Balance the Evidence

It is not easy to balance the two sides of an argument, and remain uninfluenced by the number of people supporting each viewpoint. Because this debate is so crucial for the orthodontic establishment, they have always presented a united front.

In order to support their case many unorthodox clinicians will quote long lists of supporting evidence some of which is of indifferent quality. This is quickly dismissed by established experts and the strength of their case is weakened. To avoid this error only evidence that is broadly accepted by all sides has been quoted on this site. That a case has been made for Orthotropics on this basis must justify it to some extent, but much of it will be dismissed as irrelevant.

All orthodontists accept that the teeth and their supporting bone are in a position of balance between the lips and tongue but for some reason they are reluctant to accept that mouth posture plays a significant role in facial development. It is difficult to measure the posture of the jaw or tongue and it will be said that there is no proof that posture influences facial growth, this is not true, as several of the enclosed references have shown. Orthopaedic surgeons and osteopaths freely accept that posture will influence bony form, it is only orthodontists that reject this.

They draw attention to many negative findings but do not be mislead by this. Jonathan Sandler publicity officer for the British Orthodontic Society recently published an article entitled “Fact and Fantasy” (British Dental Journal:2004 196:143) in which he claimed that “there is insufficient evidence to show that ‘Functional’ (similar to Orthotropic) appliances work” but neglected to mention that there is also insufficient evidence to show that they do not. Misleading statements like this do much to confuse readers. There is certainly no research to show that oral posture does not influence facial growth.

Orthotropic results are sometimes criticised because the teeth are not in perfect alignment. Orthotropics treatment is primarily aimed at improving the growth of the face and at the end of treatment the teeth are allowed to find their own ‘natural’ position. All patients are told “if your mouth posture does not improve the treatment will relapse,” and those who hang their mouth open after treatment do relapse. However it is important to realize that this applies to all methods of treatment and is why the teeth of most orthodontic patients re-crowd in the years following treatment (Little et al 1988) unless they wear a retainer for the rest of their life. Those orthotropic patients who co-operate should maintain straight teeth for their lifetime and if an orthotropic result does relapse the patient themselves does not complain as they know where the blame lies.

The possibility that orthodontics could damage faces will be firmly denied although it might be accepted that inappropriate treatment can, at times, cause damage. The real question is “what is appropriate?” Research projects have found that patients in general, are satisfied with the appearance of their face after treatment, however most of these have relied on the opinions of the patients themselves or others involved in the treatment. Modern protocol would consider personal views unacceptable. Other projects have excluded “poorly treated” patients or those who leave their mouths open after treatment (Bishara and Jakobsen 1997). Subtle selection of this type can produce deliberately misleading results. There does not seem to have been any significant long-term research into the risk of facial damage, a quite unacceptable situation in this age of public accountability.

Many parents are aware that their children’s faces have been damaged by orthodontic treatment, but say nothing to avoid their child’s embarrassment. You have seen several successful Orthotropics faces on this site; ask those who are critical to match these with their own results. Do not be mislead by smiling faces, only a passive expression with the lips in contact, will display the true shape of the face. Make sure that photographs are all taken from the same angle, and look closely for drooping eyelids, flat faces and thick lower lips. In general you will find that faces look worse after conventional orthodontic treatment, this is because the teeth and face are taken back while orthotropics takes them forward. Until the public becomes aware of the true situation, the existing patterns of treatment based on surgery and mechanics, are likely to be maintained.

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