A Career in Orthodontics

Alex Hines

Mr. Alburger

English III

6 December 2018
 Hines 1

Alex Hines

Mr. Alburger

English III

6 December 2018

A Career in Orthodontics

Everyone aspires to have a perfect smile. Unfortunately, most people lack a perfect smile

from birth, and therefore choose to fix their teeth. Due to the evolution of braces, people can

achieve the smile they desire. The ortho industry has thrived for thousands of years and

continues to advance through schooling, day to day tasks, and new innovations that will impact

the future for many people.

Orthodontics dates back to the year of 400 B.C (Green). The Egyptians used a very early

form of braces in order to achieve straighter teeth (Green). Historians believe they invented the

first form of braces (Green). As many archaeologists discover mummies, they notice that some

of them have metal bands or animal intestines tied around their teeth (Green). When the

Egyptians tied the metal or animal intestines around their teeth, the pressure acted upon their

teeth and forced the teeth to move into place (Green). Egyptians took the first step in creating the

ortho industry.

Ancient Greeks, Etruscans, and the Romans also used an early form of braces to

straighten their teeth (Green). Similar to the Egyptians, the Greeks, Etruscans, and Romans put

metal bands around their teeth to straighten or keep them in place (Green). When the women of

these civilizations died, people would tie gold metal bands around their teeth in order to keep

them in place (Green). They created the foundation of orthodontics through procedures like
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these. These Greeks, Romans, and Etruscans used similar techniques like the Egyptians around

the same time that civilization figured out how to straighten teeth.

Hippocrates, an Ancient Greek physician, wrote about tooth crookedness in 400 B.C

(Green). He recommended moving the teeth by pushing them regularly with one’s fingers

(Green). Historians believe that his writings on tooth crookedness remained the first to exist

(Green). A Roman natural philosopher, Pliny the Elder, had his own way of straightening the

teeth (Green). He suggested filing them down to size in order to straighten them (Green).

Evolution of orthodontics continued to advance with the Ancient Greeks.

During the 17th century, Matthaeus Gottfried Purmann began using wax to take dental

impressions (Green). This set the basis for the evolution of impressions (Green). In 1756, Phillip

Pfaff used Plaster of Paris to take dental impressions and began to improve upon Purmann’s

work (Green). Many acknowledge Pierre Fauchard as the Father of Dentistry (Green). He created

an appliance called the Bandeau in the late seventeenth century (Green). The Bandeau consists of

a strip of metal in the shape of a horseshoe that aids in straightening the teeth (Green). He would

also forcefully move patients teeth, with the help of forceps, and tie them to neighboring ones to

hold them in place while they healed (Green). Fauchard continued to advance orthodontics with

new way of creating straighter teeth.

Christophe-François Delabarre tried to create space between the teeth with items such as

wooden wedges or swelled thread (Green). Essentially, he created the first modern set of braces

(“History”). His invention used a wire “crib” that went around every two teeth, in order to align

them (“History”). In 1822 in the United States, Gunnell invented a device which he called

headgear (Green). This product fastens to the jaw and goes around the head to put slight pressure
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on the teeth (Green). Because Delabarre created the first set of modern braces, many saw it as a

major breakthrough for orthodontics.

Charles Goodyear invented vulcanized rubber in 1839 and many orthodontists realized its

potential (Green). In 1840, Chappi A. Harris published the first known book on dentistry

(Green). It included fusing knobs on bands to assist tooth rotation and putting caps on molars to

open one's bite (Green). Evolution of braces continued when Dr. Edward Maynard introduced

elastics in 1843 (“History”). These tiny rubber bands attached to the brackets to improve jaw

alignment and correct overbites and crooked teeth (“History”). The invention of rubber for

orthodontics allowed for many different advancements in the practice.

In 1846, E.G Tucker became the first American dentist to use rubber with orthodontic

appliances (Green). Edward Hartley Angle, the Father of Modern Orthodontics, identified the

properties of malocclusions, misalignments, and wrote books on how to address these issues with

orthodontic appliances (Green). In the 1950’s, orthodontists used gold for the wiring of the

braces because of the malleability of the material, but then switched to stainless steel to offer a

more affordable option for patients (“History”). Before the invention of adhesive in the 1970’s,

brackets stayed on the teeth with wire wrapped around each individual tooth (Green). Once

adhesives came around, brackets stuck like glue to the tooth’s surface (Green). Lingual braces,

braces on the back side of the teeth, appeared in the 1970s and assisted with the aesthetic

concerns of patients (Green). At the end of the 20th century, NASA made heat-activated

nickel-titanium alloy wires (“History”). Because the wires hold a flexible property when at room

temperature, they require less attention than regular steel wires (“History”). In May of 2000, Zia

Chishti and Kelsey Wirth created Invisalign (“History”). This aesthetically pleasing, clear plastic
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retainer fits to the patient's teeth with adjustments occurring every few weeks (“History”). The

many advancements that transpired from 1846 to 2000, shows how orthodontics really began to

explode, most importantly with the creation of Invisalign.

Orthodontics exists as a dental specialty where the teeth and jaw manually become

realigned into the correct position to achieve an attractive arrangement and prevent further dental

problems (Singer). The term orthodontics derives from the greek words that mean “straight

teeth” (Singer). Genes play a big role in the way our teeth and jaw align (Singer). Each person's

teeth and jaw differ from one another (Singer). Different dental problems result from the variety

of mouth types.

Orthodontic problems may arise from thumb sucking, which can move the teeth out of

appropriate positions (Singer). Children make up the majority of orthodontic patients, however,

sometimes adults undergo treatment (Singer). Each year, five million americans receive

orthodontic treatment (Singer). A few goals of orthodontics includes improving the position of

teeth for proper chewing and swallowing, encouraging proper speech, helping prevent

periodontal disease and decay, and boosting the patients self esteem by improving appearance

(Singer). Most people fix their teeth to improve their appearance.

Malocclusions define as the misalignment between teeth and jaws (Singer). Edward H.

Angle identified the three classes of malocclusions (Singer). Class one malocclusions occur

when the lower first molars position themselves slightly forward than the teeth above (Singer).

Some individuals have biliminary protrusion which occurs when the front teeth of the jaws flare

forward, which can lead to tooth decay and periodontal disease (Singer). Class one can also

identify as a normal bite and occurs often.

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Class two and three malocclusions appear under the same category (Singer). In class two,

the first molar positions itself in such a way to produce buck teeth (Singer). This happens when

the upper jaw protrudes too far forward compared to the lower jaw (Singer). A mismatch of

jawbones best describes the class two malocclusions (Singer). As both classes consist of jaw

problems, they share the same categorical malocclusion distinction.

Class three malocclusion occur when a person has a crossbite (Singer). This happens

when the bottom front incisors protrude in front of the upper ones (Singer). This problem,

although easily fixable, may require surgery in some severe cases (Singer). These classifications

do not include issues with the vertical relationships of the jaw (Singer). Examples include

overbite, where the upper teeth completely hide the lower teeth because the upper jaw shifts so

far forward, and an open bite, where a gap occurs between the upper and lower teeth (Singer).

Even though vertical jaw problems do not go into the class two or three malocclusions, treatment

exists to help fix them.

Functional malocclusions include thumb sucking, chewing the lower lip, and tongue

thrusting (Singer). Thumb sucking can cause a class two malocclusion which may result in an

open bite (Singer). Chewing the lower lip can cause the upper front teeth to flare out (Singer).

Tongue thrusting (a consequence from asthma), can cause a crossbite, an open bite, or some form

of a class two malocclusion (Singer). All functional malocclusions occur because of physical

tendencies, which lead to dental problems.

The first stage of orthodontics begins with a diagnosis and x-rays of the patient's mouth,

which can require several office visits (Singer). On the 3rd visit, the patient receives the plan for

treatment and once agreed upon, the treatment process, which can require several years of visits,
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begins (Singer). Once the patient has the orthodontic appliances on, their teeth should remain

clean or it can lead to tooth decay (Singer). Orthodontists suggest that patients avoid hard or

sticky food which may result in the appliance breaking (Singer). Patients become responsible for

taking care of their appliances and keeping their teeth clean.

Moving the teeth, directing jaw growth, altering behavior of jaw muscles, and keeping

the final position of the teeth, stands as the purpose of orthodontic appliances (Singer). Two

principles operate on this belief (Singer). The first principle transpires because bone growth

slows when pressure becomes applied in opposition (Singer). Because of the stunted bone

growth on one side of the mouth, the opposite occurs on the other side, where growth remains

stimulated and movement ensues (Singer). Orthodontics appliances cause both of these

principles to work.

Braces stand as an example of a fixed appliance, defined as a treatment that stays

attached to the mouth for the duration of the therapy (Singer). First, orthodontists place metal

cylinders around chosen anchor teeth (Singer). Then, the orthodontist attaches brackets on each

tooth and weaves a wire through them (Singer). The orthodontist bends the wire in order to help

move the teeth (Singer). Most of the time, orthodontists will suggest elastic bands to help pull the

jaw forward or push it backwards (Singer). Wearing braces, for the most part, presents with very

little discomfort.

Over the years, orthodontics has evolved to make braces more appealing to children and

adults (Singer). Several factors contribute to the demand to make braces more attractive and

appealing (Singer). In attempt to make braces more enticing, orthodontists started using a

stronger material made up of synthetic polymer that appears less visible, but still has the same
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capabilities as regular braces (Singer). Many adults want to better their teeth, but want the braces

to look as attractive as possible, which drives orthodontists into coming up with the most

effective and desirable treatment (Singer). Everyday, orthodontists try to think of new ways to

make braces more attractive.

Common problems like white spots, discoloration, and gum recession can occur if a

patient does not maintain proper hygiene (Raftacco). Ninety percent of people unable to obtain

proper hygiene see these problems occur (Raftacco). After removal of the braces, white spots

may appear where the brackets once endured (Raftacco). These stains usually last a lifetime

without the right treatment (Raftacco). The enamel on top of each tooth has a slight yellow tint,

however when enamel gets destroyed, the white tissue starts to show, which leads to tooth decay

(Raftacco). Braces make it harder to brush your teeth because food traps easily, but with proper

oral care and the right food choices, tooth decay will not occur (Raftacco). A very common

negative side effect of braces, incipient carious lesions, occur around brackets and bands

(Raftacco). Brackets placed on teeth prevent natural cleaning mechanisms such as the movement

of oral musculature and saliva from occurring (Raftacco). Because braces generate more plaque

than usual, patients become more susceptible to carious lesions (Raftacco). Ninety percent of

people who have had orthodontic appliances suffer from yellow discoloration, eighty percent

exhibit white spots on the teeth, and seventy-five percent present with tooth decay (Raftacco).

Eighty to ninety percent ​of people suffer from gum recession and a lot of people eventually

experience gingivitis (Raftacco). Decalcification occurs in eighty percent of orthodontic patients

and usually consist of treatment with a plaque controlling toothpaste containing fluoride

(Raftacco). Patients who use proper oral care such as flossing, washing their mouth, and
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receiving fluoride treatments will show no signs of white spots or decalcification (Raftacco).

Having proper oral care will benefit patients in the long run because it will avoid problems such

as these.

Orthodontists must maintain critical skills in order to be successful. These include ​active

listening, critical thinking, speaking to others to effectively convey information, identifying

complex problems while developing solutions​, and ​judgement and decision making

(“Knowledge”). With active listening, orthodontists solve problems to gain a better

understanding of a situation(“Knowledge”). Critical thinking uses the logic and reasoning of

orthodontists in order to approach problems and find solutions (“Knowledge”).​ All orthodontists

must speak to their patients and staff to convey information back and forth (“Knowledge”).

Judgement and decision making plays an important role in striving for the most effective

solutions to problems (“Knowledge”). These five main skills above become very important

when orthodontists have their own businesses.

The five most important abilities required for an orthodontist to succeed include problem

sensitivity, having a steady arm, deductive reasoning, finger dexterity, and inductive reasoning

(“Knowledge”). Problem sensitivity, the ability to tell when a problem occurs, becomes an

important skill to have because orthodontists have to decipher the importance of problems that

exist on any given day (“Knowledge”). Orthodontists must display steadi handedness when

applying or fixing appliances (“Knowledge”). With deductive reasoning, orthodontists must

possess the ability to apply general rules to specific problems that occur (“Knowledge”). Finger

dexterity defines as the ability to manipulate small objects with ones fingers which becomes a

very important skill for an orthodontist to have because most orthodontic appliances remain very
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small in order to fit the patients teeth (“Knowledge”). Inductive reasoning, or the ability to

combine pieces of information to form conclusions, remains very crucial in the field of

orthodontics (“Knowledge”). All of these abilities tie in with each other to make a successful

orthodontists.

Knowledge of medicine and dentistry, customer and personal service, knowledge of

biology, and administration remain vital to securing a successful practice (“Knowledge”).

Expertise in general medicine and dentistry serves to aid the physician in diagnosing and treating

patients (“Knowledge”). Orthodontists must possess excellent interpersonal skills to ensure

customer satisfaction (“Knowledge”). Managing a business, strategic planning, and coordination

of staff, play a key role in orthodontics (“Knowledge”). In order to remain successful in this

field, one must know how to take care of a business and plan things out (“Knowledge”). All of

these listed knowledge areas play a big role in having a successful career and business.

Typical tasks of an orthodontist include managing teeth and jaw problems through

affordable treatment options, in addition to instructing assistants and associates on dental

procedures (“Tasks”). Coordinating orthodontics with other medical services from elsewhere that

a person may receive from elsewhere becomes an important everyday task especially with new

patients (“Tasks”). Orthodontist must design appliances such as retainers and lingual arch wires,

in addition to adjusting appliances to maintain proper tooth position (“Tasks”). Everyday, they

administer x-rays of patient’s mouths and study their diagnostic records (“Tasks”). Typical tasks

tasks like these occur everyday in the life of an orthodontist.

Common work activities of an orthodontist involve observing assistants and other dental

associates to ensure the clinic runs smoothly, monitoring materials and processes of their
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assistants, and inspecting the tools used to ensure safety (“Tasks”). Orthodontists also estimate

the quantifiable characteristics of products, which means having a global sense of the differing

approaches in order to obtain a perfect smile (“Tasks”). Orthodontists must judge the quality of

the services provided from the office as a whole (“Tasks”). All day long orthodontists process

and evaluate the information of each and every patient (“Tasks”). Common work activities like

these and many more occur everyday in an orthodontic office.

A typical orthodontist in the United States earns approximately $​229,380 annually

(“Wages”). Seventy five percent of all orthodontists collect at least $147,450 (“Wages”). Fifty

percent of them made $166,400 (“Wages”). Ten percent of orthodontists in the U.S. make about

$166,400 (“Wages”). The amount that any orthodontist makes depends on how much business

they recieve. An orthodontist for the state of North Carolina makes about ​$274,520 annually

(“Wages”). The amount made depends on how much business they recieve.

Orthodontists in the United States earn on average​ $110.28 per hour (“Wages”). Ninety

percent of orthodontists make $37.68 per hour (“Wages”). Seventy five percent of United States

orthodontists collect at least $70.89 per hour (“Wages”). Fifty-ten percent earn $80.00 per hour

(“Wages”). The amount made per hour depends on the overhead. Orthodontists in North

Carolina make about $131.98 per hour (“Wages”). Ninety percent of North Carolina

orthodontists make $70.86 per hour (“Wages”). Seventy five- ten percent of them make at least

$80.00 per hour (“Wages”). The amount made per hour depends on what the business owner

decides. It also depends on the number of workers in the office.

The first step in becoming an orthodontist begins with completing four years of college

(“Career”). A student aiming towards this profession may want to select a school that offers an
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excellent dental program (“Career”). UNC Chapel Hill offers a great dental program as do many

other universities. After successfully completing college, the student must attend a dental school

(“Career”). The student must complete four full years of dental school to continue on with this

career path (“Career”). The four years of dental school plus the prior four years of college will

successfully prepare the student for their next steps in becoming an orthodontist.

While in dental school, the typical courses a student will take consist of anatomy,

physiology, and microbiology (“Career”). The classes offered specifically for orthodontics

include dental anatomy and occlusion, pediatric dentistry and dental materials (“Career”). During

their last two years of study, students must meet the requirement of gaining practice through

treating patients (“Career”). The orthodontic students go to a clinic to gain the required practice

(“Career”). Students get to learn many things about orthodontics through watching and actively

participating in the treatment of patients.

All orthodontists must obtain a license in their state in order to have the ability to practice

(“Career”). To attain a dental license, the student must graduate from an accredited dental

school, successfully complete the written National Board Dental Examinations and pass state

clinical tests (“Career”). Once they become a licensed dentist, they then have the option to

become certified by the American Board of Orthodontists (“Career”). Board certification may

assist practitioners in demonstrating their expertise in orthodontics to their patients and peers

(“Careers”). Choosing to attain this certification can help the orthodontist’s business because it

shows off their skills in the field.

To become certified, the aspiring orthodontists must pass their written and clinical exams

after completing their orthodontics residency (“Career”). In order to keep their credentials
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current, they must recertify every 10 years (“Career”). Orthodontists must have their

undergraduate degree and the completion of 4 years of study at an accredited dental school

(“Career”). They also must have their Doctor of Dental Science degree, and orthodontics

residency completed (“Career”). These credentials play a very important role in becoming a

certified, practicing orthodontist.

Steven Gardener, the founder of OrthoSelect, believes that his company will push

towards the future of orthodontics (“Digital”). His invention, the Digital Indirect Bonding

System (DIBS), combines digital technology and 3D printing (“Digital”). OrthoSelect grew from

a small lab in the mid 2000s to produce over 10,000 digital study models per month (“Digital”).

Combining cutting edge technology with innovative ideas to revolutionize everyday orthodontic

materials lies as their mission (“Digital”). OrthoSelect strives to benefit everyone with their new

technology.

Their mission led them to something called Indirect Bonding System, or the IBS

(“Digital”). The idea of bonding multiple brackets simultaneously seemed perfect, however,

technology continued to lag behind (“Digital”). DIBS incorporates digital technology and 3D

printing (“Digital”). By combining these concepts, the company hoped that this new invention

would work as planned. With the right mindset, Steve envisioned that someday his dream would

turn into a reality.

In order for this technology to work, orthodontists must submit their cases to OrthoSelect

in the form of a PVS impression, a stone model, or an intraoral scan (“Digital”). With

OrthoSelect’s software, technicians will virtually place the brackets on the patient's teeth, based

on the doctors prescription (“Digital”). The finished virtual placement of the brackets on the
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patient's teeth returns back to the orthodontist for approval (“Digital”). The orthodontist can then

make changes and fine tune bracket placement if necessary, and when completed, the doctor will

provide permission to the lab (“Digital”). Once the lab workers gain approval, they digitally

render their patent pending trays and 3D print them into a physical form (“Digital”). After

completion of the 3D printing, the brackets progress into the trays and get shipped back to the

orthodontist (“Digital”). This new system continues to advance, making orthodontists lives

easier.

Because of the use of extremely precise 3D rendering software, OrthoSelect does not

have any competition (“Digital”). The End-of-Treatment simulation, another major feature they

developed, simulates a wire running through a patient's brackets to see how easily the teeth will

align (“Digital”). OrthoSelect employs a feature where they can work with any bracket type or

bracket band (“Digital”). If they do not have a certain bracket type in their system, they can

easily scan and digitize it for use in their software (“Digital”). Scanning bracket types into the

software will assist orthodontists who chose to use the Digital Indirect Bonding System.

OrthoSelect can 3D print trays to align perfectly over the teeth rather than the intensive

manual process of vacuum forming (“Digital”). With vacuum forming, the orthodontist creates

the model, performs a great deal of measuring, and places the brackets and vacuum to form the

hard and soft layers which lends itself to potential mistakes (“Digital”). 3D printing also allows

for precise decisions and less errors (“Digital”). They last key feature of OrthoSelect’s new

technology, the flex tray, allows the brackets to release easily after completion of the bonding

(“Digital”). As technology and 3D printing continue to improve, OrthoSelect will invent more

accurate ways to create implants, appliances, and even new groundbreaking treatments
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(“Digital”). Advancements of appliances like these will change the future of orthodontics

forever.

Dr. Paquette, a world renowned orthodontist who sits on the board of Invisalign and

travels all over the world to lecture, has his own practice located in Mooresville, North Carolina.

When asked about his optimism about Paquette Orthodontics, he answered, “Yes. Orthodontists

have typically only treated about five percent of patients who can benefit from orthodontic

treatment. With more efficient treatment options, we often complete treatment now in less than a

year compared to the two or more years that it used to take” (Paquette). He also states because

the time in braces continues to decrease, more people choose to go through treatment (Paquette).

Years ago, not many people took advantage of orthodontic treatment, however, Dr. Paquette

remains confident his practice will continue to blossom.

When asked about changes occuring in his field, Dr. Paquette explains that two decades

ago, one either had braces, or they did not (Paquette). He states that previously, the braces

consisted of just brackets and wire with elastic bands to correct a patient’s bite and sometimes,

the patient had to wear headgear at night (Paquette). Today, orthodontics continues to change

with different methods of braces, Dr. Paquette says (Paquette). He elaborated on what he sees as

the biggest change in orthodontics by saying “​Of course, one of the biggest game changers came

along in 1997 when clear aligners were introduced to the market and suddenly this became a

more attractive option for adults as well” (Paquette). Clear retainers offer the option of fewer

adjustments which means a decreased amount of visits to the office and more time spent at

school or work (Paquette). As technology advances, orthodontics will continue to advance as

well.
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When asked about the downfalls within his field, he answered, “​In some states people

who are seeking an “easy way out” with orthodontics can now google it and be directed to kiosks

where they can go to in the mall get their teeth scanned and have aligners sent in the mail to

“straighten” their teeth” (Paquette). He says that patients will come in to his office and have him

fix their teeth because they did not like the way their teeth came out with the “easy” treatment

option (Paquette). Dr. Paquette hopes that as orthodontics advances, people will still sit down

face to face with a doctor to discuss treatment options (Paquette). Because of the ever changing

field of orthodontics, many problems will pop up, but outstanding orthodontists such as Dr.

Paquette will find solutions to those problems to give their patients a wonderful, confident smile.
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Works Cited

“A Digital Future: OrthoSelect Looks to the Future of Orthodontics with Its Digital Indirect

Bonding System.” ​Orthodontic Products​, no. 3, 2016, p. 96. ​EBSCOhost​,

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<​www.colgate.com/en-us/oral-health/cosmetic-dentistry/early-orthodontics/interesting-fa

cts-from-the-history-of-orthodontics-1014​.>

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Raftacco, Alejandra. “Effect of Oral Hygiene on Orthodontic Treatment- A Clinical Study.”

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EBSCOhost​,
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Paquette, David. Personal Interview. 3 Dec 2018.

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