Sir, your readers may be interested to know that I have laid a formal complaint with the General Dental Council, because I believe the trustees of the British Orthodontic Society 'are failing to provide the general public with fully informed consent about orthodontic treatment'.

There is no doubt that:

  • Most orthodontic treatment increases vertical growth

  • Those with vertical growth tend to look less attractive

  • Vertical growers tend to develop long-term crowding.

This is not the place for a detailed critique but the specialty must accept responsibility for these and other adverse side effects of modern fixed appliances. Sadly our patients are often quite unaware that they exist.

Lack of informed consent particularly applies to orthognathic surgery where patients are rarely told about alternatives such as 'Natural Growth Guidance' which claim to achieve a full correction without surgery. This is not because orthodontists do not know about them, but because they don't believe they work. This should be for the patient to decide not the orthodontist. Patients waiting for surgery are likely to want any information about non-surgical methods, regardless of their effectiveness.

The General Dental Council takes a stern attitude to any clinician who fails to mention all alternatives 'that the patient might wish to know about'. Currently about half the patients who are offered surgery subsequently have compromise treatment or accept their condition, never knowing that a full correction might have been achieved without surgery.

Because the orthodontists speak with one voice their opinions are often accepted without question, even by august bodies such as the GDC. Over the years I have frequently voiced these concerns and as a result I have been labelled an 'unscientific maverick', my character has been impugned to a point where established figures will not reply to my letters, my efforts to apply logic to orthodontic treatment have been ridiculed and I have now been thrown out of the British Orthodontic Society. I accept all this as the lot of those who challenge the establishment but sometimes it has to be done.

I have many good friends in orthodontics and I hope they will forgive this transgression but the specialty must become more self critical if we are to maintain the public's faith. It is no good saying 'this is as good as it gets'.