Adult treatment in the 21st century.

When I was in dental school back in the ’70s, the amount of our DDS curriculum devoted to clinical orthodontics was exactly one class, for one credit hour. In that class, we received a general overview of facial growth and development, a bit of instruction on space maintainers, a lecture on mixed-dentition space analysis, and precious little training in actual orthodontic treatment procedures. One thing I remember well from this limited introduction is the professor’s insistence that orthodontics was mainly for 11-to-14-year-olds. Treatment before that age was limited to serial extractions, correction of developmentally detrimental crossbites, and space maintenance. The few adult cases usually involved a handicapping Class II or Class III malocclusion (I vividly recall his referring to these Class IIIs as “Hapsburg chins”, in reference to the Austrian ruling family known for its pronounced mandibular overgrowths), which was dealt with in conjunction with orthognathic surgery. My old professor went on to point out that a small number of patients, whom he considered unreasonably vain, did seek out conventional orthodontic care, and that a few orthodontists—presumably the lunatic fringe, to his way of thinking—would actually treat these prima donnas. We students, in all of our academic innocence, accepted his sage wisdom: Orthodontics was for kids. Jump ahead 30 years: I am now in charge of the largest orthodontic training program on the West Coast. I doubt that any of my current students could be considered “innocent”, but they still seem willing to accept most of what their old professors have to say. One thing that we emphatically do not say any more is that orthodontics is strictly for kids. The last time I checked, about 75% of my patients—three out of four—were adults. This is a far cry from the percentages in my early years, when adults made up only 5-10% of my practice. At the USC Department of Orthodontics, we were recently forced to make a decision that would have seemed unthinkable just a few years ago: We had to limit the number of adult cases accepted for treatment by our residents, so they would be able to gain