Community Dental Health

cover art

Cover Date:
September 2009
Print ISSN:
0265 539X
Vol:
26
Issue:
3

Editorial - The contributions of Edward H. Angle to dental public health

The genius of Edward Hartley Angle, (1855-1930), the founder of the dental specialty of orthodontics, to create order from chaos in the study and treatment of positional discrepancies of the teeth, jaws and face advanced greatly the cause of dental public health. Angle’s innovations that had the most public health impact were (1) his identification of dental occlusion, not simply tooth irregularity, as a prime concern, (2) his development of an uncomplicated classification system for occlusal conditions, (3) his introduction of prefabricated orthodontic appliances and (4) his framing of orthodontics as a dental specialty by organizing the world’s first educational program to train orthodontists.

Public health dentistry did not exist as a distinct professional activity in the late 19th century when Edward Hartley Angle, MD, DDS, (1855-1930) was laying the foundations for the specialty of orthodontics. Yet, his genius to create order from chaos in the study and treatment of positional discrepancies of the teeth, jaws and face advanced greatly the cause of dental public health. Angle’s innovations that had the most public health impact were (1) his identification of dental occlusion, not simply tooth irregularity, as a prime concern, (2) his development of an uncomplicated classification system for occlusal conditions, (3) his introduction of prefabricated orthodontic appliances and (4) his framing of orthodontics as a dental specialty by organizing the world’s first educational program to train orthodontists. In the 18th century, Pierre Fauchard and other early dentists constructed simple appliances to move teeth into more pleasing positions. They were responding to patients’ complaints about crowded front teeth, tooth gaps and displaced teeth. The relationship between the upper and lower teeth – the bite and dental occlusion – was a non-issue until Edward H. Angle came along over a century later. Angle admired and acknowledged the mechanical ingenuity of Fauchard (1728), Fox (1803) and Schange (1841) in moving front teeth. But he went further than his predecessors by saying, “It is not enough to simply move into correct alignment irregular teeth. We should have a proper conception of the denture as a whole.” (Angle, 1907) Angle recognized that some of the commonplace thinking in “orthodontia” (the original name for the specialty until it was officially changed to orthodontics in 1938) was superficial and mistaken. The world of orthodontia that Angle entered in the 1880s was one engaged primarily in “tooth regulation,” procedures and mechanisms geared to make crooked teeth less irregular. Hardly any attention was given by doctors – or patients – to the association of bite discrepancies with the occurrence of tooth irregularities. Early on, Angle was convinced that anomalies of molar occlusion were prime factors in the development of most

orthodontic problems, including dental crowding. (Angle, 1905) Thus, he took the bold step of popularizing the word “mal-occlusion” in the late 1890s, around the time he was creating his landmark work “Classification of Malocclusion.” (Angle, 1899) Angle’s elegantly brilliant idea was to analyze the dentition from a sagittal viewpoint and divide the upper to lower dental arch relation into 3 easily discerned anatomic classes. In contrast, Clark L. Goddard, Calvin S. Case and other experts in orthodontia at the time advocated convoluted bite classification systems, each with over 20 categories of discrepancy. Published in 1899, Angle’s classification article brought order out of chaos, simplicity from existing diagnostic complexity, transformations that his creative mind seemed particularly adept at seeing and doing. In 1900, Edward Angle changed the title of his textbook from a prosaic “The Angle system of regulation and retention of the teeth…,” (1887-1899, 1st through 5th editions) to the then ground-breaking concept, “Treatment of malocclusion of the teeth….” (1900, 6th edition; 1907, 7th edition). Angle’s definition of normal occlusion and his classification of malocclusion prevailed, no doubt helped by promotions from his students who usually became the movers and shakers in the early dissemination of orthodontic knowledge around the world. In his 1899 article and 1900 textbook, Angle presented the results of the first epidemiological study of malocclusion, his survey of “several thousand cases” using his new classification system. (Angle, 1900b) This work became a model for future studies of orthodontic conditions in communities and populations. Today, frequencies and prevalence rates of occlusal variations are still largely measured in terms of Angle’s basic criteria regarding the anteroposterior position of the lower dental arch in relation to the upper arch: normocclusion (Angle Class I), distocclusion (Angle Class II) and mesiocclusion (Angle Class III). Angle’s classification, after over a century of testing and challenges, has remained the de facto global language for dental occlusal epidemiology.

Correspondence to: Professor Sheldon Peck, DDS, MScD, Clinical Professor of Developmental Biology, The Harvard School of Dental Medicine, Boston, Mass. 02115, USA. E-mail: speck@hms.harvard.edu

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Page Start
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Authors
S. Peck

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