Orthodontia, also known as orthodontics and dentofacial orthopedics, was the first specialty created in the field of dentistry. An orthodontist is a specialist who has undergone special training in a dental school or college after he/she has graduated in dentistry. It was established by the efforts of pioneering orthodontists such as Edward Angle and Norman William Kingsley. The specialty deals primarily with the diagnosis, prevention and correction of malpositioned teeth and the jaws.
The history of orthodontics has been intimately linked with the history of dentistry for more than 2000 years. Dentistry had its origins as a part of medicine. According to the AAO (American Association of Orthodontists), archaeologists have discovered mummified ancients with metal bands wrapped around individual teeth. Malocclusion is not a disease, but abnormal alignment of the teeth and the way the upper and lower teeth fit together. The prevalence of malocclusion varies, but using orthodontic treatment indices, which categorize malocclusions in terms of severity, it can be said that nearly 30% of the population present with malocclusions severe enough to benefit from orthodontic treatment.
Orthodontic treatment can focus on dental displacement only, or deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopedics". In severe malocclusions that can be a part of Craniofacial anomalies, management often requires a combination of Orthodontics and Jaw Surgery or Orthognathic Surgery. This often requires additional training, in addition to the formal 3 year specialty training. For instance, in the USA, orthodontists get at least another year of training in a form of fellowship, the so-called 'Craniofacial Orthodontics', to receive additional training in the orthodontic management of Craniofacial anomalies.
For comprehensive orthodontic treatment, metal wires are inserted into orthodontic brackets (braces), which can be made from stainless steel or a more aesthetic ceramic material. The wires interact with the brackets to move teeth into the desired positions. Invisalign or other aligner trays consist of clear plastic trays that move teeth. Functional appliances are often used to redirect jaw growth.
Additional components—including removable appliances ("plates"), headgear, expansion appliances, and many other devices—may also be used to move teeth and jaw bones. Functional appliances, for example, are used in growing patients (age 5 to 14) with the aim of modifying the jaw dimensions and relationship if these are altered. This therapy, termed Dentofacial Orthopedics, is frequently followed by fixed multibracket therapy ("full braces") to align the teeth and refine the occlusion.
Orthodontia is the specialty of dentistry that is concerned with the treatment of improper bites and crooked teeth. Orthodontic treatment can help fix the patient's teeth and set them in the right place. Orthodontists usually use braces and clear aligners to set the patient's teeth. Orthodontists work on reconstructing the entire face rather than focusing only on teeth. After a course of active orthodontic treatment, patients will typically wear retainers (orthodontic devices), which help to maintain the teeth in their improved positions while surrounding bone reforms around them. The retainers are generally worn full-time for a period, anywhere from just a few days to a year, then part-time (typically, nightly during sleep) for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages, whether or not the individual ever experienced orthodontic treatment; thus there is no guarantee that teeth will stay aligned without retention. For this reason, many orthodontists prescribe night-time or part-time retainer wear for many years after orthodontic treatment (potentially for life). Adult orthodontic patients are more likely to need lifetime retention.
Diagnosis and treatment planning
In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of a malocclusion or dentofacial deformity; (2) define the nature of the problem, including the etiology if possible; (3) design a treatment strategy based on the specific needs and desires of the individual; and (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision.
Orthodontics was the first recognized specialty field within dentistry. Many countries have their own systems for training and registering orthodontic specialists. A two- to four-year period of full-time post-graduate study is required for a dentist to qualify as Specialist Orthodontist.
In order to be enrolled as a resident an orthodontics program, the dentist must have graduated with a DDS, DMD, BDS or equivalent. Entrance into an accredited orthodontics program is extremely competitive, and generally lasts 2–3 years. Orthodontic residency programs can award the Master of Science degree, or Doctor of Science degree, depending on the individual research requirements. The class size, tuition, stipend and number of patients seen and treated will all depend on the location and setting of the program (hospital vs. university). Each training program has its own goals and treatment philosophy, however, most U.S. orthodontic programs focus on fixed straight wire appliances. All the graduates must also complete the written portion of the American Board of Orthodontics (ABO) examinations.
In order to become Board Certified, a practicing orthodontist must present six cases that have been treated entirely by the orthodontist to the ABO examiners. The orthodontist then must appear in person in front of a panel of examiners to defend the clinical decisions regarding those cases. Once certified, the certificate is renewed every 10 years, and the practitioner can add the title "Diplomate, American Board of Orthodontics".
Job outlook as a recent U.S. orthodontics graduate depends on the location of employment. Typically, more popular destinations (such as California, NYC, Seattle, Las Vegas and Texas) are heavily saturated with orthodontists. Traditional, practice transition situations (new orthodontist buying out the seller orthodontist) are becoming rare as the orthodontic market has been saturated with new and old practitioners, general dentists performing orthodontics, corporate clinics and older orthodontists delaying retirement.
In the United Kingdom, the training period lasts three years. After completion of a membership from a Royal College, a further two years are then completed to train to consultant level before a fellowship examination from the Royal College is sat. In other parts of Europe, a similar pattern is followed.
A number of dental schools and hospitals offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years (with the majority being 3 years) of full-time classes in the theoretical and practical aspects of orthodontics together with clinical experience. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidates. Candidates usually have to contact the individual school directly for the application process.
Similar to the ABO, the Canadian orthodontic specialist can take a two-part examinations (Written NDSE and Oral NDSE) offered by the Royal College of Dentists of Canada (RCDC) in their final year of the orthodontics training. Upon completion of the examinations, the orthodontist is admitted to the RCDC as a Fellow and can add the following title, FRCD(C).
In India, many dental colleges affiliated to universities offer orthodontics as specialization in Master of Dental Surgery (M.D.S) programme.The only required qualification for M.D.S is Bachelor of Dental Surgery ( B.D.S ). The present course for MDS in Orthodontics stands at 3 years in all dental colleges in India which are recognised by the Dental Council of India.
In Iran, Orthodontics and Dentofacial Orthopedics is known as a specialty since 1978. General dentists can begin their postgraduate course after participating in a comprehensive national exam (which is held once a year) and fulfilling good rankings among all participants. After three years of postgraduate academic training, students can participate in a national board exam for final evaluation and if they can reach the determined scores, they will be recognized as board certified specialist orthodontists. Iranian Association of Orthodontists (IAO) has been established in 1978 and has been contributed in several national and international congresses since its establishment.
In Bangladesh to be enrolled as a student or resident in post-graduation orthodontic course approved by Bangladesh Medical and Dental Council (BM&DC), the dentist must graduate with a Bachelor of Dental Surgery (BDS) or equivalent. At present BM&DC recognized program in Ortho[lpl]larded by Bangladesh college of Physician and Surgeons (BCPS). Bangladesh Orthodontic Society (BOS) was formed in 1993.
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 graduation degree programs, latter of which is conducted by CPSP Pakistan.[clarification needed]
- Accelerated orthodontic treatment
- American Association of Orthodontists
- Canadian Association of Orthodontists
- Indian Orthodontic Society
- Orthodontic mechanics
- Orthodontic technology
- Orthognathic surgery
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