The Tostado Take: You’re Not Behind by Dr. Julia Tostado

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The Tostado Take: You’re Not BehindA letter to the young orthodontist comparing themself to others

by Dr. Julia Tostado

If you are a young orthodontist reading this, chances are you have felt behind at some point. Maybe it was your first week out of residency when every appointment took twice as long as scheduled. It could have been the moment a patient asked a question you weren’t sure how to answer, and you wanted to appear confident and convey years of experience in your response. Maybe it was scrolling through social media after a long day and seeing flawless finishes, confident captions, and colleagues who seemed to have it all figured out.

This article is a reminder you probably need more often than you realize: You are not behind. You are early in a profession that takes time, repetition, and patience to truly master.

Orthodontics is unique in that progress is slow, outcomes are delayed, and success is rarely instant. You can do everything right today and not see the result for months or even years. That reality alone makes comparison especially dangerous. Yet many young orthodontists quietly compare themselves to classmates, coworkers, mentors, and strangers online.

The truth is that feeling behind is not a personal failure. It is a normal stage of growth.

The sudden loss of structure
Dental school and residency provide structure, whether we like it or not. There are clear expectations, deadlines, case requirements, and evaluations. You always know where you stand. Then suddenly, you graduate, and that structure disappears.

There is no checklist for real-world orthodontics. No one tells you when you should feel confident with aligners, when your finishing eye should be sharp, or when treatment planning should feel intuitive. Progress becomes harder to measure, which makes self-doubt easier to feed.

Many young orthodontists assume confidence should arrive quickly. After all, you completed years of training. You passed tests. You earned the title. What no one emphasizes enough is that true clinical confidence often develops after you are responsible for cases from start to finish, including the complications.

That’s when you are no longer seeing carefully selected cases with built-in supervision. You are managing real patients with compliance issues, biological variability, and expectations shaped by social media and marketing. That transition alone is enough to make anyone feel unsteady.

The comparison spiral no one talks about
Comparison in orthodontics rarely looks dramatic. It is subtle and constant. It shows up when you hear how many starts another associate had last month. It shows up when a colleague seems faster, more decisive, or more relaxed in the chair. It shows up when someone your age buys a practice while you are still figuring out your workflow.

What makes comparison especially unfair is that you are comparing your internal experience to someone else’s external image. You see their outcomes, not their anxiety. You see their confidence, not the years it took to build it.

Even within the same practice, two orthodontists can appear to be at very different stages while dealing with entirely different challenges. One may be efficient but struggling with patient communication. Another may connect beautifully with patients but still be refining mechanics. Both are growing, just in different ways.

Speed is not the same as skill
One of the most common worries among young orthodontists is speed. Chair time feels painfully long. Adjustments take effort. You replay appointments in your head, wondering if you could have been faster.

Speed can matter in practice on the workflow, but not at the expense of understanding. Early in your career, slower often means you are thinking. You are analyzing occlusion, evaluating force systems, and making intentional decisions. That is not inefficiency. That is learning.

Speed comes naturally once patterns become familiar. Over time, you recognize which cases need close monitoring and which ones will behave predictably. You learn when to intervene and when to let biology do the work.

A practical way to improve efficiency without sacrificing quality is to standardize your approach. Create consistent wire progressions for common case types. Develop a routine for aligner checks so nothing feels improvised. Use the same language with your assistants so the appointment flows smoothly. Systems free up mental space, enabling you to move faster and with greater confidence.

Impostor syndrome in disguise
Impostor syndrome does not always look like self-doubt. Sometimes it looks like over-explaining. You give patients every detail because you want to prove you know what you are doing. Sometimes it looks like hesitation. You delay decisions because you fear choosing the wrong option. Sometimes it looks like constantly asking for reassurance, even when you already know the answer.

Patients are remarkably perceptive. They may not understand orthodontic mechanics, but they notice confidence and clarity. This does not mean pretending to know everything. It means being comfortable with your role as the doctor guiding the process.

Clear communication is one of the most powerful tools you have. Patients want to know what the problem is, how you plan to fix it, how long it will take, and what is expected of them. When explanations are simple and calm, patients feel reassured.

One helpful strategy is to frame treatment decisions as routine, even when they feel new to you. Saying “This is a common situation and we handle it successfully all the time” is often accurate and calming. Most orthodontic challenges are variations of familiar patterns.

Social media and the highlight reel effect
Social media has changed how orthodontists learn and connect, but it has also amplified comparison. Perfect smiles, an awesome before-and-after and ideal finishes dominate feeds. What is missing are the revisions, compromises, and learning curves that led to those results.

Very few orthodontists post their average cases. Almost no one posts the case that required three refinements or the patient who stopped wearing elastics. That does not mean those cases are rare. It means they are not photogenic.

If you notice that scrolling leaves you feeling inadequate, consider adjusting how you engage. Follow accounts that focus on education and process rather than perfection. Use social media as a learning tool, not a measuring stick.

Remember that a single photo captures one moment in time. It does not reflect the complexity of the case or the experience of the doctor behind it.

Trusting your clinical judgment takes practice
Early in practice, it is natural to rely heavily on mentors. Guidance is essential, but growth requires active learning.

One effective habit is to commit to a diagnosis and plan before seeking input. Write down what you think is happening and how you would treat it. Then compare your reasoning with feedback. Over time, you will notice that your thought process aligns more often than you expect.

Mistakes are unavoidable. Every orthodontist has cases they would treat differently in hindsight. The goal is not to avoid mistakes entirely. The goal is to recognize patterns sooner and adjust more confidently.

Experience does not eliminate uncertainty. It simply shortens the time between recognizing a problem and responding to it.

Patient communication is a clinical skill
Many frustrations in orthodontic practice stem from misaligned expectations rather than poor mechanics. Clear communication prevents most conflicts.

From the first consultation, be honest about limitations. Growth is unpredictable. Compliance varies. Biology does not always cooperate. Patients appreciate transparency more than perfection.

When treatment does not go as planned, address it early. Explain what is happening, why it matters, and how you will respond. Patients are far more understanding when they feel informed.

A simple but effective habit is summarizing each visit. Today we adjusted the wire to improve alignment. Next, we will focus on space closure. This helps patients see progress even when changes are subtle.

Leading a team when you are the newest one
Working with experienced assistants can feel intimidating. They may have seen more cases than you.

The strongest teams are built on mutual respect. Ask questions. Acknowledge experience. At the same time, step into your role as the doctor responsible for decisions.

Clear communication builds trust. When assistants understand your preferences and reasoning, appointments run more smoothly. Over time, confidence grows on both sides.

Leadership is not about knowing everything. It is about setting direction, making decisions, and creating a culture of collaboration.

Redefining success early in your career
Many young orthodontists define success narrowly. Perfect finishes. High production. Rapid ownership. While these goals are valid, they are not the only measures of progress.

Success can be gaining confidence in diagnosis. It can be improving patient communication. It can be enjoying your work more than you did six months ago.

Orthodontics is a long career. There is room to evolve. Many highly respected doctors did not feel truly comfortable until years into practice. Their early years were not failures. They were foundations.

Practical takeaways
  • Seek mentorship.
  • Simplify patient explanations to build trust and confidence.
  • Limit comparison with others by focusing on your own progress.
  • Standardize what you can to reduce mental fatigue.
  • Give yourself permission to grow gradually.
A final perspective
If we feel behind, it can be because we care deeply about doing good work. That concern is not a weakness. It is a sign of professionalism.

Every experienced orthodontist we admire once felt uncertain and slow. The difference is time, repetition, and perspective.

We are not behind. We are exactly where we are supposed to be, and we are growing each day. If we only focus on ourselves, we will notice the big changes we have made.

What experience early in your orthodontic career helped you realize that growth was happening, even when confidence had not caught up yet? 
Author Bio
Julia Tostado Dr. Julia Tostado earned her DDS from Universidad Autónoma de Nuevo León and completed her Master of Science in orthodontics at Centro de Estudios Superiores de Ortodoncia. She currently practices at the family-owned clinic, Tostado Ortodoncia. She shares insights with the orthodontic community through her contributions on Orthotown’s social media.
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