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The Job

Orthodontists straighten teeth that are crooked or crowded or that have gaps between them. People who benefit from orthodontics include those whose facial profile shows an overbite, an underbite, protruding lips, or even a "weak chin." People who have dental and facial irregularities often have what is termed "malocclusion," sometimes called a "bad bite." A malocclusion can be corrected for cosmetic reasons, but in some cases crooked teeth can create speech problems or can be more susceptible to decay because the teeth are more difficult to keep clean.

When a patient first comes to the office, the orthodontist takes a complete medical and dental history to determine what is influencing health in general and teeth in particular. Next, the mouth is examined to look for oral evidence of disease. The health of teeth is carefully evaluated. The orthodontist notes the size and shape of each tooth and the relationship between the teeth and the gums, the lips, and the face. The patient's facial profile is assessed for uniformity, symmetry, and proportion. At this time, a "before" photo of a patient's profile and smile may be taken for the patient's record. After treatment is completed, photos will be taken again to show the results.

To make a diagnosis, orthodontists measure and evaluate relationships. They create casts from plaster by asking the patient to bite into a tray of impression material. The three-dimensional models made from the casts are mounted on hinges to show the biting motion of the patient's teeth. It's difficult for patients to hold their mouths open wide for long periods of time, so these models allow orthodontists to study the dynamics of the bite more easily and to take detailed measurements.

Orthodontists also use X-rays to show the status of tissues that can't be seen by the eye, including problems inside the teeth and with the jaws, facial bones, and tooth roots. X-rays can help an orthodontist determine if crowded teeth would benefit from an orthodontic extraction. In other cases, certain jaw discrepancies are detected with radiographs and need correction with orthodontic appliances such as braces or orthognathic (jaw) surgery.

Once a problem is diagnosed, orthodontists may give a patient an oral or a written treatment plan. This plan includes the diagnosis, the recommended treatment specifics, and a cost estimate of treatment.

There are various types of orthodontic treatment, but almost all involve metal, plastic, or ceramic braces that are banded around, or bonded to, teeth. These braces are made up of brackets and wires that move teeth into, or hold them in, proper position. Moving teeth is a very slow process (although it has gotten faster with improved materials) and requires the adjusting of the braces slightly every few weeks to few months.

Additional orthodontic appliances include headgear, a wire appliance that protrudes from the mouth and is fastened by a strap behind the head. Orthodontists use this approach to orthopedically slow the growth of the upper jaw. Rubber bands are another pulling force that, when changed daily by the patient, help move teeth into position. Another type of orthodontic appliance is the retainer. When orthodontists finish active treatment, which usually takes two to three years, the patient comes in much less often for appointments or not at all. To make sure the corrected teeth or jaw don't move back into a poor position, an orthodontist may make a removable or permanent retainer for a patient to wear at night and sometimes during the day as well. Retainers are removed when the patients eat and brush their teeth.

Most orthodontists are in private practice. Some orthodontists teach full or part time at universities. A number perform research at dental schools or for manufacturers, such as dental product manufacturers. Others are government employees, working in the military or for agencies such as the U.S. Public Health Service.

Orthodontists in private practice may need to assume additional responsibilities, such as paying bills, managing staff members, and doing paperwork. Other nonorthodontic responsibilities include working with insurance companies to obtain payment for procedures and overseeing the billing and collection of fees. To ensure the dental office is a safe place for employees and patients alike, orthodontists conduct regular evaluations of procedures and conditions in the office to be certain everything is in compliance with the federal Occupational Safety and Health Administration standards.

Staff members are in charge of taking inventory and ordering supplies, but orthodontists oversee the process. Bookkeeping and accounting are another part of orthodontists' duties—not only for billing purposes but also for keeping track of the staff members' time cards, benefits, and social security and tax deductions, and for setting salaries and raises as well.

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