Dental Problems

What is Preventive Orthodontics?

DenturesIn the quest for providing optimal dental care, the age-old maxim of prevention is better than cure holds true. In this endeavor the Pedodontist is most evenly poised to carry the mantle of providing the required services. For the preventive approach to be truly effective it needs to be apply at its earliest i.e. at the primary prevention level. However this may not always be possible and the treatment provided early in the progress of the problem may also limit the damage caused or sometimes even revert it back to normal. Thus, the key difference between prevention and interception lies primarily in the matter of timing. There is brief preview as to the modalities of treatment for the clinician, which can go a long way in preventing the development of malocclusions or at least minimizing them. In this article, there is a brief discussion on the preventive orthodontics.

Orthodontic prevention

Preventive orthodontics:

In 1966 Graber has defined preventive orthodontics as the action taken to preserve the integrity of what appears to be normal occlusion at a specific time.

In 1980 Profit and Ackerman have defined it as prevention of potential interference with occlusal development.

Preventive orthodontics can also be defined as the comprehensive monitoring of the developing dentition in a child and applying suitable measures to guide it to normal occlusion.

Interceptive orthodontics:

The American Association of Orthodontists (1969) defined interceptive orthodontics as that phase of science and art of orthodontics employed to recognize and eliminate the potential irregularities and malpositions in the developing dentofacial complex.

Proffit and Ackerman (1980) have defined it as the elimination of existing interferences with the key factors involved in the development of dentition.

Our clinical experience defines Interceptive orthodontics as an early intervention in the developing dentition to minimize the developing malocclusion or eliminate the potential factors interfering with normal occlusion.

Importance of deciduous dentition:

No other factor plays a more significant role in preventive and interceptive orthodontics than the preservation of the deciduous dentition till its normal time of exfoliation.

The deciduous teeth provide a ‘mold’for the proper growth of jaws, so that the permanent teeth may have an adequate space for aligning themselves.

Premature loss of a deciduous tooth or a group of teeth may lead to the following wide range of implications.

  • Space loss:

    The premature loss of the deciduous tooth will lead to the imbalance of forces maintaining the tooth in the mouth, leading to an uncontrolled force causing space loss. Also, the guidance of the first permanent molar is a prime consideration, for the deciduous dentition.

  • Speech:

    Specially, primary anterior teeth have a role to play in the development of speech articulation in kids. Premature loss may lead to abnormal tongue position as well.

  • Esthetics:

    A child may feel ashamed to smile or laugh with his peers because of embrasment.

  • Psychological affect:

    The child may sometimes have a more withdrawn attitude due to the unaesthetic appearance.

  • Mastication:

    It may lead to the loss of masticatory efficiency and hence improper assimilation of food. Thus general health gets affected.

  • Growth stimulation:

    Growth stimulation for the development of dentofacial structures will be absent.

In 1998 Rao state premature tooth loss may lead to certain specific effects such as:

  • Changes in dental arch length and occlusion
  • Misarticulation of consonants in speech
  • Development of oral health
  • Psychological trauma

A pedodontist frequently comes across such cases, assesses its effect and thus has a profound effect on the future dental and may be psychological status of an individual.

Preventive measures to be considered

A pedodontist is often the first person to encounter the above mentioned effects of premature loss of deciduous teeth. Thus, it is essential on the part of the pedodontist to take early measures in preventing the profound effects on future developing dentition, psychology and personality of the child. The following timely measures should be instituted.

  • A. Parent education:

    Pedodontists are largely responsible for the prevention in orthodontics. They first see the child patient. This provides the best opportunity to educate the parents to the realization that deciduous teeth are fully as important as the permanent ones, and in some respects even more so. An investment benefit to the child as well as be of priceless value later.
    In this age where the opportunity exists to start care for the child even before birth, the role of antenatal diagnosis and education cannot be denied.
    Genetic counseling involves the determination of the risk of an individual acquiring a particular disease existing in the family tree and advising the parents as the potential problems that may arise. For example, the growth of the jaws, the mandible in particular, has been seen to follow a genetic trend.

  • B. Caries control:

    Dental caries of the deciduous teeth, when neglected or when not given proper dental care is the principal cause of malocclusion of the permanent dentition. Thus, all measures that play a role in caries prevention and treatment play a major, albeit indirect, role in preventive orthodontics.
    In this context Nutritional and Diet Counseling. Fluoride applications and water fluoridation, pit and fissure sealants play an important role. Tertiary preventive measures such as the pulpectomy procedures also in their own way manage to maintain the tooth in the arch for the required time and prevent space loss.

  • C. Maintenance of tooth shedding time table:

    A difference of more than 3 months in shedding and eruption in one quadrant, compared to others, should be viewed with suspicion and investigated thoroughly.

  • D. Maintenance of dental arch integrity:

    Preventive orthodontics to a large extent is responsible for the maintenance of arch integrity, most commonly following the premature loss of a deciduous tooth.

  • E. Other measures:

    Many other factors like care of the deciduous teeth, maintenance of occlusal equilibration if there is a any functional reason, extraction of supernumerary tooth, ankylosed tooth, monitoring of incipient malocclusion are important part of preventive orthodontics in Pediatric dental practice apart from space management.

The above article discusses briefly about preventive orthodontics.

Leave a reply

Your email address will not be published. Required fields are marked *