Dr. Arthur Wool reflects on his career

In an interview with Ortho Tribune, Dr. Arthur Wool reflects on his career and why he loves it more today than when he started. In his words, “Orthodontics gave me the career opportunity that I was looking for.”

What is your educational background?
I attended Seton Hall University from 1946–1947, Rutgers University from 1947–1949 and Albright College from 1949–1950 for my BS, University of Pennsylvania, School of Dentistry from 1950–1954 for my DDS and 1956–1958 for my orthodontic certificate.

Please expound upon your military career.
I joined the Navy after graduation from dental school in 1954. After indoctrination at the Bainbridge Naval Training Center in Maryland, I was assigned to Mobile Construction Battalion No. 5, a Seabee outfit, located in Subic Bay, Luzon, Philippine Islands, and was the only dental officer in a battalion of about 1,000.

Being the only dentist present, I had to do it all, including many surgical procedures I had never performed before. Being a construction battalion, the outfit was working on making the Subic Bay Naval Station the home port of the entire U.S. 7th Fleet.  I was at this location for 10 months, whereupon the battalion was returned to its home port, Port Hueneme in Southern California near Oxnard.

The battalion shipped out four months later for Adak, Alaska, located near the end of the Aleutian Chain. It is an island that had been held by the Japanese during World War II. The battalion was working on refurbishing a large portion of the docks, as well as working on an air strip.

During the time the battalion was located in Adak, I was able to use the base hospital dental quarters to care for the battalion personnel. Adak was a very desolate island — too cold for trees or vegetation.
We arrived during the spring salmon run, and that, to a fisherman, was like being in heaven. We caught and smoked the salmon and also built a shrimp trap that we hung on one of the dock pilings.

I finished my tour at the Seattle Navy Base, being discharged from active duty on Sept. 9, 1956, and immediately rushed back to Philadelphia to enroll in the postgraduate orthodontic program at the University of Pennsylvania.

Three days after arriving in Philadelphia, on Sept. 10, 1956, my first daughter was born.

What hobbies have you enjoyed?
The hobbies and sports I have enjoyed most of my life are golf, fishing, bowling, skiing and sailing.

What motivated you to become an orthodontist?
I chose orthodontics as a career because the thought of practicing general dentistry for my life’s vocation was too upsetting. In fact, if it were not for discovering orthodontics during the later part of my second year at Penn Dental, I was planning to drop out. Orthodontics gave me the career opportunity that I was looking for.

When, where and how did you open your orthodontic practice?
I completed the orthodontic training at Penn in January 1958 and immediately opened a private practice in Reading, Pa., which was a town of about 100,000 and located about an hour west of Philadelphia. Money was scarce, and I borrowed from a bank to buy a single unit, X-ray and chair.
Orthodontic fees were not much to speak of in the late 1950s, and it was all I could do to keep up with payments on my indebtedness.

It was tough going as my second daughter had arrived in 1958.

What special areas of orthodontics are you interested in?
I enjoy all aspects of orthodontics, especially the very difficult Class II division I deep bite cases, as well as pronounced bi-maxillary protrusion cases — both types that require extractions.
It was always a thrill to complete one of these cases and be rewarded with the transformation of a poor face and poor dentition into one of beauty. I do not see how any pleasure could surpass this.

In your opinion, is there a need to change the methods of how postgraduate orthodontic programs educate their residents?
During the course of 24 years, I have been able to converse with many hundreds of orthodontists during national and regional AAO meetings as I exhibited for Wonder Wire and later Modern Arch, two separate orthodontic supply companies that I had started.

Both businesses sell orthodontic supplies and were started immediately after the issuing of two different arch patents.

Both arches impacted directly on treatment know-how and appliance procedure.

I was surprised by the seemingly closed minds on the part of both recent graduates of many different orthodontic programs, as well as by orthodontists who had graduated programs 20, 30 and 40 years ago.
I believe this state of affairs to be a carryover from the teaching they received during their graduate programs. The old-timers knew where they were headed but used different methods to achieve their end results.

Recent graduates had been instilled with one treatment approach, and all cases were fit into this regimen.
It is my opinion that today’s students would benefit greatly from treating a few cases with the 1950s hardware.

I would enjoy watching recent graduates spot-weld standard edgewise brackets on the steel strips to make bands, solder buccal tubes, bend all arches from straight wire and make a 21-by-25 steel arch with first, second and third order bends.

Because of the great advances in appliance hardware, the introduction of palatal splitting devices, micro-screws, etc., today’s orthodontic graduates are turning out commendable results.
In spite of the shortcomings in the appliance approach because of a narrowed teaching program, whose dictates are the distillation of the department head’s own personal preferences, overall, orthodontic end results are better today than yesterday.

I feel this is mostly due to multi-banding, the takeover by edgewise brackets and the miniscule reliance on techniques such as labio-lingual, Crozat and Johnson Twin Wire.

What changes in orthodontic education have you observed during your career, which you consider to be either positive and/or negative?
I would like to see a greater emphasis in orthodontic teaching placed upon open-minded exploration, both didactic and practical, of various approaches to treatment procedure. The old saying that “there are many ways to skin a cat” applies particularly well to orthodontic treatment.

Given a tough orthodontic problem, there are literally dozens of approaches that would finish with a good end result, not just one. Unfortunately, today’s graduates are taught essentially one approach, and the different sequences in case progress must follow one another from beginning to end.
Regarding the subject of sliding mechanics, I have heard too many orthodontists state that they do not do any of that. That is a pity.

I also have heard many condemn the use of Class II elastics. That is also a pity; both are valuable treatment aids when used with care and discrimination and a good helping of common sense.

What changes in orthodontic education would you like to see made and why?
I think a greater emphasis ought to be placed on force mechanics as it relates to tooth movement. Teeth want to move, just like birds want to fly, but a bird will not get off the ground with an anvil around its neck.
Modern appliances afford new ways to move teeth, open bites and retract profound protrusions, all with a surprising minimum of auxiliary aids. The elastics and springs I have been selling for many years in the two distributorships I have owned are skewed to a far higher number of those that exert more force on the teeth than is required.

Aside of a headgear, I never applied more than three ounces of force via any device I placed in the mouth. More often than not, I used forces in the one-and-one-half-ounce to two-ounce range.
The greater the force used in the mouth, the more capacity for damage. I try to convince customers of mine to lighten up on heavier coil springs and elastics, but it is far too often a futile endeavor.

Please recount the most interesting part of your personal journey in orthodontics.
The most interesting period of my practice years started when I completed my orthodontic training and was let loose upon the public. In any one mouth could be found a gold lingual arch, some lower edgewise bands and an upper Johnson Twin Wire Appliance. In short, I was fumbling. Cases took longer than they should have, but I was cautious and did not want to make mistakes.

As time went on, I was using more and more edgewise brackets and less and less lingual arches and twin arches. My approach was becoming more multi-banded.

Tackling a large protrusion was a constant battle with posterior friction. There is not a single gram of tooth-moving capacity available until you have first overcome all friction. So, create an atmosphere of low-friction mechanics for all cases.

There also are several other factors that I believe can contribute to what I call better service to the patient and also a service that is more thoughtful and humane.

Besides as low as possible in applied forces, all appliances should be as aesthetic as possible, as comfortable as possible, easy to brush and clean, as minimal an amount of hardware placed in the mouth as required to do the job and should let you get in and out of the mouth as fast as you can.

I was constantly searching during my early years for better and easier ways to guide my patients through their appliance therapy and to produce better and better end results in an easier fashion for both myself and the patients. I found myself enrolled in a Begg Light Wire course being taught by Milton Simms, an associate of Raymond Begg in Adelaide, Australia.

I started about 25 cases with Begg brackets, but I was not happy trying to produce torque correction with round wires. But my time with light wire proved to me at least that the major parts of tooth movement in most cases ought to be done with light round wires, saving the tight fit of rectangular wires for the time when this fit was needed.

It seemed logical that bite opening and tooth movement along an arch ought to be done by sliding mechanics.

With the correct and insightful use of arches and their bending, coupled with light elastic forces, most of all the need for supplemental anchorage in maximum anchorage type cases — such as headgear, sectionals, lingual arches, palatal buttons, canine retraction, etc. — is unneeded.
Over the course of about eight years evolved a most happy blending of Begg mechanics with that of edgewise.

What closing remarks would you like to make?
I have been practicing orthodontics for 50 years, and as time passes, I love it even more.
As the years rolled on, I reduced my patient load because my type of practicing was very tiring in many aspects.

I work standing up and do essentially all the work on patients: taking X-rays, impressions, fitting and cementing bands (and now brackets), placing all arch wires and essentially doing everything on all patients.

The only procedures I allowed the assistants to do were helping me cement bands, bond brackets and to remove arch wires.

Unfortunately this mindset kept me in a very, very modest-sized practice environment, never starting more than 90 to 100 cases per year, but allowing me time to experiment and form an inquisitive mind to practice better and better appliance therapy.