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The Big Test Wm. Randol Womack, DDS Editorial Director, Orthotown Magazine

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Faculty shortages, skyrocketing tuition and program length are just a few of the problems facing orthodontic education today. With fewer and fewer answers in sight, Orthotown Magazine has polled a team of orthodontic education insiders to discuss the current status of orthodontic education and what can be done about it.

by Wm. Randol Womack, DDS
Board Certified Orthodontist
Editorial Director, Orthotown Magazine
It’s no secret – orthodontic education is in crisis. The pool of qualified orthodontic teachers is quickly drying up, which is leading to part-time instruction that rarely sees students through entire cases, given the length of time it takes for orthodontic treatment. Meanwhile tuition for students is on the rise, yet programs remain underfunded, threatening the existence of several schools’ orthodontic curriculum. The American Association of Orthodontics (AAO) has even appointed a task force on recruitment and retention of faculty to look into these matters. In the interest of exploring the status of orthodontic education today, Orthotown Magazine chose to inquire about this subject from some prominent leaders in orthodontic teaching, both full time and part time. My response team included Dr. Robert Boyd, Dr. Art Dugoni, Dr. Henry Fields, Dr. Ron Redmond, Dr. Orhan Tuncay, and Dr. Timothy Wheeler.

I simply asked each member of the team to respond to the question: “What are the problems facing orthodontic education today?” I received the following responses from each of the team members:

On Faculty Shortage
Boyd: We have to realize that most new full-time faculty are from foreign countries as they do not have the student debt and are willing to work for 1/3 of what private practitioners will. The AAO and the AAO Foundation (AAOF) have been giving new faculty salary augmentations, but this year the AAOF is cutting way back because of the shortage of their funds due to the depreciation of their endowments. The AAO money is a year-to-year donation but that could change in short notice if the members decide to cut back on this money.

Tuncay: The bottom line is money and self-image. Our educational system drove itself to ruin by escalating the tuition. Increase in tuition is necessary because, due to the Federal Government and Congress, universities are obligated to provide more services, security, insurance and the like. Feds don’t think education is important, but the educators do; in turn, tuition goes up. The problem is simple: the orthodontic educator does not make enough money.

Wheeler: I think much of the problem with the faculty shortage was the salary difference and plenty of jobs in the private sector. However, that may be changing due to the economy. Fewer orthodontists are hiring associates and fewer will be able to retire due to the stock market impact on their retirement accounts. As a result, the academic environment may appeal to more graduates for jobs. However, dollars are still needed to support these individuals due to cutbacks at most universities.

Redmond: As only a part-time orthodontic educator, but a full-time businessman, I view the problems in orthodontic education from a different perspective. Full-time orthodontic educators are difficult to find, not because of a lack of talented individuals, but because of the full-time model. It’s all about dollars, except for that rare faculty member who is independently wealthy.

Fields: We have a number of programs that simply do not have the expertise to cover all the material at the level that they should be covered. The talent to teach with part-timers is in place. It is the basics of growth and development, diagnosis and treatment planning, biomechanics – the core of the didactic material that I believe is leaving us most at risk.

On Financial Barriers
Boyd: Tuition is skyrocketing due to almost no state support for ortho programs at public universities and for private schools like ours because our costs are going way up. Tuition, lost income and living expenses for an education in orthodontics is more than $400,000, which is on top of an average of $250,000-$300,000 from dental school debt. In addition, there are almost no grant funds available for clinical orthodontic research. This makes it difficult for faculty to explore new areas of scientific investigation and to do the research necessary for promotion as an academic.

Dugoni: Clearly the challenges are escalating costs; escalating resident debt; aging facilities; maturing senior faculty; lack of consistent donors; lack of funding for research; inability to recruit chairs and faculty, etc.

Redmond: Most orthodontic programs are underfunded, both from their institutional base and from their alumni. With increasing financial demands on programs related to research and technological advancement, many residents are graduating ill-equipped to face modern orthodontic practice. Governmental changes in the repayment of student loans will go a long way in solving education debt. Anyone close to orthodontic education and the increasing mountain of individual debt must be concerned about the potential ethical issues facing our graduates. Fortunately, the Department of Education has recently devised a plan to reduce monthly payments on federally-funded loans, with the remaining balance forgiven after 25 years, and for those in “public service,” 10 years.

Fields: The AAOF has done wonderful things, but it is evident that the resources it has are limited and how fragile they are in economic times. It is all about the money. A differential of 3- or 4-to-one between modest private practice and academics is not healthy and will ruin our profession

On Foundations & Program Length
Boyd: The schools are now expected to oversee the preparation of resident’s case work-ups for the American Board of Orthodontics. This is putting huge pressure to increase the length of all programs to 36 months duration because they want 100 percent of the treatment to be done by the resident. The average time for difficult treatments like premolar extractions is 34 months, which makes the costs of education even higher. Orthodontic departments are also expected to generate their own support for their own teaching from tuition and clinic income plus generate a surplus amount of income to use for other dental school departments, which are not as effective in income production. This puts pressure on the ortho departments to do more and more financially productive activities instead of focusing on pure academic areas, especially in the more fundamental biological areas.

Wheeler: The academic setting is important for our students to get exposure to all areas of orthodontics both didactically and clinically. Here they learn the basics and develop the necessary thought processes. While they are exposed to some practice management education, this is not priority. I think practitioners would be all the wiser if they learned from the new associates as they are usually exposed to the newest techniques and materials.

Solutions?
Boyd: Most commercial supply companies need to invest more in orthodontic university based research to make sure the schools can meet the levels of research needed to be an effective academic environment. Full-time orthodontic private practitioners need to be more generous in alumni giving to the departments they graduated from. Lastly, earmark more federal dollars for clinical orthodontic research.

Tuncay: Teachers are often joked about and portrayed as “those who can’t.” Yet, they are the ones who are the most sophisticated hi-tech folks who can teach something seriously. The committed educators teach and advance the field through research. If the field does not advance, everyone will catch up with us. Realistically, there is no reason why a faculty member could not work at the school two to three days a week and at a practice two to three days per week. Orthodontists, and especially those who are attracted to teaching, are bright folks. They can do anything. Funds to sustain the educational establishment will not come from the feds. But we can generate them in our clinics and through the generosity of our alumni. Negotiations at the level of the university presidents and the board of trustees can make the orthodontic department fiscally independent. Educators are the only ones who can safeguard the future of the specialty. But who will be in charge of presidential and board of trustees deal making?

Redmond: In a successful business model, I can’t imagine anyone agreeing to full-time teaching employment that exceeds 2.5 days/week, leaving the other 2.5 days/week for private practice. I believe this model, especially in a metropolitan area, would provide a superior chairman and other full-time faculty with a better grasp of current practice modalities. In addition, I think is it time to fully embrace a modified version of the preceptor programs. With the increasing facility of distance learning, virtual classrooms will reduce the space requirements at physical facilities and help control overhead. The more time spent in a private orthodontic practice during orthodontic residency (especially if the 36-month model becomes universally accepted) the better prepared our residents will be. Although there were 10 residents in my class (68-70), I was the only one who spent two days/week in the last seven months of my residency in private practice with Dr. Terry Root. He thought of this as an extended educational opportunity. Dr. Root was also one of my clinical instructors in orthodontics at USC. I have always felt that I had a “head start” over my classmates as we headed into private practice. How else does a resident learn the languaging skills, patient flow management, scheduling skills, staff management and all the other nuances of private practice?

Fields: The use of Internet teaching is critical. We have these things available and it is interesting to see the slow movement to use them even when the data indicates their usefulness. We need to get faculty into revenue-generating practice settings. Those can be intramural, hybrid or private. The data indicates that the private setting is more productive by a factor of three. We need to have more endowments and more support from alumni. If each alumnus gave $5,000 after five years in practice (one case per year), programs with five residents who have 35-year careers would have 30 years worth of these givers at once. 150 x $5k = $750k annually. Chairs could be endowed rapidly and discretionary monies would be available. This strengthens the programs and their research options, too. That is not too much to ask from an alumnus. In addition, clinics have to run more like practices and the suppliers have to underwrite more. Options like night clinics also must be considered.

Dugoni: There are answers; education must re-invent itself with a new model that is not mired in the past or in the status quo. A task force open to innovation and flexibility is paramount. A cookie-cutter plan is doomed to failure. Various scenarios need to be developed to meet different challenges for private and publicly supported schools. There are interesting possibilities – out of crisis there is usually generated the momentum to change.
Respondent Bios
Robert Boyd, DDS, is currently the Frederick T. West Endowed Chair of the department of Orthodontics at the Arthur A. Dugoni School of Dentistry at the University of the Pacific. He earned his DDS degree from Temple University, post graduate certificates in Periodontics and Orthodontics from the University of Pennsylvania and a MS degree in Education from the University of Florida. Dr. Boyd is a Diplomate of the American Board of Orthodontics, a fellow of both the American and International Colleges of Dentists and is a member of the Pierre Fauchard Academy.

Arthur A. Dugoni, DDS, has been the Dean of the School of Dentistry at the University of the Pacific since 1978. He is former president of the ADA. He is a Fellow of the American International College of Dentists, the Academy of Dentistry International and the Pierre Fauchard Academy. In 2004 the school was named in his honor as University of the Pacific Arthur A. Dugoni School of Dentistry.

Henry W. Fields, DDS, MS, MSD, is professor of orthodontics and served as dean of The Ohio State University College of Dentistry from 1991 through 2001. He currently teaches undergraduate and graduate students in pediatric dentistry and orthodontics and maintains an intramural practice. Additionally, Dr. Fields assumed the position of Division Chair of Orthodontics on November 1, 2006. A native of Tipton, Iowa, Henry received his BA from Dartmouth in 1969, his DDS and MS in pediatric dentistry in 1973 and 1975 respectively, and his MSD in orthodontics from the University of Washington in 1977. He was engaged in teaching, research, patient care and administration at the University of North Carolina from 1977 until 1991. Fields is also a member of the AAO Faculty Shortage Committee.

Ron Redmond, DDS, MS, FACD, practices orthodontics with his two sons, Bill and John, in four locations in the Los Angeles area of California. Dr. Redmond is an alumnus of the University of Southern California orthodontic program and serves as the Chairman of the Schulman Study Group and is a Regent at the Arthur E. Dugoni School of Dentistry at the University of the Pacific. Dr. Redmond lectures nationally and internationally and is an active clinical instructor at USC.

Orhan C. Tuncay, DMD, is a Professor and Chairman of the Department of Orthodontics at Temple University Kornberg School of Dentistry in Philadelphia, Pennsylvania. Dr. Tuncay was President of the American Board of Orthodontics and is currently President of the American Dental Association Foundation working to raise $1 billion for dental education. He has received fellowships in the American and International College of Dentists as well as the Academy of Dentistry International. In 2009 Dr. Tuncay received the William J. Gies award for Outstanding Achievement in dental education from the American Dental Education Association.

Timothy T. Wheeler, DMD, PhD, is the Chairman of the Department of Orthodontics, Director of the Orthodontic Graduate Program, Assistant Dean for Advanced and Graduate Education at the University of Florida. He has been the principal investigator on several National Institutes of Health and industry-funded grants. Wheeler also directs the North Atlantic Component of the Edward H. Angle Society of Orthodontists.
Orthotown Magazine
November 2025
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