One of the ceaseless wonders of the world: The power of a smile – Malcolm Forbes

Upon graduating from dental school, a person is awarded a DDS ( Doctor of Dental Surgery) or DMD ( Doctor of Dental Medicine) degree. The two degrees are exactly equivalent, and neither is better,  nor more prestigious than the other.

Although this person may be performing orthodontic treatment, he or she may not call themselves an Orthodontist. They are General Dentists performing orthodontic treatment. Both General Dentists and Orthodontists are capable of providing quality orthodontic services to children and adults. The choice of whether to see a Specialist or not is up to the consumer or patient.

Some other dental graduates may elect to pursue further residency training. One and two year general dentistry residencies exist, and upon finishing these programs, the dentist also often goes into clinical practice.  This person is still categorized as a general dentist or family dentist, but has the advantage of being better clinically trained and experienced.

Finally, some dentists may wish to pursue specialty training in one of dentistry’s nine ADA ( American Dental Association ) recognized specialties.  Orthodontics is dentistry’s oldest recognized specialty, and competition for such residency training positions is often very keen.  Most orthodontic specialty programs are three years long, and include academic and clinical training. Only after completing a formal Orthodontic Residency Training program can a dentist formally declare themselves to be an Orthodontist.

If a doctor for example  is presenting himself as “ Dr.  Joe Smith - Family Dentistry and Orthodontics”  chances are good that he or she is a General Dentist  or Family  Dentist who has elected to emphasize orthodontic treatment as a significant portion of their practice.

Before a person can start putting on Braces or providing Invisalign Aligners,  they have to complete Dental School and earn, either a  DDS or DMD Degree.

In the United States, the DDS is the more traditional dental degree awarded by dental schools and stands for Doctor of Dental Surgery.  A DMD is awarded by the remaining dental schools and stands for Doctor of Dental Medicine. The two are exactly  equivalent. Neither one, nor the other is a superior credential, and each is the final terminal professional doctoral degree for a dentist. Prestigious Dental Schools such as those at UCLA, the University of Iowa,  and the University of North Carolina all offer a DDS Degree. Equally prestigious programs such as those at Fairleigh Dickinson University (dental program now defunct), the University of South Carolina,  or West Virginia University offer or have offered a DMD Degree.  

Dentists are required to pass Part I and Part II of the National Dental Boards which are administered by the American Dental Association (ADA).   A further clinical and written examination is required for a dentist to be granted a state license to actually practice dentistry.   Clinical testing usually does not include placing any Braces or other orthodontic appliances.  Passing this clinical state board examination helps ensure that each candidate for a state license can demonstrate  a certain minimum level of  competence.  Each state has their own jurisdictional power, and one has to have a license from each individual state in order to practice in that state.  A Virginia Dental License, for example,  does not allow one to  practice in Tennessee.

In recent years, regionally recognized clinical examinations have been offered. A newly graduated dentist can take a standard examination which may be recognized regionally by many states.   The North East Regional Board  (NERB) Examination for example is recognized by many states such as NY, NJ, PA, MA, and others.  

Another pathway whereby a dentist can receive a state dental license is by  demonstrating that he or she has been licensed for a certain minimal time an another state jurisdiction, and is granted a dental license via a  Reciprocity Agreement or Licensure by Credentials. In either of these cases, the dentist must already hold a valid and current state dental license.

As of  March 2008 approximately half of all Orthodontists in the United States were “ Board Certified . The American Board of Orthodontics  ( ABO) is the only organization formally recognized by the American Dental Association (ADA) to certify Orthodontists as being officially “Board Certified”.  The ABO Certification process has three steps which require completion.

Picture of the Seal of The American Board of Orthodontics (ABO) as it appears on the Certificate awarded to Orthodontists who have successfully completed Parts I, II, and III of the rigorous ABO Board Certification Examination.

Part I is the post-doctoral Clinical Orthodontics Residency  which a dentist first has to complete. These programs are in general require  three years of full time training in order to complete. Some two year programs still exist.  A person must have completed a DDS or DMD degree before being admitted into such a program.

Part II is a rigorous written examination covering basic science as well as clinical topics.  

Part III is a combined two part examination. First there is an oral examination in which candidates are asked questions about sample cases which the ABO Examiners provide. The remaining part, and often viewed as the MOST DIFFICULT, is the examination and grading of actual treated patient  cases which demonstrate different types of Orthodontic problems such as Crowding, Cross-bites, Skeletal Jaw Discrepancies, and more.

In past years, a person could only be considered “ Board Certified” provided they had fully completed all three Parts, including the notoriously difficult Part III.  Until as recently as 2003, the percentage of Board Certified Orthodontists under the traditional full completion guidelines ( Parts I, II and III ) stood as low as about 25 %.  To make this process more inviting, changes were instituted to increase the percentage of  Board Certified Orthodontists.

Under recent new rules, Orthodontists may be what in effect is “ conditionally Board Certified “ and they are given  5 years to complete the full required set of patient treatment cases and present them to the ABO Examiners. Unfortunately, the term “Conditionally Board Certified”  is not used. There is currently no way to readily  distinguish  whether an Orthodontist has fully completed or is still working to complete Part III. The American Board of Orthodontics in its desire to increase the percentage of Orthodontists who are Board Certified has thus somewhat muddied the waters. If a person does not complete Part III within the required  5 year or so window, then the “Board Certified” status will be officially withdrawn.

It remains to be seen whether this new certification process will be able to be rigorously monitored and enforced. Dentists, including  Orthodontists, are subject to practice  regulation at the state level by State Boards of Dentistry, Boards of Health Professions, etc. The American Board of Orthodontists, a private entity in St. Louis, Missouri may or may not have the wherewithal to do anything about an Orthodontist who, having not fully completed all the necessary  sections of Part III, continues to present himself as “ Board Certified” on stationery, business cards, and to his patients.

The recent ABO changes have in fact stirred up some controversy and  discussions within some Orthodontic circles. Many Orthodontists who completed the full rigorous traditional  ABO certification requirements see it as a cheapening of the status of the term “ Board Certified”.  This view is balanced by those who saw  the 25 %  Board Certification rate among Orthodontists as to low, and were concerned  that many competing non-Orthodontists ( General Dentists) were  beginning to treat larger and larger number of patients with Braces and Invisalign.

Being “ Invisalign Certified “does not imply that a doctor is a specialist or has the formal ADA recognized training ( Orthodontic Residency)  to be able to claim that they are Orthodontists. Any dentist, be they an Orthodontic Specialist or a General Dentist, can seek to become “Invisalign Certified” by paying approximately $ 1900 USD and attending a one or two day week end course at a hotel. It is a rare person indeed who upon taking the Invisalign course does not in turn receive their “ Invisalign Certified” Certificate.

General Dentists and Orthodontists can become “ Invisalign Certified”. Only an Orthodontist however can become  “Board Certified”.