So you want to be an orthodontist. You love teeth and want a specialty where you can have a great lifestyle, avoid back pain, and delegate most of your tasks to your assistants. Let’s debunk the public perception myths and give it to you straight. This is the reality of orthodontics.
What is Orthodontics?
Orthodontics is the specialty of dentistry that deals with the diagnosis, prevention, and correction of malpositioned teeth and jaws. Although orthodontists are best known for straightening teeth, a more accurate description of what they do is ensure their patients have a healthy “occlusion,” which includes proper alignment of teeth, jaws, and the bite. This means that the teeth are not only straight in the upper and lower jaws but also fit well when the jaws close together.
Improper alignment can lead to a variety of problems including asymmetric growth of the jaws, irregular wear, impaction, and early loss of teeth. In addition, issues such as crowding may inhibit your ability to adequately clean your teeth and gums which can lead to other issues down the road such as tooth decay, inflammation of the gums, and loss of bone around the tooth.
Other problems include difficulty with speech, chewing, and swallowing in addition to aesthetic concerns if the jaws and bite are not fitting together properly. Therefore orthodontists are critical in developing proper form and function in the oral cavity, which can ultimately help patients maintain their teeth for longer.
Every patient is different, so it’s the orthodontist’s job to use a combination of in-person exams and x-ray imaging to develop a personalized treatment plan. Although most patients immediately think of braces when they hear orthodontics, these are not the only tools in the orthodontist’s arsenal.
There are a variety of appliances such as aligners, palatal expanders, micro-implants, headgear, and facemasks, also known as reverse pull headgear, that an orthodontist may use to improve a patient’s bite. The tools used will depend on the patient’s complexity and individual needs.
An important method of differentiating an orthodontist’s practice is private practice vs academic vs community clinics.
Private Practice vs Academic vs Community
Most orthodontists work in private practice. Some own their practice and take care of the administrative work that comes along with owning a business. Others work as an associate at private practices or work at a dental service organization or DSO, and only deal with the clinical aspects of orthodontics. Associate orthodontists have fewer administrative responsibilities while owner orthodontists juggle both the clinical and business aspects of the practice.
Although owning a practice does come with larger financial profits and no limits on income potential, there are more stresses associated with owning a business. On the other hand, associateships are much less stressful but come with income limits.
Other orthodontists choose to stay in academics or go into academics after a career in private practice. These orthodontists are often more interested in research and teaching than in the business aspect of dentistry.
While some academic orthodontists will largely forgo practicing clinical orthodontics in favor of research or administrative responsibilities, some will oversee complex cases that private practice orthodontists refer to academic institutions for multidisciplinary care. For instance, many craniofacial cases and some orthodontic cases requiring jaw surgery are referred to academic institutions as they require multiple dental and medical specialties.
Lastly, there are community clinics which are largely volunteer-based. Orthodontists that work in these clinics tend to have a passion for orthodontics and are either financially stable or work in private practice on the side. Community clinics often offer limited compensation and have fewer resources and staff, resulting in more strenuous work for the orthodontist. Although these practices are not common, they usually serve patients who need orthodontics as a medical necessity, such as those with craniofacial abnormalities, who cannot afford to seek treatment in private practice or academic settings.
In terms of compensation, private practice orthodontists will typically make the most, followed by academic orthodontists, and lastly community clinic orthodontists. That being said, there is a high degree of variability in compensation, especially within private practice.
Misconceptions About Orthodontics
Let’s clear up some misconceptions about orthodontics.
To start, many people believe that orthodontists only treat children. In reality, orthodontists see a wide spectrum of patients starting from around age 7 to age 70 and beyond in some instances.
Another common misconception is that anyone who offers braces or aligners is an orthodontist. This is not true. Although some general dentists and online companies offer orthodontic services, they are not the same as an orthodontist. To ensure proper treatment and avoid permanent damage to your teeth, the surrounding gums and bone, your smile, and even your facial appearance, it is best to seek treatment from an orthodontist who has completed an accredited residency program.
Many people also think that orthodontics is an easy specialty. To a layperson, it may seem that orthodontists just put on braces and straighten people’s teeth. In reality, orthodontics is much more complex than that. Orthodontists have to consider the patient’s bite and where the teeth are most stable within the bone, which varies from patient to patient. There is also a great deal of physics and biomechanics involved in orthodontics that may not be apparent to those outside of the field.
How to Become an Orthodontist
To become an orthodontist, you must first become a dentist, which requires completing college and four years of dental school. If you know you want to be a dentist or orthodontist from high school, there are combined dental programs that reduce the number of years required for college and dental school as well.
After dental school, you need two or three years of orthodontics residency to become an orthodontist. There are two types of orthodontics residency programs: academic and hospital-based.
Academic orthodontics residency programs are often affiliated with a dental school and include both a didactic component and a clinical component as part of their curriculum. This means that residents will split their time between the classroom and the clinic. These programs can either be two years or three years in duration.
One of the benefits of completing a three-year program is that they generally include a Master’s degree upon completion whereas many two-year programs do not. Additionally, a full orthodontic treatment generally takes 2-3 years to complete, so residents in three-year programs will have the opportunity to see more complex cases from beginning to end whereas students of two-year programs may not be able to see these cases to completion.
That being said, there are definite downsides to three-year academic programs, the big one being tuition. Unlike medical residencies where you are paid to be there, the majority of academic orthodontic residencies charge tuition. These residencies are not cheap either, with some schools charging upwards of $110,000 per year.
Hospital-based orthodontic residencies are, as the name suggests, affiliated with hospitals instead of academic institutions. They are generally two years long and, unlike academic programs, are mostly clinical with fewer didactic and research components. In addition, many hospital residency programs offer stipends as opposed to charging tuition.
In terms of competitiveness, orthodontics is known for being one of the most competitive dental specialties, with only around 55% of applicants matching into orthodontics each year.
Dental students best suited for orthodontics are often well-rounded and highly motivated. They tend to be social and enjoy a low-stress environment with a healthy work-life balance.
Subspecialties within Orthodontics
For orthodontists that want to subspecialize further, there is only one main fellowship option available.
Craniofacial orthodontics is a 1-year fellowship program that provides orthodontists with additional training and skills in the management of complex craniofacial anomalies. This includes issues such as cleft lips and palate and other dentofacial deformities.
Craniofacial orthodontists will often work as a part of a craniofacial team, which includes plastic surgeons, oral surgeons, pediatricians, pediatric dentists, prosthodontists, speech pathologists, otolaryngologists, geneticists, and neurosurgeons among others.
It should be noted that many orthodontists receive training in craniofacial orthodontics during residency and will still treat craniofacial patients in their respective practices. As such, those that pursue fellowships in craniofacial orthodontics are generally passionate about treating patients with craniofacial abnormalities and want the extra experience, or they are interested in working in academic or hospital settings.
In terms of compensation, craniofacial orthodontists typically make less than general orthodontists as they will most likely be focusing on craniofacial syndromes instead of the more bread-and-butter orthodontic treatments which are often paid out-of-pocket.
What You’ll Love About Orthodontics
There’s a lot to love about orthodontics.
To start, the lifestyle of an orthodontist is desirable relative to most medical and dental specialties. Most orthodontists work regular 9-5 business hours. The number of days you work depends on the lifestyle you want – some will work only a few days per month while others work 5-6 days a week.
Although there is generally a tradeoff between lifestyle and compensation, orthodontists are also at the higher end of compensation relative to other dental specialties. According to the U.S. Bureau of Labor Statistics, the average orthodontist takes home around $267,000 per year.
Orthodontics is also less physically demanding than many other dental specialties. Whereas most dental specialties struggle with strain on the back and hands from lengthy procedures, much of an orthodontist’s work can be delegated to assistants. As a result, the orthodontist’s main job is to direct the treatment rather than directly perform the procedures, leading to more downtime during patient care.
Another benefit of being able to delegate work is that orthodontists can see many more patients per day. The average orthodontist will see around 30-60 patients per day with some seeing greater than 100 patients per day. Patient volumes will vary, however, depending on the size of the practice as well as the systems that are in place to delegate work to assistants.
Orthodontics is also known for being a relatively low-stress occupation. There are no life-threatening emergencies and most mistakes are often reversible.
Lastly, the fulfillment of building relationships with patients over years of treatment can be rewarding as you transform the smile and lower face of the patient.
What You Won’t Love About Orthodontics
Although orthodontics is an awesome specialty, it’s not for everyone.
To start, the training to become an orthodontist is long and comes with additional opportunity costs. Unlike medical school, residency is not required after dental school. This means that instead of going out to practice as a general dentist and making a solid six-figure income, you’ll be committing an additional two to three years to orthodontics residency.
Orthodontics is also highly competitive relative to other dental specialties, meaning that you will have to work much harder than your peers during dental school to graduate at the top of your class.
Some people also find orthodontics to be somewhat repetitive. As a general dentist, you are able to perform a wide variety of procedures; however, once you specialize in orthodontics, your scope becomes much more limited.
Being an orthodontist can also be socially exhausting at times. Because much of the work can be delegated to dental assistants, orthodontists see higher volumes of patients per day than most other medical and dental specialties. This means meeting and interacting with anywhere from thirty to more than one hundred different people each day, which can be exhausting – even for the most extroverted of orthodontists.
Lastly, according to the American Association of Orthodontists, approximately 79% of orthodontists own or share ownership of a practice. This means putting up with the additional administrative burdens and stress that come along with owning a business.
Should You Become an Orthodontist
How can you decide if orthodontics is right for you?
If you’re passionate about teeth and want to help your patients have straighter, healthier smiles while improving the aesthetics of their lower face, orthodontics might be a good fit.
In terms of personality, you should be at least somewhat social and enjoy being a leader. You should work well with others and be comfortable delegating tasks to other members of the team.
Lastly, if you want a career that has a good work-life balance and are unwilling to compromise on compensation, orthodontics won’t make you choose between work and family.