Which Is Farther, North or by Bus?
When I talk to my colleagues, it often occurs to me that we communicate in a kind of orthodontic double-speak. A description of a patient's condition as a "Class I malocclusion with a Class II skeletal pattern, a skeletal open bite, and a long-face syndrome" leaves me wondering just what kind of problem that patient has.
At the heart of this double-speak is the use of dental terms to describe skeletal conditions and skeletal terms to define dental relationships. For example, the Angle classification of malocclusions--which is limited to the relationships of the teeth--is clear and useful. There is little argument about the arrangement of the molars in a Class I, Class II, or Class III malocclusion. But when this dental classification is applied to skeletal structures, it is no longer informative and may be downright confusing. Does a "Class II skeletal pattern" mean the patient's mandible is retruded? Does it mean the maxilla is positioned too far forward? Or is there a combination of the two?
Another example of orthodontic doublespeak is the term "skeletal open bite". Does this imply a uniform opening between the upper and lower dental arches, from the left second molars around the arch to the right second molars? Does it mean there is minimal overbite of the anterior teeth, accompanied by a long lower face? Or is it intended to distinguish between a very large and a very small open bite?
And what about "long-face syndrome"? Webster's defines syndrome as "a complex of symptoms indicating the existence of an undesirable condition or quality". What is the "complex of symptoms" in a "long-face syndrome"? Is this meant to describe a long lower face in conjunction with a deep overbite and a short posterior face? Does it include excessive maxillary incisor display? I gather from my discussions with colleagues that there is little agreement about precisely what is meant by "long-face syndrome".
Even more disturbing than the confusion caused by double-speak in our communication is the effect it has on our thinking. As George Orwell pointed out, the real danger of double-speak is that it leads to double-think. By mixing the terms we use to describe dental and skeletal structures, we introduce a distortion in our thinking that can prevent us from accurately assessing orthodontic conditions. It stands to reason that a population of patients having excessive overjet with a Class II skeletal pattern would all receive similar orthodontic treatment. However, if this population were divided into two groups, differentiated by mandibular retrognathia and maxillary prognathia, the diagnoses might result in quite different treatment recommendations.
I would argue that dental terminology should be used exclusively to describe dental relationships. Terms such as "Class II, division 1 malocclusion", "posterior open bite", "excessive overjet", "deep overbite", and "dental midline deviation" must not be applied to any skeletal structures. Conversely, terms such as "mandibular retrognathia", "maxillary prognathia", and "long lower face" must be reserved for skeletal structures only.
This argument might seem purely academic, but it is of fundamental importance. Our thinking is shaped by our vocabulary. As long as we continue to mislabel patients' conditions, we will lack the clear vision we need to come up with appropriate solutions. We might as well ask ourselves, "Which is farther, north or by bus?"