PCSO Bulletin: Winter 2000 Oral History interview with Dr. John P. Anderson

This interview with Dr. John P. Anderson is part of the PCSO Oral History Project's continued effort to preserve the history of the PCSO by interviewing senior members of our orthodontic community. Norman Wahl interviewed Dr. Anderson, PCSO President from 1978 to 1979, on May 8, 1996. This particular history has an interesting account of the development of extraction preferences. It also contains some wonderful and touching stories. - Ed.

A: Well, Emery Fraser, Pete Bishop, Dick Riedel, Paul Lewis, Ken Kahn, and Bill Takano.

A: Dick had a great influence on my clinical orthodontics and I appreciated the manner of teaching. He would be so understanding of questions that seemed difficult to us. Emery Fraser had a little more influence on my personal life.

A: Well, we had something in common. My father-in-law was also a dentist and they were in dental school together. That made a bond between us, so it was easy for me to confide in him and ask for his opinion.

A: Oh, yes. I never had anyone keep me attentive for so long. I remember we started at 1:30 in the afternoon—with maybe one break—and we didn’t finish until six. In some classes, not necessarily up there, but in some classes I’d be drowsy in 45 minutes, but he just kept things going,

Q: Was there a strong influence of Tweed, due to some of the Northwestern Study Club teachers?

A: Most of the instructors were friends of Dr. Tweed, and had been to his course (in Arizona) shortly after graduation.

A: Not entirely, although I was greatly impressed with his results. I was surprised at his patient load, which was considerably lower than most orthodontists. As I was getting out, I noticed that many orthodontists carried a bigger patient load than I was acquainted with. Tweed had so few cases at one time. He would tell us that if we carried more than 50 full cases, we weren’t taking enough time. In that era of orthodontics, we were interested in treating a larger patient load. My involvement with Dr.Tweed has always influenced me against having too large a practice. Of course, he would see patients more frequently than a lot of men.

His cephalometric analysis set a goal of a rather straight profile. It had a lot of influence on my thinking. I think for a while, I was too interested in getting the base of the teeth into a standard or into a figure—more than [interested in] realizing what the face was.

Q: In other words, would you say that you extracted less and less as time went on?

A: Certainly toward the end of my practice I was extracting less, but I was more concerned with selecting the best teeth to extract. I think Dick Riedel had a lot of influence on this, going to second bicuspids, especially in the lower, instead of always removing the first bicuspids. My feeling at first was that a little crowding could not be corrected without extraction. How much was "little" was kind of the determining factor. Retracting of the lower anteriors had a lot to do with that too—not just crowding. Certainly having a face with good balance was quite important in my treatment philosophy. For the last ten years I’ve been doing some nonextraction cases I wouldn’t have thought of before, and I’m wondering, What are they going to look like 15 years from now? But the pendulum has swung both ways. In the early fifties, the edgewise appliance wasn’t quite as prevalent in Arizona as it was in Illinois, California, or Washington. St Louis was doing pretty much the philosophy of Tweed—extraction cases. The rest were expanding, using Crozats and universal. Beginning in the 1950s, extraction became basic to graduate programs. Then it settled down between excessive expansion and different tooth extractions or nonextraction.

There was a phase where some were taking out second molars. But that was a tough decision to make. I won’t say I never took out maxillary second molars, but it was very, very seldom—and never mandibular second molars. Pete Bishop was the only one I know of who took out upper second molars—with good headgear and the possibility, of course, of the wisdom teeth coming down. I think Pete had an easier philosophy on fuller faces and extraction than the rest of us.

Q: Did you ever have a parent who thought the child’s face looked fine even though it was very poor to you?

A: Well, I won’t say that the parent was the one who decided. Those types of faces I did more as second bicuspid extraction cases. But it was getting to the point where parents—also general dentists—were saying, "Gee, that face is too flat," or "The teeth are too upright." I had, at that time, felt that if the crowding was that severe, there was no way I could do good treatment with so much expansion.

A: Actually I started out in downtown Portland for the first five years and at that time there were hardly any specialists. Dr. Thurmond Hice was in an outlying district, but Dr. Paul Klein and I were in Portland. We were having lunch one day. Paul said that he was thinking about going out to a suburb of southern Portland and I was thinking of Beaverton. Well, we decided that very noon, and he left within a few months. It took me a little longer, but within six months I had moved out to Beaverton. Beaverton is seven miles west of Portland, in a different county that extends to the coast. I was the first orthodontist in that county and something like the 30th dentist, so only a small number were getting started. I thought, "Boy, I’m gonna have to start all over again." But strangely enough, I don’t think I had four or five patients that I had to transfer to somebody else because of transportation problems—they all followed me out there. In fact, most of them were pleased to get out of the downtown area.

A: Rollie was probably one of my closest friends and, in fact, I think the one who got me interested in orthodontics. He came out of Washington in ’51 and was new to Oregon. He taught at the school and I was a student at the time. Having the same last names and both coming from the Midwest, a friendship developed. I guess he and Dr. Ralph Cooper were the primary instigators of my getting into orthodontics.

A: Yes, that was interesting. Dr. Gene Butori was a Washington graduate. Dr. Denny Rees was one of the early edgewise orthodontists in the Portland area. He came out of the service as a prisoner of war—he was on the Bataan Death March. He was a dentist in the service and may have done a little orthodontics before he went in.

Anyway, everybody was referring to Denny and he had such a huge practice that he needed help. Dr. Guy Woods was a University of Illinois graduate and they started together. When Gene came down, they formed one of the first orthodontic partnerships that treated the same patients. In fact, I took over his office space when Denny and Gene went into their new, larger office.

Q: Was there any feeling on the part of the orthodontic society that this group was using too many auxiliaries or having too much production?

A: I didn’t have that opinion. They had a lot of things going for them —with illness and sickness they would be covered, they had the advantage of working with several other men, and they did their diagnoses and treatment plans together. At the beginning there was some concern among local dentists and orthodontists. There were no other group practices in Portland, or even in Oregon, for quite some time. But they were outstanding men. They did fewer extractions and were more influenced by Angle’s philosophy. They had a good mixture of orthodontic techniques.

Q: Would you say that you started practicing during the "golden age" of orthodontics?

A: It was more the start of the golden age. People were beginning to hear about having their teeth straightened. Some of it was good and some of it was bad. I think I was the 13th orthodontist in the whole state. I remember Dr. Ralph Cooper, who was right above me, saying, "John, I’m so busy, I’m gonna send some patients down to you. Ralph was a universal man and a very short man. I used to call him "one of the biggest little men I’ve ever known." Practices started quite fast, certainly by today’s measure. But Dr. Tweed cautioned us: "Don’t let your practice get out of hand." At the University of Washington we each had ten cases and we reviewed all the other patients under treatment. We started a study club very early and we talked about sizes of practices and how they should be managed and cared for.

A: Dr. Rollie Anderson and Dr. Paul Klein, who were from Northwestern. He was a genius in all aspects of technique. Another wonderful man, Dr. Frank Piacentini, joined us a little later. Dr. Mat Mathews, who came from Georgetown University, helped start and headed the orthodontic department at the University of Oregon Dental School. He eventually got into private practice in Portland. We had a great group. We were probably the longest active study club in the Northwest.

Q: Do you think that the specialty has deteriorated in any respects since you started practicing?

A: I don’t like to use the word deteriorated, but what I noticed was the difference in the use of auxiliary help. It was my goal to have an informative exam and consultation with the patient and parent, to explain all aspects of treatment. Sometimes I wonder if I explained too much, but I had many comments like, "We certainly appreciate the explanation." Some of them were pretty detailed. It was also my practice to "put a finger in every mouth that came into the office," and not delegate too much. But as time went on, especially with elastic ties, it was certainly permissible for them to tie in arch wires. I tried to get to know the patient—which was the fun part of it.

Getting back to deterioration, when I say "government intervention," I don’t want to leave the impression that the government took over our practices. OSHA was a big concern for me as to how much it would affect my practice. I didn’t have to change my office very much, but it was another kind of government intervention. I think they’ve calmed down a little in regard to smaller practices now. Malpractice was also a concern.

The Oregon economy really went downhill from ’80 to ’85. Lumber took a dive and I felt quite an orthodontic downtrend during that time. Of course, I was getting older and new men were graduating. But things are certainly better now. I notice that the young men are treating more cases. Starting ten cases a month was quite a few in those days, and at one time seven to ten was my objective. Now 20 or more is not unusual.

A: I was involved quite heavily at the time in dental organizations. Oregon had one of the first plans—a Teamsters Union dental health program, which was started in the late ’50s. As more and more came in, it caused more conflict among dentists. Some were concerned that insurance programs were going to take over everything, while a good number of us were working with these dental service corporations, hoping they might not only help the family but the dentist as well. Now, looking back, I think it was a saving grace for dental practices, especially in smaller towns where the only livelihood was either fishing or lumber. When orthodontic insurance came out, I worked quite closely with the AAO as well as the PCSO. I think it was a godsend for many practices to treat families that could not have afforded orthodontic care. Some local companies had an orthodontic clause in their dental contract.

A: No, absolutely not, although there were programs like that. There were some where you couldn’t meet expenses and those were the ones that we were really concerned about. One way to do it would be to cut down the service to the patient, which was, of course, something we didn’t want to do. But the programs we were involved with here in the Northwest were very good in that you could have your fee taken care of, or at least partially. The AAO was very helpful in trying to show companies what could be done.

A: Yes, I was on the legislative council for the AAO for four or five years and, of course, when I was in the PCSO we were active in that as well. At the start, it caused an awful lot of division among dentists—not just orthodontists. There came a time when dental programs were better established, but when they started out with just the dental service corporations, you had two camps and there was a lot of animosity among dentists.

A: Yes, but there was always room for improvement. I was always on the side of promoting dental service corporations, if it could be done correctly. I was associated with some general dentists, close friends, who were also deeply involved. I had some misgivings about it, but it saved a lot of practices.

A: Well, we at that time brought in new PCSO delegates. That was about ’73 or ’74. We needed younger men involved—and I felt very strongly about this. It was getting to a point where you started out in the orthodontic organization and just stayed there until you either retired or died. The Northern Section of the PCSO made a serious effort to involve younger members, and I think the entire PCSO delved into it.

I remember when I graduated from dental school, we were encouraged to join our dental association, but their office was only open two days a week at that time. That’s just an inkling of how things have grown since ’53 and ’55. I was involved with the Oregon Dental Association before I was involved with the orthodontic association. I enjoyed that part very much and the making of friends all over our area and on the coast was very gratifying to me.

Another thing I’d like to see: more and better programs on buying and selling of practices. A person should be thinking about how he is going to retire ten years before he actually does. In my case, a buy-and-sell agreement was made by a man not involved in dentistry and it worked out pretty well. But there are so many things I didn’t do that I wish I had.

A: On preparing the practice for sale and how it should be done, I had a problem with some investments at the time and the practice was starting to dwindle. I wasn’t starting as many cases—people could see it. I was getting older, and as I said, my referral sources were not only retiring but also passing away. Younger men were coming in and they had their own peers to refer to. Then, I was not as active in my organizations as before —and this has been a big regret for me. It was getting too expensive to go back to national meetings, plus there were family priorities. I belong to the International College of Dentists, and now they’ve got a retirement clause that makes it a little easier for me to stay in. I was a longtime member of the Rotary and my church, but I wasn’t as involved with the AAO and the PCSO as much as I wanted to be toward the end of my practicing career.

It was a marvelous specialty for me and one which I thoroughly enjoyed, especially the people I worked with and grew up with. I’ve always had a kind of running list of ten people who influenced my life the most. Some of them are outside of dentistry, but Al Moore and Dick Riedel were really on the top of that list.

I’ve got a doorstop that a patient gave me. It’s a fairly large stone, maybe six or seven inches across and a very smooth river-rock type of stone. He painted on it, "Braces are beautiful." You see, both of his parents were killed in the middle of his treatment, and an aunt became his guardian. I wanted to take very special care of him. At the end of treatment, he brought in this little stone and I’ve got it outside my door right now. I looked at the date on the back of it the other day, and it said 1973. That’s the kind of thing you get a thrill out of.

We had a class of ten in our graduate group and one of them died shortly after we got out. Three years ago we decided to get together and they all came up here to Black Butte with their wives. It’s a destination resort—fishing and golfing—it was the greatest time we ever had. Jim Thurston was in our class, one of the leaders. Well, he had just been diagnosed with cancer and they wanted to operate, but he said, "Not until I get back from our gathering." After our reunion in September, he went back and had his operation. Before he passed away three months later, his receptionist went down to see him. Just as she was leaving, he said, "Tell Johnny Anderson I had the greatest time in the world."

Winter 2000 PCSO Oral History Project

Dr. John P. Anderson