THE EDITOR

To the Editor:

I have read many articles in the AMERICAN JOURNAL

OF ORTHODCINTICS AND DENTOFACIAL ORTHOPEDICS overthe years and have usually been able to evaluate thecontent and draw some conclusions about the signifi-cance of the work, However, after reading the article byKalra, Burstone, and Nanda (“Effects of a Fixed MagneticAppliance on the Dentofacial Complex”) in the June 1989issue, I was filled with various conflicting feelings aboutwhat I had read.

I was astonished that the described appliance pro-duced large and significant effects on the teeth and bone.In fact, the authors claim that an increase of 3.2 mm inmandibular length occurred over a 4-month treatmentperiod. This annualizes to nearly 1 cm of mandibularchange! Comparing this value to standard values, thisamounts to a 300% change over normal. Furthermore,a 2 mm improvement in molar relation occurred; suchan amount would correct many Class II malocclusionsand all in 4 months’ time. Amazing!!

On the other hand, the appliance, which was inten-tionally applied to persons with increased lower faceheights, made the lower face even larger compared tocontrols (+ 7.8 mm in 4 months). It also produced cross-bites and apparently even anterior open bites (0 to 3 mmof overbite at the start and - 3.8 mm of change during4 months of treatment). Curious??

I know the authors are accomplished and respectedinvestigators and the report represents a preliminary in-vestigation on human subjects, so many details are leftout and many refinements will occur, but all of this ishard to comprehend.

Thus, I will also claim that I am skeptical of theresults, but only in an attempt to goad a reply. Surely afew clinical photographs (models, intraoral views, radio-graphs-anything!) would be enlightening if not con-vincing as to the desirable and undesirable features ofthis new appliance.

Rolf G. Behrents, DDS, MS, PhDProfessor and ChairmanDepartment of OrthodonticsThe University of TennesseeMemphis, Tenn.

To the Editor:An interesting phenomenon is presently occurring in

academic orthodontics: there are reported to be some

dozen or so vacant chairmanship positions and an es-timated 30 or more full-time faculty positions openthroughout the United States and Canada. One maychoose to interpret this situation as merely the “changingof the guard,” or one may decide that it is more than apure coincidence that such instability and temporarymanagement is the rule in so many orthodontic depart-ments or divisions. (This issue of divisions or sectionswill be addressed later.)

The root of the problem may not be in the specialtyof orthodontics or in what is widely perceived as thecritically ill profession of dentistry. It is evident that theWestern World that was technologically and scientificallyadvanced for much of the 20th century is not so ad-vanced any more-not if comparisons are made againstthe newly emerging powers, predominantly from the FarEast. Demographers predict a more uneven distributionof wealth, scientific discoveries, and eventually a truedominance by the “Pacific Basin” nations, if we do notawaken in time and start doing something about it. Pop-ular and well-respected television programs have dealtwith these issues. They uniformly ask the question: Howlong can we afford to postpone the action? They alsouniformly emphasize that in this country we have a realproblem with our system of education. All levels are likelyculprits, but at this time the most evident is aur systemof higher education.

Let us return to the scope of orthodontic education.What is happening with and in our orthodontic teachingunits? Are those units doing well? Or are there seriousproblems? Why is there so much turnover and testabilityin those units? These questions will be addressedthrough the eyes of an orthodontic educator with 20 yearsof teaching experience, not all of which was in the sameschool or geographic location.

The astute readers of our AMERICAN JQURNAL OF

ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS undoubt-edly notice more published material from outside theUnited States and Canada. Clearly, a positive effort isbeing made by our editorial board to make the JCXJRNALmore of an international publication, but the fact remainsthat more is done and that a larger volume of the newwork, presumably of better overall quality, comes fromabroad. A participant-visitor at our latest annual meetingcould have noticed that the principal speakers and es-sayists were not the well-known academic names ofAmerican orthodontics. Unfortunately, this was evenmore true of the recent North American Begg Societymeeting.

If our JOURNAL publishes so many foreign contribu-tions and our large meetings go practically withoutacademic contributors from the United States, is it

logical to believe that less leadership is evident now inacademic orthodontics? This should not belittle the val-iant efforts made in certain departments, but the majorityare not doing very much or what they are doing is lesspublishable, marketable, or presentable.

The next issue to address is that of manpower andof internal structure under which our teaching units op-erate. It has already been pointed out that we no longercan uniformly say “departments of orthodontics,” be-cause many schools have changed or plan to changethis teaching unit into a section, a division, a program,or a similar lower-designation unit. This restructuring andrenaming process does not seem to affect all disciplinesequally; orthodontics appears to be on top of the hit list.it does not take a high degree of eloquence to convincethe reader that the loss of departmental designation gen-erally means the loss of its autonomy and the loss ofprestige, and even higher financial and fiscal depend-ability.

Let us consider briefly the question of academic man-power within teaching units. First, who wants to teach,and why? Sure, there are genuinely interested personswith the talent to be teachers, but they rightly expect tobe justly compensated for their work and effort. It is dis-heartening to report that newly graduating orthodontistsentering private practice frequently command incomeshigher than full-time orthodontic faculty members withyears of experience. In many places, and for many years,this problem was handled by hiring graduates of foreigndental schools, who generally could not obtain an un-restricted license to practice orthodontics. This impor-tant, albeit somewhat unfair, avenue of securing facultymembers is drying up as more and more states do notallow appointments of clinical faculty without “proper”credentials. In addition, it is common for a junior facultymember to stay in a department for a relatively shortperiod of time. After a year or two, he or she often resignsfor one or more of the following reasons: financial dis-crepancy between the faculty salary and practice in-come; workload put upon the faculty, especially in unitswhere there are vacancies or shortages of faculty mem-bers; increasing pressures from a school’s tenure andpromotion committees; and, finally, the currently highievel of insecurity about the future of many dental schools(i.e., closing of the dental schools at Georgetown, OralRoberts, Emory: Fairleigh Dickinson, Washington Uni-versity, etc,).

All these factors directly affect the department head,who is frequently the only senior faculty member in theunit. There is also the increasing expectation of ABOcertification which in the past has been made difficult toachieve in an academic setting. The practice opportu-nities are often very limited, mainly because of time con-straints. One other factor making the life of the head ofan orthodontic unit difficult is the proverbial incompati-bility with the school’s administration. It is really hard toknow why dental school deans and heads of orthodonticunits do not work well together. Have you checked re-cently how many dental school deans are orthodontists?

It is hard to understand why more ~~~odo~tist§ are notrecognized for their achievements and administrativeabilities, and named deans.

Another peril for our aging o~hodontic leaders is apossibility of job burnout. Those who have been at thehelm of a department for many years, and who have notbeen adequately supported, recognized and compen-sated, are likely to seek a way out. Two options areclearly available: one is the switch to a private practice;the other, a relatively new alternative, is early retirement.A significant number of weathered orthodontic educatorshave been taken out of education by either mechanism.

Where is the solution? Indeed, where is this smallsegment of our higher education heading? Quo vadis?I can offer no easy answers, for it will take a great dealof careful planning and determined action on the part oforthodontists (and that will have to include both the pri-vate and the academic sectors) and the dental schools’administrators alike. Salaries and other forms of com-pensation will have to be carefully reevaluated becausediscrepancies have to be eliminated. recognition in non-material, nonmonetary forms is in order. Perhaps sometooting of our own horn may be needed. The alarmingfact must come into clear focus and receive immediateattention: orthodontic educators, particularly departmentheads, are an endangered species. Let us awake thoseempowered to take some action before it is too late.

A concerned orthodontic department head

Veristic reporting

To the Editor:

I am often inspired by the case reports that are pub-lished in the AMERICAN JOURNAL OF ORTHODONTICS AND

DENTOFACIAL ORTHOPEDICS, by both the quality of the re-sults and the polish of the treatment records. f-lowever,the case presented in the April 1989 issue ~Q~hodonticTreatment of a Patient Born With a Severe Right Uni-lateral Cleft Lip and Palate”) appeared deficient in a num-ber of areas.

The management of a patient with a cleft palate isinvariably an educating experience for both the clinicianand the observer; the treatment objectives are demand-ing and the limitations frustrating. The clinician is alsopresented with a number of compromising options ofretaining unfavorable teeth or moving teeth into unfa-vorable locations. The case in question is no exceptionand should be cited for some of the controversies itpresents. Briefly, I would like to address the followingpoints.

1. Anterior esthetics is a key consideration, but nomention is made of why the upper midline was main-tained to the left, opting for prosthetic replacement at thegraft site. This vital aspect of the treatment was barelyreferred to after the brief note in the statement of theproblem. This option has also resulted in an edge-to-