Orthodontist How to become, career path, income potential

What is an orthodontist?

An orthodontist is a dentist who treats patients to straighten their teeth. They diagnose issues with misaligned teeth such as overbites, occlusions, misaligned jaws, and overcrowded mouths. Once the diagnosis is made, the orthodontist devises a treatment plan to repair the condition and straighten the teeth.

The most common treatment orthodontists perform is straightening misaligned teeth with braces, retainers, or other methods. But they also treat other conditions, including extracting teeth if the patient’s mouth is overcrowded. They mainly treat children after some or all of their adult teeth have come in, but they also treat adults with crooked teeth. 

Although braces are by far the most widely used tool to correct misaligned teeth, they may also use newer technologies, such as Invisalign. The device isn’t visible but works to align the teeth much the same way as braces. Moving teeth to the correct location is slow, so orthodontists create treatment plans specifically for each patient and typically monitor them for 1 or 2 years or more, adjusting the straightening devices every 8 weeks or so, until the teeth are straight. 

Other common devices used to treat patients are palate expanders, which widen the upper jaw’s arch, giving the area more space, and headgear, typically used for extreme overbites. Headgear connects the back of the head to a wire in the front of the mouth and pulls the front teeth back.  

Professionals in this profession administer local anesthetics to patients who are undergoing dental procedures such as extractions for braces application. They may also perform dental cleanings to remove plaque and tartar buildup during regular orthodontic checkups, although most orthodontists employ dental clinicians for this. Orthodontists take x-rays of the teeth and jaw and interpret them to monitor progress and devise treatment programs.

Qualifications and eligibility

To become an orthodontist, you will need to complete a Bachelor of Science degree or equivalent, typically in biochemistry, physics, molecular biology, or biomedical science. After earning your degree, you must pass the Dental Admissions Test (DAT) before applying to dental school. Some schools also require that you pass the Graduate Record Exam (GRE). You will also need to have a good grade point average (GPA), experience shadowing, and excellent letters of recommendation.

The dental school curriculum basically mirrors medical school for the first two years, where students take anatomy, biochemistry, physiology, microbiology, immunology, and pathology classes. In the second two years, students focus on clinical practice and diagnosing and treating oral diseases. Depending on the school, dental schools may award a Doctor of Dental Surgery (DDS) or a Doctor of Medicine in Dentistry (DMD).  

After completing dental school, you must pass the National Board of Medical Examiners Examination and a state or regional clinical licensing exam before you can apply for your state dental license. Other requirements may differ by state. To maintain your license, you are required to complete continuing education requirements for the remainder of your career to stay up-to-date on the latest scientific and clinical developments.

After graduating from dental school, you are required to complete an orthodontic residency for at least two to three years, depending on the orthodontic program you choose. During your residency, you learn several techniques and common practices under the supervision of a practicing orthodontist. Some residencies require that you complete a relevant research project and attend various conferences. After completing your orthodontic program, you will receive a master’s degree in orthodontics or an orthodontics certificate.

When you have completed your residency, you can apply for board certification by taking the American Board of Orthodontics exam, which includes both written and oral examinations. Once you pass the exam, you will receive your board certification and are eligible to practice orthodontics. To maintain your certification, you must take a renewal examination every 10 years. 

A professional in this role must have excellent communication skills to clearly explain procedures to patients of various ages and backgrounds in a way they can understand. They also address any questions or concerns patients may have. Orthodontists work with a team that consists of clinical directors and assistants, treatment coordinators, administrative personnel, and more.

They need to be able to work well within the team and effectively explain treatment options and procedures so everyone on the team is on the same page. They need good eyesight, excellent hand-eye coordination, and the ability to stay focused for long periods. Most are in private practice and need excellent leadership qualities. They should be able to put nervous patients at ease and have compassion and empathy for them. Orthodontists must also be good problem solvers as they diagnose issues with the teeth and jaws and develop the right treatment plans. 

Work environment

Most orthodontists work in private practice, but some may work in healthcare facilities, teach, or conduct research. They work in clean, well-lit, conditions and see many patients in a day. They wear protective gear when examining patients or performing surgical procedures, including gloves, masks, and safety glasses, to reduce the risk of contracting a disease from patients.

They may be exposed to radiation from patient X-rays. They typically perform many of the same activities on different patients over the course of a day. The work can be hazardous and stressful, both physically and mentally. 

Typical work hours

Most orthodontists work a typical 40-hour week during normal business hours. They may have to work evenings and weekends to accommodate their patients or when responding to emergencies.   

Types of orthodontists

All orthodontists, except those in academics or research, treat patients for misaligned teeth and jaws. The most common types of orthodontic issues they treat are:

Crossbite

Patients with a crossbite have their upper teeth sitting inside the lower teeth when they close their mouths. Crossbites typically cause teeth to chip or wear down and can also cause lip pain.  A crossbite can cause teeth grinding, jaw problems, and abnormal facial development if left untreated.

Crowding

Crowding is a common issue and one in which the majority of patients seek an orthodontist. It occurs when the mouth doesn’t have enough room to accommodate all the teeth. Crowded teeth are hard to floss and can contribute to tooth decay if not treated. 

Spacing

Spacing refers to unnatural gaps between your teeth. Most spacing occurs between the two front teeth, although it can happen between any two teeth. Excessive spacing may lead to gingivitis and tooth decay by allowing too much gum area to be exposed to bacteria

Improper bite

An improper bite is when your upper and lower teeth don’t meet correctly when you bite down. If not treated, an improper bite can adversely affect the shape of your face and the appearance of your teeth. You can have an overbite, where your upper teeth are too far forward, or an underbite, where they are too far back. You can wear down your teeth prematurely if this condition isn’t treated.

Improper eruption

When you lose your baby teeth, the adult teeth erupt through the gums. Improper eruption occurs when your teeth only come out part way, at an angle, or in the wrong location. Orthodontists treat these conditions with braces, aligners, or tooth extraction.  

Impacted teeth

An impacted tooth is one that never erupts from the gums. Wisdom teeth are commonly impacted, causing pain to older adolescents and younger adults. Canines can frequently become impacted as well in patients who have overcrowded teeth. 

The most common types of orthodontic treatment are:

Braces

Braces consist of metal brackets, wires, and bands that function to close gaps and align teeth. Braces are mostly used to straighten teeth in adolescents, but they are also used for adults.

Two-phase orthodontics

Orthodontists use two-phase orthodontics to prevent younger patients from needing more severe orthodontic treatment later in life. Phase 1 is commonly used to treat children as young as 7 or 8 and uses expanders and other dental appliances to create more room in the jaw for incoming teeth, reducing the need for tooth extractions or jaw surgery when the child is older. Phase II typically starts after most or all of the adult teeth have come in, and involves using braces or aligners. 

Aligners

Orthodontic aligners straighten teeth without wires or brackets. They are made of clear plastic that fits over your teeth. Patients move from one aligner to the next as teeth slowly move into place. The advantage of aligners is that you can remove them to eat, brush your teeth, and floss. 

Income potential

The earning potential for an orthodontist can vary greatly depending on geographic location, education, experience, and acquired skills.  

  • According to the U.S. Bureau of Labor Statistics, the median annual wage for orthodontists was $267,280 in May 2021. The lowest 10 percent earned less than $95,940. The industries with the highest pay for orthodontists in May 2921  were:
    • Offices of Dentists – $277,590
    • Offices of Physicians – $226,640
    • General Medical and Surgical Hospitals – $113,020 
  • The states with the greatest number of orthodontists were:
    • Maryland – 540 (avg annual pay – $336,720)
    • Ohio – 470 (avg. annual pay – $229,040)
    • California – 250 (avg. annual pay – $245,750)
    • Virginia – 210 (avg. annual pay – $324,660)
    • Texas – 180 (avg. annual pay – $249,080)
  • As of Sep 2022, the average annual pay for an orthodontist in the United States is $303,730 a year. While the highest salaries are $399,500 and as lowest are $69,500, the majority of orthodontist salaries currently range between $260,000 to $374,500, with the top 10% making $396,500 annually across the United States. The 5 states with the highest annual pay for orthodontists are listed as:
    • Hawaii – $343,049
    • Massachusetts – $339,140
    • Nevada – $336,803
    • Rhode Island – $332,748
    • Oregon – $327,805
  • The bottom 3 states are:
    • Florida – $233,427
    • Georgia – $217,638
    • Louisiana – $215,464
  • The highest paying cities for orthodontists are:
    • New York, NY – $333,478
    • Los Angeles, CA – $315,761
    • Dallas, TX – $300,014
    • Austin, TX – $298,445
    • Houston, TX – $294,052

Position trends

The U.S. Bureau of Labor Statistics projects that the overall employment of orthodontists will grow 5% from 2021 to 2031, which is slightly below the average for all occupations. This amounts to about 300 openings per year over the next 10 years. The demand for orthodontists will continue as many children have issues with misaligned teeth and parents will want to have their teeth straightened.   

Career path

After completing residency, many pursuing this role start their careers as associates in orthodontic practices, dental clinics, or hospitals. In these roles, they usually work for other orthodontists and gain experience as well as build up their financial resources.

Typically, orthodontists with several years of experience buy a practice of their own where they manage a staff that assists patients who are seeking orthodontic care. They also hire and oversee associate orthodontists. 

Other opportunities for orthodontists include teaching at university dental schools. Some teach part-time while maintaining their practice. Orthodontists also may work in research, testing new procedures and devices, and many are employed by dental schools. Still, others are employed by government agencies and the military, where they may be stationed across the country or around the world. 

Career advancement for orthodontists generally involves increasing the size of their practices. They typically do this by building good relationships with nearby general dentists who refer patients to the orthodontist. Other advancement opportunities include becoming officers and committee chairs of professional associations or publishing papers on techniques and developments in the field.

Steps to becoming an orthodontist

1. Prepare while in high school

Students should begin preparing for a career in orthodontics as early as high school by taking science and math courses to build the foundation they’ll need as an undergraduate and when in dentistry school.  

2. Get a bachelor’s degree

Students typically complete bachelor’s degrees in biochemistry, molecular biology, biological sciences, biomedical engineering, biomedical sciences, chemistry, or a related field. 

In general, required course study includes biochemistry, anatomy, physical chemistry, and physiology. These are essential classes that will prepare students for dental school. Maintaining a high GPA in college is important to ensure the standards for admission into dental school are met.

3. Prepare for the DAT

You are required to take the Dental Admission Test (DAT) before being accepted into dental school. Most students take the exam in the summer prior to their junior year. Begin preparing by taking practice exams to evaluate your strengths and weaknesses and focus your study on the areas in which you need the most help. Many test-prep books, guides, and courses are available to help you prepare for the exam. Two of the most popular resources are available through Kaplan and the Princeton Review.

4. Take the DAT

The DAT assesses your scientific and academic knowledge and is essential for dental school admittance. The DAT is a scale-scored test from 1 to 30 and you must score a minimum of 17 to meet most school requirements. You can take the DAT up to 3 times total, with a 90-day wait time between each exam.

5. Apply to dental schools

Most students apply to dental schools during the summer after they pass the DAT. It is important to choose a program that is accredited by the Commission on Dental Accreditation of the American Dental Association (ADA). Some top dental schools in the country are: 

6. Complete dental school

Dental schools take four years to complete for full-time students. Depending on the school, you will earn a Dental Medicine (DMD) or Doctor of Dental Surgery (DDS) degree. Both are essentially the same. The first two years of dental school are academic, and the last two are clinical, where you gain experience treating dental patients. Some of the most affordable dental schools are:

7.  Take the National Board Dental exam

Although state laws may vary, all states require you to pass the National Board of Dental Examinations before applying for a state license. The multiple-choice licensing exam covers dentistry-related sciences, anatomy, ethics, and clinical knowledge. Most states also require a hands-on practical exam. Check in your state for specific requirements.  If you have your license in one state, you may need to meet other criteria if relocating to another state. Make sure you know the requirements before making a move to another state.

License renewal varies by state, but is typically every 1 to 3 years. The renewal includes passing an exam and a certain amount of continuing education credits, which also varies by state.

8. Complete your residency

After you’ve graduated from dental school, you are required to complete a residency in orthodontics. Residencies typically take a minimum of 2 years to complete but can take up to 3 years or longer. You can find residency opportunities through the Postdoctoral Application Support Service or the Postdoctoral Dental Matching Program

9. Get your orthodontics license

Once you’ve completed your residency, you may have to apply for your state license in orthodontics, however, some states only require a dental license. Contact your state board to find out the requirements in your state. Licensing involves passing an exam, which can vary from state to state. After passing the exam, you can begin working as an orthodontist.   

10. Consider getting board certified

You don’t have to be certified by the American Board of Orthodontics to practice, but certification can put you ahead of other orthodontists in your area. The test consists of 240 written questions and a clinical exam. You must take a renewal exam every 10 years to maintain certification. 

11. Join professional associations

Joining an organization can open up a wealth of resources and networking opportunities for you. Here are some of the top organizations:

Tips for becoming an orthodontist

If you are planning to become an orthodontist, a few things can help you on your path. Here are some tips:

  • Study hard. Becoming an orthodontist takes a lot of hard work, time, and dedication. Make sure you have a knack for math and the sciences and are a good student, even in high school.
  • Make sure you are 100% committed to becoming an orthodontist. It takes at least 10 years of full-time school and clinical practice, so you’ll have your mind set on it.   
  • Have a passion for helping others improve their look and their smile. Have an interest in working with the teeth and facial bones.
  • Have compassion and empathy toward people. Patients who visit an orthodontist can be nervous and scared. Your compassion can ease their anxieties and help calm them.  
  • Develop good communication skills. Orthodontists work with patients, clinical technicians, dentists, and many others. You’ll need to be able to communicate effectively and explain procedures to patients of all ages and backgrounds in a way they will understand.  
  • Find opportunities to volunteer at an orthodontist’s office where you can see what they do and gain insight into the job.  
  • Talk to orthodontists in your area about the pros and cons of becoming an orthodontist. 
  • Find a mentor to help you weave your way through the process from applying to dental schools to choosing the right residency and everything in between. 
  • When you get into dental school, stay focused. There is so much thrown at you, and you’ll have to make sure you are organized and not falling behind.

Orthodontist interview questions to expect

  • When there is extreme crowding in a child’s mouth, would you recommend extractions or a palate expander?
  • Why do you believe it’s important to encourage an early set of braces while the jaw is still developing?
  • Are you familiar with the various types of orthodontic braces and retainers?
  • Can you name the most common reasons why patients need orthodontic treatment?
  • At what age would you recommend a patient start orthodontic treatment?

Orthodontist FAQs