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People may think that orthodontists are for kids, but orthodontists are actually specialists in straightening teeth and correcting the bite in patients of all ages. Today, many dentists offer some kind of treatment for better aligning and straightening the teeth. So, with both dentists and orthodontists offering tooth alignment how do you know where to go?  It is important to understand the differences in care or treatment you may receive by a dentist versus an orthodontist.

What is the difference in training for a dentist and an orthodontist?

Dentists and orthodontists specialize in different things. Dentists are experts at keeping the mouth clean and the gums healthy. They are experts in providing restorative care such as fillings and crowns and even some cosmetic dental procedures such as bonding or veneers.  An orthodontist is a specialist in straightening teeth and aligning the bite.

It’s like many other areas of medicine, the patient has the choice to go to a generalist or a specialist. If you think you have skin cancer – do you want to see your family medicine doctor or do you seek out a dermatologist, someone who is a doctor first and then had specialty training in the skin?  If you have a heart issue, do you want to see a generalist or a cardiologist who has trained for many years in specific, accredited residencies, fellowships, etc.

Orthodontists first become dentists by attending four years of dental school and then go on to complete another two and a half to three years of specialty training in a recognized and accredited residency.  During that training they look at orthodontic cases every day – working with mentors and faculty to learn the best techniques to align teeth in a comfortable, efficient, and esthetic manner.  They also study journal articles, conduct research projects, and read literature reviews on straightening and aligning teeth and improving bites. Through this training, that takes place both in a classroom setting and in a clinic setting, orthodontists learn to treatment plan the best outcome for each individual patient.  Only orthdontists can say they have been trained specifically to obtain the most ideal esthetics and bite for each patient.

Through this extra specialty training an orthodontist hones their skills and ability to diagnose and treatment plan the complex issues associated with bite fit and tooth alignment. That expert skill comes from the repetition of treating only orthodontic cases plus the expertise from large amounts of research and literature study.  The thought is, do you want a doctor that does 5 knee repairs a year or a doctor that does 5 knee repairs a week operating on your knee?  The same is true in orthodontics—they only do braces and Invisalign and retainers so they are the experts at tooth alignment.

General dentists, on the other hand, do not have any formal orthodontic training. They are usually trained on using clear aligners to straighten the teeth through a weekend course or by a sales rep for the product they are selling. They do not have detailed training in smile design or bite alignment and the techniques necessary to get the teeth to come together properly, whereas an orthodontist has gone through rigorous training and testing as a part of their education.

What is the difference in treatment?

While all patients expect the end product of orthodontic treatment, whether by a dentist or an orthodontist to be a beautiful, confident smile and straight teeth, they do not always understand or value the importance of treating those things that are not seen outwardly. Ultimately the alignment of the bite is important for the longevity of that beautiful smile and helps to prevent uneven wear or cracking or chipping teeth as you age.  An orthodontist is an expert in assessing and correcting bite issues and the way the teeth fit together, and treating issues such as a crossbite, overbite or underbite, this helps to keep teeth healthy for years to come.

Orthodontists are also true experts in what is known as the “detailing phase” of treatment - the last six months of treatment. At this point they are working on the micro level – fine tuning and detailing each tooth in this finishing phase. They look at each tooth three dimensionally and make sure it has the very best placement. They assess the tip, torque, and angulation, of every tooth and insure it is positioned correctly next to its neighboring teeth as well as the opposing tooth.

An orthodontist has several types of braces available to them -  metal braces, ceramic braces, and Invisalign, also known as clear aligners.  An orthodontist assesses each patient individually and recommends the type of braces necessary to achieve both the bite corrections and have a great looking smile. Dentists, on the other hand, primarily stick to the Invisalign or a generic version even if the patient would benefit from traditional braces. While many patients are good candidates for clear aligners, there are certain cases where it is not the right product and will not provide the proper correction of the teeth. Only an orthodontist who is specialty trained is  able to offer all options and decipher which treatment modality is best for the individual patient.

Understand Your Insurance Coverage for Braces

One thing that is often misunderstood is how dental insurance companies help to pay for orthodontic treatment. Insurance companies usually have a lifetime maximum benefit for orthodontic treatment. So once you use that benefit for orthodontic treatment, it does not renew. For most other dental benefits you have a preset amount for the year and that renews with each year. For orthodontic treatment insurance companies consider it a one-time benefit, regardless of where you seek care.

Orthodontists commonly see patients in their office who have started by seeking treatment from their family dentist or even have tried ordering clear aligners on-line for a discount, who come to realize that they are not happy with the end result.  These patients usually need additional treatment. In these cases, their insurance benefit for orthodontics has already been used and these patients then need to pay out-of-pocket for any additional treatment necessary to straighten or correct their teeth.  So, it is always  more economical for the patient to start with a specialist and get the right result the first time.

If you are interested in straightening your teeth and want an excellent result, start with an orthodontist. Dr Holt and his team offer a complimentary visit (worth $300) that includes a set of 8 photos, a digital panoramic x-ray, and a personal consultation with Dr. Holt.

If you’ve seen advertisements or considered programs where you can straighten your teeth by buying clear aligners on-line or through the mail, think again. The American Association of Orthodontists ("AAO") recently issued a consumer alert for direct-to-consumer orthodontics and has raised serious concerns about this service because there are over 1000 customer complaints and consumer horror stories on the Better Business Bureau's website for SmileDirectClub and other companies that sell options to straighten teeth by ordering clear aligners through the mail.

Consumers are often lured into these programs by the lower cost or convenience, but unfortunately, they don’t often understand how it works and they are unaware that there is no oversight by an orthodontist. In fact, unless you live in an urban area where you can go in and have a tech provide a scan of your teeth, you will most likely take your own impressions of your teeth with a putty at home.  Once you do that and mail it in, they ship you a set of plastic trays that you wear to align your teeth.

There are several problems with this model:

• There is no dental assessment to see if you are a good candidate for clear aligners to straighten the teeth. Some individuals with more complex issues need metal braces to achieve a well-aligned bite and a healthy smile
• There is no exam to assess dental, periodontal, jaw or joint health to determine if you will do well with the treatment. Additionally, there is no oversight of changes that may occur over the course of treatment.
• There is no tracking or monitoring of progress or the movement of the teeth, which means there is not an opportunity to make needed adjustments along the way.
• When the treatment time is up and you have cycled through all the sets of aligners, that’s the result you get, and it is a result that many people are unhappy with.

While people are often unhappy with the end result because their teeth are not straight or they didn’t achieve the result that they had hoped for, it’s important to note that the consequences can be even more serious. When you are moving teeth, if not done correctly, it can lead to potentially irreversible and expensive damage such as tooth and gum loss or a misaligned bite.

Who is the right candidate for straightening teeth with clear aligners?

 When people want straight teeth one of the first things that an orthodontist will do, beyond a dental health assessment, is to determine the best method or technique to use to straighten the teeth. Clear aligners, such as Invisalign, are not always the right option for every person. An underbite or overbite, jaw or joint pain, uneven tooth wear or a misaligned bite are all signs that metal braces may be needed to achieve an optimal result. These individuals with more complex cases or bite-related problems would not be ideal candidates for clear aligners.  Orthodontists would instead recommend regular metal braces, because they can be more aggressive with the treatment, predict the outcome more accurately and achieve a more optimal result.

The right candidate for clear aligners is often someone in their thirties, fourties or fifties who had braces when they were younger and may have had some movement in their teeth.  Sometimes this is because they didn’t wear their retainer or as they have aged the jaw has changed shape which has caused some aesthetic shifting. Clear aligners are ideal for these patients who have a good bite and generally well-aligned teeth.

Benefits of seeing an orthodontist

If you want to achieve the best result, you best see an orthodontist.  Orthodontists attend dental school and then complete another three years of training beyond that specifically in orthodontics, facial development and the biomechanics of the jaw. They are uniquely qualified and dedicated to getting the best possible outcome.  When seeing an orthodontist you can expect:

• That you will have a complete and thorough oral health assessment to determine if you are a good candidate for orthodontic treatment and identify any underlying periodontal concerns.
• To form a relationship with your doctor and create mutually agreed upon goals for straightening your teeth.
• You will receive the right kind of braces for your individual treatment plan – sometimes that is clear aligners, other times it may be metal braces, or some combination of both.
• Your progress will be monitored every step of the way. The doctor will monitor your teeth to ensure they are tracking with the digital treatment plan and a 3D model of what the teeth are supposed to look like at each stage of the process. As they compare the teeth in the mouth and the bite to that digital model, they make necessary adjustments, because sometimes additional techniques or modifications in the treatment plan are needed to achieve the optimal result.

Keep in mind that even though some cosmetic dentists now offer clear aligners, they still do not have the additional years of specific orthodontic training that is critical for treating complex cases and achieving superior results.  An orthodontist is not just focused on the aesthetic look of the smile, but rather the underlying health of the jaw, the bite and the alignment.  It’s proper alignment that helps to maintain a healthy jaw and avoid problems with sore joints and chipped or broken teeth from uneven wear you age. The truth is, good orthodontic care keeps you mouth not only looking great, but feeling great for a lifetime!

While you have braces, it’s important that you brush your teeth regularly. We recommend four times daily to avoid the accumulation of food particles in your teeth and braces.  Ideally, it is best to follow the schedule below: 

• In the morning after breakfast 
• After lunch or right after school 
• After dinner 
• At bedtime

Flossing while Wearing Braces

Flossing takes more time and patience when you are wearing braces, but it is very important to floss your teeth every day. We recommend flossing at night to make sure your teeth are clean before you go to bed.

Use a floss threader to get the floss under your archwire. Pull a small length of floss from the dispenser through the threader and slide it up and down along the front of each tooth. Use care around your archwire, and do not floss too aggressively around it or put too much pressure on it.

Rinsing with an Antibacterial Mouthwash

To reduce inflammation to your gums and cheeks, we suggest using a hydrogen peroxide antiseptic mouth rinse. This rinse will help prevent infection and decrease irritation that may develop from your braces. Rinse your mouth with two teaspoons of the hydrogen peroxide rinse for one minute, and then spit it out. You may use it up to four times daily following brushing. Just like using peroxide for a scrape on your skin, this hydrogen peroxide mouth rinse helps the inside of your mouth heal. It can be used for general irritation caused by your braces or for canker sores, cheek bites and other minor injuries to the gums.

Using an Interdental Toothbrush

An interdental (between the teeth) toothbrush is used to clean underneath and around your archwires and braces. Please use the interdental toothbrush gently to avoid damaging your wires.

Topical Fluoride

We recommend using a sodium fluoride gel to help prevent tooth decay while you are wearing braces. This gel kills bacteria and replaces minerals in the tooth enamel that have been removed by harmful acids. Using a fluoride gel does not replace daily brushing and flossing, but it should be applied following your daily schedule at bedtime. Place a small strip of the gel on a toothbrush and apply it to your teeth for one minute. Then spit it out. Do not eat or drink for 30 minutes afterward. It is important for the active ingredient to stay on your teeth for 30 minutes, so do not wash it away by eating, drinking or rinsing.

Cleaning Your Removable Appliance or Retainer

If you have a removable appliance, brush it every day as a part of your regular brushing and flossing schedule. Because food particles and plaque can accumulate on your appliance just as they do on your teeth, soak it daily in water with a dissolved denture-cleaning tablet at room temperature.

At one time or another, anyone may pick up a bad habit. But there are some situations where a bad habit can actually have a negative impact on their health and influence the development and function of his or her teeth, jaws and mouth. Some examples of these bad habits are:

• Persistent thumb sucking
• Tongue thrusting
• Mouth breathing

The sucking reflex is natural in early childhood and it usually disappears between ages 2 and 4. But if it persists much longer than that, the pressure of the thumb on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaw to change shape. This can lead to the orthodontic problem known as an “open bite,” and may even effect speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth, also known as tongue thrusting.

Mouth breathing — an abnormal breathing pattern in which the mouth always remains open, passing air directly to the lungs — is related to alterations in the muscular function of the tongue and face. It may cause the upper and lower jaw to grow abnormally, which can also lead to serious orthodontic problems. Although mouth breathing may start from a physical difficulty, it can become a habitual action that's hard to break.

Unfortunately, these potential problems aren't always easy to recognize on your own, but your orthodontist will be able to spot them. Fortunately, there are several orthodontic treatments that are available to help correct these bad habits and the sooner they're taken care of, the less damage they may cause.