Family traditions

Last week, I published a post where I stated that it is important for an orthodontist to know the history of the specialty. I also briefly mentioned a board certification, indicating that it is one of the greatest orthodontic traditions.

Today I would like to look closer at several other traditions and traits that have shaped our specialty.

On the road to the Charles Tweed Foundation, June 2019

Breakaway tendency

Historically, orthodontics has always been on the forefront of dentistry. From the moment Edward Angle set orthodontics apart from the rest of the dental field in 1900, the specialty has always been driven by its revolutionary spirit. Thus, in 1929 by the efforts of Albert Ketcham it became the first dental specialty to establish its own board. In 1930, Holly Broadbent invented a cephalometer. The subsequent decade of cephalometric research had led to a thorough understanding of growth patterns, facial esthetics and the benefits of taking bicuspids out, which increased the schism between orthodontists and general practitioners.

Pure blood

As a result of the accumulated orthodontic knowledge and expertise, it had become necessary to protect the boundaries of the new specialty. It was Charles Tweed who in 1940s undertook the first legislative attempt to keep generalists away from orthodontics. The debates on if and in what amount a general practitioner can do orthodontics are continuing to the present day. I think that it should be understood that this segregation is demanded not out of a whim, but in the best interests of both the patients and generalists themselves. It is only orthodontists who are aware of how far wrong treatment planning can lead an untrained operator together with his or her gullible patients.

Adherence to science

Since the early 2000s, we have seen an increase in the use of randomised control trial (RCT) methodology in orthodontics. These new studies have added a lot to our knowledge and helped to resolve disputes that had been in the specialty for decades, for example, the necessity of early class II treatment. Therefore, the ability to interpret and implement in practice the results of the recent RCTs has become another important trait of an orthodontist.

This obedience let orthodontists sleep well at night. Not only because it adds certainty to clinical decisions, but also because it can be a protection in potential legal cases.


These three traditions seem to me wise and vitally important for an orthodontic specialty to function well. Although we should bear in mind that all three of them were molded in the developed democratic countries with the developed dental industries during the periods of relevant economic stability. Obviously, Edward Angle would not have been able to perform his exodus, if there hadn’t been an organized infrastructure to detach from. Clearly, it is impossible to preserve the boundaries of the specialty, if there is no strict regulation in the dental field. And there is surely no good sleep, if the scientific literature is neglected.

Could the same traditions have been formed and preserved in an authoritarian country such as China or USSR? I doubt so. Could an orthodontist comfortably practice in such countries today? Let everyone decide for oneself…

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