Ramblings On Avoiding Exaggeration, Quackery and Malpractice

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sirwired
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Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#1 Post by sirwired »

As frequent readers of this forum might have noticed, I'm a rather active poster here, to say the least. However, nothing in this post should be construed as professional orthodontic advice. I'm not an orthodontist; I'm not even a dentist; I don't even play a dental receptionist on TV. :mrgreen: (I'm an Engineer for a computer company.)

***********************

Over the few years I've been here, rarely a month goes by without a a couple posters asking about a particular brand of treatment, or some new miracle technique. This post is meant as a guide to separating fact from hype and fiction. At best, buying into some misleading marketing may waste some of your money; at worst you may end up even worse off than you started, with irreversible damage to your teeth, smile, and gums.

When shopping for orthodontic treatment, a few things you should look out for and keep in mind:

[*]For goodness sakes, at least consult with a board-certified orthodontist before commencing treatment with a general dentist. At least in the US, it is legal for any licensed dentist to practice orthodontics. However, this is legal in the same sense that it is legal for my family doctor to perform open-heart surgery (if he could actually find a hospital that would let him do such a thing.) That doesn't mean it's a good idea. When shopping for an orthodontist, take care that you are consulting with someone that actually IS an orthodontist. A dentist that carefully only claims to be practicing orthodontics may be a signal they haven't actually gone through the extensive additional training one must receive to become an orthodontist. If in doubt, ask before even booking a consult.

While a case may look "simple" to you, and "simple" to a general dentist, the truth is that a general dentist usually will not have had any training in ortho beyond a few lectures during dental school, and a couple of continuing education classes by his ortho supplier. (Invisilign tried to limit their products to orthodontists, but an anti-trust suit forced them to sell to general dentists; the remaining ortho suppliers got the message and will now sell to any dentist.)

There are general dentists out there that can perform quality orthodontics, but it's very difficult for a patient to figure out who actually knows what they are doing before commencing treatment. It's sometimes painfully clear after a failed treatment who didn't know what they were doing.

[*] On that note, try to avoid appliances, brands, and systems that are generally sold only by general dentists. If a dentist is trying to sell you this or that appliance or brand of braces, go to the website for that company and use the provider search. If you see few, if any, actual orthodontists in the list, it's probably not the best idea. (Even better, go to the "Provider" link on the website. If it targets their marketing towards general dentists, with prominent claims to "Increase your practice income by $XXXX", be afraid. Be Very Afraid.)

[*] Branded systems: This is just a personal quirk of mine, but I'm not a huge fan of practices that make a big deal about the brand of orthodontic products they use. (Damon's are well-known for heavy marketing... guess who pays for it in the end?) There really isn't much that makes one supplier of brackets different from another. All the major suppliers have self-ligating and conventional systems. They all have metal brackets and clear brackets. I would never choose an orthodontist, or pay extra, based solely on if they offered This or That brand of braces. They all have pluses and minuses, but most of the differences matter much more to the orthodontist than you. If offered the choice between self-ligating and conventional, I might pay a little extra for self-ligating (they're smaller), and of course ceramics cost a little more... but paying extra just for Ormco Damons vs. say, 3M SmartClips, doesn't really make much sense.

[*] There are no dramatic shortcuts. If the only thing a dentist sells is "systems" that explicitly promise to have you out of braces in less than a year, again, be wary. (Six Month Smiles, Fastbraces, etc.) They are usually general-dentist oriented systems that "train" providers over a long weekend in a hotel ballroom that more-or-less "haul" teeth into line and put you right into retention. While this looks cosmetically okay, with most, if not all, cases, the angles will be all off, leading to an unhealthy and/or unstable bite. Certainly there are some cases for which you can be out of braces in six months, but it's awful hard to know which cases those are after one or two courses taught by an orthodontic supplier. And it doesn't take a special "system" to finish braces quickly. (There are ways to reduce treatment times, like pre-formed wire systems, but you generally won't see them at a general dentist's office, and they still won't have most cases out in six months or so.)

[*] Be very wary of providers that claim they "never extract". Okay; I'll be the first to admit that sometimes extractions don't go well. Extractions done needlessly can indeed cause all sorts of issues with the face. (This is readily apparent in many extractions done due to decay where the extraction isn't followed up by orthodontics or an implant; any dentist can tell you about this.) Sometimes even orthodontists screw this up; not all orthodontists are created equal. However, orthodontic extractions have become less common over time, but are occasionally still necessary. Sometimes if the teeth don't fit, they just don't fit. This is especially true in adults who have completed their bone growth. A clear extraction case treated without extractions will have stability problems over time. (If you see somebody who's had braces, and their teeth are straight, but splay outward soon afterwards, that's often why.)

Feel free to ask an orthodontist suggesting extractions why he/she cannot attempt expansion, or ask what issues might be encountered if treatment is done without extractions. But if you've consulted with an ortho that suggests extractions (and the reasons make sense), and one that doesn't, you should ask that ortho how they plan to deal with the consequences the first ortho mentioned. They may even both have a viable treatment plan; sometimes there aren't any "right" answers.

If the non-extracting dentist starts go go into some long song-and-dance about how "nature designed us to always keep all our natural teeth", back away slowly out the door and I hope you didn't have to pay for that consult. (This is called the "naturalistic fallacy")

Sometimes there just is not enough room in the arch for all the natural teeth; an orthodontist that never extracts is simply refusing to use "all the tools in the toolbox". If you do some research, you'll often find that they claim to be following the philosophies of dentists and doctors who practiced in the early 1900's, before what we would consider current information on medicine and dentistry.

[*] I don't suggest buying into a system, appliance, or a provider, that claims they are doing something "Orthodontists Don't Want You To Know". (Orthotropics is the first appliance example that comes to mind; there are others... I sometimes see ALF advertised this way. And plenty of sketchy providers market themselves like this.) Such a conspiracy makes no sense whatsoever. If an orthodontist saw a viable way to treat patients quickly, easily, stably, and totally avoid extractions/surgery (a common claim of such systems), why wouldn't they leap on such a system? It's not like the tooth fairy visits orthodontists and hands them a proverbial boat payment for every tooth they extract. Orthodontists generally are paid a flat fee for your whole case. Systems that let orthodontists treat patients faster, with fewer visits, less work, and fewer complications, allow them to cash the check and hit the proverbial golf course that much faster... it's not like they take some sort of blood oath to ignore treatment innovations. I'm not saying that orthodontists avoid "inertia" in treatment methods, but I am saying that whatever the reasons a new treatment doesn't catch on quickly, fanciful conspiracies aren't on the list.

[*] Non-"traditional orthodontics": If an orthodontist/appliance/brand says they are different from "traditional orthodontics", be wary. There really isn't any such thing. Orthodontics, as practiced by all sorts of orthodontists that make no such claims, use a wide range of appliances, techniques, and products.

[*] "Functional" orthodontics / orthodontists: All orthodontists are trained to consider function when treating patients. There are zero actual requirements for a dentist/ortho to tack the word "Functional" before their practice name. (As in, any dentist doing orthodontics can claim to be be practicing "Functional Orthodontics", and any orthodontist can be a "Functional Orthodontist".) I wouldn't necessarily avoid an orthodontist that claims to be "Functional", but I wouldn't give any weight to the designation either.

[*] This should not be confused with "Functional Appliances", which despite what some providers or appliance websites would have you think, are quite common in "traditional" orthodontic practice. A lot of these "miracle" appliances talk as if jaw expansion as an alternative to extractions and/or surgery is some sort of new innovation. I had a jaw expander in my mouth as a child nearly 30 years ago prior to getting braces... they aren't new. (A LOT of appliances are guilty if this in their marketing materials: ALF, DNA, Orthotropics, Bio-bloc, etc.; there's not that many ways to exert force on your teeth and mouth. Many times they are just a branded version of a basic appliance that's been around for a while.)

[*] Expansion: All I have to say about jaw expansion in adults is that it's very controversial as to the amount and stability of non-surgical expansion once the palatal suture has fused in late adolescence. Some studies have shown decent success, other studies don't. I suspect success has to do with factors that have not yet been determined. It's a choice I'm glad I didn't have to make.

[*] On surgery: If you see more than one orthodontist, and one recommends jaw surgery, make sure to ask the other one if they ever refer adult patients for orthognathic surgery. ("Never" is the wrong answer; an ortho that never sends patients to a surgeon either doesn't treat enough adults, or, again, is not using all the tools in the toolbox.)

[*] Supplements, "detoxing", vitamins, etc.: Apart from products actually requiring prescriptions (high-fluoride toothpaste, chlorhexidine rinse, antibiotics, etc.) you really should not be buying consumables from your dentist/ortho. There aren't any magical dental vitamins or herbs that need to be bought at great expense from your provider. (Again, the "Provider" link on websites can be really useful here; promises to "increase practice income" are a big Red Flag.) And don't get me started on "detoxing", homeopathy, or dentists that try hard to sell non-fluoride toothpastes to patients...

****************

I hope this is helpful to adults considering braces. As always, remember I'm just a (well-read) guy on the internet. For any big decisions, consult a licensed professional after doing your own research.

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Nozzelnut
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Location: Rochester, NY

Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#2 Post by Nozzelnut »

Well said.
Round 3 (lifetime) Damon stainless applied 3/16/20 (after 4 weeks attempting invisalign)
Upper ceramics 5/21/14, Lower stainless 5/28/14
Double jaw surgery was 6/18/15. Estimated time Jan 2016; still on at my 2 year anniversary...
Braces removed 7/20/18; upper and lower Hawley and Essix retainers with bonded lower too.
I'm emphatically against extraction orthodontics!

Ciara
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#3 Post by Ciara »

Wonderful advice! This should be pinned and all people new to adult orthodontics should read it.

ljms
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#4 Post by ljms »

Excellent post! I agree. This should be a sticky.

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djspeece
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#5 Post by djspeece »

I second the nomination to make this a sticky. I think a recurring theme in sirwired's post is to come armed with questions for whatever provider you consult; another might be "If it seems to good to be true, it probably is to good to be true;" and trust orthodontics to a trained orthodontist. The teeth have a life of their own, it is complex, and it takes a trained and experienced eye to make an accurate assessment, identify challenges, and prescribe an effective treatment plan for orthodontics. I would also hasten to add that there are probaby many cases where there is not a clear cut advantage to one approach over another (e.g., surgical vs. more conservative) and of course that is an area in which you will absolutely need to find an orthodontist that you completely trust, and weigh the benefits and risks together for both approaches.
Well done, sirwired!
Dan

Pain is inevitable. Suffering is optional. -- Buddist saying

cata
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#6 Post by cata »

Great, informative post! :thumbsup:
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Kiwi Orthodontist
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#7 Post by Kiwi Orthodontist »

I am an orthodontist, and I couldn't agree more. Great post - thanks.

bmueller
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malprac

#8 Post by bmueller »

Thanks for sharing this! True, true, true!

clouds1
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#9 Post by clouds1 »

Really useful post, thanks!

MrPlenty
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#10 Post by MrPlenty »

Good info

gglass
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#11 Post by gglass »

Impressive post from just a consumer. Your spot on

kbrown6245
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#12 Post by kbrown6245 »

Great post!

ToniMaree
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#13 Post by ToniMaree »

Great advice. Makes me realise that I probably didnt do enough research before starting treatment. Though I am very happy so far and havent encountered the problems you have mentioned.

passport
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Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#14 Post by passport »

I laughed when I read the vitamin thing. As strange as it may sound, it really happens. I once saw an otolaryngologist for some impacted ear wax. He was professional and nice enough, but on the way out, gave me several samples of some kind of special branded ear vitamin. He said "these will really help." With what problem exactly? All the vitamins contained were tiny amounts of vitamin C, various B vitamins, and beta carotene. And maybe some zinc. Honestly, I think Flintstones vitamins would have been just as effective (if at all). Having a harmless but unnecessary thing pushed on me ensured that I never went back.

Skortho
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Joined: Mon Jan 23, 2017 3:47 am

Re: Ramblings On Avoiding Exaggeration, Quackery and Malpractice

#15 Post by Skortho »

[quote="passport"]I laughed when I read the vitamin thing. As strange as it may sound, it really happens. I once saw an otolaryngologist for some impacted ear wax. He was professional and nice enough, but on the way out, gave me several samples of some kind of special branded ear vitamin. He said "these will really help." With what problem exactly? All the vitamins contained were tiny amounts of vitamin C, various B vitamins, and beta carotene. And maybe some zinc. Honestly, I think Flintstones vitamins would have been just as effective (if at all). Having a harmless but unnecessary thing pushed on me ensured that I never went back.[/quote]
He's trying to get more cash out of you maybe? Lol

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