Some dentists send patients who need braces to orthodontists, while others treat them themselves, according to a recent Wealthy Dentist survey. One in four dentists reported that they treat most orthodontic patients themselves. By contrast, one in three refers out all orthodontic patients.

"It’s a win for everyone," said an Illinois dentist who refers out all orthodontics. "Patients are well served, we are looked upon as caring, and orthodontists are geared specifically to do this."

A California dentist who refers less than 20% of orthodontic patients said, "I am happy to refer out those cases which I don’t feel competent to treat or which I just don’t want to treat for whatever reason. Having been actively treating orthodontic cases in my general practice for over 20 years now, there are not a lot of cases which I refer out."

"Minor tooth movement is within the purview of dentist and pedodontist. Treatment planning for major malocclusions is better done by an orthodontist and an oral surgeon," said a Minnesota oral surgeon.

The most remarkable differences were related to geographic location. Rural dentists were more likely to treat orthodontic patients themselves. More than half of rural dentists (54%) reported treating braces patients themselves, while only 9% of urban dentists and 26% of suburban dentists did. "I do orthodontic work in my office and have been for 20 years. I only refer out surgical ortho cases," said a general dentist in rural Wisconsin.

Gender differences were dramatic. Male dentists were more than twice as likely to treat orthodontic patients. Female dentists were more likely than their male colleagues to refer these patients out to a specialist. "I believe that only a good orthodontist can get really good, long-lasting results," said a female dentist.

"I don’t need to refer for 95% of cases or more," said a male dentist.

Some dentists see it as their duty to refer patients out to dental specialists. "I feel the best treatment for my patients is for a specialist to do things for which they are better trained than I am. This goes for orthodontics, oral surgery, periodontics, and endodontic work. Weekend courses do not compare to the rigorous training that specialists receive in their residencies," said a North Carolina dentist who refers more than 80% of orthodontic cases. "Our profession is awash in undertrained dentists putting their bottom line ahead of their patients’ best interest, and I feel this will marginalize our profession in the medical community."

Some general dentists have found that there’s good money to be made in doing orthodontic work. "It is my understanding that GPs do 80% of all ortho in the USA," commented a Michigan dentist who refers less than 20% of orthodontic patients. "If we (GPs) as a whole just knew how easy ortho is, the vast majority could increase monthly income by 15 to 25%. I took my classes from USDI, love doing it, and now me and my stay-at-home wife are both driving Mercedes."

Invisalign is changing the role of general dentists in orthodontic treatment. "We offer Invisalign braces in our office, but all wire and brackets are referred to a traditional orthodontist," commented an Oregon dentist.

A Michigan dentist disagreed with that strategy, saying, "The vast majority of GPs have no formal training, so they should refer out. Most of the GPs who do Invisalign have no clue about ortho and are doing a disservice to their patients."

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