WHAT DO ORTHODONTISTS DO?
Orthodontists straighten teeth. Until 1999 more than half of the orthodontics in the UK was done by general dentists but after this the General Dental Council registered orthodontists as specialists and discouraged general dentists from doing orthodontic treatment. Over a thousand UK dentists have undergone an extra two or three year training to become specialist orthodontists. While orthodontic techniques have changed substantially over the last one hundred years, the basic principal of straightening the teeth with a mix of mechanics and extractions has remained largely unchanged and figures suggest that less than 5% of their treatment is now Growth Guidance. General dentists previously did most of the Growth Guidance treatment and so unfortunately this option has become largely unavailable in the UK.
Four years ago in England and Wales the NHS spent £1,623,000 on adult orthodontics and £66,580,000 on childrens’ orthodontics. There were 139 claims per thousand for children aged between 10 and 17 compared with 95 five years ago. (Dental Practice Board Annual review 1997/8). Orthodontists use either fixed ‘tracks’ or removable appliances. The majority think that ‘tracks’ are best but each technique has advantages in some situations. The National Health Service pays for most treatment in this country, less than 10% being done privately. The NHS pays about £750 for ‘tracks’and £300 for removable appliances, while private charges vary from £1500 to £10,000.
Generally throughout the world orthodontists believe that the shape of the jaws is inherited and that it is impossible to change the shape permanently. However some believe that the upper jaw can be widened to increase room for the teeth, and a few believe that the lower jaw can be made to grow forward. These latter techniques are discouraged by some State run Services and only used in a very small proportion of cases. Sadly most techniques involve the extraction of teeth either before or after treatment.
Orthodontists claim to avoid extractions, but UK figures would suggest that teeth are extracted in about 80% of cases and in a sample test, 91% of British orthodontists recommended extractions in a patient who had no crowding of his teeth. About 250,000 children receive orthodontic treatment, in the UK, each year most of whom have four or more teeth extracted. Because orthodontic treatment does not make room for the wisdom teeth approaching half of patients who receive orthodontic treatment loose eight permanent teeth.
Although research is constantly taking place, most orthodontic treatment is still ’empirical’, or in other words it is based on trial and error. As a result methods of treatment have alternated each decade with everybody extracting teeth for a period and then when the results are criticised no one extracts for a period. In each of these periods, as now, they were convinced they were right but unfortunately no type of treatment has proved very successful in the long term and the teeth usually re-crowd afterwards. Because of this many orthodontists now tell their patients to wear an appliance to hold their teeth straight forever.
Some orthodontists avoid extractions during treatment by pulling back the side teeth with a strap aground the back of the head or neck. This ‘Head Gear’makes room to straighten the front teeth, but unfortunately increases the unattractive vertical growth, and increases the need for extractions later on. Head Gear is condemned as unethical by others who point out that people with good looking faces and naturally straight teeth have forward growth.
Because of these failures an increasing number of orthodontists are turning to surgery to correct jaw discrepancies. The upper and lower jaws are cut and moved to better positions. The facial improvement is sometimes dramatic, but between 20% and 30% are subsequently rated as unsatisfactory. About 3,000 children and young adults have facial surgery in this country each year, but probably twice this number refuse surgery and accept their facial deformity. Many of this latter group are very distressed (letters available)
In conclusion, few orthodontists are sure why teeth are crooked. They can be straightened with orthodontic appliances but the crowding is likely to return, unless they are held straight for ever. In addition, there is a risk that the face can be damaged but no one is sure how often this occurs or how severe the damage might be.