THE EDITOR'S CORNER

There is a basic philosophical disagreement between most orthodontists and organized general practitioners and pedodontists. It has always been the policy of organized dentistry, and this is reflected in the state dental practice acts, that a dentist is licensed to perform any and all dental procedures. It is left to his own good judgment whether he is capable to perform a treatment or not. The disagreement that orthodontists have with this principle is not on a basis that all orthodontists are saints and all GPs and pedodontists sinners. It is simply that the public is not served nor orthodontics advanced by allowing untrained or undertrained practitioners to perform it. It would be interesting to know how many general practicing dentists and pedodontists would or could support the ADA contention and even more interesting to know to whom they would entrust the orthodontic treatment of their own child.

Nevertheless, in a recent issue of the National News of the Academy of General Dentistry, the following item appeared under the title "AAO Eliminates Discriminatory Dental Care Policy"--

"The House of Delegates of the American Association of Orthodontists (AAO) recently amended one of its major policies on dental care programs to recommend that orthodontic treatment under prepaid programs not be limited solely to orthodontists.

The concept of amending this policy was discussed by the Academy's Executive Committee when it had a one-day meeting with the officers of the AAO in St. Louis, Mo. on April 1, 1976.

The AAO's previous "Policy Relative to Dental Care Programs (Item 5)" stated the following: "The practice of orthodontics is a special area of dentistry demanding additional study, training, and experience. Therefore, orthodontic treatment under prepaid programs and publicly funded programs should be rendered by those having the qualifications necessary for announcement of limitation of practice approved by the House of Delegates of the American Dental Association whenever and wherever possible."

The italicized section of this statement was rescinded by the AAO House, so the newly adopted statement adopted on April 28 reads:

"The practice of orthodontics is a special area of dentistry demanding additional study, training and experience. Therefore, orthodontic treatment should be rendered by those having the qualifications necessary."

If the former policy was discriminatory, the latter one is indiscriminate. This is a step backward. We will not gain credibility with the public and with public activists-- in the form of legislators, union leaders, and consumer advocates-- when we agree to principles and practices that are not in the public interest. Because, if we endorse the principle of "caveat emptor" in the doctor/patient relationship, we are jeopardizing our remaining mechanism of professional credibility--which is peer review--and we are consigning the future of this question to the courts. Some day some judge is going to decide that performing procedures you know little or nothing about is malpractice. If we would contemplate that occurrence without making strenuous efforts to prevent it, we are not entitled to the public trust and privileged position that we enjoy; nor will we be permitted to sustain it.

Leaving the problem to be solved by the courts or even by peer review groups endorses consideration after the fact, after someone may feel that malpractice was performed upon him.

If a GP or a pedodontist has full orthodontic graduate university training, there is no question about his right to practice orthodontics. If he has less, the day may be fast approaching when he may be open to malpractice charges. The patient has a right to assume that a dentist who performs certain procedures is qualified to do so by education and training. All of dentistry is headed for possible ignominy if we continue to profess that any dentist can do anything he pleases in dentistry.

In defining educational requirements in orthodontics as a full two-year graduate university program, one must add "or its equivalent" to recognize that some outstanding individuals might achieve a high level of competence through other training, including preceptorship. If so, there has to be something equivalent to state board examination in orthodontics to test their competence, which leads us back to specialty licensure of a qualifying nature for all practitioners of orthodontics, with orthodontic treatment restricted to those holding the specialty license.

If we are to insist on stringent educational requirements, there must be a reasonable availability of education opportunity. This may be counter to a mood or even a movement to constrict orthodontic class size in light of the increasing number of orthodontists and decreasing number of children. Publicizing the economic problems in orthodontic practice would be a responsible way to influence this factor.

Similarly, publicizing to dentists and dental students the sophistication of orthodontic treatment should deter many who otherwise do not know what they do not know.

Finally, publicizing to the public the differences between a trained orthodontist and an untrained dentist who offers to do orthodontics would be a responsible endeavor in the public Interest.

We presently have two levels of orthodontic treatment in this country and we should not in any way contribute to its continuance.