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Back to the Future

Back to the Future

Had orthodontists been able to read Peter Drucker's latest book, Innovation and Entrepreneurship, 20 years ago, they would not have been surprised by the so-called innovations we are experiencing in orthodontics today. Drucker says there are four near-certain, easily visible indicators of impending change in an industry:

1. Rapid growth

2. Complacency and inappropriate self-perception

3. Convergence of technologies

4. Rapid structural change in the way business is conducted

All these requisites for change have been happening in orthodontics, but few saw the challenge until the whole package had developed.

Explosive growth began in the '60s when universities expanded their orthodontic programs and graduated increased numbers of orthodontists every year. The number of orthodontic patients grew simultaneously, chiefly owing to the inclusion of orthodontic benefits in labor contracts, the baby boom of the late '40s and '50s, and the nightly display of the most beautiful smiles in the universe on color television. More and more people wanted nice smiles, and the orthodontic specialty took off.

With this rapid growth, orthodontists became complacent. Was this not, after all, the Golden Age of orthodontics? And with complacency came a continuation of the diagnosis and treatment methods of the '40s and '50s. Orthodontists only wanted to provide full treatment of the full complement. Early treatment and interceptive orthodontics were excluded. There was little interest in cooperating with colleagues in the preparation of mouths for periodontic and prosthetic work. Orthodontists had a narrow view of their role in dentistry, a role that was rapidly becoming inappropriate to what was happening inside and outside the profession.

Orthodontic technologies converged with the development of bonding, straightwire appliances, and more flexible wires. Orthodontists began bonding in earnest about 10-15 years ago. It was no longer necessary to separate teeth, pinch and fit bands, or bend complicated archwires. If bonding simplified the initiation of treatment, straightwire appliances were touted as simplifying treatment itself. Dentists were told they no longer needed to understand 1st, 2nd, and 3rd order bends or how to set anchorage. The almost simultaneous development of multistranded and titanium wires guaranteed that complex wire bending would no longer be required. Convergent with these orthodontic technological advances were the development and success of the Pill, which contributed to the baby bust of the '60s. This, along with the success of fluoridation programs, greatly reduced the busyness of general dentists. Simultaneously, dental schools increased the number of students.

There was suddenly a larger number of dentists and a smaller demand for their services.

Drucker's fourth requisite for change is rapid structural change in the way business is conducted. Dentistry may only be at the beginning of structural change. We have not yet seen the ultimate influence of advertising. We are only beginning to see the movement for independent operation of hygienists and others in the preventive area. Independence in operative dentistry may be on the horizon. We are still seeing the growth of the denturist movement. We may be about to witness the entry of major national management and marketing companies into the dental and orthodontic fields.

Structural change in orthodontics, as in other fields, has been accompanied by rapid societal change. There are now fewer marriages, more divorces, and a trend toward one child families. Increasing numbers of orthodontists are competing among themselves and with nonorthodontists for at best a static number of children. Fortunately, there has begun an awakening on the part of adults to the idea that they, too, can benefit from orthodontic treatment. That may be the only bright spot in an otherwise dark demographic picture.

When producers in an industry have a near monopoly, they tend to disregard the effects of change until they start to lose market share. They may then bestir themselves and develop a counterstrategy. Now that orthodontists have the benefit of Drucker's thoughts about change and have witnessed this change, what rational person would deny it is happening and continue to do business as usual?

If hindsight is worth anything, it is as the parent of foresight. Orthodontists still have an opportunity to develop treatment, management, and marketing efforts to cope with change, but time is running out.


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