|Dental degree, specialty training|
|Private practices, hospitals|
Orthodontics[a][b] is a specialty of dentistry that deals with the diagnosis, prevention and correction of malpositioned teeth and jaws. It can also focus on modifying facial growth, known as dentofacial orthopedics.
Abnormal alignment of the teeth and jaws is common, nearly 30% of the population has malocclusions severe enough to benefit from orthodontic treatment. Treatment can take several months to a few years, it involves the use of dental braces and other appliances to slowly move the teeth and jaws around. If the malocclusion is very severe, jaw surgery may be used. Treatment is usually started before a person reaches adulthood since bones can more easily be moved around in children.
Orthodontics as a modern science dates back to the mid 1800s. Influential contributors to the field include Norman William Kingsley (1829–1913) and Edward Angle (1855–1930). Angle created the first simple system for classifying malocclusions, a system which is still used today.
A typical treatment for incorrectly positioned teeth (malocclusion) takes about 1 to 3 years to complete, with braces being altered slightly every 4 to 10 weeks by the orthodontist. Multiple methods exist for adjusting malocclusion. In growing patients there are more options for treating skeletal discrepancies, either promoting or restricting growth using functional appliances, orthodontic headgear or a reverse pull facemask. Most orthodontic work is started during the early permanent dentition stage before skeletal growth is completed. If skeletal growth has completed, jaw surgery can be an option. Sometime teeth are extracted to aid the aid the orthodontic treatment (teeth are extracted in about half of all of cases, most commonly the premolars).
Orthodontic therapy can include the used of fixed or removable appliances. The majority of orthodontic therapy is delivered using appliances that are fixed in place, for example with braces that are bonded to the teeth with adhesives. Fixed appliances can have a greater mechanical control of the teeth and the treatment outcome is greater with the use of fixed appliances.
Fixed appliances are for example used to rotate teeth that don't fit to the arch shape of the other teeth, to move multiple teeth to different places, to change the angle of teeth, or to change the position of the root of the tooth. It is not preferable if the patient has poor oral hygiene (as that can result in decalcification, tooth decay, and other problems), if the patient isn't motivated (as treatment lasts several months and commitment to oral hygiene is required), or if the malocclusions are mild.
Braces are usually placed on the front side of the teeth, but may also be placed on the side facing the tongue (called lingual braces). Brackets made out of stainless steel or porcelain are bonded to the center of the teeth using an adhesive. Wires are placed in a slot in the brackets which allows for controlled movement in all three dimensions.
Apart from wires, forces can be applied using elastic bands, and springs may be used to push teeth apart or to close a gap. Several teeth may be tied together with ligatures and different kinds of hooks can be placed to allow for connecting an elastic band.
Jaw surgery may be required to fix severe malocclusions. The bone is broken during surgery and is stabilised with titanium (or bioresorbable) plates and screws to allow for healing to take place. After surgery, regular orthodontic treatment is used to move the teet into their final position.
After orthodontic treatment has completed, there is a tendency for teeth to return, or relapse, back to their pre-treatment positions. Over 50% of patients have some reversion to pre-treatment positions within 10 years following treatment. To prevent relapse, the majority of patients will be offered a retainer once treatment has completed, and will benefit from wearing their retainers. Retainers can be either fixed or removable. Removable retainers will be worn for different periods of time depending on patient need to stabilise the dentition. Fixed retainers are a simple wire fixed to the tongue-facing part of the incisors using dental adhesive and can be specifically useful to prevent rotation in incisors. Other types of fixed retainers can include labial or lingual braces, with brackets fixed to the teeth.
Top and bottom retainers
There are several speciality areas in dentistry, but the speciality of orthodontics was the first to be recognized within dentistry. Specifically, the American Dental Association recognized orthodontics as a speciality in the 1950s. Each country has their own system for training and registering orthodontic specialists.
In Canada, obtaining a dental degree, such as a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry (DMD), would be required before being accepted by a school for orthodontic training. Currently, there are 10 schools in the country offering the orthodontic specialty. Candidates should contact the individual school directly to obtain the most recent pre-requisites before entry. The Canadian Dental Association expects orthodontists to complete at least two years of post-doctoral, specialty training in orthodontics in an accredited program, after graduating from their dental degree.
Similar to Canada, there are several colleges and universities in the United States that offer orthodontic programs. Every school has a different enrollment process, but every applicant is required to have graduated with a DDS or DMD from an accredited dental school. Entrance into an accredited orthodontics program is extremely competitive, and begins by passing a national or state licensing exam.
The program generally lasts for two to three years, and by the final year, graduates are to complete the written American Board of Orthodontics (ABO) exam. This exam is also broken down into two components: a written exam and a clinical exam. The written exam is a comprehensive exam that tests for the applicant's knowledge of basic sciences and clinical concepts. The clinical exam, however, consists of a Board Case Oral Examination (BCOE), a Case Report Examination (CRE), and a Case Report Oral Examination (CROE). Once certified, certification must then be renewed every ten years. Orthodontic programs can award the Master of Science degree, Doctor of Science degree, or Doctor of Philosophy degree depending on the school and individual research requirements.
Dhaka Dental College in Bangladesh is one of the many schools recognized by the Bangladesh Medical and Dental Council (BM&DC) that offer post-graduation orthodontic courses. Before applying to any post-graduation training courses, an applicant must have completed the Bachelor of Dental Surgery (BDS) examination from any dental college. After application, the applicant must take an admissions test held by the specific college. When successful, selected candidates undergo training for six months.
Throughout the United Kingdom, there are several Orthodontic Specialty Training Registrar posts available. The program is full-time for three years, and upon completion, trainees graduate with a degree at the Masters or Doctorate level. Training may take place within hospital departments that are linked to recognized dental schools. Obtaining a Certificate of Completion of Specialty Training (CCST) allows an orthodontic specialist to be registered under the General Dental Council (GDC). An orthodontic specialist can provide care within a primary care setting, but to work at a hospital as an orthodontic consultant, higher level training is further required as a post-CCST trainee. To work within a university setting, as an academic consultant, completing research toward obtaining a PhD is also required.
In Pakistan to be enrolled as a student or resident in postgraduation orthodontic course approved by Pakistan medical and dental council, the dentist must graduate with a Bachelor of Dental Surgery (BDS) or equivalent degree. Pakistan Medical & Dental Council (PMDC) has a recognized program in orthodontics as Master in Dental Surgery (MDS) orthodontics and FCPS orthodontics as 4 years post graduate degree programs, latter of which is conducted by CPSP Pakistan.[clarification needed]
In Australia, to obtain an accredited three-year full-time university degree in orthodontics you will need to be a qualified dentist (complete an AHPRA registered general dental degree) with a minimum of two years clinical experience. There are several universities in Australia that offer orthodontic programs: University of Adelaide, University of Melbourne, University of Sydney, University of Queensland, University of Western Australia, University of Otago. Orthodontic Courses are accredited by the Australian Dental Council and reviewed by the Australian Society of Orthodontists (ASO). Prospective applicants should obtain information from the relevant institution before applying for admission. After completing a degree in orthodontics, specialists are required to be registered with the Australian Health Practitioners Regulation Agency (AHPRA) in order to practise. 
- Orthodontic technology
- Orthodontic indices
- List of orthodontic functional appliances
- Molar distalization
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