Is Early Treatment Necessary? An ongoing battle....

I know that in orthodontics there is a move away from early treatment.  Tulloch and similar studies have been used to vilify early treatment since the results of two-phase and one-phase treatments seem to be the same. And since two-phase treatment is less economical to both the patient and the orthodontist, then why do it?  Reasonable argument.  Especially since new approaches to fixed appliances have resulted in better arch development, better facial appearance and less extractions. 
However, the AJODO (the most revered juried journal in the field) recently published a systematic review(1) on the efficacy of functional appliances.  In summary, the review found statistical significance but little clinical significance to the way functionals could make a mandible grow.  And it also concluded that the data supports “that 2-phase treatment has no advantages over 1-phase treatment.”

But wait.  It concludes: “several benefits must be attributed to the early treatment …”

1. prevention of trauma to maxillary incisors associated with a large overjet, (ed: every one agrees with this one)
2. psychosocial advantages for the child during an important formative period of life,(ed. kids and mothers,  especially, appreciate this)
3. interception of the development of dysfunction, (which is why teeth get crooked in the first place)
4. stable dentoalveolar correction (ed. stability: the holy grail of orthodontics)
5. improved prognosis and shorter duration of treatment with fixed appliances.(ed. Better Faces: Less Braces!

So given those five reasons, why wouldn’t you want to do early treatment for our children??? Since when is money and efficiency more important that the health of our children?

(1) Marsico,E, et.al. Effectiveness of orthodontic treatment with functional appliances on mandibular growth in the short term, AJODO,  2011, 139:1, 24-36.

The way I want to change the world.

I am thinking about orthodontics as a health service, not only an esthetic service...

Up until recently, I’ve felt that ortho was mainly an esthetic service, and that just few people really NEED it. Crooked teeth don't hurt. No one ever dies of a bad bite. But they WANT it.  And there are many benefits from a pleasing smile in our culture.  Better self-esteem.  More confidence smiling and speaking.  Pride in accomplishment.  Improved dental awareness and care.  All good things.  But like plastic surgery, it is a discretionary service, maybe even a luxury.  

From my new point of view, however, orthodontics, if and when it broadens its scope, can be a health oriented service that IS NEEDED by thousands of children.  When you look at alignment of teeth as merely a product of, a symptom of, or a solution to, a larger ailment that has health consequences well beyond just those of a pretty smile, then orthodontics takes on a greater significance.  

If crooked teeth are a symptom of early feeding and nutrition, then it is a health related matter.  If crooked teeth are a symptom of imbalanced musculo-skeletal alignment which contains vertebral subluxations and cranial strains, then it is a health related matter.  If crooked teeth are a symptom of suboptimal respiration where oxygen is not being processed efficiently and tissues are not being nourished as they should, then it is a health related matter.  If crooked teeth are related to mouth breathing, snoring, airway restriction, asthma, allergies, frequent upper respiratory infections, and sleep disorders, just to name a few, than orthodontics is certainly a health related matter.

What I am suggesting is that there is the possibility of a whole new line of concentration within our specialty.  One that is crying out for our attention. One that provides us with tremendous opportunity for improving the health of our children, now and into their future.  

Of course, we should still concentrate on the esthetic benefits of a beautiful smile.  But I also suggest that it is time to forgo esthetic goals when they are accomplished at the expense of health. Or when they are performed in ignorance of the health ramifications to our children. Ideally, our children have the right to enjoy both enhanced esthetics and enhanced health.

And that what I want to see happen in my lifetime.