Orth means “straight” and odont means “tooth.” Orthodontists are dental specialists who diagnose problems with teeth, jaws, and lower facial development and treat malpositioned and misaligned teeth and jaws. According to the U.S. Department of Labor, more than 10,000 orthodontists work in the United States.
Orthodontist Career History
Archeologists have found evidence that metal bands and catgut were used thousands of years ago by people trying different methods to straighten teeth. According to the American Association of Orthodontists (AAO), Hippocrates wrote about the teeth straightening process around 400 b.c. However, it was not until the 1800s that orthodontia began emerging as a separate area in the science of dentistry. In 1880 Norman W. Kingsley published his Treatise on Oral Deformities; for this work he became known as the “Father of Orthodontics” Orthodontia was officially recognized as the first specialty of dentistry with the founding of the AAO in 1900.
In the early days of modern orthodontia, braces were always made of metal, such as gold and later stainless steel, and fitting braces to a patient was a time-consuming process. In the 1960s, it may have taken nearly a whole day for an orthodontist to put braces on a person’s teeth. Technology has brought about major changes in the field. By the late 20th century, orthodontists were using highly effective materials, such as NASA-developed heat-activated nickel-titanium wires that are very lightweight and flexible. Braces now can be white, clear, or colored. In certain cases, orthodontists sometimes even can place “invisible braces,”—those that are attached to the tongue side of the teeth. The process of putting braces on teeth does not take nearly as long now, and patients need fewer follow-up visits for adjusting their braces.
Another change in the field has resulted from the AAO’s recommendation that children first be evaluated by an orthodontist by age seven. At that age, even children who have teeth that appear straight may have the beginnings of a jaw malformation that is not detectable by an untrained eye. A malformation can become a serious problem after a child becomes a teenager. Parents often bring their children to an orthodontist at the suggestion of their child’s general dentist, who may suspect a dental or facial development that should be evaluated and monitored.
In addition to seeing younger patients, orthodontists are now finding that their clientele includes older, grown patients. In 2002, movie star Tom Cruise, for example, became one of the growing number of adults to put on braces. Braces made from high-tech wires, ceramics, and even hard, plastic trays give adults the option of wearing something subtle, versatile, and effective. The field of orthodontia should continue to grow as new technologies develop, as the corrective process becomes less painful, and as people of all ages seek the services of orthodontists.
Orthodontist Job Description
Orthodontists straighten teeth that are crooked or crowded or that have gaps between them. People who benefit from orthodontics include those whose facial profile shows an overbite, an underbite, protruding lips, or even a “weak chin.” People who have dental and facial irregularities often have what is termed “malocclusion,” sometimes called a “bad bite.” A malocclusion can be corrected for cosmetic reasons, but in some cases crooked teeth can create speech problems or can be more susceptible to decay because the teeth are more difficult to keep clean.
When a patient first comes to the office, the orthodontist takes a complete medical and dental history to determine what is influencing health in general and teeth in particular. Next, the mouth is examined to look for oral evidence of disease. The health of teeth is carefully evaluated. The orthodontist notes the size and shape of each tooth and the relationship between the teeth and the gums, the lips, and the face. The patient’s facial profile is assessed for uniformity, symmetry, and proportion. At this time, a “before” photo of a patient’s profile and smile may be taken for the patient’s record. After treatment is completed, photos will be taken again to show the results.
To make a diagnosis, orthodontists measure and evaluate relationships. They create casts from plaster by asking the patient to bite into a tray of impression material. The three-dimensional models made from the casts are mounted on hinges to show the biting motion of the patient’s teeth. It’s difficult for patients to hold their mouths open wide for long periods of time, so these models allow orthodontists to study the dynamics of the bite more easily and to take detailed measurements.
Orthodontists also use X rays to show the status of tissues that can’t be seen by the eye, including problems inside the teeth and with the jaws, facial bones, and tooth roots. X rays can help an orthodontist determine if crowded teeth would benefit from an orthodontic extraction. In other cases, certain jaw discrepancies are detected with radiographs and need correction with orthodontic appliances such as braces or orthognathic (jaw) surgery.
Once a problem is diagnosed, orthodontists may give a patient an oral or a written treatment plan. This plan includes the diagnosis, the recommended treatment specifics, and a cost estimate of treatment.
There are various types of orthodontic treatment, but almost all involve metal, plastic, or ceramic braces that are banded around, or bonded to, teeth. These braces are made up of brackets and wires that move teeth into, or hold them in, proper position. Moving teeth is a very slow process (although it has gotten faster with improved materials) and requires the adjusting of the braces slightly every few weeks to few months.
Additional orthodontic appliances include headgear, a wire appliance that protrudes from the mouth and is fastened by a strap behind the head. Orthodontists use this approach to orthopedically slow the growth of the upper jaw. Rubber bands are another pulling force that, when changed daily by the patient, help move teeth into position. Another type of orthodontic appliance is the retainer. When orthodontists finish active treatment, which usually takes two to three years, the patient comes in much less often for appointments or not at all. To make sure the corrected teeth or jaw don’t move back into a poor position, an orthodontist may make a removable or permanent retainer for a patient to wear at night and sometimes during the day as well. Retainers are removed when the patients eat and brush their teeth.
Most orthodontists are in private practice. Some orthodontists teach full or part time at universities. A number perform research at dental schools or for manufacturers, such as dental product manufacturers. Others are government employees, working in the military or for agencies such as the U.S. Public Health Service.
Dr. Chris Carpenter has been an orthodontist for 10 years. He is a private practitioner in a Denver orthodontic practice that employs a staff manager, a receptionist at the front desk, and four dental assistants. Each morning starts off with a “huddle” so that Carpenter and his staff can review the 40 to 60 patients’ treatments for the day and prepare as much as possible beforehand. He advises his staff of the supplies he will need for the day. The office has five treatment chairs. Patients are seated upon arrival, and Carpenter then examines each patient, he adjusts their wires and changes their bands, and then he dictates final instructions to a dental assistant. The dental assistant completes the final aspects of the treatment and coordinates details for the next appointment.
“I pay bills, manage staff members, and do paperwork,” Carpenter says. “I spend a considerable amount of time writing diagnosis and treatment plan letters with copies of radiographs to send to patients’ general dentists.” Other nonorthodontic responsibilities include working with insurance companies to obtain payment for procedures and overseeing the billing and collection of fees. To ensure the dental office is a safe place for employees and patients alike, Carpenter conducts a regular evaluation of procedures and conditions in the office to be certain everything is in compliance with the federal Occupational Safety and Health Administration standards.
Staff members are in charge of taking inventory and ordering supplies, but orthodontists oversee the process. Bookkeeping and accounting are another part of Carpenter’s duties—not only for billing purposes but also for keeping track of the staff members’ time cards, benefits, and social security and tax deductions and for setting salaries and raises as well.
Orthodontist Career Requirements
You should begin preparing for an orthodontics career with a course load that emphasizes, but is not restricted to, math and science subjects. Courses such as algebra, geometry, trigonometry, and calculus are important to take. Biology, chemistry, physics, and health are also necessary. Additionally, you should take computer science, English, history, and other classes recommended by your school as baseline courses for college preparation.
Getting admitted to dental school requires that you first complete three to four years of undergraduate college education. Because gaining acceptance into a dental school is fiercely competitive, maintaining a strong grade point average while you are in college is necessary. While a bachelor’s degree is not strictly required, it is a credential that significantly increases an applicant’s chances of being admitted to a dental school.
Recommended college courses are similar to those suggested in high school. A typical degree for someone entering this field is a bachelor of science in biology. Required coursework generally involves taking math classes, such as algebra, geometry, trigonometry, and calculus. Science courses include biology, anatomy, physiology, anthropology, zoology, botany, and microbiology.
On the practical side, business classes such as marketing, economics, accounting, management, and finance prepare you for owning and operating a business. Liberal arts courses such as psychology, sociology, and English may also help a future orthodontist become more comfortable in communicating with people.
You must score well on the Dental Admissions Test (DAT) before being admitted into a dental program, which usually takes three to five years to complete. Doing well on the DAT helps dental schools determine whether or not you will succeed in dental school. Dental school courses are made up of advanced science classes, clinical work, and laboratory classes. During the last two years of dental school, clinical treatment is emphasized, and you give supervised treatment to patients at a university dental clinic. Graduates receive a Doctor of Dental Surgery (D.D.S.) or Doctor of Dental Medicine (D.M.D.) degree.
This degree qualifies you to work as a general dentist. To become an orthodontist, however, you will be required to continue in your schooling. Postgraduate programs, which are accredited by the American Dental Association Commission on Dental Accreditation, may last from two to three years. Gaining acceptance to a postgraduate program in orthodontics is also competitive. Therefore, it is critical that you maintain a high grade point average during dental school.
Chris Carpenter was thoroughly trained in dental school, and during his orthodontic postgraduate program he earned a master’s degree in orthodontics. Following dental school, he attended a 30-month residency in orthodontics. Altogether, he went to school for 10 years after high school. To keep abreast of advancements in orthodontics, orthodontists regularly take continuing education courses. Other educational activities include attending workshops and seminars, reading professional journals, and participating in study clubs. This helps a practicing orthodontist acquire the most up-to-date skills and knowledge of the best materials to use.
Certification or Licensing
Board certification is available through the American Board of Orthodontists (ABO). To achieve ABO diplomate status, orthodontists must file an application with the ABO, be interviewed and approved as a candidate, pass written and oral examinations, and provide written orthodontic case histories. It may take eight to 10 years to gain ABO diplomate status.
Before new dentists are allowed to practice, they must first pass a licensing examination in the state in which they are planning to practice. This test may include working on a patient. In some states, orthodontists must also pass a specialty licensing examination. In order to maintain their licenses, orthodontists, like all dentists, must take continuing education courses.
Orthodontists who run their own practices should be self-motivated and have management skills. These qualities will help them run their practices efficiently and attain maximized profitability while providing the highest quality results.
Good organizational skills and efficient work habits are essential for all orthodontists because they see so many patients, each having individual treatment issues, in a single day. In fact, several patients might be seated in orthodontic chairs at the same time, waiting for treatment. The orthodontist must move swiftly yet efficiently from one to the next.
Being an effective communicator while under time pressure is critical. One moment an orthodontist may be discussing the need for good tooth brushing with an eight-year-old patient while an adult patient is waiting for a consultation on a new treatment plan and an insurance company representative is on hold about a claim misunderstanding. Because they see a large number of patients in a day, orthodontists often do not have the luxury of spending a lot of time to make their point or explain treatment options. In addition to being good communicators, orthodontists must be good listeners. They must have good people skills. Patients want to know that their orthodontist hears and cares about their concerns.
Orthodontists like to help people. After the braces come off, most patients will feel more self-assured and confident when they speak or smile, which is one of the reasons orthodontists find satisfaction in their jobs.
Being an orthodontist is physically challenging. Manual dexterity and strength are necessary assets. Fingers, hands, wrists, and arms are in controlled motion within a small space throughout the day. There is little room for error. Keen vision and perception in three dimensions are needed to locate tiny openings and parts of only a few millimeters in size. Excellent eye-hand coordination as well as an artistic eye and the ability to judge symmetry will help when it’s time to apply the braces. To prevent the back injuries that can plague orthodontists as they lean over patients all day, it’s important that orthodontists take the time to stretch during the day and exercise regularly.
Exploring Orthodontist Career
One way to learn more about the field is to talk to an orthodontist to learn about this work. Ask your dentist, check the phonebook, or contact the American Association of Orthodontists to see if there is an orthodontist in your area who would be willing to speak with you. You can then line up an informational interview with this person. Check with nearby dental schools to see if they offer any kind of student programs about dentistry. If they do not have such a program, see if you can take a tour of the school or talk to teachers or students about the dental school. For some hands-on experience, try to get a part-time job (maybe as a receptionist or clerical assistant) at an orthodontist’s office. If that is not possible, look for a part-time job at a general dentist’s office. Working in such a setting will give you an idea of what to expect in the broad field of dentistry.
The U.S. Department of Labor reports that there are more than 10,000 orthodontists in the United States and almost all of them are in private practice, according to the American Dental Association (ADA). Orthodontists may own their own practices or may work as associates or partners with other orthodontists. Some orthodontists work in hospitals and dental clinics.
Other opportunities for orthodontists include teaching at university dental schools, either on a full-time or a part-time basis. Those who teach part time usually maintain a private practice as well. Often part-time instructors are not paid or are paid only a small salary because the prestige of having a university teaching position is considered enough compensation. Also, orthodontists sometimes volunteer to teach a class to build their careers. Some orthodontists work in dental schools where there are research opportunities. Others perform research while testing new materials and procedures and writing about them for industry. Researchers may test new orthodontic materials or techniques by working on anything from model mouths to animals.
Some orthodontists are employed by government agencies, such as the U.S. Public Health Service, the Indian Health Service, or the Department of Veterans Affairs. Orthodontists also work in the military and are stationed across the country or around the world with the air force, the navy, or the army.
Dentists often start out by working as associates for established dentists with their own practices. They may work as associates for several years to gain experience and build up their financial resources. Then many buy a dental business or start their own. Orthodontists may start their careers in a similar manner. A good resource to consult is the scientific journal of the AAO, the American Journal of Orthodontics and Dentofacial Orthopedics, which lists practices to rent or buy as well as job opportunities. The Journal of the American Dental Association also features classified job ads, some of which are for orthodontists.
As is true with other professions, it is important for orthodontists to make and maintain contacts among their colleagues. One way of doing this is by attending AAO or ADA meetings. Through networking at such events, an orthodontist might hear about current job openings or meet someone who is interested in starting a practice with a partner.
Orthodontists in private practice can advance by increasing the size of their practices. One way to do this is to build a reputation with the general dentists in the surrounding community who will refer patients to the orthodontist. Orthodontists who can effectively communicate with a patient’s general dentist and facilitate easy coordination of treatment are more likely to be trusted by the general dentist and therefore get more patient referrals.
Involvement in orthodontic associations and study clubs may lead orthodontists to active participation in organized dental events. Some orthodontists even become officers and committee chairs of their professional associations. Those in research and teaching often advance by publishing papers on techniques and developments in the field.
Orthodontists’ earnings are influenced by factors such as the size of the practice, the amount of experience the orthodontist has, and the size of the population in which he or she works. Despite such variables, though, orthodontists can generally expect to have high earnings. The AAO says that orthodontists under age 30 often have a starting salary that’s double the income of other college graduates.
According to the American Dental Association Survey Center, the mean average net salary of orthodontists who are younger than 40 is about $140,000. That’s the lower end of the salary range. The average annual income for orthodontists in private practice is $153,000. On the upper end of the range, orthodontists who work more than 32 hours a week work an average of 38.9 hours and make $163,000. The average net income for orthodontists older than 40 is $157,000. According to research by Salary.com, a typical orthodontist earned a median base salary of approximately $112,756 in 2006. Half of the people in this job earned between approximately $92,634 and $136,719. The U.S. Department of Labor reports that the median annual earnings for orthodontists were $145,600 in 2005 with the lowest paid 10 percent earning $73,300 or less and the highest paid 10 percent earning $165,870 or more annually.
The location of an orthodontist’s private practice can also play a role in determining income. Orthodontists practicing in Washington, Virginia, Arkansas, Alabama, and Florida typically have higher incomes than those in other states.
Orthodontists in affluent and growing suburbs may have greater income potential than those in all but economically thriving parts of urban or rural areas. Specialists’ incomes are also affected by how many other specialists in their area of expertise are working in the community. In an area with few or no other orthodontists, an orthodontic practice may have an edge and find it easier to obtain referrals.
Orthodontists who have their own practice will have to make arrangements for their own health insurance, retirement plan, vacation, time off, and sick leave. They will have to do the same for any staff members as well.
The patient’s area in an orthodontist’s office, like a dentist’s office, is a sterile environment containing such things as orthodontic chairs, supply cabinets, and assorted orthodontic instruments. Orthodontists also usually have a separate office where they do their paperwork and take care of other office matters. Orthodontists often work regular business hours four or five days a week. To accommodate working patients or parents, they may have night or weekend hours too. On their days off they may still go to the office to take care of the miscellaneous things involved in running a small business.
Orthodontists involved in research typically work regular business hours. They have access to labs, which are clean environments, and a variety of medical equipment. Those who teach at universities may have their own offices. When they are supervising students who are working on patients, they are in settings similar to dental offices with orthodontic chairs, supplies, and medical instruments. While university dental schools may be much larger than a private office, a sterile environment is also maintained there.
Orthodontist Career Outlook
The U.S. Department of Labor predicts employment for all dentists, including specialists like orthodontists, will grow about as fast as the average through 2014. Since our society values physical attractiveness, the motivation to receive orthodontic treatment can be cosmetic in nature, and demand for these services should continue to be strong. But because orthodontics is largely an optional procedure, poor economic conditions can reduce the number of people who can afford to get braces. Patients or their families without solid income are not likely to pursue or follow through with orthodontic treatment. However, to make the service more accessible, many offices provide financing, accept credit cards, or refer the patient to financing sources where instant over-the-phone approval may be obtainable.