The progress we have made over the past 100 years has been truly significant. In 1915, Woodrow Wilson was still in his first term as president of the United States, and our country had not entered the Great European War (later known as World War I). Women would not get the right to vote until 1920, which was the same time that the first radio broadcast was aired in Pittsburgh at KDKA. We had just come through the Great Extraction Debate of 1911 (with Dr Calvin S. Case in favor of selected extractions vs Dr Martin Dewey as a substitute for Dr Edward Hartley Angle arguing for nonextraction); that controversy continues today, and the cyclic pattern of the debate should allow us to continue this lively discussion into future generations. The debate about 1 phase vs 2 phases (early intervention) of treatment will also not be solved now and probably not in the future.
By 1915, Angle had developed 2 of his 4 appliances: the E (expansion) arch, which did not work well in extraction cases, and the pin and tube (later called the Begg Technique). Then, in 1916, he introduced the ribbon arch (later called the twin wire; the redesign did not solve the problem with torque control) and, in 1925, the edgewise appliance (published as “latest and best” in 1928 before his death in 1930).
The American Board of Orthodontics first met in 1929 in Colorado.
A select few advances have broadened orthodontics to a larger spectrum of Americans as well as to others throughout the world. Orthodontics has expanded to the middle economic class and is now universally accepted for all, including adolescents, children, and adults, independent of race, religion, or sex.
Technologic advances have been spectacular: bonding with or without banding teeth, prescriptions in appliances, digital imaging (2- and 3-dimensional), materials science technology dervied from our space programs, cone-beam computed tomography, temporary skeletal anchorage devices, and rigid expansion for surgical patients, to name but a few.
“Five big ones” from the middle of the last century have changed modern life: computers and nuclear science, both of which developed during the 1940s and made great advances in the 1990s; and understanding of DNA, the popularization of birth control, and the development of satellites (allowing instant communication today worldwide), which began in the 1950s. All 5 of these applications have had profound effects on orthodontics and society in general. That trend will continue. The shift toward the sciences is relatively new in human history but has expanded considerably since 1915.
Balance and harmony. Art and science. Growth and development. These topics will probably be with us for the next 100 years, as they have been for the past 100 years. Nature vs nurture (genetics vs environment). The professional person or group vs the business person or group. Emotions vs cognitions or thoughts (classical vs operant conditioning). Fixed appliances vs removable appliances. These areas will continue to be developed and explored with time, since time is the fourth dimension.
We need a framework to assist in orienting the past to the future through the present. These thinkers and authors can assist us in our journey.
Mortimer Adler (1986). Adler discussed the 4 language arts: reading, writing, speaking, and listening. There are hard (printed) and electronic modes of reading and writing. Speaking requires both verbal and nonverbal communication skills, with nonverbal skills highlighted, as at least half of our communication is nonverbal. Seeing is believing. Also, how we say things is as important as what we say. Being able to listen actively is an important skill for doctors. Adler also discussed the 4 goods of the human mind: information, organized knowledge, understanding, and wisdom. They are in an ascending scale of values. For the past 25 years, we have been in the Information Age (which replaced the Industrial Age, which replaced the Agricultural Age). There is a 4-fold differentiation of knowing: know that, know what, know how, and know why and wherefore. History, empirical sciences (orthodontists are empirical scientists), and mathematics are related to “knowing that” and “knowing what.” Philosophy is related to “knowing what” and “knowing why and wherefore.” Art and prudence are related to “knowing how.”
Benjamin Bloom (1972). Bloom’s “taxonomy on cognition” differentiates cognitive skills in a progression from knowledge to comprehension to application to analysis to synthesis and finally to evaluation. These skills are fundamental and have been used in academics for decades. They are applied in a sequential pattern, but unfortunately this is not always the case in many evaluations. Evidence-based decisions should help us here. Selected verbs for each area are used to identify the 6 stages.
Thomas L. Beauchamp and James F. Childress (1979). Beauchamp and Childress presented a bioethical framework with principles, rules, and ideals. The principles are autonomy, nonmaleficence, beneficence, and justice. These are not rank ordered. Justice is the weakest application. Major progress in this area was seen in the 1960s with the civil rights, voting rights, and Title IX congressional actions. The rules are veracity (truthfulness), confidentiality, privacy, and fidelity (faithfulness). The ideals are forgiveness, beneficence (high risk), mercy, and generosity. The framework of the orthodontic specialty and its orthodontists is nicely placed within this bioethical framework.
Elisabeth Kübler-Ross (1969). Kübler-Ross assisted us in understanding a process that is difficult to discuss (dying—not death itself); this process has been shown to be associated with major traumatic events such as unemployment. This process seems to be universal and follows a sequential order: (1) denial and isolation: denial is an early and important self-defense mechanism along with undoing and is a common problem in human interaction; (2) anger; (3) bargaining; (4) depression; (5) acceptance; and (6) hope; to give up hope is a major problem in a doctor’s presentation to patients.
Within the frameworks of these 4 thinkers, several useful signs help to guide us in a reflective orientation: generation shifts and cyclic patterns. A generation shift happens approximately every 22 years, with active vs passive and with outward vs inward generational constellations in waves. After one generation, the cycles began to recur, since there is a tendency to see repeated episodes of ideas that were forgotten or ignored. We have had at least 4 generational shifts in the past 100 years.
An important concept that is used in orthodontics on a daily basis comes from our colleagues in weather forecasting. It is the nonmathematical concept of chaos. The idea is that small changes can create large variations from the initial prediction. Sailers understand this concept, as do orthodontists as we adjust our treatment at each visit (rediagnose and revise the treatment plan throughout). We are not the same persons at the beginning of the treatment, nor are our patients.
It is difficult for an orthodontist who is in the middle or later portion of his or her professional life to truly understand the conditions that the newer orthodontist faces. There are more women in the specialty and a more diverse patient community, including adults. There is a broader range of therapeutic interventions. We are now living in an age of multitasking, information overload, and continuous overstimulation with a higher cost:debt ratio of dental and orthodontic education. Who will be the future educators? Our current prospects need to be mentored, because academics is a rough game. You can influence many, but you can control only yourself. It is a challenge to blend the past and the present with the future. It is a bold and exciting enterprise for us.
Remember that we are clinical scientists who are growth and development oriented. We are in the people business and are part of the service economy. How do we treat patients today? One at a time. We treat to the face, understanding the dynamics and variabilities in direction, speed, and amounts of hard and soft tissues of the dentofacial complex, in both the static and the functional modes, with the stability and the health of our patients as our goals. We alter, redirect, sustain, or correct disturbances in human growth and development. The opportunity to be an orthodontist and a member of an academic orthodontic department is a cause for celebration during our 2015 celebration of 100 years of the AJO-DO .
Thank you for this opportunity to share my thoughts and ideas with you.