Three Questions to Ask When Choosing an Orthodontist

I recently broke a tooth. Being a child of the 1960’s, my mouth is full of good old-fashioned silver fillings. Like everyone else in my generation, I didn’t enjoy the benefits of fluoride in the drinking water. In fact, one of the most popular toothpaste commercials of my day showed a young child bouncing into the house after a dental checkup bragging “Mommy! Mommy! I only have one cavity!” Today we’d be upset if our kids had a new cavity at each visit, but back then cavities were the norm.

The minute my tooth broke I knew that I was going to need an implant. When my dentist confirmed my self-diagnosis, I asked to be referred to the oral surgeon who would do the best job. Not surprisingly my dentist gave me three names. Although I’d heard of these doctors, I didn’t know how good each was at placing implants. I immediately asked my dentist to clarify the referral. “If YOU were getting an implant today, who would you want to do it?” The dentist didn’t even hesitate. “Oh, if I were having one MYSELF, I’d go to…” I was then given the name of the doctor that I subsequently called.

Why do dentists give out more than one business card when it comes to referring you and your kids to an orthodontist? Do you really need more than one opinion? How do you choose between them?

Sadly, the practice of referring patients to more than one specialist arose out of a fear of being sued. That’s right. The reason that your dentist gives you more than one card is because he’s been told that if he only gives you one name and something goes wrong, he could be liable along with the specialist. By referring more than one, the logic is that your dentist can escape liability by saying, “Hey, I gave you several names. The choice to go to Dr. X was yours!” (BTW, this is a merely a myth as no dentist has been sued for just giving a referral unless he himself participated in the bad treatment or knowingly referred a patient to an incompetent specialist.)

Is this practice of multiple referrals good for patients? In my experience it is not. It usually just causes confusion. Most patients assume that because their dentist gave them three cards, it really doesn’t matter which one they choose. Unfortunately, only rarely does the second orthodontist offer the same treatment plan as the first. These conflicting treatment plans may then lead the patient to pursue a third opinion further complicating their decision. How could three orthodontists, all licensed by the state, have such different solutions to the same problem?

Orthodontists differ in training, experience, and in personality. Some were trained to expand, others to remove teeth. Some are just out of school and are still overly optimistic about what can be accomplished. Others have been at it too long and are overly pessimistic. Some doctors are perfectionists while others are more lackadaisical (“That’s good enough!”). Some really want what’s best for the patient while others want what is best for their practices. Regardless of why, orthodontists really are different and the results they provide will not be the same. When choosing an orthodontist for your family, consider asking the following three questions:

First, what treatment is the orthodontist proposing? How is he going to fix the crowding? How about the overbite? How come he wants to start now and doctor down the street wants to wait? How can he straighten all the teeth now when some baby teeth remain? How long will the treatment take? Can he show you examples of other patients treated in the same way? In other words, make sure you understand exactly what the doctor is proposing and why his plan is different.

Second, if there is a big difference in fees, why? Are the treatment plans actually the same? Do both fees include the same services (i.e. retainers, x-rays, etc.) We recently had a patient show us a quote that was $1500 less for a first phase. Upon investigation we found that the lower fee merely covered an expander and not braces. Another quote was more than $1000 less but only fixed the top teeth. A “six month” treatment quote was almost $2500 less but would not fix the bite. Again, if there is a difference in the fee, ask why!

Third and most importantly, ask your dentist what I asked mine. If he was having his teeth straightened today, which orthodontist would he choose? Don’t let him get away with giving you three cards! Ask him who treated his children. In that way, you’ll get his best recommendation and save you the trouble of shopping around!


NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.