Topics of the day:
1. Re: Untangling efficacy of differing treatment
Dear Ms Vredenburg,
What an orthodontists decides to do mostly depends on the current opinions of the institution where he or she was trained, that is local tradition, and on informations that have been collected after leaving university (fashion, colleagues' opinions, personal experience, educational courses, congresses, literature study - in approximated order of relevance). However, there is no established way of collecting these informations systematically, so most of our specialty is based on chance - where you have been trained - and clinical folklore rather than on sound evidence. There is a tendency to follow personal authority and high reputation ('I do so because xy said this was the best way'), and another tendency to maintain the opinions gathered during education for the entire professional life. Thus, it is no surprise that you get six different treatment proposals - which probably all will do the job, but differ in time, costs, social burden and risks. While most orthodontists do not seem to consider this variety as a problem, it may be a problem in the view of the consumer, i.e. our patients.
The questions of efficiency of different treatment approaches, as far as time, costs and risks are concerned, have rarely been studied until to the last decade. Since the year 2000, evidence-based medicine, a concept conceived in the nineties of the last century, is adopted in orthodontics slowly. The idea is to base clinical decisions on sound data, that is evidence from clinical studies, and not on folklore.
Unfortunately, there are strong resisting forces among orthodontists to make evidence-based medicine the rationale of their daily work - with some horror I remember an editorial in a clinical orthodontic journal (JCO) with many ill-founded arguments against evidence-based medicine. While the author did not seem to have understood what evidence-based medicine really means, he opposed vigorously to it's implementation in orthodontics. What we can infere from such sources: there is still a long way to go to change the specialty from an art form to a science.
Thank you for expressing your critical view on our specialty. And my appeal to the profession: let's strive for a sound, scientific base of our work.
I am very appreciative of your letter, as it stimulated me to think of what kind of response would be informative and reassuring, at the same time.
After forty four years of practicing orthodontics, I am ready to apply some of the experience I have acquired over the years to addressing your concerns.
First of all, I am sure you realize that orthodontics, being a creative discipline, is as much an art as a science. If orthodontic treatment could be systematized into a cookbook approach. and treatment involved nothing more than looking into a manual, I doubt that there would be many orthodontists, as treatment would lose its spontaniety and creativity. If you were to commission a portrait, for example, and approached six artists for a preview of their approach, I'm sure you would get six disparate views, and who is to say which is the best.
If you were to approach a number of cosmetic surgeons for advice on correcting a problem you would get numerous answers, many of which would have validity. If a businessman asked six advertising agencies to come up with a campaign, I doubt if any two would be similar, yet they would all have some validity. Remember, you can get to Rome by many roads.
Secondly, orthodontists tend to have an approach which demonstrates great transparency. We routinely tell our prospective patients far more than they really care to know. What most parents are concerned with, in my opinion, is can this case be successfully treated, how much will it cost, and will it hurt? A surgeon, before an operation, may answer some general questions about his work, but I doubt if he will bother to discuss the intricacies of his surgery in depth. If you were to ask for six opinions on how they intend to proceed, in detail, you would not get very far.
So you may be confused by too much information rather than by too little. And I am afraid we orthodontists have to accept some of the blame for this.
What I try to do, during a consultation, is to find some before and after models of a similar case. and let them speak for themselves, and try to keep the technical jargon and self-serving treatment plans to a minimum.
If I have not fully addressed your concerns, send another email to ESCO, and I will respond.
A final word: If a parent approached me and informed me that they had six previous consultations, I would probably not want to treat that patient. So make up your mind which of the six orthodontists you feel most comfortable with and go for it. If there is a seventh, better not tell him or her about the other six. Good luck.
As far as your daughters malocclusion, there is only one diagnosis. However, there could be many valid treatment plans to achieve the optimal result. Don't sweat the details of the mechanics or the particular gadget being used. If possible you should go to the orthodontist that your dentist refers you to. Your dentist knows you and knows the orthodontists in the community and should give you the best direction. Hope this helps.
Kevin C. Utley, D.D.S., M.S.
The Electronic Study Club for Orthodontics (ESCO) is a free forum for exchange of information and opinions among orthodontists, and for distribution of professional information, sponsored by the Department of Orthodontics, University of Illinois at Chicago . Information distributed on this list-server is NOT edited or refereed, and it represents only the opinions of the writers of the individual messages. Such writers bear the sole responsibility for the content of messages they author. Authors are required to verify information regarding other parties included in their messages.
* What information can you get on ESCO?
* How to subscribe to ESCO?
* How to change your address?
* How to post messages on ESCO?
* How to get copies of old digests of ESCO?
For answers to these questions and more, please check our web site: http://www.uic.edu/depts/dort/esco.html
To view and search old digests, please view our web site: http://listserv.uic.edu/archives/esco.html
Enjoy your reading!