The history of orthodontics and oral maxillofacial surgery was not just about improving functional ability of jaw but also has a dark past of genetic selection. It was largely influenced by Eugenics, post-world war era, and Darwinian theories.

Introduction

The development of orthodontia has a troubling past of racial ideologies. Craniofacial features, including jaw shape and dental alignment, were often framed as markers of racial superiority or inferiority.

Similarly, craniofacial surgery has also come a long way, evolving from ancient practices such as trephination (a procedure where holes were drilled into the skull, originally believed to release spirits) and head binding to achieve a particular shape. ³

Now the principles are guided by proper imaging, consulting factors like function, as well as aesthetics.

Eugenics and The Dark History of Facial Surgery

Eugenics is the selection of desired heritable characteristics in order to improve future generations, typically in reference to humans.¹

Those in support were influenced by the idea of Darwin's theory of survival of the fittest and Mendel's theory of hereditary abilities of physical characters. They aimed to promote the spread of what they considered desirable features through selective reproduction, while discouraging or preventing procreation among those with “undesirable” qualities. The idea was to increase procreation among individuals and communities with highly desirable qualities and reduce or sterilize people with disabilities, diseases, or low economic status. Historical records show that some U.S. states passed sterilization laws, and procedures were sometimes carried out on individuals with cleft lip and palate. ²

Thus, when eugenics shaped the medical and social circles in the early 1900s, Mendel's theory of inherited physical features also became popular. The jaw shape, size of the chin, and shape of the head were all thought to be features that could be altered for better appearance.

Malocclusions were seen as an inferior quality. Supporters of jaw correction argued that they were improving the population, and it was established as positive eugenics. These medical issues were portrayed as mutations rather than simple health conditions.

A form of social Darwinism entered medical practice, where treatments were prescribed not primarily for functional outcomes but to eliminate undesirable traits.

At the same time, with the discovery of anesthetics, world war victims were also undergoing surgeries in a large pace. Surgeons treated disfigured soldiers and field of facial surgery also proliferated. However, outside wartime medicine, these techniques were sometimes applied in ways shaped by eugenic thinking. Correcting jawlines, noses, or cranial features was promoted not only for health but to conform individuals to prevailing ideals of beauty and racial “normalcy.” Ethnic and racial influence of these practices were visible.

Along with these practices, the early 1900s also saw offices being set up to establish eugenics programs.

Shifting Paradigms: Ethics and Biomedicine

The horrors of eugenics started gaining global reckoning when its principles were horrifically used for ethnic cleansing. The adoption of eugenics by Nazi Germany led many scientists to distance themselves from the idea and publicly denounce it.

Medical ethics was reinvented and policies framed after the decline of eugenics. Orthodontics and craniofacial surgery increasingly emphasized patient-centered care like treating malocclusion, cleft lip and palate, and other craniofacial anomalies to improve health and function rather than conforming to racialized ideals.

Instead of serving social engineering, craniofacial medicine turned toward restoring function (chewing, breathing, speech) and improving quality of life.

Biotechnology and the New Era of Craniofacial Reconstruction

Today, craniofacial surgery and orthodontics are at the forefront of biomedical innovation:

• 3D Printing and Digital Imaging: Surgeons can create personalized implants and surgical guides with unmatched precision. This marks a new phase in “3D printing in jaw reconstruction.”

• Tissue Engineering and Stem Cells: Research into regenerating bone and cartilage is opening possibilities for reconstructing jaws without synthetic materials.

• Genomic Insights: Advances in genetics help identify congenital syndromes that affect craniofacial development, allowing earlier interventions. These discoveries also connect to broader “eugenics in medicine” debates, now reframed through an ethical lens.

• Minimally Invasive Orthodontics: New appliances and digital planning tools reduce treatment time and discomfort.

These tools are applied with an ethical framework that emphasizes inclusivity, cultural sensitivity, and the patient’s own goals

Lessons for the Present

The history of orthodontics and craniofacial surgery reveals how medicine can be misdirected when social prejudice drives clinical decision-making. While early practitioners justified interventions with racial theories, modern medicine insists on respecting diversity in human appearance and focusing on patient-centered outcomes.

Conclusion

The journey from the eugenics-influenced orthodontics of the early 20th century to today’s technologically advanced craniofacial reconstruction reflects both scientific progress and ethical growth. Modern practitioners not only repair jaws and faces but also uphold principles of respect, equity, and patient autonomy. This history of orthodontics and craniofacial surgery should serve as a reminder that medical innovation must always be guided by science, compassion, and ethics, not by prejudice or pseudoscience.

References

1. “Eugenics | Definition, History, & Facts.” 2025. Britannica. Accessed September 2025. https://www.britannica.com/science/eugenics-genetics.

2. Suwa, B., et al. 2024. “History of Eugenics in Otorhinolaryngology: Ernst Rüdin and the International Eugenics Network.” International Archives of Otorhinolaryngology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11008944/.

3. “Abstract Journal Craniomaxillofacial Surgery – ANZ Journal of Surgery.” 2024. ANZ Journal of Surgery. https://onlinelibrary.wiley.com/doi/full/10.1111/ans.18956.

4. Cerrati, Eric W., J. Regan Thomas, et al. 2017. “The Multicultural Evolution of Beauty in Facial Surgery.” Brazilian Journal of Otorhinolaryngology 83 (4): 373–74. https://www.scielo.br/j/bjorl/a/kcGpvdbg9gdbs8m9FH5MHmc/?lang=en

5. Helfand, Jessica. 2020 (or the year the article was published). “Darwin, Expression and the Lasting Legacy of Eugenics.” Scientific American. https://www.scientificamerican.com/article/darwin-expression-and-the-lasting-legacy-of-eugenics/.

6. Darwin, Expression and the Lasting Legacy of Eugenics | Scientific American. https://www.scientificamerican.com/article/darwin-expression-and-the-lasting-legacy-of-eugenics/

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