post of the year to update you on my ambitions for the next year. 

Over the past year, I have been spending a significant amount of time on this blog. I hope that this has led to an increased number of hits.  This year broke the previous records, and my blog was read 530,000 times this year. Thank you for reading my posts.

Next year I am keen to include more guest posts.  I also hope that I can find some time to prepare and post some lectures and podcasts.  

I am delighted to announce that Professor Padhraig Fleming has agreed to join me as co-editor.  His first role will be authoring the guest posts. I am really looking forward to his input as he will improve this blog. His details are here. 

As many of you know, I upgraded the blog servers, software and security a couple of years ago. This has increased our running costs, and we need donations of approximately £3000 per year.  As a result, we will be running what is now our annual donations plea in April. We hope that you can make a contribution to keep this orthodontic blog running for another year.

Now onto the hopes and dreams.

Randomised trials

Our specialty needs more high quality randomised trials that look at common clinical problems and dilemmas.  Despite the efforts of many investigators, the evidence base of a fair proportion of orthodontic treatment is somewhat lacking.  In spite of this, we are still adopting new treatments (for new diseases) with very little evidence.  I would really like to see trials published into breathing, the effectiveness of clear aligners and the influence of orthodontic treatment on the socio-psychological status of our patients.  It would be great to see these published this year.

Systematic Review

The systematic review is an excellent technique for providing a high level of evidence.  The best systematic reviews are those published by the Cochrane Collaboration. This is because of the tight editorial control and the need to update the review every two years.  While the orthodontic journals publish systematic reviews. Unfortunately, they are of variable quality.  Some are excellent, others are rather poor.  One characteristic of the poor review is that they include low-quality retrospective studies or even papers that have been retracted! 

I cannot help feeling that there are too many systematic reviews being published. For example,  I do not need to see another review of the effects of functional appliances. We know the answer to this question. I hope that the journal editors become more selective in accepting systematic reviews for publication.  We shall certainly not be discussing any more poor quality reviews on this blog.

Breathing disorders

The AAO held a conference on breathing and orthodontics last year. This came up with very clear conclusions.  Unfortunately, these seem to be being ignored, and we appear to be going headlong into providing untested orthodontic treatments for a disease that may not be influenced by orthodontics.  I can hope that those promoting this treatment read the AAO white paper and re-think their main reasons for providing this treatment.


This is becoming a very controversial area.  There appear to be two main issues.  One of these is the introduction of aligner treatment for teenage patients, including claims that mandibles can grow with special advancement appliances.  I gather that some research has been carried into this, but I wonder if we shall see the results published this year?   Perhaps, Invisalign can reassure us?

The other issue is direct to consumer treatment. This is an important problem as treatment is being provided without the patient seeing a dentist or orthodontist.  In the UK, this has been raised with the Dental Regulator, the General Dental Council. Since then, the silence around this is deafening. It is time for the regulators to get their heads out of the sand to protect our patients.

Key Opinion Leaders

I know that I go on about KOLs a lot. However,  the influence of some of these people and their companies is possibly one of the biggest threats to orthodontics.  I have posted about KOLs many times and pointed out that there is nothing wrong with being a KOL providing that it is declared.  This means that we can evaluate their claims with knowledge of the large amounts of money being paid to the KOL.  My personal view is that if a KOL is funded by a company to discuss their products, then I will take their claims with a pinch of salt.

I have decided that we will introduce a “KOL of the month” blog post.  In these posts we will highlight the KOL and their claims.. We will clearly be looking for the most extreme claims.  There is no shortage of possible candidates!

Social media

Lastly, I hope that those who are very active on social media behave themselves and consider that trolling and insulting people may lead to harm.  We need to be more professional.  I know that in the past, I have been very blunt in social media discussions.  I have decided not to take part in these any longer as they can be destructive.  However, I will still use social media to publicise blog posts and make sure the blog remains current.

Final thoughts.

Finally, I hope that this blog continues to grow and that people find it useful. If you have any suggestions for posts or areas of interest can you mail me directly or make a suggestion in the comments sections.  Let’s have a good year.

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Have your say!

  1. Bravo.
    On this side of the pond, I continue to enjoy, respect and appreciate the substantial efforts you put into the blog posts. Looking ahead, including podcasts will be an appetizing addition. The 2020 list of “hopes and dreams” is mighty appealing. KOL’s, social media, aligners, airway – all good examples that “facts” run second (or even third) to “beliefs”. With some regularity, your blogs bring the image of Toto pulling down the curtain. Obviously, that only applies to those who read and evaluate critically what you’ve written – a form of selection biased, I suppose. Rock on.

  2. Thanks for your thoughtful posts. Happy 2020!

  3. Kevin,
    “Lang may your lum reek”* as the Scots say.
    Bill Reay

    *’Long may your chimney smoke’.

  4. Thanks to all involved in any way with this blog/I know that this is a source of reliable information !

  5. Happy New Year everyone –

    I agree, Kevin – orthodontics and craniofacial sleep medicine can be viewed as two different specialties. Hope you don’t have nightmares 🙂

  6. Dr O. I love your blog and your comments are always Spot On.

  7. I totally agree – we could cut soooo many articles from journals and just focus on doing quality RCT’s (or well designed and appropriately matched retrospective studies if an RCT is not appropriate) to answer questions we have, rather than do another SR concluding we need more RCT’s!!

    When I was a resident, my thesis was on craniofacial morphology and OSA and Peter Vig stated to me back in 1994, that OSA will be huge. He was right, just 20 years ahead of his time. Unfortunately, some have grabbed and run with it as a marketing tool to appeal to human desires. We want something, they (companies and some KOL’s) provide a supposed answer or cure (without sound evidence) and people grasp at it. As humans we also tend to want the easy route with some appliance or gadget to fix it rather than start with strategy #1 which is lose weight! Not all OSA patients are obese but it is a big risk factor. Potentially, up to 45% of obese subjects may suffer from OSA but also, a 10% reduction in body weight can result in a 25% improvement in apnea. If we want to help our patients, screen them for OSA, refer appropriately and draw to their attention (in a diplomatic way) the importance of a healthy weight range. Diagnose and then treat soundly rather than the hammer/nail philosophy and feel we have to place an expander or molar distaliser.

  8. Thank you for all posted,I have learned a lot from your blog , and I have translated your article into Chinese and put it on my personal social media platform. Too many Chinese doctors follow my blog,they have also learned a lot,thank you so much.Happy new year

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