By: Dr. James Noble

  1. Don’t get frustrated learning.

Orthodontics is not black and white. It takes time and repetition to understand concepts and to think like an orthodontist thinks. You may find yourself sitting in a treatment planning session wondering what in the world is being discussed. Programs are 2-3 years in length for a reason and we all know orthodontics can’t properly be taught by taking a few weekend courses.  Keep your mind open, listen, and don’t get frustrated.  Don’t let fellow residents, instructors or staff patronize you and intimidate you from asking questions and don’t be afraid to let them know that you don’t understand.  We were all there and with time and effort you will understand because orthodontics isn’t rocket science. If you put the hours in then you will be rewarded.


  1. Try as many different products, systems and appliances that you possibly can.

You will never have another opportunity to sample so many different orthodontic products. If your program doesn’t have something you want to try, get them donated by your sales rep. Try different types of twin brackets (pre-pasted and not), self-ligating brackets, miniscrews (you should not allow yourself to graduate without having placed several miniscrews). Try different functional appliances and modalities to correct Class II and III dental and skeletal relationships, for example: Headgear, Twin Block, Distal Jet, Herbst, Forsus, Powerscope, Carriere, Protraction facemask.  Treat cases with 0.018, 0.022 and bi-dimensional techniques. Use different bracket prescriptions. Try to treat a case using lingual braces using Harmony or Incognito. Get experience using Invisalign and other clear aligner systems. Try different types of primer, SEP, and bonding paste. Use different curing lights. Try a positioner. Use different types of wire and archforms. Sample, sample, sample and sample some more. You will never have this chance again.  Don’t let what instructors say they may not use, influence what you will try or use. Try it and judge for yourself.  Your program is very much what you make of it.  And when you graduate, ask each sales rep to give you 10 cases to try.  They want to lock you up with their bracket early because they know it’s not often orthodontists switch.


  1. Treatment plan and see as many cases as you can.

The more cases you thoughtfully review and the more you treatment plan and discuss with your peers and instructors, the more efficient, effective and confident you will be your first day in private practice. Patients will then be able to see the confidence you resonate and they will be more inclined and comfortable to start treatment that day.  Don’t take one instructor or a senior resident’s word for any treatment plan as final; there are many roads to Rome and ways to skin a cat.   You will do yourself a disservice if you use the same treatment plan and philosophy to treat multiple patients.  Seek opinions from different instructors and outside faculty and listen to their rationale for treatment. Try different approaches with the same type of case, even if it’s as little as treating a borderline case with extraction versus non-extraction.

Most residency programs have very little treatment planning on patients in the mixed dentition and you will be overwhelmed in private practice seeing these patients with a plethora of problems, so make sure you gain experience and do your reading in this area.

You often don’t have enough time at each patient visit to understand the mechanics of what is going on, so take photographs at every appointment and study them later at home. This will give you a chance to perfect your photography skills which you can pass along to your team in private practice.

Don’t limit yourself to only treating patients, there is so much more to learn! Understand the intricacies of your programs orthodontic software program which will be your backbone in private practice. Spend time with the laboratory technician and know how to use a scanner or take proper alginate impressions. You may not be doing this in private practice but you are the leader and you need to be well versed in all aspects of the game to ensure excellence in the performance of your team. A football coach may not know how to throw the ball as far and as accurate as his star quarterback but he needs to teach and guide him.  Learning now is best available from online forums, so be an active part of forums such as Pragmatic Orthodontic Clinical Discussions. Don’t limit yourself to seeing your own patients, but follow the progression of the cases of your fellow residents.   The more you see, the better you will be.


  1. Listen, question, challenge, argue and be evidence-based in your thinking.

Sitting around the treatment planning table nodding your head in agreement with a standard treatment plan, especially if you don’t agree with it, will not help you become a better orthodontist.  Don’t be afraid to question dogma and convention.  Just because something has been done a certain way for 100 years, doesn’t mean its right or has been done well or efficiently for that long.  Don’t let blanket statements go unquestioned and be prepared to know the evidence when you make statements. Respectfully question any product claims made by a sales representatives and ask them for evidence to back up what they say.


  1. Relationships, Relationships, Relationships.

We’re in a relationship profession.  We each have our individual skills, talents and expertise but we also have our weaknesses which someone else may have as a strength. If we join our individual strengths, we can synergize together and the whole can be more than the sum of each part. This concept can be applied to many areas including studying different didactic topics or working together with ideas to build a practice.   Your co-residents are experiencing the exact challenges and having meaningful relationships with them, even if it’s just one, with be invaluable as you will grow more together.

Relationships go beyond our co-residents but include every individual in your program. The dental assistants have likely being doing it for years and they can teach you tricks and ways to be efficient. They may even introduce you to former grads and tell you about job opportunities. Your company sales reps may be the best person to contact about potential associate positions and location for practices. You should visit the private practice of all your instructors and pick their brain and learn from their mistakes and expertise.  They are donating their time to teach you because they enjoy it and will be happy to take you under their wing, if you ask.


  1. Be a CE junkie.

Go to every possible seminar, course, conference and event that your program director allows you to go. You are limited in your program to the education given by your instructors.  When you go to these meetings, spend time talking to others, because every orthodontist can teach you something and you will find most have a genuine desire to help residents and new grads.  If you go to the AAO, spend at least half the time in the exhibit hall meeting vendors and other orthodontists. Try not to be exclusive to courses and conferences focused on clinical and didactic material but practice management, which you are likely receiving little education in your program.


  1. Be proud of your profession and plant seeds to give back after graduation.

We decided to become orthodontists, train and sacrifice for years because we want to treat the most challenging cases and deliver the best treatment for our patients. We should be proud of our expertise and flaunt our specialty status!  We have a responsibility to let our patients know the value of seeing an orthodontist and not be afraid to express to them that they are receiving the best care. Our specialty is at a crossroads and the ones who are going to save it are the younger generation, because we have the most invested in it. The senior orthodontists have had their golden years, the time is now for us to work together to educate the public. Get involved!

We have so many blessings as orthodontists and we have a responsibility to give back. You can do this in many ways!  You can be part of the Smiles for a lifetime foundation, teach at your local orthodontic residency program, join your local or national orthodontic society, and spend a day a week working in the hospital or children’s aid society. You don’t have to stick to orthodontics to volunteer your time to give back to others. This will enrichen your professional life, give you a sense of purpose and bring you more personal rewards than you could imagine.


  1. Talk to as many orthodontists, dentists, hygienists, staff, family members, friends and make them aware of when you’re graduating and coming back.

Once you sign your lease, or purchase a practice, let the word out. If you’re secretive, another new grad may be opening right down the street and they may not if they know you’ll be there.  If you plan to practice in your home town, you do not want to move back home and realize that your mother’s best friend’s children are receiving orthodontics from their general dentist!  If you plan on going somewhere new, make it your goal to be a social butterfly and meet new people. Let people know what you’re studying, what an orthodontist is, and that you’re excited for the opportunity to treat them and their families and be the community orthodontist.


  1. Read journals and magazines– be knowledgeable and stay current on every aspect of orthodontics.

If your program is not strong on a particular aspect of orthodontics, and no program can cover everything well, it is important to focus in these areas in your reading. Make sure you spend time not only reading the orthodontic literature and journals such as the AJODO and Angle, but also reading journals on practice management such as the Progressive Orthodontist.

  1. Strive for absolute excellence in all aspects of orthodontics and life.

Fill your pockets with tips, tricks and pearls on effective and efficient orthodontic biomechanics and practice management and do your best on every case you treat and every interaction you encounter.