Risk management in orthodontics: experts' guide to malpractice

  • T.M. Graber,
  • T. Eliades &
  • A. Athanasiou
Surrey: Quintessence price £78, pp238 ISBN 0867154314 | ISBN: 0-867-15431-4

A glance at the title of this book would immediately trigger an interest in most orthodontists and probably some of the legal profession. So what is the aim of this book and what is the content?

The aim is to explore the cause of some of the things that can go wrong during orthodontic treatment and then to define risk factors associated. The overall aim is to place in context unfounded and undocumented anecdotal statements in relation to treatment procedures, materials and adverse tissue or systematic reactions. The second half of this book deals with risk management and is written by an orthodontist, an insurance specialist, an attorney and an orthodontist/periodontist, all of whom have some experience of malpractice. Twenty-one specialists from six countries made a contribution to this text.

The first chapter provides a classification of things that may go wrong in orthodontics. The remainder of Section 1 then deals with potential iatrogenic responses and this is broken up into 10 chapters. They cover enamel damage and root resorption, damage to tooth supporting tissues, temporomandibular disorders, pain and discomfort in relation to orthodontics. The use of materials and unfavourable responses are also explored. Finally there is a chapter on orthodontic treatment for the medically compromised patient.

Many of the chapters are written in a style similar to that of a personal literature review. There is seldom any real attempt to stratify the strength of evidence that is presented. This is disappointing when one is looking for hard evidence. All the chapters are beautifully illustrated, although the odd faded diazo lets the overall picture down.

The chapters on pain and discomfort and polymers in orthodontics are novel and interesting. The chapter on temporomandibular disorders is well written and sensible. In section 2 there is an excellent chapter on malpractice aspects of orthodontic treatment in patients with periodontal disease. It is easy to read and well illustrated. The chapters on avoiding malpractice law suites contain good advice but do not look for any hard evidence. Overall a brilliant idea for a text, I think let down in the way that hard evidence is presented since most of it could easily be countered. This is not necessarily the fault of the authors; we need to provide better primary research to support what we do clinically.

Every postgraduate library needs a copy of this text. My guess is that subsequent additions will improve their level of evidence and become a must for all practices throughout the world.