The Role of Space Maintainers in Pediatric Orthodontics

The Role of Space Maintainers in Pediatric Orthodontics

Importance of Early Orthodontic Evaluation

The importance of primary teeth in a child's development and dental health cannot be overstated. Often referred to as "baby teeth," these initial set of 20 teeth serve critical functions beyond their temporary presence in the mouth. Primary teeth play an essential role not only in the development of speech and chewing abilities but also in guiding the proper alignment and spacing for permanent teeth. As such, maintaining their health is crucial for ensuring a seamless transition to a lifetime of oral well-being.


One significant aspect of primary teeth is their function as placeholders for permanent teeth. They help maintain the necessary space required for adult teeth to emerge correctly. Interceptive orthodontics can guide facial and jaw development Orthodontics for young children jaw. This is where space maintainers become a vital component in pediatric orthodontics. Space maintainers are devices used when a primary tooth is lost prematurely due to decay or injury, potentially leading to malocclusion or misalignment issues if not addressed promptly.


Space maintainers act as substitutes for missing primary teeth by occupying the empty space left behind, preventing adjacent teeth from shifting into it. Without these devices, adjacent teeth may drift into the gap, causing crowding or misalignment problems when permanent teeth begin to erupt. Ensuring that there is enough room for future adult teeth reduces the likelihood of more complex orthodontic treatments being needed later on.


The use of space maintainers highlights how proactive measures can preserve dental health from an early age. By maintaining proper spacing during childhood, parents can help their children avoid potential challenges associated with crowded or crooked adult teeth, which often require corrective braces or extensive orthodontic work.


Beyond their structural roles, healthy primary teeth contribute significantly to a child's self-esteem and social interactions. A bright smile encourages confidence and facilitates clearer communication skills during formative years-a period when mastering language plays a pivotal role in overall cognitive development.


In conclusion, while primary teeth may seem transient, they are foundational to both physical and psychological aspects of child development and long-term dental health. The implementation of space maintainers underscores the importance of preventative care within pediatric dentistry; it serves as an effective strategy to safeguard against future complications by securing spaces essential for proper tooth alignment. By valuing and protecting these early-stage assets, we are investing in healthier smiles that last a lifetime.

Space maintainers are an often overlooked yet essential component in the field of pediatric orthodontics. These small but significant devices play a crucial role in ensuring the proper development of a child's dental structure following the premature loss of primary teeth. To fully appreciate their function, it's important to understand both their definition and purpose within orthodontic treatment.


At its core, a space maintainer is an orthodontic appliance designed to hold open the space left by a lost tooth. Primary teeth, commonly known as baby teeth, serve more than just a temporary role in a child's mouth; they act as placeholders for permanent teeth. When one is lost prematurely due to decay or injury, adjacent teeth can drift into the vacant space. This movement can lead to misalignment issues when permanent teeth eventually erupt. Space maintainers counteract this by maintaining the necessary room for future adult teeth.


There are various types of space maintainers, each tailored to different dental situations and needs. They can be either fixed or removable, with fixed options being more common due to their reliability and reduced risk of being misplaced by children. Some popular designs include band-and-loop maintainers and crown-and-loop maintainers for individual missing teeth, as well as lingual holding arches or Nance appliances for multiple missing spaces in more complex cases.


The purpose of using space maintainers extends beyond mere preservation of gaps between teeth; it is about guiding proper oral development and preventing potential long-term complications. Misaligned permanent teeth can lead to difficulties with chewing, speaking, and maintaining oral hygiene, which might necessitate extensive orthodontic treatment later on in life. By employing space maintainers at an early stage, dental professionals aim to avoid these complications altogether or reduce their severity.


In addition to physical benefits, the psychological aspect should not be underestimated. Children who experience significant dental issues may suffer from low self-esteem due to aesthetic concerns or functional difficulties like speech impediments. By preserving the natural spacing needed for proper alignment through space maintenance, children are likely to face fewer obstacles related to oral health as they grow older.


In conclusion, space maintainers serve a pivotal function in pediatric orthodontics by safeguarding against future malocclusion following premature tooth loss. Their implementation helps ensure that children's mouths develop correctly during their formative years while minimizing potential challenges associated with misaligned permanent teeth later on. As such, they represent an invaluable tool within preventive dentistry focused on nurturing healthy smiles from childhood into adulthood.

Benefits of Early Intervention in Orthodontics

Space maintainers play a crucial role in pediatric orthodontics, serving as essential tools to ensure proper dental development in children. When primary teeth are lost prematurely due to decay, injury, or other factors, space maintainers help preserve the necessary space for permanent teeth to erupt correctly. The absence of such devices can lead to overcrowding, misalignment, and more complex orthodontic issues later in life. Understanding the different types of space maintainers used in pediatric dentistry is vital for both practitioners and parents seeking the best care for their children's dental health.


There are two main categories of space maintainers: fixed and removable. Each type has its specific applications and benefits.


Fixed space maintainers are cemented onto the teeth, providing constant support without requiring removal or adjustment by the child. One common example is the band-and-loop maintainer. This device consists of a metal band attached to an adjacent tooth with a loop that extends into the gap left by the missing tooth. It is particularly effective for maintaining space after losing a single molar. Another variant is the crown-and-loop maintainer, which is similar but uses a crown instead of a band when additional strength is needed.


Another type of fixed maintainer is the distal shoe appliance, designed for cases where a primary second molar has been lost before eruption of the first permanent molar. This device includes an extension that guides the permanent molar into its correct position as it erupts.


Removable space maintainers resemble orthodontic appliances like retainers and can be taken out by the child for cleaning or during meals. These are usually recommended when multiple teeth are missing or when some flexibility in treatment is desired. Removable options require significant adherence to wearing schedules and maintenance routines from both parents and children.


While each type serves its purpose effectively, selecting between fixed and removable options depends on several factors including age, specific dental conditions, oral hygiene habits, and compliance levels of young patients.


Space maintainers are invaluable in preventing long-term dental problems stemming from premature tooth loss. They ensure proper alignment and spacing within developing jaws while minimizing potential complications during later orthodontic treatments. By understanding these devices' roles and variations, parents can make informed decisions alongside dental professionals to safeguard their children's future smiles effectively.

Benefits of Early Intervention in Orthodontics

Overview of Comprehensive Orthodontic Strategies

Space maintainers play a crucial role in pediatric orthodontics, serving as a preventive measure to address premature tooth loss in children. Understanding the indications for their use is essential for ensuring proper dental development and maintaining oral health.


The primary indication for employing space maintainers is the early loss of primary teeth, which can occur due to various reasons such as trauma, decay, or extraction. Primary teeth are vital not only for chewing and speaking but also for guiding the eruption of permanent teeth. When a primary tooth is lost prematurely, it disrupts the natural alignment by allowing adjacent teeth to drift into the vacant space. This drifting can result in misalignment or crowding when permanent teeth attempt to erupt.


Space maintainers act as placeholders to prevent this undesirable movement of adjacent teeth. They are particularly beneficial when there is significant time before the emergence of permanent successors. By holding space within the dental arch, these devices ensure that sufficient room remains available for incoming permanent teeth, thus reducing the likelihood of malocclusion-a condition where the teeth are not properly aligned when the mouth is closed.


Several factors influence the decision to use a space maintainer. The age of the child and their stage of dental development are critical considerations. If a child loses a primary tooth at an age where its permanent successor will not emerge soon, installing a space maintainer becomes imperative. Additionally, assessing whether there is adequate remaining space for future eruptions without intervention helps determine their necessity.


It's important to note that while space maintainers are highly effective preventive tools, they require regular monitoring by dental professionals. Maintenance involves checking for proper fit and function and making adjustments as needed due to changes in oral anatomy over time.


In conclusion, space maintainers are indispensable in pediatric orthodontics because they preserve necessary spacing after premature tooth loss. Their strategic use prevents complications related to misaligned or crowded dentition later on and supports optimal oral development during childhood-a foundation crucial for lifelong dental health.

Role of Technology in Modern Pediatric Orthodontics

When it comes to pediatric orthodontics, one of the essential tools in a dentist's arsenal is the space maintainer. These devices play a crucial role in ensuring that children's teeth develop properly after early tooth loss due to decay, injury, or necessary extraction. Understanding what parents should expect during the procedure for fitting space maintainers can help ease concerns and ensure a smoother experience for both the child and the parent.


Space maintainers are small appliances made of metal or acrylic designed to hold open spaces left by lost teeth. This preventative measure ensures that permanent teeth have enough room to emerge correctly. If the gap left by a missing tooth isn't maintained, adjacent teeth may drift into the vacant spot, leading to misalignment issues and potentially more complex orthodontic treatments in the future.


The procedure for fitting a space maintainer typically begins with an initial consultation. During this appointment, the pediatric dentist will examine your child's mouth and take X-rays if necessary. This evaluation helps determine whether a space maintainer is needed and which type would be most effective, as there are several varieties tailored to specific dental situations.


Once it's decided that a space maintainer is required, an impression of your child's mouth will be taken. This step is crucial because it ensures that the appliance fits snugly and comfortably. The impression is then sent to a dental laboratory where skilled technicians carefully craft a custom-fit device designed specifically for your child's oral structure.


On your subsequent visit, usually within a few weeks, the dentist will fit the space maintainer in your child's mouth. The process is straightforward and generally painless-most children adapt quickly without discomfort. However, it's important for parents to reassure their child about what to expect during this appointment as some kids might feel anxious about something new in their mouths.


After placement, regular follow-up visits are critical. These appointments allow the dentist to monitor progress and make adjustments if necessary as your child grows or as new teeth begin emerging. Maintaining good oral hygiene is also vital; children should continue brushing twice daily and flossing as recommended by their dentist.


Parents play an integral role in this process by encouraging their children to avoid sticky or chewy foods that could dislodge or damage the appliance. Additionally, watching out for any signs of irritation or problems ensures prompt attention from dental professionals when needed.


In conclusion, while having a space maintainer fitted might initially seem daunting for both parents and children alike, understanding each step can alleviate much of this anxiety. Parents should rest assured knowing these devices serve an essential function-they guide young developing smiles towards healthy growth patterns while preventing more severe orthodontic issues down the line. By collaborating closely with their pediatric dentist throughout this journey-from evaluation through maintenance-parents can support optimal outcomes for their child's future dental health.

Tips for Parents: Ensuring Successful Orthodontic Outcomes for Children

Space maintainers play a crucial role in pediatric orthodontics, serving as a preventive measure to avert potential dental complications that can arise from early tooth loss. These devices are especially important for children who lose their primary teeth prematurely due to decay, injury, or other health issues. Understanding the benefits of using space maintainers is essential for parents and caregivers looking to ensure optimal dental health and development for their children.


One of the most significant benefits of space maintainers is their ability to preserve arch length. When a child loses a primary tooth too soon, the adjacent teeth may begin to shift into the empty space. This movement can lead to crowding and misalignment issues when the permanent teeth eventually emerge. By keeping the surrounding teeth in their correct positions, space maintainers help maintain proper spacing, allowing enough room for adult teeth to grow in naturally and align correctly.


Another advantage is that space maintainers can prevent more extensive and costly orthodontic treatments later on. If left unaddressed, premature tooth loss can result in complex alignment problems that require braces or even surgical interventions during adolescence or adulthood. By addressing these spacing issues early with space maintainers, parents can often avoid these invasive procedures, significantly reducing both treatment time and financial costs.


Moreover, space maintainers support normal oral function during a critical period of growth and development. They allow children to chew food properly and speak clearly by maintaining necessary spaces in their mouths. Proper chewing helps with effective digestion and nutrition absorption-a vital aspect of overall health-while clear speech supports social interaction and learning.


Space maintainers also contribute positively to a child's self-esteem. Dental irregularities such as crowding or protruding teeth can affect how children perceive themselves and how they interact with peers. By ensuring that permanent teeth have adequate room to erupt straightly, space maintainers help promote an attractive smile which bolsters confidence.


While the use of space maintainers provides numerous advantages, it requires collaboration between orthodontists, parents, and children for successful outcomes. Regular dental check-ups are essential to monitor growth patterns and adjust devices as needed. Parents must ensure that their child maintains excellent oral hygiene around the maintainer to prevent plaque buildup or cavities.


In conclusion, space maintainers serve as an invaluable tool in pediatric orthodontics by preventing future dental issues related to premature tooth loss. Their ability to preserve arch length reduces the risk of crowding and misalignment; they minimize the need for extensive orthodontic treatments; they support normal oral functions; and they aid in fostering positive self-esteem among young patients. Through careful monitoring and maintenance, these devices help pave the way for healthier smiles well into adulthood.

Space maintainers may not be a term that comes up often in dinner table conversations, yet their role in pediatric orthodontics is crucial. These small but mighty devices are designed to hold the space for permanent teeth when a child loses a baby tooth prematurely due to decay, injury, or other dental issues. Understanding their care and maintenance can make all the difference in ensuring effective treatment and promoting healthy dental development.


For parents and children embarking on the journey of using space maintainers, it is essential to view them as allies in fostering proper oral health. When a primary tooth is lost too soon, neighboring teeth may shift into the vacant spot, potentially leading to crowding or misalignment problems when permanent teeth begin to emerge. Space maintainers work to prevent these issues by keeping adjacent teeth in place until the adult tooth is ready to erupt.


Caring for these devices is relatively straightforward but requires diligence. The first step involves maintaining excellent oral hygiene. Encourage your child to brush twice daily and floss regularly around the space maintainer-and don't forget regular dental checkups! These visits are critical for monitoring progress and making adjustments if necessary.


Diet also plays a pivotal role. Certain foods can compromise the integrity of space maintainers; sticky candies and chewing gum should be avoided as they can dislodge or damage the appliance. Similarly, hard foods like nuts or popcorn can pose a risk of breakage or bending of wire components. Instead, opt for softer alternatives-think apple slices rather than whole apples.


Communication with your child about their space maintainer is equally important. Make sure they understand its purpose and encourage them to speak up if they feel any discomfort or notice changes such as loosening of the device. Prompt attention from an orthodontist can resolve potential issues before they become significant problems.


Incorporating these tips into daily routines helps ensure that space maintainers do their job effectively without causing undue disruption in your child's life. Remember, this is a temporary measure with long-term benefits: preserving room for permanent teeth promotes a healthier smile down the road.


For both parents and children alike, patience and consistency are key elements throughout this process. With proper care and guidance, space maintainers serve as valuable tools in safeguarding your child's future oral health while paving the way toward achieving optimal alignment during their formative years.


Ultimately, appreciating the role of space maintainers within pediatric orthodontics underscores how proactive measures taken today can significantly impact tomorrow's dental landscape for our young ones-ensuring beautiful smiles that last a lifetime.

For other uses, see Thumbsucker (disambiguation).
Infants may use pacifiers or their thumb or fingers to soothe themselves
Newborn baby thumb sucking
A bonnet macaque thumb sucking

Thumb sucking is a behavior found in humans, chimpanzees, captive ring-tailed lemurs,[1] and other primates.[2] It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any organ within reach (such as other fingers and toes) and is considered to be soothing and therapeutic for the person. As a child develops the habit, it will usually develop a "favourite" finger to suck on.

At birth, a baby will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. From the first time they engage in nutritive feeding, infants learn that the habit can not only provide valuable nourishment, but also a great deal of pleasure, comfort, and warmth. Whether from a mother, bottle, or pacifier, this behavior, over time, begins to become associated with a very strong, self-soothing, and pleasurable oral sensation. As the child grows older, and is eventually weaned off the nutritional sucking, they can either develop alternative means for receiving those same feelings of physical and emotional fulfillment, or they can continue experiencing those pleasantly soothing experiences by beginning to suck their thumbs or fingers.[3] This reflex disappears at about 4 months of age; thumb sucking is not purely an instinctive behavior and therefore can last much longer.[4] Moreover, ultrasound scans have revealed that thumb sucking can start before birth, as early as 15 weeks from conception; whether this behavior is voluntary or due to random movements of the fetus in the womb is not conclusively known.

Thumb sucking generally stops by the age of 4 years. Some older children will retain the habit, which can cause severe dental problems.[5] While most dentists would recommend breaking the habit as early as possible, it has been shown that as long as the habit is broken before the onset of permanent teeth, at around 5 years old, the damage is reversible.[6] Thumb sucking is sometimes retained into adulthood and may be due to simply habit continuation. Using anatomical and neurophysiological data a study has found that sucking the thumb is said to stimulate receptors within the brain which cause the release of mental and physical tension.[7]

Dental problems and prevention

[edit]
Alveolar prognathism, caused by thumb sucking and tongue thrusting in a 7-year-old girl.

Percentage of children who suck their thumbs (data from two researchers)

Age Kantorowicz[4] Brückl[8]
0–1 92% 66%
1–2 93%
2–3 87% –
3–4 86% 25%
4–5 85%
5–6 76%
Over 6 — 9%

Most children stop sucking on thumbs, pacifiers or other objects on their own between 2 and 4 years of age. No harm is done to their teeth or jaws until permanent teeth start to erupt. The only time it might cause concern is if it goes on beyond 6 to 8 years of age. At this time, it may affect the shape of the oral cavity or dentition.[9] During thumbsucking the tongue sits in a lowered position and so no longer balances the forces from the buccal group of musculature. This results in narrowing of the upper arch and a posterior crossbite. Thumbsucking can also cause the maxillary central incisors to tip labially and the mandibular incisors to tip lingually, resulting in an increased overjet and anterior open bite malocclusion, as the thumb rests on them during the course of sucking. In addition to proclination of the maxillary incisors, mandibular incisors retrusion will also happen. Transverse maxillary deficiency gives rise to posterior crossbite, ultimately leading to a Class II malocclusion.[10]

Children may experience difficulty in swallowing and speech patterns due to the adverse changes. Aside from the damaging physical aspects of thumb sucking, there are also additional risks, which unfortunately, are present at all ages. These include increased risk of infection from communicable diseases, due to the simple fact that non-sterile thumbs are covered with infectious agents, as well as many social implications. Some children experience social difficulties, as often children are taunted by their peers for engaging in what they can consider to be an “immature” habit. This taunting often results the child being rejected by the group or being subjected to ridicule by their peers, which can cause understandable psychological stress.[11]

Methods to stop sucking habits are divided into 2 categories: Preventive Therapy and Appliance Therapy.[10]

Examples to prevent their children from sucking their thumbs include the use of bitterants or piquant substances on their child's hands—although this is not a procedure encouraged by the American Dental Association[9] or the Association of Pediatric Dentists. Some suggest that positive reinforcements or calendar rewards be given to encourage the child to stop sucking their thumb.

The American Dental Association recommends:

  • Praise children for not sucking, instead of scolding them when they do.
  • If a child is sucking their thumb when feeling insecure or needing comfort, focus instead on correcting the cause of the anxiety and provide comfort to your child.
  • If a child is sucking on their thumb because of boredom, try getting the child's attention with a fun activity.
  • Involve older children in the selection of a means to cease thumb sucking.
  • The pediatric dentist can offer encouragement to the child and explain what could happen to the child's teeth if he/she does not stop sucking.
  • Only if these tips are ineffective, remind the child of the habit by bandaging the thumb or putting a sock/glove on the hand at night.
  • Other orthodontics[12] for appliances are available.

The British Orthodontic Society recommends the same advice as ADA.[13]

A Cochrane review was conducted to review the effectiveness of a variety of clinical interventions for stopping thumb-sucking. The study showed that orthodontic appliances and psychological interventions (positive and negative reinforcement) were successful at preventing thumb sucking in both the short and long term, compared to no treatment.[14] Psychological interventions such as habit reversal training and decoupling have also proven useful in body focused repetitive behaviors.[15]

Clinical studies have shown that appliances such as TGuards can be 90% effective in breaking the thumb or finger sucking habit. Rather than use bitterants or piquants, which are not endorsed by the ADA due to their causing of discomfort or pain, TGuards break the habit simply by removing the suction responsible for generating the feelings of comfort and nurture.[16] Other appliances are available, such as fabric thumb guards, each having their own benefits and features depending on the child's age, willpower and motivation. Fixed intraoral appliances have been known to create problems during eating as children when removing their appliances may have a risk of breaking them. Children with mental illness may have reduced compliance.[10]

Some studies mention the use of extra-oral habit reminder appliance to treat thumb sucking. An alarm is triggered when the child tries to suck the thumb to stop the child from this habit.[10][17] However, more studies are required to prove the effectiveness of external devices on thumb sucking.

Children's books

[edit]
  • In Heinrich Hoffmann’s Struwwelpeter, the "thumb-sucker" Konrad is punished by having both of his thumbs cut off.
  • There are several children's books on the market with the intention to help the child break the habit of thumb sucking. Most of them provide a story the child can relate to and some coping strategies.[18] Experts recommend to use only books in which the topic of thumb sucking is shown in a positive and respectful way.[19]

See also

[edit]
  • Stereotypic movement disorder
  • Prognathism

References

[edit]
  1. ^ Jolly A (1966). Lemur Behavior. Chicago: University of Chicago Press. p. 65. ISBN 978-0-226-40552-0.
  2. ^ Benjamin, Lorna S.: "The Beginning of Thumbsucking." Child Development, Vol. 38, No. 4 (Dec., 1967), pp. 1065–1078.
  3. ^ "About the Thumb Sucking Habit". Tguard.
  4. ^ a b Kantorowicz A (June 1955). "Die Bedeutung des Lutschens für die Entstehung erworbener Fehlbildungen". Fortschritte der Kieferorthopädie. 16 (2): 109–21. doi:10.1007/BF02165710. S2CID 28204791.
  5. ^ O'Connor A (27 September 2005). "The Claim: Thumb Sucking Can Lead to Buck Teeth". The New York Times. Retrieved 1 August 2012.
  6. ^ Friman PC, McPherson KM, Warzak WJ, Evans J (April 1993). "Influence of thumb sucking on peer social acceptance in first-grade children". Pediatrics. 91 (4): 784–6. doi:10.1542/peds.91.4.784. PMID 8464667.
  7. ^ Ferrante A, Ferrante A (August 2015). "[Finger or thumb sucking. New interpretations and therapeutic implications]". Minerva Pediatrica (in Italian). 67 (4): 285–97. PMID 26129804.
  8. ^ Reichenbach E, Brückl H (1982). "Lehrbuch der Kieferorthopädie Bd. 1962;3:315-26.". Kieferorthopädische Klinik und Therapie Zahnärzliche Fortbildung. 5. Auflage Verlag. JA Barth Leipzig" alıntı Schulze G.
  9. ^ a b "Thumbsucking - American Dental Association". Archived from the original on 2010-06-19. Retrieved 2010-05-19.
  10. ^ a b c d Shetty RM, Shetty M, Shetty NS, Deoghare A (2015). "Three-Alarm System: Revisited to treat Thumb-sucking Habit". International Journal of Clinical Pediatric Dentistry. 8 (1): 82–6. doi:10.5005/jp-journals-10005-1289. PMC 4472878. PMID 26124588.
  11. ^ Fukuta O, Braham RL, Yokoi K, Kurosu K (1996). "Damage to the primary dentition resulting from thumb and finger (digit) sucking". ASDC Journal of Dentistry for Children. 63 (6): 403–7. PMID 9017172.
  12. ^ "Stop Thumb Sucking". Stop Thumb Sucking.org.
  13. ^ "Dummy and thumb sucking habits" (PDF). Patient Information Leaflet. British Orthodontic Society.
  14. ^ Borrie FR, Bearn DR, Innes NP, Iheozor-Ejiofor Z (March 2015). "Interventions for the cessation of non-nutritive sucking habits in children". The Cochrane Database of Systematic Reviews. 2021 (3): CD008694. doi:10.1002/14651858.CD008694.pub2. PMC 8482062. PMID 25825863.
  15. ^ Lee MT, Mpavaenda DN, Fineberg NA (2019-04-24). "Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials". Frontiers in Behavioral Neuroscience. 13: 79. doi:10.3389/fnbeh.2019.00079. PMC 6491945. PMID 31105537.
  16. ^ "Unique Thumb with Lock Band to Deter Child from Thumb Sucking". Clinical Research Associates Newsletter. 19 (6). June 1995.
  17. ^ Krishnappa S, Rani MS, Aariz S (2016). "New electronic habit reminder for the management of thumb-sucking habit". Journal of Indian Society of Pedodontics and Preventive Dentistry. 34 (3): 294–7. doi:10.4103/0970-4388.186750. PMID 27461817. S2CID 22658574.
  18. ^ "Books on the Subject of Thumb-Sucking". Thumb-Heroes. 9 December 2020.
  19. ^ Stevens Mills, Christine (2018). Two Thumbs Up - Understanding and Treatment of Thumb Sucking. ISBN 978-1-5489-2425-6.

Further reading

[edit]
  • "Duration of pacifier use, thumb sucking may affect dental arches". The Journal of the American Dental Association. 133 (12): 1610–1612. December 2002. doi:10.14219/jada.archive.2002.0102.
  • Mobbs E, Crarf GT (2011). Latchment Before Attachment, The First Stage of Emotional Development, Oral Tactile Imprinting. Westmead.
[edit]
  • "Oral Health Topics: Thumbsucking". American Dental Association. Archived from the original on 2010-06-19.
  • "Pacifiers & Thumb Sucking". Canadian Dental Association.

 

  • Sub-Millimeter Surgical Dexterity
  • Knowledge of human health, disease, pathology, and anatomy
  • Communication/Interpersonal Skills
  • Analytical Skills
  • Critical Thinking
  • Empathy/Professionalism
  • Private practices
  • Primary care clinics
  • Hospitals
  • Physician
  • dental assistant
  • dental technician
  • dental hygienist
  • various dental specialists
Dentistry
A dentist treats a patient with the help of a dental assistant.
Occupation
Names
  • Dentist
  • Dental Surgeon
  • Doctor

[1][nb 1]
Occupation type
 Profession
Activity sectors
 Health care, Anatomy, Physiology, Pathology, Medicine, Pharmacology, Surgery
Description
Competencies  
Education required
 Dental Degree
Fields of
employment
  
Related jobs
  
ICD-9-CM 23-24
MeSH D003813
[edit on Wikidata]
An oral surgeon and dental assistant removing a wisdom tooth

Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of the mouth, most commonly focused on dentition (the development and arrangement of teeth) as well as the oral mucosa.[2] Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint. The practitioner is called a dentist.

The history of dentistry is almost as ancient as the history of humanity and civilization, with the earliest evidence dating from 7000 BC to 5500 BC.[3] Dentistry is thought to have been the first specialization in medicine which has gone on to develop its own accredited degree with its own specializations.[4] Dentistry is often also understood to subsume the now largely defunct medical specialty of stomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions. However, some specialties such as oral and maxillofacial surgery (facial reconstruction) may require both medical and dental degrees to accomplish. In European history, dentistry is considered to have stemmed from the trade of barber surgeons.[5]

Dental treatments are carried out by a dental team, which often consists of a dentist and dental auxiliaries (such as dental assistants, dental hygienists, dental technicians, and dental therapists). Most dentists either work in private practices (primary care), dental hospitals, or (secondary care) institutions (prisons, armed forces bases, etc.).

The modern movement of evidence-based dentistry calls for the use of high-quality scientific research and evidence to guide decision-making such as in manual tooth conservation, use of fluoride water treatment and fluoride toothpaste, dealing with oral diseases such as tooth decay and periodontitis, as well as systematic diseases such as osteoporosis, diabetes, celiac disease, cancer, and HIV/AIDS which could also affect the oral cavity. Other practices relevant to evidence-based dentistry include radiology of the mouth to inspect teeth deformity or oral malaises, haematology (study of blood) to avoid bleeding complications during dental surgery, cardiology (due to various severe complications arising from dental surgery with patients with heart disease), etc.

Terminology

[edit]

The term dentistry comes from dentist, which comes from French dentiste, which comes from the French and Latin words for tooth.[6] The term for the associated scientific study of teeth is odontology (from Ancient Greek: ὀδούς, romanized: odoús, lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.

Dental treatment

[edit]

Dentistry usually encompasses practices related to the oral cavity.[7] According to the World Health Organization, oral diseases are major public health problems due to their high incidence and prevalence across the globe, with the disadvantaged affected more than other socio-economic groups.[8]

The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth, extraction or surgical removal of teeth, scaling and root planing, endodontic root canal treatment, and cosmetic dentistry[9]

By nature of their general training, dentists, without specialization can carry out the majority of dental treatments such as restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays), and diagnosis. Dentists can also prescribe medications used in the field such as antibiotics, sedatives, and any other drugs used in patient management. Depending on their licensing boards, general dentists may be required to complete additional training to perform sedation, dental implants, etc.

Irreversible enamel defects caused by an untreated celiac disease. They may be the only clue to its diagnosis, even in absence of gastrointestinal symptoms, but are often confused with fluorosis, tetracycline discoloration, acid reflux or other causes.[10][11][12] The National Institutes of Health include a dental exam in the diagnostic protocol of celiac disease.[10]

Dentists also encourage the prevention of oral diseases through proper hygiene and regular, twice or more yearly, checkups for professional cleaning and evaluation. Oral infections and inflammations may affect overall health and conditions in the oral cavity may be indicative of systemic diseases, such as osteoporosis, diabetes, celiac disease or cancer.[7][10][13][14] Many studies have also shown that gum disease is associated with an increased risk of diabetes, heart disease, and preterm birth. The concept that oral health can affect systemic health and disease is referred to as "oral-systemic health".

Education and licensing

[edit]
Main article: Dentistry throughout the world
A sagittal cross-section of a molar tooth; 1: crown, 2: root, 3: enamel, 4: dentin and dentin tubules, 5: pulp chamber, 6: blood vessels and nerve, 7: periodontal ligament, 8: apex and periapical region, 9: alveolar bone
Early dental chair in Pioneer West Museum in Shamrock, Texas

John M. Harris started the world's first dental school in Bainbridge, Ohio, and helped to establish dentistry as a health profession. It opened on 21 February 1828, and today is a dental museum.[15] The first dental college, Baltimore College of Dental Surgery, opened in Baltimore, Maryland, US in 1840. The second in the United States was the Ohio College of Dental Surgery, established in Cincinnati, Ohio, in 1845.[16] The Philadelphia College of Dental Surgery followed in 1852.[17] In 1907, Temple University accepted a bid to incorporate the school.

Studies show that dentists that graduated from different countries,[18] or even from different dental schools in one country,[19] may make different clinical decisions for the same clinical condition. For example, dentists that graduated from Israeli dental schools may recommend the removal of asymptomatic impacted third molar (wisdom teeth) more often than dentists that graduated from Latin American or Eastern European dental schools.[20]

In the United Kingdom, the first dental schools, the London School of Dental Surgery and the Metropolitan School of Dental Science, both in London, opened in 1859.[21] The British Dentists Act of 1878 and the 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.[22][23] However, others could legally describe themselves as "dental experts" or "dental consultants".[24] The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry.[25] The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally.[22] Dentists in the United Kingdom are now regulated by the General Dental Council.

In many countries, dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. In a few countries, to become a qualified dentist one must usually complete at least four years of postgraduate study;[26] Dental degrees awarded around the world include the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) in North America (US and Canada), and the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) in the UK and current and former British Commonwealth countries.

All dentists in the United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree. This schooling is followed by four years of dental school to qualify as a "Doctor of Dental Surgery" (DDS) or "Doctor of Dental Medicine" (DMD). Specialization in dentistry is available in the fields of Anesthesiology, Dental Public Health, Endodontics, Oral Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Pathology, Orthodontics, Pediatric Dentistry (Pedodontics), Periodontics, and Prosthodontics.[27]

Specialties

[edit]
Main article: Specialty (dentistry)
A modern dental clinic in Lappeenranta, Finland

Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include:

  • Anesthesiology[28] – The specialty of dentistry that deals with the advanced use of general anesthesia, sedation and pain management to facilitate dental procedures.
  • Cosmetic dentistry – Focuses on improving the appearance of the mouth, teeth and smile.
  • Dental public health – The study of epidemiology and social health policies relevant to oral health.
  • Endodontics (also called endodontology) – Root canal therapy and study of diseases of the dental pulp and periapical tissues.
  • Forensic odontology – The gathering and use of dental evidence in law. This may be performed by any dentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.
  • Geriatric dentistry or geriodontics – The delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.
  • Oral and maxillofacial pathology – The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases.
  • Oral and maxillofacial radiology – The study and radiologic interpretation of oral and maxillofacial diseases.
  • Oral and maxillofacial surgery (also called oral surgery) – Extractions, implants, and surgery of the jaws, mouth and face.[nb 2]
  • Oral biology – Research in dental and craniofacial biology
  • Oral Implantology – The art and science of replacing extracted teeth with dental implants.
  • Oral medicine – The clinical evaluation and diagnosis of oral mucosal diseases
  • Orthodontics and dentofacial orthopedics – The straightening of teeth and modification of midface and mandibular growth.
  • Pediatric dentistry (also called pedodontics) – Dentistry for children
  • Periodontology (also called periodontics) – The study and treatment of diseases of the periodontium (non-surgical and surgical) as well as placement and maintenance of dental implants
  • Prosthodontics (also called prosthetic dentistry) – Dentures, bridges and the restoration of implants.
    • Some prosthodontists super-specialize in maxillofacial prosthetics, which is the discipline originally concerned with the rehabilitation of patients with congenital facial and oral defects such as cleft lip and palate or patients born with an underdeveloped ear (microtia). Today, most maxillofacial prosthodontists return function and esthetics to patients with acquired defects secondary to surgical removal of head and neck tumors, or secondary to trauma from war or motor vehicle accidents.
  • Special needs dentistry (also called special care dentistry) – Dentistry for those with developmental and acquired disabilities.
  • Sports dentistry – the branch of sports medicine dealing with prevention and treatment of dental injuries and oral diseases associated with sports and exercise.[29] The sports dentist works as an individual consultant or as a member of the Sports Medicine Team.
  • Veterinary dentistry – The field of dentistry applied to the care of animals. It is a specialty of veterinary medicine.[30][31]

History

[edit]
See also: History of dental treatments
A wealthy patient falling over because of having a tooth extracted with such vigour by a fashionable dentist, c. 1790. History of Dentistry.
Farmer at the dentist, Johann Liss, c. 1616–17

Tooth decay was low in pre-agricultural societies, but the advent of farming society about 10,000 years ago correlated with an increase in tooth decay (cavities).[32] An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry,[33] although a 2017 study suggests that 130,000 years ago the Neanderthals already used rudimentary dentistry tools.[34] In Italy evidence dated to the Paleolithic, around 13,000 years ago, points to bitumen used to fill a tooth[35] and in Neolithic Slovenia, 6500 years ago, beeswax was used to close a fracture in a tooth.[36] The Indus valley has yielded evidence of dentistry being practised as far back as 7000 BC, during the Stone Age.[37] The Neolithic site of Mehrgarh (now in Pakistan's south western province of Balochistan) indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead-crafters.[3] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.[38] The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500 years ago.[39] Dentistry was practised in prehistoric Malta, as evidenced by a skull which had a dental abscess lanced from the root of a tooth dating back to around 2500 BC.[40]

An ancient Sumerian text describes a "tooth worm" as the cause of dental caries.[41] Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the Homeric Hymns,[42] and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.[43]

Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus, Kahun Papyri, Brugsch Papyrus, and Hearst papyrus of Ancient Egypt.[44] The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws.[44][45] In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment.[46] Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics.[47] However, it is possible the prosthetics were prepared after death for aesthetic reasons.[44]

Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.[48] Use of dental appliances, bridges and dentures was applied by the Etruscans in northern Italy, from as early as 700 BC, of human or other animal teeth fastened together with gold bands.[49][50][51] The Romans had likely borrowed this technique by the 5th century BC.[50][52] The Phoenicians crafted dentures during the 6th–4th century BC, fashioning them from gold wire and incorporating two ivory teeth.[53] In ancient Egypt, Hesy-Ra is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.[54] The earliest dental amalgams were first documented in a Tang dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528.[55][56]

During the Islamic Golden Age Dentistry was discussed in several famous books of medicine such as The Canon in medicine written by Avicenna and Al-Tasreef by Al-Zahrawi who is considered the greatest surgeon of the Middle Ages,[57] Avicenna said that jaw fracture should be reduced according to the occlusal guidance of the teeth; this principle is still valid in modern times. Al-Zahrawi invented over 200 surgical tools that resemble the modern kind.[58]

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac most probably invented the dental pelican[59] (resembling a pelican's beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key[60] which, in turn, was replaced by modern forceps in the 19th century.[61]

Dental needle-nose pliers designed by Fauchard in the late 17th century to use in prosthodontics

The first book focused solely on dentistry was the "Artzney Buchlein" in 1530,[48] and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685.[23]

In the United Kingdom, there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921.[62]

Modern dentistry

[edit]
A microscopic device used in dental analysis, c. 1907

It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend (c. 1656 pub. 1690) made an early dental observation with characteristic humour:

The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein 'tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head.

The French surgeon Pierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watchmakers, jewelers and even barbers, that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities. He asserted that sugar-derived acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth and in the gums could appear in the later stages of tooth decay.[63][64]

Panoramic radiograph of historic dental implants, made 1978

Fauchard was the pioneer of dental prosthesis, and he invented many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone. He also introduced dental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery".[63][64]

A modern dentist's chair

After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter. In 1763, he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that the chances of a successful tooth transplant (initially, at least) would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable achievement for the period.[65]

Major advances in science were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK, the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time.[66]

Hazards in modern dentistry

[edit]
Main article: Occupational hazards in dentistry

Long term occupational noise exposure can contribute to permanent hearing loss, which is referred to as noise-induced hearing loss (NIHL) and tinnitus. Noise exposure can cause excessive stimulation of the hearing mechanism, which damages the delicate structures of the inner ear.[67] NIHL can occur when an individual is exposed to sound levels above 90 dBA according to the Occupational Safety and Health Administration (OSHA). Regulations state that the permissible noise exposure levels for individuals is 90 dBA.[68] For the National Institute for Occupational Safety and Health (NIOSH), exposure limits are set to 85 dBA. Exposures below 85 dBA are not considered to be hazardous. Time limits are placed on how long an individual can stay in an environment above 85 dBA before it causes hearing loss. OSHA places that limitation at 8 hours for 85 dBA. The exposure time becomes shorter as the dBA level increases.

Within the field of dentistry, a variety of cleaning tools are used including piezoelectric and sonic scalers, and ultrasonic scalers and cleaners.[69] While a majority of the tools do not exceed 75 dBA,[70] prolonged exposure over many years can lead to hearing loss or complaints of tinnitus.[71] Few dentists have reported using personal hearing protective devices,[72][73] which could offset any potential hearing loss or tinnitus.

Evidence-based dentistry

[edit]
Main article: Evidence-based dentistry

There is a movement in modern dentistry to place a greater emphasis on high-quality scientific evidence in decision-making. Evidence-based dentistry (EBD) uses current scientific evidence to guide decisions. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on the latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.[74] It was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. It is part of the larger movement toward evidence-based medicine and other evidence-based practices, especially since a major part of dentistry involves dealing with oral and systemic diseases. Other issues relevant to the dental field in terms of evidence-based research and evidence-based practice include population oral health, dental clinical practice, tooth morphology etc.

A dental chair at the University of Michigan School of Dentistry

Ethical and medicolegal issues

[edit]

Dentistry is unique in that it requires dental students to have competence-based clinical skills that can only be acquired through supervised specialized laboratory training and direct patient care.[75] This necessitates the need for a scientific and professional basis of care with a foundation of extensive research-based education.[76] According to some experts, the accreditation of dental schools can enhance the quality and professionalism of dental education.[77][78]

See also

[edit]
  • Dental aerosol
  • Dental instrument
  • Dental public health
  • Domestic healthcare:
    • Dentistry in ancient Rome
    • Dentistry in Canada
    • Dentistry in the Philippines
    • Dentistry in Israel
    • Dentistry in the United Kingdom
    • Dentistry in the United States
  • Eco-friendly dentistry
  • Geriatric dentistry
  • List of dental organizations
  • Pediatric dentistry
  • Sustainable dentistry
  • Veterinary dentistry
 

Notes

[edit]
  1. ^ Whether Dentists are referred to as "Doctor" is subject to geographic variation. For example, they are called "Doctor" in the US. In the UK, dentists have traditionally been referred to as "Mister" as they identified themselves with barber surgeons more than physicians (as do surgeons in the UK, see Surgeon#Titles). However more UK dentists now refer to themselves as "Doctor", although this was considered to be potentially misleading by the British public in a single report (see Costley and Fawcett 2010).
  2. ^ The scope of oral and maxillofacial surgery is variable. In some countries, both a medical and dental degree is required for training, and the scope includes head and neck oncology and craniofacial deformity.

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Frequently Asked Questions

A space maintainer is a dental device used to hold open the gap left by a lost baby tooth. Its purpose is to prevent adjacent teeth from drifting into the empty space, which can ensure proper alignment and spacing for incoming permanent teeth, reducing the need for more extensive orthodontic treatment later.
Children should be evaluated for a space maintainer as soon as possible after losing a primary tooth prematurely. Typically, this evaluation occurs around ages 5 to 7, depending on when the tooth loss happens, to ensure timely intervention and optimal results.
Yes, there are several types of space maintainers, including fixed and removable options. Fixed maintainers like band-and-loop or crown-and-loop devices are cemented onto adjacent teeth, while removable ones resemble retainers and can be taken out by the child. The choice depends on factors such as location of missing teeth and childs ability to cooperate.