An orthodontist is a dental specialist who diagnoses and corrects misaligned teeth, jaws, and bites. While all orthodontists are dentists, not all dentists are orthodontists. The distinction comes down to additional training: after completing four years of dental school, orthodontists spend another two to three years in a full-time residency program focused exclusively on how teeth move, how jaws grow, and how to fix problems with alignment.
How Orthodontists Differ From Dentists
A general dentist handles a broad range of oral health needs: cleanings, fillings, crowns, root canals, and gum disease. An orthodontist narrows that focus to one thing: the position and alignment of teeth and jaws. Their additional residency training amounts to roughly 3,700 hours of specialized instruction in tooth movement, jawbone growth, facial bone positioning, and the soft tissue surrounding them. That residency must be accredited by the Commission on Dental Accreditation.
After residency, orthodontists can pursue voluntary board certification through the American Board of Orthodontics. This involves passing both a written exam and a clinical exam, with a 10-year window to complete all components. Not every practicing orthodontist holds this credential, but it signals a commitment to demonstrated competency beyond the minimum licensing requirements.
Conditions Orthodontists Treat
The umbrella term for most alignment problems is “malocclusion,” which simply means the teeth don’t fit together properly when you close your mouth. There are several common types:
- Overbite: Your upper teeth overlap your lower teeth more than they should, creating a deep vertical bite.
- Underbite: Your lower front teeth extend beyond your upper front teeth.
- Crossbite: Some of your upper teeth sit inside your lower teeth when your mouth is closed, essentially the reverse of where they should be.
- Crowding: There isn’t enough room in the jaw for all your teeth, causing them to overlap or twist.
- Spacing: Gaps between teeth from missing teeth or jaws that are too wide for the teeth present.
These problems range in severity. A Class I malocclusion means your jaw alignment is fine but your upper teeth stick out slightly. A Class II malocclusion involves a significantly recessed lower jaw, while Class III means the lower jaw juts forward noticeably. Class III cases are generally the most difficult to correct and sometimes require surgery.
Tools and Treatment Methods
Traditional metal braces remain the most common orthodontic tool. Brackets are bonded to each tooth with a specialized glue that’s strong enough to stay on during treatment but weak enough to remove afterward. Bands wrap around the molars, and an archwire threads through everything to apply gradual pressure. Clear aligners are the other major option, using a series of custom-molded plastic trays to shift teeth in small increments.
But orthodontics involves more than just straightening visible teeth. A palatal expander, for instance, widens the upper jaw itself. A small screw in the device is turned regularly, separating the bones of the palate by up to three-quarters of an inch. This creates room for crowded teeth and corrects crossbites. It works best in children and adolescents whose bones are still growing.
Space maintainers are another category of appliance, used mostly in kids who’ve lost baby teeth early. A metal bar fitted behind the teeth holds open the gap so permanent teeth have room to come in where they should. Bite splints, custom rubber mouthpieces worn on the lower teeth, help correct crossbites by preventing the patient from biting down fully while the upper teeth are repositioned.
Retainers come into play after active treatment ends. Most patients receive a clear plastic retainer the day braces come off, then transition to a more durable version. Many orthodontists also bond a thin wire behind the front teeth (upper, lower, or both) that stays in place for at least two years and ideally longer, quietly preventing the teeth from drifting back.
How Long Treatment Takes
The average orthodontic treatment with fixed braces lasts about 20 months, though individual cases vary widely. Studies report mean treatment times ranging from 14 to 33 months depending on the complexity of the problem. Cases evaluated under American Board of Orthodontics standards averaged closer to 24.6 months.
Rushing treatment has real downsides. Corrections that happen too quickly tend to be incomplete or unstable, making teeth more likely to shift back afterward and requiring longer retention periods. The treatment timeline your orthodontist recommends reflects a balance between moving teeth efficiently and giving the bone and surrounding tissue enough time to remodel around the new positions.
When Kids Should First Visit
The American Association of Orthodontists recommends children have their first orthodontic screening by age 7. That doesn’t mean most 7-year-olds need braces. The point is to catch developing problems early, when the jaw is still growing and intervention is simpler. A child with a narrow upper jaw, for example, can benefit from a palatal expander at this stage, potentially avoiding tooth extractions or surgery later. In some cases, removing a baby tooth or an impacted tooth at the right time lets permanent teeth emerge closer to their ideal position without any appliance at all.
Early treatment, sometimes called Phase I, typically involves a limited period of braces or an appliance to address a specific structural issue. Full comprehensive treatment (Phase II) usually happens later, once most or all permanent teeth have come in.
Orthodontists and Jaw Surgery
When a bite problem stems from the bones themselves rather than just the teeth, braces alone can’t fix it. Skeletal jaw discrepancies, like a significantly underdeveloped or overdeveloped jaw, often require orthognathic surgery performed by an oral surgeon. The orthodontist’s role in these cases is substantial and spans the entire process.
Before surgery, the orthodontist spends months repositioning teeth so they’ll fit together correctly once the jaw is moved. This “decompensation” phase removes the ways your teeth have naturally adapted to the misaligned jaw, which sometimes means your bite temporarily looks worse before surgery improves it. After surgery, postoperative orthodontics typically lasts 6 to 12 months to refine the bite, stabilize the new jaw position, and monitor for any shifting. Throughout the process, tight coordination between the orthodontist and surgeon is essential. Poor communication between the two is one of the most common reasons outcomes fall short.
Adults and Orthodontic Treatment
Orthodontics isn’t just for teenagers. Adults make up a growing share of orthodontic patients, though treatment can take somewhat longer because adult bone is denser and no longer actively growing. The same tools work (braces, clear aligners, retainers), but certain interventions like palatal expansion become more limited or may require surgical assistance. Problems that could have been intercepted with a simple appliance during childhood sometimes require more invasive correction in adulthood.
The core principle stays the same at any age: teeth move through bone in response to sustained, gentle force. An orthodontist’s training is built around understanding exactly how much force to apply, in what direction, and for how long to achieve stable results that last well beyond the day the braces come off.