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Science and Skepticism

Author/DatePost
Laura_Kasman
Aug 14 2005
skepticism and orthodontic procedures?

I do medical research for a living (not clinical - I work on mouse cells mostly) so I am not an expert on this topic. However, I read the latest medical journals and this is the summary of what I found out. In light of the facts, I found the whole mammography propaganda machine so disturbing that I decided to write this up.

If you are female and 40 or over I know you have been advised, pushed, maybe even told that you are risking your life if you don't get a mammogram every year. Personally, I take the ALARA (As Low As Reasonably Achievable) principle for radiation exposure, drilled into me in the research environment seriously, and try to avoid all X-rays unless I'm in severe pain AND it seems warranted. So, when I got my first push to get a mammogram at age 40, skeptic that I am, I read the studies. What I found amazed me. As of 2005, 7 large clinical trials have been completed to look at whether or not regular mammograms reduce death from breast cancer. These have been carefully analyzed for their adherence to good scientific methods in a Cochrane Review.

The conclusion of all these studies amazed even skeptical me. At best, the results indicate that if 1000 women over 50 years old are screened for cancer by mammography for 10 years, AT MOST one life will be saved from breast cancer. The best, most carefully done study found NO DIFFERENCE in breast cancer mortality between women who received regular mammography screening and those who had none. And overall mortality was not reduced in any of the studies- in other words, women who got regular mammograms did not live any longer on average than women who didn't.

Worse, mammography was not harmless. For every 1000 women screened for 10 years, 3 will get mastectomies and 2 will have "tumorectomies", and over 100 will be made to have additional tests due to false positives and all the anxiety that comes with that - all for at most one and most likely no lives saved from breast cancer.

How then can it be that women are being told to get screened now at younger and younger ages? I think there ia ample evidence to say that medicine is a ship that is slow to turn, especially when health care providers have spent hundreds of thousands of dollars on fancy mammography equipment that unlike CT scanners or X-ray machines can be used for nothing else. And there is big, big money in mammography at $100 per woman per year on average. Women's health programs are great PR for hospitals as well. Makes you think they really care about you.

I welcome any thoughts on this or other evidence you've heard to the contrary, but for now my conclusion is that this is a medical test I can safely skip forever.

Are we the only parents that think the "rapid palate expanders" that are being recommended by orthodontists for so many kids these days are barbaric? Our daughter has the unruly teeth of any 9 year old - some are too big and some are too small and a few are loose (a stage we now know is referred to as "mixed dentition"). Her teeth are crowded, and we would have thought that was a natural consequence of her adult teeth growing into a child's mouth that will catch up later. However, a few months ago an orthodontist recommended we have a palate expander put in her mouth. For those of you unfamiliar, it is a set of metal wires anchored to a molar on each side of the mouth that is steadily expanded with a key every day for weeks to push the sides of the mouth apart. This can be done on both the upper and lower jaw and as you can imagine, it makes eating, brushing and talking a challenge. And it hurts. It also costs about $3000.

Then after a wait period, when most of the adult teeth are in, the kid is put in regular braces for another year or two or three (and another $3000).

My initial reactions were (1) Cranking our daughter's perfectly normal face apart with a key every day is barbaric (2)To make all that extra time with wires in your mouth worth it there has to be some amazing benefit. Our regular dentist and hygenist think it's terrible of us not to do it if the orthodontist says to!

My second reacton was to search Pubmed (www.pubmed.gov) a free database online of thousands of peer-reviewed medical journals. Well it turns out that some orthodontists did some blinded clinical trials on palate expanders in kids with normal mouths except they were in mixed dentition with crowded teeth, and guess what - by the end of the treatment, experts couldn't tell the difference.

In one study, kids were randomized to early treatment with palate expansion, headgear, or observation without treatment. Then these three groups were randomized again to be treated by one of four dentists who did not know their early treatment history. At the end, when all patients had completed treatment, other experts were asked to look at each patient and grade the way their teeth were lined up according to standard orthodontic criteria. The average grades were the same for all groups. In addition, there was no difference in the number of permanent teeth pulled between the groups, so palate expansion didn't make enough extra room to save adult teeth.

In another study, the researchers sent X-rays and mouth casts to a number of orthodontists and asked them say whether or not the child needed orthodontic treatment, how they would do it, and how difficult it would be. Half the X-rays and casts were from kids who had had palate expanders already, and half had not. Again, except for the palate expander group being rated a little less difficult on average, there was no difference between the groups.

And if the experts can't tell the difference, will your kid's significant other, or teacher, or job interviewer? We're saving our $$ and letting our kid be a kid without metal in her mouth from the age of 8 on.

Larry_Carter_Center
Oct 9 2005
breast testing and teeth

I am glad to have the benefit of Laura's views on both radiation aimed at breasts with no other indication as well as dental technology on growing young mouths.....my 11 year old is approaching puberty and has fine teeth that do not need over zealous "practice" from profit motive dentists.....amalgam alone is an indictment of this profession.....HOWEVER I hope that all primates practice breast self exams for lumps.....and I wonder if

ultrasound devices are less or at all risky for diagnostics? What about frequent white cell and red blood cell counts? Platelet assessments? Plasma analysis? I am sure that Edison said that: "the physician of the future shall interest his patinet in his own healing" We needs lots more information, home test kits and basic anatomy schooling in earliest grades to accomplish the goal of self health maintenance and maximizing idiopathic medicine....our

species deserves long lives, happy lives and pacific living without war trauma, roadway trauma, occupational safety and home hygiene

MK
Dec 4 2007
Palate Expander studies

Laura, Your post was very informative regarding the Palate Expander procedure. We are facing the same decision for our 7 year old daughter now and would like to do more homework on the topic. You cited 2 studies found in pubmed.gov. Can you recall the authors or the titles of the studies? I would like to take a look. I realize that your post was from a while ago. Any help would be appreciated.

Also, since your post was from 2 years ago, your daughter is now 11. Have you had any additional experience since then on the topic that you can share?

-Mike

Laura_Kasman
Dec 5 2007
Palate expander update

Mike,

Thanks for your post. By coincidence, our daughter is getting braces put on tomorrow! She has had an appliance just on top for a few months already, to try to move some teeth back and make space. Tomorrow she gets the regular brackets. Although it wasn't our main consideration, we were a bit surprised to find out that skipping the first palate-expander phase didn't reduce the cost. The orthodontist who proposed the two-phase treatment charges $6000 per person apparently, no matter what the method of treatment. That office also wanted us to have 4 adult teeth pulled before starting treatment. I've talked to lots of people who had teeth pulled for orthodontic reasons and they all said it was no big deal, but we decided to talk to some other orthodontists.

The orthodontist we went with instead wanted to try a fixed appliance for a few months to try to make space and save those teeth. Frankly, it looks something like a palate expander except there is no key to turn to expand it and I think it is supposed to push teeth back, not out. Apparently he feels that worked, since tomorrow he is putting on the regular braces and thinks there will be enough room for all the teeth. That's a little amazing to me seeing the jumble there is now, but he's done this hundreds of times so he should know. He also charges about $1000 less than the other practice. Of course none of it is very pleasant to have in your mouth.

The articles I referred to previously are listed below. I haven't read anything about this topic recently. If you find out anything new, please let me know.

Laura

The articles I read were:

Evidence-based orthodontics for the 21st century by Marc Ackerman, D.M.D. JADA, Vol. 135, Feb 2004. It's online at http://jada.ada.org/cgi/content/full/135/2/162?ck=nck#F3

Benefits of early Class II treatment: Progress report of a two-phase randomized clinical trial by J.F. Camilla Tulloch, et al. in American Journal of Orthodontics and Dentofacial Orthopedics Vol 113(1): 62-72.

Outcomes in a 2-phase randomized clinical trial of early Class II treatment by J.F. Camilla Tulloch, et al. in American Journal of Orthodontics and Dentofacial Orthopedics Vol 125(6): 657-667. The author can be contacted for reprints if you can't get access to the article on-line.

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