Overwhelmed Over Possible Outcomes: Confirmation Bias in Airway Dentistry

The tonsils are huge, the snoring persistent, and the teeth are misaligned so you need this appliance that costs a small fortune…oh and I also need you to get bodywork and myofunctional therapy for another small fortune outside of this office.

This may sound familiar and ring a well-meaning bell in your mind that keeps you from agreeing to things your dentists suggests right away. There is no denying that there has always been an existing stigma about honesty and dentistry. You come in assuming you have no problems and may leave learning you have problems to the tune of a few hundred dollars in copayment. The tooth that never bothered you needs a root canal, the crown that feels fine should be replaced, or an infection lurks under the bone and can only be seen in the radiograph you cannot interpret. Second opinions and changing of dental offices is common as fear and mistrust are abundant.

There is no difference in airway dentistry. In fact, you may often see reviews online that sound like polar opposites. One raves about how the doctor changed their lives and another that claims the doctor is only after your money. The truth may be accurate in both reviews, meanwhile, the intent was pure.

How exactly do you get to the bottom of treatment necessity when it comes to airway dentistry? I fear that confirmation bias may be flooding the field and altering objectivity. Creating a new field of well-meaning, educated people who push too far, over assess, and degrade modern medicine.

What is confirmation bias?

In this day and age, confirmation bias is another way of saying Google. When you seek information in this age of abundant resources and find a response that confirms what you sought, this is confirmation bias. When my dentist tells me that mouth breathing is bad and causes malocclusion I can type into a search engine “mouth breathing malocclusion” and have millions of web pages pop up that will align those things. The alternative is true as well, I can type in “malocclusion causes” and find millions of results with various theories and be selective about which ones I want to believe and trust.

We lack the ability to get conclusive answers that will definitively give us objectivity. It’s a problem for the common patient who is concerned about the problems raised by the dentist but doesn’t get confirmation from other providers. You can contact your physician regarding mouth breathing and tonsils and they may tell you that tonsiliar tissue tends to resorb naturally by age 20. You google just that and find it to be true and think your dentist is a money hungry predator.

The truth is, the dentist may be concerned about the child’s development in the time before maturity. What damage would have been done prior to getting there? Sleep apnea, chronic respiratory infections, severe malocclusion, deviated septum, narrow airway development, severe gag reflex, acid reflux, etc. The possibilities that may occur are numerous and unpredictable. Yet, a medical professional may see this all as speculative preventative care based on grand scale possibilities and not reality.

What is the professional concern with confirmation bias?

Airway focused practices are growing in size and scope. Dentists, physical therapist, osteopathic doctors, otolaryngologists, dental hygienists, occupational therapists, craniosacral therapists, speech-language pathologists, naturopathic doctors, and chiropractors have become aware and involved in the importance of evaluating and treating airway centered disorders.

Teamwork and interdisciplinary collaboration are the keys to optimal outcomes and treatment success. In social media there are groups and pages dedicated to posting new research, case studies, books, blogs, information and courses. As well as general conversation about the importance of the work we do, professional questions, and sharing treatment roadblocks and outcomes.

Within this social sphere of shared interest is the idea that is the only way. A supposed social confirmation bias. Wherein the answers are always that preventative treatment trumps no treatment. Wait and see is never an option. In cases where there are signs and symptoms that are concerning to the patient or parent, I am in full agreement. If you are concerned, seek treatment. But where there is no smell of smoke, I would not run and advise that person of an impending fire.

I have yet to see anyone post of a reason to not use an appliance or therapy. It seems like airway centered treatments are a catchall for various conditions. So why not utilize it on a grand scale in the general population? It is here that I find the problem with confirmation bias. We have stopped searching for alternatives. Areas where a delay in treatment still led to minimal or no problems. This is it. We have the golden key and if you start early enough you can lead a healthy life well into adulthood.

Does treatment guarantee results?

It is possible for you to delay treatment for a time at which you may be able to afford those small fortunes required. Or even longer, for the slim chance that insurance will cover at a larger percentage. You may or may not have any issues that result. Those issues, may or may not be things that bother you.

Let’s take my husband as an example. He had chronic ear infections as a child and very narrow arches. Ear tubes were placed more than once, teeth extracted, and braces placed. To this day, he still has very narrow arches and a class III malocclusion. Yet he managed for the longest time to be the healthiest member of our family of 6. We all would catch and share the same colds and infections. But he would happily make it through every cold and flu season without a sniffle.

It wasn’t until my interest in airway was peaked through our children that I realized his imperfection. I strongly suspect he has sleep apnea. Is he bothered by it? No. Is he struggling to sleep because of it? No. Does he wake up feeling un-refreshed? No. Am I concerned that he may not wake up one night due to lack of oxygen? Not really.

So where exactly is his problem? Where is the asthma or chronic congestion? Where is the picky eating or gag reflex? Where is the reflux? The only issue physically present was a tongue thrust that we corrected with myofunctional therapy. (For the therapists or professionals reading, his class III is full edge to edge with crossbite in 6 & 27. So it was able to be corrected.)

There was no problem. My in-laws did not need to do extensive treatment to prevent him having a terrible life. Most likely, they would have been unable to afford it and felt incredibly guilty.

Stop feeling guilty about the unknown

I talk to many people either about their own treatment or that of their children. Many are in distress about the extent of their treatment plans. Multiple providers to schedule and modifications to make. The question I get most often: what will happen if I do nothing?

Honestly no one knows. Healthcare may be a science, but nothing about it is exact. To the best of current research all recommendations given to you by your medical or dental professional is precisely what they told you. Does that guarantee results and absolutely negate any future negative outcomes? No.

With no guarantees and only anecdotal or researched possibilities to go by, there is no need to hold onto guilt. If a small fortune is not realistic in your budget, then treat in stages, postpone treatment, or neglect treatment.

Whatever you choose, base it not on confirmation bias. It will always go your way when you want it to. Know that your provider’s intentions are pure, information valid, and results to create a positive outcome. While not always the intended or presumed outcome, you will see a positive change. Everything that follows will remain unknown.

Karese Laguerre is a Registered Dental Hygienist and Orofacial Myologist. In her years of working with various patient populations in the dental field, she encountered similar trends and limitations in dental malocclusion and mouth-breathing. The correlation between the two became even more relevant as her own children grew in age and with the pursuit of extensive hours in continuing education she achieved training in treating the primary cause, improper oral resting posture. She is passionate about the education of airway matters to the general public.

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