Sir, in the past GDPs were respected as long-term monitors of orthodontic success and this enabled them to contribute substantially to the debate. There are now moves afoot to create an orthodontic certificate or diploma for general dentists who have such interests. What are their thoughts about the current range of treatment options available and how are they able to use them?

As some had forecast, 'orthodontic registration' has led to a restriction in the range of orthodontic techniques practised. Dental students are currently advised to limit orthodontic treatment to simple cases, while those general dentists who until 1999 provided over half the orthodontic treatment in the UK using a range of fixed and functional techniques, have by now, either been grandfathered in as specialists or are progressively retiring. They are being replaced by 'Registered Orthodontists' who have been taught a relatively unified form of fixed appliance therapy.

In 1965 the British Association of Orthodontics (BAO) was established to help redress similar imbalances and to represent those clinicians who felt that the teaching at some hospitals was too prescriptive. At that time growth guidance methods such as 'Functional Appliances', 'Non-Extraction', and 'Early Treatment' were viewed with suspicion and it was BAO that helped to make them acceptable, subsequently developing into a powerful organisation. However in 1994 BAO combined with BSSO to form the British Orthodontic Society (BOS). Following this the influence of the schools became re-established and fixed appliances, frequently coupled with extractions, again predominate.

Fixed appliances undoubtedly provide an effective and predictable means of straightening teeth but have been criticised for a number of possible side effects, and also because the teeth have a tendency to relapse in the long term. Is it healthy for one type of treatment to predominate to such an extent when in many countries and at different times other methods have been preferred?

Functional appliances represent only 3% of NHS treatment. Is this because they are ineffective, unreliable or because fees have been reduced to discourage their use?

Undoubtedly their success is dependent on co-operation, but this decision is often made by the authorities or by orthodontists who prefer fixed therapy. Many parents are left unable to pursue non-extraction options that are available abroad. This is despite the fact that there is really no firm evidence either way.

Recently, at the behest of some orthodontists there has been a concerted attempt to restrict (suppress) 'growth guidance' and several general practitioners who use functional appliances have found themselves targeted by the GDC for 'overstating their effectiveness'. Is this reasonable when the truth is so clouded by entrenched beliefs coupled with so few facts?

We think the truth can only be established by a truly independent enquiry and we have offered to pay for the substantial cost of such an enquiry, but the BOS has so far been reluctant to participate. We would ask BDA members to support this offer of a scientific enquiry so that an appropriate balance can be established based on truth.

Could any concerned dentists or orthodontists contact us either via the journal or direct to contact@ol2enwide.biz.