ON ORAL CARE
Orthodontists vs. Dentists: What's the Difference?
They both know a ton about teeth. But there’s a lot more to it than that.
Here’s how things used to be: You went to the dentist to have your teeth cleaned and cavities filled, and you went to the orthodontist to have your teeth straightened. But today, with so many alternatives to braces available, the choice isn’t quite so clear-cut anymore. After all, if your general dentist can straighten your teeth with invisible aligners, why seek out an orthodontist specifically? And what's the difference between a dentist and an orthodontist, anyway?
"All orthodontists are dentists, but not all dentists are orthodontists," Dr. Angela Abernathy, a general and cosmetic dentist in New York City, tells The Impression.
Here's what she means — and why it matters.
Dentists and orthodontists both get degrees in dentistry to start.
Both dentists and orthodontists begin their training in dental school, which is typically four years long. Science courses — biology, physiology, anatomy, biochemistry, pharmacology, and microbiology — comprise most of the first two years, according to the American Dental Education Association. During that time, dentists- and orthodontists-to-be begin their practical training on models of teeth, which is definitely a comforting thought.
In years three and four, dental students' education occurs primarily outside of the classroom, as they spend time treating patients in dental clinics and being exposed to the 10 different dental specialties.
"All dental students get a taste of the various specialties through a rotation in their general training," Dr. Joyce Kahng, a general dentist and USC School of Dentistry faculty member, tells The Impression. "Some students are immediately drawn to a particular specialty or even entered dental school with aspirations to become an endodontist. However, most students need the rotations to help them determine whether it is something worth investing in."
That proved true for Dr. Abernathy, who went into school thinking she'd be an orthodontist.
"I had an interest in dentistry from a relatively young age, as I actually liked going to the dentist," she says. "I actually wanted braces, and my experience is what ultimately solidified that dentistry would be my chosen career path. I did have an interest in orthodontics as well as oral surgery, but I found that I liked general dentistry better and had a strong interest in cosmetics."
Dr. K. Amanda Wilson was all in for orthodontics, though. When she graduated from dental school in 2001, it was one of the toughest specialties to get into. The students who chose the field had a reputation for being both academically competitive and outgoing, sociable people.
"I loved the aesthetics of it," Dr. Wilson, who now works as a consultant for dentists and orthodontists, tells The Impression.
The difference between dentists and orthodontists comes from post-doctoral training.
The paths of dentists and orthodontists diverge once students receive their DMD (Doctor of Dental Medicine) or DDS (Doctor of Dental Surgery) degrees. They’re the same thing, and state licensing boards accept either, but different schools use different initials.
In some states, such as California, general dentists can start working right away, armed with the expert knowledge they’ve gained in dental school. In states like New York and Delaware, though, general dentists also have to complete a residency before they enter practice. Under the supervision of seasoned faculty members, they use their residencies to get hands-on experience with every type of dental issue they can and “increase [their] speed and confidence with different procedures," Dr. Abernathy says.
But while general dentists may or may not have to complete a residency, depending on where they live, aspiring orthodontists have no choice but to continue their studies in an accredited residency program. The 2-3 year orthodontic residency is much more focused than dental school, as residents learn everything they need to know about the different types of malocclusions (Latin for “bad bite”) and the complex techniques involved in straightening teeth and correcting other kinds of dental or facial abnormalities.
Training covers subjects like the biomechanics of tooth movement, the anatomy of the face and neck, and orthodontic treatment planning. Some programs also allow students to earn a master's degree in dental science.
Once their residencies are complete, orthodontists have the option to take the American Board of Orthodontics exam to become board-certified specialists in the field.
So what does a dentist do, and what does an orthodontist do?
General dentists are primary oral healthcare providers, which means they’re your first line of defense for managing the health of your mouth. During a routine dental exam, your dentist will check to see that your teeth and gums are healthy, using both the naked eye and x-rays to look for cavities and gum disease. They’ll also give your teeth a thorough cleaning (or have their dental hygienist do so), using special tools to scrape off any accumulated calculus — which you probably know as tartar — and then polish them.
Dentists also check for signs of oral cancer and other diseases and hold you accountable to a proper oral hygiene routine. (Are you flossing every day?) And as every nervous patient knows, they perform important oral-care procedures like fillings, crowns, bridges, and root canals.
“I don’t dread going to the dentist, but I certainly wouldn’t say it’s my favorite thing,” Christina B., a dental and orthodontics patient, tells The Impression. “You know never know if a simple cleaning will turn into painful event like getting a cavity filled or something worse.”
Your dentist will determine whether you need to see a specialist for a problem, or if he or she can treat it. While many dentists provide some orthodontic services, including braces and Invisalign, orthodontists, as we’ve seen, are specialists in straightening teeth. So whether you lost your retainer years ago, your teeth shifted out of place when you were pregnant, or you’ve just always had a gap that drives you crazy, an orthodontist can definitely help.
“[General dentists] know all different kinds of dentistry, but for a more challenging case, you should always stick with an orthodontist,” Dr. Wilson explains. “Patients don't always know where that line is.”
In addition to looking for crooked, crowded, or spaced-out teeth, an orthodontist will assess your occlusion, the technical term for how your teeth meet when you bite down. That can affect how you chew, breathe, and speak, in addition to how you look.
"One thing I found surprising is that the orthodontist said I had a lisp from tongue thrusting, which my dentist never mentioned," Lauren K., an orthodontics patient, tells The Impression. "She also gave me tips for how to position my tongue while I sleep to avoid making my teeth worse."
After seeing your teeth and jaw at all angles, the orthodontist will come up with a treatment plan, which can vary greatly depending on the type and severity of your issues. In the most severe cases, surgery might be required, but for most people, treatment with appliances like clear aligners, braces, and retainers are sufficient to gradually shift their teeth into position. Orthodontists assess just how much push and pull you’ll need over how much time to put things in place and then keep them there.
While Christina B. was able to close the gap between her front teeth with invisible aligners, Lauren K. discovered that they wouldn’t work for her. Though she'd had braces as a teenager, she didn't wear her retainer, and her teeth shifted into a noticeable overbite. She’s getting lingual braces — braces on the back of her teeth — to fix the problem.
Lauren admits she was nervous about getting orthodontic services as an adult. “I didn't want to relive my awkward teen years!” she says. But now she’s looking forward to improving her smile. The dentists quoted in this piece are not affiliated with Candid. Their participation does not amount to an endorsement.
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