Exceedingly few orthodontic findings are diseases – precisely, the concept of disease is only valid for the lip-jaw-palate clefts. In fact, most of the orthodontic findings have to be classified as deviations from the ideal without causing disease. However, orthodontists often claim that orthodontic deviations could indirectly cause other diseases.
We have conducted two searches in the internet in order to find out what orthodontists claim about health significance of orthodontic treatment – and we will compare these statements with the current state of science.
In August 2014 the search term “orthodontist Berlin” was entered into Google’s search engine and the first 20 entries of practices were examined. In April 2017 we repeated the same procedure for Frankfurt/Main.
How Orthodontists Describe the Health-Related Benefit of Orthodontics
Both searches revealed that 80 percent of the practices advertised health-related benefits of orthodontic treatment according to disease prevention. First of all, the orthodontists in Berlin mentioned craniomandibular dysfunctions (CMD) (9), periodontitis (8), tooth decay, orthopaedic diseases (7 each), gastro-intestinal disorders (4), speech impairments (3), respiratory problems (2) and tinnitus/vertigo (1).
Similar to Berlin the orthodontists in Frankfurt mentioned CMD prevention (12) most frequently, followed by orthopaedic diseases (11), periodontitis (7), tooth decay, speech impairment (5 each), respiratory problems, psychological disorders (4 each), headaches (3), tinnitus and gastro-intestinal disorders (2 each). There were up to seven mentions on a website. This clearly demonstrates that a large majority of German orthodontists advertises with massive health-related benefits of orthodontics.
The question rises how we are able to know whether there are such health effects. Fortunately, there are medical databases like Pubmed which offer scientific studies providing information about these correlations.
We will discuss the correlations between orthodontics and the most frequently mentioned diseases in light of the epidemiological studies which have been published. (Epidemiology = part of medicine which deals with the spread, causes and consequences of disease.)
No Significant Correlation Between Tooth Position and CMD
There are plenty of studies concerning risk factors for CMD. The most important: being female, being in reproductive age, followed by several psychological disorders. The bite and tooth position play a secondary role as risk factors for CMD. Scientists of the university in Greifswald concluded from their data that only 13 percent of CMD symptoms would correlate with dental disorders and the other 87 percent would have to have other causes.
Since the mid-90ies of the past century several systematic reviews have shown that orthodontic treatment is neither preventive nor curative for CMD but at the same time, vice versa, it’s no risk factor for CMD. However, this once again highlights the fact that such statements of the CMD-preventive effect by orthodontic treatment given by German orthodontists are simply wrong.
Michelotti A., Iodice G.: The role of orthodontics in temporomandibular disorders,
Journal of Oral Rehabilitation 2010 37; 411–429
No Correlation Between Tooth Position and Tooth Decay
Among all the epidemiological studies about tooth decay there’s none showing a significant correlation to orthodontic findings. Tooth decay is mainly caused by a combination of food intake of sugars and an insufficient dental hygiene, whereas in individual cases local factors can play a minor role but aren’t important regarding the entire population.
The best way to prevent tooth decay is based on a healthy nutrition and using a tooth brush and dental floss instead of dental braces. The statements concerning tooth decay reduction through orthodontic treatment are also wrong.
Periodontitis Isn’t Caused by Misaligned Teeth
It’s the same with periodontitis. Although it sounds reasonable that misaligned teeth are difficult to clean and are therefore a risk factor to periodontitis, there’s no evidence of orthodontic treatment having a beneficial health-related effect on periodontal diseases.
In a systematic review – unrivalled in quality even today – the authors concluded that orthodontics even leads to a minor clinical periodontal worsening whereas a benefit couldn’t be proved. It is quite astonishing that our orthodontists seem to ignore these studies and claim the opposite in a dishonest way.
Bollen AM1, Cunha-Cruz J, Bakko DW, Huang GJ, Hujoel PP.The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. J Am Dent Assoc. 2008 Apr;139(4):413-22.
No Correlation to Orthopaedic Diseases
A uniform finding of almost every major epidemiological study is a total lack (or almost total lack) of correlation between tooth alignment and CMD. It is not surprising that this also applies to the correlation between tooth alignments on the one hand and body posture and orthopaedic diseases on the other hand. Those correlations are often claimed, but they can’t be found in the epidemiological studies, even less in therapy studies.
Against this background, orthodontics is neither good for CMD therapy nor for curing orthopaedic diseases. In this regard, statements given by many orthodontists concerning the health-related effect of orthodontics on orthopaedic diseases is simply wrong.
Manfredini D et al. Dental occlusion, body posture and temporomandibular disorders: where we are now and where we are heading Journal of Oral Rehabilitation 2012 39; 463–471
The Tooth Position Doesn’t Cause Gastro-Intestinal Disorders
It can be proved that people who show an ideal occlusion have a more efficient chewing apparatus than those who suffer from major orthodontic disorders. For this study the probands chew silicon pieces in a given period of time, spit them out and the particle size is measured. Nevertheless, a correlation between tooth position, orthodontics and gastro-intestinal disorders or body weight couldn’t be found. It is no wonder because in modern societies people consume highly processed food which doesn’t need extensive chewing. Therefore, the claim about orthodontics preventing gastro-intestinal disorders is proving to be false.
Orthodontics and Breathing
There’s one orthodontic procedure which has a demonstrable health-related effect on nasal breathing: the palatal expansion. This method leads to an expansion of the palatal bone followed by widening of the nasal ducts which reduces the nasal breathing resistance. Due to palatal expansion several health-related effects could be described, for example from ear symptoms in many otologic diseases to enuresis. Most of these positive effects can be traced to an improved breathing and ventilation of the tubes. However, it’s not clear whether these effects are temporary or permanent. Nevertheless, the palatal expansion could be appreciated from a medical point of view, but not in regard to the old-fashioned removable expansion plates which German orthodontists make use of.
Some studies showed a slight health-related effect on the pharyngeal breathing after treatment with functional orthodontic appliances. The effect is moderate and unlikely to be maintained for a very long time. Against this background, orthodontists should not act as respiratory therapists, even if the future might prove a health-related effect of orthodontics on breathing.
Tooth Position, Orthodontics and Headache
Many different headache diagnoses are described. The most well-known are the tension headache and migraine. Among these, a tooth-related headache can’t be found. The misalignment of teeth and malpositioning of jaws do not normally belong to the known causes. This is why the claim of headache prevention through orthodontics has to be considered as dishonest.
Orthodontics and Tinnitus/Vertigo
Tinnitus and vertigo are symptoms of the inner ear which is a separated anatomical and functional region from the dental and maxillofacial area. Due to the neuronal connections of the head and throat region a highly developed activity of the chewing muscles can eventually enhance these symptoms. But muscle activity is not the primary cause for the inner ear symptoms. For this reason it’s dishonest to give people false hopes who suffer from tinnitus or vertigo by claiming orthodontic treatment could heal them. An unspecific effect of muscle relaxation – which doesn’t depend on orthodontics – is possible. Several studies in children could show that palatal expansion had a positive effect on some ear symptoms which is probably based on improved tube ventilation. But all statements about tinnitus and vertigo are dishonest.
Orthodontics and Speech
In this medical sector very few studies can be found about this, but these are mostly case studies and opinion articles. It seems highly plausible that major misalignments of the front teeth could have an effect on speech. In this respect, orthodontic treatment could be part of the therapy. As evidence still leaves much to be desired orthodontists should not claim orthodontics being essential for a proper speech development.
Tooth Position, Orthodontics and Psyche
In recent years, some studies have revealed that orthodontics has (at least a temporary) health-related effect on young patients improving their well-being and strengthening their self-confidence. Those effects are moderate and it’s not clear whether they are temporary or permanent. Apparently, children who not only suffer from major tooth misalignements but also from mobbing can benefit from an orthodontic treatment. Nevertheless, this is not the basis for claiming orthodontics as a global preventer of psychological problems.
The Main Effect of Orthodontics is the Esthetic Improvement
Against this background it doesn’t surprise that two of the most prominent representatives of the Swedish orthodontics drew their conclusion in a review article regarding the need for orthodontic treatment. They stated that esthetic improvement through orthodontics is the main effect. Therefore, the authors recommended postponing the beginning of the treatment until adolescence because at this point the teenagers develop a sense of dental esthetics and are able to make an informed consent regarding the initiation of orthodontic treatment. (Mohlin B, Kurol J.To what extent do deviations from an ideal occlusion constitute a health risk? Swed Dent J. 2003;27(1):1-10)
A well-known American orthodontist stated that the major part of orthodontics isn’t a therapy of diseases but an enhancement of body conditions. He rigorously asked orthodontists to free themselves from propagating their treatments as primary health care. (Ackerman MB. Selling orthodontic need: innocent business decision or guilty pleasure? J Med Ethics 2010;36:275-278).
“Medical“ Marketing of Orthodontic Treatment is Dishonest
In summary, we can state that the medical marketing of 80 percent of the German orthodontists regarding the health-related effect of orthodontics is inaccurate and misleading.
The aggressive advertising of the German orthodontists might be correlated – compared with other countries – to the high density of supply: the countless healthcare providers have to make a living from their profession. It has proven to be a mistake that the German government has withdrawn from the regulation of supply. In 2001 there were quantitative regional limitations for dentists and orthodontists. Since then the orthodontic market has been left unregulated.
Patients and parents of young patients should not be fooled by orthodontic advertising: Almost all of the orthodontic treatments are elective and based on the patient’s wish to improve the tooth alignment, but not a compulsory medical program.