Maintaining Ethical Standards in Modern Practices

Maintaining Ethical Standards in Modern Practices

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Maintaining Ethical Standards in Modern Practices


In the rapidly evolving world of pediatric orthodontics, ethical considerations are more critical than ever. As healthcare professionals, orthodontists have a profound responsibility to prioritize the well-being of young patients while navigating complex medical and technological landscapes.


The foundation of ethical practice begins with informed consent and transparent communication. When treating children, this means engaging not just with the patient, but also with parents and guardians. Every treatment recommendation must be clearly explained, potential risks discussed openly, and alternative options presented without bias.


Orthodontic check-ups help track the progress of tooth movement Dental braces for children physician.

Modern technological advances like digital imaging and 3D modeling have transformed orthodontic care, offering unprecedented precision. However, these tools also introduce ethical challenges. Practitioners must ensure that cutting-edge techniques serve the patient's genuine medical needs, not merely represent the most expensive or trendy intervention.


Patient privacy remains paramount. With increasing digital record-keeping, safeguarding personal health information becomes a critical ethical obligation. Orthodontists must implement robust data protection protocols and maintain strict confidentiality standards.


Cost considerations cannot compromise treatment quality. Ethical practitioners balance economic realities with comprehensive care, ensuring that financial constraints do not prevent children from receiving necessary treatments.


Continuous professional development is another crucial ethical commitment. Staying updated with latest research, techniques, and professional guidelines demonstrates a dedication to providing the highest standard of care.


Ultimately, maintaining ethical standards is about treating each child as a unique individual deserving respect, compassion, and the best possible medical intervention. It's a holistic approach that extends far beyond technical skill, embodying the true spirit of healthcare.

Informed Consent and Communication Strategies: Navigating Pediatric Care with Compassion and Clarity


In the complex landscape of modern medical practice, obtaining informed consent and effectively communicating treatment options with children and their parents represents a delicate and critical ethical responsibility. Healthcare professionals must balance medical expertise with genuine empathy, creating an environment of trust and understanding.


The cornerstone of ethical pediatric care lies in transparent, age-appropriate communication. For younger children, this means using simple language, visual aids, and gentle explanations that demystify medical procedures. Older children and adolescents require more nuanced approaches that respect their growing autonomy while acknowledging parental decision-making rights.


Parents play a pivotal role in this process. Clinicians must provide comprehensive information about potential treatments, risks, benefits, and alternative options. This involves active listening, addressing concerns, and creating space for questions. The goal is not just to obtain a signature on a consent form, but to genuinely involve families in medical decision-making.


Developmental considerations are crucial. A one-size-fits-all approach fails to recognize the unique psychological and emotional needs of different age groups. A conversation with a 6-year-old will look dramatically different from one with a 14-year-old, requiring practitioners to adapt their communication style accordingly.


Strategies like using child-friendly terminology, employing visual demonstrations, and allowing both parents and children to express their feelings can transform what might be a intimidating medical interaction into a collaborative, less stressful experience.


Ethical communication also means respecting cultural diversity, recognizing that families bring different perspectives, beliefs, and communication styles to medical encounters. Sensitivity to these nuances can significantly improve understanding and trust.


Ultimately, informed consent is more than a legal requirement-it's a profound expression of respect for patient autonomy and family dynamics. By approaching these conversations with empathy, clarity, and genuine care, healthcare professionals can create meaningful partnerships that support healing and well-being.

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Insurance Coverage and Impact on Orthodontic Expenses

Balancing Clinical Recommendations with Patient and Family Preferences While Prioritizing the Child's Best Interests


In the complex world of pediatric healthcare, medical professionals face a delicate and challenging task of navigating ethical considerations that involve multiple stakeholders. The core of this challenge lies in finding a harmonious approach that respects clinical expertise, family dynamics, and the child's fundamental well-being.


Healthcare providers must recognize that every child is unique, with individual medical needs, personal circumstances, and family contexts. While medical recommendations are grounded in scientific evidence and professional expertise, they cannot be implemented as rigid, one-size-fits-all solutions. Instead, they require a nuanced, compassionate approach that actively involves the patient's family and considers their perspectives.


The principle of patient autonomy is crucial, even when dealing with pediatric patients. Although children may not have full decision-making capacity, their voices and preferences should be heard and respected to the extent possible. This means creating an environment of open communication where families feel empowered to ask questions, express concerns, and participate meaningfully in treatment decisions.


At the same time, medical professionals have an ethical obligation to advocate for the child's best interests. This might sometimes mean respectfully challenging family preferences that could potentially compromise the child's health or long-term well-being. The key is to approach such situations with empathy, clear communication, and a genuine commitment to collaborative decision-making.


Effective communication becomes the bridge between clinical recommendations and family preferences. By providing comprehensive, understandable information, explaining potential risks and benefits, and listening actively to family concerns, healthcare providers can build trust and mutual understanding.


Ultimately, the goal is to create a patient-centered approach that balances medical expertise with family perspectives, always keeping the child's holistic well-being at the forefront. This requires emotional intelligence, cultural sensitivity, and a genuine commitment to collaborative care.


By embracing these principles, healthcare professionals can navigate the complex ethical landscape of pediatric care with compassion, respect, and a profound dedication to serving their youngest patients.

Payment Plan Options for Pediatric Orthodontic Care

Maintaining Ethical Standards in Modern Practices: Addressing Potential Conflicts of Interest


In the ever-evolving landscape of orthodontic care, practitioners face increasing challenges in maintaining transparent and ethical financial discussions with patients. The delicate balance between professional recommendations and financial considerations requires careful navigation and unwavering commitment to patient welfare.


Conflicts of interest can subtly emerge in treatment planning, potentially compromising the integrity of patient care. Orthodontists must be acutely aware of how personal or financial motivations might inadvertently influence treatment recommendations. This means being brutally honest about treatment options, their associated costs, and alternative approaches that might better serve the patient's clinical and financial needs.


Transparency becomes the cornerstone of ethical practice. Patients deserve a clear breakdown of proposed treatments, associated costs, and potential alternative options. This approach goes beyond mere financial disclosure - it's about building trust and empowering patients to make informed decisions about their oral health.


Modern practices are increasingly adopting comprehensive consent processes that explicitly address potential financial conflicts. This might include detailed treatment plans with multiple options, clear cost breakdowns, and open discussions about insurance coverage and payment strategies. The goal is to remove any perception of hidden agendas or manipulative financial practices.


Professional organizations and regulatory bodies have increasingly emphasized the importance of ethical financial discussions. Continuing education programs now regularly include modules on maintaining professional integrity and managing potential conflicts of interest.


Ultimately, the most successful orthodontic practices are those that prioritize patient trust over short-term financial gains. By maintaining transparent, patient-centered approaches to treatment planning and financial discussions, practitioners can ensure they're providing the highest standard of ethical care.


The challenge is ongoing, requiring constant self-reflection and a commitment to putting patient needs first. It's not just about avoiding conflicts of interest, but actively creating an environment of trust, transparency, and genuine patient care.

Factors Influencing Orthodontic Treatment Costs

Maintaining Patient Privacy and Confidentiality Throughout the Treatment Process


In today's healthcare landscape, protecting patient privacy isn't just a legal requirement-it's a fundamental ethical obligation that lies at the heart of quality medical care. Healthcare professionals are entrusted with some of the most sensitive and personal information imaginable, and the responsibility to safeguard this information is paramount.


Patient confidentiality goes far beyond simply keeping medical records locked away. It's about creating an environment of trust where individuals feel safe sharing their most intimate health concerns without fear of judgment or unauthorized disclosure. From the moment a patient walks into a medical facility to the completion of their treatment, every interaction must be approached with the utmost respect for their personal information.


Modern technology has both complicated and enhanced our ability to protect patient privacy. Electronic health records offer incredible advantages in terms of accessibility and comprehensive care, but they also present new challenges for maintaining confidentiality. Healthcare providers must invest in robust cybersecurity measures, implement strict access controls, and train staff thoroughly on privacy protocols.


The consequences of breaching patient confidentiality can be devastating. Beyond potential legal ramifications, such breaches can destroy the trust between healthcare providers and patients, potentially discouraging individuals from seeking necessary medical care. A patient's right to privacy is as critical as their right to quality treatment.


Practical strategies for maintaining confidentiality include using secure communication channels, ensuring private consultation spaces, carefully managing digital records, and implementing strict staff training programs. Healthcare professionals must be vigilant, treating each patient's information as a sacred trust.


Ultimately, maintaining patient privacy is about recognizing the fundamental human dignity of every individual who seeks medical care. It's a commitment that requires constant attention, technological sophistication, and genuine compassion.

Comparing Different Orthodontic Practices and Their Pricing Strategies

Developing Age-Appropriate Communication Techniques in Orthodontic Care


In the evolving landscape of modern orthodontic practice, the ability to effectively communicate with young patients has become more critical than ever. Gone are the days of a one-size-fits-all approach to patient interaction. Today's orthodontic professionals recognize that engaging young patients requires a nuanced, empathetic, and developmentally sensitive communication strategy.


For children and teenagers, an orthodontic journey can be intimidating and emotionally challenging. The physical changes, potential discomfort, and social anxieties associated with braces or other orthodontic treatments can create significant psychological barriers. This is where age-appropriate communication becomes a powerful tool for building trust, reducing anxiety, and empowering patients to take an active role in their treatment.


With younger children, communication should be playful and visual. Using simple language, colorful illustrations, and interactive demonstrations can help demystify the orthodontic process. Explaining procedures like they're an exciting adventure rather than a medical intervention can transform fear into curiosity and engagement.


Teenagers require a more sophisticated approach. They value authenticity and want to be treated as young adults. Communication should focus on building their confidence, explaining the long-term benefits of treatment, and addressing their social concerns. Involving them in decision-making processes and providing clear, honest information helps them feel respected and in control of their healthcare journey.


Technology can be an excellent ally in this communication strategy. Interactive apps, virtual consultations, and digital treatment tracking can make the orthodontic experience more engaging and transparent. These tools not only provide information but also give young patients a sense of ownership over their treatment.


Moreover, practitioners must develop active listening skills. Understanding a patient's unique concerns, fears, and expectations allows for more personalized and compassionate care. This approach goes beyond medical treatment, addressing the emotional and psychological aspects of orthodontic care.


Training orthodontic staff in these communication techniques is equally important. Every team member should be equipped to interact with young patients in a supportive, age-appropriate manner.


By prioritizing thoughtful, empathetic communication, orthodontic practices can transform what might be a stressful experience into a positive, empowering journey of personal growth and self-improvement.

Additional Fees and Potential Hidden Expenses in Orthodontic Treatment

Implementing Comprehensive Screening Processes in Pediatric Orthodontic Care


In the ever-evolving landscape of pediatric orthodontics, maintaining the highest ethical standards requires a proactive and thoughtful approach to patient care. Comprehensive screening processes have emerged as a critical component in identifying and mitigating potential risks and complications that may arise during treatment.


The importance of thorough screening cannot be overstated. Young patients are particularly vulnerable, and their unique physiological and psychological needs demand a nuanced, holistic assessment. This goes far beyond simple dental examinations. A comprehensive screening process involves multiple layers of evaluation, including medical history, developmental assessments, family background, and potential genetic predispositions.


Modern orthodontic practices are increasingly adopting integrated screening protocols that combine clinical observations with advanced diagnostic tools. Digital imaging, genetic risk assessments, and comprehensive health evaluations provide practitioners with a more complete picture of a patient's potential challenges. These technologies allow for early detection of potential complications, enabling preemptive interventions and personalized treatment plans.


Moreover, ethical screening isn't just about medical risks. It encompasses psychological assessments, understanding the patient's emotional readiness for treatment, and ensuring that interventions are truly in the child's best interest. This holistic approach respects the patient's autonomy and promotes a collaborative treatment environment.


Family involvement is another crucial aspect of comprehensive screening. Open communication with parents and guardians helps create a supportive ecosystem that prioritizes the child's overall well-being. By transparently discussing potential risks, expected outcomes, and treatment alternatives, orthodontic professionals build trust and demonstrate their commitment to ethical practice.


Continuous professional development and staying updated with the latest research and screening methodologies are essential. As our understanding of pediatric orthodontics grows, so too must our screening processes evolve to provide the most responsible and compassionate care possible.


In conclusion, implementing comprehensive screening processes is not just a technical requirement but a moral imperative. It represents our collective commitment to protecting and nurturing the most vulnerable patients while maintaining the highest standards of professional ethics.

Continuous Professional Development and Staying Updated with Ethical Guidelines in Pediatric Orthodontics


In the ever-evolving world of pediatric orthodontics, maintaining the highest ethical standards is not just a professional obligation but a fundamental commitment to patient care and trust. As healthcare professionals, orthodontists working with children must continuously adapt, learn, and grow to provide the most effective and compassionate treatment possible.


Professional development goes far beyond simply completing mandatory continuing education credits. It's about cultivating a genuine passion for learning and understanding the complex needs of young patients. The field of orthodontics is constantly changing, with new technologies, treatment methodologies, and research emerging regularly. Staying current means actively engaging with professional journals, attending conferences, participating in workshops, and maintaining open dialogues with peers.


Ethical guidelines are the cornerstone of responsible pediatric orthodontic practice. These guidelines aren't just a set of rules, but a comprehensive framework that ensures patient safety, informed consent, and holistic care. Practitioners must be particularly sensitive when working with children, who are vulnerable and rely entirely on the expertise and integrity of their healthcare providers.


Modern technology has transformed how orthodontists approach continuing education. Online webinars, virtual conferences, and digital learning platforms make it easier than ever to stay informed about the latest research, techniques, and ethical considerations. Professional organizations like the American Association of Orthodontists provide invaluable resources for practitioners committed to excellence.


Moreover, ethical practice involves more than clinical skills. It encompasses communication, cultural sensitivity, and a deep understanding of each patient's unique psychological and physiological needs. Orthodontists must continuously develop their interpersonal skills, learning to communicate effectively with both children and their parents.


Ultimately, continuous professional development is about maintaining a growth mindset. It's recognizing that there's always more to learn, more ways to improve, and more opportunities to provide exceptional care. By staying curious, open-minded, and committed to ethical practice, pediatric orthodontists can ensure they're offering the best possible treatment for their young patients.


The journey of professional development is ongoing, challenging, and incredibly rewarding. It's a testament to the dedication and compassion that defines the most exceptional healthcare professionals in pediatric orthodontics.

"Deep bite" and "Buck teeth" redirect here. For the village, see Deep Bight, Newfoundland and Labrador.
Malocclusion
Malocclusion in 10-year-old girl
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In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864;[1] Edward Angle (1855–1930), the "father of modern orthodontics",[2][3][need quotation to verify] popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

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

Causes

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

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

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

Behavioral and dental factors

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

Primary vs. secondary dentition

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Malocclusion can occur in primary and secondary dentition.

In primary dentition malocclusion is caused by:

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

In secondary dentition malocclusion is caused by:

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

Signs and symptoms

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

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

The symptoms are as follows:

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

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

Classification

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

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

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

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

Overbites

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

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

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

Angle's classification method

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

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

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

Review of Angle's system of classes and alternative systems

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

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

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

Incisor classification

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

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

Canine relationship by Ricketts

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

Crowding of teeth

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

The following criterion is used:[25]

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

Causes

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

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

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

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

Treatment

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

Treatment

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

Crowding

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

Class I

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

Class II

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A few treatment options for class II malocclusions include:

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

Class II Division 1

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

Class II Division 2

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

Class III

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

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

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

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

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

Deep bite

[edit]

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

Open bite

[edit]

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

Tooth size discrepancy

[edit]

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

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

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

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

Other conditions

[edit]
Further information: Open bite malocclusion
Open bite treatment after eight months of braces.

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

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

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

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

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

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

See also

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

References

[edit]
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  52. ^ CLASSIFICATION OF SKELETAL AND DENTAL MALOCCLUSION: REVISITED; Mageet, Adil Osman (2016). "Classification of Skeletal and Dental Malocclusion: Revisited". Stomatology Edu Journal. 3 (2): 205–211. doi:10.25241/2016.3(2).11.
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Further reading

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

 

Redirect to:

  • Tooth decay
  • From a page move: This is a redirect from a page that has been moved (renamed). This page was kept as a redirect to avoid breaking links, both internal and external, that may have been made to the old page name.

 

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

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

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

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

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

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

Terminology

[edit]

The term dentistry comes from dentist, which comes from French dentiste, which comes from the French and Latin words for tooth.[6] The term for the associated scientific study of teeth is odontology (from Ancient Greek: á½€δούς, romanized: odoús, lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.

Dental treatment

[edit]

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

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

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

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

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

Education and licensing

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

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

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

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

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

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

Specialties

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

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

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

History

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

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

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

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

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

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

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

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

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

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

Modern dentistry

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

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

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

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

Panoramic radiograph of historic dental implants, made 1978

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

A modern dentist's chair

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

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

Hazards in modern dentistry

[edit]
Main article: Occupational hazards in dentistry

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

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

Evidence-based dentistry

[edit]
Main article: Evidence-based dentistry

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

A dental chair at the University of Michigan School of Dentistry

Ethical and medicolegal issues

[edit]

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

See also

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

Notes

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

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[edit]
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