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Orthodontia education
The International
Journal
of
Oral Surgery Orthodontia, and Radiography (All
rights
resewed)
ORIGINAL
I%Y
1’.
1~.4I,L.A(‘E
%KRI%S,
ARTICLES
I>.I).s.,
()KI,AffO31.I
(:ITY,
0KL.i.
REVIEWING Dr. William ,J. Gries’s report I Ndental education for the Carnegie Foundation,
of his surveys and study of n-e find that dentistry began first to attain importance in 1840. It was at this time that dentists in th(k United States established the first journal of dentistry, the first national society of dentists, and the first dent,al school. For nearly thirty years therrThere were no educational prerequisites after dentistry remained superficial. It was regarded, generally, as a trade and no legal restrictions to its practice. which anyone might undertake who was disposed to do so. Thert> were ten dental schools in 1868, whose combined graduates were ninety dentist-s. ‘l’hc graduate course of training was an apprenticeship with less t,han a year 01’ theoretic t*raining. About the same year, in response to cumulative demands for great,er responsibility and efficiency in dental service, the legislat,ures of the states began to enact lams that specified definite requirements of admixsion t,o practice and gave power of enforcement to boards of dental examiners. The public and professional importance of the regulative function of the State Board of Dental Examiners was plainly evident from the outset. The mandatory effect of these regulations made for dentistry greater strides than The National Association of Dental Examiners was in all previous history. organized in 1883, whose principal objectives were t,o develop a common undwstanding and to unify the system. In the beginning when dentistry was loosely organized and had bwn rebuked by th.e medical schools, a large number of independent commercial schools mere established. The quality of education was naturally made subhoma
*Read City.
at the Okla.,
tenth February
annual 25,
meetin,1930.
of
the
Soutbwestrrn
Society
of
Orthodontists.
Okla-
The financial returns were very handscrvient to the maximum net profits. some in inst,itutions which were efficiently managed. It has since been clearly proved that neither graduate nor undergraduate scl~ools can dtrvclop thca high est quality of education and humanitarian service on finances consisting of fees paid by students. The National Association of Dental Facilities was organized in 1884 and the Kational Council of Dental Education in 1909. The reprrsent,ativrs of t!he greater educational institutions having large sectarian, statt’, and c~tlowIII merit funds for support. gradually gained control of t,hrse organixat,ions. 1922 the point, sysitem of school grading was adopted which has fore4 a rwpitl elimination of the proprietary schools. The general broadening of dental health service, as time elapses with it,s concurrent mechanical, esthetic, and medical demands, makes it impossible to l)ractiee expertly all aspects of it. As a conseqnence several important specialties have arisen. By reason of its outstanding reconst,ructive character and major evidences of preventive and curative quality. the art of correcting irregularities of the t.eeth and dentofacial deformities has made the practice of orthodontia. one of t,he most important utilities in dentistry. In addition t,hr complicated t,cchnical, clinical, and scientific charact,er of &is brancb of ctrntistry has made it possible to develop into the leading specialty of dellOral surgery has since acquired the distinction of an accredit,4 dental tistry. specialty, and others, such as periodontia, prosthodontia ant1 l)edodont,ia HI’P T I1 t’ among those attaining concreteness and rapidly increasing in number. scope. complexity, and difficulties that arise in preparing for the I)r;tcticcl of any one of t,he specialties are of such magnitude as to lead one to believe t,hat it is even impossible for anyone to acquire a full knowledge of its possibilitic~s. and, T might add, its responsibilities. In holding this brief review of the evolution of general tlrnt,al education in mind and in comparin g it with the development of ort,hotlontia education since it, was first established as a specialty some thirty years ago, one will find great, similarity. Sincere preparation for specialization in the difierrnt branches is being attained chiefly by self-training or private instruction in thcl short course proprietary schools. The dental schools, with but. about four PXW~ tions, hare failed to provide proper courses of instruction for specialization. The general practitioners desiring additional knowledge and training to prrpare for specialized practice and those mishin g to incrrasr their pcneral fitness for the practice of the several major branches havr been left rxposrd to commercial enterprises. Dental supply houses and certain othrr commercial agencies and individual denti& with itinerant courses have been in a large measure supplying the need. Some of them are compatible Iv-it11 profrssional &ics, and doubtless merit a place in dental education, but advanced dent+, should not be so complet,ely dependent, upon commercial education. We should learn t,o look to our higher educational institutions for graduate instruction as well as for the undergraduate courses. The older methods filled the gap and served a useful purpose, but they have grown obsolete under thr more advanced methods of proridin g dental education and should give wa3
to the newer administrative personnel and field force with adequate clerical assistance. Full-time inst,ructors are available to teach the correlated subjwt)s without extra cost. Diversified courses in medicine ancl dent&r?- can be supplied in such number that losses in some can be balanced with profits in otllers. It is not, always necessary to exprct certain branches to pay their \~a>‘, as st,ate appropriat,ions and budgets would cover a wasonable amount of tl+ ficiencirs for the good of the cai&. Dental societies have been striving t,o meet, the nerd by earnestly conducting short courses of instruction at their mect~ings, but such measuresP are superficial and inadequat,e. Only partiall!, despite their emergency value, trained and experienced men, who nsually change with each succeeding atlnrinistrat,ion. serve on the program committees. There is unavoidably a large loss of time? and general conditions make it difficult, if not wholly impossible. for t,he Iccturrrs and clinicians to leave the proper understanding and tecllnical knowledge of their subject in the minds of their audiences. Only too frequently me see more damage than good brought about as thus result of ‘it. The extension course, w2lic.h has recently been introduced in Ot~la1~oma through t,he cooperation of the State Dental Soc:iet,y, State IIealth Department, and the Extension Division of the St~ate l’niversity, is a gwat iml)rorcmerit over t,he older met.hods. A special itinrralit course of instruction in children’s dentistry involving six weeks, of on(b afternoon illltl cavriiing iI week, and another in general dentistry using t,he same amount of time, \VPW given. This is equivalent to a continuous course of ow week. Eight of tllcl best instruct,ors, including Dr. Art,hur Black, IIran of Worthwestcrn T:nirrrxity, presented the courses. The fees were $25 and $40 rcsptwtivcty. with practically no loss of time or additional expenw to the applicants. l’trrw courses were considered a real success. The general adoption of this plan would relieve the societiw of a large and unnecessary burden and permit, t,hc organizations t,o give mow attelltion to t,hc general business affairs of dentistry which arc constantly increasing in number and importance. Thep, llllfO~tl~lli~t~l~, have bad tittlc ilitrrest and at,tention. This type of ext,ension conrsc: because of the unavoidable brevity, ~vould not provide sufficient training for the exclusive practice of any of t,he specialties on a properly standardizcld basis unltw it hc made progressive. I:nder present condit,ions any dentist may publicly announce Ilimwlf as a specialist, and suprrior to gPnldtTill practitioners in particular linw of oral health service, wit,hout having to subrnit t,o any special ducatiol~al rrquirrmrnt,s or demonstrate ho an examining board the validit,?- of his claims. 111 dentistry as in medicine there is an incrrasin, 0. trndrncy for men to bwome I’nrest~rictetl abuses of this l)rivispecialists without proper preparation. lrgr, even though they are made by honest effort, t8hrrat,cn to destroy public and professional confidence to a degree that will stunt dental progress. The obligation of the universities to provide a systematic curriculum for the training of specialists in orthoclontia and in other t,ypes of oral health Dr. Gries rwommrnds, arid many other leading service is clear and urgent. educators agree, that education for the practice of the specialt,irs should
come only through a combined medicodental curriculum equal in length and character to such as is offered tb candidates for higher degrees. The present, fife-?-car lmclergraduate course, as some have suggested, might be reducetl to follr by increasing the annual term to eleven months. The present three niontlis’ vi~CatiO?l period for professional training appears to require an Illinecessary amount of t,ime and money. Preparation for specialization coultl begin by majoring in the undergraduate study to deternlinc one’s apt itudc. The addition of an optional full year , graduate curriculum, based upon that undergraduate curriculum and conducted on a high plane of scholastic c~tnaiit~. for systematic and int,ensive t,raining in orthodontia and other types of orill sl)ecializatiou, should have a commensurat,e degree of NS. After this is firmly established, an additional year embracing furthr~r study and at,tainmerits in research shoulcl lead to a Ph.I>. Statutor>- preparation coulcl a~‘t,llallJ- bpgiii t.llr year following the attainment, of a I1.11.S. tlcgwe or latrr. Ample opportunit,y could further be pro\-idecl by offering the course in SCP tions7 or in l)ilrt, by extension service. While several of the most prominent universities of the country have made an earnest effort to establish this course of training, they are having a, hard struggle for several reasons. Organized dentistry including the special branches has failed to give them proper publicity. The limited obligation of state universities to stat,e jurisdictional -policies is another reason. ‘J’hc con~~wtitire influence of the proprietary scl~ools is still another. The ljrofrssion en masse is unaware and has so far failed to realize and appreciate the true significance of the new standard, which is being only too slowly c’stablishr~tl. The adwnced standards cannot be developed without increased fina.ncial support, but with proper professional support and addit,ional adequat,e resources t,he most important dental schools could promptly efiect the proposed improvements. Although dentistry is an important mode of universal health service, the public has done little to advance it. Endowments and state aid for the c~stablishment and maintenance of the best of schools is urgently needed in the pnblie interest. In t,his important aspect dental education is identical \\,ith medical education, but hitherto in an era known for its generous financial support deservedly accorded medicine, the educational facilities and research neecled for the advancement of oral health service have been almost wholly ignored. It is, however , gratifying to observe that there are numerous philanthropists and university authorities who appreciate the true value elf such laudable undertakings and are prepared and willing to lend a helping hand if t.hey are properly approached and assisted. The ptlblic has come to realize t,hat dent,al health occupies a very important place in our economic, social, and moral structure and is willing that a fair portion of the public funds be invested in dental education, just as it is in our state schools of medicinr, law, journalism and others. It is the duty of organized dentistry to divert more of its time atid energies to the business of elevating and safegua,rding its educational standards and assist in the promotion of research.
Orthodontia
E&cation
While dentistry and orthodontia have made remarkable progress in t,he development of mechanical agencies for restorative work, t,hey ha.ve been baffled by pathologic causes and their removal and control. The tendency to irregular alignment in dentition and facial deformities appears to be growing; decay of teeth is rampant, and the loss of teeth owing to tliseasc of t-heir investing tissues was never more common. The avenues for dental rcasewrch are wide and numer0u.s. It would be interesting a.nd valuable to know the types of oral abnormalities that are directly influenced by heredity. 1 believe it is safe to assume that one of the next great, advancements for the prevention of disease and mental and physical cripples must come through a bet,trr appreciation of eugenics and a closer understanding of the laws of inheritance. The recent establishment of the American Board of Orthodontia, which is patterned after the Board of Opht,halmology and others of a similar kind It is sure to have a stimnis a most commendable and worthy undertaking. lating effect upon higher education in the ranks of orthodontists by way of professional distinction in the orthodontia field, but will probably have little effect in regulating the qualifications for admittance to the specialty. After it is once established, it should be the further ambition of the American Society of Orthodontia board to legalize it in order that it, might serve its purpose more completely. By making it a national examining board by process of legislation, it would have the power of enforcin g the desired qualifications for practice. Without this power of enforcement, if it be fair to judge its probable achievemvents in this direction by the influence of t.he other similar organizations, it will have relatively little efFect upon raising the educational requirements for the exclusive practice of orthodontia. Distinctive requirements by law for the exclusive practice of orthodontia would in no way interfere with the dental practitioner who desired to use jt in the general routine of practice. Dentistry has been so engrossed in the mechanics of practice that it has neglected many of its public and professional obligations, which might he classed as public and professional business. The recent concerted and partially successful effort to lower the professional dignity and prestige of orthodontia by legislation, which would place it in the same professional classification as chiropodists, chiropractors and the like, by establishing a three-year course of special instruction without first obtaining a dental degree, and was put over unchallenged before the legislature of Arizona, should be a good object lesson to our orthodontia societies, which stand for the better things. When such impractical dental laws are enact,ed without resistance, is it not reasonable to assume that more constructive types might be had if they were introduced and supported by the whole profession? The problem of fulfilling OUP public obligations in the work of prevention, which must come from research in universities and of supplying qualie fied orthodontists to meet the requirements of public service is a serious and difficult problem. Public enlightenment and demand for the best of medicodental service is going forward at such a broad and rapid pace through vari-
800 O!IS educational channels, that our principal difficulty is to keep the profession in the procession. Soon after launchin g our educational program for the laity in Oklahoma it became necessary to check onr operations and to formulate a program of educational work for the profession in order to keep our activit,ies properly balanced. For example, hundreds of parents over the state mere t,aking their children to de&al offices’ for corrective work, with a definite knowledge of the kind of advice and remedial work they should receive. It is the business and duty of all official and nonofficial health organizations to teach and enforw the fundamental rules and laws of health that are recognized as scientificall) sound ancl of practical value. When the official stat,e health organization instructs the parents and children through educational mediums, that the smallest cavit,y shoulcl be filled, that all chronically infected teeth should be I’P moved, and that malocclusion should be treated during the transit,ional period of dentition, and t,hat certain other corrective and preventive work is indicated to safeguard the health of the child, and then to have false adyict: or faulty corrective work of the pract.itioner run count,er to the recommentlations of the department, the applicant naturally loses confidence in dentist,ry. The State Health Department is rightly considered an ant,horitativr agency in the regulation of public health measures, illld when the profession fails to keep itself properly informed alon g the more advanced scientific lines of preventive and reconstructive hea1t.h service, it handicaps educational progress. We now have under preparation a set of rules for the guidance of I)ril(:titioners doing children’s clentistry. The responsibilities for dental healt,h education of’ the lmblic should bo It is vested in public health authorities and public educat,ional institutions. an important public welfare work and should be done la.rgely at public taxpense. Dent21 societies are only in a position to do a small portion of it. They shol~ld be concerned mostly- in the development of research to discover more effective methods of cure and control. Also to stltdy wa\-s and means and causing t,he discoveries of science to bwome oprrat,ive of introducing through the dift’crrnt health agencies by establishing closer contacts. Orthodontia education should be recognized as an integral part of all drnt,al health programs and carried forward as a unit in the general scheme of health education. The ultimate success of a general healt,h program is tleprntlt~rlt upon a properly balanced relationship of all branches of the healing art. It would be very desirable to have a standing comntittee on orthodontia edllcation in the Southwestern Society to assist the bureaus in t,he screral states in preparing the proper kind of educational material. The establishrnent of a bureau of dental health education in t,he State IIea1t.h IIcpartment makes it possible to meet on a common ground with all t,he various organizations that arc interested in the advancement of health education. It, nlakes it possible to open up many avenues that would otherwise be closed. Dental health education has found its way into the activities of the Oklahoma Public Health Association, Oklahoma Crippled Children’s SocieQ, Oklahoma Educational Association. Oklahoma Dental Society, Parent Teachers’ Association, County Health Units, Red Cross, Bureau of JIaternity and Infancy. Oklahoma Nrdi-
Orthodontia Education.
801
cal School and Hospital, Oklahoma Cniversity and others. It has everywhere received sympathetic support and discovered many opportunities to make further advances with liberal financial support. The bureaus of dental health and of maternity and infancy are by far the most popular departments, and A booklet on dental health dental health has an important place in the latter. for mother and child is sent every expectant mot,hrr. The physicians cooperate splendidly as provided by law in reporting their cases. It is plainly clvident, that, philant,hropic assistance and public funds could be made available with t,he proper kind of an appeal anal guarantees of honest, efficient management. W\:(l have just reecnt,ly made application to tht> Roseuwald Foundation for funds to establish some research and demonstration clinics for children that will operate on a low fee for the low wage earner. The Extension Division of Education of the State T!niversit,y will manage it as a part of the educational program. The faster and more completIely these special classes of work are introduced and established in our large institutions, the prea.ter will be our educational achievements. It is to t,hrse institutions whclre they have efficient. boards of administration that we should go with our educational problems for assistance. They were established in the int,rrest of education b>- the public for the public at public expense in so far as education can be provided on a sound and practical economic basis. Special appropriations, while highly desirable, are not always so necessary as many think to carry on this special research and edueat.ional work. Many of t,he universities have sufficient funds in the budget to allow their full-time medical instructors to engage in research. All that is needed is to arouse their interest, and t,o give them t,he proper cooperation. Research is their hobby, and an important part of their life’s work, as their repntat,ion and command of salaries are largely dependent upon their achievements in the line of research. It does not diminish their incomes, on the other hand, it increases them. These men, if >-ou will observe, are anxious to venture into new and unexplored fields for a new thrill. The private practitioners have neitSher time nor facilities to do very much mit,hout medical assistance. Dental health education in its public relations must necessarily embrace all phases of dent,istry if it is to render the maximum service at the minimum cost. The success of one branch of the work is dependent upon others, and the work must be so molded as to fit into the general plan of our polit,ical, social, and economic structure. Scientific research t,o provide more effective means of prevention and cure undoubtedly is our greatest need. In this work we can act only as a directing agency, since no appropriations arc made to the State Department of Health for research. The general program includes education of dentists to the importance of etiology, diagnosis, prognosis and methods of treatment. 1. Directing parental attention to the importance of prophylactic dentistry. 3. Est,ablishing dental health clinics for 10~ wage earners and indigent cases.
SO')
T. Mfa.llace 8owels
3. Bringing the attention of public officials t,o the economic value of mouth hygiene service. 4. Introducing curative dental service in state hospitals and penal instit utions. 5. Cooperating with the medical profession and getting curative dental health service to function effectively in hospitals. 6. Directing employment of dental hygienists and dentists who are qnalitied to establish clinics and dental health programs in school systems, large industries and in supervising research and demonst,ration clinics. 7. Providing low pay and free dent,al dispensaries in connection with l)ublit charities. The business of supplying dental healt,h service to the public is a stupcndous and difficult task. St,atist,ics indicate t,hat about 80 per cent of 0111 families have an income of not more than $3,000 per annum. It can be reasonably assumed by our investigations and others that about 85 per rent, of the children have defective t.eeth, while 50 per cent, have anomalous dentures and about 80 per cent have conspicuous and extreme oral malformations which would seriously affect normal health and development. It is, therefore, obvious that adequat,e corrective service, even though it comes within the range of the more inexpensive lines of general dental service, is not, accessible to the vast majorit,y of our people if the private practitioners are IO be compensated properly. Remedial orthodontia service on account, of the time and expense involved in treatment is far beyond the reach of another large percentage of the families and cannot be made available unless t,he responsibility is placrtl on public or endowed institutions. There are, however, possibilities of puttin, u it, wit,hin reach of a much oreater percentage of the people if we would make a serious effort to solve ;he problem. Dental orthopedic clinics should operat,e more extensively in dental colleges and should certainly have a place in all the hospitals for crippled chilclrrn in the country. A more careful study of modern business met,hods. as they apply to ort,hodont,ia practice, would make an extension of service possible in many places. One, two. or three orthodontists by a copartnership arrangement could bt~y or const,ruct. a combination building, of a style t,hat could be easily remodeled int,o a general business building in the line of the cit,y’s growth and development to get the appreciation on their realty investment, which would greatly reduce or eliminat,e rents. Less expensive equipment could be provided. An orthodontist who desired further experience and training before entering private practice could be employed on a st)raight salary or on net percentage or on a combination of bot*h. Prophylaxis in orthodontia, \vhich must. be given at, each visit, ut’ilizes an astonishing amount of time. This work could be transferred to a dental hygienist. An efficient and honest secretary and a compet,ent technician might be made available t,o make appliances as An assignment of various duties to others capable of performing directed. them would reduce to a low cost everything except the essentials, such as
diagnosis and treatment. The private practit,ioner could then send those unable to meet his regular fee scale to the clinic where a lower fee scale would be operating. A large number would find their wan- t,o the clinic through the dental profession and other ways of approach. d fair and rensonably accurate check-up could be made of their worthiness for admittance I hrough Credit Men’s Association and other means of investigation. The extension of time between visits to the tnaximum, consistent w&h safe and efficient service to reduce working time to t,hr minimum, would fnrt,her allow for a much larger volume for a mass production basis. l’he loss of time and the crowded hours of practice, which is an economic \f+aste due to the thought,less and overzealous scnt,imentj of school attendance This obstac*lr as it relates to the welfare of children deserve consideration. might be greatly reduced by impressing parents, trachrrs. principals. and school authorities \vit,h the importance of children’s rcceiuinp prevcntirt~ and corrective orthodontic service without being prnalizrd for their absence. The necessary rules regulating school attenclance must be duly rwognizrtl, but when they interfere with t,ht child’s fnt,nre Jvell-being, t,hry should be modified to a degree that will allow reasonable opportunity for trcatmr~nt. IIealth is considered of first importance in edncat,ion, and school authoritiw will make any reasonable concessions that seem warranted, if they can llav(l the proper assurances t,hat. the privilege will not be abusrd. Many suiwrintendents of schools will issue a special bull&in aut,horizing princilmls and teachers to allow full credit, for attendance, witShout, any penalty, 11po11 written excuses from the ort,hodontist covering t,hr child’s abscnct‘. An efficient office arrangement and strict a.tlhercnce to sound business The same principles are principles of pract,ice should be other essentials. likewise applicable to the general conduct of a private practice. This plan should in no way interfere with the man in private practice, who should have a full and unrestricted opportunity t,o increase his few in relative proportion to the number of people who want to purchase his services autl arc rated higher t.han the clinic will admit. These suggestions might be helpful in solving the economic ~~rohlrni 01 medicodent.al service with which we have recently been corrfrontrtl by pubI ica opinion. They furthermore may have a tendency to elevate the present-da!, standards of specialized t,rainin,, CTwhich are so badly in need of at,t,rntiou.
Journal
of
Oral Surgery Orthodontia, and Radiography (All
rights
resewed)
ORIGINAL
I%Y
1’.
1~.4I,L.A(‘E
%KRI%S,
ARTICLES
I>.I).s.,
()KI,AffO31.I
(:ITY,
0KL.i.
REVIEWING Dr. William ,J. Gries’s report I Ndental education for the Carnegie Foundation,
of his surveys and study of n-e find that dentistry began first to attain importance in 1840. It was at this time that dentists in th(k United States established the first journal of dentistry, the first national society of dentists, and the first dent,al school. For nearly thirty years therrThere were no educational prerequisites after dentistry remained superficial. It was regarded, generally, as a trade and no legal restrictions to its practice. which anyone might undertake who was disposed to do so. Thert> were ten dental schools in 1868, whose combined graduates were ninety dentist-s. ‘l’hc graduate course of training was an apprenticeship with less t,han a year 01’ theoretic t*raining. About the same year, in response to cumulative demands for great,er responsibility and efficiency in dental service, the legislat,ures of the states began to enact lams that specified definite requirements of admixsion t,o practice and gave power of enforcement to boards of dental examiners. The public and professional importance of the regulative function of the State Board of Dental Examiners was plainly evident from the outset. The mandatory effect of these regulations made for dentistry greater strides than The National Association of Dental Examiners was in all previous history. organized in 1883, whose principal objectives were t,o develop a common undwstanding and to unify the system. In the beginning when dentistry was loosely organized and had bwn rebuked by th.e medical schools, a large number of independent commercial schools mere established. The quality of education was naturally made subhoma
*Read City.
at the Okla.,
tenth February
annual 25,
meetin,1930.
of
the
Soutbwestrrn
Society
of
Orthodontists.
Okla-
The financial returns were very handscrvient to the maximum net profits. some in inst,itutions which were efficiently managed. It has since been clearly proved that neither graduate nor undergraduate scl~ools can dtrvclop thca high est quality of education and humanitarian service on finances consisting of fees paid by students. The National Association of Dental Facilities was organized in 1884 and the Kational Council of Dental Education in 1909. The reprrsent,ativrs of t!he greater educational institutions having large sectarian, statt’, and c~tlowIII merit funds for support. gradually gained control of t,hrse organixat,ions. 1922 the point, sysitem of school grading was adopted which has fore4 a rwpitl elimination of the proprietary schools. The general broadening of dental health service, as time elapses with it,s concurrent mechanical, esthetic, and medical demands, makes it impossible to l)ractiee expertly all aspects of it. As a conseqnence several important specialties have arisen. By reason of its outstanding reconst,ructive character and major evidences of preventive and curative quality. the art of correcting irregularities of the t.eeth and dentofacial deformities has made the practice of orthodontia. one of t,he most important utilities in dentistry. In addition t,hr complicated t,cchnical, clinical, and scientific charact,er of &is brancb of ctrntistry has made it possible to develop into the leading specialty of dellOral surgery has since acquired the distinction of an accredit,4 dental tistry. specialty, and others, such as periodontia, prosthodontia ant1 l)edodont,ia HI’P T I1 t’ among those attaining concreteness and rapidly increasing in number. scope. complexity, and difficulties that arise in preparing for the I)r;tcticcl of any one of t,he specialties are of such magnitude as to lead one to believe t,hat it is even impossible for anyone to acquire a full knowledge of its possibilitic~s. and, T might add, its responsibilities. In holding this brief review of the evolution of general tlrnt,al education in mind and in comparin g it with the development of ort,hotlontia education since it, was first established as a specialty some thirty years ago, one will find great, similarity. Sincere preparation for specialization in the difierrnt branches is being attained chiefly by self-training or private instruction in thcl short course proprietary schools. The dental schools, with but. about four PXW~ tions, hare failed to provide proper courses of instruction for specialization. The general practitioners desiring additional knowledge and training to prrpare for specialized practice and those mishin g to incrrasr their pcneral fitness for the practice of the several major branches havr been left rxposrd to commercial enterprises. Dental supply houses and certain othrr commercial agencies and individual denti& with itinerant courses have been in a large measure supplying the need. Some of them are compatible Iv-it11 profrssional &ics, and doubtless merit a place in dental education, but advanced dent+, should not be so complet,ely dependent, upon commercial education. We should learn t,o look to our higher educational institutions for graduate instruction as well as for the undergraduate courses. The older methods filled the gap and served a useful purpose, but they have grown obsolete under thr more advanced methods of proridin g dental education and should give wa3
to the newer administrative personnel and field force with adequate clerical assistance. Full-time inst,ructors are available to teach the correlated subjwt)s without extra cost. Diversified courses in medicine ancl dent&r?- can be supplied in such number that losses in some can be balanced with profits in otllers. It is not, always necessary to exprct certain branches to pay their \~a>‘, as st,ate appropriat,ions and budgets would cover a wasonable amount of tl+ ficiencirs for the good of the cai&. Dental societies have been striving t,o meet, the nerd by earnestly conducting short courses of instruction at their mect~ings, but such measuresP are superficial and inadequat,e. Only partiall!, despite their emergency value, trained and experienced men, who nsually change with each succeeding atlnrinistrat,ion. serve on the program committees. There is unavoidably a large loss of time? and general conditions make it difficult, if not wholly impossible. for t,he Iccturrrs and clinicians to leave the proper understanding and tecllnical knowledge of their subject in the minds of their audiences. Only too frequently me see more damage than good brought about as thus result of ‘it. The extension course, w2lic.h has recently been introduced in Ot~la1~oma through t,he cooperation of the State Dental Soc:iet,y, State IIealth Department, and the Extension Division of the St~ate l’niversity, is a gwat iml)rorcmerit over t,he older met.hods. A special itinrralit course of instruction in children’s dentistry involving six weeks, of on(b afternoon illltl cavriiing iI week, and another in general dentistry using t,he same amount of time, \VPW given. This is equivalent to a continuous course of ow week. Eight of tllcl best instruct,ors, including Dr. Art,hur Black, IIran of Worthwestcrn T:nirrrxity, presented the courses. The fees were $25 and $40 rcsptwtivcty. with practically no loss of time or additional expenw to the applicants. l’trrw courses were considered a real success. The general adoption of this plan would relieve the societiw of a large and unnecessary burden and permit, t,hc organizations t,o give mow attelltion to t,hc general business affairs of dentistry which arc constantly increasing in number and importance. Thep, llllfO~tl~lli~t~l~, have bad tittlc ilitrrest and at,tention. This type of ext,ension conrsc: because of the unavoidable brevity, ~vould not provide sufficient training for the exclusive practice of any of t,he specialties on a properly standardizcld basis unltw it hc made progressive. I:nder present condit,ions any dentist may publicly announce Ilimwlf as a specialist, and suprrior to gPnldtTill practitioners in particular linw of oral health service, wit,hout having to subrnit t,o any special ducatiol~al rrquirrmrnt,s or demonstrate ho an examining board the validit,?- of his claims. 111 dentistry as in medicine there is an incrrasin, 0. trndrncy for men to bwome I’nrest~rictetl abuses of this l)rivispecialists without proper preparation. lrgr, even though they are made by honest effort, t8hrrat,cn to destroy public and professional confidence to a degree that will stunt dental progress. The obligation of the universities to provide a systematic curriculum for the training of specialists in orthoclontia and in other t,ypes of oral health Dr. Gries rwommrnds, arid many other leading service is clear and urgent. educators agree, that education for the practice of the specialt,irs should
come only through a combined medicodental curriculum equal in length and character to such as is offered tb candidates for higher degrees. The present, fife-?-car lmclergraduate course, as some have suggested, might be reducetl to follr by increasing the annual term to eleven months. The present three niontlis’ vi~CatiO?l period for professional training appears to require an Illinecessary amount of t,ime and money. Preparation for specialization coultl begin by majoring in the undergraduate study to deternlinc one’s apt itudc. The addition of an optional full year , graduate curriculum, based upon that undergraduate curriculum and conducted on a high plane of scholastic c~tnaiit~. for systematic and int,ensive t,raining in orthodontia and other types of orill sl)ecializatiou, should have a commensurat,e degree of NS. After this is firmly established, an additional year embracing furthr~r study and at,tainmerits in research shoulcl lead to a Ph.I>. Statutor>- preparation coulcl a~‘t,llallJ- bpgiii t.llr year following the attainment, of a I1.11.S. tlcgwe or latrr. Ample opportunit,y could further be pro\-idecl by offering the course in SCP tions7 or in l)ilrt, by extension service. While several of the most prominent universities of the country have made an earnest effort to establish this course of training, they are having a, hard struggle for several reasons. Organized dentistry including the special branches has failed to give them proper publicity. The limited obligation of state universities to stat,e jurisdictional -policies is another reason. ‘J’hc con~~wtitire influence of the proprietary scl~ools is still another. The ljrofrssion en masse is unaware and has so far failed to realize and appreciate the true significance of the new standard, which is being only too slowly c’stablishr~tl. The adwnced standards cannot be developed without increased fina.ncial support, but with proper professional support and addit,ional adequat,e resources t,he most important dental schools could promptly efiect the proposed improvements. Although dentistry is an important mode of universal health service, the public has done little to advance it. Endowments and state aid for the c~stablishment and maintenance of the best of schools is urgently needed in the pnblie interest. In t,his important aspect dental education is identical \\,ith medical education, but hitherto in an era known for its generous financial support deservedly accorded medicine, the educational facilities and research neecled for the advancement of oral health service have been almost wholly ignored. It is, however , gratifying to observe that there are numerous philanthropists and university authorities who appreciate the true value elf such laudable undertakings and are prepared and willing to lend a helping hand if t.hey are properly approached and assisted. The ptlblic has come to realize t,hat dent,al health occupies a very important place in our economic, social, and moral structure and is willing that a fair portion of the public funds be invested in dental education, just as it is in our state schools of medicinr, law, journalism and others. It is the duty of organized dentistry to divert more of its time atid energies to the business of elevating and safegua,rding its educational standards and assist in the promotion of research.
Orthodontia
E&cation
While dentistry and orthodontia have made remarkable progress in t,he development of mechanical agencies for restorative work, t,hey ha.ve been baffled by pathologic causes and their removal and control. The tendency to irregular alignment in dentition and facial deformities appears to be growing; decay of teeth is rampant, and the loss of teeth owing to tliseasc of t-heir investing tissues was never more common. The avenues for dental rcasewrch are wide and numer0u.s. It would be interesting a.nd valuable to know the types of oral abnormalities that are directly influenced by heredity. 1 believe it is safe to assume that one of the next great, advancements for the prevention of disease and mental and physical cripples must come through a bet,trr appreciation of eugenics and a closer understanding of the laws of inheritance. The recent establishment of the American Board of Orthodontia, which is patterned after the Board of Opht,halmology and others of a similar kind It is sure to have a stimnis a most commendable and worthy undertaking. lating effect upon higher education in the ranks of orthodontists by way of professional distinction in the orthodontia field, but will probably have little effect in regulating the qualifications for admittance to the specialty. After it is once established, it should be the further ambition of the American Society of Orthodontia board to legalize it in order that it, might serve its purpose more completely. By making it a national examining board by process of legislation, it would have the power of enforcin g the desired qualifications for practice. Without this power of enforcement, if it be fair to judge its probable achievemvents in this direction by the influence of t.he other similar organizations, it will have relatively little efFect upon raising the educational requirements for the exclusive practice of orthodontia. Distinctive requirements by law for the exclusive practice of orthodontia would in no way interfere with the dental practitioner who desired to use jt in the general routine of practice. Dentistry has been so engrossed in the mechanics of practice that it has neglected many of its public and professional obligations, which might he classed as public and professional business. The recent concerted and partially successful effort to lower the professional dignity and prestige of orthodontia by legislation, which would place it in the same professional classification as chiropodists, chiropractors and the like, by establishing a three-year course of special instruction without first obtaining a dental degree, and was put over unchallenged before the legislature of Arizona, should be a good object lesson to our orthodontia societies, which stand for the better things. When such impractical dental laws are enact,ed without resistance, is it not reasonable to assume that more constructive types might be had if they were introduced and supported by the whole profession? The problem of fulfilling OUP public obligations in the work of prevention, which must come from research in universities and of supplying qualie fied orthodontists to meet the requirements of public service is a serious and difficult problem. Public enlightenment and demand for the best of medicodental service is going forward at such a broad and rapid pace through vari-
800 O!IS educational channels, that our principal difficulty is to keep the profession in the procession. Soon after launchin g our educational program for the laity in Oklahoma it became necessary to check onr operations and to formulate a program of educational work for the profession in order to keep our activit,ies properly balanced. For example, hundreds of parents over the state mere t,aking their children to de&al offices’ for corrective work, with a definite knowledge of the kind of advice and remedial work they should receive. It is the business and duty of all official and nonofficial health organizations to teach and enforw the fundamental rules and laws of health that are recognized as scientificall) sound ancl of practical value. When the official stat,e health organization instructs the parents and children through educational mediums, that the smallest cavit,y shoulcl be filled, that all chronically infected teeth should be I’P moved, and that malocclusion should be treated during the transit,ional period of dentition, and t,hat certain other corrective and preventive work is indicated to safeguard the health of the child, and then to have false adyict: or faulty corrective work of the pract.itioner run count,er to the recommentlations of the department, the applicant naturally loses confidence in dentist,ry. The State Health Department is rightly considered an ant,horitativr agency in the regulation of public health measures, illld when the profession fails to keep itself properly informed alon g the more advanced scientific lines of preventive and reconstructive hea1t.h service, it handicaps educational progress. We now have under preparation a set of rules for the guidance of I)ril(:titioners doing children’s clentistry. The responsibilities for dental healt,h education of’ the lmblic should bo It is vested in public health authorities and public educat,ional institutions. an important public welfare work and should be done la.rgely at public taxpense. Dent21 societies are only in a position to do a small portion of it. They shol~ld be concerned mostly- in the development of research to discover more effective methods of cure and control. Also to stltdy wa\-s and means and causing t,he discoveries of science to bwome oprrat,ive of introducing through the dift’crrnt health agencies by establishing closer contacts. Orthodontia education should be recognized as an integral part of all drnt,al health programs and carried forward as a unit in the general scheme of health education. The ultimate success of a general healt,h program is tleprntlt~rlt upon a properly balanced relationship of all branches of the healing art. It would be very desirable to have a standing comntittee on orthodontia edllcation in the Southwestern Society to assist the bureaus in t,he screral states in preparing the proper kind of educational material. The establishrnent of a bureau of dental health education in t,he State IIea1t.h IIcpartment makes it possible to meet on a common ground with all t,he various organizations that arc interested in the advancement of health education. It, nlakes it possible to open up many avenues that would otherwise be closed. Dental health education has found its way into the activities of the Oklahoma Public Health Association, Oklahoma Crippled Children’s SocieQ, Oklahoma Educational Association. Oklahoma Dental Society, Parent Teachers’ Association, County Health Units, Red Cross, Bureau of JIaternity and Infancy. Oklahoma Nrdi-
Orthodontia Education.
801
cal School and Hospital, Oklahoma Cniversity and others. It has everywhere received sympathetic support and discovered many opportunities to make further advances with liberal financial support. The bureaus of dental health and of maternity and infancy are by far the most popular departments, and A booklet on dental health dental health has an important place in the latter. for mother and child is sent every expectant mot,hrr. The physicians cooperate splendidly as provided by law in reporting their cases. It is plainly clvident, that, philant,hropic assistance and public funds could be made available with t,he proper kind of an appeal anal guarantees of honest, efficient management. W\:(l have just reecnt,ly made application to tht> Roseuwald Foundation for funds to establish some research and demonstration clinics for children that will operate on a low fee for the low wage earner. The Extension Division of Education of the State T!niversit,y will manage it as a part of the educational program. The faster and more completIely these special classes of work are introduced and established in our large institutions, the prea.ter will be our educational achievements. It is to t,hrse institutions whclre they have efficient. boards of administration that we should go with our educational problems for assistance. They were established in the int,rrest of education b>- the public for the public at public expense in so far as education can be provided on a sound and practical economic basis. Special appropriations, while highly desirable, are not always so necessary as many think to carry on this special research and edueat.ional work. Many of t,he universities have sufficient funds in the budget to allow their full-time medical instructors to engage in research. All that is needed is to arouse their interest, and t,o give them t,he proper cooperation. Research is their hobby, and an important part of their life’s work, as their repntat,ion and command of salaries are largely dependent upon their achievements in the line of research. It does not diminish their incomes, on the other hand, it increases them. These men, if >-ou will observe, are anxious to venture into new and unexplored fields for a new thrill. The private practitioners have neitSher time nor facilities to do very much mit,hout medical assistance. Dental health education in its public relations must necessarily embrace all phases of dent,istry if it is to render the maximum service at the minimum cost. The success of one branch of the work is dependent upon others, and the work must be so molded as to fit into the general plan of our polit,ical, social, and economic structure. Scientific research t,o provide more effective means of prevention and cure undoubtedly is our greatest need. In this work we can act only as a directing agency, since no appropriations arc made to the State Department of Health for research. The general program includes education of dentists to the importance of etiology, diagnosis, prognosis and methods of treatment. 1. Directing parental attention to the importance of prophylactic dentistry. 3. Est,ablishing dental health clinics for 10~ wage earners and indigent cases.
SO')
T. Mfa.llace 8owels
3. Bringing the attention of public officials t,o the economic value of mouth hygiene service. 4. Introducing curative dental service in state hospitals and penal instit utions. 5. Cooperating with the medical profession and getting curative dental health service to function effectively in hospitals. 6. Directing employment of dental hygienists and dentists who are qnalitied to establish clinics and dental health programs in school systems, large industries and in supervising research and demonst,ration clinics. 7. Providing low pay and free dent,al dispensaries in connection with l)ublit charities. The business of supplying dental healt,h service to the public is a stupcndous and difficult task. St,atist,ics indicate t,hat about 80 per cent of 0111 families have an income of not more than $3,000 per annum. It can be reasonably assumed by our investigations and others that about 85 per rent, of the children have defective t.eeth, while 50 per cent, have anomalous dentures and about 80 per cent have conspicuous and extreme oral malformations which would seriously affect normal health and development. It is, therefore, obvious that adequat,e corrective service, even though it comes within the range of the more inexpensive lines of general dental service, is not, accessible to the vast majorit,y of our people if the private practitioners are IO be compensated properly. Remedial orthodontia service on account, of the time and expense involved in treatment is far beyond the reach of another large percentage of the families and cannot be made available unless t,he responsibility is placrtl on public or endowed institutions. There are, however, possibilities of puttin, u it, wit,hin reach of a much oreater percentage of the people if we would make a serious effort to solve ;he problem. Dental orthopedic clinics should operat,e more extensively in dental colleges and should certainly have a place in all the hospitals for crippled chilclrrn in the country. A more careful study of modern business met,hods. as they apply to ort,hodont,ia practice, would make an extension of service possible in many places. One, two. or three orthodontists by a copartnership arrangement could bt~y or const,ruct. a combination building, of a style t,hat could be easily remodeled int,o a general business building in the line of the cit,y’s growth and development to get the appreciation on their realty investment, which would greatly reduce or eliminat,e rents. Less expensive equipment could be provided. An orthodontist who desired further experience and training before entering private practice could be employed on a st)raight salary or on net percentage or on a combination of bot*h. Prophylaxis in orthodontia, \vhich must. be given at, each visit, ut’ilizes an astonishing amount of time. This work could be transferred to a dental hygienist. An efficient and honest secretary and a compet,ent technician might be made available t,o make appliances as An assignment of various duties to others capable of performing directed. them would reduce to a low cost everything except the essentials, such as
diagnosis and treatment. The private practit,ioner could then send those unable to meet his regular fee scale to the clinic where a lower fee scale would be operating. A large number would find their wan- t,o the clinic through the dental profession and other ways of approach. d fair and rensonably accurate check-up could be made of their worthiness for admittance I hrough Credit Men’s Association and other means of investigation. The extension of time between visits to the tnaximum, consistent w&h safe and efficient service to reduce working time to t,hr minimum, would fnrt,her allow for a much larger volume for a mass production basis. l’he loss of time and the crowded hours of practice, which is an economic \f+aste due to the thought,less and overzealous scnt,imentj of school attendance This obstac*lr as it relates to the welfare of children deserve consideration. might be greatly reduced by impressing parents, trachrrs. principals. and school authorities \vit,h the importance of children’s rcceiuinp prevcntirt~ and corrective orthodontic service without being prnalizrd for their absence. The necessary rules regulating school attenclance must be duly rwognizrtl, but when they interfere with t,ht child’s fnt,nre Jvell-being, t,hry should be modified to a degree that will allow reasonable opportunity for trcatmr~nt. IIealth is considered of first importance in edncat,ion, and school authoritiw will make any reasonable concessions that seem warranted, if they can llav(l the proper assurances t,hat. the privilege will not be abusrd. Many suiwrintendents of schools will issue a special bull&in aut,horizing princilmls and teachers to allow full credit, for attendance, witShout, any penalty, 11po11 written excuses from the ort,hodontist covering t,hr child’s abscnct‘. An efficient office arrangement and strict a.tlhercnce to sound business The same principles are principles of pract,ice should be other essentials. likewise applicable to the general conduct of a private practice. This plan should in no way interfere with the man in private practice, who should have a full and unrestricted opportunity t,o increase his few in relative proportion to the number of people who want to purchase his services autl arc rated higher t.han the clinic will admit. These suggestions might be helpful in solving the economic ~~rohlrni 01 medicodent.al service with which we have recently been corrfrontrtl by pubI ica opinion. They furthermore may have a tendency to elevate the present-da!, standards of specialized t,rainin,, CTwhich are so badly in need of at,t,rntiou.