Here's a human-like essay on how professional guidelines shape clinical judgments in orthodontic treatment for children:
Professional guidelines play a crucial role in shaping clinical decision-making for orthodontists working with pediatric patients. These carefully developed frameworks aren't just bureaucratic checklists, but essential roadmaps that help practitioners navigate the complex world of dental and facial development.
When an orthodontist evaluates a young patient, professional guidelines provide a structured approach to assessment. They offer evidence-based recommendations that consider multiple factors like age, dental maturity, skeletal growth, and potential intervention strategies. These guidelines aren't rigid rules, but flexible frameworks that allow for individual patient nuances.
For instance, guidelines might suggest specific timing for interceptive orthodontic treatments. A child with significant bite misalignment might benefit from early intervention, while another with minor crowding could wait. Professional recommendations help orthodontists make these critical decisions with confidence and scientific backing.
Moreover, these guidelines evolve with ongoing research. They represent a collective wisdom of experts who continuously analyze clinical outcomes, technological advancements, and emerging understanding of craniofacial development. This means practitioners aren't working in isolation, but are connected to a broader professional knowledge network.
The beauty of professional guidelines is their balance between standardization and personalization. They provide a consistent baseline of care while allowing skilled clinicians to adapt recommendations to each unique patient's needs. This approach ensures both high-quality treatment and individualized care.
Ultimately, professional guidelines serve as a compass, guiding orthodontists toward optimal treatment strategies while maintaining the art and science of clinical judgment. They represent a sophisticated blend of research, experience, and patient-centered care.
The Role of Established Orthodontic Associations in Developing Comprehensive Clinical Practice Recommendations for Children's Dental Alignment
Orthodontic associations play a crucial role in shaping the landscape of pediatric dental care, particularly when it comes to developing comprehensive clinical practice recommendations for children's dental alignment. These professional bodies serve as the critical bridge between cutting-edge research and practical clinical application, ensuring that orthodontic treatments are both scientifically sound and patient-centered.
At the heart of these recommendations is a commitment to evidence-based practice. Associations like the American Association of Orthodontists (AAO) and similar international organizations meticulously review current research, clinical studies, and emerging technologies to create guidelines that reflect the most up-to-date understanding of dental alignment in children. This process involves extensive collaboration among experts, researchers, and practicing clinicians who bring diverse perspectives to the table.
The development of these guidelines is far from a simple checklist. Instead, it's a nuanced approach that considers multiple factors, including a child's individual growth patterns, potential genetic predispositions, and unique dental challenges. Orthodontic associations recognize that no single approach works for every child, which is why their recommendations provide a flexible framework rather than a rigid protocol.
Perhaps most importantly, these guidelines serve to standardize care while simultaneously promoting innovation. They establish minimum standards of treatment while encouraging practitioners to adapt their approach to individual patient needs. This balance is critical in ensuring that children receive the most appropriate and effective dental alignment interventions possible.
Moreover, these recommendations extend beyond technical considerations. They also address ethical concerns, patient communication, and long-term treatment outcomes. By providing a comprehensive approach, orthodontic associations help practitioners navigate the complex landscape of pediatric dental care with confidence and compassion.
As dental technology continues to evolve, these associations remain at the forefront of research and clinical practice. They continuously update their recommendations, ensuring that children receive the most advanced and appropriate care possible. This ongoing commitment demonstrates the critical role professional guidelines play in shaping clinical judgments and ultimately improving patient outcomes.
Professional guidelines play a crucial role in shaping clinical judgments across healthcare disciplines, serving as a compass for practitioners navigating complex medical decision-making. These guidelines are not static documents but dynamic frameworks that evolve through a sophisticated interplay of multiple critical factors.
Evidence-based research stands at the forefront of developing robust professional guidelines. Rigorous scientific studies provide the foundational knowledge that informs clinical recommendations, ensuring that practitioners have access to the most current and reliable information. Researchers continuously analyze large-scale clinical trials, meta-analyses, and longitudinal studies to refine understanding of medical interventions and best practices.
Patient safety emerges as another paramount consideration in guideline development. Healthcare professionals must balance potential treatment benefits with potential risks, creating nuanced recommendations that prioritize patient well-being. This approach requires a holistic view that considers individual patient characteristics, potential complications, and long-term health outcomes.
Developmental considerations add another layer of complexity to professional guidelines. Different patient populations - from pediatric to geriatric - require tailored approaches that account for unique physiological and psychological characteristics. Guidelines must be flexible enough to accommodate these variations while maintaining core principles of effective care.
Technological advancements have dramatically transformed how professional guidelines are created and implemented. Digital platforms, artificial intelligence, and advanced data analytics now enable more precise, personalized clinical recommendations. These technologies allow for real-time updates and more sophisticated risk assessment models.
The interconnected nature of these factors means that professional guidelines are continuously refined. They represent a delicate balance between scientific knowledge, practical application, and human-centered care. Healthcare practitioners rely on these guidelines not as rigid protocols, but as intelligent frameworks that support critical thinking and individualized patient care.
Ultimately, professional guidelines serve as a bridge between theoretical medical knowledge and practical clinical application. They empower healthcare professionals to make informed, consistent, and compassionate decisions that improve patient outcomes and advance medical practice.
Professional Guidelines: Shaping Clinical Judgments in Pediatric Orthodontics
In the ever-evolving landscape of pediatric orthodontics, professional guidelines play a crucial role in transforming clinical decision-making and patient care. These carefully crafted recommendations serve as a compass, guiding practitioners through the complex terrain of diagnostic assessment, treatment planning, and intervention strategies for young patients.
The impact of these guidelines extends far beyond simple procedural recommendations. They represent a collective wisdom distilled from years of clinical research, evidence-based practice, and expert consensus. By establishing standardized approaches, these guidelines help normalize clinical judgment across different practices and reduce variability in treatment outcomes.
For pediatric orthodontic interventions, guidelines provide critical frameworks for assessing developmental stages, identifying potential orthodontic challenges, and determining the most appropriate timing for specific treatments. They help clinicians navigate the delicate balance between early intervention and watchful waiting, ensuring that each child receives personalized care tailored to their unique developmental trajectory.
Moreover, these professional guidelines serve as a protective mechanism, helping practitioners make informed decisions that prioritize patient safety and long-term oral health. They incorporate the latest research findings, technological advancements, and understanding of craniofacial development, creating a dynamic roadmap for clinical practice.
However, it's important to recognize that guidelines are not rigid protocols but flexible frameworks. Skilled clinicians understand the need to blend these recommendations with individual patient characteristics, considering factors like genetic predispositions, overall health, and specific anatomical variations.
The continuous refinement of these guidelines reflects the orthodontic community's commitment to advancing patient care. Through ongoing research, collaborative discussions, and a dedication to evidence-based practice, professional organizations ensure that these guidelines remain responsive to emerging scientific insights and technological innovations.
In essence, professional guidelines in pediatric orthodontics represent a sophisticated blend of scientific rigor, clinical expertise, and patient-centered care. They empower practitioners to make nuanced, informed decisions that support optimal oral health and developmental outcomes for young patients.
Standardization of Treatment Approaches: How Professional Guidelines Minimize Clinical Variability
In the complex world of orthodontic practice, professional guidelines play a crucial role in creating a consistent and evidence-based approach to patient care. Standardization isn't about removing individual clinical expertise, but rather about establishing a reliable framework that ensures patients receive high-quality treatment regardless of which practitioner they consult.
Professional guidelines serve as a critical bridge between academic research and clinical practice. They synthesize the latest scientific evidence, expert consensus, and best practices into practical recommendations that help orthodontists make more informed decisions. Without such guidelines, clinical judgment could vary dramatically between practitioners, potentially leading to inconsistent treatment outcomes and patient experiences.
Consider, for example, the diagnosis and treatment of malocclusion. Guidelines provide clear protocols for assessment, helping practitioners systematically evaluate dental and skeletal relationships, tooth positioning, and potential intervention strategies. This standardized approach reduces subjective interpretation and ensures that patients receive more predictable and reliable treatment plans.
Moreover, these guidelines are not static documents. They evolve continuously, reflecting the latest research and technological advancements in orthodontic care. Professional organizations like the American Association of Orthodontists regularly review and update these recommendations, ensuring that practitioners have access to the most current and effective treatment protocols.
The beauty of standardization lies in its ability to maintain high-quality care while still allowing room for individual clinical judgment. Guidelines provide a foundational framework, but skilled practitioners can still adapt approaches to individual patient needs, balancing scientific recommendations with personalized care.
By embracing these professional guidelines, orthodontists can enhance treatment consistency, improve patient outcomes, and contribute to the ongoing advancement of their professional field. It's a delicate balance of scientific rigor and individual expertise that ultimately serves the most important stakeholder: the patient.
Here's a human-like essay on the topic:
Ethical Considerations and Patient-Centered Care in Children's Orthodontic Treatments
Professional guidelines play a crucial role in shaping clinical judgments, particularly when it comes to pediatric orthodontic care. At the heart of these guidelines lies a delicate balance between medical necessity, patient well-being, and ethical decision-making.
When treating children, orthodontists must navigate complex considerations that go far beyond simple dental alignment. Patient-centered care means looking at the whole child - their emotional, psychological, and physical development - not just their teeth. Professional guidelines increasingly emphasize the importance of understanding each child's unique circumstances, family dynamics, and individual developmental stages.
Ethical considerations become paramount in pediatric orthodontics. Unlike adult patients, children cannot always fully comprehend or consent to treatment in the same way. This means practitioners must involve parents, consider the child's perspective, and ensure that any proposed intervention genuinely serves the child's best interests.
Modern professional guidelines stress informed consent, transparent communication, and a holistic approach to treatment. This means explaining procedures in age-appropriate language, addressing potential anxieties, and creating a supportive environment that makes dental interventions less intimidating.
Moreover, ethical guidelines now recognize that orthodontic treatment isn't just about aesthetic improvement. It's about supporting a child's self-esteem, social integration, and long-term oral health. Each treatment plan must be carefully tailored, considering potential psychological impacts alongside clinical outcomes.
The evolution of these guidelines reflects a growing understanding that medical care is fundamentally about human connection and compassionate practice. By prioritizing patient-centered approaches, orthodontic professionals can transform what might be a stressful experience into a positive, empowering journey for young patients.
Challenges and Limitations of Current Professional Guidelines in Addressing Individual Patient Variations
Professional medical guidelines have long been considered the gold standard for clinical decision-making, providing a structured approach to patient care. However, the one-size-fits-all nature of these guidelines increasingly reveals significant shortcomings in addressing the complex realities of individual patient experiences.
At the heart of the challenge lies the inherent diversity of human biology and personal health contexts. While guidelines offer valuable evidence-based recommendations, they often struggle to capture the nuanced variations that make each patient unique. Genetic differences, lifestyle factors, comorbidities, and personal health histories create a complex tapestry that cannot be fully addressed by standardized protocols.
Emerging treatment methodologies, particularly in fields like precision medicine and personalized healthcare, are challenging traditional guideline frameworks. These innovative approaches emphasize individual patient characteristics, genetic markers, and tailored interventions that may fall outside established clinical recommendations.
Moreover, the rapid pace of medical research creates a persistent lag between current guidelines and cutting-edge treatment possibilities. By the time guidelines are formally published and adopted, new scientific insights may have already emerged, rendering some recommendations potentially outdated or incomplete.
Clinicians find themselves in a delicate balancing act - respecting established guidelines while maintaining the flexibility to make judgment calls that truly serve individual patient needs. This requires a sophisticated approach that combines evidence-based knowledge with clinical intuition and patient-specific considerations.
The most progressive medical institutions are now recognizing the need for more dynamic, adaptable guideline frameworks. These emerging models emphasize flexibility, continuous updating, and acknowledgment of individual patient variations as central to effective healthcare delivery.
Ultimately, professional guidelines should be viewed as valuable tools rather than rigid prescriptions. They provide essential guidance while leaving room for professional judgment, patient preferences, and the inherent complexity of human health.
As medical science continues to evolve, the most effective approach will involve creating more nuanced, adaptable guidelines that respect both scientific evidence and individual patient uniqueness.
Professional Guidelines: Navigating the Future of Pediatric Orthodontic Care
The landscape of pediatric orthodontic care is constantly evolving, with professional guidelines serving as critical navigational tools for clinicians seeking to provide the most effective and compassionate treatment. These guidelines are far more than just static documents; they represent a dynamic framework of knowledge that bridges the gap between cutting-edge research and practical clinical application.
As healthcare continues to advance, professional guidelines become increasingly sophisticated, reflecting the complex interplay between scientific discovery and patient-centered care. For pediatric orthodontics, this means a continuous refinement of approach that prioritizes both clinical precision and developmental sensitivity. Clinicians today are not just following rules, but engaging with a living document that adapts to new research, technological innovations, and deeper understanding of childhood developmental processes.
The real power of these guidelines lies in their ability to standardize care while simultaneously encouraging individual clinical judgment. They provide a robust foundation of best practices, but also recognize the unique nature of each patient's specific needs. This balanced approach ensures that treatment is both scientifically sound and personally tailored.
Emerging research continues to push the boundaries of what's possible in pediatric orthodontic care. From advanced imaging technologies to more nuanced understanding of craniofacial development, clinicians now have unprecedented tools at their disposal. Professional guidelines help integrate these innovations into practical clinical protocols, ensuring that theoretical advancements translate into meaningful patient outcomes.
Moreover, the collaborative nature of modern medical research means that these guidelines are increasingly developed through international cooperation. Experts from different backgrounds and healthcare systems contribute their insights, creating a more comprehensive and globally relevant approach to pediatric orthodontic care.
The future of these guidelines is particularly exciting. We can anticipate more personalized approaches, greater integration of digital technologies, and a more holistic understanding of how orthodontic interventions impact overall childhood development. The goal is not just to correct dental alignment, but to support comprehensive physical and psychological well-being.
For clinicians, staying current with these evolving guidelines is both a professional responsibility and an opportunity for continuous learning. It requires a commitment to ongoing education, critical thinking, and a genuine passion for improving patient care.
As we look forward, professional guidelines will continue to be essential tools that transform scientific knowledge into compassionate, effective clinical practice. They represent our collective commitment to providing the highest standard of care for our youngest patients.
![]() A pediatrician examines a neonate.
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Focus | Infants, Children, Adolescents, and Young Adults |
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Subdivisions | Paediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below) |
Significant diseases | Congenital diseases, Infectious diseases, Childhood cancer, Mental disorders |
Significant tests | World Health Organization Child Growth Standards |
Specialist | Pediatrician |
Glossary | Glossary of medicine |
Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth until the age of 18.[1] The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25.[2][3] Worldwide age limits of pediatrics have been trending upward year after year.[4] A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παá¿–ς (pais "child") and á¼°ατρÃÅ’ς (iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties (e.g. neonatology requires resources available in a NICU).
The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus, published in the fifth century B.C., and the famous Sacred Disease. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus, Soranus of Ephesus, Aretaeus, Galen, and Oribasius, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.[5] Already Hippocrates, Aristotle, Celsus, Soranus, and Galen[6] understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men").[7] Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya.[6]
Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. Sushruta Samhita, an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics.[8] Another ayurvedic text from this period is Kashyapa Samhita.[9][10] A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics.[11] Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field.[6] The Byzantines also built brephotrophia (crêches).[6] Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children.[12][13] Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.[14][5] In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.[6]
While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.[15] It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.[5] The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,[16][17] while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject".[18] However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.[19]
The term pediatrics was first introduced in English in 1859 by Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."[20] Jacobi is known as the father of American pediatrics because of his many contributions to the field.[21][22] He received his medical training in Germany and later practiced in New York City.[23]
The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage.[24] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[25] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the nearby Necker Hospital, founded in 1778.[26]
In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now WrocÅ‚aw), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.[24] The first Children's hospital in Scotland opened in 1860 in Edinburgh.[27] In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).[28] Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.[29]
The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.[30]
Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults.[30][31][32] Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.[30]
Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.[31][30][32] Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.[31]
Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.[31][32]
Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.[31][32] Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.[31]
Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin.[31] Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.[31][30]
Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.[30]
Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.[31] Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.[31][32] Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.[30]
Drug elimination is primarily facilitated via the liver and kidneys.[31] In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine.[32] In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.[30][31] Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.[31]
A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.[citation needed]
The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic.[33] Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.[34]
In ancient times, society did not view pediatric medicine as essential or scientific.[35] Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.[5] As a result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors.[35] Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.[5]
In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.[34]
The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family, argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights.[36] The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.[37]
In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.[37] Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults.[38] Hence, continuing the discussion on whether children are capable of making important health decisions until this day.
According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.[37]
Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions.[39] Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.
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The examples and perspective in this section deal primarily with United States and do not represent a worldwide view of the subject.(September 2019)
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Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.[citation needed]
In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.[40]
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The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".
Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and the degree of specialization.
In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.[41]
In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of 'pediatric organizations (see below) rather than universities and depends on the jurisdiction.
Subspecialties of pediatrics include:
(not an exhaustive list)
(not an exhaustive list)
By writing a monograph on 'Diseases in Children' he may also be looked upon as the father of paediatrics.
Rosen von Rosenstein.
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This article needs additional citations for verification.(August 2016)
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Dental braces (also known as orthodontic braces, or simply braces) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.
The application of braces moves the teeth as a result of force and pressure on the teeth. Traditionally, four basic elements are used: brackets, bonding material, arch wire, and ligature elastic (also called an "O-ring"). The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction.[1]
Braces apply constant pressure which, over time, moves teeth into the desired positions. The process loosens the tooth after which new bone grows to support the tooth in its new position. This is called bone remodelling. Bone remodelling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible: direct resorption, which starts from the lining cells of the alveolar bone, and indirect or retrograde resorption, which occurs when the periodontal ligament has been subjected to an excessive amount and duration of compressive stress.[2] Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen, and voids will occur distal to the direction of tooth movement.[3]
Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America, most orthodontic treatment is done by orthodontists, who are dentists in the diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.
The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, moulds, and impressions are made. These records are analyzed to determine the problems and the proper course of action. The use of digital models is rapidly increasing in the orthodontic industry. Digital treatment starts with the creation of a three-dimensional digital model of the patient's arches. This model is produced by laser-scanning plaster models created using dental impressions. Computer-automated treatment simulation has the ability to automatically separate the gums and teeth from one another and can handle malocclusions well; this software enables clinicians to ensure, in a virtual setting, that the selected treatment will produce the optimal outcome, with minimal user input.[medical citation needed]
Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied, orthodontic spacers may be required to spread apart back teeth in order to create enough space for the bands.
Teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases, the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental works make securing a bracket to a tooth infeasible. Orthodontic tubes (stainless steel tubes that allow wires to pass through them), also known as molar tubes, are directly bonded to molar teeth either by a chemical curing or a light curing adhesive. Usually, molar tubes are directly welded to bands, which is a metal ring that fits onto the molar tooth. Directly bonded molar tubes are associated with a higher failure rate when compared to molar bands cemented with glass ionomer cement. Failure of orthodontic brackets, bonded tubes or bands will increase the overall treatment time for the patient. There is evidence suggesting that there is less enamel decalcification associated with molar bands cemented with glass ionomer cement compared with orthodontic tubes directly cemented to molars using a light cured adhesive. Further evidence is needed to withdraw a more robust conclusion due to limited data.[7]
An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Ligatures are available in a wide variety of colours, and the patient can choose which colour they like. Arch wires are bent, shaped, and tightened frequently to achieve the desired results.
Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the arch wire will stiffen and seek to retain its shape, creating constant light force on the teeth.
Brackets with hooks can be placed, or hooks can be created and affixed to the arch wire to affix rubber bands. The placement and configuration of the rubber bands will depend on the course of treatment and the individual patient. Rubber bands are made in different diameters, colours, sizes, and strengths. They are also typically available in two versions: Coloured or clear/opaque.
The fitting process can vary between different types of braces, though there are similarities such as the initial steps of moulding the teeth before application. For example, with clear braces, impressions of a patient's teeth are evaluated to create a series of trays, which fit to the patient's mouth almost like a protective mouthpiece. With some forms of braces, the brackets are placed in a special form that is customized to the patient's mouth, drastically reducing the application time.
In many cases, there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion, in which the palate or arch is made larger by using a palatal expander. Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to separate them. An expander can be used on an adult without surgery but would be used to expand the dental arch, and not the palate.
Sometimes children and teenage patients, and occasionally adults, are required to wear a headgear appliance as part of the primary treatment phase to keep certain teeth from moving (for more detail on headgear and facemask appliances see Orthodontic headgear). When braces put pressure on one's teeth, the periodontal membrane stretches on one side and is compressed on the other. This movement needs to be done slowly or otherwise, the patient risks losing their teeth. This is why braces are worn as long as they are and adjustments are only made every so often.
Braces are typically adjusted every three to six weeks. This helps shift the teeth into the correct position. When they get adjusted, the orthodontist removes the coloured or metal ligatures keeping the arch wire in place. The arch wire is then removed and may be replaced or modified. When the archwire has been placed back into the mouth, the patient may choose a colour for the new elastic ligatures, which are then affixed to the metal brackets. The adjusting process may cause some discomfort to the patient, which is normal.
Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gumline contours after the braces come off. After braces treatment, patients can use a transparent plate to keep the teeth in alignment for a certain period of time. After treatment, patients usually use transparent plates for 6 months. In patients with long and difficult treatment, a fixative wire is attached to the back of the teeth to prevent the teeth from returning to their original state.[8]
In order to prevent the teeth from moving back to their original position, retainers are worn once the treatment is complete. Retainers help in maintaining and stabilizing the position of teeth long enough to permit the reorganization of the supporting structures after the active phase of orthodontic therapy. If the patient does not wear the retainer appropriately and/or for the right amount of time, the teeth may move towards their previous position. For regular braces, Hawley retainers are used. They are made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient's palate. For Clear Removable braces, an Essix retainer is used. This is similar to the original aligner; it is a clear plastic tray that is firmly fitted to the teeth and stays in place without a plate fitted to the palate. There is also a bonded retainer where a wire is permanently bonded to the lingual side of the teeth, usually the lower teeth only.
Headgear needs to be worn between 12 and 22 hours each day to be effective in correcting the overbite, typically for 12 to 18 months depending on the severity of the overbite, how much it is worn and what growth stage the patient is in. Typically the prescribed daily wear time will be between 14 and 16 hours a day and is frequently used as a post-primary treatment phase to maintain the position of the jaw and arch. Headgear can be used during the night while the patient sleeps.[9][better source needed]
Orthodontic headgear usually consists of three major components:
The headgear application is one of the most useful appliances available to the orthodontist when looking to correct a Class II malocclusion. See more details in the section Orthodontic headgear.
The pre-finisher is moulded to the patient's teeth by use of extreme pressure on the appliance by the person's jaw. The product is then worn a certain amount of time with the user applying force to the appliance in their mouth for 10 to 15 seconds at a time. The goal of the process is to increase the exercise time in applying the force to the appliance. If a person's teeth are not ready for a proper retainer the orthodontist may prescribe the use of a preformed finishing appliance such as the pre-finisher. This appliance fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor problems.
A group of dental researchers, Fatma Boke, Cagri Gazioglu, Selvi Akkaya, and Murat Akkaya, conducted a study titled "Relationship between orthodontic treatment and gingival health." The results indicated that some orthodontist treatments result in gingivitis, also known as gum disease. The researchers concluded that functional appliances used to harness natural forces (such as improving the alignment of bites) do not usually have major effects on the gum after treatment.[10] However, fixed appliances such as braces, which most people get, can result in visible plaque, visible inflammation, and gum recession in a majority of the patients. The formation of plaques around the teeth of patients with braces is almost inevitable regardless of plaque control and can result in mild gingivitis. But if someone with braces does not clean their teeth carefully, plaques will form, leading to more severe gingivitis and gum recession.
Experiencing some pain following fitting and activation of fixed orthodontic braces is very common and several methods have been suggested to tackle this.[11][12] Pain associated with orthodontic treatment increases in proportion to the amount of force that is applied to the teeth. When a force is applied to a tooth via a brace, there is a reduction in the blood supply to the fibres that attach the tooth to the surrounding bone. This reduction in blood supply results in inflammation and the release of several chemical factors, which stimulate the pain response. Orthodontic pain can be managed using pharmacological interventions, which involve the use of analgesics applied locally or systemically. These analgesics are divided into four main categories, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and local anesthesia. The first three of these analgesics are commonly taken systemically to reduce orthodontic pain.[13]
A Cochrane Review in 2017 evaluated the pharmacological interventions for pain relief during orthodontic treatment. The study concluded that there was moderate-quality evidence that analgesics reduce the pain associated with orthodontic treatment. However, due to a lack of evidence, it was unclear whether systemic NSAIDs were more effective than paracetamol, and whether topical NSAIDs were more effective than local anaesthesia in the reduction of pain associated with orthodontic treatment. More high-quality research is required to investigate these particular comparisons.[13]
The dental displacement obtained with the orthodontic appliance determines in most cases some degree of root resorption. Only in a few cases is this side effect large enough to be considered real clinical damage to the tooth. In rare cases, the teeth may fall out or have to be extracted due to root resorption.[14][15]
According to scholars and historians, braces date back to ancient times. Around 400–300 BC, Hippocrates and Aristotle contemplated ways to straighten teeth and fix various dental conditions. Archaeologists have discovered numerous mummified ancient individuals with what appear to be metal bands wrapped around their teeth. Catgut, a type of cord made from the natural fibres of an animal's intestines, performed a similar role to today's orthodontic wire in closing gaps in the teeth and mouth.[16]
The Etruscans buried their dead with dental appliances in place to maintain space and prevent the collapse of the teeth during the afterlife. A Roman tomb was found with a number of teeth bound with gold wire documented as a ligature wire, a small elastic wire that is used to affix the arch wire to the bracket. Even Cleopatra wore a pair. Roman philosopher and physician Aulus Cornelius Celsus first recorded the treatment of teeth by finger pressure. Unfortunately, due to a lack of evidence, poor preservation of bodies, and primitive technology, little research was carried out on dental braces until around the 17th century, although dentistry was making great advancements as a profession by then.[citation needed]
Orthodontics truly began developing in the 18th and 19th centuries. In 1669, French dentist Pierre Fauchard, who is often credited with inventing modern orthodontics, published a book entitled "The Surgeon Dentist" on methods of straightening teeth. Fauchard, in his practice, used a device called a "Bandeau", a horseshoe-shaped piece of iron that helped expand the palate. In 1754, another French dentist, Louis Bourdet, dentist to the King of France, followed Fauchard's book with The Dentist's Art, which also dedicated a chapter to tooth alignment and application. He perfected the "Bandeau" and was the first dentist on record to recommend extraction of the premolar teeth to alleviate crowding and improve jaw growth.
Although teeth and palate straightening and/or pulling were used to improve the alignment of remaining teeth and had been practised since early times, orthodontics, as a science of its own, did not really exist until the mid-19th century. Several important dentists helped to advance dental braces with specific instruments and tools that allowed braces to be improved.
In 1819, Christophe François Delabarre introduced the wire crib, which marked the birth of contemporary orthodontics, and gum elastics were first employed by Maynard in 1843. Tucker was the first to cut rubber bands from rubber tubing in 1850. Dentist, writer, artist, and sculptor Norman William Kingsley in 1858 wrote the first article on orthodontics and in 1880, his book, Treatise on Oral Deformities, was published. A dentist named John Nutting Farrar is credited for writing two volumes entitled, A Treatise on the Irregularities of the Teeth and Their Corrections and was the first to suggest the use of mild force at timed intervals to move teeth.
In the early 20th century, Edward Angle devised the first simple classification system for malocclusions, such as Class I, Class II, and so on. His classification system is still used today as a way for dentists to describe how crooked teeth are, what way teeth are pointing, and how teeth fit together. Angle contributed greatly to the design of orthodontic and dental appliances, making many simplifications. He founded the first school and college of orthodontics, organized the American Society of Orthodontia in 1901 which became the American Association of Orthodontists (AAO) in the 1930s, and founded the first orthodontic journal in 1907. Other innovations in orthodontics in the late 19th and early 20th centuries included the first textbook on orthodontics for children, published by J.J. Guilford in 1889, and the use of rubber elastics, pioneered by Calvin S. Case, along with Henry Albert Baker.
Today, space age wires (also known as dental arch wires) are used to tighten braces. In 1959, the Naval Ordnance Laboratory created an alloy of nickel and titanium called Nitinol. NASA further studied the material's physical properties.[17] In 1979, Dr. George Andreasen developed a new method of fixing braces with the use of the Nitinol wires based on their superelasticity. Andreasen used the wire on some patients and later found out that he could use it for the entire treatment. Andreasen then began using the nitinol wires for all his treatments and as a result, dental doctor visits were reduced, the cost of dental treatment was reduced, and patients reported less discomfort.
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