A day in the life of an orthodontic therapist

Chrystal Sharp walks through a day in the life of an orthodontic therapist, highlighting her responsibilities and role in the patient journey.

A day in the life of an orthodontic therapist can be both hugely rewarding and exciting. We see our patients regularly from every four to 12 weeks during their orthodontic treatment, which can span from six to 24 months depending on the complexity or aims of treatment.

This means we can build a unique rapport with our patients while offering a service that truly matters, in some cases offering life-changing results, which in turn enriches our day by adding overall enjoyment to our role.

With our scope of practice being so varied in the orthodontic procedures we offer, we can see patients from the very beginning of their treatment to the very end. We are able to carry out each part of the treatment, apart from interproximal reduction (IPR), under the prescription of an orthodontist or dentist.

Every day is different

Each day can be very different and this is what makes the role of the orthodontic therapist so unique. However, it can also be challenging at times due to the varying lengths of treatment time and the different procedures we offer.

How your clinical day runs will largely depend on how the clinic you work within utilises an orthodontic therapist. I feel an orthodontic therapist should be incorporating their full scope of clinical practice into their clinical day in order to avoid deskilling, while also ensuring full enjoyment of the role.

As an orthodontic therapist, this can be managed by ensuring you are working within like-minded clinics and adopting an open communication with your practice principal and management team. This, in turn, will help create autonomy of your clinical diary.

It is hugely important to ensure you can carry out procedures to the best of your clinical ability, meaning you have the relevant time and resources available along. You also need full exposure to the brace type/orthodontic treatment being offered, therefore incorporating your role into the full patient journey and working to your full potential.

Typically, the day of an orthodontic therapist will be very varied, with no two days being the same. When working to our full potential, our scope of practice allows us to see the patient from the initial consultation under the prescription or alongside our prescribing orthodontist or dentist.

Patient discussion

Starting with the initial discussion with the patient on what they desire to change about their smile, we can then take the full series of orthodontic records consisting of intra and extraoral photographs, radiographs (if radiography qualified) and a digital scan or impression for pre-treatment study models to be cast.

My favourite part of this process is taking the digital scan of the patient’s teeth as we can visually show a dental oral health overview of their teeth along with processing an outcome simulation. This provides the patient with a computer-generated before and after image of what orthodontic treatment could achieve.

This part of the discussion usually enables a patient to become more relaxed as they get excited when visually seeing certain aspects of their smile they currently dislike adjusting to a position they desire. Allowing us to be at the forefront of the patient’s smile journey means we gain the patient’s trust as we explain step-by-step how the their orthodontic journey will take place.

As an orthodontic therapist, seeing the patient from the consultation, or becoming a part of that process, positively enforces a team approach while optimising the patient experience. The fit of the orthodontic appliance can be daunting to a patient, as any dental procedure can be, coupled with being carried out by someone they are just meeting for the first time and not the prescribing clinician that carried out the consultation makes the experience difficult for both the therapist and the patient.

Fitting the appliance

Once the patient has chosen the orthodontic appliance they wish to proceed with, the next stage is for the orthodontic therapist to fit the appliance. We also need to share the relevant aftercare and oral hygiene instructions with the patient.

There are many orthodontic appliances that can be utilised, and each orthodontist or dentist has a preference. This can range from fixed orthodontic appliances to removable appliances, such as aligners.

At the start of an orthodontic therapist’s career, exposure to as many orthodontic appliances is key for developing skill and feeling confident working with any orthodontic appliance. This helps you find your niche within your role to create full enjoyment.

Some orthodontic appliances may have a steep learning curve, such as lingual appliances which are placed behind the teeth, making access and clinical vision more challenging. As orthodontic therapists, we should be continually investing and enhancing our skills by attending post-qualification courses. Personally, I feel investing in dental loupes will not only enhance your clinical vision, but your clinical skills too.

Adjusting and monitoring

Once the appliance has been fitted, we will then continue to see the patients every four to 12 weeks, adjusting and monitoring their appliances under the direct prescription or alongside the prescribing clinician. This is where the rapport with our patients truly grows, witnessing the shift in the patient’s confidence as their smile starts to positively change.

The orthodontic therapist plays a pivotal role in the management of the patient’s journey, ensuring they are following our care instructions such as oral hygiene or compliance with aligner or elastic wear.

When working in clinics that are utilising the best technology, artificial intelligence allows us to monitor our patients more closely. We can then streamline our orthodontic workflow, allowing the patient’s experience and care to be elevated. This also allows our clinical diary to be better managed as the patient’s remote scan will allow us to effectively prepare the timings of our procedures, lengthening or shortening as required.

An example of this would be a patient attending for a regular adjustment of their fixed appliance, but a bracket has detached. We can then lengthen this appointment or ask the prescribing clinician to adapt the prescription, as we may not be able to carry out the adjustment as prescribed due to the breakage.

Equally in this scenario, the appointment could have been for the brace to be removed, but if a relapse of a tooth position has occurred due to the breakage, the brace will not be removed. Then we can shorten the appointment ahead of time, allowing other clients to be seen.

Orthodontic therapists are the perfect candidate to overlook remote monitoring as they have the relevant clinical knowledge, while also allowing you to optimally prepare for your day.

Removal

Lastly, when the patient and treating clinician agree that the result has been achieved, the orthodontic therapist can remove the orthodontic appliance (or attachments if the patient has clear aligners). This is the most rewarding part of my job – revealing the final result and unveiling the new smile with the patient’s confidence shining through.

The orthodontic therapist will provide the aftercare, explaining how to maintain the patient’s new smile, along with the fitting of fixed retainers and ordering of removable night time retainers, then taking the final records.

Sometimes on the completion of treatment, the smile they desire may not be achieved, so a multidisciplinary approach may be be required, such as dental implants, bridges or composite bonding. As an orthodontic therapist, we can refer to our colleagues for this and advise the patient on the treatments available.

Continuing to grow and progress as an orthodontic therapist is essential to maintain enjoyment within our role, staying ahead of the curve as the technology changes. There are currently more orthodontic courses and conferences which allow orthodontic therapists to attend. Attending these is the key to your success, along with taking pride in your clinical work.

You could also look at entering dental awards, such as those from FMC, which will allow you to grow as a clinician and monitor your progress.

My hope is that, as more orthodontic therapists qualify, the scope of practice will develop and open the possibility for further qualifications.