As I am doing a routine dental check-up on one of my young patients, I feel her despair. I also am biting my tongue, as the orthodontist her father decided to take her to is using the magic Herbst appliance to grow her deficient mandible. In my mind, I am thinking things that I could not say without risking a slander lawsuit.
The orthodontic journals still contain articles where the authors are proclaiming stimulation of mandibular growth, when most authorities agree that it is not what really is happening. An orthodontist friend came across a patient who was in a Herbst for a prolonged period of time. The patient had severe deterioration of the TMJ but repeated requests for radiograph evidence were ignored. Are we trying to keep something secret?
If we use facial analysis and determine that a deficient mandible is the cause of a ’bad bite’ what options should dentists offer? If a patient is a teen are we really allowing children to be tortured by convincing the parent orthodontics is the cure, when often it only gives the impression of a correction. Posturing the mandible forward is an unnatural state and doctors use certain techniques they may be venturing into voodoo science.
Decades ago my cousin fell asleep at the wheel and was ejected from his vehicle. His left leg was hanging by a thread, but they pieced it together rather than amputating. The bone fragments healed, but the damaged leg ended up three quarters of an inch shorter than the unaffected side. He could have had it surgically lengthened but instead he either walks with a limp or wears a shoe that corrects the discrepancy with a thicker heel.
These compromises are similar to what we can offer in dentistry for a deficient mandible. We can offer a surgical advancement (high risk-text book results- but numbness and death are compromises), correct any anterior alignment concerns (cosmetic ortho -compromises), dabble with ‘camouflage’ treatment (compromises) or even pretend to grow the mandible with appliances.
If the mandible cannot be stimulated to grow, then this treatment is as silly as charging my cousin $8,000 to teach him to correct his gait with an uplifted heel (walk on your tip toes if you want to be taller Mr. Tom Cruise).
The limited post-orthodontic supervision time may serve to protect the orthodontic practitioner from legal responsibility and from seeing the truth that the treatment often falls short of the claims. It is one thing to say you can do something, another to lie when you know you can’t and another to fool yourself into thinking you can do it even when the science says it doesn’t work.
With all the stink about general dentists doing ‘shorter term braces’ I simply shake my head. The ones making the most fuss are often doing things that are using outdated techniques that need to be put in a museum. I see an ad for an upcoming convention where periodontists and orthodontists are getting together…why are they excluding the best referral source they have on the planet?