What is the Difference Between an Orthodontist and a Dentist that Does Orthodontics?

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 3^rd or 4^th  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?