Selling orthodontic need: innocent business decision or guilty pleasure?

The principal objective for most patients seeking orthodontic services is a detectable improvement in their dentofacial appearance. Orthodontic treatment, in the mind of the patient, is something that makes you look better, feel better about yourself, and perhaps enhances your social possibilities, ie, to find a companion or make a positive impression during a job interview. Orthodontics, as a speciality, has collectively advanced the idea that enhanced occlusion (bite) improves the health and longevity of the dentition, and as a result many patients seeking orthodontic services affirm that their secondary goal of treatment is an oral health benefit. It would appear that there is some disparity between the end-user of orthodontic services and the orthodontic provider's perception of what constitutes orthodontic need. The aim of this paper is to examine two contrasting models that characterise how dentists 'sell' orthodontic services to patients and to discuss the conflict between professional ethics, practice management and evidence-based decision-making in orthodontic practice.