March 25, 2024

Orthodontics “In the Court of the Crimson King”?

“The gardener plants an evergreen
Whilst trampling on a flower
I chase the wind of a prism ship
To taste the sweet and sour
The pattern juggler lifts his hand
The orchestra begin
As slowly turns the grinding wheel
In the court of the Crimson King”.

What is he on about now?

During my teenage years, I spent a considerable amount of time listening to UK progressive rock music. One of my all-time favourite songs is “The Court of the Crimson King”, which is the title track of the debut album of the British band King Crimson. The song is about a mythical court that is governed by nature, symbolism, and rituals. The first verse reflects upon the systems that restrain people. While the second verse speaks about the obstacles that we must overcome to fulfil our hopes and dreams. The final verse concludes with the acceptance of chaos.

I was listening to this song a few weeks ago, and it got me thinking about orthodontists who offer treatments that some people may find controversial. For example, using orthodontic treatment to cure breathing problems. I found a connection between the song and my thoughts on this topic. Therefore, I have decided to discuss the interaction between the orthodontic establishment and those orthodontists who provide treatments that have little evidence to support them. I will use this song as a framework for my post.

The mythical court.

In this context, the “court” refers to the field of orthodontics or any system that operates under the rules and principles of evidence-based care. This includes a system of “checks and balances” that employs scientific methods such as randomized trials, systematic reviews, and complex studies. These methods should be mandatory before adopting any treatment. However, some people on the orthodontic fringe argue that these academic customs and symbols impede progress and hinder the adoption of new treatments. Consequently, they consider themselves as disruptors, mavericks or lone voices.

The obstacles

“The Keeper of the City keys puts shutters on our dreams”.  

orthodontics King Crimson

“Innovator” orthodontists often face various challenges in their journey. One of which is the need for evidence to support their treatments. To overcome this obstacle, an orthodontist must conduct research and navigate the publishing and refereeing process to publish their findings. However, with determination, persistence, and co-operation with researchers these obstacles can be overcome. A good example of this is the development of TADs.

Cycles of success and failure

“The gardener plants an evergreen whilst trampling on a flower”.

I understand this to mean that the current system prefers to rely on well-established theories and conventional treatments over new and unstable philosophies. As a result, innovations are stifled.

The purpose of the Court

“The yellow jester does not play, but gently pulls the strings and smiles as the puppets dance in the Court of the Crimson King”.  

This leads us to a theory among some innovators that suggests the true purpose of the “system” is to hinder progress and prevent knowledge from spreading. According to this theory, the current scientific and governance systems in the “Ivory Towers of academia” are actively working against the “groundbreaking” work done by fringe orthodontists. 

The narrative of the song ends with the protagonist still fighting for justice. But ultimately, the Court upholds the status quo. I believe this is where we currently stand in the ongoing debates and discussions within our field.

Final thoughts

It appears that there are currently two opposing factions in the field of orthodontics. The majority, which includes orthodontists, academic centres, and professional organizations, adhere to traditional methods and represent the “Court of the Crimson King”. On the other hand, there is a smaller group that seeks to challenge the established norm and introduce new treatments without strong evidence to support them. This could result in potentially harmful consequences for patients or their financial situation.

This leads to confusion. The future outcome is uncertain, but it’s evident that there is a division between clinician-scientists and those who rely on case reports and discussions. Unfortunately, our patients are the ones who are potentially suffering the most due to this confusion.

This leads us to some questions.

Who benefits the most from this confusion? Is it those who require evidence or the “fringe” whose motivation may be either a legitimate need for innovation or to simply increase revenue?

My reference to the “Court of the Crimson King” underscores the challenges faced by our field. I believe that the different factions involved need to engage in more dialogue. I’m going to listen to some Pink Floyd now.”

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Have your say!

  1. Makes a lot of sense and even more so the way you have presented the ‘challenges’, if I may use the word.

    Another point which I find pertinent to add would be the mushrooming of self proclaimed orthodontist or in simpler terms the company certified ‘tooth aligners’. Many don’t know what they are doing and many in the Orthodontic fraternity don’t know how to react to the situation…. Either Orthodontics will evolve as an actual speciality or perish as a speciality, will depend on the nerrative put forward by the various organisations at the forefront….Individual success stories are immaterial…

  2. “According to NBC News, hard facts are not enough to change beliefs and are nearly useless for motivating action. According to NPR, research suggests that misinformed people rarely change their minds when presented with facts, and often become even more attached to their beliefs.”

  3. I don’t think Pink Floyd is going help….Because “All in all, you are just another brick in the wall”

  4. Do you have to be “on” something to listen to stuff like this?? Joking apart, a great analogy. Often vested interests at play.

  5. Unfortunately, I have to agree with John, cause currently the biggest motivator is “Money” and not some, silly love for Orthodontics !

  6. Beyond the learning from many blog posts, the sharing of knowledge from these posts, and the intricate knowledge of nuances of research bias, IMO, this post in particular sums up the existential challenge of our times in orthodontics.

    *Science before marketing crowd vs Marketing and who needs science crowd.
    *The unpaid waiting for evidence crowd vs the highly compensated selling an unproven product crowd.
    *The doing what’s best for humanity and our patients crowd vs I’ll get mine with my unproven tongue space claims blog series crowd.

    There is not specialty or area of medicine that does not have its unscientific fringe and charlatans. Orthodontics is not alone nor is it untouched by this nefariousness.

    IMO, while the internet has provided a means of rapid dissemination of excellent information, it had also provided charlatans with a platform. They can promote their tongue space and orthotropic ideas, and only the Facebook administrators of the group are there to stop their claims.

    However, what happens if the FB administrators are truly unqualified to filter these claims? What if their only claim to fame is charisma, large biceps, or just random luck in timing a FB group start? Worse, what if the FB administrator’s goal is to profiteer off of its members at any price or by any means?

    IMO, the internet is still playing out in the Ying and the Yang of its effects. Unquestionably, it has offered the opportunity and information for us to become better orthodontists. It has also offered the temptation for us to take the wrong road.

    Will we follow the chaos and harm ultimately resulting from it in the court of the Chrimson King, or we follow the science and wait for proof before loyalty to a system or monarch?

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