Marc Bernard Ackerman, DMD, MBA

Insanity is Doing the Same Thing Over and Over Again and Expecting Different Results      Albert Einstein                                    

If the railroads had understood that they were in the transportation industry rather than the train business, they could have easily expanded into air travel. However they didn’t and the mighty railroads disappeared in the last quarter of the 20th Century. If orthodontists in the same time period had defined their business as maximizing human potential through enhancement of human appearance, they could have easily been a key player in the nascent holistic medicine movement along side of plastic surgery, mental health, and physical fitness

Let’s take a trip back 40 years and see why this didn’t happen. In 1978 one man tried to change the orthodontic paradigm and if the specialty had heeded his advice, things would be quite different today. His name was Avrom E. King (1934-2006). Mr. King was not an orthodontist but a psychologist and healthcare futurist who operated a consulting firm out of Scottsdale, Arizona called the Nexus Group. In August of 1978, the AAO Board of Trustees held their interim meeting in St. Louis and one of the featured speakers was Avrom King. A short report of this meeting was published in the News and Comment section of the November 1978 AJO, “…Strategies must be developed in order to obtain goals that are preferred rather than those that are historically dictated. With Mr. King’s philosophy goes a redefinition of professional function and a reorganization of the dental office to provide a more humanistic approach to “whole person” dentistry with the maximum potential for personal and professional growth.”. Gene Gottlieb the founding Editor of the JCO, who has always been ahead of his time, published a lengthy interview with Avrom King in 1979 about the future of orthodontic practice. Three questions that Dr. Gottlieb asked Mr. King were laser focused on the crux of the issue.

  • Gottlieb: “It seems to me that orthodontists are going to have to look for solutions on an individual basis, rather than on any group action.”
  • King: “…all aspects of organized dentistry are bureaucratic. We know that it functions best during times of slow and sequential change, it tends to respond, rather than to initiate action. It tends to depend on yesterday’s behavior for anticipating tomorrow’s needs.”
  • Gottlieb: “Will it be a satisfactory enough conception of orthodontics to straighten teeth? If the orthodontist views himself simply as a tooth straightener, do you think he can be replaced?”
  • King: “He will be replaced by another tooth straightener who works in a different kind of delivery system. Surely.”
  • Gottlieb: “How does orthodontics fit into the concept of holistic healthcare?”
  • King: “Very much so. My guess is that most people who come to an orthodontic office, adolescents as well as adults, do not have that bad a tooth problem and what you are dealing with is a sense of body integrity, a sense of perfection.”


King’s new paradigm was not dependent on any technology and it consisted of 3 simple shifts in the prevailing orthodontic mindset. First, orthodontics is not about teeth in and of themselves but how the alignment of teeth affects an individual’s self-concept. Second, orthodontics is a behavioral art and not a clinical science. That is to say, a practitioner’s attitude, personality and ability to communicate in an insightful caring manner is far more important to the patient than their ability to level curves of Wilson. Third, take a forward facing approach to the future by embracing rather than fighting alternative delivery systems and competition in the marketplace.

Editor in Chief of the AJO (1978-1985) Wayne G. Watson published an editorial in December 1979 titled, “Orthodontic care, an “informed” free choice.” At that point in time the Federal Trade Commission stripped professional organizations the right to place restrictions on their members’ ability to advertise. Organized orthodontics came to the conclusion that orthodontic advertising by non-orthodontists would create more competition in the marketplace and patients needed protection against “substandard care”. Watson wrote that in order to combat that impending threat, the Officers and Board of Trustees of the AAO had hired a public relations agency Batz-Hodgson-Neuwoehner, Inc. “to inform the public that members of the Association are concerned about society’s welfare and are competently trained to provide improvements of dental health and self-image.” The media plan included print, newspaper, radio and television ads. A catchy slogan “We shape health, not just teeth” was created. He wrote, “our first priority, therefore, should be to tell the public that those AAO members who dispense orthodontic care are adequately trained.” As far as I can tell, AAO members were not assessed an additional tariff for that campaign.

Did the campaign work? No. Could it have worked? Maybe. However, the specialty did not truly believe what they were saying and did it in a half-hearted self-serving way, spilling blood in the water of public confidence. Orthodontists are still arrested in their development and can’t divorce themselves from the Angle/Tweed occlusion-centric paradigm. Tables at meetings are still covered with plaster and there is no shortage of orthodontists who delight in displaying before and after casts in glass cabinets in their offices. Unfortunately it has never occurred to them that the public does not use the discrepancy index to choose an orthodontic provider nor does the public use the objective grading system to measure the benefits they derive from orthodontic treatment.

Is there anything different about today’s AAO marketing campaign than that of 1979? No. Avrom E. King presented at the 85th Annual Session of AAO (1985) and the theme of the meeting was “the changing faces of orthodontics.” King’s talk was titled, “How to strategically plan for prosperity in orthodontics” and in the lecture synopsis he envisioned a new “golden era” for orthodontics. The golden era of orthodontics is right now. Shed the yoke of fear, embrace the orthodontic wellness paradigm, follow King’s 3 tenets and I guarantee you that 38 years from now you’ll stand in front of a glass case at the museum of orthodontic history looking at your reflection and thinking, “What a career…What a smile!”

4 thoughts on “Insanity

  1. Thanks Marc for this. I wonder what Avrom would have to say about the Airway Paradigm and 3d imaging that is emerging now in orthodontics. A true holistic approach to orthodontics and Healthcare. Early recognition in children may improve not only their smile and confidence… but long term health. “Breath is life”

  2. Great article, Marc. I took several courses with Avrom King in Phoenix. He introduced me to the concept of “Intentional Living”. He was a true visionary and futurist. I often go back and re-read his Nexus newsletters with amazement. So much has come true.

  3. Very useful, informative, and a lovely piece of writing to be read. I agree the idea of advancement in orthodontic treatment, it will bring positive change in the life of human being.

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