Metal Mouth Message Board

Every state has different laws about what assistants can and can't do, so it depends. With the proper training, assistants should be quite capable of of placing brackets on the teeth before a final check by the orthodontist, and frankly I have seen assistants with better bracket placement than some orthodontists

The AAO does offer some courses where assistants can be certified, but even if they receive certification by the AAO, the orthodontist really needs to spend a lot of time on their own to make sure their team is well trained to help them deliver the standard of care they set for every patient.

Really what you want is someone who is following the letter of the law in your state, whatever that may be, and an orthodontist who is committed to delivering the best possible smile for you or your children. Nothing should ever be delegated to a team member if they aren't capable of doing it up to your standards or if state law forbids it.

An assistant did mine. And one of the other assistants was giving her guidance. The orthodontist was with another patient. It was a little unnerving.

auco99 wrote:An assistant did mine. And one of the other assistants was giving her guidance. The orthodontist was with another patient. It was a little unnerving.

Did the orthodontist check or move the brackets before they were cured with the light?

I don't think so, but the entire experience was a blur, so I can't say for sure. I'd have felt less anxiety had the installing assistant not been receiving technique tips from the other assistant, but I guess it worked out okay.

In general, in the UK the orthodontist does all the work except pulling teeth!
I would be a bit worried if I had a young trainee person doing all the handy work when I was spending £2700 for the orthodontist's expertise.

Then again, it's such a long process I'm sure it's more important that the orthodontist is involved in wire choice, elastics, etc.

kennyandrew85 wrote:In general, in the UK the orthodontist does all the work except pulling teeth!
I would be a bit worried if I had a young trainee person doing all the handy work when I was spending £2700 for the orthodontist's expertise.

Then again, it's such a long process I'm sure it's more important that the orthodontist is involved in wire choice, elastics, etc.

That's interesting. Generally, the offices I've met with here in the US, like the one I went to as a kid, had a few stations with assistants, sometimes with a bench close by for patients waiting for the next free assistant. The orthodontist would check in with patients at the bench or station.

It looks like the orthodontists are working almost the same in the UK as here.
My ortho has one and one pt at the time and does most of the work himself. His assistants are doing the cleaning after each pt and taking x-rays We do a lot of chatting since he loves to chat and hear how things are going etc

It’s common that orthos has one and one pt at the time and are doing most of the work themselves here. Never seen the "American Style", the one with a lot of pts at the time and the assistants doing most of the pt work.

My orthodontist does everything herself, and only sees one patient at a time. She has a nurse with her to pass or hold things. This is in an NHS hospital. Before I was referred for surgery I saw a private ortho for an initial consultation, and he had a lot of chairs in one big room with assistants doing lots of the work.

a little off topic but do most of you get treated one patient at a time, or do you go in a room where there are like 5 patients all sitting there at the same time and the orthodontist moves around from one person to one person?

For myself, the ortho placed the brackets, and did the curing himself for the "free-handed" brackets on my 2nd molars. The remainder of the brackets were templated in a plastic impression; he pushed that into place, and the assistant cured.

For adjustments, I believe the "standard" in the US is for the assistant to do ligature removal, the ortho does an evaluation and selects the new wires (and places bends in it if necessary), gives instructions on any other things, like elastics, and the assistant inserts and ligates the wires.

I have to admit, having a highly-trained orthodontist spending his time putting on the ligatures seems to be kind of inefficient. Just like I don't expect my general dentist to scrape tartar or polish my teeth...

The "multi-chair" main room seems to also be pretty common. Because each patient doesn't need a huge amount of work most of the time, and there is nothing messy or gory going on, individual exam rooms are kind of a waste of space. (Although my ortho puts his adult patients in the Initial Eval / Records room in one of his offices.)

My ortho placed the brackets and does all the wire work each adjustment and tells the assistant what to do. The assistant placed my molar bands (she has about 40 years experience).

The assistants do all the wire re-placement and elastics and all that stuff. There is about 4 chairs and the ortho moves around to each patient, I see him for maybe 4-5 minutes each adjustment.

It seems like a great system and he is able to see about 10 patients an hour I think. As everyone is in a different stage of treatment or pre or post treatment its a busy little office but runs very effectively.

I have been very happy with their work so far and feel they are very competent and trustworthy

My original ortho did all the work himself, everything but removing and replacing o-rings. My new ortho is much younger, and her one of her assistants had the nerve to try to put a wire tie on a tooth without the ortho telling her to. I made it clear that that was unacceptable, and waited till the ortho came over. I'm sure they dislike it, but I don't really care.

My ortho does all the work herself with the assistance of a nurse in a single chair surgery. I must say I appreciate the individual attention and privacy and I always have the impression she has given me as much time as I need. When I look at my watch afterwards, I am surprised at how little time I have actually been in her surgery.

From what I have seen whilst waiting for my appointments, she works very hard, not stopping between appointments and always on time.

Hmmm. Interesting topic. I kind of always thought you just centered the bracket on the tooth and that was it, never thought about it being really precise. It must be obviously. It all seems so simple and magical. lol

I just assumed the ortho would place them, but now when I get my brackets I'm going to be sure it's him! I'd feel better anyway, unless the assistant looks really experienced.

Figuring out where "centered" is is a bit of an art. Also, modern brackets are called "pre-adjusted appliances." As in, they already have the correct angles and depth "dialed in" by precisely angling the bracket slot with the back of the bracket. (A single tooth might have a few dozen different combinations of angles and measurements within a single bracket product line. Figuring out which one to use is one place where the ortho is really earning his/her pay.) The reduces the amount of wire-bending the ortho has to do; he/she puts in a pre-formed archwire, and the bracket does the rest.

But none of that works if the bracket is not placed precisely on the tooth, at the exact correct angle. The ortho generally uses forceps much longer than you'd think he/she would need, I think because the position of the handle tells the ortho what they need to know about the bracket placement.