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Straight talk

Sunday, August 3, 2003
Check out any glossy magazine and you’ll be dazzled by the Hollywood smiles. With a $5000 price tag, the pressure to possess the perfect smile is painful, let alone the agony of losing teeth and months trapped in braces. But what if traditional treatment was doing more harm than good?

What if it was actually damaging your face? Those questions are at the centre of a bitter row in the world of orthodontics, where a group of mavericks are promising the good looks without the extractions — and often without braces.

PETER OVERTON: These days everybody wants that perfect smile. Getting it has become almost a rite of passage for teenagers and a costly investment for parents. But now for the bad news — maybe the treatment we've trusted for generations is all wrong.

DR JOHN MEW: There is no doubt that orthodontics can damage faces. All orthodontists know this. I've spoken to orthodontists who actually say to me, "I've got to get these teeth straight" and, all right, maybe it has damaged the face slightly, but you know, "that's the only way I can get the teeth straight".

PETER OVERTON: English orthodontist Dr John Mew is a maverick, dead against the popular treatment we take for granted — pulling out teeth and putting on braces. Sure, you'll have nice straight teeth, but — and here's the real revelation — often your face will actually end up looking less attractive.

Have you damaged faces in the past?

DR JOHN MEW: Well, look at mine. My father treated me by taking four teeth up here and pulling everything back and I've now got a very long face, very flat cheeks and a big nose. I might have been a good-looking chap.

PETER OVERTON: To get a clearer idea, you should meet identical twins Ben and Quentin Creed. They're a classic test case. Ben had traditional treatment — four teeth out and braces. Quentin tried Dr Mew's method — no extractions, no braces. Now you can definitely tell them apart.
Quentin, what's your opinion of the result?

QUENTIN CREED: Well, I think it speaks for itself, doesn't it? It's blatantly different. From being a mirror image to having different features altogether. I've got more pronounced cheeks, longer jaw bone, more pronounced than my brother's, bigger smile, fuller lips.

BEN CREED: I've got a longer face, the smaller smile, less pronounced features and just generally more of a flatter face.

PETER OVERTON: Do you see that as a result of braces and extractions?

BEN CREED: Yes, it's probably due to the extractions and the braces that I had, yeah.

PETER OVERTON: The crux of Dr Mew's argument is that extraction and braces push the face back, making it flatter and longer.

DR JOHN MEW: The orthodontists prefer what they call a straight face. I like a full face with the front part of the face further forward. All your film stars have that face.

PETER OVERTON: So how does Dr Mew achieve this kind of film star good looks — straight teeth and perfect cheeks and lips? Well, to put it simply, instead of removing teeth to fit the jaws, Dr Mew changes the shape and size of the jaws to fit the teeth.

DR JOHN MEW: We took her jaw forward. Although it looks too far forward there, in fact, she finished at the end of the first stage of treatment with it looking even worse here. But of course that unlocked the lower jaw, which then enabled that to be brought forward and we eventually finished with her looking like that.

ANDREW HALL: Really it's quite shocking how little jaw I had and goofy I was.

PETER OVERTON: Eighteen-year-old Andrew Hall is another of Dr Mew's success stories.

When you look in the mirror now, what do you see, a handsome young man?

ANDREW HALL: Well, yes, obviously I am. Much better … I'm very glad I didn't end up just staying like that, because it is quite atrocious.

PETER OVERTON: Has it had a flow-on effect in terms of your self-esteem and confidence?

ANDREW HALL: Yes, I could see how it would have … I might not have been quite so confident had I not been this good looking.

DR DEREK MAHONY: When you look at a patient's smile who have had teeth out, you can see the teeth are straight, but there's no fullness to the lip. When I lecture internationally, this is commonly known as the Sydney smile.

PETER OVERTON: Sydney orthodontist Dr Derek Mahony has a similar philosophy to Dr Mew. He says pulling out teeth is the easy option for the orthodontists but usually not the best option for the patients.

DR DEREK MAHONY: I would say in clinical practice, eight out of every 10 patients that go to the traditional orthodontists are having teeth removed.

PETER OVERTON: Eighty percent of people?

DR DEREK MAHONY: Eighty percent of the patients.

PETER OVERTON: Dr Mahony does use braces, but extracts teeth in fewer than five percent of patients.

DR DEREK MAHONY: Last year I saw 163 people for second opinions and of those 163, we were able to treat all without extractions.

PETER OVERTON: And what had they been told by the traditional orthodontists?

DR DEREK MAHONY: They had been told they needed at least four teeth out and possibly then the extraction of their wisdom teeth after treatment. So that's nearly eight teeth.

DR GEOFF WEXLER: We've got a survey that shows that 60 percent of treatments done by orthodontists in this country are done without extracting teeth.

PETER OVERTON: Dr Geoff Wexler is spokesman for the Australian Society of Orthodontists and not surprisingly he supports the status quo.

Forty percent of people in this country are having extractions, according to your research?

DR GEOFF WEXLER: It's not my research, but yes, according to the best research, which is very authoritative in the country.

PETER OVERTON: But the Australian Orthodontics Society put its name to this study?

DR GEOFF WEXLER: It's not their research. It will be published in due course and I believe it belongs to the University of Adelaide.

PETER OVERTON: So is Derek Mahony wrong in saying the extraction rate in Australia is 80 percent?

DR GEOFF WEXLER: Derek? No. He is just quoting you his own experience and there are lots of different variations in orthodontic practices, that's normal.

PETER OVERTON: Well, how about this example. Nineteen-year-old Michael Buggy went to six Sydney orthodontists for his condition, some minor crowding. All insisted he lose four teeth. But his mother Valerie wasn't so sure.

VALERIE BUGGY: And I was horrified, because I didn't think that he had such a big problem and I begged them not to take them out. I said, "Isn't there, in all the knowledge that you have and all the studying that you've done, isn't there another way?" But they were quite steadfast that no, the teeth have got to come out or the problem would come back.

PETER OVERTON: Finally Valerie gave in and took Michael to the dentist for the extractions.

VALERIE BUGGY: He was just at the point of having them out, she had all the tools in her hand and she said, "You don't want this to happen, do you?" And I said, "No, I don't, but what else can I do?" And as luck would have it she gave me this dentist's card and said, "Give him a ring."

PETER OVERTON: That card belonged to Derek Mahony and he straightened Michael's teeth without extractions.

VALERIE BUGGY: I would like to actually show these orthodontists that said to me, "You'll be back, you'll be sorry." I'd like to show them his smile now and I just wish that orthodontists would get together and give any mother like me the opportunity not to have the teeth taken out.

PETER OVERTON: Can I show you this patient here? Do you think he needs extractions?

DR GEOFF WEXLER: Well, I wouldn't.

PETER OVERTON: You wouldn't?


PETER OVERTON: Six eminent orthodontists recommended to this patient's mother that he needed to have the classic four on the floor.

DR GEOFF WEXLER: What you've presented me here is part of the information. Based on what you've shown me I wouldn't, but there might be other factors that you haven't shown me in this patient's diagnosis.

PETER OVERTON: He's had very successful treatment with Derek Mahony without extractions. Does that surprise you?


PETER OVERTON: Are faces being damaged by traditional extraction-type orthodontics?

DR GEOFF WEXLER: I haven't seen any evidence at all to say that faces are being damaged in general.

PETER OVERTON: Try telling that to dentist Dr Mike Fennel. He pulled out four of his son's teeth on the advice of an orthodontist. The result? David's face ended up looking like this.

DR MIKE FENNEL: It ruined the look of his mouth. So from the nose upwards he looked great, but from the nose downwards he just looked terrible, but how do you tell that to your son? In fact, he looked like an old man. At the age of 18 he looked like an old man with no teeth in.

PETER OVERTON: Is "damaged" the right word?

DR MIKE FENNEL: Yes, it is really.

PETER OVERTON: Traditional orthodontics did that to his face?

DR MIKE FENNEL: They did, yes. Yes.

DR DEREK MAHONY: If you look at Zoe, what's caused all this crowding is really not genetics, it's more related to the way she breathes and if you open really wide there, Zoe, you can see that narrow, top jaw V-shape arch.

PETER OVERTON: Dr Mahony says the key is to diagnose the problem and start treatment at an early age. And the problem often starts here in the roof of the mouth. When children suck their thumbs or breathe through their mouths, it can be pushed in and this narrowing can have a knock-on effect. The lower jaw's forced back and down, producing what most of us would call buck teeth.

DR DEREK MAHONY: We can treat as early as six and seven. The benefit of treating early is that we're working with growth and as a result we're making the space before the eruption of the teeth. So I think age is the most important factor that separates the new approach to orthodontics to the traditional approach.

DR GEOFF WEXLER: Ninety percent of orthodontic treatment that is done in Australia, according to the education and training of the specialists, it's done after the age of 10 and the main reason I think is simply that the teeth don't come through until after the age of 10.

PETER OVERTON: But doctors Mew and Mahony would argue that it's imperative to treat them at a young age, because that's when they're growing, that's where they change the mouth structure and the jaw structure.

DR GEOFF WEXLER: Once again you've got one or two people going against the rest of the orthodontists in the country, who think that a few people should be treated early. Probably most people should be assessed early to catch the few and the rest should be followed closely and treated at the most appropriate time, which turns out to be later.

DR DEREK MAHONY: It's very easy to have a production line in orthodontics where everyone comes in at a certain age, has a certain number of teeth out and goes through the orthodontic process. I think a lot of traditional orthodontists aren't used to dealing with young children and as a result it's a far easier approach for them to deal with the mainstream 14-year-old extraction type case.

PETER OVERTON: Young kids just put in the too-hard basket?

DR DEREK MAHONY: Absolutely.

PETER OVERTON: Is patients' welfare being compromised here?

DR DEREK MAHONY: I think patients' choice is certainly being denied and ultimately a patient's end results aren't as good as they could be. I'm saddened for the profession to think that there are so many people who aren't willing to offer their patients at least the choice.

PETER OVERTON: Dr Mahony and Mr Mew are by no means alone in this crusade, but they're battling against a powerful establishment.

DR JOHN MEW: It's amazing, if you challenge conventional orthodontistry you will be resented. It's the lot of all those who try and change the system.

PETER OVERTON: And even if the traditionalists don't agree, Dr Mew says his results speak for themselves.

DR JOHN MEW: I must say I've been amazed how deeply resented I am at times. I mean, I've even been threatened with assault at meetings. People hate me with a depth that's really quite surprising.

PETER OVERTON: Ultimately, though, perhaps we should leave the final judgment to the patient, like the now not-so-identical twins Ben and Quentin. After all, they have to live with the results.

QUENTIN CREED: I'd definitely go for Dr Mew's method.

BEN CREED: Would you?


BEN CREED: I think if I had the option again, then I would go for Mr Mew's methods. Yeah, it does give better results. Quentin got the better deal. His treatments, without the extractions, he's got the better features, he's more pronounced and mine are less pronounced and a smaller smile.

PETER OVERTON: How do you go with the girls then? You say Quentin has the better smile.

BEN CREED: He may have the better smile, but it's all the chat up and everything else. It's not just the facial features that counts!

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