The end of orthodontics, or is it?
A few weeks ago, I returned from the AAO congress in a dystopian mood and published a post called “are these the early days of the self-destruction of orthodontics”. In retrospect, this was a particularly bleak personal viewpoint. A young Russian Orthodontist, Alex Ditmarov, who translates my blog posts, has politely disagreed with me. He has written a more uplifting post on his own blog. He has kindly allowed me to publish this on my blog. I thought that this was great.
The end of orthodontics, or is it?
A month ago, Kevin O’Brien published in his popular orthodontic blog a post titled ‘Are these the early days of the self-destruction of orthodontics?’ The text was inspired by his visit to the annual AAO meeting where he has been giving a lecture on Bill Proffit’s legacy.
The situation around orthodontics was presented in a desperate tonality: key opinion leaders maliciously misguide young specialists, the American market is plagued with teledentistry, Europe is full of myofunctional charlatans, etc. As a result, we are awaiting the end of the speciality.
After reading the post, I felt a bit disappointed. Firstly, I have just started practising orthodontics less than 5 years ago and do not admire the perspective of its nearing death. Secondly, even though I admit the presence of all the issues listed, I don’t think they are fatal. Paradoxically, they might be even beneficial.
At the moment I am waiting for a connection flight to Moscow at Amsterdam airport. I have been visiting another orthodontic event in the USA, the Tweed Study Course.
In contrast to the AAO meeting, this event has no advertising part, no presence of companies or key opinion leaders and is known as the most popular hands-on orthodontic course in the world held with little changes since 1941.
I first learned about it through an article by James Vaden published four years ago in the AJO-DO. A year later, I filmed an interview with the course director Herbert Klontz. By now, it has been watched on YouTube more than 3,600 times. You can find it here.
Last week, I finally fulfilled my long-awaited goal and completed the course myself. This was an absolutely invigorating experience. I have not just learned some wire-bending tricks and cephalometric nuances, but have been completely reassured that fundamental orthodontic knowledge has not been lost and continues being transmitted to the young generation with love and passion.
What about KOL, teledentistry and myofunctional charlatans then?
Of course, our perception of the overall situation is dependent on what we focus our vision on. Let’s focus for a while on orthodontic fringes mentioned by Kevin.
Myofunctionalists have been around for many decades. From Alfred Paul Rogers, who considered to be the father of myofunctional therapy to his present-day followers they were stating the same mantra: 1. muscles influence hard tissues 2. through myofunctional exercises we can correct hard tissue pattern. Interestingly, there is still no single case in the literature that would prove the second point. However, the first point is with no doubt correct. Muscles influence hard tissues, that is it! And the most sophisticated myofunctional therapy can’t help that!
Can myofunctionalists be the threat to orthodontics? I doubt so. They, of course, can harm a patient’s bank account, but they definitely can neither worsen nor cure a malocclusion. Therefore, they will just stimulate a patient to be pickier in finding a reliable orthodontist next time.
Key Opinion Leaders
Back in the days, they were called representatives or reps. Marketing strategies were less aggressive, and magic brackets were not yet invented. Nowadays, the situation with opinion leaders has become more complicated due to the advance of technologies. Social media delivers unproven data straight to our smartphones, huge theatralized events in support of new, untested appliances are held around the globe, and impressive sums of money are paid for lip service.
Can this be a threat to orthodontics? This could be a potential threat to some indiscriminate orthodontists. However, thanks again to new technologies we already have an antidote: https://openpaymentsdata.cms.gov Here you can simply put the name of a medical practitioner and check the amount of money one received from a supply company. I think it should be a necessary check for any orthodontist or patient who has doubts in the sincerity of strong statements.
Again, I don’t think this is the end of orthodontics. This situation just makes us more vigilant.
This is a very new movement. The most popular teledentistry procedure relating to teeth straightening is sending clear aligners straight to a patient letting him, or her treat a malocclusion on one’s own. Obviously, it can be hazardous. It can lead to soft tissue loss, severe bite problems, root resorption, etc.
This might become a severe threat to a patient’s health. I feel really sorry for those who already have harmed themselves with this. However, I don’t think this is a threat to orthodontic speciality. Sadly, but this is even a beneficial phenomenon since, in the long run, it creates lots of patients who are urgently in need of regular orthodontic care.
To summarise, we have plenty of disagreeable orthodontic movements going around. But having a closer look, we see that most of them represent changes in the modern-day economy, but not orthodontics. These are just new ways of making money.
As a result, more and more patients become involved in the teeth-straightening industry. Even though demand and supply are growing, the number of reliable orthodontists is staying more or less the same. In this condition, the role of filtering mechanisms such as board certification becomes crucial. I think the creation of an international orthodontic board is inevitable. It is only a question of how and when.
From the present point in time, we can see ahead both the death and the golden decades of orthodontics. It is the fork of the river. And it is we who are in charge.
Emeritus Professor of Orthodontics, University of Manchester, UK.