The American Dental Association classified orthodontics as a specialty in the 1950s. This specialty was one of the first areas to be recognized by the ADA. As of today, nine areas have been officially designated as specialty areas in dentistry. It is interesting to note that most of the activity in many of the specialties also is accomplished by general dental practitioners. However, most American dentists would agree that they received almost no instruction in orthodontics while in dental school, and their involvement in this area has been minimal, if any, since graduation.
Why has orthodontic therapy been accomplished primarily by specialists, while general dentists accomplish most of the treatment in the other specialty areas? The answer to that question would require a significant amount of study, but I feel that most dentists would speculate that it is the lack of orthodontic education in dental school, as well as fear of the unknown, that have impeded most general practitioners from becoming involved with orthodontics. A few general practitioners have taken short courses on some aspects of orthodontics and have accomplished limited orthodontic therapy. Others have taken longer courses and have upgraded their orthodontic education to a level at which they are able to accomplish most areas of orthodontic therapy.
This article discusses the issue of general dentists’ becoming involved with orthodontic therapy, as well as current procedural developments that have the potential to change the degree of general dentists’ involvement in orthodontics.
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ORTHODONTIC TREATMENT IN GENERAL PRACTICE
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There are several areas of orthodontic therapy that potentially fall within the realm of general dental practice. The following treatment needs are observed by general practitioners every day; they are what most orthodontists would consider to be minimal. Some are malocclusion or malpositioning situations that occur frequently in adults who are receiving restorative or prosthodontic care. Other orthodontic needs occur during the natural collapse of the occlusion associated with aging and periodontal breakdown. Some orthodontic situations are encountered by general practitioners and pediatric dentists during the developmental stages of childhood and adolescence. Descriptions of a few of these treatment needs follow.
Tipped teeth related to extraction of adjacent teeth.
Often, teeth drift into abnormal positions after adjacent teeth have been extracted. Sometimes, these clinical situations can be corrected by restorative or prosthodontic therapy, but frequently, orthodontic therapy makes subsequent restorative therapy easier and more predictable.
Collapsed occlusion related to secondary occlusal trauma.
People 50 years of age and older commonly have long-standing periodontal disease, with its associated bone degeneration and drifting of teeth. After treatment of the periodontal disease and stabilization of the periodontal health, it is desirable to close diastemas and stabilize the occlusion. This minor orthodontic therapy can be accomplished simply and rapidly. After the orthodontic treatment has been completed, on the day of removal of active orthodontic forces, an occlusal equilibration should be accomplished to stabilize the teeth in their new positions, and to remove the long shift from centric relation to centric occlusion usually associated with secondary occlusal trauma. In my opinion, all of this therapy should be within the realm of general practice.
Dentitions with a few anterior teeth out of alignment.
Misalignment in anterior teeth occurs frequently, and it impairs the appearance of the patient’s smile. Usually, the misalignment is related to lack of space in the respective arch for the width of the teeth. A simple stripping of some of the enamel from the interproximal surfaces of the teeth and movement of the malpositioned teeth back into the arch form is an effective procedure that is appreciated by the patient.
Minimal malocclusions in the mixed dentition.
General dentists and pediatric dentists see patients on a routine six-month basis, and they easily can observe potentially negative developments in their patients’ occlusions. When simple occlusal problems are noted at an early time, orthodontic therapy prevents significant future orthodontic challenges.
As with any other specialty (including my own, prosthodontics), general practitioners who do not have conventional orthodontic education but who have received additional education and clinical experience in orthodontics should be able to accomplish orthodontic procedures within the realm of their interest.
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A RECENT ORTHODONTIC ADVANCE
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In 1997, Align Technology Inc. (Santa Clara, Calif.) developed the concept called Invisalign. As is now common knowledge among dentists and most of the lay public, this technique uses a series of clear plastic traylike "aligners" that are used over a period of months in the mouths of patients who need orthodontic therapy. The orthodontic appliances are not easily observed when in the mouth. Because of the esthetic improvement this concept represents in comparison with standard orthodontic brackets and wires, patients’ acceptance of it has been very good.
The Invisalign concept is suited mainly to adults or to adolescents who have a fully erupted dentition. It is not for all patients with orthodontic needs. The table
provides a comparison between traditional orthodontic treatment and the Invisalign technique.
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ORTHODONTIC TREATMENT IN GENERAL...
A RECENT ORTHODONTIC ADVANCE
