Preventive Orthodontics Question And Answers

Preventive Orthodontics

Write short notes on various procedures undertaken in preventive and interceptive orthodontics.
Answer. It is defined as “the action taken to preserve the integrity of what appears to be normal occlusion at a specific time”.

Procedures Undertaken in Preventive Orthodontics

Procedures to be undertaken are divided into two types:

• Preventive procedures without appliances
  • Parental education
  • Predental procedures
  • Oral hygiene
  • Caries control
  • Care of deciduous dentition
  • Management of ankylosed teeth
  • Maintenance of occlusal equilibrium
  • Removal of supernumerary teeth
  • Restoration of decayed teeth
  • Habit correction
  • Disking
  • Management of tongue tie
  • Locked permanent first molar.

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• Preventive procedures with appliances
  • Space maintenance
  • Mouth protectors.

Preventive Procedures without Appliances

Parent Education

• Preventive orthodontic should begin before the birth of child.
• The expecting mother should be educated on mattrs such as nutrition.
• After birth mother should be educated on proper nursing and care of the child.
• When botted mother advised to use physiologic nipple not conventional nipple.
• The parents should educated for maintenance of good oral hygiene (to prevent nursing botte syndrome).

Predental Procedures

• Preventive procedures should be started before teeth eruption.
• Malocclusion occur because of improper selection of feeding nipple for baby and also because of improper positioning of botte.
• Physiologic nipple should be used.

Oral Hygiene

Oral hygiene measures should be taught to the parents and children.

• Infants (0 to 1 year): Brushing should be advocated with eruption of fist deciduous tooth. Moist gauze or moist cloth is used for massaging the gums and cleaning the teeth.
• Toddlers (1 to 3 years): Toothbrushing should be done with low floridated toothpaste. Parent should brush for the child.
• (3–6 years): Brushing of children is carried out under the supervision of parents. Fluoridated toothpaste should be introduced.
• School age (6–12 years): Brushing technique used should be proper and regular brushing is done.

Caries Control

Provisional caries should be detected properly and proper restoration should be undertaken immediately to prevent mesial movement of adjacent teeth and thus prevent loss of arch length.

Care of Deciduous Dentition

• Resorption pattern of primary teeth should be checked properly which causes establishment of nice occlusion.
• Abnormality in resorption leads to space deficiency.
• Deciduous canines and second deciduous molars are subjected to aberrant absorption
• After shedding of primary teeth, permanent tooth erupt in 3 to 6 months.

Management of Ankylosed Teeth

• Ankylosed deciduous teeth deflect permanent teeth to abnormal location.
• They should be diagnosed and remove surgically at proper time.

Maintenance of Occlusal Equilibrium

This is to be done as preventive, interceptive and corrective orthodontic procedure.

• Functional shifts causing pseudo class III as well as crossbite should be checked and eliminated.
• Overextended restorations should be reduced since they lead to occlusal prematurities.

Removal of Supernumerary Teeth

• Supernumerary and supplemental teeth can interfere with the eruption of nearly normal teeth.
• Supernumerary teeth should be identifid and extracted before they cause displacement of other teeth.

Restoration of Decayed Teeth

• Interproximal filings should be done to prevent loss in space.
• Overextended restoration changes occlusal relationship.

Habit Correction

• Early correction should be done which eliminate unfavorable sequelae of habits which leads to malocclusion.
• Habits such as tongue thrusting, mouth breathing, etc. should be recognized and treated.

Disking

• It is to be done in oversized fist or second deciduous molars.
• It facilitate eruption of permanent teeth.

Management of Tongue Tie

• It occurs because of thickening of genioglossus muscle which join midline of tongue where it elevated in vertical fold.
• It disappears after 4 years of age
• In case if it remains after 4 years frenectomy is done.
• Tongue tie causes difficulty in feeding.

Locked Permanent First Molar

• Tooth can be slightly or deeply locked.
• Deeply locked tooth require extraction of second deciduous molar and space maintenance for second molars.
• Slightly locked permanent fist molar erupts without any treatment.

Preventives Procedure with Appliances

Space Maintenance

Space maintenance is concerned with the maintenance of space lost by early loss of primary tooth by passive appliance or gaining of space lost.

Mouth Protectors

• It provides protection against injuries to teeth in the contact sports.
• They are of two types, i.e. prefabricated and custom made.

Procedures Undertaken in Interceptive Orthodontics

It is defined as “that phase of science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in developing dentofacial complex.” Graber The procedures undertaken in interceptive orthodontics are:

• Removal of superanumerary tooth.
• Removal of ankylosed tooth.
• Equilibration of occlusal disharmonies.
• Correction of developing crossbite.
• Control of abnormal habits by Serial extraction, Muscle exercises, Space regainer, Interception of skeletal malrelation.
• Disking.
• Through early straightening of permanent incisors.
• Removal of sof tissues or bony barrier to enable eruption of teeth.

Serial Extraction

Eruption of permanent incisors in early mixed dentition may result in crowding in patients with severe tooth size-arch length discrepancy of 8-10 mm or more. Such patients would ultimately require extraction of four premolars to provide space for proper alignment of remaining permanent teeth. Rationale of serial extraction procedure is to intercept malocclusion at early mixed dentition period by extracting certain primary and permanent teeth and guiding the eruption of remaining permanent teeth in best possible occlusion.

Correction of Developing Crossbite

Anterior crossbite should be intercepted and treated at an early stage, if lef untreated it can cause severe skeletal malocclusion. Dentoalveolar anterior crossbites are best treated by tongue blade therapy. Skeletal anterior crossbites are best treated by myofunctional appliances. Functional anterior crossbite is treated by eliminating occlusal prematurities.

Control of Abnormal Habits

Oral habits such as thumb sucking, tongue thrusting, etc. should be intercepted by the dentist at age of 3.5 years to 4.5 years. Oral habits are intercepted by removal orthodontic appliance such as oral screen or by fied orthodontic appliance such as fied crib.

Proximal Stripping

Proximal stripping of first and second deciduous molars is required to facilitate eruption of adjacent succedaneous permanent teeth into normal occlusion.

Correction of Occlusal Interferences

Occlusal interferences can deflct mandible anteriorly, laterally or posteriorly. So as soon as occlusal prematurities are ruled out by dentist, they should be intercepted by reduction of crown height by pear-shaped stone in center angled handpiece.

Space Regaining

This can be done by using following appliances, i.e.

• By using cantilever spring: Space lost due to mesial driftng of permanent molar as well as distal driftng of deciduous first molar when deciduous molar get lost prematurely, this is regained by use of two figer springs.
• By using jack screw: Space is regained by use of removable orthodontic appliance which has jack screw in a way which increases the arch length which is obtained by distalization of molar.
• Gerber space regainer: It is an orthodontic molar band which is used for the tooth which has to be distalized. It consists of U-shaped hollow tubing.

Removal of Soft Tissue and Bony Barrier to Enable Eruption of Teeth

• It involves excision of soft tissue as well as removal of bone covering the crown of unerupted tooth for making the space so that tooth can erupt easily.