One of the most critical and contentious issues for specialist and nonspecialist professionals in the coming decades will be to evaluate the outcomes of health care services. Performance measures are imperative for elective orthodontics, because of the relatively weak evidence that they lead to significant improvements in dental and oral health, occlusal function, and psychological well-being of patients. Such measures are particularly crucial for orthodontic treatment eligible for benefit payments, because they will assure third-party dental insurers that the annual premiums levied from governments (taxes), employers (in lieu of salary increments), and individuals (in lieu of other discretionary expenditures) are well spent (ie, not wasted). Performance measures will also improve the "standards of orthodontic practice," so the continued integrity of the profession is contingent on their development.