Q&A: Show me the evidence
At this year’s British Orthodontic Conference, Professor Greg Huang from Washington State University will deliver the prestigious Northcroft memorial lecture. Here, Ireland’s Dental asks Dr Huang about his career and his focus on evidence-based dentistry.
Why did you study dentistry?
My father was a paediatrician, and I always admired him for taking care of kids. However, there were two things about being a paediatrician that concerned me – there were lots of after-hours emergencies, and your patients were typically ill. When I considered careers that might allow me to work with healthy kids while minimising emergencies, dentistry, and in particular, orthodontics, seemed to be a perfect fit.
What were the highlights of private practice?
When I completed my orthodontic training, I started a practice in my hometown in Florida. I really enjoyed treating patients who were the kids of my friends and neighbours, and many of my patients and their parents had been patients of my father. To me, that sense of belonging to a community is the most special part of being a health care provider. I had a great time practising in that setting for 10 years.
Why the move into academia?
After about eight years in practice, I wondered if I might be able to contribute more to our profession. I had been teaching one day a month at the University of Florida, and I decided to consider a five-year stint in full-time academia. Naively, I thought my job would mainly be clinical teaching, as I had primarily been a clinician. However, now I realise that to be successful in academia, scholarship and service are equally important. Five years went by quickly, and as I became more immersed in research and administration, the original five years has quickly turned into 21 years.
What have been some of the most satisfying investigations?
I have had a very fulfilling career in clinical research, but in particular, the investigations into third molar removal, remineralisation of white spots, vibration, and currently, the adult anterior open bite study stand out. Also, I feel that the systematic reviews we have conducted on periodontal health, open bite, deep bite, self-ligating brackets, and vibration have been real contributions to the orthodontic literature.
Describe your motivation to develop the field of evidence-based orthodontics?
Believe it or not, my entry into this field was completely by chance. When I began my academic career, I decided to pursue a degree in epidemiology in order to improve my knowledge of clinical research. This just happened to coincide with the push towards evidence-based medicine and evidence-based dentistry. After completing my epidemiology degree in 2001, I started getting invitations to speak on evidence-based orthodontics. There is nothing mysterious or magical about evidence-based care. It just means we need to have a good understanding of the principles of clinical research, and then integrate the evidence with our education/experience and the patient’s preferences/condition. I was approached by Wiley around 2008 to write a textbook on evidence-based orthodontics. This text is now in its second edition, and I think an evidence-based approach to orthodontic care is well entrenched in most graduate programmes.
And what has been the impact?
Things don’t change overnight, and the impact of EBO continues to grow. However, I do believe that the systematic reviews and meta-analysis that have been published in recent years have produced changes in our profession. For example, systematic reviews have changed our views on specific techniques, like early treatment for Class II patients or the advantages of self-ligating brackets. Also, the lack of evidence is important, as it reminds us that we do need better evidence for many of our treatments. In the US, the American Board of Orthodontics is emphasising an evidence-based approach to their exams. Finally, many manufacturers are tempering their advertising claims based on the evidence-based findings reported in the literature.
Describe the work of the practice-based network study?*
This seven-year project, funded by the National Institute of Dental and Craniofacial Research (NIDCR), has allowed us to investigate some very interesting and important questions in the field of dentistry and orthodontics. The advantages of network research include good generalisability, as well as the ability to enrol many patients in a relatively short period of time. In the case of the anterior open bite study, we had participation from more than 90 clinicians and almost 350 patients from all over the United States. NIDCR has just decided to renew the network for another seven-year cycle.
Are you embarking on new studies and/or projects?
I hope to follow the subjects in the anterior open bite study for the next three to five years. I am also interested in real-time 3D imaging of the tongue, to assess differences in tongue posture and function in normal versus open bite subjects. Over my 30-year career in orthodontics, I have always found it interesting that orthodontists can achieve successful results with many different techniques and treatment plans. If this is true, then we should also be investigating other aspects of care, like efficiency, predictability, safety, cost, and of course, stability.
What do you consider to be some of the challenges and opportunities for the profession?
Over many decades, our profession has faced both opportunities and challenges from technical advances. For example, straight wire appliances, bondable brackets, and niti wires have all improved orthodontics, but they have made it easier for non-orthodontists to provide orthodontic care. The aligner revolution, coupled with 3D technology (particularly, the advances that are possible with 3D scanning and printing), are the latest example of technical advances in our field that are both exciting and a little scary, due to their potential impact on the delivery of orthodontic care. In the United States, a large pharmacy chain is placing intra-oral scanners in their stores as a gateway for aligner treatment, with no dental professional on-site.
What are your interests outside the profession?
I am a husband and also father to two teenagers, so that occupies quite a bit of my time outside of work. Hobbies include racquetball, hiking, photography and piano.
*Dr Huang will describe findings from the large, prospective, practice-based network study conducted in the United States at the British Orthodontics Conference taking place in Glasgow from 19 to 21 September.