Realising your potential

With the rise in orthodontic treatment by general dentists, Neil Counihan from the London Orthodontic Academy says it is essential that you get the right training with the right people

Orthodontics is one of the fastest growing and most rapidly changing areas of general dentistry. Fuelled by increased spending on oral care and the rising popularity of cosmetic dentistry, this has helped to more than double annual UK spending on dental services between 2006 and 2015 (1). It is forecast to grow by 2.1% per year over the next four years (2).
In today’s economic climate, it is not uncommon for dental practices to look for extra avenues to drive additional revenue and increasingly we are seeing orthodontics as route targeted to achieve this. However, out of the UK’s population of 40,000 dentists (3) it is estimated that less than 1,500 are specialist orthodontists4. As a result, waiting times for orthodontic treatment can range from six months to two years or more (5).

Which training path?

To fill this skills gap, general dentists who wish to start undertaking orthodontic treatment have to essentially make a decision of whether to undertake three years’ full-time specialist training to gain their MOrth and become a specialist orthodontist or attend short courses to improve their competency and become ‘certified’ on one of the myriad of orthodontic appliance systems there are on the market today.

There are advantages and disadvantages in both options. Specialist training provides comprehensive training in diagnosis, treatment planning and clinical management and allows you onto the specialist list. However, it is very expensive, with no opportunity of doing it part time. Also the idea of studying during the weekends and having to do written and verbal exams is a turn-off to many.

The other option of not specialising and attending short courses eliminates these disadvantages. However, the end result is that often dentists do not feel they have enough knowledge, understanding or support to undertake many orthodontic cases other than very simple and straightforward ones.

In today’s litigious culture this can create a dangerous combination and leaves dentists frustrated in not being able to take on more complex cases or alternatively deciding to start a case and soon realising they are in over their heads and are not sure who to turn to. For such reasons, many orthodontists feel that general dentists should not offer or undertake orthodontic treatment at all.

The right choice

Based on my experience running some of London’s fastest growing and most prestigious orthodontic clinics, I have to say I do not agree. Dentists can and should do orthodontics to meet the unmet need in the UK. That being said, going on a two or three-day certification course to learn how to use a different orthodontic appliance system theoretically or at best on a typodont is simply not enough for the inexperienced practitioner. This belief was reinforced after attending an orthodontic course where a general dentist pulled out a large number of study models and was asking for advice on what to do. In each case he was using a different system and was struggling with it.

General dentists need good theoretical and clinical training in order to given them the confidence and ability to be successful with their orthodontic treatments. They should also have a proper support structure to help them and avoid complaints, litigation and sleepless nights. While some brace companies do offer remote support I cannot help but feel that this is not enough.

This is why we decided to form the London Orthodontic Academy. We believe that an alternative was required to face the training void general dentists face today. The 12-day programme taught over 10 months, not only provides general dentists with a core knowledge of the fundamental principles of orthodontics but also allows them to learn in a clinical setting, treating patients under the supervision of the specialist orthodontist team.

The London Orthodontic Academy also provides direct mentoring and support for all dentists registered on the course and can provide second opinions and discuss cases not going to plan. Such support gives dentists the confidence to safely undertake orthodontic treatment in their own practices. Dentists also have access to the Academy’s online forum and their own mentors where they can directly ask the Academy’s specialist orthodontists  for advice.


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Neil Counihan is one of the UK’s leading orthodontists. After finishing his training in 1995, he joined one of London’s most esteemed straight-wire practices before setting up his first private practice in South West London in 2000. He set up the internationally renowned Metamorphosis Orthodontics in 2014. Dr Counihan is a registered specialist in orthodontics and a course leader and mentor at the London Orthodontic Academy. He regularly speaks and lectures on orthodontics around the world. He is also one of a handful of orthodontists in the UK who regularly undertakes orthognathic cases.

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