THE EDITOR'S CORNER

To a lion or a tiger in the forest, loss of teeth or impairment of tooth function can be a life or death matter. To civilized man whose hands are tools that are superior to teeth and whose diet places no great strain on the dental apparatus, teeth have become as important in terms of appearance and comfort as they are as functioning tools or as a means of defense.

For some reason or other, appearance and comfort have not been enough reason for being for many orthodontists, and orthodontic thought has been replete with attempts to relate correction of malocclusion to prevention of periodontal disease, prevention of caries, correction of pernicious oral habits, improved speech, improved oral health, improved general health. While such relationships may exist, research so far has been unable to substantiate that they do.

This was called to our attention once again by a report by Dr. Coenraad Moorrees along with Drs. Burstone, Christiansen, Hixon, and Weinstein of a State-of-the-Art Workshop on malocclusion conducted by the National Institute of Dental Research. The report was published in the January 1971 issue of the American Journal of Orthodontics. It is instructive to pull some of the statements from their text and list them--

". . . a precise and meaningful definition of malocclusion does not exist."

". . . the etiology of malocclusion remains largely unresolved . . ."

"The general awareness that the teeth are involved in the production of speech does not imply a causal relationship between malocclusion and speech problems."

"Masticatory efficiency is known to be impaired with loss of teeth, but almost no difference has been reported between subjects with excellent occlusion and those with most types of malocclusion."

". . . no evidence exists that malocclusion . . . affects the digestive process and general health."

"In the absence of destructive or degenerative symptoms, prediction of future periodontal breakdown as a result of occlusal trauma is hazardous . . ."

". . one may still question whether specific traits or characteristics of malocclusion initiate or accelerate periodontal pathosis."

"In spite of the battery of reports from cross-sectional or longitudinal studies, a precise description of normal facial and dental development is not available."

In response to these largely negative evaluations, the Workshop concluded its report with recommendations for channelling future research into these areas. I believe that the professional, business and university communities should support this research. However, I would add that there are other areas for research which have great immediacy and, while I would not neglect the areas covered in the report, I would give a very high priority to research which would seek to:

1. Identify the problem in orthodontics. Where should the dentition be located?

2. Evaluate our present concepts in diagnosis and treatment to determine what our goals should be and what are the most efficient procedures to get there.

3. Establish standards of treatment timing.

4. Study coordination of tooth movement and growth. How much of each contributes to the results that are obtained?

5. Analyze the effect of soft tissue maturation in the adult. Is this why we seem to see less malocclusion in adults than in children?

6. Determine what contributes to the stability of an orthodontic result.

7. Standardize preventive and interceptive measures to eliminate some treatment and shorten others, and

8. Investigate the administrative, social and economic aspects of orthodontic treatment with a view toward developing a plan for orthodontic care available to everyone who may need it or want it.