THE EDITOR'S CORNER

Many orthodontists would favor a full moratorium on graduate orthodontic students as a solution to the declining ratio of children per orthodontist and its effect on the economics of orthodontic practice. However, this is neither a wise nor a workable solution and we should turn our attention to those that are more likely to succeed and are a more responsible approach to problem solving.

There is no doubt that if all the orthodontic departments closed tomorrow, there would be a measurable reduction in the number of practicing orthodontists in the future and a marked slowing of the decline of the child population to orthodontist ratio. Not a stopping, since the child population is declining; but a slowing.

Serious though the economic problems of many orthodontic practices may be, unless the schools have some other reason for doing so, it is as incorrect to try to cut off orthodontic education as it would be to forcibly retire practicing orthodontists at a specified age. Orthodontists have forever been under fire for supposedly restricting orthodontic education for their own economic gain. The charge would be clearly substantiated for the first time by such an action. Furthermore, if you merely control the number of orthodontic specialists without controlling the number of pedodontists and GP's doing orthodontics, you have accomplished nothing but the probable expansion of the pedodontist and GP activity in orthodontics.

While the number of dental students in this country is increasing, the rate of specialization is declining. In orthodontics, the number of applicants is reported to be declining. For all specialties, about 40% of the graduate students in this country come directly from dental school and 60% from among practicing dentists. While economics is said not to be the chief motive for specializing, if the unfavorable economic factors in orthodontics were made known to dental students and practicing dentists, it could become a strong deterrent to a number of those who might otherwise choose to become orthodontists. Similarly, given a true picture of the future in pedodontics, it is likely that fewer dental students and dentists would choose to pursue it. So, correct information about the predictable future in orthodontics and pedodontics could be the most effective control of the flow of new specialists in these two areas. In fact, it is unfair to permit an individual who is unacquainted with this information to spend the time, money and energy it takes to achieve specialty status, only to find that there is a diminishing market for his services.

So, it seems likely that the number of applicants to orthodontic programs can be expected to continue to decline, even if no action is taken by the schools to encourage the decline, just because information about the economics of orthodontic practice and its future prospects becomes more widely known. In a democracy, without socialized dentistry, the law of supply and demand can and should prevail to control the number of practicing orthodontists. The law will probably operate faster if information with regard to supply and demand in orthodontics is made available to students and practicing dentists.

At the same time, the more imaginative dental school programs may take some leadership in expanding their vision of orthodontics to include curriculum emphasis in public health orthodontics, in government agency programs, in hospital based rehabilitative programs, in the orthodontic industry, in third party program administration, in teaching and research, in mixed group practice, in occlusion, TMJ and surgical orthodontics, perio-orthodontics, prostho-orthodontics and a myriad of other programs that would innovate and broaden the scope of orthodontics. Of course, schools may elaborate their programs only to find that their graduates choose clinical orthodontics as a career. But, the purpose of schools in broadening their programs would not be to divert students from clinical orthodontics, but to explore expanding horizons in orthodontics as well as alternative career opportunities in orthodontics.

There are indications that we may have experienced as much as a 20% drop-off in enrollment in orthodontic graduate departments and we are likely to see at least an equal decrease within the next five years. The difference between this amount and a purposeful reduction of class sizes by half would not be significant enough to justify such a move.

The fact is that neither one of these could solve the economic problems in orthodontics and the number of students graduating each year is but one aspect of the total problem. Further, of the variables over which orthodontists have little or no control--birth rate, number of orthodontists and others doing orthodontics, taxes, and inflation--it is the number of orthodontists that has a built-in tendency to move in the right direction as far as improvement of orthodontic economics is concerned. We ought to let it move naturally, in response to supply and demand.