Every orthodontist is a dentist, but not every dentist is an orthodontist. The core difference is specialization: a general dentist handles the broad range of oral health needs you encounter throughout life, while an orthodontist completes an additional two to three years of residency training focused specifically on aligning teeth, correcting bite problems, and guiding jaw development. That extra training shapes everything from the conditions they treat to the tools they use.
Education and Training
Both dentists and orthodontists start with the same foundation: four years of dental school, earning either a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree. After graduation, a general dentist can obtain a license and begin practicing right away.
An orthodontist takes a different path. After dental school, they enter a competitive residency program that typically runs about 33 to 36 months. At UCSF, for example, the orthodontic residency is a full-time, 35-month program. During that time, residents focus on preventing and correcting misaligned bites and facial disproportions in both children and adults, with heavy emphasis on how the face and jaw grow and function. Some residents pursue an additional master’s or doctoral degree alongside the clinical training. By the time an orthodontist sees their first patient independently, they’ve completed roughly seven to eight years of post-college education.
What a General Dentist Does
A general dentist is your primary care provider for oral health. Their scope is wide: cleanings to remove plaque and tartar, fillings to restore decayed teeth, crowns that cap damaged or weakened teeth, root canals, extractions, gum disease treatment, and preventive care like sealants and fluoride applications. They also screen for oral cancer, take X-rays, and manage overall mouth health over time.
Think of your general dentist as the person who keeps everything running. They’re the ones you see every six months, and they’re usually the first to spot a problem that needs a specialist’s attention.
What an Orthodontist Treats
Orthodontists focus on one thing: how your teeth and jaws fit together. The technical term for a misaligned bite is malocclusion, and it comes in several forms. A Class II malocclusion means the lower jaw is set too far back, creating an overbite. A Class III malocclusion means the lower jaw protrudes forward, resulting in an underbite. Crowding, gaps, crossbites, and open bites all fall under the orthodontist’s expertise.
The tools they use reflect that narrow focus. Traditional metal braces, clear ceramic braces, clear aligner systems, orthodontic headgear to encourage jaw repositioning, palate expanders, and retainers are all standard in an orthodontic practice. Some general dentists do offer braces or clear aligners for mild cases, but severe or complex malocclusions typically require a specialist. As Cleveland Clinic notes, your dentist might refer you to an orthodontist when a bite problem goes beyond straightforward alignment.
When Your Dentist Refers You Out
General dentists decide whether to refer based primarily on how complex the case is and the patient’s age. Research published in the American Journal of Orthodontics found that 41% of referral decisions hinged on case complexity and 21% on whether the patient was still growing. Growing children and teenagers present unique challenges because their jaws are actively developing, which is exactly the kind of situation orthodontists train for years to manage.
When choosing which orthodontist to send you to, dentists weigh the specialist’s perceived skill level (66% of the decision) and how close the office is to the patient (34%). That proximity factor matters because orthodontic treatment involves frequent visits over months or years.
The Clear Aligner Question
Clear aligners have blurred the line between what general dentists and orthodontists offer. Both can become certified to provide popular aligner systems, but their training backgrounds create real differences in how they approach treatment.
A study published in The Angle Orthodontist found that general practitioners graduate from dental school with limited training in orthodontic diagnosis and treatment. Some pursue continuing education courses afterward, but whether that’s enough for comprehensive orthodontic care remains a point of debate in the profession. The study also found significant disagreements between the two groups about which cases are appropriate for aligner treatment. Orthodontists and general dentists differed sharply on whether aligners should be used for cases involving large gaps between front teeth or asymmetric bite problems. Those differences likely stem from the orthodontist’s deeper clinical training with fixed appliances and biomechanics.
Neither group reported feeling fully comfortable with aligners right after their initial certification. But orthodontists bring years of additional training in tooth movement principles, which gives them a broader toolkit when cases don’t go as planned.
Board Certification for Orthodontists
After completing residency, orthodontists can pursue board certification through the American Board of Orthodontics (ABO), which is recognized as the national certifying board for the specialty. The process involves passing a written examination (candidates become eligible after at least 18 months of residency) followed by a scenario-based clinical exam after graduation. The clinical exam evaluates four equally weighted areas: gathering diagnostic data, planning treatment objectives, managing active treatment, and analyzing outcomes.
Board certification is time-limited, not permanent. Orthodontists must renew every 10 years. Not all practicing orthodontists are board-certified, since it’s voluntary, but it signals an extra level of commitment to demonstrated competency.
Age 7: The First Orthodontic Visit
The American Association of Orthodontists recommends that every child be screened by an orthodontist by age 7. At that point, enough permanent teeth have come in for a specialist to detect developing problems with jaw growth or tooth alignment. Most kids won’t need treatment at 7, but an early evaluation lets the orthodontist monitor growth over time and intervene at the ideal moment if something does need correction. Catching certain issues early, like a narrow palate or a developing crossbite, can simplify treatment later and potentially reduce costs.
Your general dentist typically handles dental checkups before and during this period, and they’ll often be the one who suggests that first orthodontic screening based on what they observe during routine visits.
Cost and Visit Patterns
Seeing a general dentist usually means two visits per year for cleanings and exams, plus occasional appointments for specific problems. Orthodontic treatment looks completely different: once you begin, you’ll visit the orthodontist every four to eight weeks for adjustments or progress checks, and treatment commonly spans 12 to 24 months or longer depending on complexity.
Orthodontic treatment tends to be a larger upfront financial commitment, often ranging from a few thousand dollars to several thousand, depending on the type of appliance and length of treatment. Many orthodontic offices offer payment plans. Dental insurance frequently covers a portion of orthodontic care, though lifetime maximums for orthodontics are common and separate from your general dental benefits. General dental visits, by contrast, are more routine expenses that insurance typically covers at higher percentages for preventive care.