How to Choose an Orthodontist – It’s not just about your smile

Braces? Invisalign?  Isn’t it the same no matter where you go?  Unfortunately, NO!

Orthodontic treatment, in any form, is a medical procedure.  It is not just a cosmetic procedure.  While it may not seem like it, movement of your teeth can effect your health now and into the future.  It is important to understand that the fit of your bite can directly effect the bony joint that allows your mouth open and close.  Your bite can effect the “wear and tear” on the joint and the “wear and tear” on your teeth.  A good bite also lends some protection to your joint and your teeth in cases of trauma or the slow constant effects of stress.  Many problems will not likely become evident immediately, but can become evident over time.

If you had a procedure on your knee, no matter minor, would you trust your care everyone who claimed they could fix it?  Most likely you would research your options and seek out recommendations.  But ultimately you would choose to go the provider who does the best work!  When choosing someone to do your orthodontic treatment you should consider doing the same thing.  Who does the best work really matters!

Judging who does the best work is not an easy task.  Today, many providers focus on just aligning the front teeth to make a pretty smile.  While they know the treatment in incomplete, they justify it with …”the patient is happy”.  Do you want your final result judged on that criteria or by accepted standards for treatment that have been in place for decades?  To help you judge  who does the best work, we have attempted to provide you with some criteria and questions you should consider asking within this section of the website.  If you have questions about the criteria or anything about the orthodontic treatment you are considering, please feel free to contact Dr. Ziaja’s office at 586-247-6453.

With an orthodontist seemingly on every corner and many general dentists dabbling in orthodontics and Invisalign, how do you choose where to have treatment and what type of orthodontic treatment to pursue?  There is no absolute quantifiable way to compare orthodontic treatment and orthodontists.  Items you should consider in your assessment and the questions you should ask before you choose an orthodontist include:

Is the orthodontist a Diplomate of the American Board of Orthodontics?ABO Chart

Diplomate status is achieved after completion of orthodontic training and state licensure.  Only 20% of all orthodontists are Diplomates.  It is not required to practice orthodontics, but is an optional three-part examination given to assess an orthodontist’s qualifications and quality of treatment.  The orthodontist presents cases they have treated to the Board.  Along with an oral and written examination, the orthodontist’s treatment and knowledge are evaluated by the top orthodontists in the country.   Of all of the orthodontists in the area, less than five are Diplomates.  Dr. Ziaja is a Diplomate of the American Board of Orthodontics. They define a standard of what quality treatment should achieve.

If the orthodontist is a Diplomate, does it guarantee you will receive top quality treatment?

No, but it improves the chances.  Ultimately, the quality of treatment is determined by the ethics and integrity of the provider.  After an orthodontist has achieved Diplomate status, they have no obligation to strive to treat patients to the standards set by the American Board of Orthodontics in their daily practice.  It is important to ask whether the orthodontist continues to treat to these standards, as Dr. Ziaja does. 

Additional specific questions to ask include:

Is the bite being corrected to American Board of Orthodontics standards or are the front teeth just being straightened to make the smile look pretty?

The smile tells you nothing about the quality of the treatment.  Anyone can straighten your front teeth to make them look better.  If the bite is not corrected when the teeth are straightened, then the correction will relapse out of alignment quicker because the bite is not supporting the retention of the alignment.  When a bite is properly fitting, the top and bottom teeth fit together like 2 gears meshing together.  This meshing allows the proper functioning of the teeth and facilitates better retention and long term health.

When the bite does not fit together properly it is like a “tooth” in the gears being misaligned.  The gears will not function properly because they are rubbing against each other causing them to wear unevenly.  In a dental situation, you probably won’t be able to tell the difference in the short term.  Even after the braces are removed, the smile may look fine even if the bite is not fixed.

It’s in the long term where the differences are significant because the teeth will wear unevenly.  Many dentists believe when teeth wear unevenly it leads to fractured teeth, root canals, bruxism, clenching, TMJ and periodontal (gum) problems.

Orthodontic treatment, by many orthodontists and general dentists, is to only align the teeth.  It is important to ask whether your treatment goal is to correct your bite to American Board of Orthodontics standards. 

Fixing the bite takes longer, but improves the stability of the cosmetic alignment and helps reduce the risk of developing TMJ and gum problems later in life.  Dr. Ziaja’s goal on every patient is to fix the bite.

Are the 12 year molars being aligned and fit into the proper bite? 

A vast majority of orthodontists do not align the second molars.  Why?  Because it makes treatment more difficult, it is more complicated for their clinical staff, and the treatment takes longer.  Non-aligned second molars can cause future TMJ problems, headaches, and damage to the teeth due to grinding.  Dr. Ziaja routinely aligns all of his patients second molars.  Treatment time is also typically longer if the second molars are banded.

Are bite problems corrected in all 3 planes of space? 

This means the bite is corrected in every direction (vertical, right to left, and front to back).   These corrections can be difficult and time consuming to correct.  Their correction is often skipped in exchange for speed.  Correcting them is important for the best esthetics, jaw, and long term gum health.

Does the orthodontist take progress panoramic radiographs to verify the root position of the teeth? 

We consider these progress panoramic radiographs important to fully complete treatment.  We move the brackets or bend the orthodontic wires to achieve proper root parallelism in the bone.  This means that not only are the teeth straight, but the roots are also straight.  This is important for long term stability and for periodontal health.  If the roots are not straight, there is a greater chance the teeth will relapse back into their initial, pre-treatment position.  We reposition the brackets and take the x-rays at no additional charge.

Who is providing the treatment, the doctor or the staff? 

In most offices, the staff does most of the treatment with only cursory involvement of the doctor.  To maintain volume, patient visits are shorter and treatment goals reduced so the staff can handle them.  Difficult orthodontic problems are not addressed because they are too difficult for the staff to manage.  In our office, Dr. Ziaja provides the treatment with limited staff support.  He bends all the wires and sees every patient at every appointment. 

Why do treatment times vary so much between different orthodontists? 

For decades orthodontic treatment took around two years to complete.  Now, some practitioners promise ultra-short treatment times ranging from 3 to 15 months.  The claim is better technology allows for faster treatment.  Virtually every orthodontist uses the same, new technology.  While it is often claimed, no one has an exclusive claim on any special technology.  Think about it.  Could a supplier stay in business if it only provided its special technology to one orthodontist?  Technology, unfortunately, can’t change the biology of tooth movement.  A tooth can only be moved as fast as the biology permits.  Treatment whose goal is not to fix the bite but to align the teeth is generally faster and less expensive.  Generally, if a treatment time is projected to be less than 18 months it is likely the treatment will not correct all of the existing problems in the bite.

Are the same treatment plans being compared? 

Different treatment plans to fix and properly align the bite involve different costs and patient cooperation requirements.  Different options often don’t create the same result.  A proposed Phase I treatment (7-10 yr. olds) that does not fix the bite will be cheaper, but may mean that extraction of permanent teeth or jaw surgery will be needed in the later phase of treatment.  We can discuss alternative treatment plans that have different costs and different outcomes.

Does the fee include retainers?  What type is used? 

Our retainer fees are included as part of your braces fee and are not a separate charge dropped on you at the end of treatment.  Unlike most offices, we offer both traditional retainers with a wire and plastic or the clear, Invisalign-type retainer.  We do not charge extra for the traditional retainer, which has superior longevity compared to a clear retainer.

Are appointments available at the times you desire? 

While most offices close by 5 PM or earlier, we offer day and evening appointments to accommodate working patients and parents. 

What is the difference between an orthodontist and someone doing orthodontics?

If an office performs any dental services (like dental cleanings) other than braces, the provider is a general dentist and not a specialty trained, state certified specialist.  An orthodontist has an advanced 2 to 3 year degree beyond a general dentistry degree.  In the state of Michigan, a specialist is not allowed to practice general dentistry and is the only one who can legally and ethically state they are an orthodontist.  A general dentist can perform orthodontic treatment, but they are ethically obligated to inform you that they are not state certified specialist.  If your treatment is being performed by the same practitioner who provides your dental care, then your provider is a general dentist and not an orthodontic specialist.  Don’t assume that your provider is an orthodontist or has an orthodontist overseeing your treatment.

What about Direct to Consumer companies?

Read this consumer alert flyer from the AAO Direct  to  Consumer  companies.