The Myth of Need vs. Want in Orthodontics
by 6monthsmiles, on 3/18/15, 12:54 PM
“Does anyone truly NEED orthodontics?” For most dental professionals, this may initially seem like a silly question as they operate under the assumption that many patients “need” orthodontics.
I’d like to make the point that very few patients truly NEED orthodontic treatment. Sure, many adolescents and adults WANT straight teeth but I’d like to cast some light on the topic of orthodontic NEEDS vs. orthodontic WANTS. Please follow my logic with an open mind and I believe you will consider some things you may have never considered before.
What do you do when a parent asks you “Does my child need braces?” In my experience, most dentists tend to look at the child’s teeth and say “well, if you want your child to have straight teeth then they should have braces.” Most dentists don’t know exactly what to do with the parent’s choice of the word “NEED.” As professionals, it is our responsibility to make recommendations regarding what our patients need in order for their teeth to function properly. But, most dentists don’t feel comfortable telling parents that their child needs orthodontic treatment. This is because at their core, whether it is conscious or subconscious, dentists realize that very few people truly need orthodontics.
Though most of us weren’t taught much about orthodontics in dental school, we were conditioned to believe that orthodontic treatment was primarily about improving function and secondarily about improving cosmetics. By and large, this belief is a myth. Do you have a perfect Class 1 occlusion? You probably don’t. Do most of your patients have a perfect Class 1 occlusion? They most likely do not. So, why aren’t you running out to undergo comprehensive orthodontic treatment and why aren’t you recommending ortho for most of your adult and adolescent patients? The simple truth is that people who don’t have ideal bites are functioning just fine and having no problems nourishing themselves properly. As the old adage goes, “If it ain’t broke, why fix it?”
The reality is that orthodontics is primarily a cosmetic procedure. Sure, there are some patients who have malocclusions so severe that orthodontic treatment can actually enhance their ability to function (patients with significant open bites, jaw discrepancies etc.). But, these extreme malocclusions are very rare. The vast majority of patients who undergo orthodontic treatment do so because they want the social benefits associated with straight teeth. These patients do not seek orthodontic treatment for reasons related to function.
As opposed to what most people tend to believe, almost all orthodontic treatment is cosmetic in nature. Whether it is comprehensive orthodontics, aligner therapy or short term orthodontics, all of these treatment modalities are primarily cosmetic. Aligner therapy ( www.invisalign.com) and short term orthodontics ( www.SixMonthSmiles.com) are approaches that involve a focus on cosmetic tooth movement without a focus on finishing with a “perfect” Class 1 occlusion. Over the last 5-10 years, these approaches have become extremely popular with adult patients because they provide straight teeth in relatively short periods of time and with clear appliances (clear aligners or clear braces).
Most dentists think of aligner therapy and short term orthodontics as cosmetic procedures, but they consider comprehensive orthodontic treatment as a functional procedure. This is the myth that I’m attempting to expose. The scientific literature shows clearly that malocclusions do not prevent adequate functionality, and that a Class 1 occlusion does not lessen a patient’s chances for experiencing TMD signs and/or symptoms. Studies such as those published in Quintessence Int. (2004), The Journal of Craniomandibular Disorders (1991) and The Angle Orthodontics (2004) clearly show that malocclusions, Angle class and occlusal interferences do not correlate with a prevalence of signs/symptoms of TMD. In fact, the Quintessence study showed that Class 2 patients actually demonstrate less prevalence for TMD.
With all this said, the following question is begged: “What are the benefits of comprehensive orthodontic treatment over other modalities like aligner treatment or short term orthodontics?” The answer is simple; the benefit of long term traditional orthodontic treatment is that it usually yields the MOST cosmetic result. A Class 1 occlusion with ideal overjet, ideal overbite and good maxillomandibular intercuspation is usually the most visually appealing dental scheme. However, since few associations exist between malocclusion and function/TMD, comprehensive orthodontic treatment does not provide any significant benefits other than esthetic benefits.
Treatment options like short term orthodontics and aligner therapy are booming now because adult patients are seeking the social benefits related to having straight teeth. Most of these patients understand that they could have a “better” result if they were to wear braces for years. But, ultimately they are quite satisfied with the results that are produced with aligners and short term ortho. Since most orthodontists tend to have an “all or nothing” treatment approach, these adult patients are looking to their general dentist for a solution that makes sense for them.
As dentists, we really value the appearance of a “perfect” Class 1 occlusion. We would be happy if all adult patients would wear braces for as long as it takes to get the best looking result. However, when patients refuse traditional orthodontic treatment, we can feel comfortable offering more “adult friendly” orthodontic options because these can be fantastic services for our patients. When we clearly understand that very few people actually NEED orthodontic treatment, we can confidently focus on our patient’s desires and treat them accordingly. I believe everyone should be able to smile with confidence… and I believe that as general dentists, we should be able to help!