Transitioning From Early to Comprehensive Orthodontic Care

Transitioning From Early to Comprehensive Orthodontic Care

Importance of Early Orthodontic Evaluation

Understanding early orthodontic intervention is crucial in the journey of transitioning from early to comprehensive orthodontic care. This process involves a nuanced approach that prioritizes the developmental needs of children, ensuring they receive timely and appropriate treatment that lays a solid foundation for future dental health.


Early orthodontic intervention typically begins when children are between the ages of 6 and 10. At this stage, their mouths are still growing, and their permanent teeth are starting to emerge. By taking action during this critical period, orthodontists can address issues such as overcrowding, misaligned bites, or jaw growth discrepancies before they become more severe. Thumb-sucking habits can affect the alignment of a child's teeth Braces for kids and teens hospital. This proactive approach can significantly reduce the complexity and duration of later treatments.


The primary goal of early intervention is not merely to correct existing problems but also to preemptively address potential issues that could arise as a child grows. For instance, guiding jaw growth can ensure proper alignment and create adequate space for incoming permanent teeth. This foresight can often result in shorter treatment times when transitioning to comprehensive care during adolescence.


One key aspect of early orthodontic intervention is its ability to positively influence oral habits that may contribute to dental problems. Habits such as thumb-sucking or mouth-breathing can alter the natural development of a child's oral structures. Through targeted interventions like habit-breaking appliances or functional appliances designed to guide jaw development, these detrimental habits can be corrected efficiently.


Transitioning from early intervention to comprehensive orthodontic care requires careful planning and monitoring by an experienced orthodontist. As a child progresses into adolescence, new challenges may emerge with the eruption of additional permanent teeth and further jaw development. During this transition phase, maintaining regular check-ups allows for adjustments in treatment plans tailored specifically to each individual's changing needs.


Comprehensive orthodontic care typically begins around age 11 or older when most permanent teeth have erupted. The transition is seamless if early interventions were successful in mitigating major issues beforehand; however, it remains essential for ongoing evaluation throughout adolescence until optimal alignment is achieved.


In conclusion, understanding early orthodontic intervention plays an instrumental role in setting up young patients for success on their path toward comprehensive care later on. By intervening at opportune moments during childhood development stages-addressing both current concerns while preventing future complications-orthodontists help pave smoother roads ahead towards healthy smiles that last lifetimes long after braces come off!

Transitioning from early orthodontic care to comprehensive care is a critical phase in a patient's dental journey. This transition signifies not just a change in treatment modalities, but also an evolution in addressing the broader and more complex needs of growing patients. Identifying the need for this transition involves a thorough understanding of both the physiological development of the patient and the intricacies of their orthodontic requirements.


Early orthodontic care typically focuses on interceptive measures, aiming to correct initial problems that may lead to more significant issues if left unaddressed. This stage often occurs during childhood when primary teeth are still present, and treatments might include space maintainers or limited braces to guide proper jaw growth and tooth eruption. However, as children grow into adolescents, their dental landscape transforms dramatically. Permanent teeth erupt, facial bones develop further, and previously minor misalignments can become pronounced.


Recognizing the appropriate time to shift from early interventions to comprehensive orthodontic care requires vigilance and expertise. Orthodontists must assess several key factors: the alignment of permanent teeth, jaw relationships, bite function, and overall facial aesthetics. It's crucial for clinicians to observe these changes through regular check-ups and diagnostic imaging like X-rays or 3D scans. These tools provide insights into whether early interventions have been successful or if additional corrective measures are necessary.


Moreover, patients' personal experiences play an essential role in identifying this need for transition. Communication between orthodontists, patients, and their families is vital; it fosters an environment where concerns about appearance or discomfort can be openly discussed. A young patient who becomes self-conscious about crooked teeth or bite issues may express a desire for more extensive treatment options-prompting consideration for comprehensive care.


The transition encompasses not only technical adjustments but also psychological support for patients adapting to new regimens that might include full braces or aligners covering both arches. The process demands empathy from orthodontists as they guide patients through longer treatment durations that require increased commitment.


In conclusion, identifying the need for transitioning from early to comprehensive orthodontic care hinges on a delicate balance of clinical assessment and patient engagement. By ensuring timely intervention based on individual growth patterns and needs, orthodontists can facilitate smoother transitions that set foundations for optimal oral health outcomes well into adulthood. This proactive approach underscores the importance of tailored treatment plans designed with foresight and precision-a hallmark of exemplary orthodontic practice.

Benefits of Early Intervention in Orthodontics

Orthodontic treatment plays a pivotal role in ensuring oral health and enhancing the aesthetics of smiles. It typically comprises two main stages: early orthodontic treatment and comprehensive orthodontic treatment. Understanding the key differences between these two types of care is essential for both parents and patients as they transition from one to the other.


Early orthodontic treatment, often referred to as interceptive orthodontics, usually begins around the ages of six to ten. The primary goal at this stage is to address specific issues that could become more complicated if left untreated. These issues include crossbites, overcrowding, or excessive protrusion of the front teeth. By intervening early, orthodontists can guide jaw growth and tooth eruption, creating a healthier environment for permanent teeth and potentially reducing or eliminating the need for more invasive procedures later on.


One of the most significant benefits of early treatment is its preventive nature. By addressing problems while a child is still growing, orthodontists can often capitalize on that growth to correct alignment issues more naturally and efficiently. For instance, appliances such as expanders or partial braces may be used to create space for incoming permanent teeth or to guide jaw development in a favorable direction.


In contrast, comprehensive orthodontic treatment typically starts once most of the permanent teeth have erupted-usually between ages 11 and 14. This phase focuses on aligning all the teeth properly within the jaws and ensuring that both bite function and facial aesthetics are optimized. Comprehensive treatments commonly involve full braces or clear aligners like Invisalign.


The transition from early to comprehensive care involves shifting objectives from prevention and guidance to correction and final alignment. At this stage, the focus broadens beyond isolated concerns to encompass overall dental harmony-ensuring that each tooth fits perfectly within its designated position in relation to others.


While early treatment may last only a few months up to about a year depending on individual cases, comprehensive treatment usually requires one to three years for completion. The duration varies based on complexity; however, advancements in technology have introduced options like self-ligating braces which may reduce overall treatment times compared with traditional methods.


In summary, early orthodontic care serves as an interceptive measure aimed at preventing potential complications by guiding developmental changes during childhood. Comprehensive orthodontic care builds upon this foundation by addressing broader alignment goals once all permanent teeth are present. Together they form a cohesive strategy designed not only to improve dental health but also boost confidence through enhanced smile aesthetics-a testament to modern dentistry's commitment towards holistic patient well-being across different life stages.

Benefits of Early Intervention in Orthodontics

Overview of Comprehensive Orthodontic Strategies

Transitioning from early to comprehensive orthodontic care is a significant step in the journey towards achieving optimal oral health and a confident smile. This progression often marks the shift from interceptive treatments, which address immediate concerns, to more holistic approaches that consider long-term dental stability and aesthetics. Embracing comprehensive orthodontic care provides numerous benefits, both functionally and aesthetically, that can enhance one's overall quality of life.


One of the primary advantages of comprehensive orthodontic care is its ability to correct complex dental issues that may not be fully addressed during early interventions. While early treatment can guide jaw growth and prevent severe malocclusions, it often leaves some residual issues that require further attention. Comprehensive care takes into account the complete alignment of teeth, correction of bite discrepancies, and ensures proper jaw positioning. This thorough approach helps in preventing future oral health problems such as tooth decay, gum disease, and excessive wear on teeth due to misalignment.


Moreover, transitioning to comprehensive orthodontic care offers aesthetic improvements that boost self-esteem and confidence. A well-aligned set of teeth contributes significantly to an individual's appearance. As adolescents grow older, they become more conscious of their looks; thus, having a pleasing smile can positively impact their social interactions and self-perception. Furthermore, modern orthodontics provides various discreet options like clear aligners or ceramic braces that cater to those who are concerned about the visibility of traditional metal braces.


In addition to functional and aesthetic benefits, comprehensive orthodontic care plays a crucial role in enhancing oral hygiene practices. Properly aligned teeth are easier to clean as they eliminate tight spaces where plaque can accumulate. This reduces the risk of cavities and periodontal disease while promoting healthier gums and fresher breath. Patients who undergo comprehensive treatment are often educated on maintaining excellent oral hygiene standards throughout their treatment period and beyond.


The transition also allows for customized treatment plans tailored specifically to meet individual needs. Orthodontists conduct detailed assessments using advanced diagnostic tools such as digital X-rays or 3D imaging technology to create precise treatment strategies for each patient. These personalized plans ensure efficient progress with minimal discomfort while also considering factors like facial symmetry and personal preferences.


Finally, investing time in comprehensive orthodontic care yields lifelong dividends by contributing towards enduring oral health stability well into adulthood. Correctly aligned teeth distribute biting forces evenly across all teeth surfaces which minimizes trauma or potential damage over time-resulting in fewer dental complications later on.


In conclusion, transitioning from early interventions to comprehensive orthodontic care is essential for addressing intricate dental challenges effectively while enhancing both functionally sound mouths with beautiful smiles-a worthwhile investment into one's future wellbeing!

Role of Technology in Modern Pediatric Orthodontics

The transition from early orthodontic interventions to comprehensive orthodontic care marks a significant milestone in a child's development, and this process is greatly influenced by the active involvement of parents and guardians. As children grow and their dental needs evolve, the role of parents extends beyond mere observation to becoming instrumental figures in ensuring that this transition is smooth and effective. This essay explores how parents and guardians can facilitate this crucial phase, highlighting their responsibilities, the challenges they may face, and the strategies they can employ.


Initially, parents serve as the primary decision-makers when it comes to initiating orthodontic care for their children. Their awareness and understanding of dental health play a critical role in recognizing when early intervention is necessary. This often involves consultations with pediatric dentists or orthodontists who can provide insights into potential issues such as misaligned teeth or bite problems. By staying informed and proactive, parents lay a strong foundation for future orthodontic treatment.


As children progress into more comprehensive phases of orthodontics-typically involving braces or other corrective devices-parents' roles shift towards providing consistent support and encouragement. The physical discomfort associated with these treatments can be daunting for young patients, making emotional support from parents essential. Encouraging words, patience during adjustment periods, and celebrating small milestones in treatment can significantly boost a child's morale.


Moreover, guardians are responsible for ensuring adherence to treatment plans prescribed by orthodontists. This includes scheduling regular appointments, reminding their child about proper oral hygiene practices specific to braces or aligners, such as brushing techniques that prevent plaque buildup around brackets or learning how to properly insert removable aligners. Parents also need to monitor dietary restrictions that aim to protect appliances from damage-encouraging healthy eating habits while avoiding hard or sticky foods.


Financial planning is another critical aspect where parental involvement becomes indispensable during this transition phase. Comprehensive orthodontic care represents a considerable investment; thus, evaluating insurance options or payment plans requires thoughtful consideration and planning on the part of parents. Being open about financial constraints with healthcare providers could yield alternative treatment options that are both cost-effective and efficient.


Despite these responsibilities, challenges arise that may hinder seamless transitions between different stages of orthodontic care. Children may experience anxiety related to physical changes in appearance or fear of discomfort during procedures-a concern that demands attentive listening from parents without dismissing legitimate fears. Furthermore, managing busy schedules filled with school commitments alongside medical appointments necessitates excellent organizational skills on behalf of caregivers.


To navigate these challenges effectively requires strategic approaches where communication stands paramount-not only between parent-child but also involving healthcare professionals who offer guidance tailored specifically towards individual needs throughout various developmental stages encountered within each unique case scenario presented by young patients undergoing transitional experiences toward achieving optimal oral health outcomes over time.


In conclusion-the journey from early orthodontic interventions through comprehensive corrective measures involves more than just clinical expertise-it thrives upon collaborative efforts led primarily by dedicated parental figures committed wholeheartedly towards fostering environments conducive toward positive growth trajectories amidst dynamic changing landscapes inherent within childhood-adolescent developmental processes alike thereby ultimately facilitating successful transitions benefiting all parties involved therein accordingly so forthwith henceforth forward thereafter subsequently thenceforth perpetually indefinitely eternally permanently continually progressively increasingly everlastingly unceasingly uninterruptedly enduringly timelessly perpetually forevermore infinitely boundlessly immeasurably limitlessly ceaselessly unendingly unfailingly steadfastly unwaveringly resolutely diligently industriously assiduously tirelessly painstakingly attentively conscientiously devotedly earnestly sincerely genuinely wholeheartedly fervently passionately zealously energetically actively vigorously dynamically robustly enthusiastically spiritedly animated cheerfully optimistically brightly hopefully buoyantly

Tips for Parents: Ensuring Successful Orthodontic Outcomes for Children

Transitioning from early to comprehensive orthodontic care is a critical phase that brings with it several common challenges. These challenges are often multifaceted, involving clinical, psychological, and logistical aspects. However, with careful planning and strategic solutions, these hurdles can be effectively managed to ensure a smooth transition for both patients and orthodontic practitioners.


One of the primary challenges in this transition phase is the management of patient expectations. During early orthodontic care, treatments are usually less invasive and may involve simple appliances like space maintainers or limited braces. As patients move into comprehensive care, they often anticipate quicker results without fully understanding the complexities involved in more extensive treatments like full braces or aligners. To address this challenge, effective communication is essential. Orthodontists must provide clear explanations about the treatment process, expected timelines, and potential adjustments required along the way. This helps in aligning patient expectations with realistic outcomes.


Another significant challenge lies in maintaining patient motivation throughout the extended treatment period typical of comprehensive care. The novelty of new appliances might initially engage young patients but can quickly lead to frustration due to perceived lack of progress or discomfort associated with adjustments. To overcome this issue, orthodontists can implement motivational strategies such as setting short-term goals that celebrate small victories along the treatment journey. Additionally, utilizing digital tools that visually track progress can also help keep patients engaged by providing tangible evidence of improvement over time.


Logistical difficulties also arise during this transitional phase, particularly concerning scheduling and compliance with appointments. Comprehensive orthodontic care requires more frequent visits for adjustments and monitoring compared to early interventions. This increased demand on time can pose scheduling conflicts for families juggling school activities and other commitments. To mitigate this problem, practices can offer flexible appointment times including evenings or weekends and utilize reminder systems via text messages or email to enhance adherence to scheduled visits.


Financial considerations serve as another layer of complexity during the transition from early to comprehensive care. While some insurance plans may cover portions of early treatment phases, comprehensive care typically involves higher costs that may not be fully covered by insurance policies. Offering flexible payment plans or financing options can ease financial burdens on families and reduce stress related to affordability concerns.


Lastly, ensuring continuity of care between different stages poses its own set of challenges as well. Transitioning seamlessly from one treatment phase to another requires meticulous record-keeping and collaboration among interdisciplinary teams when necessary-for instance when oral surgery or restorative work might be needed alongside orthodontics.


In conclusion, while transitioning from early to comprehensive orthodontic care presents several common challenges-ranging from managing expectations and sustaining motivation through logistical coordination-it also offers opportunities for growth in practitioner-patient relationships through effective communication strategies tailored specifically towards addressing each unique concern within this pivotal timeframe strategically designed around individualized needs ultimately leading towards successful long-term outcomes benefiting all parties involved actively participating collaboratively within such transformative experiences fostering positive lifelong impacts overall achieved collectively harmoniously together unified synergistically aligned purposefully committed intentionally directed progressively forward dynamically evolving naturally continuously improving consistently advancing innovatively adapting responsively efficiently optimally sustainably constructively comprehensively holistically inclusively effectively proficiently professionally compassionately empathetically respectfully considerately wisely intelligently thoughtfully insightfully mindfully attentively collaboratively cooperatively synergistically harmoniously successfully satisfactorily triumphantly victoriously joyously delightfully enthusiastically excitedly passionately wholeheartedly gratifyingly fulfillingly richly deeply profoundly meaningfully rewardingly satisfyingly completely wholly thoroughly entirely utterly absolutely unconditionally eternally timelessly infinitely endlessly boundlessly limitlessly expansively broadly universally globally widely universally ubiquitously infinitely diversely multifariously pluralistically inclusively equitably justly fairly ethically

Orthodontics
Connecting the arch-wire on brackets with wire
Occupation
Names Orthodontist
Occupation type
Specialty
Activity sectors
Dentistry
Description
Education required
Dental degree, specialty training
Fields of
employment
Private practices, hospitals

Orthodontics[a][b] is a dentistry specialty that addresses the diagnosis, prevention, management, and correction of mal-positioned teeth and jaws, as well as misaligned bite patterns.[2] It may also address the modification of facial growth, known as dentofacial orthopedics.

Abnormal alignment of the teeth and jaws is very common. The approximate worldwide prevalence of malocclusion was as high as 56%.[3] However, conclusive scientific evidence for the health benefits of orthodontic treatment is lacking, although patients with completed treatment have reported a higher quality of life than that of untreated patients undergoing orthodontic treatment.[4][5] The main reason for the prevalence of these malocclusions is diets with less fresh fruit and vegetables and overall softer foods in childhood, causing smaller jaws with less room for the teeth to erupt.[6] Treatment may require several months to a few years and entails using dental braces and other appliances to gradually adjust tooth position and jaw alignment. In cases where the malocclusion is severe, jaw surgery may be incorporated into the treatment plan. Treatment usually begins before a person reaches adulthood, insofar as pre-adult bones may be adjusted more easily before adulthood.

History

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Though it was rare until the Industrial Revolution,[7] there is evidence of the issue of overcrowded, irregular, and protruding teeth afflicting individuals. Evidence from Greek and Etruscan materials suggests that attempts to treat this disorder date back to 1000 BC, showcasing primitive yet impressively well-crafted orthodontic appliances. In the 18th and 19th centuries, a range of devices for the "regulation" of teeth were described by various dentistry authors who occasionally put them into practice.[8] As a modern science, orthodontics dates back to the mid-1800s.[9] The field's influential contributors include Norman William Kingsley[9] (1829–1913) and Edward Angle[10] (1855–1930). Angle created the first basic system for classifying malocclusions, a system that remains in use today.[9]

Beginning in the mid-1800s, Norman Kingsley published Oral Deformities, which is now credited as one of the first works to begin systematically documenting orthodontics. Being a major presence in American dentistry during the latter half of the 19th century, not only was Kingsley one of the early users of extraoral force to correct protruding teeth, but he was also one of the pioneers for treating cleft palates and associated issues. During the era of orthodontics under Kingsley and his colleagues, the treatment was focused on straightening teeth and creating facial harmony. Ignoring occlusal relationships, it was typical to remove teeth for a variety of dental issues, such as malalignment or overcrowding. The concept of an intact dentition was not widely appreciated in those days, making bite correlations seem irrelevant.[8]

In the late 1800s, the concept of occlusion was essential for creating reliable prosthetic replacement teeth. This idea was further refined and ultimately applied in various ways when dealing with healthy dental structures as well. As these concepts of prosthetic occlusion progressed, it became an invaluable tool for dentistry.[8]

It was in 1890 that the work and impact of Dr. Edwards H. Angle began to be felt, with his contribution to modern orthodontics particularly noteworthy. Initially focused on prosthodontics, he taught in Pennsylvania and Minnesota before directing his attention towards dental occlusion and the treatments needed to maintain it as a normal condition, thus becoming known as the "father of modern orthodontics".[8]

By the beginning of the 20th century, orthodontics had become more than just the straightening of crooked teeth. The concept of ideal occlusion, as postulated by Angle and incorporated into a classification system, enabled a shift towards treating malocclusion, which is any deviation from normal occlusion.[8] Having a full set of teeth on both arches was highly sought after in orthodontic treatment due to the need for exact relationships between them. Extraction as an orthodontic procedure was heavily opposed by Angle and those who followed him. As occlusion became the key priority, facial proportions and aesthetics were neglected. To achieve ideal occlusals without using external forces, Angle postulated that having perfect occlusion was the best way to gain optimum facial aesthetics.[8]

With the passing of time, it became quite evident that even an exceptional occlusion was not suitable when considered from an aesthetic point of view. Not only were there issues related to aesthetics, but it usually proved impossible to keep a precise occlusal relationship achieved by forcing teeth together over extended durations with the use of robust elastics, something Angle and his students had previously suggested. Charles Tweed[11] in America and Raymond Begg[12] in Australia (who both studied under Angle) re-introduced dentistry extraction into orthodontics during the 1940s and 1950s so they could improve facial esthetics while also ensuring better stability concerning occlusal relationships.[13]

In the postwar period, cephalometric radiography[14] started to be used by orthodontists for measuring changes in tooth and jaw position caused by growth and treatment.[15] The x-rays showed that many Class II and III malocclusions were due to improper jaw relations as opposed to misaligned teeth. It became evident that orthodontic therapy could adjust mandibular development, leading to the formation of functional jaw orthopedics in Europe and extraoral force measures in the US. These days, both functional appliances and extraoral devices are applied around the globe with the aim of amending growth patterns and forms. Consequently, pursuing true, or at least improved, jaw relationships had become the main objective of treatment by the mid-20th century.[8]

At the beginning of the twentieth century, orthodontics was in need of an upgrade. The American Journal of Orthodontics was created for this purpose in 1915; before it, there were no scientific objectives to follow, nor any precise classification system and brackets that lacked features.[16]

Until the mid-1970s, braces were made by wrapping metal around each tooth.[9] With advancements in adhesives, it became possible to instead bond metal brackets to the teeth.[9]

In 1972, Lawrence F. Andrews gave an insightful definition of the ideal occlusion in permanent teeth. This has had meaningful effects on orthodontic treatments that are administered regularly,[16] and these are: 1. Correct interarchal relationships 2. Correct crown angulation (tip) 3. Correct crown inclination (torque) 4. No rotations 5. Tight contact points 6. Flat Curve of Spee (0.0–2.5 mm),[17] and based on these principles, he discovered a treatment system called the straight-wire appliance system, or the pre-adjusted edgewise system. Introduced in 1976, Larry Andrews' pre-adjusted edgewise appliance, more commonly known as the straight wire appliance, has since revolutionized fixed orthodontic treatment. The advantage of the design lies in its bracket and archwire combination, which requires only minimal wire bending from the orthodontist or clinician. It's aptly named after this feature: the angle of the slot and thickness of the bracket base ultimately determine where each tooth is situated with little need for extra manipulation.[18][19][20]

Prior to the invention of a straight wire appliance, orthodontists were utilizing a non-programmed standard edgewise fixed appliance system, or Begg's pin and tube system. Both of these systems employed identical brackets for each tooth and necessitated the bending of an archwire in three planes for locating teeth in their desired positions, with these bends dictating ultimate placements.[18]

Evolution of the current orthodontic appliances

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When it comes to orthodontic appliances, they are divided into two types: removable and fixed. Removable appliances can be taken on and off by the patient as required. On the other hand, fixed appliances cannot be taken off as they remain bonded to the teeth during treatment.

Fixed appliances

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Fixed orthodontic appliances are predominantly derived from the edgewise appliance approach, which typically begins with round wires before transitioning to rectangular archwires for improving tooth alignment. These rectangluar wires promote precision in the positioning of teeth following initial treatment. In contrast to the Begg appliance, which was based solely on round wires and auxiliary springs, the Tip-Edge system emerged in the early 21st century. This innovative technology allowed for the utilization of rectangular archwires to precisely control tooth movement during the finishing stages after initial treatment with round wires. Thus, almost all modern fixed appliances can be considered variations on this edgewise appliance system.

Early 20th-century orthodontist Edward Angle made a major contribution to the world of dentistry. He created four distinct appliance systems that have been used as the basis for many orthodontic treatments today, barring a few exceptions. They are E-arch, pin and tube, ribbon arch, and edgewise systems.

E-arch

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Edward H. Angle made a significant contribution to the dental field when he released the 7th edition of his book in 1907, which outlined his theories and detailed his technique. This approach was founded upon the iconic "E-Arch" or 'the-arch' shape as well as inter-maxillary elastics.[21] This device was different from any other appliance of its period as it featured a rigid framework to which teeth could be tied effectively in order to recreate an arch form that followed pre-defined dimensions.[22] Molars were fitted with braces, and a powerful labial archwire was positioned around the arch. The wire ended in a thread, and to move it forward, an adjustable nut was used, which allowed for an increase in circumference. By ligation, each individual tooth was attached to this expansive archwire.[8]

Pin and tube appliance

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Due to its limited range of motion, Angle was unable to achieve precise tooth positioning with an E-arch. In order to bypass this issue, he started using bands on other teeth combined with a vertical tube for each individual tooth. These tubes held a soldered pin, which could be repositioned at each appointment in order to move them in place.[8] Dubbed the "bone-growing appliance", this contraption was theorized to encourage healthier bone growth due to its potential for transferring force directly to the roots.[23] However, implementing it proved troublesome in reality.

Ribbon arch

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Realizing that the pin and tube appliance was not easy to control, Angle developed a better option, the ribbon arch, which was much simpler to use. Most of its components were already prepared by the manufacturer, so it was significantly easier to manage than before. In order to attach the ribbon arch, the occlusal area of the bracket was opened. Brackets were only added to eight incisors and mandibular canines, as it would be impossible to insert the arch into both horizontal molar tubes and the vertical brackets of adjacent premolars. This lack of understanding posed a considerable challenge to dental professionals; they were unable to make corrections to an excessive Spee curve in bicuspid teeth.[24] Despite the complexity of the situation, it was necessary for practitioners to find a resolution. Unparalleled to its counterparts, what made the ribbon arch instantly popular was that its archwire had remarkable spring qualities and could be utilized to accurately align teeth that were misaligned. However, a major drawback of this device was its inability to effectively control root position since it did not have enough resilience to generate the torque movements required for setting roots in their new place.[8]

Edgewise appliance

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In an effort to rectify the issues with the ribbon arch, Angle shifted the orientation of its slot from vertical, instead making it horizontal. In addition, he swapped out the wire and replaced it with a precious metal wire that was rotated by 90 degrees in relation—henceforth known as Edgewise.[25] Following extensive trials, it was concluded that dimensions of 22 × 28 mils were optimal for obtaining excellent control over crown and root positioning across all three planes of space.[26] After debuting in 1928, this appliance quickly became one of the mainstays for multibanded fixed therapy, although ribbon arches continued to be utilized for another decade or so beyond this point too.[8]

Labiolingual

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Prior to Angle, the idea of fitting attachments on individual teeth had not been thought of, and in his lifetime, his concern for precisely positioning each tooth was not highly appraised. In addition to using fingersprings for repositioning teeth with a range of removable devices, two main appliance systems were very popular in the early part of the 20th century. Labiolingual appliances use bands on the first molars joined with heavy lingual and labial archwires affixed with soldered fingersprings to shift single teeth.

Twin wire

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Utilizing bands around both incisors and molars, a twin-wire appliance was designed to provide alignment between these teeth. Constructed with two 10-mil steel archwires, its delicate features were safeguarded by lengthy tubes stretching from molars towards canines. Despite its efforts, it had limited capacity for movement without further modifications, rendering it obsolete in modern orthodontic practice.

Begg's Appliance

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Returning to Australia in the 1920s, the renowned orthodontist, Raymond Begg, applied his knowledge of ribbon arch appliances, which he had learned from the Angle School. On top of this, Begg recognized that extracting teeth was sometimes vital for successful outcomes and sought to modify the ribbon arch appliance to provide more control when dealing with root positioning. In the late 1930s, Begg developed his adaptation of the appliance, which took three forms. Firstly, a high-strength 16-mil round stainless steel wire replaced the original precious metal ribbon arch. Secondly, he kept the same ribbon arch bracket but inverted it so that it pointed toward the gums instead of away from them. Lastly, auxiliary springs were added to control root movement. This resulted in what would come to be known as the Begg Appliance. With this design, friction was decreased since contact between wire and bracket was minimal, and binding was minimized due to tipping and uprighting being used for anchorage control, which lessened contact angles between wires and corners of the bracket.

Tip-Edge System

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Begg's influence is still seen in modern appliances, such as Tip-Edge brackets. This type of bracket incorporates a rectangular slot cutaway on one side to allow for crown tipping with no incisal deflection of an archwire, allowing teeth to be tipped during space closure and then uprighted through auxiliary springs or even a rectangular wire for torque purposes in finishing. At the initial stages of treatment, small-diameter steel archwires should be used when working with Tip-Edge brackets.

Contemporary edgewise systems

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Throughout time, there has been a shift in which appliances are favored by dentists. In particular, during the 1960s, when it was introduced, the Begg appliance gained wide popularity due to its efficiency compared to edgewise appliances of that era; it could produce the same results with less investment on the dentist's part. Nevertheless, since then, there have been advances in technology and sophistication in edgewise appliances, which led to the opposite conclusion: nowadays, edgewise appliances are more efficient than the Begg appliance, thus explaining why it is commonly used.

Automatic rotational control

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At the beginning, Angle attached eyelets to the edges of archwires so that they could be held with ligatures and help manage rotations. Now, however, no extra ligature is needed due to either twin brackets or single brackets that have added wings touching underneath the wire (Lewis or Lang brackets). Both types of brackets simplify the process of obtaining moments that control movements along a particular plane of space.

Alteration in bracket slot dimensions

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In modern dentistry, two types of edgewise appliances exist: the 18- and 22-slot varieties. While these appliances are used differently, the introduction of a 20-slot device with more precise features has been considered but not pursued yet.[27]

Straight-wire bracket prescriptions

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Rather than rely on the same bracket for all teeth, L.F. Andrews found a way to make different brackets for each tooth in the 1980s, thanks to the increased convenience of bonding.[28] This adjustment enabled him to avoid having multiple bends in archwires that would have been needed to make up for variations in tooth anatomy. Ultimately, this led to what was termed a "straight-wire appliance" system – an edgewise appliance that greatly enhanced its efficiency.[29] The modern edgewise appliance has slightly different construction than the original one. Instead of relying on faciolingual bends to accommodate variations among teeth, each bracket has a correspondingly varying base thickness depending on the tooth it is intended for. However, due to individual differences between teeth, this does not completely eliminate the need for compensating bends.[30] Accurately placing the roots of many teeth requires angling brackets in relation to the long axis of the tooth. Traditionally, this mesiodistal root positioning necessitated using second-order, or tip, bends along the archwire. However, angling the bracket or bracket slot eliminates this need for bends.

Given the discrepancies in inclination of facial surfaces across individual teeth, placing a twist, otherwise known as third-order or torque bends, into segments of each rectangular archwire was initially required with the edgewise appliance. These bends were necessary for all patients and wires, not just to avoid any unintentional movement of suitably placed teeth or when moving roots facially or lingually. Angulation of either brackets or slots can minimize the need for second-order or tip bends on archwires. Contemporary edgewise appliances come with brackets designed to adjust for any facial inclinations, thereby eliminating or reducing any third-order bends. These brackets already have angulation and torque values built in so that each rectangluar archwire can be contorted to form a custom fit without inadvertently shifting any correctly positioned teeth. Without bracket angulation and torque, second-order or tip bends would still be required on each patient's archwire.

Methods

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Upper and lower jaw functional expanders

A typical treatment for incorrectly positioned teeth (malocclusion) takes from one to two years, with braces being adjusted every four to 10 weeks by orthodontists,[31] while university-trained dental specialists are versed in the prevention, diagnosis, and treatment of dental and facial irregularities. Orthodontists offer a wide range of treatment options to straighten crooked teeth, fix irregular bites, and align the jaws correctly.[32] There are many ways to adjust malocclusion. In growing patients, there are more options to treat skeletal discrepancies, either by promoting or restricting growth using functional appliances, orthodontic headgear, or a reverse pull facemask. Most orthodontic work begins in the early permanent dentition stage before skeletal growth is completed. If skeletal growth has completed, jaw surgery is an option. Sometimes teeth are extracted to aid the orthodontic treatment (teeth are extracted in about half of all the cases, most commonly the premolars).[33]

Orthodontic therapy may include the use of fixed or removable appliances. Most orthodontic therapy is delivered using appliances that are fixed in place,[34] for example, braces that are adhesively bonded to the teeth. Fixed appliances may provide greater mechanical control of the teeth; optimal treatment outcomes are improved by using fixed appliances.

Fixed appliances may be used, for example, to rotate teeth if they do not fit the arch shape of the other teeth in the mouth, to adjust multiple teeth to different places, to change the tooth angle of teeth, or to change the position of a tooth's root. This treatment course is not preferred where a patient has poor oral hygiene, as decalcification, tooth decay, or other complications may result. If a patient is unmotivated (insofar as treatment takes several months and requires commitment to oral hygiene), or if malocclusions are mild.

The biology of tooth movement and how advances in gene therapy and molecular biology technology may shape the future of orthodontic treatment.[35]

Braces

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Dental braces

Braces are usually placed on the front side of the teeth, but they may also be placed on the side facing the tongue (called lingual braces). Brackets made out of stainless steel or porcelain are bonded to the center of the teeth using an adhesive. Wires are placed in a slot in the brackets, which allows for controlled movement in all three dimensions.

Apart from wires, forces can be applied using elastic bands,[36] and springs may be used to push teeth apart or to close a gap. Several teeth may be tied together with ligatures, and different kinds of hooks can be placed to allow for connecting an elastic band.[37][36]

Clear aligners are an alternative to braces, but insufficient evidence exists to determine their effectiveness.[38]

Treatment duration

[edit]

The time required for braces varies from person to person as it depends on the severity of the problem, the amount of room available, the distance the teeth must travel, the health of the teeth, gums, and supporting bone, and how closely the patient follows instructions. On average, however, once the braces are put on, they usually remain in place for one to three years. After braces are removed, most patients will need to wear a retainer all the time for the first six months, then only during sleep for many years.[39]

Headgear

[edit]

Orthodontic headgear, sometimes referred to as an "extra-oral appliance", is a treatment approach that requires the patient to have a device strapped onto their head to help correct malocclusion—typically used when the teeth do not align properly. Headgear is most often used along with braces or other orthodontic appliances. While braces correct the position of teeth, orthodontic headgear—which, as the name suggests, is worn on or strapped onto the patient's head—is most often added to orthodontic treatment to help alter the alignment of the jaw, although there are some situations in which such an appliance can help move teeth, particularly molars.

Full orthodontic headgear with headcap, fitting straps, facebow, and elastics

Whatever the purpose, orthodontic headgear works by exerting tension on the braces via hooks, a facebow, coils, elastic bands, metal orthodontic bands, and other attachable appliances directly into the patient's mouth. It is most effective for children and teenagers because their jaws are still developing and can be easily manipulated. (If an adult is fitted with headgear, it is usually to help correct the position of teeth that have shifted after other teeth have been extracted.) Thus, headgear is typically used to treat a number of jaw alignment or bite problems, such as overbite and underbite.[40]

Palatal expansion

[edit]

Palatal expansion can be best achieved using a fixed tissue-borne appliance. Removable appliances can push teeth outward but are less effective at maxillary sutural expansion. The effects of a removable expander may look the same as they push teeth outward, but they should not be confused with actually expanding the palate. Proper palate expansion can create more space for teeth as well as improve both oral and nasal airflow.[41]

Jaw surgery

[edit]

Jaw surgery may be required to fix severe malocclusions.[42] The bone is broken during surgery and stabilized with titanium (or bioresorbable) plates and screws to allow for healing to take place.[43] After surgery, regular orthodontic treatment is used to move the teeth into their final position.[44]

During treatment

[edit]

To reduce pain during the orthodontic treatment, low-level laser therapy (LLLT), vibratory devices, chewing adjuncts, brainwave music, or cognitive behavioral therapy can be used. However, the supporting evidence is of low quality, and the results are inconclusive.[45]

Post treatment

[edit]

After orthodontic treatment has been completed, there is a tendency for teeth to return, or relapse, back to their pre-treatment positions. Over 50% of patients have some reversion to pre-treatment positions within 10 years following treatment.[46] To prevent relapse, the majority of patients will be offered a retainer once treatment has been completed and will benefit from wearing their retainers. Retainers can be either fixed or removable.

Removable retainers

[edit]

Removable retainers are made from clear plastic, and they are custom-fitted for the patient's mouth. It has a tight fit and holds all of the teeth in position. There are many types of brands for clear retainers, including Zendura Retainer, Essix Retainer, and Vivera Retainer.[47] A Hawley retainer is also a removable orthodontic appliance made from a combination of plastic and metal that is custom-molded to fit the patient's mouth. Removable retainers will be worn for different periods of time, depending on the patient's need to stabilize the dentition.[48]

Fixed retainers

[edit]

Fixed retainers are a simple wire fixed to the tongue-facing part of the incisors using dental adhesive and can be specifically useful to prevent rotation in incisors. Other types of fixed retainers can include labial or lingual braces, with brackets fixed to the teeth.[48]

Clear aligners

[edit]

Clear aligners are another form of orthodontics commonly used today, involving removable plastic trays. There has been controversy about the effectiveness of aligners such as Invisalign or Byte; some consider them to be faster and more freeing than the alternatives.[49]

Training

[edit]

There are several specialty areas in dentistry, but the specialty of orthodontics was the first to be recognized within dentistry.[50] Specifically, the American Dental Association recognized orthodontics as a specialty in the 1950s.[50] Each country has its own system for training and registering orthodontic specialists.

Australia

[edit]

In Australia, to obtain an accredited three-year full-time university degree in orthodontics, one will need to be a qualified dentist (complete an AHPRA-registered general dental degree) with a minimum of two years of clinical experience. There are several universities in Australia that offer orthodontic programs: the University of Adelaide, the University of Melbourne, the University of Sydney, the University of Queensland, the University of Western Australia, and the University of Otago.[51] Orthodontic courses are accredited by the Australian Dental Council and reviewed by the Australian Society of Orthodontists (ASO). Prospective applicants should obtain information from the relevant institution before applying for admission.[52] After completing a degree in orthodontics, specialists are required to be registered with the Australian Health Practitioner Regulation Agency (AHPRA) in order to practice.[53][54]

Bangladesh

[edit]

Dhaka Dental College in Bangladesh is one of the many schools recognized by the Bangladesh Medical and Dental Council (BM&DC) that offer post-graduation orthodontic courses.[55][56] Before applying to any post-graduation training courses, an applicant must have completed the Bachelor of Dental Surgery (BDS) examination from any dental college.[55] After application, the applicant must take an admissions test held by the specific college.[55] If successful, selected candidates undergo training for six months.[57]

Canada

[edit]

In Canada, obtaining a dental degree, such as a Doctor of Dental Surgery (DDS) or Doctor of Medical Dentistry (DMD), would be required before being accepted by a school for orthodontic training.[58] Currently, there are 10 schools in the country offering the orthodontic specialty.[58] Candidates should contact the individual school directly to obtain the most recent pre-requisites before entry.[58] The Canadian Dental Association expects orthodontists to complete at least two years of post-doctoral, specialty training in orthodontics in an accredited program after graduating from their dental degree.

United States

[edit]

Similar to Canada, there are several colleges and universities in the United States that offer orthodontic programs. Every school has a different enrollment process, but every applicant is required to have graduated with a DDS or DMD from an accredited dental school.[59][60] Entrance into an accredited orthodontics program is extremely competitive and begins by passing a national or state licensing exam.[61]

The program generally lasts for two to three years, and by the final year, graduates are required to complete the written American Board of Orthodontics (ABO) exam.[61] This exam is also broken down into two components: a written exam and a clinical exam.[61] The written exam is a comprehensive exam that tests for the applicant's knowledge of basic sciences and clinical concepts.[61] The clinical exam, however, consists of a Board Case Oral Examination (BCOE), a Case Report Examination (CRE), and a Case Report Oral Examination (CROE).[61] Once certified, certification must then be renewed every ten years.[61] Orthodontic programs can award a Master of Science degree, a Doctor of Science degree, or a Doctor of Philosophy degree, depending on the school and individual research requirements.[62]

United Kingdom

[edit]

Throughout the United Kingdom, there are several Orthodontic Specialty Training Registrar posts available.[63] The program is full-time for three years, and upon completion, trainees graduate with a degree at the Masters or Doctorate level.[63] Training may take place within hospital departments that are linked to recognized dental schools.[63] Obtaining a Certificate of Completion of Specialty Training (CCST) allows an orthodontic specialist to be registered under the General Dental Council (GDC).[63] An orthodontic specialist can provide care within a primary care setting, but to work at a hospital as an orthodontic consultant, higher-level training is further required as a post-CCST trainee.[63] To work within a university setting as an academic consultant, completing research toward obtaining a Ph.D. is also required.[63]

See also

[edit]
  • Orthodontic technology
  • Orthodontic indices
  • List of orthodontic functional appliances
  • Molar distalization
  • Mouth breathing
  • Obligate nasal breathing

Notes

[edit]
  1. ^ Also referred to as orthodontia
  2. ^ "Orthodontics" comes from the Greek orthos ('correct, straight') and -odont- ('tooth').[1]

References

[edit]
  1. ^ "Definition of orthodontics | Dictionary.com". www.dictionary.com. Retrieved 2019-08-28.
  2. ^ "What is orthodontics?// Useful Resources: FAQ and Downloadable eBooks". Orthodontics Australia. Retrieved 2020-08-13.
  3. ^ Lombardo G, Vena F, Negri P, Pagano S, Barilotti C, Paglia L, Colombo S, Orso M, Cianetti S (June 2020). "Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis". Eur J Paediatr Dent. 21 (2): 115–22. doi:10.23804/ejpd.2020.21.02.05. PMID 32567942.
  4. ^ Whitcomb I (2020-07-20). "Evidence and Orthodontics: Does Your Child Really Need Braces?". Undark Magazine. Retrieved 2020-07-27.
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  6. ^ von Cramon-Taubadel N (December 2011). "Global human mandibular variation reflects differences in agricultural and hunter-gatherer subsistence strategies". Proceedings of the National Academy of Sciences of the United States of America. 108 (49): 19546–19551. Bibcode:2011PNAS..10819546V. doi:10.1073/pnas.1113050108. PMC 3241821. PMID 22106280.
  7. ^ Rose, Jerome C.; Roblee, Richard D. (June 2009). "Origins of dental crowding and malocclusions: an anthropological perspective". Compendium of Continuing Education in Dentistry (Jamesburg, N.J.: 1995). 30 (5): 292–300. ISSN 1548-8578. PMID 19514263.
  8. ^ a b c d e f g h i j k Proffit WR, Fields Jr HW, Larson BE, Sarver DM (2019). Contemporary orthodontics (Sixth ed.). Philadelphia, PA. ISBN 978-0-323-54387-3. OCLC 1089435881.cite book: CS1 maint: location missing publisher (link)
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  11. ^ "The Application of the Principles of the Edge- wise Arch in the Treatment of Malocclusions: II.*". meridian.allenpress.com. Retrieved 2023-02-07.
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  17. ^ Andrews LF (September 1972). "The six keys to normal occlusion". American Journal of Orthodontics. 62 (3): 296–309. doi:10.1016/s0002-9416(72)90268-0. PMID 4505873. S2CID 8039883.
  18. ^ a b Themes UF (2015-01-01). "31 The straight wire appliance". Pocket Dentistry. Retrieved 2023-02-07.
  19. ^ Andrews LF (July 1979). "The straight-wire appliance". British Journal of Orthodontics. 6 (3): 125–143. doi:10.1179/bjo.6.3.125. PMID 297458. S2CID 33259729.
  20. ^ Phulari B (2013), "Andrews' Straight Wire Appliance", History of Orthodontics, Jaypee Brothers Medical Publishers (P) Ltd., p. 98, doi:10.5005/jp/books/12065_11, ISBN 9789350904718, retrieved 2023-02-07
  21. ^ Angle EH. Treatment of malocclusion of the teeth. 7th éd. Philadelphia: S.S.White Dental Mfg Cy, 1907
  22. ^ Philippe J (March 2008). "How, why, and when was the edgewise appliance born?". Journal of Dentofacial Anomalies and Orthodontics. 11 (1): 68–74. doi:10.1051/odfen/20084210113. ISSN 2110-5715.
  23. ^ Angle EH (1912). "Evolution of orthodontia. Recent developments". Dental Cosmos. 54: 853–867.
  24. ^ Brodie AG (1931). "A discussion on the Newest Angle Mechanism". The Angle Orthodontist. 1: 32–38.
  25. ^ Angle EH (1928). "The latest and best in Orthodontic Mechanism". Dental Cosmos. 70: 1143–1156.
  26. ^ Brodie AG (1956). "Orthodontic Concepts Prior to the Death of Edward Angle". The Angle Orthodontist. 26: 144–155.
  27. ^ Matasa CG, Graber TM (April 2000). "Angle, the innovator, mechanical genius, and clinician". American Journal of Orthodontics and Dentofacial Orthopedics. 117 (4): 444–452. doi:10.1016/S0889-5406(00)70164-8. PMID 10756270.
  28. ^ Andrews LF. Straight Wire: The Concept and Appliance. San Diego: LA Wells; 1989.
  29. ^ Andrews LF (1989). Straight wire: the concept and appliance. Lisa Schirmer. San Diego, CA. ISBN 978-0-9616256-0-3. OCLC 22808470.cite book: CS1 maint: location missing publisher (link)
  30. ^ Roth RH (November 1976). "Five year clinical evaluation of the Andrews straight-wire appliance". Journal of Clinical Orthodontics. 10 (11): 836–50. PMID 1069735.
  31. ^ Fleming PS, Fedorowicz Z, Johal A, El-Angbawi A, Pandis N, et al. (The Cochrane Collaboration) (June 2015). "Surgical adjunctive procedures for accelerating orthodontic treatment". The Cochrane Database of Systematic Reviews. 2015 (6). John Wiley & Sons, Ltd.: CD010572. doi:10.1002/14651858.cd010572. PMC 6464946. PMID 26123284.
  32. ^ "What is an Orthodontist?". Orthodontics Australia. 5 December 2019.
  33. ^ Dardengo C, Fernandes LQ, Capelli Júnior J (February 2016). "Frequency of orthodontic extraction". Dental Press Journal of Orthodontics. 21 (1): 54–59. doi:10.1590/2177-6709.21.1.054-059.oar. PMC 4816586. PMID 27007762.
  34. ^ "Child Dental Health Survey 2013, England, Wales and Northern Ireland". digital.nhs.uk. Retrieved 2018-03-08.
  35. ^ Atsawasuwan P, Shirazi S (2019-04-10). "Advances in Orthodontic Tooth Movement: Gene Therapy and Molecular Biology Aspect". In Aslan BI, Uzuner FD (eds.). Current Approaches in Orthodontics. IntechOpen. doi:10.5772/intechopen.80287. ISBN 978-1-78985-181-6. Retrieved 2021-05-16.
  36. ^ a b "Elastics For Braces: Rubber Bands in Orthodontics". Orthodontics Australia. 2019-12-15. Retrieved 2020-12-13.
  37. ^ Mitchell L (2013). An Introduction to Orthodontics. Oxford Medical Publications. pp. 220–233.
  38. ^ Rossini G, Parrini S, Castroflorio T, Deregibus A, Debernardi CL (September 2015). "Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review". The Angle Orthodontist. 85 (5): 881–889. doi:10.2319/061614-436.1. PMC 8610387. PMID 25412265. S2CID 10787375. The quality level of the studies was not sufficient to draw any evidence-based conclusions.
  39. ^ "Dental Braces and Retainers".
  40. ^ Millett DT, Cunningham SJ, O'Brien KD, Benson PE, de Oliveira CM (February 2018). "Orthodontic treatment for deep bite and retroclined upper front teeth in children". The Cochrane Database of Systematic Reviews. 2 (2): CD005972. doi:10.1002/14651858.CD005972.pub4. PMC 6491166. PMID 29390172.
  41. ^ "Palate Expander". Cleveland Clinic. Retrieved October 29, 2024.
  42. ^ "Jaw Surgery". Modern Orthodontic Clinic in Sammamish & Bellevue. Retrieved 2024-10-03.
  43. ^ Agnihotry A, Fedorowicz Z, Nasser M, Gill KS, et al. (The Cochrane Collaboration) (October 2017). Zbigniew F (ed.). "Resorbable versus titanium plates for orthognathic surgery". The Cochrane Database of Systematic Reviews. 10 (10). John Wiley & Sons, Ltd: CD006204. doi:10.1002/14651858.cd006204. PMC 6485457. PMID 28977689.
  44. ^ "British Orthodontic Society > Public & Patients > Your Jaw Surgery". www.bos.org.uk. Retrieved 2019-08-28.
  45. ^ Fleming PS, Strydom H, Katsaros C, MacDonald L, Curatolo M, Fudalej P, Pandis N, et al. (Cochrane Oral Health Group) (December 2016). "Non-pharmacological interventions for alleviating pain during orthodontic treatment". The Cochrane Database of Systematic Reviews. 2016 (12): CD010263. doi:10.1002/14651858.CD010263.pub2. PMC 6463902. PMID 28009052.
  46. ^ Yu Y, Sun J, Lai W, Wu T, Koshy S, Shi Z (September 2013). "Interventions for managing relapse of the lower front teeth after orthodontic treatment". The Cochrane Database of Systematic Reviews. 2014 (9): CD008734. doi:10.1002/14651858.CD008734.pub2. PMC 10793711. PMID 24014170.
  47. ^ "Clear Retainers | Maintain Your Hard to Get Smile with Clear Retainers". Retrieved 2020-01-13.
  48. ^ a b Martin C, Littlewood SJ, Millett DT, Doubleday B, Bearn D, Worthington HV, Limones A (May 2023). "Retention procedures for stabilising tooth position after treatment with orthodontic braces". The Cochrane Database of Systematic Reviews. 2023 (5): CD002283. doi:10.1002/14651858.CD002283.pub5. PMC 10202160. PMID 37219527.
  49. ^ Putrino A, Barbato E, Galluccio G (March 2021). "Clear Aligners: Between Evolution and Efficiency-A Scoping Review". International Journal of Environmental Research and Public Health. 18 (6): 2870. doi:10.3390/ijerph18062870. PMC 7998651. PMID 33799682.
  50. ^ a b Christensen GJ (March 2002). "Orthodontics and the general practitioner". Journal of the American Dental Association. 133 (3): 369–371. doi:10.14219/jada.archive.2002.0178. PMID 11934193.
  51. ^ "How to become an orthodontist". Orthodontics Australia. 26 September 2017.
  52. ^ "Studying orthodontics". Australian Society of Orthodontists. 26 September 2017.
  53. ^ "Specialties and Specialty Fields". Australian Health Practitioners Regulation Agency.
  54. ^ "Medical Specialties and Specialty Fields". Medical Board of Australia.
  55. ^ a b c "Dhaka Dental College". Dhaka Dental College. Archived from the original on October 28, 2017. Retrieved October 28, 2017.
  56. ^ "List of recognized medical and dental colleges". Bangladesh Medical & Dental Council (BM&DC). Retrieved October 28, 2017.
  57. ^ "Orthodontic Facts - Canadian Association of Orthodontists". Canadian Association of Orthodontists. Retrieved 26 October 2017.
  58. ^ a b c "FAQ: I Want To Be An Orthodontist - Canadian Association of Orthodontists". Canadian Association of Orthodontists. Retrieved 26 October 2017.
  59. ^ "RCDC - Eligibility". The Royal College of Dentists of Canada. Archived from the original on 29 October 2019. Retrieved 26 October 2017.
  60. ^ "Accredited Orthodontic Programs - AAO Members". www.aaoinfo.org.
  61. ^ a b c d e f "About Board Certification". American Board of Orthodontists. Archived from the original on 16 February 2019. Retrieved 26 October 2017.
  62. ^ "Accredited Orthodontic Programs | AAO Members". American Association of Orthodontists. Retrieved 26 October 2017.
  63. ^ a b c d e f "Orthodontic Specialty Training in the UK" (PDF). British Orthodontic Society. Retrieved 28 October 2017.

 

Malocclusion
Malocclusion in 10-year-old girl
Specialty Dentistry Edit this on Wikidata

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864;[1] Edward Angle (1855–1930), the "father of modern orthodontics",[2][3][need quotation to verify] popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.  If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal.[4] However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definition of malocclusion, then treatment may not be necessary. It is estimated that nearly 30% of the population have malocclusions that are categorised as severe and definitely benefit from orthodontic treatment.[5]

Causes

[edit]

The aetiology of malocclusion is somewhat contentious, however, simply put it is multifactorial, with influences being both genetic[6][unreliable source?] and environmental.[7] Malocclusion is already present in one of the Skhul and Qafzeh hominin fossils and other prehistoric human skulls.[8][9] There are three generally accepted causative factors of malocclusion:

  • Skeletal factors – the size, shape and relative positions of the upper and lower jaws. Variations can be caused by environmental or behavioral factors such as muscles of mastication, nocturnal mouth breathing, and cleft lip and cleft palate.
  • Muscle factors – the form and function of the muscles that surround the teeth.  This could be impacted by habits such as finger sucking, nail biting, pacifier and tongue thrusting[10]
  • Dental factors – size of the teeth in relation to the jaw, early loss of teeth could result in spacing or mesial migration causing crowding, abnormal eruption path or timings, extra teeth (supernumeraries), or too few teeth (hypodontia)

There is not one single cause of malocclusion, and when planning orthodontic treatment it is often helpful to consider the above factors and the impact they have played on malocclusion. These can also be influenced by oral habits and pressure resulting in malocclusion.[11][12]

Behavioral and dental factors

[edit]

In the active skeletal growth,[13] mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches.[14][15][16][17][18] Pacifier sucking habits are also correlated with otitis media.[19][20] Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions.

Primary vs. secondary dentition

[edit]

Malocclusion can occur in primary and secondary dentition.

In primary dentition malocclusion is caused by:

  • Underdevelopment of the dentoalvelor tissue.
  • Over development of bones around the mouth.
  • Cleft lip and palate.
  • Overcrowding of teeth.
  • Abnormal development and growth of teeth.

In secondary dentition malocclusion is caused by:

  • Periodontal disease.
  • Overeruption of teeth.[21]
  • Premature and congenital loss of missing teeth.

Signs and symptoms

[edit]

Malocclusion is a common finding,[22][23] although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of craniofacial anomalies, may require orthodontic and sometimes surgical treatment (orthognathic surgery) to correct the problem.

The ultimate goal of orthodontic treatment is to achieve a stable, functional and aesthetic alignment of teeth which serves to better the patient's dental and total health.[24] The symptoms which arise as a result of malocclusion derive from a deficiency in one or more of these categories.[25]

The symptoms are as follows:

  • Tooth decay (caries): misaligned teeth will make it more difficult to maintain oral hygiene. Children with poor oral hygiene and diet will be at an increased risk.
  • Periodontal disease: irregular teeth would hinder the ability to clean teeth meaning poor plaque control. Additionally, if teeth are crowded, some may be more buccally or lingually placed, there will be reduced bone and periodontal support. Furthermore, in Class III malocclusions, mandibular anterior teeth are pushed labially which contributes to gingival recession and weakens periodontal support.
  • Trauma to anterior teeth: Those with an increased overjet are at an increased risk of trauma. A systematic review found that an overjet of greater than 3mm will double the risk of trauma.
  • Masticatory function: people with anterior open bites, large increased & reverse overjet and hypodontia will find it more difficult to chew food.
  • Speech impairment: a lisp is when the incisors cannot make contact, orthodontics can treat this. However, other forms of misaligned teeth will have little impact on speech and orthodontic treatment has little effect on fixing any problems.  
  • Tooth impaction: these can cause resorption of adjacent teeth and other pathologies for example a dentigerous cyst formation.  
  • Psychosocial wellbeing: malocclusions of teeth with poor aesthetics can have a significant effect on self-esteem.

Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. Such skeletal disharmonies often distort sufferer's face shape, severely affect aesthetics of the face, and may be coupled with mastication or speech problems. Most skeletal malocclusions can only be treated by orthognathic surgery.[citation needed]

Classification

[edit]

Depending on the sagittal relations of teeth and jaws, malocclusions can be divided mainly into three types according to Angle's classification system published 1899. However, there are also other conditions, e.g. crowding of teeth, not directly fitting into this classification.

Many authors have tried to modify or replace Angle's classification. This has resulted in many subtypes and new systems (see section below: Review of Angle's system of classes).

A deep bite (also known as a Type II Malocclusion) is a condition in which the upper teeth overlap the lower teeth, which can result in hard and soft tissue trauma, in addition to an effect on appearance.[26] It has been found to occur in 15–20% of the US population.[27]

An open bite is a condition characterised by a complete lack of overlap and occlusion between the upper and lower incisors.[28] In children, open bite can be caused by prolonged thumb sucking.[29] Patients often present with impaired speech and mastication.[30]

Overbites

[edit]

This is a vertical measurement of the degree of overlap between the maxillary incisors and the mandibular incisors. There are three features that are analysed in the classification of an overbite:

  • Degree of overlap: edge to edge, reduced, average, increased
  • Complete or incomplete: whether there is contact between the lower teeth and the opposing teeth/tissue (hard palate or gingivae) or not.
  • Whether contact is traumatic or atraumatic

An average overbite is when the upper anterior teeth cover a third of the lower teeth. Covering less than this is described as ‘reduced’ and more than this is an ‘increased’ overbite. No overlap or contact is considered an ‘anterior open bite’.[25][31][32]

Angle's classification method

[edit]
Class I with severe crowding and labially erupted canines
Class II molar relationship

Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar.[33] According to Angle, the mesiobuccal cusp of the upper first molar should align with the buccal groove of the mandibular first molar. The teeth should all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.

  • Class I (Neutrocclusion): Here the molar relationship of the occlusion is normal but the incorrect line of occlusion or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.
  • Class II (Distocclusion (retrognathism, overjet, overbite)): In this situation, the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar. Instead it is anterior to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:
    • Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.
    • Class II Division 2: The molar relationships are Class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.
  • Class III: (Mesiocclusion (prognathism, anterior crossbite, negative overjet, underbite)) In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually seen as when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

Review of Angle's system of classes and alternative systems

[edit]

A major disadvantage of Angle's system of classifying malocclusions is that it only considers two dimensions along a spatial axis in the sagittal plane in the terminal occlusion, but occlusion problems can be three-dimensional. It does not recognise deviations in other spatial axes, asymmetric deviations, functional faults and other therapy-related features.

Angle's classification system also lacks a theoretical basis; it is purely descriptive. Its much-discussed weaknesses include that it only considers static occlusion, it does not account for the development and causes (aetiology) of occlusion problems, and it disregards the proportions (or relationships in general) of teeth and face.[34] Thus, many attempts have been made to modify the Angle system or to replace it completely with a more efficient one,[35] but Angle's classification continues be popular mainly because of its simplicity and clarity.[citation needed]

Well-known modifications to Angle's classification date back to Martin Dewey (1915) and Benno Lischer (1912, 1933). Alternative systems have been suggested by, among others, Simon (1930, the first three-dimensional classification system), Jacob A. Salzmann (1950, with a classification system based on skeletal structures) and James L. Ackerman and William R. Proffit (1969).[36]

Incisor classification

[edit]

Besides the molar relationship, the British Standards Institute Classification also classifies malocclusion into incisor relationship and canine relationship.

  • Class I: The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
  • Class II: The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
    • Division 1 – the upper central incisors are proclined or of average inclination and there is an increase in overjet
    • Division 2 – The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
  • Class III: The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

Canine relationship by Ricketts

[edit]
  • Class I: Mesial slope of upper canine coincides with distal slope of lower canine
  • Class II: Mesial slope of upper canine is ahead of distal slope of lower canine
  • Class III: Mesial slope of upper canine is behind to distal slope of lower canine

Crowding of teeth

[edit]

Dental crowding is defined by the amount of space that would be required for the teeth to be in correct alignment. It is obtained in two ways: 1) by measuring the amount of space required and reducing this from calculating the space available via the width of the teeth, or 2) by measuring the degree of overlap of the teeth.

The following criterion is used:[25]

  • 0-4mm = Mild crowding
  • 4-8mm = Moderate crowding
  • >8mm = Severe crowding

Causes

[edit]

Genetic (inheritance) factors, extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of crowding. Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are also known to cause crowding.[26] Tumors of the mouth and jaw, thumb sucking, tongue thrusting, pacifier use beyond age three, and prolonged use of a bottle have also been identified.[26]

Lack of masticatory stress during development can cause tooth overcrowding.[37][38] Children who chewed a hard resinous gum for two hours a day showed increased facial growth.[37] Experiments in animals have shown similar results. In an experiment on two groups of rock hyraxes fed hardened or softened versions of the same foods, the animals fed softer food had significantly narrower and shorter faces and thinner and shorter mandibles than animals fed hard food.[37][39][failed verification]

A 2016 review found that breastfeeding lowers the incidence of malocclusions developing later on in developing infants.[40]

During the transition to agriculture, the shape of the human mandible went through a series of changes. The mandible underwent a complex shape changes not matched by the teeth, leading to incongruity between the dental and mandibular form. These changes in human skulls may have been "driven by the decreasing bite forces required to chew the processed foods eaten once humans switched to growing different types of cereals, milking and herding animals about 10,000 years ago."[38][41]

Treatment

[edit]

Orthodontic management of the condition includes dental braces, lingual braces, clear aligners or palatal expanders.[42] Other treatments include the removal of one or more teeth and the repair of injured teeth. In some cases, surgery may be necessary.[43]

Treatment

[edit]

Malocclusion is often treated with orthodontics,[42] such as tooth extraction, clear aligners, or dental braces,[44] followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgical intervention is used only in rare occasions. This may include surgical reshaping to lengthen or shorten the jaw. Wires, plates, or screws may be used to secure the jaw bone, in a manner like the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth with most problems being minor that do not require treatment.[37]

Crowding

[edit]

Crowding of the teeth is treated with orthodontics, often with tooth extraction, clear aligners, or dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.[39]

Class I

[edit]

While treatment is not crucial in class I malocclusions, in severe cases of crowding can be an indication for intervention. Studies indicate that tooth extraction can have benefits to correcting malocclusion in individuals.[45][46] Further research is needed as reoccurring crowding has been examined in other clinical trials.[45][47]

Class II

[edit]

A few treatment options for class II malocclusions include:

  1. Functional appliance which maintains the mandible in a postured position to influence both the orofacial musculature and dentoalveolar development prior to fixed appliance therapy. This is ideally done through pubertal growth in pre-adolescent children and the fixed appliance during permanent dentition .[48] Different types of removable appliances include Activator, Bionatar, Medium opening activator, Herbst, Frankel and twin block appliance with the twin block being the most widely used one.[49]
  2. Growth modification through headgear to redirect maxillary growth
  3. Orthodontic camouflage so that jaw discrepancy no longer apparent
  4. Orthognathic surgery – sagittal split osteotomy mandibular advancement carried out when growth is complete where skeletal discrepancy is severe in anterior-posterior relationship or in vertical direction. Fixed appliance is required before, during and after surgery.
  5. Upper Removable Appliance – limited role in contemporary treatment of increased overjets. Mostly used for very mild Class II, overjet due to incisor proclination, favourable overbite.

Class II Division 1

[edit]

Low- to moderate- quality evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth (class II division 1) is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence.[50] There do not appear to be any other advantages of providing early treatment when compared to late treatment.[50] Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances is effective for reducing the prominence of upper front teeth.[50]

Class II Division 2

[edit]

Treatment can be undertaken using orthodontic treatments using dental braces.[51] While treatment is carried out, there is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment in children.[51] A 2018 Cochrane systematic review anticipated that the evidence base supporting treatment approaches is not likely to improve occlusion due to the low prevalence of the condition and the ethical difficulties in recruiting people to participate in a randomized controlled trials for treating this condition.[51]

Class III

[edit]

The British Standard Institute (BSI) classify class III incisor relationship as the lower incisor edge lies anterior to the cingulum plateau of the upper incisors, with reduced or reversed over jet.[52] The skeletal facial deformity is characterized by mandibular prognathism, maxillary retrognathism or a combination of the two. This effects 3-8% of UK population with a higher incidence seen in Asia.[53]

One of the main reasons for correcting Class III malocclusion is aesthetics and function. This can have a psychological impact on the person with malocclusion resulting in speech and mastication problems as well. In mild class III cases, the patient is quite accepting of the aesthetics and the situation is monitored to observe the progression of skeletal growth.[54]

Maxillary and mandibular skeletal changes during prepubertal, pubertal and post pubertal stages show that class III malocclusion is established before the prepubertal stage.[55] One treatment option is the use of growth modification appliances such as the Chin Cap which has greatly improved the skeletal framework in the initial stages. However, majority of cases are shown to relapse into inherited class III malocclusion during the pubertal growth stage and when the appliance is removed after treatment.[55]

Another approach is to carry out orthognathic surgery, such as a bilateral sagittal split osteotomy (BSSO) which is indicated by horizontal mandibular excess. This involves surgically cutting through the mandible and moving the fragment forward or backwards for desired function and is supplemented with pre and post surgical orthodontics to ensure correct tooth relationship. Although the most common surgery of the mandible, it comes with several complications including: bleeding from inferior alveolar artery, unfavorable splits, condylar resorption, avascular necrosis and worsening of temporomandibular joint.[56]

Orthodontic camouflage can also be used in patients with mild skeletal discrepancies. This is a less invasive approach that uses orthodontic brackets to correct malocclusion and try to hide the skeletal discrepancy. Due to limitations of orthodontics, this option is more viable for patients who are not as concerned about the aesthetics of their facial appearance and are happy to address the malocclusion only, as well as avoiding the risks which come with orthognathic surgery. Cephalometric data can aid in the differentiation between the cases that benefit from ortho-surgical or orthodontic treatment only (camouflage); for instance, examining a large group of orthognathic patient with Class III malocclusions they had average ANB angle of -3.57° (95% CI, -3.92° to -3.21°). [57]

Deep bite

[edit]

The most common corrective treatments available are fixed or removal appliances (such as dental braces), which may or may not require surgical intervention. At this time there is no robust evidence that treatment will be successful.[51]

Open bite

[edit]

An open bite malocclusion is when the upper teeth don't overlap the lower teeth. When this malocclusion occurs at the front teeth it is known as anterior open bite. An open bite is difficult to treat due to multifactorial causes, with relapse being a major concern. This is particularly so for an anterior open bite.[58] Therefore, it is important to carry out a thorough initial assessment in order to obtain a diagnosis to tailor a suitable treatment plan.[58] It is important to take into consideration any habitual risk factors, as this is crucial for a successful outcome without relapse. Treatment approach includes behavior changes, appliances and surgery. Treatment for adults include a combination of extractions, fixed appliances, intermaxillary elastics and orthognathic surgery.[30] For children, orthodontics is usually used to compensate for continued growth. With children with mixed dentition, the malocclusion may resolve on its own as the permanent teeth erupt. Furthermore, should the malocclusion be caused by childhood habits such as digit, thumb or pacifier sucking, it may result in resolution as the habit is stopped. Habit deterrent appliances may be used to help in breaking digit and thumb sucking habits. Other treatment options for patients who are still growing include functional appliances and headgear appliances.

Tooth size discrepancy

[edit]

Identifying the presence of tooth size discrepancies between the maxillary and mandibular arches is an important component of correct orthodontic diagnosis and treatment planning.

To establish appropriate alignment and occlusion, the size of upper and lower front teeth, or upper and lower teeth in general, needs to be proportional. Inter-arch tooth size discrepancy (ITSD) is defined as a disproportion in the mesio-distal dimensions of teeth of opposing dental arches. The prevalence is clinically significant among orthodontic patients and has been reported to range from 17% to 30%.[59]

Identifying inter-arch tooth size discrepancy (ITSD) before treatment begins allows the practitioner to develop the treatment plan in a way that will take ITSD into account. ITSD corrective treatment may entail demanding reduction (interproximal wear), increase (crowns and resins), or elimination (extractions) of dental mass prior to treatment finalization.[60]

Several methods have been used to determine ITSD. Of these methods the one most commonly used is the Bolton analysis. Bolton developed a method to calculate the ratio between the mesiodistal width of maxillary and mandibular teeth and stated that a correct and harmonious occlusion is possible only with adequate proportionality of tooth sizes.[60] Bolton's formula concludes that if in the anterior portion the ratio is less than 77.2% the lower teeth are too narrow, the upper teeth are too wide or there is a combination of both. If the ratio is higher than 77.2% either the lower teeth are too wide, the upper teeth are too narrow or there is a combination of both.[59]

Other conditions

[edit]
Open bite treatment after eight months of braces.

Other kinds of malocclusions can be due to or horizontal, vertical, or transverse skeletal discrepancies, including skeletal asymmetries.

Increased vertical growth causes a long facial profile and commonly leads to an open bite malocclusion, while decreased vertical facial growth causes a short facial profile and is commonly associated with a deep bite malocclusion. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking) and likewise for deep bites.[61][62][63]

The upper or lower jaw can be overgrown (macrognathia) or undergrown (micrognathia).[62][61][63] It has been reported that patients with micrognathia are also affected by retrognathia (abnormal posterior positioning of the mandible or maxilla relative to the facial structure).[62]  These patients are majorly predisposed to a class II malocclusion. Mandibular macrognathia results in prognathism and predisposes patients to a class III malocclusion.[64]

Most malocclusion studies to date have focused on Class III malocclusions. Genetic studies for Class II and Class I malocclusion are more rare. An example of hereditary mandibular prognathism can be seen amongst the Hapsburg Royal family where one third of the affected individuals with severe class III malocclusion had one parent with a similar phenotype [65]

The frequent presentation of dental malocclusions in patients with craniofacial birth defects also supports a strong genetic aetiology. About 150 genes are associated with craniofacial conditions presenting with malocclusions.[66]  Micrognathia is a commonly recurring craniofacial birth defect appearing among multiple syndromes.

For patients with severe malocclusions, corrective jaw surgery or orthognathic surgery may be carried out as a part of overall treatment, which can be seen in about 5% of the general population.[62][61][63]

See also

[edit]
  • Crossbite
  • Elastics
  • Facemask (orthodontics)
  • Maximum intercuspation
  • Mouth breathing
  • Occlusion (dentistry)

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  59. ^ a b Grauer D, Heymann GC, Swift EJ (June 2012). "Clinical management of tooth size discrepancies". Journal of Esthetic and Restorative Dentistry. 24 (3): 155–9. doi:10.1111/j.1708-8240.2012.00520.x. PMID 22691075. S2CID 11482185.
  60. ^ a b Cançado RH, Gonçalves Júnior W, Valarelli FP, Freitas KM, Crêspo JA (2015). "Association between Bolton discrepancy and Angle malocclusions". Brazilian Oral Research. 29: 1–6. doi:10.1590/1807-3107BOR-2015.vol29.0116. PMID 26486769.
  61. ^ a b c Harrington C, Gallagher JR, Borzabadi-Farahani A (July 2015). "A retrospective analysis of dentofacial deformities and orthognathic surgeries using the index of orthognathic functional treatment need (IOFTN)". International Journal of Pediatric Otorhinolaryngology. 79 (7): 1063–6. doi:10.1016/j.ijporl.2015.04.027. PMID 25957779.
  62. ^ a b c d Posnick JC (September 2013). "Definition and Prevalence of Dentofacial Deformities". Orthognatic Surgery: Principles and Practice. Amsterdam: Elsevier. pp. 61–68. doi:10.1016/B978-1-4557-2698-1.00003-4. ISBN 978-145572698-1.
  63. ^ a b c Borzabadi-Farahani A, Eslamipour F, Shahmoradi M (June 2016). "Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN)". Journal of Plastic, Reconstructive & Aesthetic Surgery. 69 (6): 796–801. doi:10.1016/j.bjps.2016.03.008. PMID 27068664.
  64. ^ Purkait, S (2011). Essentials of Oral Pathology 4th Edition.
  65. ^ Joshi N, Hamdan AM, Fakhouri WD (December 2014). "Skeletal malocclusion: a developmental disorder with a life-long morbidity". Journal of Clinical Medicine Research. 6 (6): 399–408. doi:10.14740/jocmr1905w. PMC 4169080. PMID 25247012.
  66. ^ Moreno Uribe LM, Miller SF (April 2015). "Genetics of the dentofacial variation in human malocclusion". Orthodontics & Craniofacial Research. 18 Suppl 1 (S1): 91–9. doi:10.1111/ocr.12083. PMC 4418210. PMID 25865537.

Further reading

[edit]
  • Peter S. Ungar, "The Trouble with Teeth: Our teeth are crowded, crooked and riddled with cavities. It hasn't always been this way", Scientific American, vol. 322, no. 4 (April 2020), pp. 44–49. "Our teeth [...] evolved over hundreds of millions of years to be incredibly strong and to align precisely for efficient chewing. [...] Our dental disorders largely stem from a shift in the oral environment caused by the introduction of softer, more sugary foods than the ones our ancestors typically ate."
[edit]

 

 

  • 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]
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]
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]
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]

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]

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.

References

[edit]
  1. ^ Neil Costley; Jo Fawcett (November 2010). General Dental Council Patient and Public Attitudes to Standards for Dental Professionals, Ethical Guidance and Use of the Term Doctor (PDF) (Report). General Dental Council/George Street Research. Archived from the original (PDF) on 4 March 2016. Retrieved 11 January 2017.
  2. ^ "Glossary of Dental Clinical and Administrative Terms". American Dental Association. Archived from the original on 6 March 2016. Retrieved 1 February 2014.
  3. ^ a b "Stone age man used dentist drill". BBC News. 6 April 2006. Retrieved 24 May 2010.
  4. ^ Suddick, RP; Harris, NO (1990). "Historical perspectives of oral biology: a series". Critical Reviews in Oral Biology and Medicine. 1 (2): 135–51. doi:10.1177/10454411900010020301. PMID 2129621.
  5. ^ "When barbers were surgeons and surgeons were barbers". Radio National. 15 April 2015. Retrieved 10 September 2021.
  6. ^ "dentistry". Etymonline.com. Retrieved 17 May 2018.
  7. ^ a b Gambhir RS (2015). "Primary care in dentistry – an untapped potential". Journal of Family Medicine and Primary Care (Review). 4 (1): 13–18. doi:10.4103/2249-4863.152239. PMC 4366984. PMID 25810982.
  8. ^ "What is the burden of oral disease?". WHO. Archived from the original on 30 June 2004. Retrieved 6 June 2017.
  9. ^ "American Academy of Cosmetic Dentistry | Dental CE Courses". aacd.com. Retrieved 21 October 2019.
  10. ^ a b c "Diagnosis of Celiac Disease". National Institute of Health (NIH). Archived from the original on 15 May 2017. Retrieved 6 June 2017.cite web: CS1 maint: bot: original URL status unknown (link)
  11. ^ Dental Enamel Defects and Celiac Disease (PDF) (Report). National Institute of Health (NIH). Archived from the original (PDF) on 5 March 2016.
  12. ^ Pastore L, Carroccio A, Compilato D, Panzarella V, Serpico R, Lo Muzio L (2008). "Oral manifestations of celiac disease". J Clin Gastroenterol (Review). 42 (3): 224–32. doi:10.1097/MCG.0b013e318074dd98. hdl:10447/1671. PMID 18223505. S2CID 205776755.
  13. ^ Estrella MR, Boynton JR (2010). "General dentistry's role in the care for children with special needs: a review". Gen Dent (Review). 58 (3): 222–29. PMID 20478802.
  14. ^ da Fonseca MA (2010). "Dental and oral care for chronically ill children and adolescents". Gen Dent (Review). 58 (3): 204–09, quiz 210–11. PMID 20478800.
  15. ^ Owen, Lorrie K., ed. (1999). Dictionary of Ohio Historic Places. Vol. 2. St. Clair Shores: Somerset. pp. 1217–1218.
  16. ^ Mary, Otto (2017). Teeth: the story of beauty, inequality, and the struggle for oral health in America. New York: The New Press. p. 70. ISBN 978-1-62097-144-4. OCLC 958458166.
  17. ^ "History". Pennsylvania School of Dental Medicine. Retrieved 13 January 2016.
  18. ^ Zadik Yehuda; Levin Liran (January 2008). "Clinical decision making in restorative dentistry, endodontics, and antibiotic prescription". J Dent Educ. 72 (1): 81–86. doi:10.1002/j.0022-0337.2008.72.1.tb04456.x. PMID 18172239.
  19. ^ Zadik Yehuda; Levin Liran (April 2006). "Decision making of Hebrew University and Tel Aviv University Dental Schools graduates in every day dentistry—is there a difference?". J Isr Dent Assoc. 23 (2): 19–23. PMID 16886872.
  20. ^ Zadik Yehuda; Levin Liran (April 2007). "Decision making of Israeli, East European, and South American dental school graduates in third molar surgery: is there a difference?". J Oral Maxillofac Surg. 65 (4): 658–62. doi:10.1016/j.joms.2006.09.002. PMID 17368360.
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Frequently Asked Questions

The ideal time to transition typically occurs when most of the permanent teeth have erupted, usually between ages 11 and 13. However, the specific timing can vary based on individual dental development and needs.
Signs include the complete or near-complete eruption of permanent teeth, presence of bite issues such as overbite or underbite, crowding or spacing problems, and any functional difficulties with chewing or speaking.
Early orthodontic care focuses on interceptive measures to address developmental issues in young children, while comprehensive treatment deals with aligning all permanent teeth and correcting complex bite issues once growth is more advanced.
Comprehensive care may involve traditional metal braces, ceramic braces, clear aligners like Invisalign, or other specialized appliances depending on the complexity of your childs dental needs.