An orthodontist is a dentist who completed a two-to-three-year residency dedicated to moving teeth and correcting bites; a general dentist is the broad-scope provider most patients see for everything else.
The line used to be simple — orthodontists did braces, GPs did not — but clear aligners changed that.
Many general dentists now offer aligner treatment for simple cases themselves, which pushes the referral mix an orthodontist sees toward the harder ones.
The short answer
A general dentist can legally treat simple cases of crowding or spacing with clear aligners, and a growing number do.
An orthodontist is the specialist trained specifically in tooth movement and bite correction, and is who a GP refers to once a case involves a real bite discrepancy, jaw growth, or more than minor movement.
Unlike a specialty such as endodontics, orthodontics has historically run mostly direct-to-consumer — patients and parents book an orthodontist themselves rather than arriving only by referral.
What's changed is the GP side of that picture: general-dentist aligner treatment now absorbs some of the simple cases that might once have gone to a specialist by default.
What each one does
A general dentist runs comprehensive primary oral care — exams, fillings, crowns, extractions, and preventive care — and, for many GPs today, a menu of clear-aligner treatment for straightforward crowding or spacing.
An orthodontist does one thing in depth: diagnosing alignment and bite problems, planning tooth movement over months or years, and placing and adjusting braces, aligners, retainers, and appliances that guide jaw growth in children.
| Comparison | General dentist | Orthodontist |
|---|---|---|
| Typical alignment case | Mild crowding or spacing, adult aligners | Significant bite discrepancies, jaw growth, complex or multi-appliance cases |
| Training beyond dental school | None required to offer aligners | CODA-accredited orthodontics residency, at least 24 months and 3,700 scheduled hours |
| Board certification | Not applicable to this scope | American Board of Orthodontics (ABO) — voluntary |
| How the patient arrives | Existing patient of record | Direct booking, or referral for harder cases |
What the orthodontics residency adds
Both start the same way: a bachelor's degree, then four years of dental school for a DDS or DMD, then licensure.
A general dentist can begin offering aligner treatment there, using the training built into the aligner system and continuing education.
An orthodontist continues into an accredited residency — CODA's accreditation standard sets a minimum of 24 months and 3,700 scheduled hours, the only one of the four specialties covered here with a set-hours floor (see the 3,700-hour requirement) — focused entirely on the biomechanics of tooth movement, diagnosing and treating complex bite and jaw-alignment problems, and guiding jaw growth in growing children.
After residency, many orthodontists pursue certification from the American Board of Orthodontics (ABO) — voluntary, but a recognized signal of expertise.
The residency is what a general dentist's aligner training doesn't reach: years of dedicated practice on the harder end of tooth movement, not a different license or a different legal scope.
Which cases a GP keeps — and which get referred
There's no fixed rule — it moves with each dentist's training, comfort, and the aligner system they use — but a pattern has emerged as GP aligner treatment has grown.
General dentists tend to keep mild-to-moderate crowding or spacing in adults, where the movement needed is limited and predictable.
What tends to get referred to an orthodontist: significant bite discrepancies (overbite, underbite, crossbite), cases needing more than minor tooth movement, anything involving jaw growth or interceptive treatment in children, and cases that stall or don't track as planned under a GP's aligner protocol.
A GP who invests more in orthodontic training keeps more in-house; one with a lighter aligner caseload refers more of the above.
Why the referral mix is skewing more complex
Orthodontics remains more direct-to-consumer than a specialty like endodontics — most patients and parents still book an orthodontist directly rather than waiting on a GP to send them.
But the case mix an orthodontist actually sees has shifted: as more general dentists offer simple aligner treatment themselves, the cases orthodontists get by direct booking or referral skew toward the ones a GP's aligner protocol wasn't built for.
That's a different dynamic from endodontics, where referral has always been the primary channel — orthodontics is adding a referral layer on top of a market that was already mostly direct-to-consumer, rather than being referral-driven from the start.
Pay: tracked under separate codes
The U.S. Bureau of Labor Statistics tracks general dentists on their own occupational code: SOC 29-1021, Dentists, General, with a national median of $170,950 a year (OEWS, May 2025).
See the dentist salary guide for the full breakdown.
Orthodontists have their own dedicated code too — SOC 29-1023 — with a national median of $289,140 a year (OEWS, May 2025), among the highest in dentistry.
Most orthodontists own or partner in their practices, so real earnings blend clinical pay with practice profit; see what an orthodontist does or the orthodontist salary guide for the percentile breakdown.
This article is general career information, not clinical, legal, or financial advice. Referral patterns, training requirements, and pay vary by dentist, region, and practice.