EDITORIAL

Orthodontic challenges as seen by constituent society presidents

Part II

P art I of this editorial discussed recommendations concerning auxiliary personnel and orthodontic public health service as expressed in the 1969 addresses of the presidents of the eight constituent societies of the American Association of Orthodontists. Although each president spoke of orthondontics’ achievements, the greater emphasis was on the unresolved problems facing the specialty and the profession. Part II continues in a similar manner on various other issues, including education, prepaid health programs, state societies, membership requirements, and orthodontics’ responsibilities to society and to organized dentistry.

Insofar as orthodontic education is concerned, the constituent society presidents were unanimous in recommending its extension in every area, includ- ing undergraduate, postgraduate, graduate, and continuing education programs. Also stressed was the idea that courses should be presented by orthodontic societies as well as by dental schools and that they should be given for general dentists as well as for orthodontists. Orthodontics’ educational achievements and responsibilities were well defined by President William H. Olin when he told the Midwestern Society that :

Our graduate programs in orthodontics today are well staffed in most areas, with excellent full- and part-time instructors. Basic science education, as well as clinical edu- cation, is more than adequate. Certain basic requirements are necessary for an advanced orthodontic program, and these are standardized throughout the United States and Canada.

Most orthodontic graduate programs require 24 months’ attendance; however, there are programs offering 30 to 36 months of training. At the present time, openings each year in both graduate and postgraduate programs number more than 350, and this number is increasing as new facilities become available.

As I studied the names of the faculty members responsible for our graduate programs throughout the United States,* I was impressed and well satisfied that our young ortho-

*University Graduate and Postgraduate Programs in Orthodontics, AM. J. ORTHODONTICS 55: 399-403, 1969.

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dontic graduate students are receiving a more than adequate educational program today. However, we should constantly be revising our advanced programs in an effort to make

changes where changes may be necessary for improvement. General practioners also have many continuation courses that need improvement in both the general and special areas of practice.

Of equal concern to President Olin was the low level of undergraduate education in orthodontics, the responsibility for which lies as much, if not more, with the schools as with the specialty. Orthodontics hears constantly that the general dentist must assume increased responsibility in the treatment of

malocclusion; yet the schools do not provide enough time for the orthodontic departments to teach it properly so that graduate dentists will have the com- petence to treat orthodontic cases at present-day standards. President Olin stated the problem thus:

One of the main problems in the educational area is that of the undergraduate ortho-

dontic program, which I feel is inadequate at the present time and which must be increased if we are to improve our image with the general practitioner of dentistry. We have placed too much of our emphasis on the graduate and postgraduate programs; consequently, the undergraduate program at this time is inadequate.

The responsibility for correcting these inadequacies, however, does not lie only with the orthodontic department, but also in the curriculum committee and in organized ortho-

dontics as well. Most orthodontic educators find it difficult, if not impossible, to get an increase in their total hours in the undergraduate curriculum. Many of our undergraduate programs are lacking in clinical experience and in clinical education. Most of the emphasis is placed on orthodontic theory. We must also strive to improve the clinical experience of the undergraduate dental student.

The advantages of holding continuing education programs in conjunction with annual constituent society meetings was discussed by several presidents. Very likely they were influenced by the success of the courses given for the last 8 years by the Midwestern Society on the day following its annual meeting. At the Southern meeting President Faustin N. Weber said :

Recently, there have been changes in the format of some of the annual meetings of the constituent societies. Recognizing the value of programs of continuing education for orthodontists, and wishing to attract more of their members to the annual meeting, some societies are holding intensive one- or two-day courses either immediately preceding or immediately following their annual meeting. When courses are arranged thus, many men who would not leave their offices for the sole purpose of taking a continuing education course, will spend the extra day or two required to take a course if it is given at that period of time they annually give to attending their constituent society meeting.

The arrangement has another advantage: If the course is a timely one, given by a clinician of wide repute, many men who would not hesitate to enroll for such a course but who are inconsistent attenders at annual meetings may be persuaded to attend both the course and the meeting, once they decide to sign up for the former. This is an arrange- ment that future program chairmen may wish to consider adopting for the Southern Society of Orthodontists. Both of the reasons just stated are valid ones for scheduling continuing education courses.

President Richard C. Philbrick carried continuing education programs

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even farther when he told the Pacific Coast Society that “thought should be given to having part of our programs sponsored by universities so that we can get credit toward keeping our licenses to practice dentistry.” Dr. Philbrick also forecast that the day will come when evidence of continuing competence will be required periodically by state and national dental examining agencies. President Jerome S. Cullen also spoke of joint collaboration between societies and universities when he described the Middle Atlantic’s new continuing education program in this statement :

This is the first time in history that a day of continuing education has been a part of

our annual meeting. it differs from the usual program format in that it covers a specific topic in depth and has an appeal to those who feel particularly involved with this prob- lem. It has been expressed in many areas that orthodontic societies should abdicate their continuing education responsibilities to the universities. This matter is an address within itself. However, I ask that our component societies consider the possibilities of jointly sponsoring such courses with universities within their states.

President Olin also expressed concern over the criticism that has been directed toward orthodontics. “Some is justified and some is not,” he said. “Our fellow dental practitioners claim they are barred from going back to school to take courses either toward a degree in orthondontics or merely to improve their skill as general practitioners doing orthodontics. ” These criticisms can be solved effectively only by increasing the number of openings for graduate students or by increasing the length of undergraduate programs so that dentists in the future will have the essential background for advanced short courses in ortho- dontics. In his address before the Rocky Mountain Society, President Louis S. Miller had this explanation for the charges against orthodontics :

Nothing succeeds like success. We, as orthodontists, are being bombarded from all sides. It seems that everyone wants to get into the specialty, regardless of training and qualification. . . . The paradox of the whole situation is that the underlying reason for the success of orthodontics in general is that the quality of orthodontics was brought up by the hard work of men of integrity who were willing to join study groups, attend special ad- vanced courses, gain American Board certification, and, last of all, open their offices and treated cases to the criticism of other colleagues who were also willing to “put their cards on the table.”

The general theme of President Philbrick’s address was change-in mechanics, in materials, in education, and in social responsibility. New departures will come with prepayment plans, an area in which “general dentistry has been living for several years. Our prepayment plans are going to come through plans which were originally made with general dentistry. We are not going to have separate orthodontic plans as we once thought. Therefore, it behooves every one of us to be active-1 repeat, active-in our dental society-where the action is.” This was also the message of President George R. Webber at the Southwestern meeting when he said :

Our members are urged to be active in their state orthodontic organizations and, more importantly, to take an active role in their local and state dental organizations. Pre- paid dental plans continue to expand and grow, with orthodontics being included. It has

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been said by leaders of labor, industry, government, and the professions that we are in an era of rapid change.

Most of US will agree with this. The crucial fact is that changes that have occurred and are occurring in dentistry seem to result from decisions and opinions of others, with little or no consultation with the dental profession. Examples would be the many dental plans, some including orthodontics, having a variety of coverages, fixed fee schedules, closed panel clinics established by labor, allowances based on percentile, and legislation,

among others. Is it not reasonable and logical IO expect and demand that representatives of dentistry

be consulted and invited to participate and guide the changes which apparently are de- sired by those outside the profession ? This is why our members must become more active in their dental organizations, civic groups, and communities.

President James I-1. Teetzel uttered a similar warning when he told the> Great Lakes Society that “another area of concern is that, with government and union programs now widely accepted for general dental care, orthodontics will soon be included. This creates the problem of who will speak for ortho- dontics in establishing these programs. Government agencies and labor unions will be represented by men trained in negotiation. Will we be represented by men equally as well trained or by orthondontists inexperienced in negotiation and unfamiliar with the functioning of prepaid treatment programs? Our Society should also be prepared to provide men skilled in the area of negotiation and knowledgeable with respect to prepaid dental planning. Individually, we must, therefore be ever active and alert in dental groups at all levels.” President Wilbur D. Johnston will make many similar recommendations in his North- eastern Society presidential address, which will not be read until next fall because of a bylaws change in annual meeting dates.

Certain issues were of concern to a few presidents and ignored by others. Three presidents spoke of state component societies, two stressed the Truth- in-Lending Act, two spoke on orthodontic public health requirements, and others discussed new membership indoctrination, qualifying examinations, and orthodontics’ Ymage.” Three addresses were also of historical interest. Presi- dent Cullen stressed that, even though the Middle Atlantic is the youngest constituent society, “we are growing rapidly. When the Northeastern Societp of Orthodontists reached a membership of 500 in 1951, a group of 71 left to form the Middle Atlantic Society so as to preserve the advantages of a sme.ll specialty group. In a comparatively short time we have almost achieved that magic half-century number and we, in turn, have our own component societies. We now have 397 active and associate members, 31 associate candidates, and 26 nonresident members. Within our jurisdiction we have five university graduate orthodontic programs, one approved hospital orthodontic residency program, and the University of Maryland plans to open its graduate program in the fall of 1970. Little wonder that Middle Atlantic has grown so quickly.”

In a similar manner, President Weber related historical facts to show how orthodontics had changed in two decades since the Southern Society met last in Memphis. His comments follow :

In reviewing the printed program for the 1948 meeting in Memphis, several striking

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differences in the orthodontics of that day and this become manifest. An examination of

the advertisements that the manufacturers of orthodontic supplies featured in the program will impress you with the fact that most appliances were fabricated from bands, attach- ments, and wires made from alloys of precious metals; chrome alloys were used, but only by a minority of the orthodontists. Preformed bands were unheard of, and the hundreds of prefabricated auxiliaries that we now take for granted and use daily in our modern practices were not even dreamed of. Anyone who has practiced orthodontics during the past five years knows that in this short period of time there has been an almost bewilder- ing array of new products developed by the manufacturers of orthodontic materials and supplies designed to make our clinical efforts more effective and less time consuming.

A further examination of the printed program for the meeting of 1948 reveals that the total membership, including all classes of members, was only slightly more than 100. Today, if all categories of members are included, the membership of the Southern Society of Orthodontists is more than 600.

President Teetzel went back to the organization of the Great Lakes Society in Detroit on April 13, 1926, when it was formed with a grand total of 37 charter members. The Society now has 643 active and associate members. In his tribute to the Great Lakes pioneers, Dr. Teetzel said: “The founders of our society were certainly remarkable men. They had few guideposts for organization and no one to tell them how to treat cases definitely one way or another. There was no almighty judge for right or wrong to support their beliefs in the face of criticism. These men were highly independent.”

The various presidents’ addresses provide evidence that this spirit still exists and that orthodontics’ traditional idealism is still alive. President Cullen spoke well when he said:

The demands today for efficient and comprehensive delivery of all types of health services are staggering. An attempt to meet these needs demands of us a constant concern

and quest to ever improve ourselves as professional men and as individuals. To actively strive for excellence is not only our charge but our obligation to our fellow man. . . . If we are to meet the challenges before us, and if we are to fulfill our obligation to society, we must be aroused to all aspects of orthodontic care in an effort to improve even further

our service to society.

To this, President Miller aptly added: “This great success story will not last if we as orthodontists fail to uphold the standards we all respect. We must not be lured into the trap of lowering our standards by accepting more cases from any source than we can treat to the best of our ability. Integrity, honesty, and skill will be rewarded by the respect of the public and that of our colleagues in dentistry as well.”

B. P. D.