Orthodontists are dental specialists or dentists who have acquired specialization in orthodontic treatment or orthodontics. Orthodontics comes from the Greek words orthos, meaning straight, and dontos, meaning teeth. Responsibilities in this particular specialization include the prevention, diagnosis, and treatment of dental and facial irregularities, particularly to straighten crooked teeth, correct jaw alignment, and fix bad bites.
Orthodontics is a specialty within the profession and study of dentistry. So what is the difference between dentists and orthodontists?
While both a general dentist and an orthodontist handle cases and provide treatments for patients of all ages, they vary in the scope of their responsibility. A general dentist is a skilled general practitioner who oversees a person’s overall dental health. The general dentist has the ability and training to diagnose and treat common oral diseases and problems concerning the teeth, the mouth, and the gums. On the other hand, an orthodontist is primarily concerned about dental alignment towards proper facial development.
In most cases, people will begin under the care of a general dentist and then depending on their situation and need or the recommendation of their general dentist, people will add on the care of an orthodontist. This can happen as early as the age of 7. Orthodontic treatment is done in conjunction with general dental care, and not in replacement of. While an orthodontist provides treatment like braces and aligners, a dentist will take care of person’s overall oral health. This typically involves regular check-ups and cleaning sessions. But in some cases, people will seek treatment from an orthodontist who can also perform their dental health care.
Education & Training
Remember that an orthodontist is a specialized dentist. As such, before a person becomes an orthodontist, he must first complete education and training as a dentist.
Complete undergraduate study. Most dental programs require students to have a bachelor’s degree while some also accept students who have undergone at least two years of undergraduate education. During a student’s stay as an undergraduate, he is expected to complete the prerequisites to a dental program. These courses include biology, chemistry, physics and other science courses. Most aspirants choose to major in a science program, but they can choose to major in any degree as long as the prerequisites are completed.
Get admitted to a dental school. Once the prerequisites have been met, a student applies to dental school and takes the Dental Admission Test (DAT). This is administered by the American Dental Association (ADA) and passing this exam is necessary to secure a slot in dental school.
Fulfill the requirements of dental school. Aspiring dentists choose between two paths. One is towards a Doctor of Dental Surgery and the other is towards a Doctor of Dental Medicine. Both programs take up an average of four years with the first two years focusing on more science courses. The student may expect education in biochemistry, physiology, microbiology and anatomy. The latter two years of either program will be largely spent on acquiring clinical experience. This is done under the guidance and tutelage of licensed dentists. This is the time where the aspirant gets a taste of the different specialties in dentistry. These include pediatric dentistry, orthodontics, periodontics, prosthodontics and maxillofacial surgery.
At this point, the aspiring orthodontist is already a dentist. To become an orthodontist, further education and training is necessary.
Gain further education into the specialty. After gaining a Doctor of Dental Surgery or a Doctor of Dental Medicine, aspiring orthodontists apply to the specialty program. Most programs in the specialty of orthodontics require three years of training which will involve study in orthodontics or tooth movement, surgical orthodontics and dentofacial orthopedics, which is the guidance of facial development. Aside from these important studies, the training may also include training in research methodology and teaching, the completion of a research project, preparation of case reports and attendance in various conferences. Upon completion of the program, the student is then qualified as a dental specialist in orthodontics.
Earn a board certification. In order to acquire board certification, the first step is to take and pass the written examination. This is available through the voluntary certification offered by the American Board of Orthodontics after 18 months of the postgraduate program in orthodontics. Passing the written exam earns the applicant the qualification to take the clinical exam. Afterwards, periodic examinations may be necessary to recertify.
Getting a license. A license is necessary in order to practice as a professional and in the United States of America, the license permits a professional to practice both general dentistry and orthodontics.
Roles & Responsibilities
The most commonly known role of an orthodontist is to apply braces and straighten teeth. But this is not all that orthodontists do. Listed below are the various responsibilities of these dental specialists.
Closing wide gaps between the teeth
Aligning the tips of the teeth
Straightening crooked teeth
Treatment of an improper bite
Improving oral functions like speech and eating
Improving the long-term health of the teeth and the gums
Preventing long-term and excessive wear or trauma of the teeth
Diagnosis of Conditions
Orthodontic treatments are typically not carried out until a child reaches the age of 12. This is the time when adult teeth have emerged and fully developed.
In the diagnosis of a patient’s condition, the orthodontist performs a meticulous assessment of the child’s teeth and predict how they would develop without treatment. Certain diagnostic procedures are also done. These may include an assessment of the patient’s full medical and dental health history, a clinical examination, x-rays of the jaw and the teeth, as well as creating plaster models of the teeth.
According to the results of the assessment, the orthodontist will create a suitable treatment plan for the patient.
Conditions Handled
Malocclusion refers to bad bite, when the jaws and the teeth do not develop properly in childhood. This may occur due to frequent thumb-sucking, injury to the facial bones and teeth or other unknown reasons.
This condition may change appearance of a person’s teeth and the shape of the face. It is not a disease and it will not affect a person’s health but it may affect a person’s mental or emotional health, which is arguably just as important. It may cause embarrassment, decreased self-confidence and in severe cases, even depression. At its most severe, malocclusion may affect the way a person eats and speaks, as well as require special attention to oral hygiene.
Malocclusion manifests in several ways.
Protruding front teeth exposes a person to greater risk of damaging their teeth, particularly during sports activities or in falling down.
Crowding happens when a person’s jaw is narrow, providing less space to accommodate all of the person’s teeth.
Spacing is the term used for when there are gaps between a person’s teeth. This is the reverse of crowding when the teeth do not fill-up the mouth. This can also happen if a tooth is missing.
Impacted tooth is a condition where an adult tooth does not emerge or only partially emerges from the gum.
Open bite happens when a person clenches his teeth such that the jaws are closed but there is a gap or opening between his upper and lower front teeth.
Deep bite or overbite is a condition where there is a significant protrusion of the upper teeth over the lower teeth when they are clenched.
Underbite is, just as the name suggests, the reverse of an overbite. It is characterized by a significant depression of the upper teeth compared to the the lower teeth when they are clenched. This resembled the appearance of a bulldog’s teeth.
Asymmetrical teeth is characterized by a mismatch or misalignment between the upper and the lower teeth. This is better observed when the mouth is closed but the teeth are showing.
Cleft Lip and Cleft Palate are two other conditions handled by orthodontists, typically in partnership with other professionals like speech therapists, plastic surgeons and oral surgeons. Craniofacial orthodontics deals with the non-surgical treatment of the cleft lip and the cleft palate.
These conditions are birth defects that develop while a fetus is in the uterus. This occurs when there is not enough tissue in the mouth or around the lip such that the areas do not develop joined together as they should.
When a child has a cleft lip, his lip is split into two parts, causing a gap to appear. It can extend up to or even beyond the base of the child’s nose. This can also mean that there is less bone and gum tissue in the mouth.
On the other hand, the palate is the area behind the upper front teeth. A cleft palate can occur in the bony area or in the softer area towards the back of the palate.
A craniofacial orthodontist provides early dental intervention and equip parents with the knowledge in proper oral care. They may choose to use a soft bristled brush or if this is not possible, a toothette. This is a stick attached with a sponge swab at the tip, quite similar to cotton swabs or buds. Consultation with a craniofacial orthodontist should be in place well before the child’s first teeth begin to emerge.
Throughout the patient’s life, the orthodontist may recommend dental appliances to assist in normalizing his speech or make up for missing teeth. It is also possible that treatment to align teeth may be necessary.
Treatment
In today’s world, getting braces is a common thing. Braces may look alike and an orthodontist’s job may seem monotonous, but it is not easy. First and foremost, they are tasked to craft a treatment plan and cost estimate for their patients. They should be able to effectively address the patient’s concern, and at the same time, consider the budget of the patient.
Proper diagnosis is also crucial at this stage and at times, orthodontists do not only apply dental appliances, they have to design, fabricate or modify dental appliances to fit the specific needs of their patients.
Even after application, they have to continually adjust the appliances in order to produce the desired effect and maintain its normal function. Aside from this, when necessary, they also coordinate their treatment with other dental and medical services in order to complement and align the treatment with others that the patient has to go through.
Appliances Used
In orthodontic treatments, specialists employ various dental appliances to prevent and correct various conditions.
There are fixed orthodontic appliances, namely:
Braces are the most popular and primary appliance used by orthodontists. These are used to treat overbites, underbites, overcrowding, spacing, and other issues. Braces consist of brackets, wires and bands which are regularly tightened at specific time intervals, throughout the duration of the treatment. The bands come in many different colors that make the treatment fun for kids, but there are also more low-key options for adults like ceramics and clear bands.
Fixed space maintainers are used when baby teeth are lost earlier than usual. These help prevent other teeth from growing into the space meant for the missing tooth. Space maintainers comprise of a band attached to one tooth and a wire extended the tooth on the other side of the gap. This stretches and keeps the gap open.
Special fixed appliances are sometimes recommended to control or curb thumb-sucking or tongue thrusting habits. However, these may be uncomfortable so experts usually only recommend them when they are absolutely necessary.
There are also removable orthodontic appliances, such as:
Aligners are similar to braces in that they align and straighten teeth. These are typically clear plastic trays that fit around the teeth thereby molding them into the prescribed alignment. Because it is a clear plastic tray, this is practically invisible to others. These are used in the treatment of underbites, overbites, open bites and crowding. These can be removed when a person eats, flosses or brushes their teeth.
Retainers are designed to stop the teeth from returning to their original positions and are placed on the roof of the mouth. With some modification, they may also be used to help kids cut the habit of thumb-sucking.
Headgears aim to slow down the growth of the upper jaw and retain the position of the back teeth while the front ones are pulled back. It comprises a strap at the back of the bad and then attached to a face bow, a metal wire in the front.
Palatal expanders are appliances designed to widen the arch of the upper jaw. This device involves a plastic plate placed in the palate. The screws on the plate exert pressure on the joints, moving them outward. This pressure expands the size of the palatal area or the roof of the mouth area.
Splints are jaw repositioning appliances. They are used to move and adjust either the upper or the lower jaw. This changes the alignment and aids the jaw to close more naturally. This is often used for people suffering with temporomandibular joint disorder.
Removable space maintainers are alternatives to fixed space maintainers and functions the same way.
Lip and cheek bumpers are especially made appliances that relieve pressure exerted by the cheeks or the lip on the teeth. This helps eliminate or reduce the pain and discomfort caused by that pressure.
In some cases, treatment also involves tooth extraction. This is done to correct the position and the appearance of a nearby tooth.
An orthodontist’s treatment plan must produce gratifying results, giving the patient a picture-perfect smile. But it is not purely cosmetic, having properly aligned teeth and jaws also means that a patient is able to speak, bite, and chew easily. This improves the patient’s quality of life, physically and emotionally.
History
There is evidence of crude orthodontics observed from as early as 50,000 years ago. Norman Wahl wrote in the American Journal of Orthodontics and Dentofacial Orthopedics that something very similar to braces were found in Egyptian mummies. There were crude metal bands around their teeth and catgut is believed to have been tied to these metal bands to exert pressure and reposition the teeth.
Other than the Egyptians, Hippocrates is attributed with the earliest description of tooth irregularities. This was around 400 B.C. And it was not until 400 years later that Roman writer Celsus recommended applying extra-oral pressure to straighten crooked or irregular teeth. This was done by regularly pushing the tooth to the proper position or alignment, using the finger. He also made the recommendation that milk teeth should be removed once the permanent teeth have erupted. Galen was among the first to suggest other treatment measures possible and he described the procedure for filing the teeth down to resolve lack of space.
Around 1619, Fabricius described tooth extraction as a remedy for overcrowding and in 1728, Pierre Fauchard, who was a surgeon and a dentist, published Le Chirurgien Dentiste where he described a medical appliance made of ivory. It was a labial arch for use in orthodontics.
Phillip Pfaff, during his career, between 1722-1766, was the first to describe impressions taken by using sealing wax. He served as a dentist, a surgeon, as well as the court physician of Frederick the Great.
John Hunter used an inclined plane made of silver to treat prognathia. He used this in the anterior tooth-bearing region of the jaws then a cloth was bound around the heard to increase the pressure being exerted. In 1750, he also used a metal arch with ligatures for the treatment of dental irregularities.
In the early 19th centure, Joseph Fox wrote Natural History of the Teeth. His study was dedicated to the etiology of malpositioning and dental irregularities. He classified these anomalies into types and also described various treatment devices.
In 1815, Chirstophe Francoise Delabarre described ligaments with attachments and in 1840, Chirstopher Starr Brewster described a regulatory plate made of an unvulcanized natural rubber, caoutchouc.
“Orthodontia”, as a term, was first used by Joachim Lefoulon and this was found in his book Nouveau traite de l’art du dentiste. He also used an elastic gold archwire on the palatal side in order to treat crowding. It straightened teeth but it also provided a shaping effect on the alveolar process. This was the first step taken towards “orthodontics”.
M. Alexis Schangé wrote Précis sur le Redressment des Dents around the same time and described a band clamp that was adaptable. It was fixed to a tooth with a screw. It was from him that the idea of retention first appeared as a follow-up to treatment.
In 1846, Elisha Gustavus Tucker and Claude Lachaise were credited as the first users of rubber straps and their elasticity for orthodontic treatment.
Edward Angle (June 1, 1855 - August 11, 1930) is widely regarded as the Father of American Orthodontics. He introduced photography in the field of orthodontics. He also introduced expansion devices and classified dental anomalies into the three Angle classes. They were neutral, distal and mesial.
He also propagated the strict prohibition of extraction in orthopedic treatment. This was maintained up to his death and was loosened due to cases of recurrent disease.
Norman William Kingsley introduced some sort of a headgear in 1866. This extraoral traction device was used for the treatment of malocclusion by moving the upper front while giving support through the headcap.
W. E. Magill applied strips of gold, platinum, silver or nickel silver, cemented, on the teeth in 1885. In 1887, Victor Hugo Jackson developed soldered wire appliances that were removable.
Angle described the use of rigid expansion arches, in 1906. These arches had a strength of 1.4 mm then 1913, he used guidance brackets to improve the arches in his ribbon arch system. In 1916, the first feasible cephalometric procedure was introduced by J. A. W. van Loon. He made face masks in order to compare the jaw models to the face. Around 1919-21, Paul Wilhelm Simon reproduced jaw and facial relations by using the gnathostat procedure.
The edgewise mechanism of a square outer wire in a horizontal bracket slot was introduced by Angle. Modern treatment systems are still based on the mechanical principles of this technique.
In the middle of the 1920s, Viggo Andresen and Karl Haupl established their Norwegian system of orthodontics. They laid the foundation for the treatment of bite anomalies and malpositioned teeth, revolutionizing the discipline.
In 1928, Ketcham made an observation of root absorption when rigid wires were used in overloaded teeth. B. Kjellgren in 1929 promoted the serial extraction of teeth.
Removal plate devices were recommended by Charles Frederick Leopold Nord in 1930. He also developed the active plate. In 1931, teleradiography procedures were independently developed by Birdsall Holly Broadbent in the USA and by Herbert Hofrath in Germany. Arthur Martic Schwarz also determined that the capillary blood pressure must not be exceeded by orthodontic forces.
In 1936, Oppenheim developed and reintroduced in the US a system of extra-oral traction devices. In 1937, Joseph E. Johnson developed the twin wire arch. In 1952, the light wire technique was developed by E. Storey and R. Smith, and then universally expanded by P. Raymond Begg in 1956 using multiband appliances.
Orthodontists had initially anchored brackets to teeth by winding wires around each tooth but after the 1970s, the invention of dental adhesives allowed orthodontists to attach the brackets to teeth surfaces instead. Alongside this change, gold and silver wires were replaced by stainless steel. The preference stemmed from its manipulability, which also resulted in a significant reduction of costs in orthodontic treatment.
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