THE EDITOR'S CORNER
Dr. McCallum's Letter to the Editor which appears on page 583 of this issue points up a significant problem in orthodontics. This is the absence of any obvious independent testing agency for orthodontic materials.
The orthodontic manufacturing companies have been generally outstanding in their investment in research and development. As you would expect, most of the larger concerns have extensive facilities for developing and testing new products, and they have access to orthodontists to test the products under practice conditions. It would be to the advantage of both the industry and the specialty to have an independent agency test products.
From my own experience in orthodontics, I do not know of an orthodontic company that would knowingly sell an inferior or potentially harmful product. Nor would JCO knowingly accept advertising for a product that we knew to be unworthy or harmful. But, we are faced with a possible situation in which it may be open to question whether a product is worthy or unworthy. This circumstance places all of us in somewhat of a quandary, none more so than JCO. Nevertheless, JCO does not hesitate to publish serious criticism of a product even if that were to risk alienating an advertiser or a potential advertiser. The fact is that the specialty does need a forum to share our experiences. JCO is such a forum and we accept its obligations.
Many products suffer from being misused. Many of us just don't read the instructions or don't follow the directions. Many of us assign certain technical duties to auxiliary personnel and may not train them or supervise them as much as they may require.
In the case of the polycarboxylate cements, there has been an undercurrent of discontent for quite some time, which is crystallized in Dr. McCallum's letter. It is important that this problem be brought to the surface, examined and, hopefully, resolved.
There is one aspect of illuminating the problem through publication of the letter and accompanying comment that is of real concern. It is potentially unfair. What if Dr. McCallum and those who have expressed a similar opinion are incorrect? It gives the product, and all the future confirmatory testing and positive support that may be provided for the product, a difficult obstacle to overcome. Adverse criticism can linger.
However, it is a larger concern that the critics may be correct. If so, then it is damage and potential damage to teeth that we are talking about and the specialty can take no chances on that.
The crux of the problem is that the manufacturers and distributors and the orthodontists have no good recourse. If we had a way to knowing whether a complaint was justified, we would all be served. If we had a way of knowing that a complaint was not justified, the criticism could be put to rest. That is why an independent testing agency is needed to test products in orthodontics. Problems like this one could be resolved and others could be avoided.
We are all aware that there are various testing agencies for dental materials already in existence, in addition to the commercial facilities. These include the National Bureau of Standards, the ADA, university orthodontic departments to some extent, and others. Of these, the university orthodontic departments have the most potential for clinical evaluation. For, as "in vivo" is to "in vitro", so "clinical" is to "laboratory". What is needed is a mix of people with chemical, metallurgical, physics, biological and engineering training to combine with knowledgeable clinical orthodontists. After all the others are done with their basic evaluation, it is still the clinical evaluation that overrides all the rest.
You cannot really experiment in private practice, as you can in a teaching situation. Therefore, the university and teaching hospital departments offer the best available facility for clinical testing. This would require coordination, supervision and evaluation by some qualified testing agency which was responsible to some independent foundation which would also fund the program.
It is not enough to have a program in a university department or teaching hospital or selected private offices and to have the results of their efforts stashed away in some dust-laden file or some obscure journal article or to have them operating on behalf of one manufacturer only. Some system of publication should be found to make the results of testing available to orthodontists. Perhaps there should be periodic testing bulletins issued to all orthodontists by the governing foundation. We could all contribute to such an effort.
