Interview “Der Spiegel” No. 18, 2018

“Just Have a Look at This Nonsense”

The orthodontist Henning Madsen (aged 56) from Mannheim talks about needless orthodontic appliances and profit-driven colleagues.

Spiegel: The Federal Audit Office criticizes your over-zealous colleagues. Has this institution the right to judge about the sense of medical treatments?

Dr. Madsen: Not with regards to a final judgement, but the Federal Audit Office is right with respect to the subject-matter. In our country, two thirds of girls and boys get orthodontic treatment. That’s why we have achieved a lonesome leadership in orthodontic care in the world. Only in the Netherlands and the United States of America this seems to be similar. In Scandinavia – countries with a highly developed dentistry – the rate of children in orthodontic treatment is round about half of that. In Germany, something is getting out of control.

Spiegel: What is it exactly?

Dr. Madsen: German orthodontists overdo the treatments – so that the public health insurance has to pay over one billion euros each year. Moreover, the orthodontists make a lot of mistakes. Just have a look at this nonsense about the removable appliances. It has already been proved that they are less effective than fixed appliances. Nevertheless, in Germany, they are prescribed en masse – and only here. Why? These appliances are cash cows! Fiexed appliances bring only half of the profit.

Spiegel: Do orthodontists talk parents into inappropriate treatments?

Dr. Madsen: In my opinion, this is a drastic formulation. But the demand for orthodontic treatment is often triggered by orthodontists making use of inappropriate arguments. Many of them advertise with the fact that straight teeth can prevent tooth decay, periodontitis and head- or backpain. But there’s no proof for this at all.

Spiegel: Do your colleagues act wrong even in other ways?

Dr. Madsen: Internationally, orthodontics starts at the age of 11 – 12, when the permanent dentition has developed. In contrast, in Germany most of the orthodontic treatments start at the age of eight or nine. That’s the reason why treatment duration is quite long: up to four years. My colleagues in Scandinavia can’t believe it. They ask me: “What are you doing for such a long time?”

Spiegel: Are you an outsider among the orthodontists with a radically different way of thinking?

Dr. Madsen: The accusation of being uncooperative is nothing new to me. But everything that I’m complaining about has been known since 2001 and has been criticized severely and repeatedly in expert reports. There’s a need of action – but nothing happens. In my opinion, the lethargy shown by the health policy is incredible. ME