Chrystal Sharp discusses what an orthodontic therapist is, what they can and can’t do, and why they are an essential part of the patient journey.
Orthodontic treatment is more in demand than ever, especially with patients looking for a less invasive, more holistic approach to creating their desired smile. A multitude of reasons may lead a patient to seek orthodontic treatment, whether it be solely for aesthetics, function or a combination of both.
With more social media awareness in cosmetic treatment such as aligner treatment or composite bonding, patients now understand prior alignment of teeth is usually required to later allow for a less permanent cosmetic procedure to be carried out in achieving the smile they desire.
It is therefore becoming more common for both specialist orthodontists and general dental practitioners to provide orthodontic treatment, leading to the need to utilise an orthodontic therapist within a private clinic. In turn, this allows for an increased patient availability and the best use of clinical time.
What is an orthodontic therapist?
A niche role within the DCP (dental care professional) sector with only around 1,022 registered to date, orthodontic therapists are highly skilled registered dental care professionals. They can carry out certain parts of a patient’s orthodontic treatment and work alongside and under the prescription of either orthodontists or general dentists, or a combination of both.
When an orthodontic therapist is working to the full potential, meaning to carry out the full scope of their practice, this role will positively enhance the daily workflow by creating more time in the prescribing clinician’s diary by continuing the treatment of existing patients.
This then allows the prescriber to focus on new patients or higher value treatment, which accelerates the growth of the business. If using aligners, this also increases the advantage points or provider status of that clinician, which in turn increases the profitability by reducing the associated manufacturing costs.
Most importantly, the role of the orthodontic therapist ensures that patient care is maintained as patient numbers increase.
We are an integral part of the patient’s orthodontic journey, and the clinical workflow within both specialist and general dental practices that provide orthodontic treatment.
What can orthodontic therapists do?
Consultation stage
Our scope of practice allows for us to be a part of the journey from the very beginning, such as the consultation stage.
We are able to take full orthodontic records such as impressions or a scan of the teeth (digital impressions), pre-treatment photographs, prescribed orthodontic radiographs that are required such as a cephalometric or orthopantomograph X-rays (providing we have our radiography qualification), and record the patient’s existing malocclusion.
This will then allow for prescribing clinicians to diagnose and formulate a treatment plan for these baseline records. At this point, we can discuss the proposed plan, educate the patient on the current view of their oral and dental health, discuss what could be practically achievable with orthodontic treatment, and what they may need to consider pre- or post- orthodontic treatment.
Fitting and adjusting appliances
Once the orthodontic appliance type has been selected, orthodontic therapists can fit, adjust or review these appliances under the prescription of the treating clinician. This can be any orthodontic appliance, such as, but not limited to, traditional metal, ceramic or lingual fixed appliances, clear aligner attachments and functional fixed or removable appliances.
We can confidently and competently continue the care of the orthodontic patient under the written or verbal prescription of the treating clinician. This includes adjusting their orthodontic appliance, such as removing and reinserting the next archwire, changing or adding auxiliaries, reviewing the fit and tracking of Invisalign aligners, and providing the patient with the next batch of clear aligners.
Repairing broken fixed appliances or reviewing patient concerns to give appropriate advice may also be required during treatment.
Use of AI
It is more common now for clinics to be utilising AI (artificial intelligence) to monitor their patients during orthodontic treatment. For example, patients might be provided with a scan box that attaches to a mobile phone, allowing videos/images to be taken of their teeth through a smartphone app.
The patient’s orthodontic clinician will set the intervals at which they wish the patient to scan their teeth while in the comfort of their own home. These images are then assessed by their orthodontist allowing the patient to be provided with feedback and checking the teeth are moving as planned.
This allows the orthodontist to intervene as necessary and ask the patient to come to the clinic sooner or later than the next scheduled appointment. This also allows for fewer surprises at the next scheduled appointment as the patient’s teeth have been reviewed prior.
Orthodontic therapists can oversee certain elements of this to create more clinical efficiency and autonomy of the clinican’s diary. This includes allowing for the best use of clinical time by adapting the patient’s appointment as required, eg extending an appointment to accommodate a broken bracket or decreasing a brace removal appointment if things may not be going as planned.
We can then utilise the patient’s scan to secure an updated prescription from the treating clinician as changes develop which, without the remote monitoring, may not have been known until the appointment time.
Retention management
When the goals of treatment have been achieved, with the treating clinician and patient mutually agreeing on the end result, the orthodontic therapist can remove the orthodontic appliances along with any adhesives or cement from the tooth surfaces.
We can also discuss the fit and prepare the retention options along with educating the importance of lifelong retention to prevent relapse, providing instructions for the long-term care of fixed or removable retention.
Orthodontic therapists can then carry out the fitting of bonded retainers, taking of an intraoral scan or impressions for final post-orthodontic models and ordering/manufacturing of removable retainers, and later the fitting of removable retainers.
Orthodontic retention is lifelong, though retainers will not last forever and patients will require reviews, replacements or repairs. Orthodontic therapists can assist clinics in providing these appointments, ensuring continued patient care is a top priority.
Orthodontic therapists in a multidisciplinary team
Orthodontic therapists can work in specialist led clinics or general dental practices, which often means we are working within a multidisciplinary team. Treatment can often be referred and prescribed from multiple clinicians and, due to this, we usually have a varied day seeing patients at different stages of treatment.
We may be faced with situations where patients have questions about other dental treatment, such improving their oral hygiene, fixing unexpected issues such as a debonded crown or a chipped tooth, restoring spaces from previous tooth loss, tooth whitening and composite bonding.
In these situations, our scope of practice allows us to take full records, give appropriate advice and refer to other healthcare professionals to diagnose and formulate a treatment plan.
What can’t orthodontic therapists do?
Our role is limited to carrying out certain parts of orthodontic treatment under prescription, and that means the rest of dental treatment that does not fall under orthodontic treatment is reserved for other appropriate specialists, dentists, hygienists or dental therapists.
There are also some aspects of orthodontic treatment that we cannot do, including those relating to diagnosing disease, treatment planning or removal of enamel tissue such as interproximal reduction (IPR). Some orthodontic therapists may be dual qualified with dental hygiene and therapy, so depending on indemnity will be able to carry out removal of enamel tissue under prescription for IPR and continue to provide the scope of practice within their other registered titles.
Overall, the role of the orthodontic therapist allows for a varied clinical day with a diary scheduled with multiple different orthodontic procedures and appliances.
The treatment you are providing is life changing for patients. They say a smile is more than what we see; it’s a reflection of a person’s emotions such as joy, happiness and confidence. Each one is unique, no two being the same.
Each smile has the ability to convey and spread emotions to others. To be an integral part of this journey for each patient we see is hugely rewarding.
Follow Dentistry.co.uk on Instagram to keep up with all the latest dental news and trends.
