The golden age of orthodontics: Decline and aftermath. A history of the business of orthodontics

Norman Wahl, an eminent dental and orthodontic historian, presents to the reader a carefully researched history of the business of orthodontics. The book is divided into 2 parts. Part I deals with the 19th and 20th centuries and was originally a thesis that Dr Wahl completed to partially fulfill the requirements for a master’s degree in history at California State University Northridge in 1994. Part II takes the reader into the 21st century and gives a good summary of, and explanation for, the increasingly complex problems that orthodontists face in managing a practice today.

Part I begins with a brief history of organized orthodontics. The contributions of Edward Angle and Calvin Case are reviewed, and a nice historical perspective on the formation of regional orthodontic societies—of which there were 6 by 1925—is offered. In 1937, the American Society of Orthodontists became the American Association of Orthodontists (AAO). The eighth and final constituent, the Middle Atlantic Society of Orthodontists, was added to the AAO family in 1952. Dr Wahl outlines the improvements that were made in treatment mechanics during this early period in our specialty and highlights contributions of Charles Hawley, John Valentine Mershon, George Crozat, James McCoy, Frederick Noyes, Benno Lischer, Albert H. Ketcham, Albin Oppenheim, Alfred Rogers, and others. One interesting development that he discusses is the emerging laboratory businesses that made orthodontic appliances to sell to general dentists—or anyone who wanted them.

During the Depression years, over 80% of general practitioners in the Midwest included orthodontics in their services and bought appliances from the laboratories. The orthodontists of the day lamented that “orthodontia today is at its lowest ebb.” The book then summarizes the years after World War II—the years of Tweed, Brodie, Downs, and Danish orthodontist Arne Björk. The postwar years were important to the burgeoning specialty of orthodontics. Research thrived, textbooks were published, biomechanics became better understood, new materials greatly improved what appliances did, and functional appliances were introduced. Surgery for significant maxillofacial deformities was introduced, and “hopeless” patients became people who could be treated with orthodontics and surgery.

Dr Wahl surmises that the golden age of orthodontics was 1950 through 1970. Between 1954 and 1957, more than 4 million babies were born each year in the United States. Because there were few practitioners, many had waiting lists of up to 2 years. The specialty’s leaders thought this bonanza would never end, so they raised the number of students in universities who were being educated in orthodontics from 469 to 685. In 1958, the AAO inaugurated a preceptorship program. In the 11 years of its existence, the preceptorship program produced 266 orthodontists. Because orthodontics was in high demand by the public, unions got into orthodontics and sponsored union clinics, particularly in California. There was also a rekindling of interest in orthodontics by general practitioners.

Dr Wahl attributes the “decline” of orthodontics to the decline of birth rates in the 1960s and 1970s. In 1972, only 2.03 children per mother were born. By 1976, the number of births per 1000 women of childbearing age was 65. During the mid 1970s, advertising became “acceptable” due to Bates and O Steen vs State Bar of Arizona . The court ruled that it was restraint of trade for the legal profession to restrict advertising by its members. This opened the floodgates, and from the late 1970s through current times, anyone can advertise anything at any time.

The 1960s was also the era of managed care. The book gives a concise but enlightening history of managed care, access to care, and advertising issues that transpired during the 1970s, 1980s, and early 1990s. Another issue that came to the forefront during this time was group practice, which developed alongside corporate dentistry and even department store dentistry. During this period, bonded brackets, recycled bands and brackets, computerization, and the introduction (into the United States) of removable appliances, particularly the Fränkel, all impacted the specialty of orthodontics. These things along with the expanded duties of auxiliaries made the treatment of malocclusions increasingly attractive to the general dentist, and of course, orthodontic supply houses were happy to provide general dentists the wherewithal to practice orthodontics. Dr Wahl discusses these phenomena in detail.

An interesting summary of all the technological forces in orthodontics that have changed the specialty from what it was in the 20th century to what it now is in the 21st century is given in Part II. These include TADs, self-ligating appliances, accelerated tooth movement, aligners, computers, and digital study models. The specialty has drastically changed. Chapter XIII is an interesting chapter that deals with practice management. Dr Wahl discusses office staff, relationships of orthodontists to referring dentists, Internet marketing strategies, and all of the associated issues that the modern practitioner faces as he or she runs a practice. In this chapter is a breakdown of office policies, how to deal with auxiliaries who have health issues, vacation issues, and so on.

The final chapters in the book deal with HIPAA regulations, sterilization, patient transfers, how to interact with patients, how to do refunds for unhappy patients, and even how to do informed consent quality records.

Overall, the book is an excellent reference for any person who is interested in the history of the business of orthodontics. It will be an invaluable resource for anyone who is currently establishing a practice or becoming an associate in a practice. Many things are covered that someone entering the specialty needs to know and understand. I highly recommend the book for young and old alike.

Dec 10, 2018 | Posted by in Orthodontics | Comments Off on The golden age of orthodontics: Decline and aftermath. A history of the business of orthodontics
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