According to some orthodontists, this lack of objective evidence of health benefits is cause for concern. After all, treatment places a financial burden on families and the health-care system, and it also poses some health risks. Even unlikely complicationsfrom adverse reactions associated with surgical interventions to issues from the long-term effects of X-ray exposureare bound to impact a small but measurable number of patients if enough people are treated, Hujoel said. And millions of kids receive orthodontic treatment each year.

But others see things differently. The cost-benefit [ratio] there is so low, said Greco. If you can readily correct a problem as a patient develops, youd want to do that to give that patient every opportunity to develop normallyemotionally and mentally, physically.

The problem is not that individual orthodontists are intentionally misleading patients. The problem, Ackerman said, is cultural. Evidence just isnt valued as highly in orthodontics as tradition and clinical experience. Although the American Dental Association Commission on Dental Accreditation requires an evidence-based curriculum, It is largely paid lip service, Ackerman wrote in an email. (The ADA did not respond to requests for comment.) Instead, his residency experience emphasized the classical practice of orthodontics. At one point during residency, Ackerman challenged his chair on a recommendation given to a patient. He still remembers the response he received: AckermanDont confuse me with the facts, my mind is made up.

As a lecturer, Spassov was interested in incorporating a more critical discussion of evidence into his curriculum. However, he said that his colleagues dissuaded him. He says he was warned that incorporating evidence-based principles would confuse students. According to Spassov, it is easier and less confusing to just teach the same content each year. But that shouldnt justify avoiding the topic entirely, he said. Diverging evidence is at the core of science and research, he wrote in an email to Undark.

Orthodontists need to rethink how they communicate treatment needs with their patients, said Richmond. Health professionals have to be careful what they say sometimes, he said. When they say, You may have an issue, that gets stuck in your mind.

Ackerman agrees that patients deserve nuanced and accurate information. In 2007 and again in 2018, he challenged the American Association of Orthodontists about specific claims on its website: namely, that malocclusion can cause loss of teeth, speech impediment, and poor nutrition. When asked for evidence to support these assertions, the association dismissed the complaint with no real investigation, Ackerman said.

Around a decade after his first complaint, it finally modified the websiteand only slightly. Still, Vig said, its a step in the right direction.

Read more:

Americans Are Spending Billions on Unnecessary Dental Treatments - The Atlantic