Dentist or Ortho

[vincent168]

Since dentists do braces for cheaper, what would stop you from going to a dentist?

[Snowglobe32]

The same reason why I wouldn't let the mailman do open heart surgery on a loved one...

Ortho's have at least 3 more years of specialized schooling (in ortho) than a dentist. There is a reason why a dentist can offer braces at a lower rate.

Think of it this way, you're in college, getting your Bachelor's Degree, you take an anatomy course one semester, does that mean you're as qualified to be a doctor as someone who went to medical school?

I think when you go to a general dentist for braces, you are taking a huge gamble. I am sure there are success stories out there but I would never let someone who isn't certified and qualified to be an ortho, put braces on my teeth.

[sirwired]

If you have an uncomplicated case, orthodontics is not some foreign land of dentistry. A well-trained general dentist should be able to handle the work. Just as a general dentist can do gum grafts (as opposed to a periodontist), root canals (as opposed to an endodontist), and extractions (instead of going to an oral surgeon.)

The trick is: how do you know if yours is an uncomplicated case? There are certainly a lot more variables with orthodontics than with filling cavities.

[ArchWired28]

I completely agree with Snowglobe32. That is like let the car mechanic repare a plane, assuming that everything is similar anyway. I would not let a dentist do braces on me even if they were free, let alone for a modest discount that is commonly offered.
Uncomplicated case... There is NO such thing as an uncomplicated case in orthodontics. And who decides what's complicated and what's not? The most challenging cases usually look very simple, that's what I have heard from orthos. All they do is move teeth and mistakes, delays etc are still very common, so what to expect from a dentist who might do it only seldom on a random basis?

[brace33]

I definitely go with the orth

[vincent168]

The same reason why I wouldn't let the mailman do open heart surgery on a loved one...

Ortho's have at least 3 more years of specialized schooling (in ortho) than a dentist. There is a reason why a dentist can offer braces at a lower rate.

Think of it this way, you're in college, getting your Bachelor's Degree, you take an anatomy course one semester, does that mean you're as qualified to be a doctor as someone who went to medical school?

I think when you go to a general dentist for braces, you are taking a huge gamble. I am sure there are success stories out there but I would never let someone who isn't certified and qualified to be an ortho, put braces on my teeth.

Yeah I understand they have a higher qualification but I was under the impression that since they are allowed to do it (by law), it means that they should be just as good but they prefer not to limit their practice to orthodontics only.

[sirwired]

A board-certified orthodontist has been through several years of additional training beyond that of a general dentist. Yes, a general dentist is legally allowed to perform orthodontic work, just like your family doc is legally allowed to do surgery, should he/she decide to do so (and can do so with some basic level of competence.)

That said, I disagree with the other posters that state there is no such thing as an uncomplicated ortho case. There most certainly are uncomplicated cases suitable for someone without a board certification. Just like there are simple tooth extractions, and tooth extractions that should be handled by an Oral Surgeon. There are easy root canals, and those that need to go to an Endodontist. Uncomplicated perio cases, and ones requiring the continuing care of a periodontist. You get the idea...

If you trust your General Dentist to refer you to an orthodontist if it were necessary, by all means let him evaluate you for orthodontic work he can handle.

[Robot Teeth]

I honestly feel like I personally could have installed my brackets in the correct positions, bonded them correctly, installed the wires and ligs, and made every decision that my ortho has made since I got them, and be no worse off for it. I have come to the conclusion that orthodontists, while they may possess a level of in-depth knowledge unknown to dentists and furthermore, clients, are dramatically overpaid and really don't have to do much actual work or decision making. A great majority of the cases have got to be very simple to address, and once the mysticism of braces is shoved aside, the mechanics of the process really is not complicated at all.

Now of course, I'm not going to fire my ortho and take matters into my own hands, nor will I suggest that anyone else do so. But this isn't rocket science. Heck, maybe I'm just a know-it-all, because I don't consider rocket science all that complicated either. But our orthodontists are laughably overpaid for what they do (spend 5 minutes with you every two months).

Definitely still USE an orthodontist, or at least a dentist who is trained in orthodontics but does not market himself as an ortho. And shop around. Find the best price, but make sure you're comfortable and confident with them.

And whatever you do, hold your ortho accountable and do not settle for anything less than perfection in your eyes. Braces are expensive, and I'm not going to let some rich orthodontist who thinks their time is gold jerk me around, take shortcuts, let me remain uninformed, or otherwise provide me with less than optimal service for the thousands of dollars I'm paying them.

[vincent168]

So lets say all i need to do is straighten slightly crooked teeth, wouldn\'t both the ortho and dentist obtain the same results provided they use the same technology?

I was under the impression that perhaps both may have conflicting opinions about how to treat other issues e.g. whether surgery is required to fix an underbite

[joanne88]

Maybe you can consider how experienced he/she is in the field? My general dentist also does orthodontic work and he's been doing it for over 25 years. I always see both adults and teenagers walking in and out of his office with braces. Since he has a lot of patients, I would be more at ease to assume that he knows what he's doing. If he was no good, wouldn't negative comments of him spread around?

So if you trust your dentist and have been with him for several years, why not give it a try?

Best of luck with your decision.

[sirwired]

Robot Tooth,

I think you give yourself a little too much credit for the decisions necessary to start treatment. Let's say you've decided on conventional metal brackets. Looking through the 3M Unitek Product Catalog, you need to select a bracket for your upper left cuspid. You have no less than approx. 150 options (approx. double that if you count the two adhesive systems available for most of them.) They vary by product line, slot depth, bracket width, slot width, torque, angle, and hook presence. And that's just one tooth.

Do you really think you'd have the least clue which one of those 150-ish options is the "best" for your situation?

I'm not exaggerating: I've seen my ortho's trays for molar bands. For the right 1st bicuspid, I'd say he had a tray of about 150 or so individual parts. Even each individual size had a bunch of different options.

To insert into that upper arch, you have a choice of approx. 800 different archwires.

You'll attach it using one of half-dozen or so priming and adhesive options.

Okay, you don't have many decisions to make for ligatures...

To be fair, nobody outside of the 3M warehouse stocks all those different choices; an individual orthodontist is going to have his own "style" and a standard set of perhaps a few thousand bracket/band SKUs and a few dozen archwires that they'll adapt to use on every patient. And he probably uses similar standard parts as the school he went to used. But that doesn't mean he doesn't understand those choices...

And, of course, it has to go on to a particular spot on each tooth.
Do you intrude or extrude the tooth to adjust the depth?
Tip in one tooth or tip out the next?
What is the chance of root re-absorption?
What elastics go where? And when? If at all?
Do you need to start off with arch modifications?
What schedule do you use to progress the wires?
Springs? Headgear? TPAs? TADs?
Extractions?
How fast to go?
When to start?
How long will it take?
Can the periodontal tissue support the work?
Using the parts you stock in your office, how does all that effect the previous decisions?
Bends in the archwires? Where? When? Which bends? How sharp?
Which combinations of movements will produce a stable, functional, and aesthetic result?

Is this an impenetrable art? No. Orthodontists (or even regular dentists) are human, not supermen. The basic principles are physics and anatomy. But just as it's a long way from Newton's 3rd law of motion to flying a rocket ship, it's a long way from browsing an orthodontics textbook to actually forming a quality treatment plan.

Budding orthodontists don't spend three years (on top of dental school) drinking expensive beer and shopping for the Spam's they'll buy by fleecing their trapped patients for every penny they're worth. The ortho does not just pull your x-rays off the stack, look at your models for a couple minutes, grab a pair of tweezers, glue those suckers to your teeth, and then go home to swim in his piles of ill-gotten gains. I'd say there's just a little bit more work involved (much of which you don't see) and much of which could probably be explained to you, but not something you'd be able to pick up on your own after a couple of weeks of hitting the books.

Yes, I doubt my orthodontist is hurting for money. But to earn that cash, he spent about 10 years in expensive post-secondary education, scraped up a pile of cash to start a practice (all that equipment and supplies don't come cheaply) and of course, has to pay his staff, which doesn't exactly work for minimum wage.

You are welcome to believe that your orthodontist is overpaid and underworked. But it's a disrespect to the profession to say you'd probably be able to do it yourself with little study or effort.

[Robot Teeth]

I WISH my orthodontist had given as much consideration to my specific situation as you've outlined. But it's pretty clear that she has not. I won't bother trying to articulate my reasoning for this to you, because I think it's an argument that isn't worth having, but I will admit that my initial phrasing was angled in a way that undermined their expertise. We both know that it's not as easy as gluing some crap in your mouth. That being said, all of those things that you mentioned are things I would have acknowledged in advance and addressed. I had the GAC catalogue and was researching each individual configuration before I got my braces, trying to determine which one I would end up with. I love research. Of course I don't own an x-ray machine or know how to predict the extent of root resorption. But these are just things that I could obtain or learn. There's nothing I can't learn. And my particular case - the only case I've claimed to be able to "handle" - is a relatively uncomplicated one, so most of the advanced techniques and considerations aren't relevant. If anything, I'd probably end up giving more consideration to each specific facet of my treatment (and planning thereof) than I could ever hope to get from an established orthodontist with a busy practice. I'm not intimidated in the least by orthodontics, and I am notorious for paying acute attention to detail. I really think that it is something that I could learn and excel at in a relatively short amount of time. The typical three years of supplemental training doesn't impress me, because ALL of college is unnecessarily drawn out and extended, so that the university can extract the maximum amount of money from you. And that's why they charge so much. They have to pay back their student loans and pay for malpractice insurance. I don't mind "disrespecting the profession" one bit, because overall, I see orthodontists as dramatically overpaid and not deserving of the esteemed regard we hold them in. They think their time is gold and the assistants do all of the physical work anyway.

[DrJasonKTam]

Interesting debate here. Even across orthodontists, there is a wide variety of skill and experience. However, I will say that the worst orthodontist is probably as skilled as the best dentist doing orthodontics out there. There is a local dentist here who teaches other dentists how to implement orthodontics into their general practices. He has taken just about every GP course out there. Inevitably, I see a couple of cases a year that just boggle my mind on how out of control they are.

As for assistants who do all of the physical work... I think this has absolutely no bearing on who should be getting paid. There's a story of a shoe factory that was churning shoes and making big bucks. One day, the machinery stopped working, and an engineer was called in to come and fix things. The engineer came in, looked at the machinery, and pushed a button, whereby the machinery started going again. The bill was $5000.

The owner was irate. How could the engineer charge $5000 for spending such a small amount of time fixing the problem? He demanded an invoice. The engineer obliged:

$1- pushing the button
$4999- knowing which button to push

My staff work very, very hard for me and they are paid well for it. However, they do not know what needs to be done and what they do is all under my responsibility. They did not spend the hundreds of hours on my 50+versions of office design, Saturday evenings doing online courses, the time to review patient feedback and come up with solutions, go in early to do the treatment planning, etc. There is no doubt we are paid well for what we do, and no one is asking for your esteem and respect, but to marginalize our level of expertise because we don't do the physical work is a poor line.

[catgyrl]

Preach it, Dr. Tam!!

The only thing my assistant does fully on her own, without being told, is to remove my chains and ligs when I sit down. Everything else is done only AFTER my ortho checks, tells her what exactly to do, and re-checks things after. And he often has to do a lot of the "strong-arm" work involving bending wires that she just can't do. I give my ortho a lot of heat about being non-communicative, but I will say that he definitely does his work, and with as little pain as possible. He knows what he's doing.

[BBQ Grill]

I really don't trust dentist that does ortho anymore... My last one seemed like he was only intrested in doing things the easy way... Told me I needed jaw surgery, extraction, invisaline would be good for me, if not let's do braces for 1 year to fix the crooked teeth but leave the bite as is.... I spent a whole year n 8 grand to get my teeth prep for braces... Than I started reading up on the process...felt like I was taken for a ride and one day I went for a consult with my current ortho who said everything opposite.... Invisiline would not work, no need for jaw surgery, no need for extraction because I have plenty of room, must fix the bite because my wisdom teeth has caused my under bite so he wants to get it back to normal, .... So I was like jeeeeze.... Hell yeah! Let's do it....