THE EDITOR'S CORNER
Much is being said and written concerning the parallel increase in the number of trained orthodontists, decline in the population in the age groups which comprise the bulk of orthodontic patients, and the expanded use of auxiliary personnel which makes it possible for one orthodontist to treat many more patients than he formerly could.
The reconciliation of these three factors lies in an increase in the number of orthodontic patients. This can occur through expansion of orthodontic coverage in third party programs. To accomplish this requires a good public education program, professional control of performance and quality through peer review, and adjustment of the cost of orthodontic treatment to a level that a much larger segment of the population can reasonably afford individually or in third party programs. The thrust of orthodontic thinking in the practice administration area should be on how to develop an efficient organization to deliver quality orthodontic care at the lowest fees that will support such a program, including a healthy regard for the orthodontist's income under these circumstances of expanded responsibility.
It is ironic that, while many orthodontists believe that there are presently too many orthodontists being trained each year and would favor reducing the number, we have at the same time a substantial number of the present approximately 1500 pedodontists plus new pedodontic graduates each year who seem to be pressing to take a larger role in orthodontic care. Indeed, organized dentistry seems to be encouraging an approach to the future of orthodontic care in which the supervision of the developing dentition, preventive orthodontics, interceptive orthodontics, and simple orthodontic treatment in the permanent dentition would be the job of the pedodontist, while the orthodontist would treat the more complicated cases in the adult dentition. Evidence for this can be seen in the establishment of Departments of Pediatric Dentistry with a mission to educate pedodontists for those tasks, in the numerous recent textbooks advancing this concept, in lectures and courses aimed at this approach, in the proceedings of the ADA Council on Dental Education in formulating guidelines for identifying the scope of pedodontics and orthodontics, and most recently in the action of the ADA House of Delegates in approving an amendment to the Principles of Ethics to allow announcement of more than one specialty by educationally qualified dentists.
The response of orthodontists to all of this should clearly be that everyone who performs orthodontic treatment, no matter what he calls himself, must be fully educated in orthodontics. There must not be two levels of orthodontists. There should not be lesser training for pedodontists or pediatric dentists to perform a lesser job. The developing dentition is the most sensitive part of orthodontic care and requires the most knowledge and experience. It is an added consideration that patients who begin orthodontic treatment in the pedodontist's office, will, inevitably, remain there for orthodontic care in their adult dentition.
Orthodontists need not panic in light of what seems to be going on, but we must be aware of it and be prepared to make sound adjustments in our mode of practice consistent with the public interest and with the maintenance of the high level of orthodontic care. Insistence on complete orthodontic training for all dentists who would practice orthodontics is a must. Application of modern organization management to orthodontic practice in order to practice efficiently for large numbers of patients and at fees that are as low as the traffic will bear and still maintain a high level of orthodontic treatment will be fundamental to the practice of tomorrow. Practices which treat 1000 or more starts a year will be normal. Operating in dental groups will be more frequent. In fact, since orthodontics is not a pediatric subject exclusively, the dental group would offer a broader service than the pediatric dental practice.
All of this may not be what we envisioned when we went into orthodontic practice, but it is an inevitable development stemming from unmet needs in orthodontic care.
