It
is getting more difficult to tell the difference between an orthodontist and a
dentist who does orthodontics. It is common to have a patient tell me that
their former “orthodontist” was the same doctor who made their crowns or
cleaned their teeth. Because their dentist also offered to straighten their
teeth, they just assumed he or she was an orthodontist too. So what is an
orthodontist? What makes him or her different than a dentist who does
orthodontics? Does it really matter?
An
orthodontist is a licensed dentist who, after graduating from dental school,
returned to a university or medical center accredited
by the American Dental Association for two to three years of comprehensive
training in the correction of every type of malocclusion (bad smiles and
bites). Getting into an orthodontic
specialty program is very competitive. Students who are accepted into
post-graduate residencies have usually graduated at the top 1-2 percent of
their dental school class. Orthodontic residents devote at least 12-14 hours a
day, 5-6 days a week, for 2 to 3 years learning to diagnose and treat
everything from a little space that can be fixed with a simple retainer to the
most difficult under-bite that requires 3 to 4 years of treatment in addition to
jaw surgery. That amounts to 5,000 to 6,000 additional hours of intense,
supervised training after dental school.
In
my residency at the University of Pacific, I was required to start and finish
50 patients with problems of every kind so that I could get hands-on experience
in a controlled clinical setting. Because my residency was in a large dental
school, I was exposed to difficult problems of every kind. Orthodontic
residents are mentored by professors and adjunct faculty members who are
themselves specialists and have years of experience. In addition to 6 hours of
hands-on clinical instruction every day, I also received post-graduate level
courses in genetics, statistics, growth and development, orthodontic theory,
biomechanics, research techniques, surgical orthodontics, and cleft palate just
to name a few. Finally, I was required to perform an original research project
that would help advance the field of orthodontics.
Since
I also graduated from an ADA accredited dental school before my two-year
orthodontic residency, I know exactly how much orthodontic training general
dentists receive. At most dental schools, graduating dentists receive little to
no orthodontic training. Dental school
was the most challenging four years of my life. The clinical instruction I
received in school made me proficient in the important procedures most commonly
performed by a general dentist like cleaning teeth, filling teeth, making
crowns, bridges, and dentures, and performing simple root canals and
extractions.
In
the 3rd or 4th year of school, dental students do rotations
through the various dental specialty departments so that they are exposed to
more difficult issues they may encounter after graduation. These rotations may
or may not allow students to actually perform the procedures they mainly
observe. My rotations included periodontics (gum and bone surgeries),
endodontics (root canal therapy), pedodontics (children’s dentistry),
prosthodontics (replacing missing teeth), oral surgery (removing teeth and jaw
surgery), and orthodontics. In addition to shadowing these specialists for a
few weeks, we generally had a semester-long class that gave us an overview of
each specialty. As a dental student I made one retainer for a patient and that
was the extent of my hands-on orthodontic training. I can tell you that I was
in no way qualified to diagnose, treatment plan, or provide braces for anyone
with the minimal orthodontic training I received even though I graduated at the
top of my class out of 160 students.
When
a dental student passes his or her boards, he or she becomes legally licensed
to provide all dental procedures regardless of his or her training or
experience. As a new dentist, I felt comfortable diagnosing and treating common
dental problems. I could clean teeth, fill cavities, make crowns, bridges, and
dentures, do simple root canals, and perform simple extractions. After
graduation, there are continuing education courses available that allow
dentists to further their education and expand the range of services they offer
in their practices. Some of these are offered at universities, but most are
for-profit courses offered by vendors on the weekends in hotels or conference
centers. Unlike competitive university specialty programs, the only requirement
for these courses is payment of the enrollment fees. Whereas university based
specialty programs give residents two to three years of invaluable hands-on
clinical experience and rigorous course work. You read and study all of the
studies that have been done to make sure you understand the fundamentals of
orthodontics. The weekend courses that dentists take may not even allow the
doctor to perform a single procedure on a real patient before offering it in
his own practice. There is very little course work to study to really
understand what you are doing. It’s almost like learning from a cookbook. Additionally,
weekend courses have no way of overseeing the progression of treatment or
helping out the inexperienced doctor should something go wrong since the
seminar instructor is long gone.
While
a few for-profit orthodontic continuing education courses may take place on
multiple weekends during a one or two year span, in my mind it would be
difficult for them to duplicate the experience that an orthodontic resident
receives in 4,000 to 6,000 hours of full-time residency. To gain that much
experience from a weekend course, the dentist would have to spend every single
weekend in an orthodontic course for 7-8 years. That’s every single weekend! Most weekend orthodontic training courses
offer a two-day schedule that spends more time on marketing and promotion than
it does on diagnosis and treatment planning. Is it plausible that a general
dentist can produce the same results as a specialist after a single two-day
course? Furthermore, does is make sense that they can do it in a shorter
time and for less money? If it sounds too good to be true, it probably is.
Even
though your primary care physician can legally perform surgery on your heart,
your brain, give you a nose job, and
treat you for psychiatric problems, wouldn’t you seek the skills of a
specialist if you needed these services? Your smile and bite are just as
important. Before you let anyone straighten your teeth, ask them specifically
if they are a specialist (an orthodontist) and how many years of additional
training they had to become licensed as a specialist. You only have one smile
and one set of teeth. Shouldn’t you put it into the hands of a qualified
orthodontist?
