I Treat Now or Should I Wait
By Dr. Michel Champagne, BA, DMD, MAGD, IBO, CDE
With young patients, we are often faced with the same question…should I treat now or should I wait. Depending on the philosophy or should I say ‘’guru’’, we may get different answers like: the best time to treat is at the end of the mixed dentition, Class III and crossbite patients should be treated very early, with the concerns of sleep apnea, bullying, and the myofunctional concept of full potential development some will also say as soon as possible.
As medical professionals we have to beware of the concept of pseudo science, present in every lecture room at every meeting and this all over the world. Many lecturers put forward new approaches, most of time these new approaches seem logical but too often they come without any scientific proof. We have to remember that a single case study as little value and we always need at least two scientific articles with similar conclusions to consider using such an approach. Keep in mind that we treat patients and not lab rats. We are also submerged by all those electronics journals putted forward by manufacturers, the youtubes of our world, the websites proning their philosophies with no background at all. We should also remember that most of the patients went to Dr. Google first and know are coming to us for a second opinion. Probably some of those gurus are real genious and they may be recognized only in a few years.
It is interesting to come back to basics and be conscious of the value of the information (Figure 1). Randomized clinical trials (RCT) are still the most reliable source of information. But, there is always a but, for each study we must look at the PICO: P for the number and distribution of Participants, I for Intervention (is the intervention without any flaws), C for Comparison i.e. the presence of a similar control group and O for the outcome, does it match the data or did the authors tweak it a little.
To treat or not to treat becomes a case-by-case decision even with the guidelines stated in the first paragraph. Personally I like to follow this simple rule, the question I ask myself is not when is the earliest date I can start but until when can I postpone treatment without compromising patient health and the quality of the results in the shortest treatment time possible. Obviously the answer will differ from patient to patient. My intention is not to tell you when to treat your patients but before you start your next treatment on a growing patient, just take a step back and ask yourself this simple question: how wide is my window of treatment and when should I treat this specific case. As early as possible is not always the right answer.
Enjoy your orthodontics.