John Mew’s Lectures 7 – Informed Consent

As you all know, every patient attending for treatment should be informed about both the
advantages and disadvantages of every treatment. This is not as easy as it sounds and we must be
careful not to pass our own convictions on to patients without mentioning any drawbacks. For
instance almost all orthodontics these days is done by fixed appliances. We ‘know’ they are precise
and are probably the best way of aligning teeth.

What about the disadvantages? Yes fixed appliances can cause some root resorption but we can’t
treat patients without that risk. However we must remember to mentions alternatives like
removable appliances even if we don’t use or agree with them, although we are allowed to say if in
our opinion onr or the other is more suitable. It is the same with stability. Orthodontic results will
almost always relapse unless the teeth are retained indefinitely. Do we say or believe there are no
alternatives or is it that we don’t accept the claims by orthotropists that they can create permanent
stability without root resorption. We must be even handed.

A major issue is facial appearance. Many papers and individuals have suggested that damage by
fixed appliances is possible and not so many have said that this does not happen.


In fact there is very little comparative research on this very sensitive subject.

Certainly it is of great importance to the public and we need to be honest about this.

Possibly the most important issue is the widespread use of minor or major facial surgery to improve
facial appearance. Major surgery and is usually delayed until the patient is over 18 and the results
vary with many successes but some failures. This is acceptable provided the patients are warned of
possible failure but many of these operations are elective which raises the stakes. Patients who are
offered irreversible surgery must be told of every possible risk or alternative treatment.

In 2012 I conducted a survey of 1059 members of the public asking them “Imagine for a moment
that you have a child who suffers from abnormal jaws and face. Typically major corrective surgery is
the recommended treatment. A non-surgical treatment using removable appliances is also available
but most surgeons do not consider it appropriate. When deciding on a treatment for your child
would you wish to be told of non-surgical alternatives?”. 93% said they would like to know about
non-surgical alternatives even if their surgeon did not think them appropriate.

Orthotropists claim to be able to avoid most jaw surgery (see illustration below), should every
patient be told about this? Some surgeons might be reluctant to mention rival methods but it is their
responsibility to know of and mention all alternative methods that have at any time claimed to be
effective. This information should be based, not on what the surgeon believes but on what the
patient might wish to know. Currently very few surgeons tell prospective patients that there are any
non-surgical alternatives.  John Mew has been working on a lecture series going into more depth on his thoughts, ideas and what inspired them. In this episode he talks about informed consent. If there are any other topics you want us to cover please let us know. Engage with Prof John Mew or Dr Mike Mew on this topic;

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