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Health Benefits

"For any elective medical intervention there should be a clear list of benefits for the patient and these should outweigh any potential risks. It is clear that orthodontic treatment can provide significant cosmetic advantages to the patient. However, it has proved difficult to provide strong evidence in support of the widely assumed belief that treatment can also improve the oral health and psychological well-being of an individual." - Dr. Martyn Cobourne & Andrew DiBiase, Handbook of Orthodontics Second Edition

TRANSLATION: Most orthodontic treatment is done for a cosmetic improvement (doing it for other reasons may not provide the benefits claimed by the practitioner). There are risks that need to be discussed and some orthodontic treatment carries higher risks and different benefits that must be carefully considered by the patient. 'Ideal' treatment may provide textbook results but sometimes very serious complications. The more complex your situation, the more you should consider alternative opinions. 


ADVERTISING REGULATION:
In Alberta the 2016 ADA&C Advertising Guidelines state a dental professional not permitted to state faster orthodontic treatment is better than slower treatment. While there is scientific opinion to suggest shorter treatment times offer some advantages, this argument has yet to be accepted by the ADA&C. The Alberta Dental Association & College has banned the use of before & after photos, and testimonials from dental websites. 

Challenge to the ADA&C Advertising Guidelines –Section 7 – ‘Not allowed to imply or express that faster orthodontic treatment is better’

October 2016

Dear ADA&C President, CEO & Alberta Health Minister,

Since 2005 I have decided to provide orthodontic treatment in my general practice as a way to provide affordable and conservative treatment for my patients. At the time my interest in becoming a ‘cosmetic dentist’ had vaporized with the realization that many of the programs were teaching procedures that were obviously gross over-treatment particularly with the over-use of porcelain veneers and crowns.

My interest was in finding ways to provide faster orthodontic treatment, and this would include BOTH limited treatment and comprehensive treatment in a reduced time. At the time the local orthodontist was booked one year in advance and with my training in oral rehabilitation adding orthodontics was a rewarding combination. The situation made it quite simple to be able to start and finish orthodontic treatment prior to many of my colleagues. As an example if a patient needed an extraction of a lower incisor to allow the orthodontics to be completed I did it myself and continued with the orthodontics – the patient benefited from the scheduling savings and the regional acceleratory effect (when for about three months after dental surgery the biological changes allow a reported 2.3 times increase in tooth movement).

When I attended the American Association of Orthodontists Convention in San Francisco in 2015, most of the lectures related to faster orthodontic treatment. The convention floor was loaded with companies with assorted offerings that promised to allow the orthodontists to straighten teeth faster. While some lectures questioned the claims of some of the devices, it was clear faster treatment was possible and it offered advantages besides convenience.

As the current literature suggests, shorter times in orthodontics reduces the risks of tooth decay, periodontal disease and root resorption. This is a fact, but like smoking can cause lung cancer, these negative events do not always occur but a relationship has been established.

I understand the local orthodontists were not prepared to have a general dentist offer a competing orthodontic program ‘pitching speed’, but that was over ten years ago. Now all the orthodontic offices in Red Deer are claiming to offer ways they can move teeth faster and get treatment done quicker.

It was upsetting to discover the two local orthodontists at that time conspired to undermine my credibility, but this type of thing goes on in dentistry. Maybe they could have been right, and faster treatment could have ‘wrecked roots’ as they first claimed. Maybe…but it turned out they were wrong and orthodontic journals stated the benefits of shorter treatment times.

The ADA&C became involved as a result of the advertising complaints – and primarily related to an 87-page complaint filed by the senior orthodontist. The Complaints Director must have been overwhelmed by the document and felt she had to stop a madman (if she took Dr. C’s complaint at face value). She formed an opinion early on and in spite of my time and effort, continued to believe that faster orthodontic treatment was either a myth or only possible if a person was a specialist.

We know now that my election to council was no guarantee I would be able to share my understanding of the area of interest with the advertising committee, and instead the Complaint Director seemed to ensure the insertion of the ban on ‘implying faster orthodontics was better’ was in the updated rules. This obviously would make it easier to force people like me to stop spreading what she thought were lies.

In reality it created a state of contention with the scientific facts. It created a lie within the new advertising guidelines - which meant a dentist would not be allowed to tell the public the truth as we understand it today. The truth being, shorter times in orthodontic braces are associated with FEWER RISKS (Reference: AJO-DO Accelerated orthodontic tooth movement: Molecular mechanisms- ‘Accelerating orthodontic tooth movement can significantly reduce treatment duration and risks of side effects.’).

I could have just shut up and accepted the reality that the ADA&C lawyers were trying to keep the in-fighting down by making these types of conversations illegal, but if the mandate of our self-regulation is to protect the public and this is of higher importance than dentist vs dentist turf profession (anti-competitive strategies, to keep orthodontists and other specialists on a pedestal and general dentists treating the basics) then we have a problem here and it ain’t me.

Maybe self-ligating brackets don’t speed treatment, but there are ways to reduce orthodontic treatment time offering health advantages the public deserves to know exist. Someone needs to tell the Complaint Director she’s wrong and a little over her head in this matter.

Michael Zuk DDS

REFERENCES:

Pitching Speed (AJO-DO)

Accelerated Orthodontic Movement (AJO-DO)

Self-ligation –A Myth? (AJO-DO)

Comparative Assessment of Alignment (AJO-DO)

Deciphering the Truth (ortho website)

Duration of Treatment (Damon study) – (AJO)

Effect of Micro-osteoperforations (AJO)

Clinical Trial Results – Propel (Tribune)

Accelerated Orthodontics for the GP – Dentistry Today

Orthodontic Radiographs (reviewed by P Major – helpful to correct some false beliefs on record keeping)

Increasing Orthodontic and Orthognathic Surgery Efficiency – (AJO-DO)

Root Resorption – New Zealand Orthodontist NZAO

Risk Management Strategies in Orthodontics –Part One – (AJO-DO)


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