Lets Get This Thing Straight: An Overview of Orthodontics

Olivia Thomas

English III Honors Pd. 2

Mr. Piatak

February 23, 2017

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What do Khloe Kardashian, Gwen Stefani, and Tom Cruise have in common? They all

used orthodontia to adjust their pearly whites. Millions of people wear some type of appliance to

straighten their teeth, and while braces seem the most common, recent innovations have provided

other options. Orthodontics, the study of treating misplaced teeth and jaws with different

appliances, involves thousands of years of historical evolution, various types of education routes,

and an interesting daily life in the workplace.

As early as 5,000 BCE, the Sumerians documented dentistry work. These ancient records

share evidence of how people started taking care of their teeth. For example, incense, cloves,

and fennel soothed toothaches (Thivierge). Evidence from human skulls indicates that even

earlier in time, at around 50,000 BCE, crooked teeth posed an issue among the Neanderthals.

Archeologists also examined Egyptian mummies, finding individual pieces of metal placed on

teeth (Wahl). During the 1500s, books about dentistry became popular all around the world,

especially in Germany, Italy, and England. Some examples include Artzney Buchlein der

kreutter (The Little Medicinal Book for All Kinds of Diseases and Infirmities of the Teeth) and

Libellus de dentibus (A Little Treatise on the Teeth) (Thivierge). In addition to literary works,

many famous people contributed to orthodontic creation in the Middle Ages. Pierre Dionis, the

first person to create a group for this type of medical care, called dentists operators for the

teeth and stated that they could also open or widen the teeth when they are set too close

together. Pierre Fauchard, the Father of Orthodontia, contributed great knowledge regarding

the field and made his country, France, number one in dentistry. He practiced lingual

orthodontics, which meant the appliances secured onto the insides of teeth, pointing towards the

tongue, instead of facing outside. This led to many types of lingual appliances such as the
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jackscrew and the expansion plate (Wahl). From there, it did not take long for the practice to

really take shape, revolutionizing the dental industry.

As people started showing an interest in their physical look and health, the subject of

dentistry became more popular. The first profession involving dental care came about in the

seventeenth century. Although it focused mainly on repairing, cleaning, and extracting teeth, the

job included building artificial appliances and finding new ways to take care of one's mouth. By

the late 1700s, the invention of the toothbrush proved beneficial within the new occupation.

William Addis, from England, created the toothbrush by gluing pig or badger bristles onto a

piece of animal bone. Popularity quickly grew for this product, typically found in England,

France, Germany, and Japan. However, the United States did not begin producing the toothbrush

on a large scale until 1885 (Thivierge). Nowadays, toothbrushes come in multiple colors, shapes

and sizes, as well as mechanical options.

Americans interest in dentistry began in the 19th century. No dental degree existed, so

patients received care through ordinary people like physicians or barbers. The majority of

patients desired teeth realignment, due to malocclusions, which results when the teeth do not

align correctly with closed jaws. Treatment from unexperienced physicians or barbers occurred

without knowing what proper occlusion, the correct positioning of teeth, looked like. Due to the

lack of knowledge, diagnosis of patients proved unjustifiable and incorrect, which often led to

more problems. In the mid-1800s, Horace H. Hayden founded the first dental school at the

University of Maryland. Later on, the Society of Surgeon Dentists of the City and State of New

York came about as the first American dental association (Wahl). Today, numerous dental

schools and practices exist all across the United States.

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Pierre Hard invented braces in 1728, but it took 200 years to perfect them. In the early

1900s, gold, platinum, silver, and other materials created the wires, while various types of hooks

and bands gathered around the wire and the tooth. A more stable way of making sure the braces

stayed secure on teeth came about in the 1970s with the invention of a unique glue (Its All

About...). Now, in the 21st century, the development of 3D printing allows personalized,

custom braces and brackets, which according to Dr. Hill, provide greater opportunity to meet

each patients individual needs (Hill). With technological advancements continuing to occur in

drastic measures, dental care works more effectively and efficiently.

The twentieth century saw major advancements within the industry. During this time,

inventions such as dental x-rays and amalgam fillings, and innovations like sturdier, easier-to-use

handpieces, increased the quality of dental care available. Also, different career paths began

stemming from dentistry and focused on specific dental issues. Examples include endodontics

(diseases of dental pulp), periodontics (diseases of gums), orthodontics (straightening teeth), and

prosthodontics (replacing teeth) (Thivierge). Considering most teeth straightening occurs in

children and teenagers, the career path expansion provided a greater opportunity for people like

Dr. Hill to focus solely on treating this age group as well (Hill). Thanks to specific fields

branching out of dentistry, doctors now have the proper training for each specialized case that

walks through their office door.

Today, significant growth continues transforming the field of orthodontics into a more

practical and useful industry. Improvements consist of cone beam CT scanners, miniscrews, a

custom smile design, and passive self-ligating braces. Cone beam CT scanners take

three-dimensional pictures of a patients jaws, bones, and skull. Unlike previous

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two-dimensional, unclear x-rays, these scanners provide orthodontists with clear, precise images

of the mouth. This allows for a more thorough diagnosis, which gets rid of most errors or

setbacks that could occur throughout treatment. Although a current risk of radiation exposure

exists with CT scanners, scientific statistics suggest this technology offers more help than harm.

The amount of radiation exposed to patients may decrease in the future with CT scanner

innovations. Additional innovations, such as miniscrews, act as temporary anchorage devices, or

TADs, to eliminate unwanted shifts around the stronger teeth, especially molars. If these teeth

move even slightly, the entire appliance could shift, extending the treatment plan and schedule.

The TADs attach easily to the patient with a numbing cream on the gums, and after treatment

finishes, remove just as easily (Graham). While nothing in life has a 100% guarantee, todays

dental advances certainly ensure a patient will most likely come away with a successful

treatment more than ever before.

The custom smile design software, Insignia, allows an orthodontist to input a patients

information to customize an individual treatment plan complete with specific brackets and wires.

Personalized aspects of this technology create exact placement areas for the appliance, producing

the best possible bonding between teeth. A final technological improvement, passive

self-ligating braces, uses a new type of opening and closing bracket to create an area where the

wire can move freely around inside. Today, active ligation places wires in between the bracket,

resulting in friction and slower movement of teeth. With the ability of the wire to move on its

own in passive self-ligating braces, teeth shift more willinging, causing treatment to occur

quicker and more tolerable for the patient (Graham). Other futuristic methods that have started

to impact the practice include 3D photography, virtual dental models, and cone beam computed
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tomography (Graber). With the help of new technology, orthodontics will continue to advance

and could drastically in the future.

To begin the path of dentistry, during college students will need to complete basic

science courses such as chemistry, biology, and physics. Most aspiring orthodontists will choose

a science related major, even though dental schools do not have a preference for one specific

major. Dental programs typically last four years; the first two years focus on basic science

courses such as biochemistry, anatomy, physiology and microbiology. The final two years

provide exposure to different dental specialities; examples include orthodontics, periodontics,

pediatric dentistry, prosthodontics, and maxillofacial surgery. At the end of the four years,

students earn either a Doctor of Dental Surgery (D.D.S.) or a Doctor of Dental Medicine

(D.M.D.) degree (How to Become...). Given the amount of time and level of study needed,

students in dental programs must show a high degree of dedication and focus to achieve success.

Professionals in the business of dentistry consider the University of North Carolina at

Chapel Hill (UNC) School of Dentistry the best in the state, and one of the top dental schools in

the country. The general acceptance information includes: an average grade point average of

3.61, an average Dental Admission Test (DAT) score of 21, and an average admission rate of 82

students. Compared to other highly ranked dental programs, Chapel Hill admits less students

into their school and looks for slightly higher-than-average test scores for acceptance. While

hard work definitely plays a large role in studying at UNC, tuition for this program falls below

average at $25,258 for in-state students (Compare Orthodontic Schools). In addition to its

prestigious dental school, Chapel Hills School of Dentistry has a masters orthodontics program.

Founded in 1952, this program provides a 33 month curriculum to six lucky students each year.
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Throughout the course, students take part in many medical procedures such as orthognathic and

craniofacial surgery, while also attending interdisciplinary conferences. By their second year at

the university, students will gain the necessary knowledge to take the written part of the

American Board of Orthodontics examination; this will allow them to obtain board certification

preceding graduation. Once a student completes four years, they receive certification within the

field of orthodontics (Academic Programs). This combination of classwork and extensive

hands-on experience ensures graduates of UNCs orthodontic program come away prepared to

meet client needs from day one.

Three of the most reputable dental schools include the University of California-Los

Angeles (UCLA) School of Dentistry, University of California-San Francisco (UCSF) School of

Dentistry, and the University of Maryland School of Dentistry. At the University of

California-Los Angeles, the number one ranked school for dentistry, one must have an average

GPA of 3.66 and a DAT score of 22. In-state tuition falls 58% below the national average of

dental schools at $15,637 (Compare Orthodontic Schools). UCLA accepts eight students per

year, who go through a 36 month program specializing in orthodontics. Certification showing

completion of the program requires postgraduates to finish the Masters degree in Oral Biology

and the Orthodontics Postgraduate Training Program. From there, postgraduates gain countless

opportunities including participation in annual seminars, caring for patients with deformities, and

work with other professionals on finding solutions to dental issues (Moon). While orthodontia

requires a lot of schooling and real world application, the responsibility these doctors have, and

the end result of a patients happiness, justify the amount of time.

Ranked second in the United States, the University of California at San Francisco has a
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higher tuition, but requires lower test scores compared to other universities. This three year

program stresses hands-on experience in the classroom by giving students the opportunity to

work one-on-one with real life patients. Classes taught mainly by lectures and seminars educate

the purpose of the neuromuscular system, as well as how the facial structure grows and functions

(Orthodontics). Firsthand experience give UCSF students the chance to perfect their skills

while providing a much needed service to those who may not afford the care otherwise.

The final top three dental school in the country, University of Maryland, compares to the

national average when it comes to GPA, DAT scores, and tuition rates. However, Maryland

admits 105 students into their dental program, 24% above average (Compare Orthodontic

Schools). Resembling most universities, their postgraduate orthodontic program lasts 36

months, but only four new students begin training each year. During the three years, the

University of Maryland focuses on five major pillars: biomechanics, identification and treatment,

biology of the tooth, growth and development, and American Board of Orthodontics

certification. Since the campus sits in the Health Science Center of the university, graduates

have plenty of chances to work alongside and gather knowledge from other professionals in

similar fields. Unlike other schools, the University of Maryland requires students to investigate

and carry out a unique project throughout the curriculum, which will turn into a research essay

presented to a group of professors. Some theses turn out to have numerous uses within the field

and therefore become published in dental articles and discussed in medical seminaries

(Orthodontics Advanced Education). Even though the added project requirement increases the

amount of time, research, and commitment students must take on, the value and wisdom it brings

to both the student and the university seems invaluable.

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Education expectations and requirements have not changed in the orthodontic field. Even

though most dental schools look for students with a bachelors degree, they will accept

applicants with a minimum of two years of undergraduate studies. Before a student even gets

into dental school, they must complete the Dental Admission Test, or the DAT. This test, given

by the American Dental Association, evaluates students on general sciences, perceptual ability,

reading comprehension, and quantitative reasoning (How to Become...). The DAT compares

to the SAT, the Scholastic Aptitude Test, which most colleges require of high school students to

determine their general knowledge of english, reading comprehension, and mathematics. Similar

to the SAT, the DAT has a time limit of four hours and 15 minutes with a maximum score of 30

(Whats on the...). While some colleges do not require an SAT score for admission, all dental

schools do require a DAT score.

Obtaining an orthodontic degree means completing a postgraduate orthodontic program,

which takes approximately three years. Fifty nine certified orthodontic programs currently

reside in the United States, with approximately half located on the east coast (Compare

Orthodontic Schools). During the three years, students learn about orthodontics (tooth

movement), surgical orthodontics, and dentofacial orthopedics (guidance of facial development).

Furthermore, training takes place on the subject of research methodology and teaching, in

addition to completing a research project, attending conferences, and preparing case reports.

Upon completion of the program, students receive qualification as a dental specialist in

orthodontics. Likewise, earning board certification provides the opportunity to demonstrate

learned knowledge and skills in orthodontics. The American Board of Orthodontics offers

voluntary certification to orthodontists who pass a written and clinical exam. After completing
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18 months of a postgraduate orthodontics program, students take the written exam. Passing the

written exam qualifies applicants to then take the clinical exam. Regarding formal education,

every orthodontist must possess a state regulated license in order to practice. Licensing

requirements usually include graduating from an accredited dental school followed by passing a

written and practical examination. In addition to taking a state examination, students who wish

to practice a dental specialty, such as orthodontics, may need to complete a postgraduate

education program as well. In most states, a license will permit doctors to practice both general

dentistry and orthodontics (How to Become...). This allows for maximum flexibility within

the career because dentists offices will often provide an alternate career option for orthodontists

if their field does not have job openings right away.

Having a steady job before opening ones own orthodontic practice does not seem to hold

any advantages. Some students choose to go straight through school without gap years, while

others study in pieces. If a student does decide to break up their schooling, Dr. Hill suggests

interning during summers or finding a steady job at a local orthodontists office (Hill). Working

in this type of environment will allow a student to realize whether or not they truly want to

pursue a career in orthodontics. Likewise, internships allows for additional experience and real

world application of topics learned in the classroom.

According to Dr. Brett Hill of Hill Orthodontics, the dental field allows for maximum

flexibility. Since orthodontists become their own bosses, they can easily set individual work

hours and appointments. For example, Dr. Hill sees patients four days one week and then three

and a half days the next week. Although emergency appointments occur on rare occasions,

doctors still need to have availability incase something important pops up unexpectedly. He also
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believes in quality family time, which can become possible with a balanced, adjustable work

schedule (Hill). Unlike most careers, orthodontics provides a relaxed work atmosphere, which

gives doctors and dental assistants the ability to enjoy workdays and have down time on the

weekends.

Knowing what a patient and their family hopes to gain from an orthodontic experience

can encompass many challenges. Beauty is in the eye of the beholder. I must be aware of the

patients and parents cosmetic goals. Dr. Hill makes it a priority to ask if the patient has

questions or concerns regarding treatment. Another challenging aspect of the career includes

patient cooperation. If a patient refuses to wear rubber bands, has poor brushing habits, skips

appointments, and does not follow rules regarding their appliance, they will not receive the best

results. Additionally, if a patient exhibits irresponsibility over the course of their treatment,

treatment could take longer than expected, costing more time and money in the end. In order to

deal with the daily challenges and changes within the field, good dexterity seems an important

characteristic to have. Dr. Hill strongly thinks that a mind, capable of visualizing and

conceptualizing how a treatment plan will work out before it has happened, plays a major role in

an intelligent orthodontist (Hill). Despite the fact that academic intelligence seems essential to

becoming a successful orthodontists, utilizing common sense and problem solving skills can

often prove more useful in a doctors achievement.

Since older kids and teenagers make up most of the patients within the care of an

orthodontist, a large part of their experience revolves around encouragement and confidence. If

the doctor and other staff make an effort towards always incorporating positivity, patients

willingly spend quality time taking care of their teeth. Examples of positivity include
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complementing good habits, offering incentives for wearing rubber bands or other appliances,

and showing patients their own images before braces to reiterate rapid progress. According to

Barry Glaser, only six percent of youth in America use Invisalign, but 75% of his patients

undergo treatment with Invisalign. Invisalign, a clear type of braces, recently became popular

because of their invisibility. Unlike normal metal braces, these unique plastic brackets allow

patients to smile and interact with more confidence. Glaser believes this confidence boost guides

patients to take better care of their teeth compared to teens wearing metal braces (Glaser). This

option also provides older adults an opportunity to correct their smile without having a mouth

full of metal.

The future of orthodontics holds a bright outlook on job openings and positions. As

doctors reach the age of retirement, they work shorter hours and do not see as many patients,

allowing new jobs to become available and new practices to open. Also, demand for dental care

in general continues to grow because the longer people live, the more they understand the

importance of personal hygiene. With the ability to start an individual practice, countless

opportunities come about. Orthodontists have the ability to choose how to operate business,

determine unique office hours, and handpick staff and nurses. The amount of flexibility

orthodontists have allow them to enjoy their job and work environment, while still having quality

time with family at the end of the day (Thivierge). Todays young adults have a strong desire for

a quality work and social life balance; orthodontia may offer that harmony, depending on the

location of the practice.

The field of orthodontics has proved to change and better the lives of millions of people

for thousands of years and will continue to excel and evolve for years to come. Through many
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technological advancements and various types of education paths, the career thrives and cares for

patients young and old all across the nation. Millions of people wear some type of appliance to

straighten teeth at some point in their lifetime, and orthodontists have not only helped shape their

teeth, but have helped shape their lives along the way. Dr. Hill captures this well, the day the

braces come off, and seeing the excitement from the patient and parents, is what it is all about

(Hill). Ultimately at the end of the day, the relationship between the doctor and patient matters

most.
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Works Cited

"Academic Programs." UNC School of Dentistry Master in Orthodontics Program. Web. 12

Feb. 2017. <https://www.dentistry.unc.edu/academicprograms/ade/orthodontics/>

"Compare Orthodontic Schools." Start Class. Web. 12 Feb. 2017.

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Hill, Brett. E-mail interview. 14 Feb. 2017

"How to Become an Orthodontist in 5 Steps." Learn.org. Web. 25 Jan. 2017.

<http://learn.org/articles/Orthodontist_Become_an_Orthodontist_in_5_Steps.html>

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<https://www.dentistry.ucla.edu/learning/orthodontics>

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<http://dentistry.ucsf.edu/admissions/postgraduate-programs/orthodontics>

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<https://www.dental.umaryland.edu/orthodontics/postgraduate-orthodontic-program/>

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