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March 2016
Volume 37, Issue 3

More Adults Seeking Orthodontia May Be Opportunity for General Practitioners

As facial esthetics increasingly takes center stage in today’s society—orthodontia even appeared on the cover of a fashion magazine this past year— it appears that tooth straightening is not just for children any more. Indeed, record numbers of adults are now seeking orthodontic treatment. A new study commissioned by the American Association of Orthodontists estimates that more than a quarter (27%) of American and Canadian orthodontic patients are adults. The study found that from 2012 to 2014, the number of patients 18 and older seeking treatment in North America increased by 16%, resulting in a record high of 1,441,000 patients.

Healthy teeth can be moved at any age, but observers note a number of factors that have fueled the surge in adults seeking orthodontia. A significant one is the advent of technological innovations that have made treatment both faster and less conspicuous. These include the development of clear aligners (Invisalign), self-ligating brackets, mini-implants that provide temporary anchorage for cases that would have been previously limited by the amount of anchorage available from opposing or adjacent teeth, and expanded choices in wire alloys that make it possible to use fewer wires for longer intervals between appointments.

Moreover, social acceptance of adults seeking straighter teeth has grown, as testimonials to the benefits of such treatment have accrued. A 2013 study, for example, found that 75% of adult recipients of orthodontic treatment reported improvements in their careers or personal relationships; 92% said they would recommend such treatment to other adults.

Greater GP Participation

The increased demand for orthodontic treatment appears to be one factor fueling the growing number of dental general practitioners offering orthodontic services. While a 2002 survey conducted by the Academy of General Dentistry (AGD) found that only 9% of AGD members reported performing minor or complex orthodontics on a weekly basis, that fraction has steadily grown. By 2007 one estimate placed the number of general dentists providing comprehensive (bands and brackets) orthodontics at 20%, with an even higher number offering clear aligners.

The technological innovations that have streamlined and simplified orthodontic treatment have helped to attract general practitioners into this service area, in combination with the substantial financial rewards that may be achievable. Invisalign points out that at an average case price of $4,800, a general dentist treating just two orthodontic cases per week can increase practice gross revenue by almost $500,000 annually. New patients who find the practice because they’re initially seeking orthodontic services are likely to eventually want or need hygiene and general dentistry services from the practice.

The Texas-based Academy of Gp Orthodontics, which provides orthodontic continuing dental education aimed at general practitioners, calculates that initial costs of education and equipment can be recouped with just a half dozen orthodontic cases. The Academy also makes the argument that established patients already trust their general dentists and typically prefer to receive orthodontic services from them if possible. Moreover, in rural areas, specialty orthodontic services may not be available.

Meeting Standard of Care

Although the orthodontic specialty requires an additional 2 to 3 years of postgraduate training and an advanced degree in orthodontics or a certificate of proficiency, no legal prohibitions prevent general dentists from providing orthodontic services. However, any general dentist who is providing orthodontic treatment typically is expected to meet the standard of care that specialists in his or her community are providing. A commitment to ongoing education is, therefore, essential. Additionally, there needs to be concerted effort directed at integrating the orthodontic options into the practice. Some authorities have recommended establishing an orthodontic educational component into routine hygiene visits, for example, or devising a way to reward the entire practice team for new orthodontic cases.

Some orthodontists have felt threatened by the entry of general dentists into the province that once was exclusively theirs. However, other observers point out that more complicated orthodontic cases will continue to be best suited to specialty treatment, and the growing numbers of adult orthodontic patients is certain to guarantee steady growth in cases presenting complex treatment challenges. Unlike children, who are still growing and typically have healthy periodontal tissue, few restorations, and most of their teeth, many adults not only have stopped growing but often have jaw-relationship problems, missing teeth, pre-existing restorations, and/or periodontal disease. All of those conditions may necessitate specialty treatment.

A final trend worth noting is that of increasing communication and collaboration between general dentists and orthodontists. Rather than automatically referring all patients to orthodontists for any level of care, as general dentists become more sophisticated about the spectrum of care, they may provide some services themselves while becoming more adept at diagnosing, treatment-planning, and referring patients to their orthodontic colleagues when that is the best option for the patient.

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