key: cord-1039408-j2c4d7wg
authors: Thom, Allan R.; Graber, Lee W.; Maplethorp, F. Amanda; Vaid, Nikhilesh R.
title: World Federation of Orthodontists: An orthodontic umbrella organization coordinating activities and pooling resources
date: 2020-10-03
journal: J World Fed Orthod
DOI: 10.1016/j.ejwf.2020.09.005
sha: 117d9d7441f02bf5cb7db05f2de23f62036cec4e
doc_id: 1039408
cord_uid: j2c4d7wg

The idea of a global orthodontic organization, the World Federation of Orthodontists (WFO), made up of national and regional orthodontic organizations, was realized in 1995 in San Francisco at the 4th International Orthodontic Congress that was held in conjunction with the 95th annual American Association of Orthodontists meeting. This umbrella organization strives to promote quality orthodontic care, practiced and delivered by orthodontic specialists in all parts of the world. In addition, it supports its member organizations with governing principles that promote appropriate membership criteria, qualified individual leadership participation, and long-term stability of the organization over time. In response to the Coronavirus Disease 2019 pandemic, the WFO has responded proactively and plans to augment its digital resources even further in the near future. This article describes the formation of the organization, the idea that germinated through the first three international orthodontic congresses, its workflow and membership criteria, the accountability and commitment it has toward its affiliates and individual members, and its plans for future years to come.

Since its inception, orthodontics has grown exponentially and the sharing of information and resources across borders contribute immeasurably to it. An international organization, facilitating cooperation and coordination among national and regional orthodontic associations, with a defined global agenda emphasizing the advancement of the subject as well as the speciality, was the idea behind formation of the World Federation of Orthodontics (WFO). As rightly said by Dr. Lee Graber [1] , "We live in one world of orthodontics; we share clinical technologies, educational and research opportunities, and new friendships born of interacting on a global stage." e the very purpose of the existence of WFO as an umbrella organization of all its affiliates.

The first worldwide congress ever held by a dental specialty, the 1 st International Orthodontic Congress (IOC; August 16e20, 1926) at Hotel Commodore in New York City was the brainchild of Dr. William C. Fisher, the president of the then-called American Society of Orthodontists accompanied by Drs. Ellis and Butler as secretarygeneral and treasurer respectively (Fig. 1) . The constitutional bylaws for the first IOC were adopted at a meeting held at Hotel Vanderbilt on October 28, 1925. The Congress was opened on August 16, 1926, with approximately 600 specialists from 15 orthodontic societies (10 from the United States and five from Europe), but was held without a united supporting organization. English, French, Spanish, and German were the official languages of the Congress. Dr. Fischer, in his speech, emphasized that this meeting also commemorated the 25th anniversary of existence of orthodontia as a specialty, considering establishment of the Angle School of Orthodontia in 1901 as the "birth" [2] .

The 2nd IOC was held in the Savoy Hotel, London (July 20e24, 1931) under the presidency of Dr. J. H. Badcock (Fig. 2) Stephens (Secretary-General) in organizing the event that was represented by 23 component societies from 23 countries. Apart from the scientific deliberations, social activities including a golf tournament at Sunningdale, Berkshire were a highlight of the event [3] .

The outstanding success enjoyed by the 1st and 2nd IOC led to the discussion about a 3rd IOC to be held in Montreal, Canada, in 1938. The event, however, would not come to fruition, due to the untimely death of Dr. Fisher and the unfavorable world economic and political conditions. The idea of the next IOC did not get rejuvenated for 42 years. The 3rd IOC was held in London (August 13e18, 1973), through combined sponsorship of EOS and the American Association of Orthodontists (AAO). The success of the 3rd IOC can be attributed to the London Organizing Committee headed by Professor William J. Tulley (congress president) and members of American organizing committee headed by the then AAO chairman, B.F. Dewel (congress vice-president) and Dr. Hubert J. Bell, the then president of the AAO. Nearly half of the orthodontists were from the two sponsoring organizations, the EOS and the AAO, but the rest came from 50 other countries, making it a truly worldwide, international meeting (Fig. 3) . The congress apart from scientific sessions, also hosted well-received social functions and was a huge professional and artistic success [4] .

The concept of a worldwide organization of orthodontists was discussed at the 3rd IOC, but the first active steps were taken at the 1989 board of directors meeting of the Midwestern Society of Orthodontists (MSO), a constituent of the AAO. It was Dr. John Byrne, who initiated the discussion, which resulted in a resolution from the MSO to the AAO House of Delegates requesting the 1995 AAO annual session at San Francisco to be shared with the 4th IOC, which was subsequently accepted. The Board of Trustees assigned the responsibility of organizing the 4th IOC to Dr. William H. DeKock, a past president of MSO and its representative trustee on the AAO Board of Trustees. Dr. DeKock recognized that there had to be a mechanism bringing together orthodontic societies from around the world to participate and become stakeholders. Dr. DeKock was joined by Dr. Lee W. Graber as General Chairman and Drs. William Thompson and Donald Woodside as program chairmen for the congress and an international advisory committee from four different continents were also appointed to organizing the meeting in San Francisco.

The structure of WFO, as designed by Dr. DeKock, consisted of a federation of affiliated organizations, each of which by virtue of their membership categories would then validate applicants for WFO fellowship from their country or region. Dr. DeKock himself contacted the Federation Dentaire Internationale starting with a list of dental societies throughout the world and contacted each one asking for the names and addresses of any orthodontic societies in their respective countries. He then sent all identified societies a copy of draft WFO bylaws and asked if they would join the WFO. Dr. DeKock also placed a draft of the WFO bylaws before the Board of Trustees of the AAO, which resulted in an enthusiastic support, both financially and philosophically [5] .

At the 4th IOC (May 12e17, 1995), held in conjunction with the 95th annual meeting of the AAO, the idea of a unified orthodontic organization composed of various national organizations, "bringing the orthodontic world together under an umbrella organization" became reality with the charter-signing ceremony at the famous Herbst Theatre in San Francisco. The WFO was officially born, with Dr. William H. DeKock as president and Dr. Lee W. Graber, as vice-president. Sixty-nine organizations from 62 countries sent representatives to sign the charter, yet another union of world leaders in the Herbst Theatre, which served as the location for the signing of the United Nations Charter almost a half century earlier (Fig. 4) . The AAO facilitated the setting up of the WFO headquarters in their building in St. Louis and have been incredibly supportive over the years [5] .

The main purpose of WFO as defined at the 4th IOC was "to advance the art and science of orthodontics throughout the world" along with seven other objectives aimed at encouraging high standards in orthodontics throughout the world, assisting in the formation of national associations of orthodontists as well as national and regional certifying boards in the field of orthodontics, promoting orthodontic research and dissemination of scientific (Fig. 7) , the British Orthodontic Society for the 8th IOC in London (Fig. 8 ) and now the 9th IOC with the Japanese Orthodontic Society in 2020 ( Fig. 9 ). Attendance at these congresses has been excellent and the communication of new ideas and technologies in orthodontics has been superb. This further emphasizes that the camaraderie and collaboration among colleagues is integral to the advancement of orthodontics.

The WFO bylaws provides for two major governing bodies to develop policies and lead the organization. They are the Council of the WFO and the WFO Executive Committee (EC). The Council, consisting of representatives appointed by each national and regional affiliated society, meets once every 5 years during the IOC. The Council elects the 10 regional representatives of the EC that include at least one representative from each of the six major regions of the world. The EC also includes the president, who is elected by the previous EC, the secretary-general and the editor-inchief of the Journal of the World Federation of Orthodontists (JWFO) both of whom are appointed. It is the EC that develops policies and leads the WFO in the interim between each IOC ( Table 1 ). The secretary-general administers the home office of the WFO in St. Louis, MO, and serves as the chief executive and financial officer. All affiliate society applications and support as well as individual membership support is carried out under the WFO Secretariat. The WFO home office is financed by dues from affiliate organizations, fellows (members), donations, profits from the IOCs, grants, gifts, and bequests.

The WFO, with its help on governing principles, provides a structure for its affiliates that allows for appropriate membership criteria, qualified individual leadership participation, and longterm maintenance of the affiliate organization over time. Because of the strict criteria for WFO affiliate membership, those organizations that hold active affiliate status are recognized worldwide as the representative orthodontic specialty association within their geographical area (Fig. 10) .

Any national orthodontic organization may apply for WFO affiliate membership as long as they have a category of full membership that consists only of recognized orthodontic specialists, and that only this category of membership can vote or hold office. These organization have the responsibility to comply with the WFO bylaws and to advance and promote orthodontic standards consistent with those laid by the WFO. The shared objectives of affiliated organizations are to encourage high standards in orthodontic treatment and research as well as education, training, certification, and licensure within their geographic jurisdiction.

The WFO strives to maintain accountability to affiliated organizations and fellows, responsibility to promote high-quality orthodontics provided by appropriately trained professionals and leadership from a dedicated EC who give freely of their time, with no stipend; steering the WFO through all challenges at both national and international level. All fellows have ownership of the WFO and if one accepts ownership, one has by default, a responsibility to practice the highest quality orthodontics.

Starting in 2005 with a European Village Day, the WFO organizes a "world village" at every IOC, giving an opportunity to WFOaffiliated organizations to share their local speakers with the rest of the world. May 15 of every year is celebrated as World Orthodontic Health Day, a WFO initiative, now coming up to its fourth anniversary providing a platform for promotion of orthodontic treatment by orthodontists (Fig. 11) .

The WFO also helps affiliate organizations by providing a network for all affiliates to share information on local issues, common interests, and news of their association by way of the Gazette, WFO Web site and WFO App as well as an opportunity for publication of appropriate materials in the JWFO (Fig. 12) . All vehicles have proved hugely popular and the publications represent "ownership" so that the "information out" is only a result of the "information in."

In 2003, the WFO developed the WFO Orthodontic Specialty Education Guidelines. Recognizing the need for more specific direction and support for orthodontic specialty programs, the WFO followed up with an extensive review of orthodontic educational programs around the world. The result was the WFO Educational Guidelines, which was published in 2009. 4 This review was completed by a distinguished academic task force led by former WFO president, Prof. A.E. Athanasiou. The Guidelines are intended as a guide to those institutions that would seek to develop new orthodontic specialty education programs and for those who would wish to have a standard against which to measure their current offering. The guidelines are free to download at: https://www.wfo. org/about-wfo/programs/guidelines-for-postgraduate-orthodonticeducation/

Organizations have a responsibility to recognize members who make outstanding contributions to the benefit of the specialty. The WFO has granted six Regional Awards of Merit to date (Fig. 13 ). More will be awarded as there are many underrecognized deserving fellows who show a dedication to quality orthodontics, be it teaching, clinical, research, or other activities uplifting the specialty of orthodontics. Apart from this, the WFO awards the prestigious "WFO Lecture" at every IOC to a global expert of repute (Fig. 14) , the "William H. DeKock Distinguished Service Award" for contributions to the WFO and the awarding of "WFO Honorary Fellowship" to fellows who have made a global impact on the specialty (Fig. 15) . Young minds are the seed corn for the future of an organization and any support for a student member from countries with challenging economies can be life changing. An innovation to award financial scholarships to deserving student members was implemented at the 2015 IOC (Fig. 16) .

Organizations supporting each other become greater than the sum of the parts. The WFO warmly welcomes the close symbiotic relationship it has with the all its affiliated organizations. The WFO's commitment to encouraging and supporting orthodontic specialty boards through the WFO Society of Orthodontic Specialty Certification Boards is a giant step in quality assurance. A total of 18 orthodontic certifying boards, now recognized by the WFO, provide the professional passport of quality to the current and more importantly the next generation. This is an achievement that can only be gained by dedication and hard work. To support this effort the WFO Guidelines for Orthodontic Certification Boards were developed after two successful symposiums held during the 6th IOC and the 7th IOC with the aim to raise the standard of certifying boards worldwide and encourage the establishment of new certifying boards in orthodontics in countries that do not have them.

The first WFO EC focused its resources in 1995 on how to recognize who is an orthodontic specialist in different jurisdictions. WFO affiliate organizations may recognize different levels of providers of orthodontic care, but in order for an orthodontic organization to be affiliated with the WFO, its bylaws must provide a specific membership category for the "orthodontic specialist" or "orthodontist." Individuals may join the WFO at one of three membership levels depending on the stage in their career as an orthodontic specialist. These include WFO Student/Resident Member, WFO Fellow/Member or Academic Member, or Retired Fellow/Member. Each WFO national affiliate president certifies the specialty status when he or she signs the membership application of his or her organization's member to become a WFO Fellow/ Student member. All members must agree to support the purpose and objectives of the WFO as stated in the WFO bylaws.

Orthodontic specialty students (residents), using the student/ resident application, may apply directly to the WFO as long as there is a national WFO-affiliated organization in their country. In addition to the signature of the president of their WFO-affiliated organization, they must also obtain a signature from their dean or program director certifying that they are actively enrolled in a fulltime orthodontic specialty education program. 

Full Fellows/members of the WFO must satisfy strict criteria in applying for WFO fellowship. They must be educationally qualified, having completed a full course of orthodontic specialty education (i.e., one that qualifies them as an orthodontic specialist where they practice or serve as academicians). A WFO Fellow must be a member of the WFO-affiliated organization having jurisdiction in their place of practice. Although the WFO consists of more than 100 affiliated organizations, there are some countries that do not have a national orthodontic specialty society, or their society is not WFO-affiliated. In that situation, the applicant may apply directly to the WFO for Individual Fellow status, which will be vetted by the WFO EC before granting WFO Fellowship. Once a national affiliate is formed, an "Individual Fellow" must join the newly recognized national affiliated organization to maintain their WFO Fellow status.

Those who have been members of the WFO for 10 years and are retired from full-time orthodontic practice and/or teaching, may apply for retired status that maintains their WFO membership. This allows those who remain interested in the specialty to continue to participate in the WFO and keep in contact with colleagues around the world. 

Among the direct and indirect benefits of becoming a member of the WFO are unlimited access to the JWFO and the WFO Gazette, reduced registration fees to attend the IOC, reduced fees to attend meetings of other national orthodontic organizations around the world, ability to use the WFO logo on Web sites, letterhead, and electronic communications, further certifying internationally recognized credentials as an orthodontic specialist and a listing in the International Orthodontic Directory, the only directory for orthodontic specialists that is validated by the WFO's multistage certifying process.

The WFO is committed to ensuring that it continues to be the vehicle that facilitates and promotes quality orthodontic care practiced and delivered in all parts of the world, the integral part of the federation's "soul" and core ethos! As WFO celebrates its Silver Jubilee or the 25th anniversary in 2020, an important landmark in its historic evolution (Fig. 17) , the organization is planning to have dedicated projects aimed at strengthening its affiliate organizations and to reach out to its fellows. Some of the projects include creating educational resources (revision of postgraduate guidelines, educators' symposiums, and launching a Web-based learning and interaction platform with multimedia capabilities), creating governance protocols that evolve with changing times to improve better representation of concerns and challenges faced by the profession, continuing to encourage the formation of specialty orthodontic boards around the world, and granting more awards to recognize members who have contributed to the specialty academically, clinically, through advocacy, or through leadership and aiming toward having every specialist orthodontist globally be a WFO fellow through their respective national organization.

Amid the COVID-19 pandemic, which has changed all our lives, both personal and professional, the role of the WFO as an international organization of orthodontists for orthodontics has not changed. The WFO has responded proactively to the new world order and plans to augment its digital resources even further in times to come. This will enable interactions (whether fraternal, scientific or advocacy) in an orthodontic world that is united by its unequivocal commitment to the specialty and is not divided by geographical borders. Commemorating the 25th anniversary celebrations, six "Smile Flags" were to physically travel, one through each of the six different regions of the world, to spread the message of specialty orthodontic care globally. The flags were to finally converge in Yokohama at the 9th IOC. This event was transitioned quite successfully to an internet event (Fig. 18) . The 9th IOC also had to be reformatted and now is going to be the first International Orthodontic Congress to be Web hosted. The WFO is really looking forward to a day where the "world" (not just the orthodontic world) truly "unites when people smile"! 

To cope with any challenge, an organization requires resilience, direction, and commitment. The WFO is not a regulatory body, nor is it in a position to stipulate or even advise on the provision of orthodontic treatment worldwide. However, as an organization that carefully monitors membership, it can justifiably state that quality orthodontic care comes from those who are appropriately trained to the highest level in the country in which they practice. The worldwide changes in the provision of orthodontic treatment, such as third-party diagnosis, remote provision of appliances and treatment planning, and the facility of Do-It-Yourself tooth alignment, has bought about innovation that may not be in patients' best interests. Considering the inherent dangers of such, the WFO will continue at every opportunity to promulgate responsibility, to each other, to our patients, and to the highest professional standards!

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