Insurance Coverage That Reduces Out of Pocket Costs

Insurance Coverage That Reduces Out of Pocket Costs

Here's the article outline for 'Understanding Common Fee Structures in Orthodontics' focusing on orthodontic treatment for kids:

Insurance Coverage That Reduces Out of Pocket Costs for Orthodontic Treatment


Some children may need space maintainers to prevent crowding Braces for kids and teens dentist.

Navigating the world of orthodontic care for children can be financially challenging for many families. Fortunately, there are several insurance options and strategies that can help reduce the significant out-of-pocket expenses associated with braces and other orthodontic treatments.


Dental insurance plans often provide some level of coverage for orthodontic work, though the extent varies widely. Many plans offer partial coverage for children's orthodontic treatment, typically ranging from 25% to 50% of the total cost. Some employers offer specialized orthodontic riders that can significantly lower expenses, making treatment more accessible for families.


Health savings accounts (HSAs) and flexible spending accounts (FSAs) are another excellent way to manage orthodontic costs. These accounts allow families to set aside pre-tax dollars specifically for medical and dental expenses, effectively reducing the financial burden. By carefully planning and maximizing these accounts, parents can save hundreds or even thousands of dollars on treatment.


Some families might also explore alternative options like dental discount plans or orthodontic payment plans offered directly by practices. Many orthodontists now provide flexible financing options that break down the total cost into manageable monthly payments, making treatment more affordable for families with budget constraints.


It's worth noting that some insurance plans have age restrictions or specific requirements for orthodontic coverage. Children with documented medical necessity - such as severe bite misalignments or jaw issues - may qualify for more comprehensive coverage. Parents should carefully review their existing insurance policies and consult with their providers to understand the full range of available benefits.


By researching options, understanding insurance benefits, and exploring alternative payment strategies, families can significantly reduce the financial stress of orthodontic treatment. The key is to be proactive, ask questions, and carefully compare different coverage options to find the most cost-effective solution for their child's dental health needs.

Traditional Fee Structures: Per-Treatment Pricing Models —

Understanding Orthodontic Coverage: A Parent's Guide to Dental Health and Financial Planning


As a parent, navigating the world of children's healthcare can feel like walking through a maze blindfolded. Orthodontic coverage is one of those critical areas that often gets overlooked, but can have significant implications for both your child's dental health and your family's financial well-being.


Let's be real - braces aren't just about creating a Hollywood smile. They're about correcting alignment issues that can impact speech, eating, and even long-term oral health. Misaligned teeth can lead to problems like uneven wear, difficulty cleaning, and potential jaw complications down the road.


Insurance plans that include robust orthodontic coverage can be a total game-changer for families. Without proper coverage, the cost of braces can range from $3,000 to $7,000 - a hefty price tag that can send most parents into sticker shock. By choosing an insurance plan with comprehensive orthodontic benefits, you're essentially creating a financial safety net that can save thousands of dollars.


But it's not just about the money. Early intervention can prevent more complex and expensive dental issues later in life. Think of orthodontic coverage as an investment in your child's health and confidence. Straight teeth aren't just cosmetic - they're a foundation for better overall oral hygiene and self-esteem.


When shopping for insurance, look for plans that offer significant orthodontic coverage, preferably with low out-of-pocket maximums. Some plans cover up to 50% of orthodontic treatment, which can make a massive difference in your family's budget.


The bottom line? Don't underestimate the importance of orthodontic coverage. It's not just an expense - it's a strategic investment in your child's health and future.

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Insurance Coverage and Impact on Orthodontic Expenses

Navigating Orthodontic Insurance Coverage: Your Guide to Reducing Out-of-Pocket Costs


When it comes to orthodontic treatment, the cost can be overwhelming for many families and individuals. Fortunately, several types of dental insurance plans can help make straightening your teeth more affordable.


Traditional health insurance plans sometimes offer limited orthodontic coverage, but dental-specific plans tend to provide more comprehensive options. Many people find that dedicated dental insurance with orthodontic benefits can significantly reduce their out-of-pocket expenses. These plans typically cover a percentage of orthodontic treatment, which can range from 25% to 50% of total costs.


Supplemental orthodontic insurance is another smart option for those seeking additional financial support. These specialized plans can be purchased separately and often provide extra coverage beyond standard dental insurance. They're particularly useful for individuals who need more extensive orthodontic work but have limited coverage through their primary insurance.


When exploring your options, it's crucial to carefully review each plan's specifics. Some plans have age restrictions, waiting periods, or maximum lifetime benefits for orthodontic treatment. For instance, many plans offer better coverage for children and teenagers, with more limited options for adult orthodontics.


Employer-sponsored plans can also be an excellent source of orthodontic coverage. Some companies include robust dental benefits as part of their overall health insurance package, which can significantly reduce your personal expenses.


The key is to research and compare different plans, understand their specific terms, and choose the option that best meets your individual or family's orthodontic needs. Don't be afraid to ask insurance providers detailed questions about coverage, exclusions, and potential out-of-pocket costs.


By taking the time to understand your insurance options, you can make orthodontic treatment more financially manageable and achieve the smile you've always wanted.

Payment Plan Options for Pediatric Orthodontic Care

Navigating Orthodontic Insurance Coverage: Maximizing Your Benefits


When it comes to managing the costs of orthodontic treatment, understanding your employer-sponsored insurance options can be a game-changer. Many people don't realize the potential savings hidden within their workplace insurance plans, especially when it comes to dental and orthodontic coverage.


First, it's crucial to take a close look at your current insurance policy. Not all employer-sponsored plans are created equal, and some offer more comprehensive orthodontic benefits than others. Start by scheduling a meeting with your HR department or carefully reviewing your insurance documentation to understand exactly what's covered.


Many companies offer dental plans with orthodontic riders that can significantly reduce out-of-pocket expenses. These plans typically cover a percentage of orthodontic treatment, often ranging from 25% to 50% of the total cost. Some employers even provide lifetime orthodontic benefits that can be used for both children and adults, which is a fantastic opportunity many people overlook.


Flexible spending accounts (FSAs) and health savings accounts (HSAs) can be powerful tools in your orthodontic coverage strategy. These accounts allow you to set aside pre-tax dollars specifically for medical and dental expenses, effectively reducing your overall treatment costs. If your employer offers these options, it's worth considering how they can complement your existing insurance coverage.


Timing is everything when it comes to maximizing your benefits. Some insurance plans have waiting periods or specific enrollment windows, so planning ahead is key. Consider discussing treatment options with your orthodontist and insurance provider to create a strategic approach that minimizes your out-of-pocket expenses.


Don't be afraid to ask questions and explore all available options. Many employees simply accept their initial insurance offering without investigating additional ways to reduce costs. Take the time to compare different plans, speak with insurance representatives, and understand the full scope of your coverage.


Ultimately, a proactive approach can save you thousands of dollars in orthodontic expenses. By carefully examining your employer-sponsored insurance options and understanding the nuances of your coverage, you can make informed decisions that significantly reduce your financial burden.


Remember, the goal is to make orthodontic treatment as accessible and affordable as possible. With a little research and strategic planning, you can unlock hidden savings and make your dream smile a reality without breaking the bank.

Factors Influencing Orthodontic Treatment Costs

Navigating the World of Pediatric Orthodontic Costs: A Parent's Guide to Insurance Savings


When it comes to children's dental health, orthodontic treatments can be a significant financial concern for many families. The cost of braces or other corrective dental procedures can feel overwhelming, but understanding insurance options can make a world of difference.


Typically, pediatric orthodontic treatments range from $3,000 to $7,000, depending on the complexity of the case and the type of treatment needed. Traditional metal braces tend to be on the lower end of the price spectrum, while more advanced options like clear aligners can push costs toward the higher end.


The good news is that many insurance plans now offer substantial coverage for orthodontic work. Dental insurance can often cover 25% to 50% of orthodontic expenses, which can translate to significant savings for families. Some employer-provided plans even offer specialized orthodontic riders that can reduce out-of-pocket costs even further.


Parents should carefully review their existing insurance policies and consider additional dental coverage. Many plans have waiting periods and specific age restrictions, so it's crucial to plan ahead. Some flexible spending accounts (FSAs) and health savings accounts (HSAs) can also be used to cover orthodontic expenses, providing additional financial relief.


For families without comprehensive insurance, there are still options. Many orthodontic offices offer payment plans, and some provide discounts for upfront payments or multiple family members receiving treatment. Some dental schools and community health centers also offer more affordable orthodontic services.


The key is to be proactive. Start by consulting with your dentist, getting a comprehensive evaluation, and then exploring insurance options. While the cost of pediatric orthodontics can seem daunting, strategic planning and understanding available coverage can make the process much more manageable.


Remember, investing in your child's dental health early can prevent more expensive treatments down the line. It's not just about aesthetics – proper orthodontic care can prevent future dental complications and support overall health and confidence.

Comparing Different Orthodontic Practices and Their Pricing Strategies

Navigating the world of dental insurance can be overwhelming, especially when it comes to managing out-of-pocket expenses for orthodontic treatments. Fortunately, there are several strategic approaches that can help families and individuals reduce their financial burden while still accessing quality dental care.


Flexible spending accounts (FSAs) offer a smart way to set aside pre-tax dollars specifically for medical and dental expenses. These accounts allow you to allocate funds throughout the year, effectively lowering your taxable income while creating a dedicated pool of money for orthodontic treatments. The beauty of FSAs is that they provide immediate financial relief, letting you use pre-tax dollars to cover everything from braces to related dental procedures.


Health savings accounts (HSAs) present another powerful option for those with high-deductible health plans. Unlike FSAs, HSAs offer more long-term flexibility, allowing you to roll over unused funds from year to year. This means you can strategically save for more extensive orthodontic treatments, building a financial cushion that grows tax-free.


Orthodontic payment plans have also become increasingly sophisticated, with many providers offering customized financing options. These plans often feature low or zero-interest rates, making it easier for families to spread out the cost of treatment over several months or even years. Some orthodontists even provide sliding scale options or discounts for upfront payments, giving patients multiple ways to manage their expenses.


By combining these strategies with existing insurance coverage, patients can significantly reduce their out-of-pocket costs. The key is to be proactive, research available options, and work closely with both insurance providers and orthodontic offices to create a comprehensive financial approach.


Ultimately, investing in these alternative payment strategies can make orthodontic care more accessible and less financially stressful. With careful planning and the right approach, families can ensure beautiful, healthy smiles without breaking the bank.

Additional Fees and Potential Hidden Expenses in Orthodontic Treatment

When it comes to navigating the complex world of orthodontic insurance coverage, understanding the nuanced differences between providers can save you significant money and stress. Not all insurance plans are created equal, and the details can make a substantial difference in your out-of-pocket expenses.


Different insurance providers approach orthodontic coverage with varying strategies. Some plans are more comprehensive, while others have strict limitations that can catch patients off guard. Age restrictions are particularly important to consider. Many providers have specific age caps for orthodontic coverage, typically ranging from 18 to 26 years old. This means adults might face more challenges in getting coverage for braces or other dental alignment treatments.


Lifetime maximum benefits are another critical factor to examine. These caps can range from $1,000 to $3,500, depending on the specific plan. This means once you hit your lifetime maximum, you're responsible for all additional orthodontic expenses. Savvy consumers should carefully review these limits before committing to a treatment plan.


Waiting periods can also significantly impact your orthodontic journey. Some insurance providers impose waiting periods of 6-12 months before allowing full orthodontic coverage. This means you'll need to have the insurance policy in place well before starting any treatment.


To minimize out-of-pocket costs, consider these strategies:



  • Compare multiple insurance providers

  • Look for plans with more flexible age restrictions

  • Check lifetime maximum benefits

  • Understand waiting period requirements

  • Consider supplemental dental insurance


By doing thorough research and carefully comparing different insurance options, patients can find coverage that significantly reduces their orthodontic expenses. It's not just about finding the cheapest plan, but the most comprehensive one that meets your specific needs.


Remember, knowledge is power when it comes to managing healthcare costs. Take the time to read the fine print and ask questions. Your wallet will thank you.

Navigating the world of orthodontic insurance can feel like trying to solve a complex puzzle, but understanding pre-authorization processes can save you both time and money. Let me break down the essentials in a way that's actually helpful and easy to understand.


First off, pre-authorization is basically your insurance company's way of saying, "Yes, we'll consider covering this treatment." Before you get braces or clear aligners, you'll want to submit detailed documentation from your orthodontist. This typically includes x-rays, treatment plans, and diagnostic records that explain why the treatment is medically necessary.


The key is being thorough and proactive. Most insurance plans have specific criteria for orthodontic coverage. Some will only cover treatments for significant medical issues, while others might have age restrictions or require documentation of severe misalignment. I've learned that the more comprehensive your initial submission, the smoother the process goes.


When submitting claims, pay close attention to the details. Make sure every form is filled out completely, include all supporting medical documentation, and keep copies of everything. Insurance companies are notorious for requesting additional information, so being prepared can prevent frustrating delays.


Another pro tip: always verify your specific plan's coverage beforehand. Some plans cover a percentage of orthodontic treatment, while others have a lifetime maximum benefit. Understanding these nuances can help you budget and avoid unexpected out-of-pocket expenses.


Don't be afraid to communicate directly with your insurance provider. A quick phone call can clarify coverage details, potential reimbursement amounts, and any specific requirements unique to your plan. Patient advocacy can make a significant difference in reducing your overall costs.


Ultimately, successfully navigating orthodontic insurance claims is about being informed, organized, and persistent. With the right approach, you can maximize your coverage and minimize your financial stress.

Navigating the world of pediatric orthodontic insurance can feel like walking through a complex maze, especially when you're trying to understand how state-specific regulations can impact your child's dental care costs. Each state has its own unique set of insurance mandates and guidelines that can significantly influence what coverage is available and how much financial assistance families might receive.


For parents looking to manage orthodontic expenses, it's crucial to dive deep into your state's specific insurance landscape. Some states have more comprehensive mandates that require insurance providers to offer more robust coverage for pediatric orthodontic treatments. These regulations can make a substantial difference in out-of-pocket expenses, potentially saving families hundreds or even thousands of dollars.


Many states have implemented programs designed to help families manage the financial burden of orthodontic care. These might include state-sponsored assistance programs, sliding scale payment options, or specific insurance requirements that force providers to offer more affordable coverage for children's dental treatments.


The key is to do your homework. Contact your state's insurance commissioner's office, speak with local insurance agents, and thoroughly research available programs. Some states offer additional support for families with lower incomes or those facing specific medical challenges that require orthodontic intervention.


It's also worth noting that insurance regulations can change frequently, so what might have been true a few years ago could be different today. Annual reviews of your insurance options and state-specific mandates can help you identify new opportunities for reducing your out-of-pocket costs.


Ultimately, understanding these state-specific nuances can make a significant difference in managing the financial aspects of pediatric orthodontic care. While it may seem overwhelming at first, taking the time to investigate your options can lead to substantial savings and better dental care for your child.

Crossbite
Unilateral posterior crossbite
Specialty Orthodontics

In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]

Anterior crossbite

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Class 1 with anterior crossbite

An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).

Primary/mixed dentitions

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An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.

Dental crossbite

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An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.

Single tooth crossbite

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Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.

Skeletal crossbite

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An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]

Posterior crossbite

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Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to

  • Upper Airway Obstruction where people with "adenoid faces" who have trouble breathing through their nose. They have an open bite malocclusion and present with development of posterior crossbite.[12]
  • Prolong digit or suckling habits which can lead to constriction of maxilla posteriorly[13]
  • Prolong pacifier use (beyond age 4)[13]

Connections with TMD

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Unilateral posterior crossbite

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Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child

  • Lower midline deviation[15] to the crossbite side
  • Class 2 Subdivision relationships
  • Temporomandibular disorders [16]

Treatment

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A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]

Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]

Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]

Self-correction

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Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]

See also

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  • List of palatal expanders
  • Palatal expansion
  • Malocclusion

References

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  1. ^ "Elsevier: Proffit: Contemporary Orthodontics · Welcome". www.contemporaryorthodontics.com. Retrieved 2016-12-11.
  2. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  3. ^ a b Kutin, George; Hawes, Roland R. (1969-11-01). "Posterior cross-bites in the deciduous and mixed dentitions". American Journal of Orthodontics. 56 (5): 491–504. doi:10.1016/0002-9416(69)90210-3. PMID 5261162.
  4. ^ Zietsman, S. T.; Visagé, W.; Coetzee, W. J. (2000-11-01). "Palatal finger springs in removable orthodontic appliances--an in vitro study". South African Dental Journal. 55 (11): 621–627. ISSN 1029-4864. PMID 12608226.
  5. ^ Ulusoy, Ayca Tuba; Bodrumlu, Ebru Hazar (2013-01-01). "Management of anterior dental crossbite with removable appliances". Contemporary Clinical Dentistry. 4 (2): 223–226. doi:10.4103/0976-237X.114855. ISSN 0976-237X. PMC 3757887. PMID 24015014.
  6. ^ Al-Hummayani, Fadia M. (2017-03-05). "Pseudo Class III malocclusion". Saudi Medical Journal. 37 (4): 450–456. doi:10.15537/smj.2016.4.13685. ISSN 0379-5284. PMC 4852025. PMID 27052290.
  7. ^ Bjoerk, A.; Krebs, A.; Solow, B. (1964-02-01). "A Method for Epidemiological Registration of Malocculusion". Acta Odontologica Scandinavica. 22: 27–41. doi:10.3109/00016356408993963. ISSN 0001-6357. PMID 14158468.
  8. ^ Moyers, Robert E. (1988-01-01). Handbook of orthodontics. Year Book Medical Publishers. ISBN 9780815160038.
  9. ^ a b c Thilander, Birgit; Lennartsson, Bertil (2002-09-01). "A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition--occlusal and skeletal characteristics of significance in predicting the long-term outcome". Journal of Orofacial Orthopedics. 63 (5): 371–383. doi:10.1007/s00056-002-0210-6. ISSN 1434-5293. PMID 12297966. S2CID 21857769.
  10. ^ Thilander, Birgit; Wahlund, Sonja; Lennartsson, Bertil (1984-01-01). "The effect of early interceptive treatment in children with posterior cross-bite". The European Journal of Orthodontics. 6 (1): 25–34. doi:10.1093/ejo/6.1.25. ISSN 0141-5387. PMID 6583062.
  11. ^ Allen, David; Rebellato, Joe; Sheats, Rose; Ceron, Ana M. (2003-10-01). "Skeletal and dental contributions to posterior crossbites". The Angle Orthodontist. 73 (5): 515–524. ISSN 0003-3219. PMID 14580018.
  12. ^ Bresolin, D.; Shapiro, P. A.; Shapiro, G. G.; Chapko, M. K.; Dassel, S. (1983-04-01). "Mouth breathing in allergic children: its relationship to dentofacial development". American Journal of Orthodontics. 83 (4): 334–340. doi:10.1016/0002-9416(83)90229-4. ISSN 0002-9416. PMID 6573147.
  13. ^ a b Ogaard, B.; Larsson, E.; Lindsten, R. (1994-08-01). "The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children". American Journal of Orthodontics and Dentofacial Orthopedics. 106 (2): 161–166. doi:10.1016/S0889-5406(94)70034-6. ISSN 0889-5406. PMID 8059752.
  14. ^ Piancino, Maria Grazia; Kyrkanides, Stephanos (2016-04-18). Understanding Masticatory Function in Unilateral Crossbites. John Wiley & Sons. ISBN 9781118971871.
  15. ^ Brin, Ilana; Ben-Bassat, Yocheved; Blustein, Yoel; Ehrlich, Jacob; Hochman, Nira; Marmary, Yitzhak; Yaffe, Avinoam (1996-02-01). "Skeletal and functional effects of treatment for unilateral posterior crossbite". American Journal of Orthodontics and Dentofacial Orthopedics. 109 (2): 173–179. doi:10.1016/S0889-5406(96)70178-6. PMID 8638566.
  16. ^ Pullinger, A. G.; Seligman, D. A.; Gornbein, J. A. (1993-06-01). "A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features". Journal of Dental Research. 72 (6): 968–979. doi:10.1177/00220345930720061301. ISSN 0022-0345. PMID 8496480. S2CID 25351006.
  17. ^ COSTEA, CARMEN MARIA; BADEA, MÎNDRA EUGENIA; VASILACHE, SORIN; MESAROÅž, MICHAELA (2016-01-01). "Effects of CO-CR discrepancy in daily orthodontic treatment planning". Clujul Medical. 89 (2): 279–286. doi:10.15386/cjmed-538. ISSN 1222-2119. PMC 4849388. PMID 27152081.
  18. ^ Kennedy, David B.; Osepchook, Matthew (2005-09-01). "Unilateral posterior crossbite with mandibular shift: a review". Journal (Canadian Dental Association). 71 (8): 569–573. ISSN 1488-2159. PMID 16202196.
  19. ^ Nielsen, H. J.; Bakke, M.; Blixencrone-Møller, T. (1991-12-01). "[Functional and orthodontic treatment of a patient with an open bite craniomandibular disorder]". Tandlaegebladet. 95 (18): 877–881. ISSN 0039-9353. PMID 1817382.
  20. ^ Lindner, A. (1989-10-01). "Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite". Scandinavian Journal of Dental Research. 97 (5): 432–438. doi:10.1111/j.1600-0722.1989.tb01457.x. ISSN 0029-845X. PMID 2617141.
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This article is about the branch of medicine. For the journal, see Pediatrics (journal). For the branch of dentistry, see Pedodontics.

 

Pediatrics
A pediatrician examines a neonate.
Focus Infants, Children, Adolescents, and Young Adults
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°ατρÏŒς (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).

History

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Part of Great Ormond Street Hospital in London, United Kingdom, which was the first pediatric hospital in the English-speaking world.

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]

Etymology

[edit]

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]

Differences between adult and pediatric medicine

[edit]

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]

Absorption

[edit]

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]

Distribution

[edit]

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]

Metabolism

[edit]

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]

Elimination

[edit]

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]

Pediatric autonomy in healthcare

[edit]

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]

History of pediatric autonomy

[edit]

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]

Parental authority and current medical issues

[edit]

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.

Modern advancements

[edit]

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.

Education requirements

[edit]

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]

Training of pediatricians

[edit]
Pediatrics
Occupation
Names
  • Pediatrician
  • Paediatrician
Occupation type
 Specialty
Activity sectors
 Medicine
Description
Education required
  • Doctor of Medicine
  • Doctor of Osteopathic Medicine
  • Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB)
Fields of
employment
 Hospitals, Clinics

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

[edit]

Subspecialties of pediatrics include:

(not an exhaustive list)

  • Addiction medicine (multidisciplinary)
  • Adolescent medicine
  • Child abuse pediatrics
  • Clinical genetics
  • Clinical informatics
  • Developmental-behavioral pediatrics
  • Headache medicine
  • Hospital medicine
  • Medical toxicology
  • Metabolic medicine
  • Neonatology/Perinatology
  • Pain medicine (multidisciplinary)
  • Palliative care (multidisciplinary)
  • Pediatric allergy and immunology
  • Pediatric cardiology
    • Pediatric cardiac critical care
  • Pediatric critical care
    • Neurocritical care
    • Pediatric cardiac critical care
  • Pediatric emergency medicine
  • Pediatric endocrinology
  • Pediatric gastroenterology
    • Transplant hepatology
  • Pediatric hematology
  • Pediatric infectious disease
  • Pediatric nephrology
  • Pediatric oncology
    • Pediatric neuro-oncology
  • Pediatric pulmonology
  • Primary care
  • Pediatric rheumatology
  • Sleep medicine (multidisciplinary)
  • Social pediatrics
  • Sports medicine

Other specialties that care for children

[edit]

(not an exhaustive list)

  • Child neurology
    • Addiction medicine (multidisciplinary)
    • Brain injury medicine
    • Clinical neurophysiology
    • Epilepsy
    • Headache medicine
    • Neurocritical care
    • Neuroimmunology
    • Neuromuscular medicine
    • Pain medicine (multidisciplinary)
    • Palliative care (multidisciplinary)
    • Pediatric neuro-oncology
    • Sleep medicine (multidisciplinary)
  • Child and adolescent psychiatry, subspecialty of psychiatry
  • Neurodevelopmental disabilities
  • Pediatric anesthesiology, subspecialty of anesthesiology
  • Pediatric dentistry, subspecialty of dentistry
  • Pediatric dermatology, subspecialty of dermatology
  • Pediatric gynecology
  • Pediatric neurosurgery, subspecialty of neurosurgery
  • Pediatric ophthalmology, subspecialty of ophthalmology
  • Pediatric orthopedic surgery, subspecialty of orthopedic surgery
  • Pediatric otolaryngology, subspecialty of otolaryngology
  • Pediatric plastic surgery, subspecialty of plastic surgery
  • Pediatric radiology, subspecialty of radiology
  • Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation
  • Pediatric surgery, subspecialty of general surgery
  • Pediatric urology, subspecialty of urology

See also

[edit]
  • American Academy of Pediatrics
  • American Osteopathic Board of Pediatrics
  • Center on Media and Child Health (CMCH)
  • Children's hospital
  • List of pediatric organizations
  • List of pediatrics journals
  • Medical specialty
  • Pediatric Oncall
  • Pain in babies
  • Royal College of Paediatrics and Child Health
  • Pediatric environmental health

References

[edit]
  1. ^ "Paediatrics" (PDF). nhs.uk. Archived (PDF) from the original on 13 July 2020. Retrieved 2 July 2020.
  2. ^ "Choosing a Pediatrician for Your New Baby (for Parents) - Nemours KidsHealth". kidshealth.org. Archived from the original on 14 July 2020. Retrieved 13 July 2020.
  3. ^ "Age limits of pediatrics". Pediatrics. 81 (5): 736. May 1988. doi:10.1542/peds.81.5.736. PMID 3357740. S2CID 245164191. Archived from the original on 19 April 2017. Retrieved 18 April 2017.
  4. ^ Sawyer, Susan M.; McNeil, Robyn; Francis, Kate L.; Matskarofski, Juliet Z.; Patton, George C.; Bhutta, Zulfiqar A.; Esangbedo, Dorothy O.; Klein, Jonathan D. (1 November 2019). "The age of paediatrics". The Lancet Child & Adolescent Health. 3 (11): 822–830. doi:10.1016/S2352-4642(19)30266-4. ISSN 2352-4642. PMID 31542355. S2CID 202732818.
  5. ^ a b c d e Duffin, Jacalyn (2010). History of Medicine, Second Edition: A Scandalously Short Introduction. University of Toronto Press.
  6. ^ a b c d e Colón, A. R.; Colón, P. A. (January 1999). Nurturing children: a history of pediatrics. Greenwood Press. ISBN 978-0-313-31080-5. Retrieved 20 October 2012.
  7. ^ Celsus, De Medicina, Book 3, Chapter 7, § 1.
  8. ^ John G. Raffensperger. Children's Surgery: A Worldwide History. McFarland. p. 21.
  9. ^ David Levinson; Karen Christensen. Encyclopedia of modern Asia. Vol. 4. Charles Scribner's Sons. p. 116.
  10. ^ Desai, A.B. Textbook Of Paediatrics. Orient blackswan. p. 1.
  11. ^ Dunn, P. M. (1995). "Soranus of Ephesus (Circa AD 98-138) and perinatal care in Roman times". Archives of Disease in Childhood. Fetal and Neonatal Edition. 73 (1): F51 – F52. doi:10.1136/fn.73.1.f51. PMC 2528358. PMID 7552600.
  12. ^ Elgood, Cyril (2010). A Medical History of Persia and The Eastern Caliphate (1st ed.). London: Cambridge. pp. 202–203. ISBN 978-1-108-01588-2. By writing a monograph on 'Diseases in Children' he may also be looked upon as the father of paediatrics.
  13. ^ U.S. National Library of Medicine, "Islamic Culture and the Medical Arts, Al-Razi, the Clinician" [1] Archived 5 January 2018 at the Wayback Machine
  14. ^ "Achar S Textbook Of Pediatrics (Third Edition)". A. B. Desai (ed.) (1989). p.1. ISBN 81-250-0440-8
  15. ^ Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  16. ^ Lock, Stephen; John M. Last; George Dunea (2001). The Oxford illustrated companion to medicine. Oxford University Press US. p. 173. ISBN 978-0-19-262950-0. Retrieved 9 July 2010. Rosen von Rosenstein.
  17. ^ Roberts, Michael (2003). The Age of Liberty: Sweden 1719–1772. Cambridge University Press. p. 216. ISBN 978-0-521-52707-1. Retrieved 9 July 2010.
  18. ^ Dallas, John. "Classics of Child Care". Royal College of Physicians of Edinburgh. Archived from the original on 27 July 2011. Retrieved 9 July 2010.
  19. ^ Duffin, Jacalyn (29 May 2010). History of Medicine, Second Edition: A Scandalously Short Introduction. University of Toronto Press.
  20. ^ Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  21. ^ "Broadribb's Introductory Pediatric Nursing". Nancy T. Hatfield (2007). p.4. ISBN 0-7817-7706-2
  22. ^ "Jacobi Medical Center - General Information". Archived from the original on 18 April 2006. Retrieved 6 April 2006.
  23. ^ Kutzsche, Stefan (8 April 2021). "Abraham Jacobi (1830–1919) and his transition from political to medical activist". Acta Paediatrica. 110 (8): 2303–2305. doi:10.1111/apa.15887. ISSN 0803-5253. PMID 33963612. S2CID 233998658. Archived from the original on 7 May 2023. Retrieved 7 May 2023.
  24. ^ a b Ballbriga, Angel (1991). "One century of pediatrics in Europe (section: development of pediatric hospitals in Europe)". In Nichols, Burford L.; et al. (eds.). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. Vol. 22. New York: Raven Press. pp. 6–8. ISBN 0-88167-695-0.
  25. ^ official history site (in French) of nineteenth century paediatric hospitals in Paris
  26. ^ "Introducing the Necker-Enfants Malades Hospital". Hôpital des Necker-Enfants Malades.
  27. ^ Young, D.G. (August 1999). "The Mason Brown Lecture: Scots and paediatric surgery". Journal of the Royal College of Surgeons Edinburgh. 44 (4): 211–5. PMID 10453141. Archived from the original on 14 July 2014.
  28. ^ Pearson, Howard A. (1991). "Pediatrics in the United States". In Nichols, Burford L.; et al. (eds.). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. Vol. 22. New York: Raven Press. pp. 55–63. ISBN 0-88167-695-0.
  29. ^ "Commentaries: Edwards A Park". Pediatrics. 44 (6). American Academy of Pediatrics: 897–901. 1969. doi:10.1542/peds.44.6.897. PMID 4903838. S2CID 43298798.
  30. ^ a b c d e f g h O'Hara, Kate (2016). "Paediatric pharmacokinetics and drug doses". Australian Prescriber. 39 (6): 208–210. doi:10.18773/austprescr.2016.071. ISSN 0312-8008. PMC 5155058. PMID 27990048.
  31. ^ a b c d e f g h i j k l m Wagner, Jonathan; Abdel-Rahman, Susan M. (2013). "Pediatric pharmacokinetics". Pediatrics in Review. 34 (6): 258–269. doi:10.1542/pir.34-6-258. ISSN 1526-3347. PMID 23729775.
  32. ^ a b c d e f Batchelor, Hannah Katharine; Marriott, John Francis (2015). "Paediatric pharmacokinetics: key considerations". British Journal of Clinical Pharmacology. 79 (3): 395–404. doi:10.1111/bcp.12267. ISSN 1365-2125. PMC 4345950. PMID 25855821.
  33. ^ Katz, Aviva L.; Webb, Sally A.; COMMITTEE ON BIOETHICS; Macauley, Robert C.; Mercurio, Mark R.; Moon, Margaret R.; Okun, Alexander L.; Opel, Douglas J.; Statter, Mindy B. (1 August 2016). "Informed Consent in Decision-Making in Pediatric Practice". Pediatrics. 138 (2): e20161485. doi:10.1542/peds.2016-1485. ISSN 0031-4005. PMID 27456510. S2CID 7951515.
  34. ^ a b Mazur, Kate A.; Berg, Stacey L., eds. (2020). Ethical Issues in Pediatric Hematology/Oncology. pp. 13–21. doi:10.1007/978-3-030-22684-8. ISBN 978-3-030-22683-1. S2CID 208302429.
  35. ^ a b Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  36. ^ Friedman, Lainie Ross (2004). Children, families, and health care decision making. Clarendon Press. ISBN 0-19-925154-1. OCLC 756393117.
  37. ^ a b c Martakis, K.; Schröder-Bäck, P.; Brand, H. (1 June 2018). "Developing child autonomy in pediatric healthcare: towards an ethical model". Archivos Argentinos de Pediatria. 116 (3): e401 – e408. doi:10.5546/aap.2018.eng.e401. ISSN 0325-0075. PMID 29756714. S2CID 46889502.
  38. ^ Schapiro, Tamar (1 July 1999). "What Is a Child?". Ethics. 109 (4): 715–738. doi:10.1086/233943. ISSN 0014-1704. S2CID 170129444. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  39. ^ Dondorp, W.; Bolt, I.; Tibben, A.; De Wert, G.; Van Summeren, M. (1 September 2021). "'We Should View Him as an Individual': The Role of the Child's Future Autonomy in Shared Decision-Making About Unsolicited Findings in Pediatric Exome Sequencing". Health Care Analysis. 29 (3): 249–261. doi:10.1007/s10728-020-00425-7. ISSN 1573-3394. PMID 33389383. S2CID 230112761.
  40. ^ "What Education Is Required to Be a Pediatrician?". Archived from the original on 7 June 2017. Retrieved 14 June 2017.
  41. ^ "CoPS". www.pedsubs.org. Archived from the original on 18 September 2013. Retrieved 14 August 2015.

Further reading

[edit]
  • BMC Pediatrics - open access
  • Clinical Pediatrics
  • Developmental Review - partial open access
  • JAMA Pediatrics
  • The Journal of Pediatrics - partial open access
[edit]
Wikimedia Commons has media related to Pediatrics.
 
Wikibooks has a book on the topic of: Pediatrics
 
Look up paediatrics or pediatrics in Wiktionary, the free dictionary.
  • Pediatrics Directory at Curlie
  • Pediatric Health Directory at OpenMD
 
 

 

 

  • 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

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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: á½€δούς, romanized: odoús, lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.

Dental treatment

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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

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

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

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

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

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

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

Specialties

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

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

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

History

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

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

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

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

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

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

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

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

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

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

Modern dentistry

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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

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Main article: Occupational hazards in dentistry

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

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

Evidence-based dentistry

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Main article: Evidence-based dentistry

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

A dental chair at the University of Michigan School of Dentistry

Ethical and medicolegal issues

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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

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  • 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

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  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.
  21. ^ Gelbier, Stanley (1 October 2005). "Dentistry and the University of London". Medical History. 49 (4): 445–462. doi:10.1017/s0025727300009157. PMC 1251639. PMID 16562330.
  22. ^ a b Gelbier, S. (2005). "125 years of developments in dentistry, 1880–2005 Part 2: Law and the dental profession". British Dental Journal. 199 (7): 470–473. doi:10.1038/sj.bdj.4812875. ISSN 1476-5373. PMID 16215593. The 1879 register is referred to as the "Dental Register".
  23. ^ a b "The story of dentistry: Dental History Timeline". British Dental Association. Archived from the original on 9 March 2012. Retrieved 2 March 2010.
  24. ^ J Menzies Campbell (8 February 1955). "Banning Clerks, Colliers and other Charlatans". The Glasgow Herald. p. 3. Retrieved 5 April 2017.
  25. ^ "History of Dental Surgery in Edinburgh" (PDF). Royal College of Surgeons of Edinburgh. Retrieved 11 December 2007.
  26. ^ "Dentistry (D.D.S. or D.M.D.)" (PDF). Purdue.edu. Archived from the original (PDF) on 9 January 2017. Retrieved 17 May 2018.
  27. ^ "Canadian Dental Association". cda-adc.ca. Retrieved 21 October 2019.
  28. ^ "Anesthesiology recognized as a dental specialty". www.ada.org. Archived from the original on 21 September 2019. Retrieved 12 March 2019.
  29. ^ "Sports dentistry". FDI World Dental Federation. Archived from the original on 23 October 2020. Retrieved 13 July 2020.
  30. ^ "AVDC Home". Avdc.org. 29 November 2009. Retrieved 18 April 2010.
  31. ^ "EVDC web site". Evdc.info. Archived from the original on 5 September 2018. Retrieved 18 April 2010.
  32. ^ Barras, Colin (29 February 2016). "How our ancestors drilled rotten teeth". BBC. Archived from the original on 19 May 2017. Retrieved 1 March 2016.
  33. ^ "Oldest Dentistry Found in 14,000-Year-Old Tooth". Discovery Channel. 16 July 2015. Archived from the original on 18 July 2015. Retrieved 21 July 2015.
  34. ^ "Analysis of Neanderthal teeth marks uncovers evidence of prehistoric dentistry". The University of Kansas. 28 June 2017. Retrieved 1 July 2017.
  35. ^ Oxilia, Gregorio; Fiorillo, Flavia; Boschin, Francesco; Boaretto, Elisabetta; Apicella, Salvatore A.; Matteucci, Chiara; Panetta, Daniele; Pistocchi, Rossella; Guerrini, Franca; Margherita, Cristiana; Andretta, Massimo; Sorrentino, Rita; Boschian, Giovanni; Arrighi, Simona; Dori, Irene (2017). "The dawn of dentistry in the late upper Paleolithic: An early case of pathological intervention at Riparo Fredian". American Journal of Physical Anthropology. 163 (3): 446–461. doi:10.1002/ajpa.23216. hdl:11585/600517. ISSN 0002-9483. PMID 28345756.
  36. ^ Bernardini, Federico; Tuniz, Claudio; Coppa, Alfredo; Mancini, Lucia; Dreossi, Diego; Eichert, Diane; Turco, Gianluca; Biasotto, Matteo; Terrasi, Filippo; Cesare, Nicola De; Hua, Quan; Levchenko, Vladimir (19 September 2012). "Beeswax as Dental Filling on a Neolithic Human Tooth". PLOS ONE. 7 (9): e44904. Bibcode:2012PLoSO...744904B. doi:10.1371/journal.pone.0044904. ISSN 1932-6203. PMC 3446997. PMID 23028670.
  37. ^ Coppa, A.; et al. (2006). "Early Neolithic tradition of dentistry". Nature. 440 (7085). Springer Science and Business Media LLC: 755–756. doi:10.1038/440755a. ISSN 0028-0836. PMID 16598247.
  38. ^ "Dig uncovers ancient roots of dentistry". NBC News. 5 April 2006.
  39. ^ Bernardini, Federico; et al. (2012). "Beeswax as Dental Filling on a Neolithic Human Tooth". PLOS ONE. 7 (9): e44904. Bibcode:2012PLoSO...744904B. doi:10.1371/journal.pone.0044904. PMC 3446997. PMID 23028670.
  40. ^ "700 years added to Malta's history". Times of Malta. 16 March 2018. Archived from the original on 16 March 2018.
  41. ^ "History of Dentistry: Ancient Origins". American Dental Association. Archived from the original on 5 July 2007. Retrieved 9 January 2007.
  42. ^ TOWNEND, B. R. (1944). "The Story of the Tooth-Worm". Bulletin of the History of Medicine. 15 (1): 37–58. ISSN 0007-5140. JSTOR 44442797.
  43. ^ Suddick Richard P., Harris Norman O. (1990). "Historical Perspectives of Oral Biology: A Series" (PDF). Critical Reviews in Oral Biology and Medicine. 1 (2): 135–51. doi:10.1177/10454411900010020301. PMID 2129621. Archived from the original (PDF) on 18 December 2007.
  44. ^ a b c Blomstedt, P. (2013). "Dental surgery in ancient Egypt". Journal of the History of Dentistry. 61 (3): 129–42. PMID 24665522.
  45. ^ "Ancient Egyptian Dentistry". University of Oklahoma. Archived from the original on 26 December 2007. Retrieved 15 December 2007.
  46. ^ Wilwerding, Terry. "History of Dentistry 2001" (PDF). Archived from the original (PDF) on 3 November 2014. Retrieved 3 November 2014.
  47. ^ "Medicine in Ancient Egypt 3". Arabworldbooks.com. Retrieved 18 April 2010.
  48. ^ a b "History Of Dentistry". Complete Dental Guide. Archived from the original on 14 July 2016. Retrieved 29 June 2016.
  49. ^ "History of Dentistry Research Page, Newsletter". Rcpsg.ac.uk. Archived from the original on 28 April 2015. Retrieved 9 June 2014.
  50. ^ a b Donaldson, J. A. (1980). "The use of gold in dentistry" (PDF). Gold Bulletin. 13 (3): 117–124. doi:10.1007/BF03216551. PMID 11614516. S2CID 137571298.
  51. ^ Becker, Marshall J. (1999). Ancient "dental implants": a recently proposed example from France evaluated with other spurious examples (PDF). International Journal of Oral & Maxillofacial Implants 14.1.
  52. ^ Malik, Ursman. "History of Dentures from Beginning to Early 19th Century". Exhibits. Retrieved 3 May 2023.
  53. ^ Renfrew, Colin; Bahn, Paul (2012). Archaeology: Theories, Methods, and Practice (6th ed.). Thames & Hudson. p. 449. ISBN 978-0-500-28976-1.
  54. ^ "Dental Treatment in the Ancient Times". Dentaltreatment.org.uk. Archived from the original on 1 December 2009. Retrieved 18 April 2010.
  55. ^ Bjørklund G (1989). "The history of dental amalgam (in Norwegian)". Tidsskr Nor Laegeforen. 109 (34–36): 3582–85. PMID 2694433.
  56. ^ Czarnetzki, A.; Ehrhardt S. (1990). "Re-dating the Chinese amalgam-filling of teeth in Europe". International Journal of Anthropology. 5 (4): 325–32.
  57. ^ Meri, Josef (2005). Medieval Islamic Civilization: An Encyclopedia (Routledge Encyclopedias of the Middle Ages). Psychology Press. ISBN 978-0-415-96690-0.
  58. ^ Friedman, Saul S. (2006). A history of the Middle East. Jefferson, N.C.: Mcfarland. p. 152. ISBN 0786451343.
  59. ^ Gregory Ribitzky. "Pelican". Archived from the original on 25 January 2020. Retrieved 23 June 2018.
  60. ^ Gregory Ribitzky. "Toothkey". Archived from the original on 23 June 2018. Retrieved 23 June 2018.
  61. ^ Gregory Ribitzky. "Forceps". Archived from the original on 23 June 2018. Retrieved 23 June 2018.
  62. ^ Royal Commission on the NHS Chapter 9. HMSO. July 1979. ISBN 978-0-10-176150-5. Retrieved 19 May 2015.
  63. ^ a b André Besombes; Phillipe de Gaillande (1993). Pierre Fauchard (1678–1761): The First Dental Surgeon, His Work, His Actuality. Pierre Fauchard Academy.
  64. ^ a b Bernhard Wolf Weinberger (1941). Pierre Fauchard, Surgeon-dentist: A Brief Account of the Beginning of Modern Dentistry, the First Dental Textbook, and Professional Life Two Hundred Years Ago. Pierre Fauchard Academy.
  65. ^ Moore, Wendy (30 September 2010). The Knife Man. Transworld. pp. 223–24. ISBN 978-1-4090-4462-8. Retrieved 8 March 2012.
  66. ^ Dingwall, Helen (April 2004). "A pioneering history: dentistry and the Royal College of Surgeons of Edinburgh" (PDF). History of Dentistry Newsletter. No. 14. Archived from the original (PDF) on 1 February 2013.
  67. ^ "Noise-Induced Hearing Loss". NIDCD. 18 August 2015.
  68. ^ "Occupational Safety and Health Standards | Occupational Safety and Health Administration". Osha.gov.
  69. ^ Stevens, M (1999). "Is someone listening to the din of occupational noise exposure in dentistry". RDH (19): 34–85.
  70. ^ Merrel, HB (1992). "Noise pollution and hearing loss in the dental office". Dental Assisting Journal. 61 (3): 6–9.
  71. ^ Wilson, J.D. (2002). "Effects of occupational ultrasonic noise exposure on hearing of dental hygienists: A pilot study". Journal of Dental Hygiene. 76 (4): 262–69. PMID 12592917.
  72. ^ Leggat, P.A. (2007). "Occupational Health Problems in Modern Dentistry: A Review" (PDF). Industrial Health. 45 (5): 611–21. doi:10.2486/indhealth.45.611. PMID 18057804. Archived (PDF) from the original on 27 April 2019.
  73. ^ Leggat, P.A. (2001). "Occupational hygiene practices of dentists in southern Thailand". International Dental Journal. 51 (51): 11–6. doi:10.1002/j.1875-595x.2001.tb00811.x. PMID 11326443.
  74. ^ Evidence-Based Medicine Working Group (1992). "Evidence-based medicine. A new approach to teaching the practice of medicine". Journal of the American Medical Association. 268 (17): 2420–2425. doi:10.1001/jama.1992.03490170092032. PMID 1404801.
  75. ^ "Union workers build high-tech dental simulation laboratory for SIU dental school". The Labor Tribune. 17 March 2014. Retrieved 10 September 2021.
  76. ^ Slavkin, Harold C. (January 2012). "Evolution of the scientific basis for dentistry and its impact on dental education: past, present, and future". Journal of Dental Education. 76 (1): 28–35. doi:10.1002/j.0022-0337.2012.76.1.tb05231.x. ISSN 1930-7837. PMID 22262547.
  77. ^ Formicola, Allan J.; Bailit, Howard L.; Beazoglou, Tryfon J.; Tedesco, Lisa A. (February 2008). "The interrelationship of accreditation and dental education: history and current environment". Journal of Dental Education. 72 (2 Suppl): 53–60. doi:10.1002/j.0022-0337.2008.72.2_suppl.tb04480.x. ISSN 0022-0337. PMID 18250379.
  78. ^ Carrrassi, A. (2019). "The first 25 year [Internet] Ireland: ADEE (Association for Dental Education in Europe)". Association for Dental Education in Europe. Retrieved 21 October 2019.
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Frequently Asked Questions

Many dental insurance plans offer partial coverage for orthodontic treatment, typically ranging from 25% to 50% of the total cost, with lifetime maximum benefits between $1,000 and $3,000.
Most insurance plans cover orthodontic treatment for children and teenagers up to age 18 or 19, with some plans extending coverage until the child is 26 years old.
Yes, both FSA and HSA can be used to pay for orthodontic treatment with pre-tax dollars, effectively reducing your out-of-pocket costs by your marginal tax rate.