HCDM 16 | Orthodontist Career

 

Contrary to what most people believe, orthodontists are specifically dentists, but a specialization of it. To shed more light on his orthodontist career, Kris Togias, DMD sits down with Richard Marn, MD. Together, they talk about the most typical problems an orthodontist treats, the highlights of his job, and what the usual day of someone in his professions looks like. Kris also shares his grueling experiences back when he was still training and tells how he ended up choosing to become an orthodontist among other specializations out there.

Listen to the podcast here:

The Life Of An Orthodontist With Kris Togias, DMD

Did you know that an orthodontist does more than just braces? What they do is they help affect someone’s bite and bone structure sometimes with their tools and their techniques. This successful orthodontist actually didn’t get into dental school on the first attempt. He had to try more than once to get in what he did and successfully after working very hard and being persistent.

Our awesome guest is Dr. Kris Togias. He has a very successful practice in Orthodontics in Manhattan. Born in Rochester, New York and raised in Greece, he eventually moved to the United States for his undergraduate degree in biology and chemistry at the University of Rochester. He then got his degree from Tufts University School of Dental Medicine and went on to complete a postgraduate specialty residency in Orthodontics and Maxillofacial Orthopedics. I spoke with Dr. Togias from his home in New York, where he gave me a rundown of his career and how he got started.

Kris, welcome

It’s nice to finally meet with you.

I’ve known you for a few years now. For our readers, Dr. Kris Togias is the orthodontist for my kids. Also, my wife is a pediatric dentist and she refers patients to you and you guys work together on a few cases and discuss them. There’s a professional relationship that you have with my spouse. It’s funny that we have this unique relationship.

It’s a blast working with you. Your spouse is amazing.

Kris, what exactly do you do? Can you tell me what it is that is your job description and what you’re responsible for?

I’m an orthodontist. A lot of people don’t know what that is and a lot of time people ask me, “Are you a dentist?” Orthodontics is pretty much a specialty of dentistry. We have to continue after dental school for a few more years of specialized training. It’s for 2 to 3 years. That time, you learn how to assist with bone growth and orthopedic treatment in young adults. We work with a general dentist on creating a balanced bite through either opening-closing space for implants or set up a patient for surgery to have the jaw aligned to either bring the upper jaw forward and lower jaw back to correct underbite or overbite of adults.

We work with the TMJ specialist, the Temporomandibular Joint specialist to create a better bite for people who have painful joints around the bite. It’s pretty much the two components in an orthopedic and orthodontic component. Orthopedic is the younger population when we do expansions creating bigger arch. Head gears, we control growth or help growth and then adult is like more orthodontic which is creating straighter teeth, balanced bites and assisting with creating more of a healthy mouth through that way.

HCDM 16 | Orthodontist Career

Orthodontist Career: Orthodontists have this sense of community to get to know and take care of the community they are living in.

 

As an orthodontist, what are some of the tools that you’re using that are different than what a general dentist does? You’re still dentists but you have this subspecialty. Are there different tools that you are using?

We’re not as we say that classic typical drill and fill dentist. We’re not there drilling teeth around. We use brackets, wires and temporary implants to move teeth around putting forces on teeth. We are not sitting there do cleanings or which is a common question I get, “Can you do my cleaning or can you do my veneers since you’re an orthodontist?” We don’t do cosmetic dentistry. It’s purely aligned teeth. We’re creating a better balanced bite. We use aligners and typical Invisalign. Now, 3M they have what’s called clear aligners that we can use forces to create a better bite and straighter teeth.

What are the typical situations that you come across then, in your practice? What are the typical problems people have that they see you for?

It depends on the age. For example, with your spouse, we get a lot of young adults from 6, 7 and 8 years old, who developmentally have a small arch and they have a lot of crowding. At that point, we can alter the growth so we can use an expander and grow in and make a bigger arch. Correct the crossbite, correct an underbite, correct an overbite with appliances. For teenagers, most of the time it is to correct their overbite and a lot of crowding. We have to make a nice aligned dentition so in that way, they can chew better and take care of your teeth better. Crowded teeth have more gum problems in the future so we tried to create a nice foundation for the long-term life to keep their teeth longer and have a healthier smile and healthier gum tissue.

For adults, many times people do not wear their retainers. Come back to have their teeth realigned in their late 20s early 30s. Many times in adults, sometime in their life they lose teeth and their teeth shift. The spaces close up and then we have to open up spaces and fix the bite. That way they can have spaces for implants, veneers, open up the bite if they’re harming their teeth or if they grind their teeth too hard because of certain bite problems, then we can align the teeth in a better way. In that way, they don’t harm their teeth, bone and gum in the long run. They get a healthier mouth in the long run.

You mentioned that sometimes the process takes a while. We’re talking months to years. Therefore, you don’t often see patients just for one session. These are patients you’ll see over and over.

An average treatment will be about eighteen months. Within those eighteen months, we see people every month, every 4 to 6 weeks to reactivate their braces and to activate the forces. I tend to get to know people very well. After two years, those people are now your patient or a lot of them are your friends. I find that the more I’ve been working in the city now, I start seeing people on the streets. To me, that’s the most amazing thing when you have a kid run up to you, “Dr. Togias, how are you?” It’s the sweetest thing. It feels like you have a sense of community. That you are getting to know and taking care of your community in a way.

Even in the city, a sense of community?

You’d be surprised. Each neighborhood is pretty much its own community. It should be the city but, I’ll go down the street on the Starbucks in my neighborhood and there it is. My patient either coming from a different office, visit or I go to the market down the street in Union Square and you see other people there with their kids. I went to a restaurant and the more people I see, the more I started running into patients in the city. If I go to Long Island, I see people on Long Island and it feels good that you are becoming part of a community.

Work hard for what you want to do, and it will happen. Eventually, all the hard work pays off. Click To Tweet

My wife even says to me, “You have to behave now when we’re in public. You can’t embarrass me.”

When other people start recognizing I’m like, “I have to be careful.” I have too many Martinis and start walking home.

Kris, can you tell me some of the highlights of your job?

There are so many. The best time is when a kid or an adult takes the braces off. Usually, my thing is I give my patient a mirror to look at the teeth before we pick the brace off. We take the brace off, polish their teeth, and we have the before pictures next to them. When the person’s burst into tears of happy tears, when they start laughing, giggling and they cannot stop smiling, to me, it’s pure joy. One case I’m thinking of now is a young adult with very concerned parents. The kid has a midface deficiency. The middle part of his face was sunken in.

Is it a teenager?

No. Young like eight years old and the family is very concerned. I was the 3rd or 4th consult. They were nervous about everything. The kid has a severe tiny upper jaw. He’s a thumbsucker as a child or younger for a while. His parents had very similar bone structures so they know what to do. We did a nice upper jaw expansion. The kid responded so well. It didn’t even look like the same child. So much more improved with aesthetics, the balance, the bite, the speech, the chewing habit and swallowing. Everything improved within one year that this family is becoming my number one fan.

They come in and say, “You saved our child. You made him look so well and he’s comfortable.” I see him in my neighborhood when I was parking my car and then I was walking in the car you see this young kid-like, “Dr. Togias.” He was behind me, the family happened to be in the neighborhood and then the kid comes and gives a big hug. It’s almost a gift that keeps giving. It’s amazing. On a funny note, I got a nice response from a spouse after we did an adjustment of some adult. It’s a husband’s bite and teeth. We give him a retainer who moves the jaw forward a little bit. They both came up one day said, “Besides the part that he looks much better now, you have saved our marriage because he doesn’t snore anymore every night.”

They gave you credit for keeping their marriage intact.

There are so many amazing stories. Stories like that keep me going and it gives such a good feeling about it. I’m always amazed. It makes me choked up all the time to think about all these good responses I get.

HCDM 16 | Orthodontist Career

Orthodontist Career: An orthodontist is a very clean profession that barely deals with blood and pain.

 

What is your typical day like as an orthodontist? When you first start in the morning, when you show up when you leave? How many patients do you see? What are your daily habits in the office?

The one thing I liked about an orthodontist is it’s a very clean profession. We barely deal with no blood. We don’t see people in pain. We may cause people to be a little sore for a couple of days with a brace, but everybody who generally comes into the office is in a good mood. Most patients come in because they want to improve themselves. They want to do better themselves, have a better smile, a better bite or to have work done and they need to set up the teeth for better adjustments. The typical day is we all get together. I’m in New York City so usually, New York City practices tend to be a little smaller than a suburban practice. We have a smaller space.

We usually have a smaller team. Every morning before we start, we have what we call the morning huddle. All the team gets together. We review our day to make sure everything’s been ready and prepped for the day. Also, it’s a good way to see everybody. I’d like to do a little pep talk, “Let’s have a great day because we’re here to help people. We need to remember that we’re not there just to work. We’re there to make people’s life better and make the experience of their day better. We’re there not just to work, go in and do dentistry but we’re also there to take care of people.” After that, we have four dental chairs.

We have three adjustment chairs. We have a comfortable chair. I have 3 or 4 assistants. My patients coming in, we untie the people’s braces or they take their aligners out everybody has to brush your teeth the way we get a nice, clean mouth. When I go in and take an exam, every patient and each patient gets a custom treatment. One person has to get strong wire, one has to keep the same wire. We use a power chain. We work on the next step of what we do. The same with the routine visits. I have either a new patient or consultation who comes in and we set up the patient. We take panoramic X-rays and photos and we have a big screen out. We review everything.

We do an examination and we’ve talked about what would be the best event plan for that patient. Somewhere in the middle. We have also people who take the braces off or put braces on. We have the day that is the happiest day of some of the people when the braces are off. Although now, a lot of the younger population, they’re very happy when they get the braces on because they can choose colors and have fun with them. We then have our longer appointments as I call them. We’d take more than a twenty-minute routine adjustment. It’s pretty much like 7 to 8 hours a day. We see between 60 and 70 patients a day.

It’s a busy day. It’s a high pace and energy. People are coming and going especially during the afternoon. You get more kids after school. Another thing about a city practice is we see about 50/50 percentage-wise adults and kids. In more of the suburban practice, you get a lot more kids than adults getting braces. In the city, we have so many people of every age and culture and everybody lives there. We have a 50/50 population of adults and children. In the morning say from 10:00until 2:00 we have primarily adult patients who come during their lunch break or during their work.

They take a little break and come in and we do that adjustment or we give them clear aligners or do their routine visits. After 3:00 is called the zoo time when all kids get off from school. All the kids come in with snacks and they want their food. They are cranky and from 3:00 to 6:00 or 3:00 to 7:00, we have a high energy wave when you had the kids and having fun. That’s more the party time. After that, we are all exhausted and we prep for the next day. At the end of the day, we have another little huddle to review the day and then prep for the next day. We see a large amount of people so we have to be very organized so that way everything goes smoothly.

If a student wants to learn more about your profession, where would you direct them to learn more? Are there resources that they can listen to, research or read about or organizations to belong to that you would recommend them to?

There are so many pathways to go through. You can start as simple as go to your local orthodontist. Every year I have 1 or 2, high school kids. Every summer they come to hang out with my practice and they follow me around. You can sign up and see if you can be a member of a local study club or study groups. YouTube is amazing. You can see so many things on YouTube and see what exactly everything is about. There are summer programs that some universities do that you can go and sign up for research.

Don't do something for the money or because somebody's telling you to do it. Do it because it makes you happy. Click To Tweet

You sign up as a research volunteer and help with research projects and that way you get exposed to that profession. There are so many ways you can do this. Each geographic area has different opportunities. A more suburbian set up away from a big city, I would think the local orthodontist, local dentist, they’ll be a good option. You can go and shadow an office. If you’re in a bigger city, there are so many different institutions and universities. You can see if they have research programs. The engine is a good way to research a lot of this stuff too.

How did you end up being an orthodontist? Were you thinking about dental school when you were in middle school or high school?

When I started getting interested in dentistry is funny. My mom had a lot of dental work when I was in elementary and high school. I will go with her to her dental visits and I love the idea of having a small office. I love the smell of a dental office.

Your office does not smell like a dental office.

It’s a very clean scent, the chlorine or bleach. I liked the idea of a nice aquarium. I remember I loved aquariums. The dental office that my mom used to go to had an aquarium and it was a nice small practice. I was like, “This must be nice to help people’s mouth,” and my mom always has some issue with her teeth. It made her feel good after she’s going there. She was feeling a lot better about it. That profession had a good feeling every time I thought about it. As you go through high school, you realize what you want to do. I went through the stage of me wanting to be either a dentist or a doctor. I was going back and forth. I always had a tendency to take care of people.

Were you being advised by your parents to do that? Do you come from a family of doctors?

No. Both my parents are a little bit. I was born in the States, but I grew up in Greece. Both my parents were like, “You should do something you’re happy with and something you know that will be able to provide you with a good life.” That was the advice. My parents were about education. You have to get educated because they didn’t have an education growing up. That was always for them the big deal. For them, as long as I go to college and get a university degree, they didn’t care what’s going to be. As long as they stay in school and get a good education was the number one request for me.

When I was younger, then I decided to move to the States because in Greece, there were very few schools and education is not as good. There are a lot of brilliant people from Greece but the education system is not the best. I decided since I was an American citizen and I was born here decided to move back to Rochester, where I was born at. Initially, my parents couldn’t afford it and I didn’t have financial support. I signed myself up in Monroe Community College up in Rochester, New York, where it was a great tool to get there. I started taking courses and do pre-med courses.

The good thing about community college is a lot of the time they can transfer all of your credits to university afterwards. I was able to work a few days a week while I’m going to school so I was able to support myself in community college. It is a good way to start that way. While I was in there, I was able to find out back then they have a policy. It used to be called a two plus two program. You take all those courses that are transferred to a university in the community college and at the same time, you can work and pay for myself because my family couldn’t help me. After that, I moved all my credits to the University of Rochester, which at the same time I found out I worked at the University of Rochester Medical Center, Strong Hospital as a phlebotomist. The moment you work 17 to 18 hours a week, you can get benefits towards your tuition. You can get 50% of your tuition paid. You can get paid by the hospital. I was working 2 or 3 shifts.

HCDM 16 | Orthodontist Career

Orthodontist Career: Sign up as a research volunteer and help with research projects. That way, you can get exposed to your chosen profession.

 

This is why you’re going to college?

Yes.

At the University of Rochester or community college?

It was the University of Rochester. When I was transferring, in order for me to be able to afford the University of Rochester, I started working there as a phlebotomist. I started as a nurse assistant and then became a phlebotomist, which is blood draws. In case people are wondering what a phlebotomist is.

Were you intending to go to a dental school or medical school at that moment and that’s why you have headed that direction or you were still unclear?

I was in between. I didn’t know if I want to medical dentistry still and I worked in the hospital to help me clarify this. I was working as a phlebotomist so I dealt with a lot of residents. At that time, the residents, there was not as much regulation on how many hours they worked. They were all zombies. They were all exhausted, miserable and hating themselves. This whole time, the University of Rochester had a good health plan for students and they had horrible dental work and benefits in Greece. I grab the opportunities like, “Maybe we can take care of some of my old feelings, the old dental work.”

There was a good dental clinic in the hospital at the university so I studied in my work. I liked the feel. The feeling of a dental clinic was a lot more appealing to me than the medical setup. One of the dentists there, Dr. Theodore, was wonderful. The University of Rochester has a specialty dental program there. He was a professor there but he also has his own clinic at the faculty practice. I asked him if I can shadow him. I was doing work as a phlebotomist, going to school and also shadowing him to get a vibe and get a feel of both professions. I liked the dental world and it reminds me of when I was younger, where we used to go with my mom to her dentist. It’s more of a small family business type practice. It’s not like a huge clinic. It’s more personable. I like the feel that you get to know your patients and you see them for a long time.

Back then, I wasn’t thinking about orthodontics. I was more thinking of General Dentistry. You see your dentist for many years so you pretty much get to know them and becoming their personal caretaker for their mouth. I liked the feeling so that’s why dental schools instead of medical schools and stuff. Unfortunately, I had an advisor who has never helped a dental student before because the University of Rochester is a heavy medical preparatory school, not a dental school. The last time he helped somebody, the standard was a little lower. Because I was working two jobs, I wasn’t able to be number one in my class. I was top 15% or top 20%. I wasn’t able to get in the first time I applied.

Is that for dental school?

When you do something that makes you happy, you will be good at it. Click To Tweet

Yes. At that point, I started working on my Master’s. I work in Oral Medicine Master’s in order for you to make your application more desirable, there are different ways you can do it. You can augment it. If you’re not number one in your class because dentistry is pretty competitive, you have to have more of a well-rounded application. Research and anything extra. It doesn’t have to be dentistry, it can be any extracurricular activities. If you volunteering and anything else you can do. For me, I started doing the Masters in Oral Medicine and Researching Oral Medicine.

After that, I was able to move to Boston. I walk into BU and Tufts and I was trying to get into any wishes programs and I was able to get into Tufts as a research coordinator for the Oral Medicine Department. I was able to do a year of research with this amazing lady Dr. Papas. She’s an oral medicine researcher. I did a whole year of research about dry mouth and oral cancer. I got so much more information in dentistry and it also strengthened my application that I got into right away. Tufts accepted me the year after that for dental school.

Kris, before you got into dental school, what was your thinking like at that time? You had not gotten on your first attempt, were you anxious about trying to get in? Do you have a backup plan?

It was so stressed out. I do get high school students to come and shadowing up my practice or college students. It’s never easy but you just have to now lose a vision of what you want to do. You have to keep in mind your target so don’t give up. In the big picture 1 or 2 years, you have to wait and do something more in order to make your application stronger, it’s not the end of the world. When it happens, it’s awful. When you get the “We regret to inform you” letter, it is devastating but then you have to regroup. You have to say, “I didn’t get in right now, what do I need to do in order to make my application stronger?” Instead of giving up and be like, “I’m done,” you have to keep your eye on the prize that way.

There are ways you can reach and see what else you can do. I reached out to a member. At that time, in most schools, I reach out to some of the admission offices and I’m like, “Can you review my application? Why didn’t I get in? Are there any ways? What else are you guys were looking for?” A lot of them were like, “You have good grade grades.” What else you can do? You can do some research, volunteer or you can be good at athletics. You can be an amazing piano player. There are so many other ways you can differentiate yourself from everybody else.

There are a lot of other things you can do. As I say, “Give yourself a break.” Don’t beat yourself in the head like, “I didn’t get this time. It’s done. It’s over.” You have to keep trying and eventually, things will happen. It’s like in front of me, nothing happened right away. Nothing fell in my lap as I say. You have to work hard for what you want to do and then it will happen. Eventually, all the hard work pays off.

In our conversation, you talked about how you were in a clinic and there’s only one course in dental school at least where you went at that time, where you had orthodontics as a course and you’ve enjoyed it. Was there a moment for you that you said, “I want to do orthodontics?”

From a personal experience, I’ve had braces growing up in Greece having a straight smile. The more I’m still learning about the bite and how your teeth have to come together in the first year of dental school. I had a pretty severe crowding. I remember one of the professors, I think it was the lecture on dentures that is like, “When you use up the teeth, you should be able to cut a piece of lettuce with the teeth.” I tried with my own teeth and I couldn’t do that. My teeth were super crowded. I couldn’t cut a straight line on a piece of lettuce and I’m like, “What’s wrong with me?”

You are your own worst case.

HCDM 16 | Orthodontist Career

Orthodontist Career: If you’re not number one in your class because dentistry is pretty competitive, you must have more of a well-rounded application.

 

I was like, “I cannot do this.” It’s a piece of paper. You’re just supposed to be able to pinch this piece of paper with teeth when you bite down the front teeth. When you bite your front teeth, you can hold that piece of paper. I couldn’t do it with my own teeth and I’m like, “What’s going on here? Why can I only do it in two spots and not the rest of it?” I then had braces for myself for two years in dental school. I got to go every month to the ortho department to have my adjustments and then I did my externship. At the end of every dental school, you have to do a six-week externship to run different specialties.

My favorite one was the orthodontic externship because I was going through it myself. That’s the part when I realized like, “I think I like this.” You can do all the other specialties and then this was the one that spoke to me more. When I started dental school, I didn’t go in to become an orthodontist. I wanted to go to become a dentist but I had such a good experience with orthodontics and it won me over so I decided to be an orthodontist.

What was the training program like as an orthodontist? Is it much easier than dental school?

It’s different. You do a lot more patient care because you start right away and you’re already getting a body of patients from the previous resident who’s graduating. You’re already hitting the ground with a full load of patience. At that time, you have to do courses in the morning at 7:30 or 8:00 in the morning until 9:00 then you see patients from 9:00 until 12:00. It’s a course between 12:00 and 1:00 and you see patients from 1:00 to 5:00 and 5:00 to 6:00 in the evening courses. It’s a lot more intense in the load of work because you do both. You have 28 to 30 months to learn all aspects of orthodontics. It’s a lot more intense. It’s a different intensity, but you know more of the time to. In dentistry, you have to start by learning the basics and then the first few years, oral academic and in the last few years, you can pick everything you learn and you start putting on the patient, an actual person. It’s a little different but intense.

Looking back is there anything that you would do differently to get to where you’re at?

I will probably hopefully stress less. That’s the one thing. I used to stress about so much and one thing I regret that I never did the first year of dental school is the only time you have two months off from school. I decided to go and like research and work and trying to learn more. Half my class when on a road trip to the country or to the world. They went backpacking or they did something that when you start working, you cannot take two months off and do that. To me, that regret is like, “I wish I was less focused on my goal when I had the time to relax.” When you stop working in the real world, getting that free time of having two months off, although we’re going through now we have a few months off. I said to people, “Look at it as an opportunity to relax. You regroup and then when you come back to work you’re going to be super energized.” That’s a good way to see this. Those are the way you can see things that help you move forward in a way.

Are there any parting thoughts you have for maybe a student reading and might be interested in your career?

Don’t do something for the money or do it because somebody’s telling you to do it. Do it because it makes you happy. When you do something that makes you happy, you’re going to be good at it. You’d be very successful in doing it. If somebody speaks to you, do it. Find ways to do it. Don’t give up on something.

Everyone, that’s our show. To learn more about our guest mentioned in this episode, visit HealthCareersWithDrMarn.com or HCWithDrMarn.com. If you like what you read, please subscribe, rate, and review the show on your favorite podcast app. Thank you for reading. I appreciate your support. I will catch you next time.

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About Dr. Kris Togias

HCDM 16 | Orthodontist CareerBorn in Rochester, New York, Dr. Kris Togias completed his early education in Greece. Upon returning to the United States, Dr. Togias completed his undergraduate degree in Biology and Chemistry from the University of Rochester, after which he moved to Boston. He earned his dental degree from Tufts University School of Dental Medicine and went on to complete a postgraduate specialty residency in Orthodontics and Maxillofacial Orthopedics.

As a dentist with additional and specialized treatment in Orthodontics, Dr. Togias recognizes various characteristics of a malocclusion or dentofacial deformity, define the nature of the problem, including the etiology if possible, and design a treatment strategy based on the specific needs and desires of the patient. He is committed to comprehensive, high-quality orthodontic care with a focus on individualized treatment based on the unique needs of patients of all ages. While treating early orthodontic and adolescent cases, Dr. Togias also specializes in managing cases in children with growth and development concerns and syndromes such as cleft lip and palate, congenitally missing teeth, impacted and supernumerary teeth, and combination orthodontic/orthognathic surgery adult treatments.