Role of Licensing and Certification in Orthodontics

Role of Licensing and Certification in Orthodontics

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

Role of Licensing and Certification in Orthodontics


Orthodontics is a specialized field of dentistry that requires rigorous training, professional standards, and strict credentialing to ensure patient safety and high-quality care. Licensing and certification play a crucial role in maintaining the integrity and professionalism of orthodontic practice, especially when treating children.


To become a licensed orthodontist, professionals must complete an extensive educational journey. This typically involves earning a bachelor's degree, graduating from an accredited dental school, and then pursuing additional specialized training in orthodontics through a residency program. These programs usually last two to three years and provide comprehensive training in diagnosing, preventing, and correcting misaligned teeth and jaw issues.


Kids may feel mild discomfort when braces are first applied Braces for kids and teens American Association of Orthodontists.

Certification by the American Board of Orthodontics represents the gold standard in the field. This voluntary process goes beyond basic licensing, demonstrating a commitment to excellence and continuous professional development. Board-certified orthodontists must pass rigorous written and clinical examinations that test their knowledge, skills, and ability to provide top-tier patient care.


Licensing ensures that practitioners meet minimum professional standards. State dental boards carefully review an orthodontist's educational background, conduct thorough background checks, and require ongoing continuing education to maintain licensure. This process protects patients, particularly children, from unqualified practitioners and ensures that orthodontic treatments are safe and effective.


For parents seeking orthodontic care for their children, checking a practitioner's licensing and certification is crucial. These credentials provide reassurance about the orthodontist's expertise, training, and commitment to professional excellence. They indicate that the practitioner has the necessary skills to address complex dental alignment issues in growing children.


Continuing education is another critical aspect of maintaining professional credentials. Orthodontists must stay current with the latest technologies, treatment methods, and research. This ongoing learning ensures that patients receive the most advanced and effective treatments available.


While licensing and certification might seem like bureaucratic requirements, they are fundamental to maintaining high-quality orthodontic care. They protect patients, ensure professional standards, and ultimately contribute to better health outcomes for children and adults alike.


In conclusion, licensing and certification are not just formal requirements but essential safeguards that ensure orthodontic professionals are well-trained, competent, and committed to providing the highest standard of care possible.

Becoming a pediatric orthodontic specialist is a rigorous and rewarding journey that requires dedication, extensive education, and a passion for helping children achieve optimal dental health. The pathway to this specialized field is comprehensive and involves multiple stages of academic and professional development.


The initial step begins with completing a bachelor's degree, typically in a science-related field such as biology or chemistry. This foundational education provides the essential scientific background necessary for advanced dental studies. Following undergraduate education, aspiring specialists must gain admission to an accredited dental school, which involves passing the Dental Admission Test (DAT) and completing a four-year doctoral program to earn a Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD) degree.


After dental school, the next critical phase is completing a specialized orthodontic residency program. These competitive programs typically last three to four years and provide intensive training specifically in orthodontic techniques, pediatric dental development, and advanced treatment methodologies. During this residency, candidates gain hands-on experience in diagnosing and treating complex orthodontic conditions in children and adolescents.


Certification is a crucial component of becoming a recognized pediatric orthodontic specialist. The American Board of Orthodontics offers board certification, which involves a comprehensive examination process that tests both theoretical knowledge and clinical skills. This certification demonstrates a practitioner's commitment to excellence and ongoing professional development.


State licensing is another mandatory requirement. Each state has specific regulations for dental specialists, typically involving passing clinical examinations and maintaining continuing education credits. These requirements ensure that practitioners remain current with the latest advancements in orthodontic care and maintain the highest standards of professional practice.


Beyond formal education and certification, successful pediatric orthodontic specialists must develop exceptional communication skills, patience, and the ability to work effectively with children and their families. The journey is challenging but immensely fulfilling for those passionate about improving children's dental health and overall well-being.


Continuous learning remains a hallmark of this profession, with specialists regularly attending conferences, participating in research, and staying updated on the latest technological and treatment innovations in pediatric orthodontics.

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Insurance Coverage and Impact on Orthodontic Expenses

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Ensuring Quality Care: Certification Processes in Pediatric Orthodontics


Mandatory certification processes and standardized examinations play a crucial role in maintaining high professional standards for orthodontic professionals treating children. These rigorous evaluation systems are not just bureaucratic checkboxes, but essential mechanisms that safeguard patient safety and ensure quality care.


When orthodontists specialize in pediatric treatments, they must demonstrate comprehensive knowledge beyond standard dental practices. Certification processes typically require extensive training, documented clinical experience, and successful completion of comprehensive examinations that test both theoretical understanding and practical skills.


The American Board of Orthodontics, for instance, mandates a multi-step certification process that includes written and clinical examinations. These assessments evaluate an orthodontist's ability to diagnose complex dental issues, design effective treatment plans, and understand the unique physiological considerations of growing children's dental structures.


Standardized examinations cover critical areas like developmental orthodontics, interceptive treatments, and age-specific intervention strategies. Professionals must showcase their expertise in managing children's evolving dental landscapes, understanding growth patterns, and implementing minimally invasive corrective techniques.


Moreover, these certification processes aren't one-time events. Continuing education requirements ensure that orthodontists stay updated with emerging technologies, research, and best practices. This ongoing learning commitment helps maintain consistently high standards of pediatric orthodontic care.


By implementing these mandatory certification processes, the profession ensures that every child receives treatment from a thoroughly vetted, highly skilled professional committed to delivering exceptional dental healthcare.

Payment Plan Options for Pediatric Orthodontic Care

Legal and Professional Standards Governing Orthodontic Treatment for Pediatric Patients


Orthodontic care for children is a specialized field that requires rigorous legal and professional standards to ensure patient safety and high-quality treatment. The complex landscape of pediatric orthodontics is carefully regulated to protect the unique needs of young patients while maintaining the highest levels of professional practice.


Licensing plays a critical role in establishing the baseline qualifications for orthodontic practitioners. Orthodontists must complete extensive educational requirements, including a dental degree followed by specialized orthodontic training. Certification by recognized professional bodies, such as the American Board of Orthodontics, demonstrates a practitioner's commitment to advanced expertise and ongoing professional development.


The legal framework surrounding pediatric orthodontic treatment involves multiple layers of protection. Informed consent becomes particularly nuanced when dealing with young patients, typically requiring parental or guardian approval. Practitioners must carefully navigate the ethical considerations of recommending treatment for children, balancing medical necessity with potential long-term impacts.


Professional standards mandate comprehensive patient assessments, detailed treatment planning, and transparent communication with parents and guardians. These guidelines ensure that orthodontic interventions are not only clinically appropriate but also considerate of the child's physical and emotional well-being.


Ethical considerations extend beyond the technical aspects of treatment. Orthodontists must be particularly sensitive to the psychological impact of dental interventions on pediatric patients, considering factors such as self-esteem, social development, and individual comfort levels.


Continuing education is another crucial component of maintaining professional standards. Orthodontists must stay current with the latest technological advances, treatment methodologies, and research specific to pediatric orthodontic care. This commitment ensures that young patients receive the most advanced and appropriate treatment possible.


Regulatory bodies and professional associations work collaboratively to establish and enforce these standards. They provide guidelines that address everything from diagnostic protocols to treatment techniques, creating a comprehensive framework that prioritizes patient safety and treatment efficacy.


The intersection of legal requirements and professional standards in pediatric orthodontics represents a delicate balance between medical expertise, ethical considerations, and patient protection. It ensures that young patients receive care that is not only technically proficient but also compassionate and developmentally appropriate.


As the field continues to evolve, these standards will undoubtedly adapt, reflecting advances in medical knowledge, technology, and our understanding of pediatric healthcare. The ultimate goal remains constant: providing the highest quality orthodontic care that supports the physical and emotional well-being of young patients.

Factors Influencing Orthodontic Treatment Costs

Continuous Professional Development and Recertification in Pediatric Orthodontic Care


In the ever-evolving world of orthodontics, staying current is not just a professional choice-it's a critical responsibility, especially when working with children. Pediatric orthodontic care demands more than just initial training; it requires a commitment to lifelong learning and professional growth.


The landscape of orthodontic treatment is constantly changing. New technologies, advanced diagnostic tools, and innovative treatment techniques emerge rapidly. Continuous professional development ensures that orthodontists remain at the forefront of these advancements, providing the most effective and compassionate care possible for young patients.


Recertification plays a crucial role in maintaining high standards of practice. It's not merely a bureaucratic process, but a meaningful way to demonstrate ongoing competence and commitment to patient care. Through regular training and re-examination, orthodontists refresh their knowledge, learn about the latest research, and validate their skills.


For pediatric patients, this ongoing learning is particularly important. Children's orthodontic needs are unique and complex. Their developing bodies, changing dental structures, and individual growth patterns require specialized knowledge that continually evolves. A commitment to professional development means practitioners can offer the most up-to-date, personalized care.


Moreover, recertification helps build patient trust. Parents want to know that their child's orthodontist is not just qualified, but consistently updating their expertise. It signals a dedication to excellence and a proactive approach to professional growth.


The benefits extend beyond individual practice. Continuous learning contributes to the broader advancement of orthodontic care, driving innovation and improving treatment outcomes across the field.


In essence, continuous professional development and recertification are not just requirements-they are fundamental to providing exceptional pediatric orthodontic care. They represent a commitment to excellence, patient safety, and ongoing professional growth.

Comparing Different Orthodontic Practices and Their Pricing Strategies

Ethical Considerations and Patient Safety Protocols in Children's Orthodontic Treatments


When it comes to orthodontic treatments for children, ethical considerations and patient safety are paramount. Licensing and certification play a crucial role in ensuring that young patients receive the highest standard of care while protecting their physical and emotional well-being.


Orthodontic practitioners working with children must navigate a complex landscape of ethical responsibilities. This begins with obtaining proper licensing and certification, which demonstrates not just technical competence, but a deep commitment to patient welfare. Professional credentials ensure that practitioners have undergone rigorous training in both technical skills and ethical standards specific to pediatric orthodontic care.


Patient safety protocols are particularly critical in children's orthodontics. Young patients are more vulnerable and may not fully understand or communicate potential discomfort or complications. Licensed orthodontists are trained to conduct comprehensive assessments that consider a child's physical development, psychological readiness, and individual health considerations. This holistic approach goes beyond simply straightening teeth - it involves understanding the unique needs of growing patients.


Informed consent takes on special significance when treating children. Ethical practitioners must engage both the child and their parents or guardians, explaining procedures in age-appropriate language and ensuring everyone understands the treatment plan. This transparency builds trust and helps children feel more comfortable during potentially intimidating medical interventions.


Moreover, certification bodies require ongoing education, ensuring that orthodontists stay current with the latest safety protocols and technological advancements. This commitment to continuous learning directly translates to improved patient care and safety.


Ultimately, licensing and certification serve as a critical safeguard, ensuring that children receive orthodontic treatments that are not just technically proficient, but also compassionate, safe, and ethically sound. It's about protecting the most vulnerable patients while helping them achieve healthy, confident smiles.

Additional Fees and Potential Hidden Expenses in Orthodontic Treatment

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Licensing and certification play a crucial role in ensuring high-quality patient care within pediatric orthodontics. These professional credentials serve as critical benchmarks for maintaining standards of practice and protecting patient safety.


When orthodontists undergo rigorous licensing processes, they demonstrate a comprehensive understanding of complex dental and developmental principles specific to pediatric patients. Certification ensures that practitioners have not only theoretical knowledge but also practical skills in managing the unique orthodontic needs of children and adolescents.


The impact of these professional standards extends far beyond simple regulatory compliance. By mandating ongoing education and periodic skill assessments, licensing bodies help orthodontists stay current with emerging technologies and treatment methodologies. This continuous learning approach directly translates to improved patient outcomes, as practitioners remain adaptable and informed about the latest research and techniques.


Moreover, certification provides parents and patients with confidence in their chosen healthcare provider. Knowing that an orthodontist has met stringent professional standards can alleviate anxiety and build trust in the treatment process. These credentials serve as a form of quality assurance, signaling that the practitioner has been vetted by professional organizations committed to excellence.


From a clinical perspective, licensed and certified orthodontists are more likely to implement evidence-based practices, utilize advanced diagnostic tools, and develop personalized treatment plans that consider each patient's unique developmental trajectory. This patient-centered approach can significantly improve long-term dental health outcomes and overall patient satisfaction.


In conclusion, licensing and certification are not merely bureaucratic formalities but essential mechanisms for maintaining high-quality care in pediatric orthodontics. They represent a commitment to professional excellence, patient safety, and continuous improvement in healthcare delivery.

Regulatory Oversight and Professional Accountability in Pediatric Orthodontic Practices


Ensuring the highest standards of care for children's dental alignment requires a comprehensive approach to professional oversight and accountability. Licensing and certification play a critical role in maintaining the quality and safety of orthodontic treatments for young patients.


The journey begins with rigorous educational requirements that go far beyond basic dental training. Orthodontists specializing in pediatric dental alignment must complete extensive postgraduate programs, demonstrating advanced knowledge of child-specific dental development and alignment techniques. These programs aren't just about technical skills; they emphasize the unique physiological and psychological considerations of treating young patients.


Certification processes are particularly stringent in pediatric orthodontics. Professional boards conduct thorough examinations that test not only clinical expertise but also ethical standards and patient care principles. The American Board of Orthodontics, for instance, requires comprehensive assessments that evaluate a practitioner's ability to diagnose, prevent, and correct dental misalignments in children.


Ongoing professional accountability is equally crucial. Licensed orthodontists must engage in continuous education, staying current with the latest research, technological advancements, and best practices in pediatric dental care. Annual recertification and periodic professional reviews ensure that practitioners maintain the highest standards of care throughout their careers.


Regulatory bodies also play a critical role in protecting young patients. State dental boards implement strict guidelines for practice, patient safety, and ethical conduct. These regulations cover everything from treatment protocols to record-keeping and patient communication, providing multiple layers of protection for vulnerable pediatric patients.


Perhaps most importantly, this system of oversight goes beyond mere technical competence. It emphasizes the holistic approach needed in pediatric orthodontics - understanding the emotional and developmental needs of children, creating positive dental experiences, and supporting long-term oral health.


While no system is perfect, the combination of rigorous licensing, certification, and ongoing professional accountability creates a robust framework that prioritizes the well-being of young patients. It ensures that children receive not just technically proficient care, but compassionate, comprehensive treatment that supports their overall dental health and personal confidence.

Dental braces

Dental braces (also known as orthodontic braces, or simply braces) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

Process

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The application of braces moves the teeth as a result of force and pressure on the teeth. Traditionally, four basic elements are used: brackets, bonding material, arch wire, and ligature elastic (also called an "O-ring"). The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction.[1]

Braces apply constant pressure which, over time, moves teeth into the desired positions. The process loosens the tooth after which new bone grows to support the tooth in its new position. This is called bone remodelling. Bone remodelling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible: direct resorption, which starts from the lining cells of the alveolar bone, and indirect or retrograde resorption, which occurs when the periodontal ligament has been subjected to an excessive amount and duration of compressive stress.[2] Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen, and voids will occur distal to the direction of tooth movement.[3]

Types

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"Clear" braces
Upper and Lower Jaw Functional Expanders
  • Traditional metal wired braces (also known as "train track braces") are stainless-steel and are sometimes used in combination with titanium. Traditional metal braces are the most common type of braces.[4] These braces have a metal bracket with elastic ties (also known as rubber bands) holding the wire onto the metal brackets. The second-most common type of braces is self-ligating braces, which have a built-in system to secure the archwire to the brackets and do not require elastic ties. Instead, the wire goes through the bracket. Often with this type of braces, treatment time is reduced, there is less pain on the teeth, and fewer adjustments are required than with traditional braces.
  • Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen for aesthetic reasons.
  • Lingual braces are a cosmetic alternative in which custom-made braces are bonded to the back of the teeth making them externally invisible.
  • Titanium braces resemble stainless-steel braces but are lighter and just as strong. People with allergies to nickel in steel often choose titanium braces, but they are more expensive than stainless steel braces.
  • Customized orthodontic treatment systems combine high technology including 3-D imaging, treatment planning software and a robot to custom bend the wire. Customized systems such as this offer faster treatment times and more efficient results.[5]
  • Progressive, clear removable aligners may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary.[medical citation needed][6]

Fitting procedure

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A patient's teeth are prepared for the application of braces.

Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America, most orthodontic treatment is done by orthodontists, who are dentists in the diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.

The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, moulds, and impressions are made. These records are analyzed to determine the problems and the proper course of action. The use of digital models is rapidly increasing in the orthodontic industry. Digital treatment starts with the creation of a three-dimensional digital model of the patient's arches. This model is produced by laser-scanning plaster models created using dental impressions. Computer-automated treatment simulation has the ability to automatically separate the gums and teeth from one another and can handle malocclusions well; this software enables clinicians to ensure, in a virtual setting, that the selected treatment will produce the optimal outcome, with minimal user input.[medical citation needed]

Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied, orthodontic spacers may be required to spread apart back teeth in order to create enough space for the bands.

Teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases, the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental works make securing a bracket to a tooth infeasible. Orthodontic tubes (stainless steel tubes that allow wires to pass through them), also known as molar tubes, are directly bonded to molar teeth either by a chemical curing or a light curing adhesive. Usually, molar tubes are directly welded to bands, which is a metal ring that fits onto the molar tooth. Directly bonded molar tubes are associated with a higher failure rate when compared to molar bands cemented with glass ionomer cement. Failure of orthodontic brackets, bonded tubes or bands will increase the overall treatment time for the patient. There is evidence suggesting that there is less enamel decalcification associated with molar bands cemented with glass ionomer cement compared with orthodontic tubes directly cemented to molars using a light cured adhesive. Further evidence is needed to withdraw a more robust conclusion due to limited data.[7]

An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Ligatures are available in a wide variety of colours, and the patient can choose which colour they like. Arch wires are bent, shaped, and tightened frequently to achieve the desired results.

Dental braces, with a transparent power chain, removed after completion of treatment.

Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the arch wire will stiffen and seek to retain its shape, creating constant light force on the teeth.

Brackets with hooks can be placed, or hooks can be created and affixed to the arch wire to affix rubber bands. The placement and configuration of the rubber bands will depend on the course of treatment and the individual patient. Rubber bands are made in different diameters, colours, sizes, and strengths. They are also typically available in two versions: Coloured or clear/opaque.

The fitting process can vary between different types of braces, though there are similarities such as the initial steps of moulding the teeth before application. For example, with clear braces, impressions of a patient's teeth are evaluated to create a series of trays, which fit to the patient's mouth almost like a protective mouthpiece. With some forms of braces, the brackets are placed in a special form that is customized to the patient's mouth, drastically reducing the application time.

In many cases, there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion, in which the palate or arch is made larger by using a palatal expander. Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to separate them. An expander can be used on an adult without surgery but would be used to expand the dental arch, and not the palate.

Sometimes children and teenage patients, and occasionally adults, are required to wear a headgear appliance as part of the primary treatment phase to keep certain teeth from moving (for more detail on headgear and facemask appliances see Orthodontic headgear). When braces put pressure on one's teeth, the periodontal membrane stretches on one side and is compressed on the other. This movement needs to be done slowly or otherwise, the patient risks losing their teeth. This is why braces are worn as long as they are and adjustments are only made every so often.

Young Colombian man during an adjustment visit for his orthodontics

Braces are typically adjusted every three to six weeks. This helps shift the teeth into the correct position. When they get adjusted, the orthodontist removes the coloured or metal ligatures keeping the arch wire in place. The arch wire is then removed and may be replaced or modified. When the archwire has been placed back into the mouth, the patient may choose a colour for the new elastic ligatures, which are then affixed to the metal brackets. The adjusting process may cause some discomfort to the patient, which is normal.

Post-treatment

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Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gumline contours after the braces come off. After braces treatment, patients can use a transparent plate to keep the teeth in alignment for a certain period of time. After treatment, patients usually use transparent plates for 6 months. In patients with long and difficult treatment, a fixative wire is attached to the back of the teeth to prevent the teeth from returning to their original state.[8]

Retainers

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Hawley retainers are the most common type of retainers. This picture shows retainers for the top (right) and bottom (left) of the mouth.

In order to prevent the teeth from moving back to their original position, retainers are worn once the treatment is complete. Retainers help in maintaining and stabilizing the position of teeth long enough to permit the reorganization of the supporting structures after the active phase of orthodontic therapy. If the patient does not wear the retainer appropriately and/or for the right amount of time, the teeth may move towards their previous position. For regular braces, Hawley retainers are used. They are made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient's palate. For Clear Removable braces, an Essix retainer is used. This is similar to the original aligner; it is a clear plastic tray that is firmly fitted to the teeth and stays in place without a plate fitted to the palate. There is also a bonded retainer where a wire is permanently bonded to the lingual side of the teeth, usually the lower teeth only.

Headgear

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Headgear needs to be worn between 12 and 22 hours each day to be effective in correcting the overbite, typically for 12 to 18 months depending on the severity of the overbite, how much it is worn and what growth stage the patient is in. Typically the prescribed daily wear time will be between 14 and 16 hours a day and is frequently used as a post-primary treatment phase to maintain the position of the jaw and arch. Headgear can be used during the night while the patient sleeps.[9][better source needed]

Orthodontic headgear usually consists of three major components:

Full orthodontic headgear with head cap, fitting straps, facebow and elastics
  1. Facebow: the facebow (or J-Hooks) is fitted with a metal arch onto headgear tubes attached to the rear upper and lower molars. This facebow then extends out of the mouth and around the patient's face. J-Hooks are different in that they hook into the patient's mouth and attach directly to the brace (see photo for an example of J-Hooks).
  2. Head cap: the head cap typically consists of one or a number of straps fitting around the patient's head. This is attached with elastic bands or springs to the facebow. Additional straps and attachments are used to ensure comfort and safety (see photo).
  3. Attachment: typically consisting of rubber bands, elastics, or springs—joins the facebow or J-Hooks and the head cap together, providing the force to move the upper teeth, jaw backwards.

The headgear application is one of the most useful appliances available to the orthodontist when looking to correct a Class II malocclusion. See more details in the section Orthodontic headgear.

Pre-finisher

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The pre-finisher is moulded to the patient's teeth by use of extreme pressure on the appliance by the person's jaw. The product is then worn a certain amount of time with the user applying force to the appliance in their mouth for 10 to 15 seconds at a time. The goal of the process is to increase the exercise time in applying the force to the appliance. If a person's teeth are not ready for a proper retainer the orthodontist may prescribe the use of a preformed finishing appliance such as the pre-finisher. This appliance fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor problems.

Complications and risks

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A group of dental researchers, Fatma Boke, Cagri Gazioglu, Selvi Akkaya, and Murat Akkaya, conducted a study titled "Relationship between orthodontic treatment and gingival health." The results indicated that some orthodontist treatments result in gingivitis, also known as gum disease. The researchers concluded that functional appliances used to harness natural forces (such as improving the alignment of bites) do not usually have major effects on the gum after treatment.[10] However, fixed appliances such as braces, which most people get, can result in visible plaque, visible inflammation, and gum recession in a majority of the patients. The formation of plaques around the teeth of patients with braces is almost inevitable regardless of plaque control and can result in mild gingivitis. But if someone with braces does not clean their teeth carefully, plaques will form, leading to more severe gingivitis and gum recession.

Experiencing some pain following fitting and activation of fixed orthodontic braces is very common and several methods have been suggested to tackle this.[11][12] Pain associated with orthodontic treatment increases in proportion to the amount of force that is applied to the teeth. When a force is applied to a tooth via a brace, there is a reduction in the blood supply to the fibres that attach the tooth to the surrounding bone. This reduction in blood supply results in inflammation and the release of several chemical factors, which stimulate the pain response. Orthodontic pain can be managed using pharmacological interventions, which involve the use of analgesics applied locally or systemically. These analgesics are divided into four main categories, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and local anesthesia. The first three of these analgesics are commonly taken systemically to reduce orthodontic pain.[13]

A Cochrane Review in 2017 evaluated the pharmacological interventions for pain relief during orthodontic treatment. The study concluded that there was moderate-quality evidence that analgesics reduce the pain associated with orthodontic treatment. However, due to a lack of evidence, it was unclear whether systemic NSAIDs were more effective than paracetamol, and whether topical NSAIDs were more effective than local anaesthesia in the reduction of pain associated with orthodontic treatment. More high-quality research is required to investigate these particular comparisons.[13]

The dental displacement obtained with the orthodontic appliance determines in most cases some degree of root resorption. Only in a few cases is this side effect large enough to be considered real clinical damage to the tooth. In rare cases, the teeth may fall out or have to be extracted due to root resorption.[14][15]

History

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Ancient

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Old Braces at a museum in Jbeil, Lebanon

According to scholars and historians, braces date back to ancient times. Around 400–300 BC, Hippocrates and Aristotle contemplated ways to straighten teeth and fix various dental conditions. Archaeologists have discovered numerous mummified ancient individuals with what appear to be metal bands wrapped around their teeth. Catgut, a type of cord made from the natural fibres of an animal's intestines, performed a similar role to today's orthodontic wire in closing gaps in the teeth and mouth.[16]

The Etruscans buried their dead with dental appliances in place to maintain space and prevent the collapse of the teeth during the afterlife. A Roman tomb was found with a number of teeth bound with gold wire documented as a ligature wire, a small elastic wire that is used to affix the arch wire to the bracket. Even Cleopatra wore a pair. Roman philosopher and physician Aulus Cornelius Celsus first recorded the treatment of teeth by finger pressure. Unfortunately, due to a lack of evidence, poor preservation of bodies, and primitive technology, little research was carried out on dental braces until around the 17th century, although dentistry was making great advancements as a profession by then.[citation needed]

18th century

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Portrait of Fauchard from his 1728 edition of "The Surgical Dentist".

Orthodontics truly began developing in the 18th and 19th centuries. In 1669, French dentist Pierre Fauchard, who is often credited with inventing modern orthodontics, published a book entitled "The Surgeon Dentist" on methods of straightening teeth. Fauchard, in his practice, used a device called a "Bandeau", a horseshoe-shaped piece of iron that helped expand the palate. In 1754, another French dentist, Louis Bourdet, dentist to the King of France, followed Fauchard's book with The Dentist's Art, which also dedicated a chapter to tooth alignment and application. He perfected the "Bandeau" and was the first dentist on record to recommend extraction of the premolar teeth to alleviate crowding and improve jaw growth.

19th century

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Although teeth and palate straightening and/or pulling were used to improve the alignment of remaining teeth and had been practised since early times, orthodontics, as a science of its own, did not really exist until the mid-19th century. Several important dentists helped to advance dental braces with specific instruments and tools that allowed braces to be improved.

In 1819, Christophe François Delabarre introduced the wire crib, which marked the birth of contemporary orthodontics, and gum elastics were first employed by Maynard in 1843. Tucker was the first to cut rubber bands from rubber tubing in 1850. Dentist, writer, artist, and sculptor Norman William Kingsley in 1858 wrote the first article on orthodontics and in 1880, his book, Treatise on Oral Deformities, was published. A dentist named John Nutting Farrar is credited for writing two volumes entitled, A Treatise on the Irregularities of the Teeth and Their Corrections and was the first to suggest the use of mild force at timed intervals to move teeth.

20th century

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In the early 20th century, Edward Angle devised the first simple classification system for malocclusions, such as Class I, Class II, and so on. His classification system is still used today as a way for dentists to describe how crooked teeth are, what way teeth are pointing, and how teeth fit together. Angle contributed greatly to the design of orthodontic and dental appliances, making many simplifications. He founded the first school and college of orthodontics, organized the American Society of Orthodontia in 1901 which became the American Association of Orthodontists (AAO) in the 1930s, and founded the first orthodontic journal in 1907. Other innovations in orthodontics in the late 19th and early 20th centuries included the first textbook on orthodontics for children, published by J.J. Guilford in 1889, and the use of rubber elastics, pioneered by Calvin S. Case, along with Henry Albert Baker.

Today, space age wires (also known as dental arch wires) are used to tighten braces. In 1959, the Naval Ordnance Laboratory created an alloy of nickel and titanium called Nitinol. NASA further studied the material's physical properties.[17] In 1979, Dr. George Andreasen developed a new method of fixing braces with the use of the Nitinol wires based on their superelasticity. Andreasen used the wire on some patients and later found out that he could use it for the entire treatment. Andreasen then began using the nitinol wires for all his treatments and as a result, dental doctor visits were reduced, the cost of dental treatment was reduced, and patients reported less discomfort.

See also

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  • Mandibular advancement splint
  • Oral and maxillofacial surgery
  • Orthognathic surgery
  • Prosthodontics
  • Trismus
  • Dental implant

References

[edit]
  1. ^ "Dental Braces and Retainers". WebMD. Retrieved 2020-10-30.
  2. ^ Robling, Alexander G.; Castillo, Alesha B.; Turner, Charles H. (2006). "Biomechanical and Molecular Regulation of Bone Remodeling". Annual Review of Biomedical Engineering. 8: 455–498. doi:10.1146/annurev.bioeng.8.061505.095721. PMID 16834564.
  3. ^ Toledo SR, Oliveira ID, Okamoto OK, Zago MA, de Seixas Alves MT, Filho RJ, et al. (September 2010). "Bone deposition, bone resorption, and osteosarcoma". Journal of Orthopaedic Research. 28 (9): 1142–1148. doi:10.1002/jor.21120. PMID 20225287. S2CID 22660771.
  4. ^ "Metal Braces for Teeth: Braces Types, Treatment, Cost in India". Clove Dental. Retrieved 2025-02-06.
  5. ^ Saxe, Alana K.; Louie, Lenore J.; Mah, James (2010). "Efficiency and effectiveness of SureSmile". World Journal of Orthodontics. 11 (1): 16–22. PMID 20209172.
  6. ^ Tamer, Ä°pek (December 2019). "Orthodontic Treatment with Clear Aligners and The Scientific Reality Behind Their Marketing: A Literature Review". Turkish Journal of Orthodontics. 32 (4): 241–246. doi:10.5152/TurkJOrthod.2019.18083. PMC 7018497. PMID 32110470.
  7. ^ Millett DT, Mandall NA, Mattick RC, Hickman J, Glenny AM (February 2017). "Adhesives for bonded molar tubes during fixed brace treatment". The Cochrane Database of Systematic Reviews. 2 (3): CD008236. doi:10.1002/14651858.cd008236.pub3. PMC 6464028. PMID 28230910.
  8. ^ Rubie J Patrick (2017). "What About Teeth After Braces?" 2017 – "Health Journal Article" Toothcost Archived 2021-10-18 at the Wayback Machine
  9. ^ Naten, Joshua. "Braces Headgear (Treatments)". toothcost.com. Archived from the original on 19 October 2021.
  10. ^ Boke, Fatma; Gazioglu, Cagri; Akkaya, Sevil; Akkaya, Murat (2014). "Relationship between orthodontic treatment and gingival health: A retrospective study". European Journal of Dentistry. 8 (3): 373–380. doi:10.4103/1305-7456.137651. ISSN 1305-7456. PMC 4144137. PMID 25202219.
  11. ^ Eslamian L, Borzabadi-Farahani A, Hassanzadeh-Azhiri A, Badiee MR, Fekrazad R (March 2014). "The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators". Lasers in Medical Science. 29 (2): 559–64. doi:10.1007/s10103-012-1258-1. PMID 23334785. S2CID 25416518.
  12. ^ Eslamian L, Borzabadi-Farahani A, Edini HZ, Badiee MR, Lynch E, Mortazavi A (September 2013). "The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study". Acta Odontologica Scandinavica. 71 (5): 1168–73. doi:10.3109/00016357.2012.757358. PMID 23301559. S2CID 22561192.
  13. ^ a b Monk AB, Harrison JE, Worthington HV, Teague A (November 2017). "Pharmacological interventions for pain relief during orthodontic treatment". The Cochrane Database of Systematic Reviews. 11 (12): CD003976. doi:10.1002/14651858.cd003976.pub2. PMC 6486038. PMID 29182798.
  14. ^ Artun J, Smale I, Behbehani F, Doppel D, Van't Hof M, Kuijpers-Jagtman AM (November 2005). "Apical root resorption six and 12 months after initiation of fixed orthodontic appliance therapy". The Angle Orthodontist. 75 (6): 919–26. PMID 16448232.
  15. ^ Mavragani M, Vergari A, Selliseth NJ, Bøe OE, Wisth PL (December 2000). "A radiographic comparison of apical root resorption after orthodontic treatment with a standard edgewise and a straight-wire edgewise technique". European Journal of Orthodontics. 22 (6): 665–74. doi:10.1093/ejo/22.6.665. PMID 11212602.
  16. ^ Wahl N (February 2005). "Orthodontics in 3 millennia. Chapter 1: Antiquity to the mid-19th century". American Journal of Orthodontics and Dentofacial Orthopedics. 127 (2): 255–9. doi:10.1016/j.ajodo.2004.11.013. PMID 15750547.
  17. ^ "NASA Technical Reports Server (NTRS)". Spinoff 1979. February 1979. Retrieved 2021-03-02.
[edit]
  • Useful Resources: FAQ and Downloadable eBooks at Orthodontics Australia
  • Orthos Explain: Treatment Options at Orthodontics Australia
  • Media related to Dental braces at Wikimedia Commons

 

Human lower jaw viewed from the left

The jaws are a pair of opposable articulated structures at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of humans and most animals.

Arthropods

[edit]
The mandibles of a bull ant

In arthropods, the jaws are chitinous and oppose laterally, and may consist of mandibles or chelicerae. These jaws are often composed of numerous mouthparts. Their function is fundamentally for food acquisition, conveyance to the mouth, and/or initial processing (mastication or chewing). Many mouthparts and associate structures (such as pedipalps) are modified legs.

Vertebrates

[edit]

In most vertebrates, the jaws are bony or cartilaginous and oppose vertically, comprising an upper jaw and a lower jaw. The vertebrate jaw is derived from the most anterior two pharyngeal arches supporting the gills, and usually bears numerous teeth.

Jaws of a great white shark

Fish

[edit]
Moray eels have two sets of jaws: the oral jaws that capture prey and the pharyngeal jaws that advance into the mouth and move prey from the oral jaws to the esophagus for swallowing.

The vertebrate jaw probably originally evolved in the Silurian period and appeared in the Placoderm fish which further diversified in the Devonian. The two most anterior pharyngeal arches are thought to have become the jaw itself and the hyoid arch, respectively. The hyoid system suspends the jaw from the braincase of the skull, permitting great mobility of the jaws. While there is no fossil evidence directly to support this theory, it makes sense in light of the numbers of pharyngeal arches that are visible in extant jawed vertebrates (the Gnathostomes), which have seven arches, and primitive jawless vertebrates (the Agnatha), which have nine.

The original selective advantage offered by the jaw may not be related to feeding, but rather to increased respiration efficiency.[1] The jaws were used in the buccal pump (observable in modern fish and amphibians) that pumps water across the gills of fish or air into the lungs in the case of amphibians. Over evolutionary time the more familiar use of jaws (to humans), in feeding, was selected for and became a very important function in vertebrates. Many teleost fish have substantially modified jaws for suction feeding and jaw protrusion, resulting in highly complex jaws with dozens of bones involved.[2]

Amphibians, reptiles, and birds

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The jaw in tetrapods is substantially simplified compared to fish. Most of the upper jaw bones (premaxilla, maxilla, jugal, quadratojugal, and quadrate) have been fused to the braincase, while the lower jaw bones (dentary, splenial, angular, surangular, and articular) have been fused together into a unit called the mandible. The jaw articulates via a hinge joint between the quadrate and articular. The jaws of tetrapods exhibit varying degrees of mobility between jaw bones. Some species have jaw bones completely fused, while others may have joints allowing for mobility of the dentary, quadrate, or maxilla. The snake skull shows the greatest degree of cranial kinesis, which allows the snake to swallow large prey items.

Mammals

[edit]

In mammals, the jaws are made up of the mandible (lower jaw) and the maxilla (upper jaw). In the ape, there is a reinforcement to the lower jaw bone called the simian shelf. In the evolution of the mammalian jaw, two of the bones of the jaw structure (the articular bone of the lower jaw, and quadrate) were reduced in size and incorporated into the ear, while many others have been fused together.[3] As a result, mammals show little or no cranial kinesis, and the mandible is attached to the temporal bone by the temporomandibular joints. Temporomandibular joint dysfunction is a common disorder of these joints, characterized by pain, clicking and limitation of mandibular movement.[4] Especially in the therian mammal, the premaxilla that constituted the anterior tip of the upper jaw in reptiles has reduced in size; and most of the mesenchyme at the ancestral upper jaw tip has become a protruded mammalian nose.[5]

Sea urchins

[edit]

Sea urchins possess unique jaws which display five-part symmetry, termed the Aristotle's lantern. Each unit of the jaw holds a single, perpetually growing tooth composed of crystalline calcium carbonate.

See also

[edit]
  • Muscles of mastication
  • Otofacial syndrome
  • Predentary
  • Prognathism
  • Rostral bone

References

[edit]
  1. ^ Smith, M.M.; Coates, M.I. (2000). "10. Evolutionary origins of teeth and jaws: developmental models and phylogenetic patterns". In Teaford, Mark F.; Smith, Moya Meredith; Ferguson, Mark W.J. (eds.). Development, function and evolution of teeth. Cambridge: Cambridge University Press. p. 145. ISBN 978-0-521-57011-4.
  2. ^ Anderson, Philip S.L; Westneat, Mark (28 November 2006). "Feeding mechanics and bite force modelling of the skull of Dunkleosteus terrelli, an ancient apex predator". Biology Letters. pp. 77–80. doi:10.1098/rsbl.2006.0569. PMC 2373817. PMID 17443970. cite web: Missing or empty |url= (help)
  3. ^ Allin EF (December 1975). "Evolution of the mammalian middle ear". J. Morphol. 147 (4): 403–37. doi:10.1002/jmor.1051470404. PMID 1202224. S2CID 25886311.
  4. ^ Wright, Edward F. (2010). Manual of temporomandibular disorders (2nd ed.). Ames, Iowa: Wiley-Blackwell. ISBN 978-0-8138-1324-0.
  5. ^ Higashiyama, Hiroki; Koyabu, Daisuke; Hirasawa, Tatsuya; Werneburg, Ingmar; Kuratani, Shigeru; Kurihara, Hiroki (November 2, 2021). "Mammalian face as an evolutionary novelty". PNAS. 118 (44): e2111876118. Bibcode:2021PNAS..11811876H. doi:10.1073/pnas.2111876118. PMC 8673075. PMID 34716275.
[edit]
  • Media related to Jaw bones at Wikimedia Commons
  • Jaw at the U.S. National Library of Medicine Medical Subject Headings (MeSH)