The timing of orthodontic intervention in children is still a source of disagreement between general dentists and orthodontists. Except for a minor intervention such as an anterior crossbite correction, orthodontists prefer to delay treatment until most permanent teeth have erupted. Therefore, many dental practitioners and pediatric dentists, faced with a developing malocclusion, choose to undertake early orthodontic treatment themselves rather than refer.
There are arguments both for and against early intervention. There is a lack of convincing evidence for either side and given the current parameters of the argument, a resolution is very unlikely. The irony is that in the new paradigm emerging from biology and biophysics dentists are relative latecomers; orthodontists even more so. We have to see the issue from a different perspective to appreciate why this is the case.
It is clear that genetic determinism plays a much less significant role than was thought even a decade ago. Nor is genetic determinism a one-way street. A developing cell and its genes can be influenced by factors outside the cell. The new definition of a live organism is that it is “a non-linear, dynamic, complex, self-organizing system, far from equilibrium.” This definition will be examined in a subsequent blog, but the part which has the most relevance for the question of treatment timing is “self-organizing.”
A self-organizing system such as the body can “choose” its reactions to an internal or external stimulus. Equally important is that it has an extreme sensitivity to initial conditions. In other words, the sooner we can influence development, the more effective the intervention is likely to be. The importance of the timing of intervention is eloquently articulated in the scientific metaphor of the butterfly effect, in which a butterfly flapping its wings in Tokyo creates a chain reaction that ultimately causes a storm in Ohio. The imagery is fanciful, but the science behind it is sound.
In the dental world, other health disciplines have the opportunity to influence growth and may do so even before a dentist has seen a child. Early non-dental intervention may help avoid the need for later orthodontic treatment or, at least, minimize unfavorable consequences of growth, a prospect which should have every orthodontist’s attention.
One obvious conclusion is that a team approach by like-minded professionals offers the best potential for the most comprehensive management of a developing malocclusion. Such an approach focuses on treating the causes of malocclusion rather than waiting until a malocclusion is full blown and only then treating the symptoms. Orthodontists who ignore this potential trend toward an earlier, more collaborative approach to treatment may find in the next decade that the ground shifts beneath their practices.
Cooperation between dental and other health professionals should become the norm, with each profession aware of what the other can contribute to a collaborative treatment approach. At an informal level, something like this is already happening. I am aware of some dental offices already offering a combined approach, including my own, with promising results. I encourage you to start your own search. It is never too late, and there is a mutual learning experience when you find a like-minded colleague.