General dentists – scope of orthodontic practice

This scope of orthodontic practice is endorsed by the Heads of the Orthodontic Departments of all dental schools in Australia and New Zealand.

“The foundation knowledge gained in a general dental training program does not provide competency in comprehensive orthodontic diagnosis, planning or treatment. Dental graduates aspiring to practise comprehensive orthodontic treatment, or to practise as orthodontists, are required to undertake a three-year clinical doctorate or equivalent at an Australian university or a recognised overseas program.”

 

1. Orthodontic education in the general dental curriculum generally follows the following sequence from the 2nd to the 4th or 5th year of the course dependent on the school and course duration. Although the specific placement of the educational component may vary, the overall sequence of integration of the material is generally similar.

2. Level 1 - Usually second or third year of the course:

2.1 This course systematically outlines the complex interaction between normal somatic growth and development, jaw growth and the developing dentition. In studying the normal developmental process, the student will appreciate the wide variation in developmental processes. In so doing, this course will be the foundation for identifying aberrant development in the dentofacial region and the possibilities for firstly establishing possible aetiological factors and options for intervention by the clinician.

2.2 Topics in this course cover somatic growth principles, theories concerning the nature of craniofacial growth and how it is studied. Students are introduced to timing, sequence and mechanisms of tooth formation and tooth eruption and changes in the dental arches during the transition from primary to permanent dentition and finally through to the maturing adult dentition. Students are exposed to how these dental changes relate to jaw development pattern.

2.3 Students should also appreciate that these physical changes occur in a complex manner in an individual who is changing socially and emotionally, which may also influence the strategies involved in management.

2.4 At completion, a student should have achieved the ability to:

  • 2.4.1 Outline general patterns of somatic growth in children and adolescents.
  • 2.4.2 Identify normal from abnormal mechanisms and patterns of growth and development of the jaws.
  • 2.4.3 Appreciate the importance of aetiology of facial growth problems.
  • 2.4.4 Outline mechanisms and timing of normal dental development.
  • 2.4.5 Explain simple clinical problems associated with disruption of tooth development and eruption.
  • 2.4.6 Understand the impact of somatic growth and maturational changes on facial and dental development.
  • 2.4.7 Understand the fundamentals of social and emotional development of a growing child and the impact on how dental care is delivered.

3. Level 2 - usually in the third or fourth year of the course:

3.1 This course builds on the knowledge students have acquired about human growth and development to give students a perspective on orthodontic problems with special reference to dentition, prevalence and aetiology.

3.2 Students are taught diagnostic procedures for developmental problems, so that they can distinguish skeletal from dental components of these conditions.

3.3 Students are provided with an introduction to clinical orthodontic treatment. This includes learning the procedures in treating a patient in the orthodontic clinic, the actual diagnostic work-up of the patient, and participation in appointments in which treatment is planned. Students are taught to fabricate, and adjust several commonly used removable and fixed orthodontic appliances.

3.4 Students should learn to understand and explain the basic biomechanical principles involved in orthodontic tooth movement and recognise the clinical situations for which these appliances are indicated, and be aware of their limitations. Students should also be able to understand and explain the effects that these appliances can produce (both desirable and undesirable).

4. Level 3 - usually in the third or fourth year of the course:

4.1 At this stage of a student’s dental school career, they have a limited background in the development of orthodontic problems, diagnosis and treatment planning, and treatment methods. The goal of this course is to put this knowledge into the perspective of contemporary practice. The focus is on how to evaluate patients with orthodontic problems, how to decide rationally which patients are the best candidates for management in general dental practice, and which are best referred to an orthodontist, and what one should expect when interacting with orthodontists.

4.2 At completion, a student should have achieved the following outcomes:

  • 4.2.1 Describe and explain orthodontic problems and the implications on the patient's health status and society
  • 4.2.2 Describe the range of normal dental development and recognise developing malocclusion and methods for determining treatment.
  • 4.2.3 Demonstrate orthodontic diagnostic procedures for developmental problems and outline rudimentary treatment plans
  • 4.2.4 Perform simple orthodontic therapy at the general practitioner level and describe principles of comprehensive treatment.
  • 4.2.5 Explain the basic biomechanical principles involved in orthodontic tooth movement in children
  • 4.2.6 Understand the basic mechanisms and indications/contraindication for Clear Plastic Sequential Aligner treatment.
  • 4.2.7 Understand the design, fabrication, and activation/adjustment of a limited number of orthodontic appliances.
  • 4.2.8 Have some experience handling orthodontic appliances in a non-clinical environment.

5. These outcomes are specific to each Dental School but are fairly consistent across Australia.

6. The Australian Dental Council in accrediting Dental Schools’ general dental courses ensures that processes are in place for graduating students and future practitioners to demonstrate their
competency and proficiency in performing specific procedures which will define the scope of their practice.

7. Dental graduates aspiring to practice comprehensive orthodontic treatment or to practise as orthodontists are required to undertake an accredited three year clinical doctorate, or equivalent degree, at an Australian or New Zealand university or an Australian Dental Council approved program in orthodontics from another country.

8. This involves a three year fulltime course with supervised practice and instruction in a university environment. A graduate orthodontic program consists of constant supervision of orthodontic cases from diagnosis, treatment planning, progress of treatment and finished case assessment. This process is consistently concluded by a final examination process which assesses knowledge, competency and proficiency in a wide range of procedures within the scope of practice of a specialist orthodontist.

9. While some appliance therapy is taught at the undergraduate level, students are also taught about when referral to an orthodontist for management and treatment is indicated.

10. It is essential that general dental practitioners are able to identify when treatment of a patient is beyond the scope of their practice, training and skills.

11. We consider that following completion of their course, general dental practitioners should be competent at the following aspects of orthodontic treatment:

11.1 Recognition of dentofacial problems in children and adults with an understanding of the implications associated with their management whether by

  • i. Provision of removable orthodontic appliances for simple tooth movement including dental expansion. Simple appliances normally contact teeth at a single point and produce tipping movements. Treatment objectives are limited to moving a small number of teeth. Examples include; the correction of one or two teeth in crossbite, space opening for a partially impacted tooth and use of a separator to disimpact a mildly impeded tooth.
  • ii. Provision of a limited range of fixed orthodontic appliances which include passive space maintenance appliances following early loss of deciduous (baby) teeth, fixed anti-habit appliances (thumb or tongue interposition appliances), and closure of a small diastema in carefully selected cases.
  • iii. Referral to, and interaction with, specialist practitioners for treatment which is in the best interests of the patient.

12. In our view, the foundation knowledge gained in an undergraduate orthodontic program does not provide competency in comprehensive orthodontic diagnosis, planning or treatment.

13. The postgraduate course in orthodontics prepares the specialist to firstly recognise malocclusion traits, develop a comprehensive diagnosis and evidence-based treatment plan based on the patient’s specific concerns and problems. Not all patients respond similarly to the mechanotherapy because of differences in physiology and growth patterns. The specialist is trained to recognise the individual responses to treatment procedures and is trained to modify the treatment plan in a timely fashion when required. This cannot be achieved in the undergraduate program or by distance education in the general practice environment.

 

Signed by the Heads of the Orthodontic Departments of all dental schools in Australia and New Zealand.