READERS' FORUM*

A reply to a reply

I think it is necessary that I respond to the above named reply to my letter (1997;112:17A-18A). The letters concern an article that was printed in the AJO/DO (1997;112:194-202) and that stated as a conclusion, "There is a statistically sig- nificant association between childhood wear of the deciduous mandibular molar and canine teeth and the degree of whole mouth wear observed in that same person as an adult." This conclusion can be accepted only if one accepts the present method of evaluation of treated results. I find it difficult to accept this method, as it does not begin to explain the reasons for failed results, such as relapse. Most stud- ies have shown that the majority of cases will relapse. The present study also adds to the concept of failure by stating patients wilt experience continued attrition.

I realize the authors were not studying functional occlusion factors. That is the problem with the study. One cannot study attrition and draw scientific conclusions without looking at functional occlusion. The authors now feel that because the article has been published it is scientific fact. Many articles are published that are flawed in their study and conclusions but that once published somehow become scientific fact, particularly in the minds of residents and young orthodontists.

The authors state that my clinical observations are merely personal anec- dotes and that I should do scientific research and publish it in the literature. ! have never considered myself a scientist but only a clinician with 35 years of expe- rience. For more than 20 years I have had the opportunity to work with hundreds of

orthodontists each year on four different continents. Because of this experience, I have been able to observe thousands of cases. It may be clinical anecdote, but those cases treated with functional occlu- sion concepts as one of the treatment goals have the fewest problems postreten- tion. I feel it is not my job to do the sci- entific research. I leave that to the scien- tists at the universities. My plea is that when they do the research that they do it correctly and get input from skilled clini- cians who have expertise in the subject being researched so that the results are truly meaningful.

Robert E. Williams, DDS, MS Los Altos, CA 94024

For be t t e r o r w o r s e ?

I was very concerned to read the arti- cle "Profile changes in patients treated with and without extractions: Assessments by lay people" by Samir Bishara and Jane Jakobsen (112:639-644). As presented, it is very misleading. Not only were the patients selected to eliminate "poor treat- ment results" and include "well-treated" ones, but those with "mentalis muscle activity" were also eliminated. Although not mentioned in the article, this last

selection was made on the posttreatment cases only, I suspect, because the pretreat- ment overjet would have made lip seal difficult.

Even if the first two selections are ignored, all this article shows is that patients who develop a lip seal have improved appearance, a conclusion that I would strongly support. It is absolutely unjustified to conclude from this article that orthodontic treatment with or without

extractions affects the face for either bet- ter or worse.

John Mew Clinical Director

The London School of Facial Orthotropics,

21, Foxley Lane Purley, Surrey, CR8 3EH, U. K.

EDITOR'S NOTE: The authors chose not to respond.

*The viewpoints expressed are solely those of the author(s) and do not reflect those of the editor(s), publishers(s), or Association.

American Journal of Orthodontics and Dentofacial Orthopedics/April 1998 33A