I attended a recent conference sponsored by the American Association of Orthodontists (AAO) to encourage young orthodontists to become more involved in leadership in the national association. Among the attendees were current residents, newly graduated orthodontists, and doctors who had been in private practice for less than 10 years. We had 2 stimulating speakers who discussed generational differences among professionals as well as the importance of emotional intelligence when dealing with patients, staff, and professional colleagues. But the best part of the day was when the AAO staff assigned these young orthodontists to 1 of 7 discussion groups that dealt with problematic issues that face residents and new practitioners: eg, student debt, difficulty in starting a practice, relationships with referring dentists, the problem with finding orthodontic faculty, and competition from others doing orthodontics. Obviously, these topics generated some lively discussions among the young participants.
Members of the Board of Trustees were asked not to participate in the discussions unless clarification of information was necessary. We were simply there to observe and get a feeling about the needs, concerns, and desires of younger members. I was surprised at the anger and concern that prevailed in 2 discussion groups about the numbers of general dentists providing orthodontic services. Furthermore, these young practitioners were extremely disappointed with the orthodontic manufacturers whose products have made it easier for general dentists to promote and deliver orthodontic care. But is it the products that stimulate dentists to provide orthodontic services? Or is the problem in the way that we educate dental students? After all, general dentists have been providing orthodontic care for decades.
I believe that we do not provide the correct predoctoral orthodontic education to dental students. What do dental students learn about orthodontics? Not much. In many schools, the real information about how to move teeth is regarded as proprietary, reserved for orthodontic residents alone. Dental students are typically taught how to diagnose a developing malocclusion in a child and at what age to refer that child to the orthodontist. Who benefits from this approach? The patient and the orthodontist. Seems self-serving to me. If I were a general dentist who had received that type of indoctrination about orthodontics, I also might try treating a few patients myself. What should we be teaching predoctoral students? We should instruct them about how orthodontics can assist general dentists in achieving ideal treatment results for their restorative patients. Who benefits from this type of knowledge? The patient, the orthodontist, and the general dentist.
Let me give you some examples. Consider the patient with severe anterior tooth wear and short maxillary or mandibular incisors. This is a common and extremely difficult situation for dentists to manage restoratively. However, by working on a team with an orthodontist, who can intrude the abraded and overerupted teeth, the general dentist will have sufficient space to properly restore the abraded teeth without further tooth reduction. Do predoctoral students ever see examples like this during their dental training? I doubt it.
Or how about a patient with missing teeth who needs implants to restore the edentulous spaces? Do predoctoral students see interdisciplinary examples of how orthodontists can apportion spaces, develop bone in the implant sites, and establish proper tooth position? Not likely. I spent a majority of my professional life lecturing to mixed groups of orthodontists and general dentists. My lecture topics usually demonstrated examples of what orthodontists could do to improve the work of the restorative dentists. And what was the typical comment from most restorative dentists? “Why didn’t I learn this in dental school?”
We have a big problem. The problem is the lack of a restoratively centered and teamwork driven predoctoral program. I believe it’s time to fix the problem with predoctoral orthodontic education.
