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The American Board of Orthodontics
THE AMERICAN BOARD OF ORTHODONTICS B y H. E.
K e l s e y ,*
D .D .S., Baltimore, Md.
H A T E V E R credit is due for in augurating and continuing the movement that eventually resulted in the formation of the Am erican Board o f Orthodontics belongs to the late Albert H. Ketcham . Quite probably it would have died out, as ideas o f a similar nature had done previously, without his untiring devotion to the standards and ideals which the project embodies. The first board of this kind was the American Board of Otolaryngology, and Dr. K e t cham wisely sought their aid and experi ence in organizing the orthodontic board. A t that time, the American Board of Otolaryngology rendered valuable assis tance, as it has on several occasions since. T h e time and labor given to the organi zation of the orthodontic board were con siderable, but were lessened by patterning it after the otolaryngologic board, which had attained a high state of efficiency as the result of experience, during which errors could be corrected and methods of sound administrative procedure be proved and adopted. A t this time, when a number of the other dental specialties are organizing or contemplate organizing similar boards, it m ay be o f interest to the profession to learn something more of the workings of the Am erican Board o f Orthodontics, which has been in successful operation for more than ten years. A fter all, the profession as a whole and the laity gen erally are equally benefited by the oper ation o f such boards if properly con ducted and their activities brought to the attention o f all members o f the profession in a suitable manner.
W
*President, American Board of Orthodon tics.
Jour. A.D.A., Vol. 27, August 1940
It has come to our attention, on several occasions, however, that a large percent age of the dental profession are not aware o f the existence of the board, although most of the members of the profession are aware of the fact that orthodontics has existed as a specialty for many years, well organized and with national as well as re gional societies which, we believe, have had a stimulating effect upon the spe cialty and the profession as a whole. O ne o f the functions of the board is to pro vide a means whereby the general prac titioner, when referring cases for treat ment, can distinguish between those men who have and those who have not prepared themselves by study, and by close application to the principles under lying orthodontic treatment, to give service which will measure up to the highest accepted standards of the spe cialty. T h e board does not, however, as sume that only men who have been certified are capable of giving this service. Some of the best orthodontists have not applied for certificates and m ay never do so. Some do not apply because they do not care to give the time and effort to preparing the material for a test, which they could undoubtedly pass successfully. Others (as in all vocations) are not suffi ciently interested in their work to exert themselves to give the highest type of service and therefore could not meet the requirements of the board. It is because o f such conditions that certifying boards were established. In referring cases locally, dentists in general practice may be able to select perfectly competent men in their own neighborhood who might or might not hold the certificate of the board, but in
1272
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
referring patients to orthodontists in other parts of the country they can do so much more intelligently by availing themselves o f the information w hich is provided in the list of specialists who have been certified. W hat is true o f the orthodon tic board will of course be true of all other boards, and the work o f the indi vidual board can be improved and stim ulated by collaboration with other boards through a general advisory board. A movement to establish, under the patronage o f the Am erican Dental Asso ciation, a general advisory board the members of which would be represent atives of specialty certifying boards al ready in operation, or to be organized in the future, was successfully inaugu rated a few years ago, though, at the time, there was but one board (that of orthodontics) in operation. T w o or three other boards, however, were in process o f organization and have since been suc cessfully launched. Such an advisory board can be of great benefit, as has been proved by the establishment several years ago by the medical profession o f one composed o f representatives of certifying boards of the various medical specialties. T h e American Board of Orthodontics welcomes the opportunity to cooperate in a similar constructive movement. In medicine, the number of certifying boards of the various specialties has been greatly increased during the last few years, and m any hospitals today limit their staff appointments to those who have been certified by these boards. T o explain the working o f the Am eri can Board of Orthodontics, which has now reached a rather mature develop ment, I quote from a short paper pre sented before the N ew Y ork Society of Orthodontists last N ovem ber: In the beginning, a number of men who were outstanding contributors to orthodontic literature and were nationally known for their excellence in operative procedure, and who had been in practice for fifteen years or more, were certified on their record. This
was in line with a classification adopted and still in effect, and those men who were certi fied on their records, or eligible to be so certified, comprise class one. Those who have been in practice ten to fifteen years comprise class two. Those who have been in practice from five to ten years comprise class three. It must not be supposed that the Board has ever made a habit of certifying men who have been in practice fifteen years or more simply because of that one qualification. Such a man, who had not contributed to the literature or to society programs; who had, in other words, given no evidence of pro ficiency by which he could be judged, might be asked for as much material in the way of theses and case reports as would be asked of other men who had been in practice from only five to ten years. As a rule, men who have been in practice from ten to fifteen years are not asked to present as much ma terial as are those who have been in practice from five to ten years only. Thus it will be seen that a man’s record of accomplishment, his interest in his work and in his profes sional organizations, and his general record for high ethical conduct all have a bearing upon the question of requirements. The board welcomes applications from men who are sufficiently interested in what the cer tificate stands for to be willing to take the time and trouble to make a good presenta tion.1 W hile there are still men whose exten sive and genuinely valuable contributions to the profession in the field of research and practice entitle them to certification on their record alone, there will natur ally not be nearly so m any certificates issued in this manner in the future as in the past. T h e board has been in operation now for a good m any years and we believe that its most important function has been to stimulate the younger men to take a true interest in the advancement of the profession and, o f course, con currently in their own advancem ent; all with the object o f making it possible to give better service to the public. I f all i . K e l s e y , H. E .: 26:57, January 1940.
Am. }.
Orthodontics,
K e l s e y — A m e r ic a n B o a r d o f O r t h o d o n t ic s
recruits to the profession wait until they have been in practice fifteen years before m aking application, much o f the benefit just referred to would be lost, and unless their contributions by that time were sufficiently notable to entitle them to cer tification on their records, they would not be likely thereafter to adopt habits o f study and practice which would im prove them sufficiently to meet the stand ards o f their day. It is a fact that of the men who apply for certification, a very large percentage are among the out standing practitioners in their commun ities, and this has been a matter o f much satisfaction to the board. There are more than 600 orthodontists in this country and abroad, and up to the pres ent time 178 have been certified after satis factorily complying with the requirements of the board by giving evidence of high standards of practice and ethical conduct toward their patients and also toward other members of the profession and by submitting acceptable case reports and theses on sub jects suggested by the board. The board is fully aware that there are many others who are quite competent to meet its requirements as they have been built up during the more than ten years of its existence, and the ap plications of such men are always welcomed by the board. One of the most important phases of application is the securing of ade quate endorsement. The board cannot pos sibly have knowledge as to the fitness of all applicants and would not wish to take the responsibility of endorsing applications even in cases where they might be well assured through intimate personal acquaintance that the applicants possess the high ethical, moral, and professional qualifications which are, of course, fundamental “requisites” in any ap plication. Nor does the board feel that the endorsement of an applicant by some friend or friends, however outstanding, in a sec tion remote from the applicant’s own ad dress, would be acceptable without equally adequate endorsement by confrères in his own location. During the first few years, quite a good many applications were received and ac cepted, after which the applicant for one reason or another failed to prepare and
1273
present the material desired by the board (in the way of theses and case reports) at its following meeting, nor indeed thereafter in some instances for three or four years. During the last two or three years, to obviate any unfairness, the board has granted exten sions in many cases so as not to work a hardship or be unfair to anyone who might not have been fully acquainted with its working details. The board now feels that applications should be followed up by meet ing its requirements within three years, fail ing which, the board will feel justified in requiring a new application. A comment based upon our ten years o f experience might be useful to those who contemplate applying for certifica tion. W e have found that, as a rule, pre sentations made by applicants indicate that they have a good comprehension of the objectives which underlie the test for certification, but some do not. It is con ceded that all are not equally qualified to present theses which adequately de lineate the processes of reasoning from which their deductions are drawn, but it is considered important and desirable that they at least be able to express them selves with clarity and accuracy when presenting the results of their thinking or research. M an y have indulged in wide reading for the purpose o f preparing theses, and most are able to assemble the thoughts and expressions of others on a given topic and present them in conjunc tion with their own conclusions in an ac ceptable manner and in their own lan guage. Occasionally, however, a thesis will be simply a potpourri o f other men’s pub lished opinions which resemble the reports o f some o f the frequent questionnaires which are sent out. Some of these men are excellent orthodontists, who have a high percentage o f success in their work, but find it difficult to prepare a good thesis, largely owing to the fact that they have no sustained habits of reading or study. M any of them have later contributed matter of real value to the profession, which they would not have done had they not
1274
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
been stimulated to a really conscientious effort by their desire for certification, which implies a desire to improve the quality of their service and to be re garded as belonging to that group who are looked upon as leaders of the profes sion truly equipped to give the best serv ice to their patients. T h ey thus become a credit to their profession, to the board and to themselves. D r. K etcham felt strongly that a man desiring certification should present ma terial in a creditable manner and that he should maintain a creditable office in which adequate records would be kept
according to modern standards. He firmly believed that most men who de sired certification could, by diligent ap plication, prepare themselves for it even though they had neglected to maintain habits of reading and study after finishing college and possibly other special courses. T h e board has noted with much satis faction the growing appreciation o f the apparent value of its work and desires to thank the various orthodontic societies and the profession at large for the in creasingly cordial support which is being given to it. 833 Park Avenue.
A NEW AND COMPLETE TREATMENT OF PERIODONTOCLASIA B y W illia m B r o w n I n g e r so ll ,* D .D .S., W ashington, D. C.
X IS T IN G methods o f treatment of periodontoclasia1 frequently fail to reflect the point o f view o f the pro fession relative to oral disease. T he vary ing degrees o f success of the past have resulted from technics ranging from the conservative method o f instrumentation to the various customary methods o f diet adjustment and x-ray and wave thera pies, down to the scores o f related thera peutic preparations. In the past, the etiology and the treatment o f periodonto clasia have been predicated on wide di versities of opinion. W h y these diversi ties and w hy their resulting varying technics? There has been only one goal in com m on: a healthy mouth with firm teeth, and normal gingivae.
Probably the chief reason for lack of uniform ity o f opinions and methods is the paucity of fundamental knowledge possessed b y the originators of the vari ous pathologic pictures; also, a restricted sense of balance and proportion prevent ing a realization as to where each theory and procedure applies and wherein it is deficient. M any of these men expanded only on their successes, but minimized cases in w hich their therapeutic method failed. W ith the possible exception of operative dentistry (covering caries), there exist more determined riders of hobby horses in the specialty o f perio dontia than in any other branch o f den tistry. T h e method that I pursue in the treat ment o f diseased periodontal areas and *Professor of periodontia, Georgetown U n i in the eradication of pockets is the excis versity Dental School. ion of all diseased granulation tissues. 1. T h e common term “ pyorrhea,” which These tissues form in the region where refers specifically to pus flow, is only one tissue structures normally existed for the phase of the broader term “ periodontoclasia.” Jour. A.D.A., Vol. 27, August 1940
K e l s e y ,*
D .D .S., Baltimore, Md.
H A T E V E R credit is due for in augurating and continuing the movement that eventually resulted in the formation of the Am erican Board o f Orthodontics belongs to the late Albert H. Ketcham . Quite probably it would have died out, as ideas o f a similar nature had done previously, without his untiring devotion to the standards and ideals which the project embodies. The first board of this kind was the American Board of Otolaryngology, and Dr. K e t cham wisely sought their aid and experi ence in organizing the orthodontic board. A t that time, the American Board of Otolaryngology rendered valuable assis tance, as it has on several occasions since. T h e time and labor given to the organi zation of the orthodontic board were con siderable, but were lessened by patterning it after the otolaryngologic board, which had attained a high state of efficiency as the result of experience, during which errors could be corrected and methods of sound administrative procedure be proved and adopted. A t this time, when a number of the other dental specialties are organizing or contemplate organizing similar boards, it m ay be o f interest to the profession to learn something more of the workings of the Am erican Board o f Orthodontics, which has been in successful operation for more than ten years. A fter all, the profession as a whole and the laity gen erally are equally benefited by the oper ation o f such boards if properly con ducted and their activities brought to the attention o f all members o f the profession in a suitable manner.
W
*President, American Board of Orthodon tics.
Jour. A.D.A., Vol. 27, August 1940
It has come to our attention, on several occasions, however, that a large percent age of the dental profession are not aware o f the existence of the board, although most of the members of the profession are aware of the fact that orthodontics has existed as a specialty for many years, well organized and with national as well as re gional societies which, we believe, have had a stimulating effect upon the spe cialty and the profession as a whole. O ne o f the functions of the board is to pro vide a means whereby the general prac titioner, when referring cases for treat ment, can distinguish between those men who have and those who have not prepared themselves by study, and by close application to the principles under lying orthodontic treatment, to give service which will measure up to the highest accepted standards of the spe cialty. T h e board does not, however, as sume that only men who have been certified are capable of giving this service. Some of the best orthodontists have not applied for certificates and m ay never do so. Some do not apply because they do not care to give the time and effort to preparing the material for a test, which they could undoubtedly pass successfully. Others (as in all vocations) are not suffi ciently interested in their work to exert themselves to give the highest type of service and therefore could not meet the requirements of the board. It is because o f such conditions that certifying boards were established. In referring cases locally, dentists in general practice may be able to select perfectly competent men in their own neighborhood who might or might not hold the certificate of the board, but in
1272
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
referring patients to orthodontists in other parts of the country they can do so much more intelligently by availing themselves o f the information w hich is provided in the list of specialists who have been certified. W hat is true o f the orthodon tic board will of course be true of all other boards, and the work o f the indi vidual board can be improved and stim ulated by collaboration with other boards through a general advisory board. A movement to establish, under the patronage o f the Am erican Dental Asso ciation, a general advisory board the members of which would be represent atives of specialty certifying boards al ready in operation, or to be organized in the future, was successfully inaugu rated a few years ago, though, at the time, there was but one board (that of orthodontics) in operation. T w o or three other boards, however, were in process o f organization and have since been suc cessfully launched. Such an advisory board can be of great benefit, as has been proved by the establishment several years ago by the medical profession o f one composed o f representatives of certifying boards of the various medical specialties. T h e American Board of Orthodontics welcomes the opportunity to cooperate in a similar constructive movement. In medicine, the number of certifying boards of the various specialties has been greatly increased during the last few years, and m any hospitals today limit their staff appointments to those who have been certified by these boards. T o explain the working o f the Am eri can Board of Orthodontics, which has now reached a rather mature develop ment, I quote from a short paper pre sented before the N ew Y ork Society of Orthodontists last N ovem ber: In the beginning, a number of men who were outstanding contributors to orthodontic literature and were nationally known for their excellence in operative procedure, and who had been in practice for fifteen years or more, were certified on their record. This
was in line with a classification adopted and still in effect, and those men who were certi fied on their records, or eligible to be so certified, comprise class one. Those who have been in practice ten to fifteen years comprise class two. Those who have been in practice from five to ten years comprise class three. It must not be supposed that the Board has ever made a habit of certifying men who have been in practice fifteen years or more simply because of that one qualification. Such a man, who had not contributed to the literature or to society programs; who had, in other words, given no evidence of pro ficiency by which he could be judged, might be asked for as much material in the way of theses and case reports as would be asked of other men who had been in practice from only five to ten years. As a rule, men who have been in practice from ten to fifteen years are not asked to present as much ma terial as are those who have been in practice from five to ten years only. Thus it will be seen that a man’s record of accomplishment, his interest in his work and in his profes sional organizations, and his general record for high ethical conduct all have a bearing upon the question of requirements. The board welcomes applications from men who are sufficiently interested in what the cer tificate stands for to be willing to take the time and trouble to make a good presenta tion.1 W hile there are still men whose exten sive and genuinely valuable contributions to the profession in the field of research and practice entitle them to certification on their record alone, there will natur ally not be nearly so m any certificates issued in this manner in the future as in the past. T h e board has been in operation now for a good m any years and we believe that its most important function has been to stimulate the younger men to take a true interest in the advancement of the profession and, o f course, con currently in their own advancem ent; all with the object o f making it possible to give better service to the public. I f all i . K e l s e y , H. E .: 26:57, January 1940.
Am. }.
Orthodontics,
K e l s e y — A m e r ic a n B o a r d o f O r t h o d o n t ic s
recruits to the profession wait until they have been in practice fifteen years before m aking application, much o f the benefit just referred to would be lost, and unless their contributions by that time were sufficiently notable to entitle them to cer tification on their records, they would not be likely thereafter to adopt habits o f study and practice which would im prove them sufficiently to meet the stand ards o f their day. It is a fact that of the men who apply for certification, a very large percentage are among the out standing practitioners in their commun ities, and this has been a matter o f much satisfaction to the board. There are more than 600 orthodontists in this country and abroad, and up to the pres ent time 178 have been certified after satis factorily complying with the requirements of the board by giving evidence of high standards of practice and ethical conduct toward their patients and also toward other members of the profession and by submitting acceptable case reports and theses on sub jects suggested by the board. The board is fully aware that there are many others who are quite competent to meet its requirements as they have been built up during the more than ten years of its existence, and the ap plications of such men are always welcomed by the board. One of the most important phases of application is the securing of ade quate endorsement. The board cannot pos sibly have knowledge as to the fitness of all applicants and would not wish to take the responsibility of endorsing applications even in cases where they might be well assured through intimate personal acquaintance that the applicants possess the high ethical, moral, and professional qualifications which are, of course, fundamental “requisites” in any ap plication. Nor does the board feel that the endorsement of an applicant by some friend or friends, however outstanding, in a sec tion remote from the applicant’s own ad dress, would be acceptable without equally adequate endorsement by confrères in his own location. During the first few years, quite a good many applications were received and ac cepted, after which the applicant for one reason or another failed to prepare and
1273
present the material desired by the board (in the way of theses and case reports) at its following meeting, nor indeed thereafter in some instances for three or four years. During the last two or three years, to obviate any unfairness, the board has granted exten sions in many cases so as not to work a hardship or be unfair to anyone who might not have been fully acquainted with its working details. The board now feels that applications should be followed up by meet ing its requirements within three years, fail ing which, the board will feel justified in requiring a new application. A comment based upon our ten years o f experience might be useful to those who contemplate applying for certifica tion. W e have found that, as a rule, pre sentations made by applicants indicate that they have a good comprehension of the objectives which underlie the test for certification, but some do not. It is con ceded that all are not equally qualified to present theses which adequately de lineate the processes of reasoning from which their deductions are drawn, but it is considered important and desirable that they at least be able to express them selves with clarity and accuracy when presenting the results of their thinking or research. M an y have indulged in wide reading for the purpose o f preparing theses, and most are able to assemble the thoughts and expressions of others on a given topic and present them in conjunc tion with their own conclusions in an ac ceptable manner and in their own lan guage. Occasionally, however, a thesis will be simply a potpourri o f other men’s pub lished opinions which resemble the reports o f some o f the frequent questionnaires which are sent out. Some of these men are excellent orthodontists, who have a high percentage o f success in their work, but find it difficult to prepare a good thesis, largely owing to the fact that they have no sustained habits of reading or study. M any of them have later contributed matter of real value to the profession, which they would not have done had they not
1274
T h e J o u r n a l o f t h e A m e r ic a n D e n t a l A s s o c ia t io n
been stimulated to a really conscientious effort by their desire for certification, which implies a desire to improve the quality of their service and to be re garded as belonging to that group who are looked upon as leaders of the profes sion truly equipped to give the best serv ice to their patients. T h ey thus become a credit to their profession, to the board and to themselves. D r. K etcham felt strongly that a man desiring certification should present ma terial in a creditable manner and that he should maintain a creditable office in which adequate records would be kept
according to modern standards. He firmly believed that most men who de sired certification could, by diligent ap plication, prepare themselves for it even though they had neglected to maintain habits of reading and study after finishing college and possibly other special courses. T h e board has noted with much satis faction the growing appreciation o f the apparent value of its work and desires to thank the various orthodontic societies and the profession at large for the in creasingly cordial support which is being given to it. 833 Park Avenue.
A NEW AND COMPLETE TREATMENT OF PERIODONTOCLASIA B y W illia m B r o w n I n g e r so ll ,* D .D .S., W ashington, D. C.
X IS T IN G methods o f treatment of periodontoclasia1 frequently fail to reflect the point o f view o f the pro fession relative to oral disease. T he vary ing degrees o f success of the past have resulted from technics ranging from the conservative method o f instrumentation to the various customary methods o f diet adjustment and x-ray and wave thera pies, down to the scores o f related thera peutic preparations. In the past, the etiology and the treatment o f periodonto clasia have been predicated on wide di versities of opinion. W h y these diversi ties and w hy their resulting varying technics? There has been only one goal in com m on: a healthy mouth with firm teeth, and normal gingivae.
Probably the chief reason for lack of uniform ity o f opinions and methods is the paucity of fundamental knowledge possessed b y the originators of the vari ous pathologic pictures; also, a restricted sense of balance and proportion prevent ing a realization as to where each theory and procedure applies and wherein it is deficient. M any of these men expanded only on their successes, but minimized cases in w hich their therapeutic method failed. W ith the possible exception of operative dentistry (covering caries), there exist more determined riders of hobby horses in the specialty o f perio dontia than in any other branch o f den tistry. T h e method that I pursue in the treat ment o f diseased periodontal areas and *Professor of periodontia, Georgetown U n i in the eradication of pockets is the excis versity Dental School. ion of all diseased granulation tissues. 1. T h e common term “ pyorrhea,” which These tissues form in the region where refers specifically to pus flow, is only one tissue structures normally existed for the phase of the broader term “ periodontoclasia.” Jour. A.D.A., Vol. 27, August 1940