1. Introduction
Orthodontics, a specialized branch of dentistry dedicated to diagnosing, preventing, and correcting dental and skeletal irregularities, is integral to both the clinical and economic dimensions of dental care [1]. It is more resource‐intensive than other dental specialties, as patients must attend clinical services more frequently [2]. This is reflected in national spending patterns, with expenditures on orthodontic care nearly doubled between 1996 and 2016, rising from $11.5 billion to $19.9 billion, while per capita spending increased from $42.69 to $61.52 over the same period [3].
In recent years, demand for orthodontic care has surged, driven by the evolving needs of a diverse patient population. This growth is particularly evident among children, spurred by the Affordable Care Act's expansion of pediatric dental benefits and the resulting increase in referrals from general and pediatric dentists [4]. While children have traditionally been the primary recipients of orthodontic treatment, there has also been a notable rise in demand among adults [3]. Between 1981 and 2017, the proportion of adult orthodontic cases increased from 15.4% to 21% [5]. Currently, the American Association of Orthodontists (AAO) reports that one in three orthodontic patients is over the age of 18, reflecting a substantial and continuing rise in adult utilization of orthodontic services [6].
However, the rising demand for orthodontic care is accompanied by a persistent shortage of qualified professionals entering the field [7, 8]. Although orthodontic residency enrollment increased by 47% and the number of graduates rose by 31% between 2001 and 2018, the average number of applications per program has declined, from 169 in 2011 to 160 in 2021 [9]. This is particularly concerning for underserved communities. As early as 2000, the U.S. Surgeon General's Report highlighted that minority and disadvantaged populations experience poorer oral health and face significant barriers to care, particularly in accessing specialty services [10, 11]. According to the 2023 U.S. Bureau of Labor Statistics, there are approximately 6400 practicing orthodontists in the United States, with only a small fraction serving in underserved areas [12]. In Texas, these disparities are especially pronounced in health professional shortage areas and are compounded by rapid population growth and an aging workforce [13]. To address this challenge, experts have proposed expanding orthodontic training programs within Texas dental schools to increase the number of graduates and improve equitable access to care [13]. Nonetheless, the uneven distribution of providers continues to leave many communities with a lower orthodontist‐to‐population ratio, further intensifying unmet demand for care [14, 15].
The rising demand for orthodontic care, coupled with an insufficient supply of qualified professionals, underscores a critical shortage——especially in underserved regions. Addressing this challenge requires a deeper understanding of dental students' perspectives on specializing in orthodontics. Prior quantitative research has identified key factors influencing students' decisions to pursue this specialty, including early exposure to orthodontics, dental school curricula, mentorship opportunities, and perceptions of the field [16]. However, career decision‐making is complex, shaped by both measurable factors and nuanced personal and contextual influences. To date, this topic has not been examined using a mixed methods approach, limiting the depth of understanding. Integrating qualitative narratives with quantitative data offers a more comprehensive view of the factors influencing students' intentions [17]. Accordingly, this study aims to identify and explore the factors influencing dental students' intention to pursue orthodontic residency using a mixed‐methods design. Findings may inform theoretical frameworks and guide the development of educational programs that better support dental students' professional aspirations and also address the growing demands for orthodontic specialists.
2. Methodology
2.1. Ethical Considerations
The study received ethical approval from the Institutional Review Board (IRB) at Texas Tech Health Science Center at El Paso, and was deemed eligible for exempt review with the IRB protocol #E25051. Informed consent was obtained from all participants, ensuring they fully understood the study's objectives, the voluntary nature of their participation, and their right to withdraw at any time. Participants were assured that their responses would remain confidential, and all data collected was anonymized.
2.2. Study Design
This study employed a sequential exploratory mixed methods design involving two phases [17]. In the qualitative phase, semi‐structured interviews were conducted to explore dental students' motivations and perceived barriers related to pursuing a career in orthodontics. The themes that emerged from this phase informed the development of a structured questionnaire. In the quantitative phase, a cross‐sectional survey was administered to a larger sample of dental students using the questionnaire derived from the qualitative findings.
2.3. Study Setting and Population
The qualitative phase was conducted at the Woody L. Hunt School of Dental Medicine (WLHSDM), located in the underserved region of Western Texas. For the quantitative phase, the target population included third‐ and fourth‐year dental students (D3s and D4s) enrolled in the four dental schools in Texas: WLHSDM, University of Texas Health Science Center at Houston School of Dentistry, University of Texas Health Science Center at San Antonio School of Dentistry, and Texas A&M University College of Dentistry.
2.4. Sample Size
In the qualitative phase, a purposive sampling strategy was used to recruit dental students from WLHSDM to ensure a range of perspectives regarding motivations and barriers to pursuing orthodontics. Of the 10 students invited, seven consented and participated in the study. For thematic contrast, three students who expressed an intention to pursue orthodontics and four who did not were included.
For the quantitative phase, the sample size was estimated using data from Wendling et al. (2022) [16], in which 44% of a sample of 335 dental students reported shadowing an orthodontist. Applying this to the current study, and assuming a design effect of one, a significance level of α = 0.05, and a 95% confidence level, the minimum required sample size was calculated to be 178 participants.
2.5. Data Collection and Analysis
2.5.1. Qualitative Phase
Participants were recruited through email invitations distributed via institutional listservs and targeted messages directed to WLHSDM's third‐ and fourth‐year cohorts (classes of 2025 and 2026). Eligible participants were current D3 or D4 students at WLHSDM who either expressed an interest or a lack of interest in pursuing orthodontics. All participants received an information sheet outlining the study objectives and interview procedures, and informed consent was obtained prior to data collection.
Data were collected through in‐person semi‐structured interviews conducted by one of the authors (K. F.), with audio recordings managed by another author (B. B.). On average, each interview lasted approximately 30 min. Two distinct interview guides were used based on participants' expressed interest in orthodontics. For students interested in the specialty, the interviews explored motivations, perceived challenges, mentorship, clinical exposure, and financial considerations. For students not interested in orthodontics, the discussions focused on their alternative career interests and perceived deterrents related to orthodontics.
All interviews were audio‐recorded, transcribed verbatim, and analyzed using thematic analysis. An inductive coding approach was applied. Two researchers (K. F. and B. B.) independently reviewed and coded the transcripts using NVivo software (QSR International). Coding discrepancies were resolved through iterative discussion and consensus, with input from a third researcher (F. Q.) to ensure analytical rigor. Themes were developed iteratively and refined through team debriefings until thematic saturation was achieved after the seven interviews. To facilitate contrastive analysis, data from students interested in orthodontics were analyzed separately from those who were not. Representative participant quotes were included to illustrate key findings.
2.5.2. Quantitative Phase
Data for the quantitative phase were collected using an online survey instrument developed directly from the six themes identified in the qualitative phase. The survey underwent a two‐step validation process. First, content validity was established through expert review by three faculty members with expertise in dental education and survey methodology. These experts evaluated each item for clarity, relevance, and alignment with the corresponding qualitative themes. Based on their feedback, items were revised to enhance clarity, consistency, and thematic coherence [18, 19]. Second, the revised survey was pilot‐tested with a convenience sample of D3 and D4 students (n = 10) from WLHSDM who were not included in the main study sample. The primary dependent variable in the survey was the “intention to pursue orthodontic residency,” selected based on prior literature and the theory of planned behavior, which links intention with future action [20, 21]. All survey responses, including those for independent variables, were recorded using a five‐point Likert scale.
The final survey was distributed via Qualtrics to third‐ and fourth‐year dental students across the four Texas dental schools using a convenience sampling method through a shared social media group chat. Participation was voluntary, and informed consent was embedded at the beginning of the survey. Survey responses were exported to IBM SPSS Statistics (Version 28) for analysis. Preliminary data screening revealed a non‐normal distribution of variables, as confirmed by the Kolmogorov–Smirnov and Shapiro–Wilk tests (p < 0.001). Consequently, non‐parametric statistical tests were employed for subsequent analyses. The Mann–Whitney U test was used to compare ordinal responses between two independent groups, while the Kruskal–Wallis test was applied for comparisons involving more than two groups. To further explore the associations between factors influencing the intention to pursue orthodontic residency, Spearman's rank‐order correlation was conducted, followed by linear and logistic regression analyses to identify predictive relationships. Statistical significance was defined as p < 0.05 for all tests.
3. Results
3.1. Findings From Qualitative Phase
A total of six themes were identified and organized into two broad categories: motivations (four themes) and barriers (two themes).
3.1.1. Motivations for Pursuing Orthodontics
Role of Mentorship: Mentorship emerged as a pivotal influence in shaping students' career trajectories. Participants consistently highlighted how early exposure to orthodontists through personal treatments, clinical shadowing, or faculty engagement reinforced their interest in the specialty.
“My mentor was an orthodontist, and just seeing how much he enjoyed his work and how he approached cases was really inspiring to me.” – Participant A
Harmony of Science and Patient‐Centered Care: Students expressed appreciation for the unique balance in orthodontics between scientific rigor and rewarding patient relationships. They emphasized the field's reliance on principles like physics and biomechanics, alongside the satisfaction of witnessing transformative treatment outcomes.
“I've had experience with clear aligners, and I think they are an incredible advancement. It's exciting to be part of a field that's so tech‐forward.” – Participant E
“I love how you can see the progress over time with patients, and the science behind it, like how the physics of the braces works. It's satisfying to see that progression.” – Participant F
Work‐Life Balance and Financial Stability: Orthodontics was frequently described as offering a favorable work‐life balance and strong financial prospects. Participants cited flexible scheduling, minimal emergency cases, and the potential for a high income as appealing aspects.
“You get a great salary and a flexible schedule. It's the kind of job that lets you have a personal life outside of work.” – Participant D
Personal Treatment Reflections: Students noted that orthodontic patients are typically proactive and voluntarily seek treatment, which fosters a more engaged and positive provider‐patient relationship. Those who had previously undergone orthodontic treatment themselves often described the experience favorably.
“I like the fact that the patients want to be there; they're not forced to come in. It makes the work more rewarding.” – Participant C
3.1.2. Barriers to Pursuing Orthodontics
Limited Hands‐On Training and Desire for Practical Experience: Participants voiced concern over the limited orthodontic content in their curriculum, expressing a desire for more robust, hands‐on exposure. Many sought extracurricular shadowing opportunities to compensate for gaps in training.
“We need more hands‐on experiences in school. I think it would help if we could work with things like clear aligners or even do some wire bending.” – Participant I
Weighing the Cost Against Future Earnings: While the cost of orthodontic residency was viewed as a significant hurdle, many participants believed the long‐term financial benefits justified the initial investment.
“The cost is definitely a factor, but I know that once you get through the residency, you can make it back pretty quickly.” – Participant B
3.1.3. Synthesis of Findings
The findings underscore the interplay of personal, educational, and systemic factors shaping students' intentions toward orthodontic residency. While the specialty's rewards and opportunities are widely acknowledged, barriers such as financial constraints and limited academic exposure highlight areas for curricular and institutional enhancement. A total of 19 survey questions were developed based on six themes identified during the qualitative phase, which helped to explain the findings of the quantitative phase (Table 1).
TABLE 1.
Mapping of qualitative themes to survey questions.
| Theme | Corresponding survey questions a |
|---|---|
| Theme 1: Role of mentorship |
1. I have had opportunities to interact with orthodontists before my dental education. 2. I have had opportunities to interact with orthodontists during my dental education. 3. I have had sufficient access to orthodontic faculty during my dental school education. |
| Theme 2: Harmony of science and patient‐centered care |
4. My program introduced the scientific and technical aspects of orthodontics. 5. My program has provided a thorough overview of technology in orthodontics. 6. I feel confident in my understanding of the role of orthodontic technology. 7. My dental education has shown me the rewarding aspects of orthodontics. 8. I have been regularly exposed to orthodontics (e.g., clinics, patient interactions) during my dental education. |
|
Theme 3: Work‐life balance and financial stability |
9. To what extent does perceived work‐life balance affect your consideration? 10. To what extent does perceived earning potential affect your consideration? |
| Theme 4: Personal treatment reflections |
11. Have you ever had an orthodontic treatment? 12. How satisfied were you with the orthodontic treatment you received? (if applicable) |
| Theme 5: Limited hands‐on training and desire for more practical experience |
13. I have had sufficient exposure to the daily work of orthodontists. 14. I am satisfied with my orthodontic education. 15. I feel confident treating simple orthodontic cases as a general dentist. 16. I have had opportunities to observe procedures. 17. The lectures/courses cover orthodontic basics. 18. I am satisfied with hands‐on experience. |
| Theme 6: Weighing the cost against future earnings | 19. To what extent does cost affect your consideration? |
aPlease see supplementary file for the Qualtrics version of the questionnaire.
3.2. Findings From Quantitative Phase
A total of 123 dental students across the four Texas dental schools responded to the survey between January 2025 and June 2025. After data cleaning and exclusion of incomplete responses (specifically those that did not answer the question on the dependent variable), a final sample of 97 students was included in the analysis. As shown in Table 2, analysis of demographic variables——including age group, gender, race, and year in dental school——indicated no statistically significant associations with students' intention to pursue orthodontic residency (p > 0.05).
TABLE 2.
Distribution and relationship between demographic variables and intention to pursue orthodontic residency (N = 97).
| Intention to pursue orthodontic residency | |||||||
|---|---|---|---|---|---|---|---|
| Demographic variables |
Strongly disagree n (%) |
Disagree n (%) |
Neutral n (%) |
Agree n (%) |
Strongly agree n (%) |
Mean rank | p‐value |
| Age | |||||||
| 18–24 | 6 (6.2%) | 5 (5.2%) | 1 (1%) | 2 (2.1%) | 1 (1%) | 49.83 | 0.40 a |
| 25–34 | 29 (29.9%) | 28 (28.9%) | 6 (6.2%) | 2 (2.1%) | 10 (10.3%) | 50.04 | |
| 35 and above | 4 (4.1%) | 3 (3.1%) | 0 (0%) | 0 (0%) | 0 (0%) | 36.07 | |
| Race | |||||||
| White | 27 (27.8%) | 21 (21.7%) | 3 (3.1%) | 4 (4.1%) | 6 (6.2%) | 47.12 | 0.11 a |
| Black or African American | 2 (2.1%) | 1 (1%) | 0 (0%) | 0 (0%) | 0 (0%) | 32.50 | |
| Asian | 8 (8.3%) | 8 (8.3%) | 1 (1%) | 0 (0%) | 2 (2.1%) | 46.47 | |
| Native Hawaiian or Pacific Islander | 0 (0%) | 0 (0%) | 0 (0%) | 0 (0%) | 1 (1%) | 92.0 | |
| Other | 2 (2.1%) | 6 (6.2%) | 3 (3.1%) | 0 (0%) | 2 (2.1%) | 62.0 | |
| Gender | |||||||
| Male | 12 (12.4%) | 9 (9.3%) | 4 (4.1%) | 1 (1%) | 4 (4.1%) | 50.80 | 0.56 b |
| Female | 27 (27.8%) | 27 (27.8%) | 3 (3.1%) | 3 (3.1%) | 6 (6.2%) | 47.45 | |
| Current year of school | |||||||
| D3 | 27 (27.8%) | 24 (24.7%) | 2 (2.1%) | 3 (3.1%) | 7 (7.2%) | 47.23 | 0.37 b |
| D4 | 12 (12.4%) | 12 (12.4%) | 5 (5.2%) | 1 (1%) | 4 (4.1%) | 52.28 | |
Kruskal–Wallis test.
Mann–Whitney U test.
Table 3 presents the correlation and linear regression analyses examining the associations between key independent variables and dental students' intention to pursue orthodontic residency. Among motivational factors, a higher perceived importance of work‐life balance (r = 0.39, p < 0.001; β = 0.35, 95% CI: 0.18–0.51, p < 0.001), earning potential (r = 0.38, p < 0.001; β = 0.34, 95% CI: 0.17–0.50, p < 0.001), and cost of residency (r = 0.33, p = 0.001; β = 0.26, 95% CI: 0.11–0.41, p < 0.001) were all positively and significantly associated with intention to pursue orthodontic specialization. Among factors derived from Theme‐5, students who reported confidence in treating simple orthodontic cases had a significant association with intention (r = 0.22, p = 0.03; β = 0.45, 95% CI: 0.18–0.72, p = 0.001). Similarly, having opportunities to observe orthodontic procedures (r = 0.27, p = 0.01; β = 0.42, 95% CI: 0.17–0.66, p = 0.001) and being satisfied with hands‐on experience (r = 0.23, p = 0.02; β = 0.47, 95% CI: 0.21–0.73, p < 0.001) were also significantly associated with greater intention to pursue orthodontic residency.
TABLE 3.
Correlation and linear regression analysis of factors associated with intention to pursue orthodontic residency.
| Correlation | Linear regression | |||
|---|---|---|---|---|
| Independent variables | Spearman's rho | p value (rho) | β (95% CI) | p value |
| Had opportunities to interact with orthodontists before my dental education | 0.17 | 0.10 | — | — |
| Had opportunities to interact with orthodontists during my dental education | 0.14 | 0.16 | — | — |
| Had sufficient access to orthodontic faculty during my dental school education | −0.10 | 0.32 | — | — |
| Program introduced the scientific and technical aspects of orthodontics | −0.19 | 0.06 | — | — |
| Program provided a thorough overview of technology in orthodontics | −0.02 | 0.82 | — | — |
| Confident in understanding the role of technology in orthodontics | 0.16 | 0.13 | — | — |
| Dental education has shown rewarding aspects of orthodontics | −0.15 | 0.13 | — | — |
| Have been regularly exposed to orthodontics (e.g., clinics, patient interactions) during dental education | 0.11 | 0.26 | — | — |
| Extent to which perceived work‐life balance affects decision. | 0.39 | < 0.001 | 0.35 (0.18, 0.51) | < 0.001 |
| Extent to which perceived earning potential affect decision | 0.38 | < 0.001 | 0.34 (0.17, 0.50) | < 0.001 |
| Extent to which costs/fees affect the decision | 0.33 | 0.001 | 0.26 (0.11, 0.41) | < 0.001 |
| Satisfaction with their orthodontic treatment (if applicable) | −0.74 | 0.52 | — | — |
| Had sufficient exposure to the daily work environment of orthodontists | 0.20 | 0.05 | — | — |
| Satisfied with orthodontic education | 0.04 | 0.69 | — | — |
| Confident in treating simple orthodontic cases | 0.22 | 0.03 | 0.45 (0.18, 0.72) | 0.001 |
| Had opportunities to observe orthodontic procedures | 0.27 | 0.01 | 0.42 (0.17, 0.66) | 0.001 |
| Lectures/courses cover orthodontic basics | 0.05 | 0.65 | — | — |
| Satisfied with hands‐on experience | 0.23 | 0.02 | 0.47 (0.21, 0.73) | < 0.001 |
Note: Linear regression was carried out for the factors having p value < 0.05 in the correlation analysis. β: unstandardized regression coefficient.
Abbreviation: CI, confidence interval.
To further facilitate interpretation, the dependent variable——intention to pursue orthodontic residency——was dichotomized. Responses of strongly disagree, disagree, and neutral on the five‐point Likert scale were categorized as “no intention,” while agree and strongly agree were categorized as “intending to pursue” orthodontic residency. Among the analyzed respondents, 84.5% indicated no intention to pursue orthodontics. A binary logistic regression was then conducted to further evaluate the predictive value of variables that were previously identified as significant in the linear regression analysis. As presented in Table 4, dental students who perceived a favorable work‐life balance in orthodontics were nearly two times more likely to express an intention to pursue orthodontic residency (OR = 2.39; 95% CI: 1.28–4.46; p = 0.006). Similarly, students who viewed orthodontics as having high earning potential (OR = 2.05; 95% CI: 1.15–3.65; p = 0.006) and considered the cost of residency as an influencing factor (OR = 1.72; 95% CI: 1.12–2.63; p = 0.013) also showed higher odds of intending to pursue orthodontic residency. In addition, factors from Theme 5 demonstrated a strong influence. Students who reported having opportunities to observe orthodontic procedures (OR = 2.27; 95% CI: 1.36–3.78; p = 0.002) were two times more likely to express interest in orthodontic specialization. Furthermore, those who felt confident in their ability to treat simple orthodontic cases (OR = 2.73; 95% CI: 1.48–5.03; p = 0.001), and those satisfied with their hands‐on orthodontic experience during dental school (OR = 2.70; 95% CI: 1.52–4.78; p < 0.001), were approximately three times more likely to intend to apply for an orthodontic residency.
TABLE 4.
Logistic regression analysis of factors associated with intention to pursue orthodontic residency.
| Intention to pursue orthodontic residency | ||||
|---|---|---|---|---|
| Independent variables | Yes | No | OR (95% CI) | p‐value |
| Extent to which perceived work‐life balance affect decision | ||||
| Not at all | 0 (0%) | 18 (18.5%) | 2.39 (1.28, 4.46) | 0.006 |
| A little | 1 (1%) | 14 (14.4%) | ||
| Neutral | 0 (0%) | 13 (13.4%) | ||
| Somewhat | 6 (6.2%) | 20 (20.6%) | ||
| A great deal | 7 (7.2%) | 17 (17.5%) | ||
| Extent to which perceived earning potential affect decision | ||||
| Not at all | 0 (0%) | 17 (17.5%) | 2.05 (1.15, 3.65) | 0.015 |
| A little | 0 (0%) | 12 (12.4%) | ||
| Neutral | 2 (2.1%) | 12 (12.4%) | ||
| Somewhat | 6 (6.2%) | 21 (21.6%) | ||
| A great deal | 6 (6.2%) | 20 (20.6%) | ||
| Extent to which costs/fees affect the decision | ||||
| Not at all | 1 (1%) | 28 (28.9%) | 1.72 (1.12, 2.63) | 0.013 |
| A little | 1 (1%) | 15 (18.5%) | ||
| Neutral | 1 (1%) | 7 (7.2%) | ||
| Somewhat | 5 (5.2%) | 13 (13.4%) | ||
| A great deal | 6 (6.2%) | 19 (19.6%) | ||
| Confident in treating simple orthodontic cases | ||||
| Strongly disagree | 3 (3.1%) | 23 (23.7%) | 2.73 (1.48, 5.03) | 0.001 |
| Disagree | 4 (4.1%) | 44 (45.4%) | ||
| Neutral | 2 (2.1%) | 13 (13.4%) | ||
| Agree | 4 (4.1%) | 2 (2.1%) | ||
| Strongly agree | 2 (2.1%) | 0 (0%) | ||
| Had opportunities to observe orthodontic procedures | ||||
| Strongly disagree | 6 (6.2%) | 38 (39.2%) | 2.27 (1.36, 3.78) | 0.002 |
| Disagree | 1 (1%) | 36 (37.1%) | ||
| Neutral | 2 (2.1%) | 4 (4.1%) | ||
| Agree | 4 (4.1%) | 4 (4.1%) | ||
| Strongly agree | 2 (2.1%) | 0 (0%) | ||
| Satisfied with hands‐on experience | ||||
| Strongly disagree | 5 (5.2%) | 41 (42.3%) | 2.70 (1.52, 4.78) | < 0.001 |
| Disagree | 3 (3.1%) | 33 (34%) | ||
| Neutral | 1 (1%) | 7 (7.2%) | ||
| Agree | 4 (4.1%) | 1 (1%) | ||
| Strongly agree | 2 (2.1%) | 0 (0%) | ||
Abbreviations: CI, confidence interval; OR, odds ratio.
4. Discussion
This study explored motivations and barriers influencing dental students' intention to pursue orthodontic residency, using a sequential exploratory mixed methods design. The findings provide an understanding of how personal experiences, educational exposure, and perceived career benefits interact in shaping career aspirations. While students largely view orthodontics as a desirable specialty, especially for its lifestyle and financial appeal, significant barriers, particularly limited clinical exposure and financial burden, temper this interest.
The strongest predictors of intention were perceived work‐life balance and earning potential, both of which were statistically significant in the quantitative phase. These results are consistent with existing literature indicating that newer generations of dental graduates, particularly millennials and Generation Z, increasingly prioritize lifestyle factors when selecting postgraduate paths [22, 23]. The appeal of predictable schedules, minimal emergency care, and financial stability makes orthodontics especially attractive. Importantly, students weigh the upfront financial investment against anticipated long‐term rewards. Similar cost‐benefit appraisals have been documented in prior research on specialty selection across medicine and dentistry, indicating that students are not deterred by cost alone, but rather by uncertainty in return on investment [24, 25, 26].
Mentorship emerged as another central theme in the qualitative data. Students spoke about mentors, including their own orthodontists and/or faculty members, as pivotal in shaping early impressions of the specialty. This supports social learning theory, which posits that role modeling and observational learning play a critical role in career decision‐making [27, 28]. Previous studies have shown that students who are exposed to supportive mentors within a specialty are significantly more likely to consider pursuing it [26, 29, 30]. However, mentorship was not a significant predictor in the quantitative analysis, suggesting that its influence may be more subtle or indirect——shaping perceptions over time rather than through measurable short‐term effects. This discrepancy underscores the added value of qualitative inquiry in capturing formative influences that quantitative measures might overlook.
Students also valued that orthodontics harmonizes scientific rigor with patient‐centered care. The perceived balance between scientific complexity——such as biomechanics and technological innovation——and long‐term, meaningful patient care contributed to the specialty's appeal. These motivations are not unique to the current sample; similar descriptions of orthodontics as both “art and science” have appeared consistently in previous qualitative inquiries [31]. Moreover, students who had undergone orthodontic care during adolescence often reported positive impressions of the specialty and its practitioners [31, 32]. These early encounters appeared to spark long‐term interest, particularly when paired with favorable outcomes or memorable interactions. Prior research supports this pattern; firsthand exposure to healthcare, especially when paired with positive patient‐provider dynamics, can shape specialty preferences early in a student's trajectory [32, 33].
Despite these strong motivational factors, structural barriers remain. Students reported limited orthodontic exposure during dental school, particularly in terms of hands‐on training. Although many curricula include didactic orthodontics, the absence of sufficient clinical or simulation‐based experiences may constrain students' ability to visualize themselves in the role. Quantitative findings reinforced this concern: students who had opportunities to observe procedures or felt confident in managing simple cases were significantly more likely to report intention to pursue orthodontics. These associations support the theory that self‐efficacy, defined as confidence in one's ability to perform a task, is a strong predictor of career aspiration and decision‐making [27]. The implication is that increasing experiential learning opportunities in orthodontics, even at a basic level, could foster greater interest and help address the perceived inaccessibility of the specialty.
Although the study presents unique findings, several limitations should be considered when interpreting the findings. First, the study assessed intention rather than actual career outcomes, which may change as students progress through training or experience life events. Second, the sample was limited to third‐ and fourth‐year dental students, and there was unequal distribution of responses from four institutions in Texas, potentially limiting the generalizability of the findings. Third, the relatively modest sample size (n = 97) in the quantitative phase may reduce the precision of effect estimates. Lastly, reliance on self‐reported data introduces the possibility of recall or social desirability bias.
Despite the limitations, the study possesses several methodological strengths. First, while intention does not guarantee behavior, it remains an established and reliable proxy for predicting future actions, particularly in behavioral research [34]. Second, the sequential mixed‐methods design strengthens the validity of the findings by allowing qualitative themes to inform survey development, thereby ensuring conceptual alignment and relevance. Third, although the sample size was moderate, the observed associations were statistically significant and supported by relatively narrow confidence intervals, which increases confidence in the stability and reliability of the findings. Finally, the use of multiple statistical techniques, including correlation analysis, linear regression, and logistic regression, provided a comprehensive understanding of the strength and direction of associations between key factors and students' intention to specialize in orthodontics.
The study has several practical implications for dental education. Enhancing curricular exposure to orthodontics, through structured shadowing, simulation‐based modules, or early clinical rotations, may help demystify the specialty and support informed decision‐making. Schools might also consider formal mentorship programs that connect students with specialists in orthodontics, especially for those without existing professional networks. Moreover, transparent communication about the cost, duration, and competitiveness of orthodontic residencies may help students make informed decisions and reduce perceived uncertainty.
In conclusion, students' intentions to pursue orthodontic residency are shaped by an interplay of motivational and structural factors. Work‐life balance, earning potential, and mentorship emerged as consistent motivators, while limited clinical exposure and concerns about cost functioned as barriers. Enhancing orthodontic visibility and accessibility within dental curricula may help align students' career aspirations with feasible opportunities. Future longitudinal research is recommended to track how early interests translate into specialty choice and how curricular interventions may influence this trajectory over time.
Funding
The authors have nothing to report.
Conflicts of Interest
The authors declare no conflicts of interest.
Ethics Statement
This study was reviewed and approved by the Institutional Review Board of Texas Tech Health Science Center, Approval Number: #E25051.
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