The Path to Becoming an Orthodontist: Education and Certification Requirements

Orthodontics is a unique and rewarding career path, offering both professional satisfaction and financial stability. However, it's also a competitive and demanding field. This article details the comprehensive education, licensure, and certification requirements to become a successful orthodontist.

Laying the Foundation: Undergraduate Studies

The journey to becoming an orthodontist begins with a four-year undergraduate degree. While there's no specific major mandated for dental school admission, a strong foundation in science is highly recommended. Most aspiring orthodontists pursue science-based studies, such as biology or chemistry, as these provide the necessary knowledge for the Dental Admission Test (DAT) and subsequent dental school coursework. These majors typically involve extensive coursework in mathematics and science. However, some students may opt for other fields like psychology, statistics, or English. Taking advanced math and science courses in high school can provide a solid foundation for future studies.

Dental School: The First Major Hurdle

After completing an undergraduate degree, the next step is dental school. Admission to dental school is highly competitive, with an average acceptance rate of only 5.1%. A strong grade point average and a high score on the DAT are crucial for gaining admission.

At dental school, students undergo intense studies to gain a comprehensive knowledge of general dentistry. The curriculum covers various aspects of oral health, preparing students for the practice of general dentistry. Upon completion of dental school, graduates receive either a Doctor of Dental Surgery (DDS) or a Doctor of Medical Dentistry (DMD) degree.

Licensure as a General Dentist

Following graduation from dental school, aspiring orthodontists must pass a state licensing exam to practice dentistry. This license is a prerequisite for applying to orthodontic residency programs.

Read also: Orthodontist Training Requirements

Orthodontic Residency: Specializing in Orthodontics

The next critical step is completing an orthodontic residency program. During their final year of dental school, orthodontic hopefuls apply to residency programs, typically affiliated with a university and often taking place at a teaching hospital. These programs provide two to three years of specialized study in orthodontics.

Admission to these residency programs is highly competitive, requiring candidates to have passed the National Board Dental Examination (NBDE). The curriculum covers various essential topics, including tooth movement, corrective treatment application, and facial surgery principles. Residents also undertake research projects and participate in conferences.

Orthodontist Licensure: Specializing in Orthodontics

In addition to a general dentist license, a separate orthodontist license is required to practice orthodontics. Obtaining this license involves passing further examinations. Orthodontists must also keep their licensure up to date through continuing education hours and recertification exams.

Board Certification: Demonstrating Expertise

After completing all required schooling and licensing, orthodontists can seek certification from the American Board of Orthodontics (ABO). This certification requires candidates to pass both written and practical tests, demonstrating their expertise in the field. The ABO certification process demonstrates ongoing proficiency in orthodontics and a commitment to lifelong learning.

The American Board of Orthodontics (ABO) Certification Process

The American Board of Orthodontics (ABO) offers board certification to orthodontists who demonstrate exceptional knowledge and clinical skills. This certification process involves a rigorous examination that assesses an orthodontist's ability to diagnose, treatment plan, and critically evaluate cases.

Written Examination

Examinees are eligible to take the Written Examination once they have completed at least 18 months of a CODA-accredited orthodontic program.

Scenario-Based Clinical Examination

All examinees who have graduated from a CODA accredited orthodontic program and successfully completed the ABO Written Examination are then eligible for the Scenario-based Clinical Examination.

There are numerous benefits to a scenario-based examination. Most importantly, all orthodontists taking the examination will be objectively tested on their knowledge, skills, and critical thinking abilities. A scenario-based exam utilizes the most fair, reliable and valid testing methodology. Additionally, all orthodontists now have the ability to go through the certification process regardless of their practice environment and where they are within their career.

The ABO continues to collaborate and work with educators to ensure residents are prepared for the certification examination. The academic knowledge and clinical experience obtained throughout residency in itself will help prepare residents. The ABO will continue to use assessment instruments including cast radiograph evaluation (CRE) and the case management form (CMF) within the scenario-based examination.

The ABO meets with educators regularly and will continue to gain feedback on how we can best support the orthodontic programs so that the Scenario-based Clinical Examination is complementing the curriculum the educators are teaching in their programs. Many programs have expressed that they will continue to hold case presentation exams and Pathway Presentations by ABO Ambassadors, and will begin putting a larger focus on critical thinking skills. Self-evaluation of clinical patient cases will play a large part in the preparation process. Participation in case presentation evaluations/exams and continuing to use the tools previously developed the by ABO for outcomes assessments will also play an important role as examinees prepare for the exam.

With the scenario-based testing format, the ABO will be able to make a direct assessment of a candidate’s ability to formulate diagnoses, develop treatment plans, assess implementation of treatment plans, and evaluate outcomes. The test focuses on the cognitive skills and decision-making process that are critical for the proficient practice of orthodontics.

For each of the questions in a case scenario, there are at least three predetermined model responses approved by the board: (a) a fully proficient model response, (b) a borderline proficient model response (c) a borderline not or not proficient model response. These questions and responses are sent through a thorough process to be reviewed, edited, refined, and validated prior to being used in an examination.

Examinee responses are scored by trained examiners who will use an anchored rating scale to ensure consistency in scoring. The scales will address the purpose(s) of the case (e.g., diagnosis, planning, implementation, critical analysis) and are standardized for all cases serving the specified purpose. The ABO’s examiner training program educates examiners in the intended application of the scales to candidate responses. The examiner training program provides practice opportunities as well as a required assessment of agreement with criterion ratings for a selection of responses.

Points awarded to candidates are determined as a function of the ratings assigned and the weight of the question. Exam results are presented in a pass/fail format. Examinees who are unsuccessful on the examination will be provided with feedback outlining their level of success on the four main domains of the examination.

Examinees in the certification process who have 3 or more cases “banked” have two options to complete the board certification process. Option one requires the examinee to complete the number of online Board Case Exams (BCEs) to match the remaining number of Incomplete/Unsubmitted cases until a total of 6 is met. In addition, examinees with Incomplete BCOE scores are required to take the BCOE Web-based Retake Exam until this portion of the examination is passed.

Maintaining Certification

Certification Renewal is a critical component of the certification process demonstrating ongoing proficiency in orthodontics and a commitment to life-long learning. Certification Renewal offers an opportunity for board certified orthodontists to pursue continuing education, stay up-to-date on the latest technology and re-evaluate their approach and critical evaluation of cases.

Qualities of a Successful Orthodontist

Besides academic preparation and licenses, various traits and skills contribute to success in orthodontics. These include:

Patience: Orthodontic treatment can be lengthy, requiring patience in working with patients and monitoring progress.
Dexterity: Orthodontists need fine motor skills to manipulate instruments and appliances with precision.
Communication Skills: Effective communication is essential for explaining treatment plans, addressing patient concerns, and building rapport.
Enjoy working with your hands and solving problems.
Being keenly detailed and having high stamina.

The Role of an Orthodontist

Orthodontists are uniquely qualified in the diagnosis, prevention and treatment of orthodontic problems. They dedicate their professional lives to creating healthy, beautiful smiles in children, teens and adults. Well-aligned teeth are more than attractive: they make it possible to bite,chew and speak effectively. Orthodontists use a variety of “appliances,” including braces, clear aligner trays and retainers, to move teeth or hold them in their new positions.

Differences Between Orthodontists and General Dentists

While an orthodontist is trained in general dentistry, you wouldn't seek out this specialist for a toothache. Your general dentist should be your first point of contact for oral health concerns such as tooth pain. Orthodontists are trained in creating a healthy bite, developing proper alignment, understanding the size and position of your upper and lower jaws and identifying how your teeth are set within them. You might think an orthodontist only treats children or teens by placing braces or other appliances. The truth is they treat patients of all ages by solving alignment or bite problems and preventing these problems from becoming worse down the line.

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