What is the Difference between an Orthodontist and a Dentist That Does Orthodontics?

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It is getting harder to tell the difference between an orthodontist and a dentist who does orthodontics. It is not uncommon 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. What is an orthodontist? What makes him different than a dentist who does orthodontics? Does it really matter?

Orthodontists return to school for 24 to 36 months of full-time training
An orthodontist is a licensed dentist who, after graduating from dental school, returns 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 of their dental school class. Orthodontic residents devote at least 8 hours a day, 5 days a week, for 24 to 36 months learning to diagnose and treat everything from a little space that can be fixed with a simple retainer to the most difficult underbite that requires 3 to 4 years of treatment in addition to jaw surgery. That amounts to 4,000 to 6,000 additional hours of intense, supervised training after dental school.

Orthodontists recieve training asd skills required for challenging cases
In my residency at the University of Iowa, 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 medical center, 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.

General dentists receive little orthodontic training in dental school
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. Dental school was the most challenging four years of my life. The classes that I had to take to become licensed included courses in the biomedical sciences of anatomy, physiology, histology, biochemistry, microbiology, and pharmacology. I then had dentistry courses that taught me diagnosis, treatment planning, infection control, and dental anesthesia. The clinical instruction I received in school made me proficient in the “bread and butter” 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.

General dentists are typically required to treat one simple case to graduate
In the final 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 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, and I graduated at the top of my class.

Despite their limited training in orthodontics, general dentists are licensed to perform all dental procedures
When a dental student passes his boards, he becomes legally licensed to provide all dental procedures regardless of his 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.

Most general dentists learn orthodontics in a weekend course
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, weekend courses may not even allow the doctor to perform a single procedure on a real patient before offering it in his own practice. 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.

Even longer CE courses do not give general dentists the experience of a 2 to 3-year dedicated residency
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. 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.

Orthodontists are the best trained and most qualified to provide orthodontic care
Even though your primary care physician can legally perform surgery on your heart, give you a nose job, or 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. Shouldn’t you put it into the hands of a qualified orthodontist?

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.