training to practice orthodontics

To some people, the job of straightening teeth seems pretty simple and kind of dull. There are almost as many jokes about boring orthodontists as there are about boring accountants. There’s never been a TV or movie drama about an orthodontics practice. In fact, there hasn’t even been a sitcom. People seem to think of orthodontics practice as kind of a factory job with a much bigger paycheck.

After all, how hard can it be? What’s the big deal? As a matter of fact, the American Orthodontics Association (AOD) reports an upswing in Do It Yourself teeth straightening attempts. These rarely end well. There’s a whole lot more to the practice of orthodontics than most people realize.

Orthodontists are the Navy SEALs of the professions.  In fact, orthodontists are an even more select group than SEALs are. About 10% of the Navy recruits who qualify for SEAL training make it all the way through. Only about 2% of the applicants to dental school finally qualify as licensed dentists. Of these, only a tiny fraction become orthodontists.

To put it in perspective, there are about 1.3  million lawyers in the United States. There are 1 million medical doctors and 200,000 general dentists. In contrast, there are only 13,500 orthodontists. It’s easy to understand when you take into account the 11 -13 years of training it takes to become one.


The first stage of an orthodontist’s training is four years of college. The coursework is heavy on the sciences such as chemistry and biology. Some colleges offer “packaged” pre-dental programs. They design these to satisfy dental school admissions boards.

Getting into dental school isn’t easy. The average dental school accepts only about 6% of those who apply for admission. The top schools accept only about 2.6%.  Admission is extremely competitive. This means that college grades are critical. The competition begins the first day of college and never ends. Dental schools are looking for GPAs in the 3.5 -4.0 range.

Applicants to dental school must take the Dental Admission Test (DAT).  This is a standardized test like the more familiar high school SAT. Winning scores on the DAT reflect grounding in biology, chemistry, physics, calculus, English, and organic chemistry.  The test also measures perceptual ability, quantitative reasoning, and reading comprehension.  The DAT is very hard. A perfect overall score is 30. Half the students taking it score 17.5 or lower. Only 2.1% score 22.5 or higher. These students are most likely get into a top school.

The reward for admission to dental school is four more years of intense study and competition.


Four years of dental school. A Florida university squeezes the traditional 8 years of college + dental school into a combined 7-year program.  Dental school is no picnic. The first-year studies are similar to those in medical school, with an focus on dental anatomy. Contrary to popular belief, dental students learn all about the human body below the neck, too.

Contact with patients begins in the second year of dental school. Students start with basic skills like cleaning teeth. Supervision is close. During the second year, students continue academic study. They get deeper into the diseases affecting teeth. They learn skills like taking impressions in the clinic. Hours are very long.

At the end of the second year, dental students have to pass a major test in order to continue. Part I of the National Board exam screens out students who have not mastered the theoretical and problem-solving skills trained during the first two years of dental school. The exam lasts for 8 hours 30 minutes.

The first-time failure rate is about 11%. Students are allowed to try again. Of all students taking the exam 8.3% fail. Trying again doesn’t seem to help much. Up to five attempts are allowed, with at least 90 days between attempts. Naturally, failing Part I of the National Board exam is a crushing blow for a student. Unless he or she passes on another try, it’s a career-ender. However, this screening is of great value to the patient and dentist communities alike. It provides another pillar of confidence for patients.  Moreover, it protects the reputation of the dental profession. It’s quality control.


Dental students spend a lot more time in the clinic during the third year. They continue to expand their knowledge of procedures. Manual dexterity and hand-eye coordination are key skills for dentists.  Supervised practice in the clinic helps students develop these skills. It’s also another chance for schools to screen out students who fall short in this area.  Meanwhile, in the classroom and the laboratory, third-year dental students top off their knowledge of specialized topics like pharmacology. After all, dentists prescribe medications, as doctors do.

Fourth-year dental students spend most of their time in the clinic. They perform more advanced procedures, with less supervision. Finally, there’s graduation and Part II of the National Board exam. Part II takes 12 hours 30 minutes to complete.  About 11% of students fail the Part II exam.

Having finished dental school and passed the Part II National Board exam, the graduate is qualified to be a licensed dentist. But not to practice orthodontics. As a matter of fact, becoming a qualified orthodontist is still 3-5 more years down the road.


An orthodontics residency is the next step for a fresh new dentist who wants to practice orthodontics. Admission to orthodontics school is even more competitive than the contest for dental school. In fact, orthodontics programs usually take only three new students each year. Moreover, there are only 70 programs in the entire USA. Do the math.

These programs take 3-5 years to complete. Residents spend their days treating patients, guided by watchful faculty. In addition, they spend their evenings doing intense course and laboratory work in advanced subjects like craniofacial anatomy, physiology, and biostatistics. They also study the science and technology behind the treatments they perform during the day. The hours are very long.  By this time, most orthodontics residents are nearly 30 years old. They’ve spent all of their adult lives training for this specialty.

Completing residency is still not the finish line. Graduates still have to pass the American Board of Orthodontics (ABO) exams. It’ is like being put under a microscope. There’s a written exam, a clinical exam, and an oral exam. Examiners review the case files of patients the candidates treated during their residencies. No stone is left unturned.


Only after passing the ABO exam can a graduate practice the profession of orthodontics. A new orthodontist faces a fresh set of challenges. None of his or her schooling dealt with the business of founding and running a private orthodontics practice. Buying equipment, for example. Hiring employees. Renting and remodeling office space. All brand new. Remember how dental schools select well-rounded college graduates? This is one reason why. They’ve already shown they can multi-task and still excel in the professional domain.

Next time you find yourself wondering why your orthodontist bill is what it is, please recall the huge investment he or she has made to prepare for the profession. Keep it in mind if you find yourself anxious about the outcome of treatment. Your Lantana orthodontist is one of the few, the proud, who made it through one of the toughest training paths of all the professions.