Orthodontics as a career choice is both challenging and rewarding in equal measure, according to Tony Ireland, a consultant orthodontist and Emeritus Professor of orthodontics at Bristol Dental School. But what do you need to know if you're thinking about pursuing it as a student?
We asked Tony some of the questions dental students are asking about post-graduate training in orthodontics, and about exploring the opportunities in general practice.
Why should I consider orthodontics?
Orthodontics is a great area to specialise in, for lots of reasons. For a start, it's intellectually stimulating, because you have to think systematically and in four dimensions to achieve the best outcome for patients over an extended course of treatment.
It's very rewarding to see the transformation, not only in terms of aesthetics and function, but in patients' self-esteem and confidence too. There are also plenty of career options, both full and part-time, once you've qualified, including working in primary care, secondary care, teaching and research, or in a combination of any of these.
What's the current training pathway for orthodontics?
Specialty training
After dental foundation (DF) and dental core (DC) training, you can apply for dental specialty training (ST), which is full-time for three years (ST1-3).
For the past 40 years, specialist training in the UK has typically comprised a three-year full-time training programme (ST1-3) at a university dental school, often linked to a district general hospital where clinical chairside training is provided.
Trainees are typically at the clinic for six sessions (three days) per week doing personal treatments and also attending consultant-led new patient clinics and multidisciplinary clinics. The other four sessions are usually based at the dental school; two for teaching, including tutorials and problem-based learning, and two for personal research, which includes a dissertation.
Research and exams
To date, the research component has led to the award of a Masters or taught Doctoral degree (see below, What's changing from September 2024?). Students are encouraged to present their work at national conferences, such as the British Orthodontic Conference, Cranio Facial Conference or the British Society for Dental Research.
To be awarded their CCST (certificate of completion of specialist training), trainees have needed to pass not only the Membership in Orthodontics (M.Orth) exam of one of the Surgical Royal Colleges and fulfil all the training requirements, but also their University exams. They can then apply to join the General Dental Council list in orthodontics and use the title 'specialist orthodontist'.
Higher-training or practice
At this point, trainees can go into orthodontic specialist practice in the primary care setting or continue for a further two years' post-CCST training (ST4-5). This focuses on secondary care orthodontics, including complex and often multidisciplinary treatments.
After passing their Fellowship in Orthodontics exam, trainees will be eligible to apply for an NHS consultant orthodontist post in a hospital or dental hospital setting.
Recruitment to both the ST1-3 and ST4-5 training programmes is through the national recruitment process.
Another career path is to become an academic orthodontist. This requires a PhD in order to progress up the university career structure, as a teacher, researcher or both.
What's changing from September 2024?
Following a review by the GDC, there's been a push to remove the mandatory requirement for a university higher degree, like a Masters or taught Doctorate, in orthodontic specialty training (ST1-3). However, even if not mandatory it should still be an option for prospective trainees in 2024.
I would certainly recommend that prospective orthodontists complete a higher degree as part of their training. An article by Jen Jopson et al. considers the benefits in detail.
What personal qualities and dental skills are particularly useful in orthodontics?
Like much of dentistry, orthodontics requires foresight, planning, technical skill and an eye for detail.
You have to be a good people-person as you'll need to collaborate with colleagues and communicate well with patients. When you first see a patient, they're often anxious, and you'll then be seeing them every few months for the next two to three years.
They will range from small children though to mainly teenagers (and increasingly adults). You'll have to help them understand the commitment you need from them and then encourage them through the difficult times - or conversely, know when to stop treatment or try another approach if things aren't going well.
What tips do you have for dentists who want to explore orthodontics while in general dental practice?
I would advise GDPs to speak to their local consultant orthodontist. Going it alone with limited treatment orthodontics with limited training can be fraught with problems.
This issue is that you don't know what you don't know. There is a real risk of under-estimating the challenges, both in terms of diagnosis and treatment options, and therefore providing inappropriate treatment, or not obtaining informed consent from patients because they haven't been aware of their different treatment options and associated risks. Even with a third-party treatment planning service, the liability for inappropriate treatment will still remain with the dentist.
What's the most enjoyable part of being an orthodontist?
Orthodontics has certainly been a very rewarding career for me. It's a great cohort of patients to treat, and happy patients certainly make for a happy clinician.
Orthodontics is not only intellectually stimulating, but it gives you great career opportunities and variety. I've certainly found that no two days are exactly the same, and as a result I've always enjoyed going to work.
Can orthodontic practice support a young dental professional with a family?
Although the training is hard work and has personal and financial implications, the rewards are certainly there once you're qualified as a specialist orthodontist, in whichever sphere you choose.
Since I qualified, there's always been a concern that the NHS will stop funding orthodontic treatment. This has not transpired, although we're likely to see a change in the ratio of NHS to privately funded treatment.
How can dental students find out more?
First, talk to your orthodontic teachers at dental school and consider going to see an orthodontist – perhaps the person who treated you as a child - to ask them for advice and quiz them about their career.
Take a look at the careers section of the British Orthodontic Society website and sign up to their 'So you want to be an orthodontist' course once you've qualified so you have the best chance of getting onto a three-year training programme.
Finally, I'd advise you to attend events, check out the BOS website and read publications like the Journal of Orthodontics, the BDJ and dental press. This will keep you informed about the current issues and clinical talking points in orthodontic practice, as well as help you network and make contacts for the future.
This page was correct at publication on 01/02/2024. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Professor Tony Ireland PhD, MSc, BDS, FDS, M.Orth RCS (Eng)
Tony Ireland is consultant orthodontist at the Royal United Hospitals Bath and Emeritus Professor of Orthodontics at the University of Bristol. He graduated from Guy’s Hospital in London and returned there to do his postgraduate training to become a specialist in orthodontics on the three-year full time training programme, leading to an MSc and membership in Orthodontics. During his senior registrar training and early years as a consultant, he obtained his PhD in dental biomaterials.
He has been actively involved in dental education throughout his career and was most recently the training programme director of the DDS/M.Orth programme at the University of Bristol.