An open letter to the ABO: Righting past wrongs

American Journal of Orthodontics and Dentofacial Orthopedics Volume 130, Number 2

History of functional appliances I have enjoyed reading the special articles by Norm Wahl retracing the history of orthodontics in 3 millennia. I especially appreciated the inclusion in “Chapter 9: Functional appliances to mid-century” (2006;129:829-33) of the development of the tooth positioner by my grandfather, the late Harold D. Kesling. The tooth positioner, as correctly stated, is a custom appliance made over a setup of the patient’s teeth. However, the Pre-Finisher, currently marketed by TP Orthodontics (LaPorte, Ind), is not a custom appliance. It was created by my father, Peter C. Kesling, in 1978 as a finishing appliance that did not require impressions or the creation of a setup. Its function is similar to a custom tooth positioner, but a Pre-Finisher is be expected to provide and maintain detailed changes if it is used for long-term retention. Christopher K. Kesling Westville, Ind Am J Orthod Dentofacial Orthop 2006;130:127 0889-5406/$32.00 Copyright © 2006 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2006.07.001

Author’s response The comments of Dr Philip and Dr Kesling are well taken. Thank you for making these additions to the history of cephalometrics. Norman Wahl Sequim, Wash Am J Orthod Dentofacial Orthop 2006;130:127 0889-5406/$32.00 Copyright © 2006 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2006.06.008

Staff training Thank you for the fine editorial in the May issue about the staff training program (Turpin DL. Educating the orthodontic team. Am J Orthod Dentofacial Orthop 2006;129:593). You definitely captured the essence of what we are doing and provided ample encouragement for AAO members to become involved. I have often met people in professions other than orthodontics who are surprised and shocked that, before the Academy of Orthodontic Assisting, there was no formal training available for orthodontic assistants in the United States. Most people assumed otherwise. This program not only is designed for new assistants, but also is very appropriate for experienced assistants and other staff members. Although the course requires self-motivation and dedicated study time to complete successfully, it can be completed by most people by studying in the evenings for 2 or 3 months. One goal of this program is to raise the knowledge base of all our staff and, in turn, the level of care our patients receive, and the level of trust and confidence that our patients and prospective patients have in us. We are happy to join forces with the AAO to make this

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already successful program more widely available to its members. It has been a pleasure working with the AAO leaders and staff, and we look forward to making a muchneeded impact in our specialty well into the future. D. Douglas Depew Academic Director, Academy of Orthodontic Assisting Kennesaw, Ga Am J Orthod Dentofacial Orthop 2006;130:127 0889-5406/$32.00 Copyright © 2006 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2006.06.005

An open letter to the ABO: Righting past wrongs What does it mean to be disenfranchised? Among other things, it means to be deprived of some privilege. Why has the American Board of Orthodontics (ABO) sought for so many years to deprive a segment of our society from that which is now attainable by our most recent orthodontic graduates? Obviously, I’m referring to board certification. Who are the disenfranchised to whom I refer? Why, they are the educators who teach our students. What am I talking about? Okay, here it is in plain and simple language. We all agree, or at least I thought we did, that there is a crisis in orthodontic education; that’s what we have been told. Apparently, very few of us want to go into full-time academia because it’s far too lucrative to be in private practice. Because of this, we now have a significant number of foreign-trained orthodontists teaching in our programs. These doctors are not eligible for licensure in most states, and so their only option for a career in orthodontics in the United States is in orthodontic education. Let me say at the outset that the overwhelming majority of these young doctors are bright, caring, dedicated young teachers and researchers who love orthodontics and this specialty. Last but not least, they are really well trained, they know their stuff, and I am proud to call them colleagues. Many of them went through programs far more rigorous than some of our US and Canadian (US/C) accredited programs. They are as good as any graduate of a US/C program at the same time in their careers. Having said this, it makes no sense that the ABO steadfastly refuses to allow these doctors to sit for the Phase II written examination. What is the magical privilege that attaches itself only to one who is a US/C orthodontic graduate? Wait, I know; it’s the old “if you didn’t graduate from a US/C school, there is no way to determine your quality of education” argument. Let’s explore that logic for a second, since that’s all it’s worth. The education they received was good enough to allow these doctors to teach didactics to our students; the education they received was good enough to allow them to clinically supervise our students; the education they received was good enough to allow them to submit questions for the phase II written examination. Yet, their education is not good enough to allow them to take the examination. Now there’s logic for you. If the purpose of the examination is to test whether

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candidates possess the minimum requisite knowledge necessary to become board certified, then could someone please explain to me why it matters how or where the candidates gained that knowledge? If other candidates can demonstrate by passing the examination that they know what the ABO wants them to know, then why can’t our educators be allowed to demonstrate that they have acquired the same knowledge? Let’s face it, the ABO constantly asks all faculty in our accredited programs to submit questions to help develop the examination, and many of these doctors are doing just that—they are teaching our US/C students to take and pass the examination, but they themselves cannot do the same. Let me see whether I have this right. Let’s prevent them from practicing via licensure restrictions, let’s relegate them to academia where we can pay them less because no one else wants to do it, and let’s not allow them to achieve a certain level of recognition because we need to uphold a set of standards that is loosely defined at best. I am not advocating, although the logic does apply if one wishes to do so, that we allow all non-US/C trained orthodontists to take the board examination; I am talking only about full-time faculty who are non-US/C trained. Why? For 2 reasons. The first is that every organization adopts certain cultural values. Loosely construed, these values define, in part, who we are as a specialty. For that reason, we want to ensure ourselves that these candidates are familiar with them, and 1 way to ensure that is to employ them, full time, in the universities and hospitals that train our students. The second reason is that I trust, even if the ABO doesn’t, our educational institutions to hire competent full-time faculty. They have important reputations to protect, and logic dictates that they won’t hire incompetent people who might tarnish their educational images. The same arguments cannot be made for non-US/C trained orthodontists who are in private practice. How can the ABO expect our educators to be rah-rah supporters of the importance of achieving board certification if they cannot become members of the club that they encourage our students to join? Oh, and the answer is not to give these doctors certificates from the institutions where they teach, thus making them eligible. That is nothing more than a fiction (and a demeaning one at that), that, somehow, because they hold a sacred scroll from a US/C program of postgraduate orthodontic education, they become different doctors. Why put these thoughts in an open letter? Why wash our dirty laundry in public? Because in the first place, I have already gone through the proper channels and spoken to the

American Journal of Orthodontics and Dentofacial Orthopedics August 2006

proper people and have tried to have this issue addressed but have been ignored. Second, it’s the right thing to do, and apparently the ABO has attempted in other ways to right the wrongs of the past, so it should pay heed to this one also. It’s time for the ABO to step up to the plate and take another hard look at what it does, what it doesn’t do, and the whys behind those actions. It’s also time for our rank and file to tell the powers that be what they think about this subject. If you agree with what I’m espousing, let the ABO know. You can do this even without being an ABO diplomate; as an AAO member, you can call your constituent representatives; they in turn should pass your thoughts on to your trustees. If the Board of Trustees can’t or won’t do anything, then the House of Delegates can because, simply put, the ABO is sponsored by the AAO. Let’s support our educators, because the lord knows we don’t pay them enough; the least we can do is allow them to take a test. Laurance Jerrold Jacksonville, Fla Editor’s note: Dr Jerrold is correct in reminding us that the globalization of dental education has created new inequities for board certification. However, the ABO does not have the authority on its own to make the changes he suggests. The American Dental Association (ADA) has begun to consider the need for changes in accreditation policies. During its most recent House of Delegates meeting, the ADA passed a resolution to evaluate the possible accreditation of international dental schools. As a follow-up to this action, the AAO has authorized President Donald Joondeph to appoint our own task force on international accreditation to track the ADA’s activity and encourage greater awareness of the effect of globalization on dental education. The concept of international dental education is also mentioned in the Southern Association of Orthodontists’ report from the Institute of Alternative Futures (see my July editorial). As members of organized dentistry, we all need to be more aware of the inequities in licensure and board certification that might hurt dental education and indirectly interfere with the delivery of quality care to our patients. –DLT Am J Orthod Dentofacial Orthop 2006;130:127-8 0889-5406/$32.00 Copyright © 2006 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2006.05.022