General Dentist Orthodontics: The War Is On

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General dentists, orthodontists and bracesWhile three quarters of general dentists think it’s appropriate for GPs to do orthodontics, only 4% of orthodontists surveyed feel the same way.

“Would you send your wife to a family physician for her brain surgery?” asked one orthodontist.

"I have seen more bad orthodontic work done by orthodontists than GPs," offered a dental office worker. "Most GPs tend to use more caution since they are scrutinized by orthodontists and other GPs."

Three out of four general dentists think it’s totally fine for them to be doing ortho.Should general dentists do ortho?

  • 74% of GPs say it is definitely appropriate for general dentists to do ortho.
  • 15% of GPs worry this may sometimes compromise the standard of care.
  • 11% of GPs say virtually all ortho work should be done by an orthodontist.

But orthodontists are skeptical at best.

  • 4% of orthodontists feel it is definitely appropriate for GPs to do ortho.
  • 55% of orthodontists worry this could compromise the standard of care.
  • 41% of orthodontists say they should do virtually all ortho work themselves.

We asked dentists for their thoughts on general dentists and orthodontics.

Just stay within your skill level

  • “As long as the case is appropriate for one’s skill level, I see nothing wrong with a GP doing Ortho.” (Mississippi dentist)
  • “As long as the GPs have adequate and proper CE training. We should not perform ortho unless we can achieve the same level of result as specialists, and we should explain to patients what the difference in results maybe, if any, between GP and specialist so the patient can make an informed decision to have the GP or specialist treat them.” (Texas dentist)
  • “Case selection is critical and should be based upon the knowledge and skill of the GP.” (Florida dentist)
  • “The critical factor is: does the GP have the proper training to do comprehensive ortho? Some GPs want the quick way to do ortho, but they need to understand the ramifications of tooth movement more than what was presented in dental school.” (General dentist)

Professional jealousy?

  • “Some orthodontists resent GPs doing their own ortho. Why is that? I have never met a single oral surgeon, endodontist; or prosthodontist that had a problem with my practice desires. It could be a matter of greed or pride. You make the call.” (Georgia dentist)

Mind the legal risks

  • “Those who are doing it hopefully have a good lawyer on their side.” (Kentucky dental implant dentist/prosthodontist)
  • Invisalign is becoming the latest malpractice issue.
    Too many GPs are doing it and getting into trouble!” (Florida dentist)

GPs lack the training

  • “The training is often minimal and results often are not retained. I just think it is better to leave the specialties to the specialists.” (Texas dentist)
  • “General dentists don’t have the proper knowledge to perform orthodontics. ‘Little knowledge is dangerous.’” (New York dentist)

Of course orthodontists do better orthodontics

  • “Orthodontists take three years of specialty training to become orthodontists. I don’t know how that can be compared with a general dentist doing orthodontics after attending some weekend courses on orthodontics. Of course the orthodontist will know more about the specialty and in greater depth than a general dentist.” (New York orthodontist)
  • “Would you send your wife to a family physician for her brain surgery?” (Orthodontist)

GPs don’t realize how little they know

  • “I practiced general dentistry before I went back for a formal orthodontic residency thirty years ago. What I thought I knew as a general dentist and what I learned from 30 years of orthodontic specialty practice is that general dentists think they know what they are doing when they do orthodontics. The fact is they are like teenagers who think they are great drivers.” (Virginia orthodontist)

Are GPs better than orthodontists?

  • “All too often I see problems with occlusion after many orthodontists have ‘completed treatment.’ Very few orthodontists if our area ever perform an occlusal analysis or do occlusal adjustments after completing orthodontic treatment. I think GPs that do orthodontics are much more inclined to
    examine the occlusion during and after treatment than most orthodontists.” (Ohio prosthodontist)
  • "I have seen more bad orthodontic work done by orthodontists than GPs. Most GPs tend to use more caution since they are scrutinized by most orthodontists and other GPs.” (California dental office worker)
  • “I’ve seen very poor ortho results on my patients. The Orthodontist felt the results were good because the smile was nice! It didn’t seem to matter that only 2nd molars occluded and she was getting severe migraine headaches! I’ve had too many patients with blunted roots – less than a 1-1 root ratio. I now have young patients that I worry that will lose their anterior teeth! So, yes, GP’s with training are very capable of excellent ortho results.” (Michigan dentist)

It’s all about having the dental continuing education

  • “As long as they stay within their level of training and they refer when appropriate.” (Texas pediatric dentist)
  • "They’re qualified, but GPs definitely need many hours of training and a lot of supervision during their learning curve.” (California dentist)
  • “GPs can do Ortho, provided they have had appropriate courses.” (Illinois dentist)
  • “Training is the key. Cases that look easy are sometimes quite complex.” (Georgia orthodontist)
  • “You need a comprehensive program. The best I have seen is Progressive Orthodontics, which is a full 2 year program.” (Ohio dentist)
  • “The quality of GP ortho is directly related to the quality and quantity of the dental CE.
    Most GP ortho CE courses are cursory and superficial. Only one or two are a true continuum that mimics an ortho residency.” (Alaska dentist)

If a GP is trained, there’s no problem

  • “Proper training is the key. Diagnosis is the most difficult part. Once you have the background, the rest is easy.” (New York dentist)
  • “Properly trained, GPs can easily do 70% of the ortho that is in their own practice. Even the father of modern orthodontics, Proffit, says this in the first chapter of the ortho book all dental students use!” (Florida dentist)
  • “With proper training, any GP should be able to perform any procedure, whether it is endo, ortho, dental implants, etc.” (Prosthodontist)
  • “A conscientious general dentist who obtains readily-available quality education in orthodontics is no less capable than any orthodontist in producing excellent orthodontic results.” (Illinois dentist)

Treatment is all across the board

  • "Training varies so much. Some GP’s do good work, others are motivated by financial incentive ads promoted by Invisalign, and others and provide mainly compromised care.” (Orthodontist)
  • “I have seen some fine orthodontics performed by GP’s and many poorly done, misdiagnosed cases by orthodontists. It’s the head and heart that drives the brackets, not so much the paper on the wall.” (General dentist)
  • “Many GP’s have more extensive and in-depth knowledge of ortho than newbie graduates of dental school programs where time constraints have not allowed a full 2.5 year case to be completed from start to finish.” (General dentist)
  • “As a pediatric dentist I have taken hundreds of hours of continuing education in growth and development and orthodontics and facial orthopedics. I choose my cases very carefully and refer more challenging cases to the orthodontic specialists I know and trust. I have seen outstanding results from general practitioners and pediatric dentists, and I have seen countless cases completed by orthodontists that do not meet the standard of care. This is not a multiple choice question.” (New York pediatric dentist)

Ortho work requires a lot of knowledge

  • "In my experience, I have seen too many GP’s influenced or trained by one guru. They do not have the arsenal of techniques that a good orthodontist has, thus providing the best of multiple solutions to an often complex situation." (North Dakota dentist)
  • “The techniques today allow any general dentist to align teeth; however, there is more to orthodontics than tooth alignment. Function and facial esthetics must be addressed in every case. If these issues are not addressed, the alignment may be unstable, serious functional problems can develop, and facial features can be compromised. Most of the programs for general dentist do not address these issues.” (Orthodontist)
  • “This does not include INVISALIGN that advocates weekend seminar and starting cases. My full ortho training took 5 years.” (General dentist)
  • “Orthodontics is deceptively simple to do. Any dentist can attachment brackets and tie archwires (it is easier than composite restorations), but knowing how to be efficient, accurate, and organized requires knowledge of biomechanics, growth and development, and other experiences one can only acquire with graduate study is important to treatment success. This from an orthodontist with 42 years of practical experience. Sad to say that there are orthodontists that don’t have it either. have it either.” (Orthodontist)

Orthodontists have to bail out GPs

  • “With the advent of Invisalign, GP’s are doing more ortho. Every orthodontist is being asked to help or bail out GP cases as they often underestimate the complexity of cases and or are tackling more complex cases than they should due to economic pressures. Very sad for our patients.”(California orthodontist)

Why ortho and braces are complicated

  • "A general dentist spends 8,000 hours learning the basics of dentistry. A specialist, like an orthodontist, spends 4,000-6,000 hours learning the BASICS of orthodontics. When is the last time you saw an orthodontist who had graduated from a residency that you said, ‘Wow! He or she does the best orthodontic work I have ever seen! He or she never makes mistakes and is PERFECT!’ Now, imagine a person who takes a couple weekend courses, maybe 100 hours of course work. I would be very worried for the patients; the whole reason we have our jobs as dentists." (General dentist)
  • “General Dentists should provide any specialty treatment they feel comfortable providing — as long as they provide a good service, provide it legally and provide it in the patient’s best interest. It is known that 80-90% of orthodontic treatment is cosmetic. It is also known that a patient can see 10 different doctors, get 10 different treatment plans and 10 different results. (Reference: 2005 Orthodontist meeting in Las Vegas) So, which treatment plan or result is right and which one is sub-par? And do you judge the treatment at debanding or 5-10 years later after relapse? Yes, GPs see relapse on a regular basis after ‘specialist’ treatment.” (Maryland dentist)

In rural areas there may be no orthodontist

  • “In some parts of the country, it is difficult for the patient to travel to a larger town for services that require multiple visits. Plus, we see these kids from very early ages on up and can stage treatment for them.” (Minnesota dentist)
  • “I think the statistics are 25% of GPs are doing orthodontics, especially in smaller communities with no orthodontist.” (Not a dentist)

GPs can do great work with dental braces

  • “The GP I work for has been doing orthodontics for 30 years with spectacular results.” (General dentist)
  • “Minor orthodontic tooth movements which fit into an overall treatment plan definitely can be performed by GPs.” (Periodontist)
  • “No different than a GP doing endodontics, prosthodontics, pedodontics, oral surgery or perio.” (Florida pediatric dentist)

Other notes

  • “I believe that GPs need to uphold the standard of care required to practice orthodontics.” (New York dentist)
  • “Bad ortho can ruin a patient’s dentition.” (Georgia periodontist)
  • “I did ortho for ten years then gave it up because I just got too busy. It was best for building up a young patient base.” (Wisconsin dentist)

Are you kidding me?!?

  • “Yes, GPs should do ortho? What’s the big deal!” (Massachusetts dentist)
  • “It’s not rocket science.” (Australia dentist)
  • “Most ortho is done by high school graduates. There are some cases like genuine FUGLIES requiring many disciplines. Standard of care!!! are you kidding? I have yet to see a serial extraction case with a healthy joint at the age of 30. (Before thirty years old people are rubber.) Starting a case after the growth spurt results in compromise, as does: uncorrected abnormal breathing, allergies, correcting Class III before facial growth has ceased, not correcting facial asymmetries, even sleeping on one’s side!. Now that I think of it, the only thing that avoids compromise is great genetics, and good health.” (Georgia dentist)

 

Note: Survey sample included 135 respondents. Posted 8/24/2010

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