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Understanding the spectrum of opinion

15 July 2014
Different practitioners have different opinions. Explaining what and why to the patient can be time-consuming but remains the safest option, as this case illustrates...

A nine-year-old girl was referred for a hospital orthodontic consultation with severe upper and lower arch crowding. The two upper canines were buccally displaced. The orthodontist recommended that extractions of some permanent teeth in both jaws were likely to be necessary.

Both parents were quite adamant that it was not necessary nowadays to take out teeth, but that the jaws could be expanded to accommodate all the teeth. Their decision was influenced by a recent television documentary in which the American view of upper arch expansion produced a widened dental arch that could accommodate all teeth present without the need for extractions.

The orthodontist explained that in cases of severe crowding the teeth might collapse into a crowded state after the appliances have been removed.

Second opinion

The parents then went independently to seek the opinion of a private orthodontist who advised arch expansion and no extractions. The patient and parents then returned to her general practitioner for her six-monthly recall appointment and asked for further advice because of the two diverse reports.  

The general dental practitioner referred her for a third orthodontic (specialist) opinion that recommended extraction of some upper and lower permanent teeth followed by fixed appliances. As yet, the patient has not had any further orthodontic treatment.

Learning point:
When three professional people give three very different opinions, a patient could understandably be confused, and often there is no single ‘right’ answer. Helping the patient to understand a spectrum of opinion may take time but it can also prevent the misconception that anyone has made a mistake.
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These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription. 
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