Transcript of Dr Peter Vaughan's appearance on 60 Minutes

The following transcript is from a report named A Perfect Smile broadcast by the Australian 60 Minutes program on 23rd November 2003. The reporter is Peter Overton, and the producer was Kathryn Bonella. The official report page can be viewed on the 60 Minutes website.

STORY - PETER OVERTON: We'll do almost anything to give our kids that perfect smile. Take their teeth out, give them a mouthful of metal and then there's the dental bills. But this popular approach to a winning smile is being challenged. And now there's a bitter fight amongst the experts over just how and when to treat our kids.

DR PETER VAUGHAN: I would probably be the most hated dentist or orthodontist in Australia.

DR DEREK MAHONY: I think when I die there'll be a lot of people at my funeral, but most of those will be there to make sure I go six foot under, by that I mean my specialist colleagues.

DR JOHN MEW: I've even been threatened with assault at meetings. People hate me with a depth that's really quite surprising.

PETER OVERTON: Make no mistake, this is a very sensitive issue for the normally low-key dental profession, for some of its members are now being accused of performing unnecessary treatment on our children.

DR PETER VAUGHAN: Some dentists and orthodontists are treating children at the age of six, seven and eight. The treatments have no chance of working. It disgusts me. It's just child abuse.

PETER OVERTON: What concerns orthodontist Dr Peter Vaughan is the increasing trend to treat children when they're very young. He backs the long-held belief that you leave your kid's teeth alone until they're in their teens.

DR PETER VAUGHAN: I say treat them later. Around the age of 12 and 14, a lot of the treatment they do just has to be redone. It just doesn't work because they're treating too young.

PETER OVERTON: Why do you think it's happened?

DR PETER VAUGHAN: Well, there's just not enough work. Fluoride has taken away our work, so they have to invent work. They convince patients they need treatments they don't need. There is a lot of it going on.

DR JOHN MEW: It's not child abuse to treat as young as six.

PETER OVERTON: English orthodontist Dr John Mew is passionate about treating the kids young. So determined is he about tackling problem teeth early, that he's brought his fight to Australia.

DR JOHN MEW: If there's crowding in that area and you do nothing, the child's going to grow up with crowded teeth and an ugly-looking face.

PETER OVERTON: After 40 years in the business, Dr Mew is fighting the popular treatment that for so long we've taken for granted. Wait until the teenage years, then pull out teeth and put on braces. He says you'll have nice straight teeth, but your face will suffer.

PETER OVERTON: 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: In our last story, we met identical twins Ben and Quentin Creed. Dr Mew points to theirs as a classic test case. Ben had traditional treatment when he reached his teens, four teeth out and braces. Quentin tried Dr Mew's method, early treatment, no extractions, no braces. 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, more fuller lips.

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

PETER OVERTON: The crux of Dr Mew's argument is that extraction and braces push the face back and make it flat.

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: Dr Mew maintains his way can achieve these film star good looks, straight teeth and perfect cheeks and lips. He says instead of removing teeth to fit the jaws, he uses a plate to help change the shape and size of the jaws to fit the teeth. And Dr Mew says the younger the patient, the better the result. Dr Vaughan, of course, disagrees, claiming he can achieve all of this but in less time and when the patient is older.

DR PETER VAUGHAN: I can prove to you that late treatment is more successful with less treatment, with less cost to the parents.

DR JOHN MEW: Well, you're saying you can, you show me cases, I'll show you cases and it won't prove anything.

PETER OVERTON: So who to believe? Well, we brought these duelling dentists together to try to sort out this confusion. How young are you prepared to treat?

DR JOHN MEW: I've treated children of three and four years old. Once the child reaches eight, it becomes progressively more difficult to change the bone at all.

DR PETER VAUGHAN: That's crap. We treat when the patient's most rapidly growing. You and I know patients are most rapidly growing at 12 to 14.

DR JOHN MEW: No, that's not true. They're most rapidly growing at three, four, five. I prefer to try and encourage growth while the child is young, but Peter would prefer to make room for the teeth when the growth is almost complete.

DR PETER VAUGHAN: No, about 14 is my preferred age. I'm accusing all the people who treat your way of ripping off the parents and it's child abuse.

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

PETER OVERTON: But this kind of beauty doesn't always come easily.

LOUISE JENNINGS: I would say it was 18 months of torture, 18 months of torture for her physically and for us nagging her.

PETER OVERTON: Louise Jennings' daughter Hayley was seven years old when she wore this plate. It has two very sharp spikes on it to force her tongue into the correct position.

LOUISE JENNINGS: It was like two pins and they would hit her tongue. Like, so she would have red ulcerated marks on her tongue. I still feel guilty that we put Hayley ... we nagged her, we made her wear this plate.

PETER OVERTON: Surely you must have questioned the orthodontist and said, "Hey, this will hurt her."

LOUISE JENNINGS: We did, but we were then, with our questioning we were never offered another treatment.

DR PETER VAUGHAN: Can you see the two sharp spikes on that plate, they're sharp.

PETER OVERTON: Yes, they are sharp.

DR PETER VAUGHAN: Well, I got very angry. I looked at it and I could not believe someone could put that in a child's mouth. Hayley is clearly a good example of child abuse. Hayley's parents brought her to me. I looked and noticed there was a tongue posture problem so I referred her to a speech pathologist. One consultation with the speech pathologist and it was corrected.

PETER OVERTON: John, would you use one with spikes on it like that?

DR JOHN MEW: The motive of that is to cause pain if the child does the wrong thing and I provide an appliance which is designed to hurt if the child drops their jaw. You might call that child abuse, I would call it training.

ANDREW HALL: It would hurt a lot, because the little prongs on the inside poking at the inside of my mouth dug in and if you didn't keep it shut it gave you ulcers that were very, very painful

PETER OVERTON: Eighteen-year-old Andrew Hall was one of Dr Mew's patients. He says the pain was worth the gain.

ANDREW HALL: Really is quite shocking how little jaw I had and how goofy I was.

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

ANDREW HALL: Well, yes, obviously. I'm very glad I didn't end up just staying like that.

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, it is commonly known as the Sydney smile.

PETER OVERTON: Sydney orthodontist Dr Derek Mahony is in the John Mew camp: treat them young.

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.

PETER OVERTON: But there is one thing that most orthodontists do agree on - if you remove teeth, the smile will not be quite as wide.

DR DEREK MAHONY: If we want our patients to have the best facial profiles and the widest smiles, such as the movie stars - everyone wants a Julia Roberts look, a Tiger Woods look - then really we have to be able to give them that nice, wide smile and that does involve early treatment to develop the top jaw to its maximum genetic potential.

PETER OVERTON: Why aren't your colleagues embracing your technique?

DR DEREK MAHONY: I feel that possibly a lot of my colleagues have been so brainwashed into their conventional thinking, that they genuinely feel that what they're doing is the best for their patients.

PETER OVERTON: Why don't you just follow the traditional method?

DR DEREK MAHONY: I think ultimately you want to be able to sleep well at night and I couldn't possibly offer my patients what I thought was substandard treatment just to keep with the old boy club.

DR ROBERT CERNY: When Michaela came to me she had severe crowding, so we removed four teeth and with braces we straightened them in about 18 months and this is the result.

PETER OVERTON: While parents may find all this confusing, there's no doubt in Dr Robert Cerny's mind.

PETER OVERTON: So, what do you think of your smile?

MICHAELA: I think it's beautiful.

PETER OVERTON: He's a traditionalist, believing teenage years are the best time for treatment. And more importantly, Dr Cerny vehemently opposes the notion that orthodontists can influence the shape of a jaw.

DR ROBERT CERNY: If it was possible to make the jaw bones grow, every orthodontist would be doing it. But if it doesn't work and they do a procedure that doesn't work, why bother with it?

PETER OVERTON: They're bothering with it because they are convinced, that's their conviction, that it does work.

DR ROBERT CERNY: Well, they need to show hard evidence to support that.

PETER OVERTON: For Dr Cerny, the simple solution to crowded teeth is to take them out.

DR ROBERT CERNY: I myself extract in probably 90 percent of the cases I see.

PETER OVERTON: Ninety percent?

DR ROBERT CERNY: Ninety percent. Now when I say extract teeth, I mean there's a variety of teeth you go for. Anyone who doesn't extract teeth at all must be practising on another planet.

DR JOHN MEW: Well, I think he's quite wrong and it is not natural for human beings to require extractions.

PETER OVERTON: He says what you say is nonsense. So who's right in all this?

DR JOHN MEW: That's his opinion. It is in my view totally contradictory to the evidence. We know you can create permanent change in bone if you apply the right force at the right age.

PETER OVERTON: By now, you're probably just as confused as the experts about what to do with your children's crooked and crowded teeth. Well perhaps there's a darker side to all of this that might help explain the bitter row - money. As a nation we spend nearly $2 billion a year on our teeth. It's big business and a thriving industry. Dr Peter Vaughan claims it's all about the dollars and says some orthodontists and dentists are convincing patients they need unnecessary treatments to keep the money rolling in.

DR PETER VAUGHAN: I've been told we've got to give kickbacks to dentists to encourage referrals to our practice. We've got to provide the dentist with work if he's going to provide you with patients.

PETER OVERTON: How does that work?

DR PETER VAUGHAN: If I request four extractions, that's $600 for the referring dentist. So he'll refer more patients to me. They are enriching their bank accounts and not looking after the patients.

DR ROBERT CERNY: That's rubbish. That's absolute nonsense. That's saying that within the profession we're unethical and that we don't care as to how we treat our children and most of us are married men, most of us are fine contributors to the community and I'm sure that the greatest majority of orthodontists would be appalled at that suggestion.

PETER OVERTON: So what is the parent to do? Well, orthodontists would agree there's no Hollywood ending to this story and no simple way to get that Hollywood smile.

DR PETER VAUGHAN: I'll tell you, don't trust anyone in the dental world and use your common sense.

DR JOHN MEW: I feel really sorry for parents. They're facing a divided profession that themselves are not sure what is the correct way of curing crooked teeth.

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