FOCUS ON: The Orthodontic Mindset in General Practice

Michael Grossman, DDS
focus on


Michael Grossman, DDS, offers his perspective on why orthodontics is such a key factor in treatment planning as well as educating patients about DIY orthodontic companies through intelligent marketing.

Q: What is the current level of orthodontic training new GP dentists receive following dental school graduation and a one-year residency?

A: I graduated in 2004 with as much knowledge in orthodontics as I had in obstetrics, and in the almost 20 years since, I haven’t seen much improvement, and it is sad. I recently met with 2 dentists who were 2 years out. Both were amazed at how much orthodontics I do and wondered how and where I received all my training.

Q: Shouldn’t all orthodontic treatment be referred to a specialist?

A: It’s interesting that almost all general dentists extract teeth; perform root canals; place implants; treat periodontal disease; fabricate crowns, bridges, and removable prostheses; and treat children, but when asked if they offer traditional braces, they look at you like you’re crazy. But dentists should not be leaving residency and immediately placing braces or doing advanced aligner therapy without training.

Q: Where should a dentist start his or her orthodontic training?

A: This is a loaded question! The most important starting point must be a solid diagnostic foundation. Understanding skeletal diagnosis via cephalometric analysis, being cognizant of the different malocclusions, and being comfortable with the evaluation of soft tissue and facial aesthetics are the cornerstones of orthodontic diagnosis. Once the underpinnings of diagnostic ability are established, a plan can be made for what treatment modalities will be offered in practice. Too often, we see GPs take a one-day aligner certification course and jump into treatment that may be beyond their scope.

Q: Is the learning curve still steep?

A: With the advent of artificial intelligence diagnostics and 3D treatment planning, the learning curve has flattened significantly. Gone are the days of poring over ceph x-rays, hand tracing, and crunching numbers. With digital radiography and AI platforms, the tracing is complete within seconds of uploading a ceph, along with dozens of analyses to be evaluated to solidify a skeletal diagnosis. Intraoral scanners allow the GP to simulate treatment outcomes and design aligner or bracket cases.

Q: Why is this so important now?

A: DIY companies are purporting that orthodontic care can be done by way of a simple scan and at-home tray wear. Some are even promoting that, for minor cases, aligners can be worn only while sleeping. Studies show that orthodontic forces must be in place for a minimum of 10 hours in order to elicit tooth movement. I would like to see GPs up their game and learn orthodontics so they can let patients know there should be a dentist monitoring treatment progress instead of prescribing at-home unsupervised care. I have had to treat enough patients with subpar results using DIY orthodontics to be very passionate about this. And even if you refer 80% or more of orthodontic cases to a specialist, it is important that we, as GPs, are the ones who have the conversations with the patients.

Q: How does a busy GP fit this procedure into his or her schedule?

A: The beauty of providing orthodontics in general practice is that dental assistants can perform more than 80% of the clinical tasks once trained. Taking pretreatment records, verifying aligner fit, placing orthodontic wires and ligatures, fitting orthodontic bands, and patient education are all tasks that a skilled dental assistant can execute. This leaves the dentist to diagnose and direct the assistant for the next steps, place brackets or attachments, and polish cement or remove attachments at the end of treatment. And with respect to following aligner treatment, professional services now allow monitoring of cases using teledentistry and AI.

Q: Can a dental assistant really perform these tasks to a high standard of care?

A: Unequivocally, yes! I would be lying if I said I am more efficient than my skilled dental assistants at tying in an orthodontic wire or taking an iTero 3D scan. It is advised that dental assistants be highly involved in the orthodontic training a dentist receives. They will not only help the dentist be more productive, but they can also act as a patient advocate and collaborator in treatment. They can listen and distill a patient’s concerns or expectations to allow the dentist to streamline his or her time in the operatory for orthodontic visits.

Q: What’s the single most important takeaway a GP should gain from this interview?

A: Learning the orthodontic mindset as an overall part of comprehensive care will only lead to superior results for your patients. Having an orthodontic diagnosis as a foundation before any restorative treatment will help pivot the dentist from the single-tooth treadmill to more complex and involved treatment plans. Ultimately, the patients, the dental assistants, and the dentist will benefit from this implementation.

Dr. Grossman earned his DDS degree at the State University of New York at Buffalo. He is the author of Getting it Straight: The General Practitioner’s Guide to Cosmetic Orthodontic Implementation and is the founder and owner of the Cosmetic Orthodontic Systems Lab and Workshop. He can be reached at