We could not disagree more with Dr. Page’s letter regarding our article. In fact, it is the very position he proposes that inspired us to write the article.
Dr. Page accuses us of "protecting current dogma" in our call for a critical analysis of the efficacy of early orthodontic treatment. Whereas dogma refers to an authoritative tenet without adequate grounds, our recommendations on the timing of orthodontic treatment are based on sound evidence from the best and most recent scientific studies addressing this issue. For Dr. Page to suggest that all patients be treated in the early primary dentition by "functional jaw orthopedics" before it is evident that such treatment is beneficial, or even needed, is dogmatic indeed.
Moreover, without carefully controlled clinical trials to compare "functional jaw orthopedics" to normal growth and other orthodontic treatment modalities, it is not clear whether initiating this treatment at an early age is good practice, or merely a practice-management tool.
Dr. Page claims that "it is unreasonable to be vague about early treatment if one can escape from a ‘tooth moving’ mentality into the bone-affecting reality of orthodontics." To the contrary, in our article, we clearly acknowledge the skeletal benefits of growth modification. While it may not be as satisfying to refrain from making black-and-white statements in patient care, it is appropriate because we are bound to evidence-based decision making in a learned, clinical profession.
The question is not whether early treatment works or does not work. The real question is whether it works better than a later approach. A healthy dose of ambivalence is probably called for in multiphased treatment, because when considering the risk/benefit ratio, evidence does not support the conclusion that every child will benefit significantly from such treatment.
Furthermore, Dr. Page’s claim that early treatment has a long-term effect on airway function is simply not substantiated in the scientific literature.
Finally, our article calls for responsible, evidence-based delivery of care. Dr. Page’s argument for orthodontic treatment in the early primary dentition by "progressive clinicians" is based, in part, on a paper written when his home state of Maryland was still a colony. We prefer to cite recent clinical research, published in respected, refereed journals, to develop our recommendations.
Based on such evidence, we suggest the following: Two-phase orthodontic treatment is effective and desirable in certain situations, specifically described in our article. For other problems and individuals, also identified in the article, a later, preadolescent protocol may be more effective.
We wrote this article to present the scientific and clinically based knowledge available about early orthodontic treatment. Judging from the overwhelmingly positive feedback that this article has generated in the short time it has been published, this clearly is an important issue that needed clarification and merits continuation of the kinds of controlled studies upon which we base our recommendations.
