In the early 1890s, it was fairly easy to become a dentist. Most of the applicants to a dental school had just completed high school, they paid “a few pennies” to attend dental school, and their studies and training only lasted about 6 months. Upon graduation, a dentist could perform any dental procedure that he wished to do in any state. This included straightening teeth with “regulating” appliances. There were really no significant laws governing dentistry, and there were no dental specialists … only general dentists.
In 1892, a dentist named Edward H. Angle invented the specialty of orthodontics by declaring that he would limit his dental practice just to orthodontics. He believed that a dentist wanting to do orthodontics needed special knowledge and skills, and these could not be obtained in any regular dental school in the United States. So, in 1900, he started the first school of orthodontics with a course of study that was 8 weeks in length ( Fig ). In 1901, he started an organization to promote orthodontics (now called the American Association of Orthodontists). More orthodontic schools were started by other orthodontists, and in 1915 a new journal (now known as the American Journal of Orthodontics and Dentofacial Orthopedics ) was published to promote the specialty and advance the practice of orthodontics.
Given this level of organization and advancement, it is somewhat surprising that there were still dentists of that time who simply announced on their signs and business cards that they were orthodontists. They did so without any meaningful training, and their motivation was usually based on financial gain. They were sometimes called “the imitators.”
On the other hand, in 1915, it was argued that a dentist could become an orthodontist (1) after many years of orthodontic experience (this included dentists who learned orthodontics by trial and error, and were “grandfathered” into the specialty), (2) by studying and practicing with an experienced orthodontist (a preceptor-apprentice relationship), or (3) by attending and graduating from a recognized school of orthodontics.
Time, however, is never still; 100 years ago, many things were possible that are not possible now, and many things that were impossible a century ago are quite possible now. So, from 1915 over the next 100 years until now, there have been great advancements in dentistry and its related dental specialties. Oral health care improved greatly, dental technology has advanced, access to all forms of dental care has increased, and the public has become much better informed and served. Still, questions of education, scope of practice, legal issues, and professional ethics remain problematic, even today.
In 2015, students who apply for admission to a dental school usually have at least 4 years of college experience and have received a degree. They have also taken a national entrance examination in dentistry. Competition for admission into a dental school is keen; only the highest-level applicants are admitted. Approximately 5000 students are admitted into the nation’s dental schools each year. Those admitted will follow a 4-year program of study that includes almost 5000 hours of scheduled instruction and training in all aspects of dentistry. The vast majority of these hours are directed toward the control of disease (dental caries and periodontitis), pathology (extractions and surgery), and restorations of teeth (fillings, crowns, bridges, dentures, veneers, dental implants, and so on). The faculty of each dental school reflects the breadth of instruction provided; many general dentists as well as dental specialists are involved.
In terms of orthodontic education during dental school, few hours of instruction are provided; the national average is approximately 95 total hours of scheduled instruction (ie, less than 2% of the total hours of instruction). The time allowed for teaching orthodontics involves instruction in the classroom, working in a laboratory, and sometimes actually providing limited orthodontic treatment to 1 or 2 patients in the clinic. At some schools, as few as 11 hours of instruction in orthodontics are provided. The overall quality of dental education in all the dental schools in the United States is maintained by the Commission on Dental Accreditation of the American Dental Association. Accreditation is recognized by state and federal governments as a valid method of assessing academic quality and ensuring public accountability and safety.
Dentistry: The evaluation, diagnosis, prevention, and/or treatment (nonsurgical, surgical, or related procedures) of diseases, disorders, and/or conditions of the oral cavity, the maxillofacial area, and/or the adjacent and associated structures and their impact on the human body, provided by a dentist, within the scope of his or her education, training, and experience, in accordance with the ethics of the profession and applicable law (American Dental Association).
Everyone who fulfills the requirements of a dental school is granted a degree (either DDS or DMD) and is educationally qualified to be a general dentist (also sometimes referred to as a “primary care provider”). To become a licensed general dentist in any state in the United States, a graduate of a dental school must also pass the National Board Examination in Dentistry (a written examination) and a regional or state clinical examination. Once licensed, general dentists can perform any dental treatment they wish as defined by the laws of the state in which they practice general dentistry.
After graduating from dental school, about 10% to 20% of the graduates seek additional education in 1 of the 9 dental specialties or advanced training in general dentistry. One dental specialty is orthodontics. Dental graduates who wish to pursue training as orthodontists must seek admission to 1 of the 73 graduate orthodontic programs in the United States and Canada. Applications number in the thousands, but only about 350 are admitted each year. Generally, those admitted are some of the most accomplished students based on their college and dental school performances.
Orthodontic programs in the United States are 2 to 3 years in length; a minimum of 3700 hours of scheduled instruction are required for all 73 programs in the United States and Canada; the orthodontic program at Saint Louis University is 2½ years long and includes approximately 4000 hours of scheduled instruction. Time is spent in lectures, seminars, laboratory exercises, and clinical care of patients; all of these efforts focus directly on orthodontics. The vast majority of the time is spent in the clinic treating patients. The clinical faculty consists of accomplished and experienced orthodontists. At Saint Louis University, we have approximately 40 clinical instructors whose cumulative experience in orthodontics is nearly 1000 years. Under the direct supervision of the clinical faculty, the students participate in the treatment of hundreds of patients and observe the treatment of hundreds more. The goal of all orthodontic programs is to produce knowledgeable and skilled orthodontists who are proficient in straightening teeth, aligning jaws, and improving facial appearances. At the conclusion of the orthodontic training, the graduates are awarded a certificate of specialty training in orthodontics and often a master’s degree. The quality of orthodontic education in the United States is also maintained by the Commission on Dental Accreditation of the American Dental Association; accreditation of orthodontic programs began in 1966.
Upon graduation, in order to practice orthodontics, a graduate must obtain licensure as a dentist (if not done prior) and be recognized (or be licensed) as an orthodontist; the details are determined by the dental board of the state in which the orthodontist will practice.
Orthodontics and dentofacial orthopedics: Orthodontics and dentofacial orthopedics is the dental specialty that includes the diagnosis, prevention, interception, and correction of malocclusion, as well as neuromuscular and skeletal abnormalities of the developing or mature orofacial structures (American Dental Association).