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PubMed2004

Demand for orthodontic treatment among 9-18 year-olds seeking dental care in Dar-es-Salaam, Tanzania.

OBJECTIVE: To investigate the demand for orthodontic treatment among 9-18 olds seeking dental care in Dar-es-Salaam, Tanzania. DESIGN: Case-control, interview and clinical study. SETTINGS: Children seeking dental care. MAIN OUTCOME MEASURES: Demand for orthodontic treatment. RESULTS: Most of the children (85%) in the case group attended the dental clinic because of crowding. Aesthetic impairment (AC grades 8-10) and severe malocclusions (DHC grades 4-5) were higher in cases than in controls being 47 and 5%; and 67 and 18%, respectively (p<0.0001). Absolute need (combined AC grade 8-10 and DHC 4-5) was found in 29% of the cases and 5% of the controls (p<0.0001). A relative probability for a child with absolute need to seek orthodontic treatment was 7.9 higher (95%) CI for OR = (5,13), compared to a child without an absolute need for orthodontic treatment. The most prevalent severe occlusal feature placing cases in the highest need category was crowding (74%). For the cases, it was mainly a mother (45%) who first recognized the problem in the family, and tooth extraction (62%) was the most common expected mode of treatment. Most parents (96%) were prepared to pay for their children's orthodontic treatment. CONCLUSION: Most children in the case group had come to the clinic due to crowding. Ectopic canines were the driving factor for children and parents to seek orthodontic care. Further studies are recommended to map the demand for orthodontic treatment in the Tanzanian rural settings.

Adolescent↗
PubMed1997

General dental practitioners' opinions on orthodontics in primary and secondary care.

A survey of 232 general dental practitioners was undertaken by the purchasing authorities in Hereford and Worcester, England, in 1993, to establish local practitioners' views on primary and secondary care orthodontics. The response rate was 90.1%. The dentists overestimated their orthodontic case-load: 66.6% of contract holders submitted no claims for upper removable appliances (URA) treatment, but 70.8% claimed they undertook removable appliance therapy. Dentists believed orthodontics should be a feature of the General Dental Services (GDS) but did not seem inclined to commit themselves to providing it. A majority of GDPs (54.9%) felt orthodontics was uneconomic under the GDS. There was support for the treatment planning role of hospitals, but although this was available locally it did not appear to have stimulated primary care provision. Consultant outreach clinics were not generally supported but there was a desire for more opportunities for hospital clinical attachments in orthodontics. The implications for the policies of National Health Service (NHS) purchasers are considered: purchasing health authorities need to carry out systematic assessment of the views of their general dental practitioners and take account of their desired patterns of specialist provision. Policies encouraging the shift of orthodontics into primary care are called into question by this study. If demand for orthodontics is to be met, policy should concentrate on the development of hospital services and specialist practitioners.

Adult↗
PubMed2000

A longitudinal study of orthodontic treatment need in Dunedin schoolchildren.

The Index of Orthodontic Treatment Need (IOTN) was used to assess unmet orthodontic treatment need in 152 13-year-old Dunedin schoolchildren, and to compare the findings with those obtained in the same children 3 years previously. The children were randomly selected from Dunedin schools as 10-year-olds, and had not received orthodontic treatment. Approximately 86 percent of the 13-year-old children had "No-little" need for orthodontic treatment when assessed by the child-assessed Aesthetic Component (AC) and the examiner-assessed AC. Slightly less than half the children had "No-little" need for orthodontic treatment when assessed with the Dental Health Component (DHC). More 10- and 13-year-old children "Needed" orthodontic treatment with the DHC than with the AC. Both the examiner-assessed AC and the DHC assessed significantly fewer 13-year-olds as needing orthodontic treatment than the same children as 10-year-olds. Complete agreement between the grades assigned at 10 and 13 years occurred in 30-43 percent of the children and, in the treatment-need categories, between 53 percent (DHC) and 84 percent (child-assessed AC) of the children. The fall in treatment need over the 3-year period may be due to selection bias, over-sensitivity of the IOTN to mixed dentition traits, or both. Although a number of 10-year-old children were assigned different grades as 13-year-olds, many remained within the same treatment category. The apparent stability of the IOTN to assess treatment need in 10- and 13-year-old children is attributed to the grouping of different occlusal traits in the same treatment-need category, and to the small number of treatment-need categories in each component.

Adolescent↗
PubMed1975

A social perspective on need and demand for orthodontic treatment.

In addition to needs fostered by actual physical disabilities resulting from malocclusion, need and demand for orthodontic treatment may develop entirely apart from any consideration of health needs. In fact, improvement of physical function is not the primary motivation of many persons who receive orthodontic care. A variety of social factors are related to perceived needs for acceptable dentofacial appearance and to public demand for orthodontic services. Since early times human teeth have been the object of mutilations to satisfy sociocultural expectations. The mutilation, and even removal of teeth, to achieve dental cultural norms in, so-called, primitive societies may appear barbaric to an ethnocentric society. However, a significant sociocultural need can be met equally by the African or Brazilian who has had teeth filed to a point and by the Western adolescent who having had four teeth surgically removed to provide space in the arch then undergoes two years of orthodontic therapy to reposition and straighten the remaining teeth. From a sociological point of view, the need and desire of members of a society to achieve a culturally acceptable body image constitutes neither frivolity nor luxury. If children's teeth do not naturally meet the norm for esthetic dental appearance, the response of families to sociocultural expectations and pressures produces a culturally valid need for orthodontic intervention. Other social factors affecting perceived need and demand for orthodontic care are socioeconomic, desire for upward social mobility, and social change with regard to public attitudes toward the availability of dental health services and the increasing removal of financial barriers. Potential changes in present US orthodontic practice may be required if care is to be delivered to significantly larger segments of the population.

Adolescent↗
PubMed2000

Orthodontic treatment in periodontally compromised patients: 12-year report.

This work describes the therapeutic protocol of combined orthodontic-periodontal treatment and evaluates the effectiveness of surgical and nonsurgical periodontal therapy in the maintenance of a healthy periodontal status after the orthodontic treatment. Surgical periodontal treatment was performed in 267 patients affected by severe periodontal disease, and 128 patients had nonsurgical treatment. For each patient the mean value of probing depth (mPPD) and the rate of positive bleeding on probing (%BoP) of the teeth involved in the orthodontic movement were registered before the start of the periodontal treatment, at the end of the orthodontic treatment, and 2, 4, 6, 10, and 12 years after the end of the orthodontic treatment. Comparison between pretreatment and posttreatment values and between pretreatment and follow-up values showed a decrease in mPPD and %BoP that was of statistical significance. The difference between posttreatment and follow-up values was not statistically significant. These results suggest that orthodontic treatment is no longer a contraindication in the therapy of severe adult periodontitis. In these cases orthodontics improve the possibilities of saving and restoring a deteriorated dentition.

Adult↗
PubMedDate not supplied

[Effects of organic acids on corrosion of orthodontic appliances].

BACKGROUND: During the last years orthodontic practitioners and patients have developed an increasing interest on the possible undesired effects originated by the growing use of treatments in this field. Among the several undesirable effects, we have analyzed those due to allergic phenomena or cases of direct toxicity resulting from the emission of metallic ions contained in the metallic parts of the orthodontic equipment. One of the essential requirements of metals for orthodontic use is biocompatibility; international regulations (CE, ISO) value the biocompatibility of materials for orthodontics. The analysis of biocompatibility in orthodontic equipment cannot leave out of consideration the evaluation of ion emission. METHODS: In our research we have considered the release of metallic ions from orthodontic equipment in water solutions of organic acids kept at a constant temperature of 37 degrees C for 28 days. The evaluation has been possible by ionic absorption spectrophotometry. RESULTS: The results show that the release of metallic ions, low as an absolute value, has a particular trend in time. The nickel, chromium and copper concentrations have been higher during the first day than in the following 27 days. CONCLUSIONS: These data reassure about the use of orthodontic equipment, since the emission of ions is low, even if allergic problems not linked to the quantity of ions emitted cannot be excluded.

Acids↗
PubMed2001

Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old Malaysian schoolchildren.

OBJECTIVE: Data on malocclusion and orthodontic treatment need in Malaysia are limited. The purpose of this study was to evaluate malocclusion and orthodontic treatment need in a sample of 12-13-year-old schoolchildren using the Dental Aesthetic Index (DAI), and to assess the relationship between malocclusion and socio-demographic variables, perceptions of need for orthodontic treatment, aesthetic perception and social functioning. METHOD: The sampling procedure involved a multistage, clustered and stratified random sampling. The sample comprised of 1,519 schoolchildren attending 20 secondary government and government-aided schools in urban and rural areas of Klang District in Peninsular Malaysia. There were 772 males and 747 females. Each subject was administered a questionnaire eliciting standard demographic information such as gender, parents' income and ethnic origin and questions on perception of need for orthodontic treatment and satisfaction with dental appearance and function. Intra-oral examination for occlusal status using the DAI was performed for each subject. RESULTS: Most subjects (62.6%) require no orthodontic treatment. Only about 7% had handicapping malocclusion that needed mandatory treatment. Malocclusion, as defined in this study, was found to be significantly associated with gender and subjects' area of residence. There were no significant differences in mean DAI scores for Malays, Chinese and Indian children. Significant associations were found between DAI scores and perception of need for orthodontic treatment, satisfaction with dental appearance and social functioning (P<0.01). CONCLUSION: The findings will be useful for the public dental service to determine priority for orthodontic treatment as part of the comprehensive care provided by the School Dental Service (SDS).

Adolescent↗
PubMed1999

[Pre- and post surgical orthodontic treatment of mandibular prognathism].

OBJECTIVE: To analyze the patients we treated in clinic through combined orthodontic-orthognathic surgery, and get some guidance for the future clinical work. METHODS: All 40 skeletal Class III malocclusion patients we analyzed were from joint clinic of our hospital. They aged from 17 to 38. RESULTS: The duration for presurgical orthodontic treatment was 9 months on average (2-25 months), and for postsurgical orthodontic treatment about 7.6 months on average (2-15 months). The duration for whole active treatment was 16 months on average (4-41 months). The objectives of presurgical orthodontic are: Alignment of dental arches, decompensation of anterior and posterior teeth, leveling of arches, and coordination of the width of the upper and lower arches. After presurgical orthodontic treatment, most of the patients could be treated by one piece surgery, which could simplify the surgical procedure and reduce the relapse rate of surgery. During the surgery, we modified the intermaxilary fixation wires. We used rigid rectangular stainless steel wires with Edgewise appliances as the fixation wires instead of conventional canine and molar bands with multiloop wires. The aims of the postsurgical orthodontic treatment are: closing residual spacing, extrusion of posterior teeth for correction of local openbite in premolars region, paralleling of the teeth, and adjustment of occlusion. CONCLUSION: Pre- and post-ssurgical orthodontic treatment is essential to the surgical treatment for mandibular prognathism.

Adolescent↗
PubMed2002

Pulp-test responses in orthodontic patients.

The diagnosis of orofacial pain is complicated in the orthodontic patient as treatment-induced alterations to pulpal physiology may result in altered responses to pulp-test stimuli. Thirty-three subjects commencing fixed orthodontic treatment and another 15 subjects not undergoing orthodontic treatment were used in this study. Cold and electrical stimuli were applied to the maxillary incisor teeth prior to treatment, after the placement of fixed appliances and at regular intervals for both groups for up to 252 days. At baseline, response thresholds to electric testing were typically higher for orthodontic subjects, particularly for the lateral incisors. For the non-orthodontic group, the response threshold over the 252 days was relatively constant. For the orthodontic group, application of force immediately increased the response threshold to electric pulp testing, which peaked after two months. By day 252, response means for lateral incisors still remained elevated. Responses to thermal testing were more consistent and reliable. The results of this study indicate that dental practitioners should interpret responses to electric pulp testing cautiously in orthodontic patients and that thermal testing with carbon dioxide snow may be more reliable.

Adolescent↗
PubMed2003

[The correlation between tooth pain and bioactivators changes in gingival crevicular fluid after applying orthodontic stress].

OBJECTIVE: To investigate the changes of tooth pain in patients with orthodontic tooth movement, to study the changes of bioactivators in GCF in patients with orthodontic tooth movement, and explore the correlation between pain and bioactivators in orthodontic patients. METHODS: 50 patients were included, each having one treatment tooth and one contralateral control tooth. The levels of PGE(2), P substances, IL-6 and GM-CSF in GCF of upper lateral incisor were investigated before activation and at 12th hour, 24th hour, 48th hour and 72th hour after the applying labial orthodontic force, by using highly sensitive radioimmunassay. To record the changes of pain in orthodontic patients at 12th hour, 24th hour,48th hour and 72th hour after applying stress. RESULTS: At experimental sides, total amount of GCF PGE(2), P substances(SP), IL-6 and GM-CSF levels was significantly elevated compared with that before activation. The concentration of PGE(2) and SP in GCF increased significantly and reached peak point at 24th hour in patients, while the levels of IL-6 and GM-CSF in GCF remained at higher baseline through the experiment. There was an rhythm change of periodontal pain during orthodontic tooth movement. CONCLUSION: There was an rhythm changes of pain after stress in patients with orthodontic tooth movement, and the rhythm pain was correlated to the changes of some activator such as P substances and PGE(2) in periodontal ligament.

Adolescent↗
PubMed2005

Prevalence of putative periodontopathogens in subgingival dental plaques from gingivitis lesions in Korean orthodontic patients.

The objective of this study was to detect and compare the presence of periodontopathogens in the subgingival plaques of gingivitis lesions in adults who wore fixed orthodontic appliances, as opposed to adults who did not wear any orthodontic appliances. Thirty-six individuals participated in this study. Nineteen of these subjects did not wear any orthodontic appliances, and these subjects comprised the control group. The other 17 individuals had been wearing fixed orthodontic appliances for at least 3 months each. After a periodontal examination, we collected subgingival plaque samples from the gingivitis lesions of each patient. Using PCR based on 16S rDNA, we detected the presence of 6 putative periodontopathogenic species, Treponema denticola, Porphyromonas gingivalis, Tannerella forsythia (formerly Bacteroides forsythus), Prevotella nigrescens, Prevotella intermedia, and Actinobacillus actinomycetemcomitans. With regard to the presence of individual periodontopathogens, we found that T. forsythia, T. denticola, and P. nigrescens were significantly more common in the samples obtained from the orthodontic patients than in the samples obtained from the non-orthodontic patient controls. Our results indicate that the local changes associated with the wearing of fixed orthodontic appliances may affect the prevalence of periodontopathogens in subgingival dental plaques.

DNA, Bacterial↗
PubMed2005

Malocclusion and uptake of orthodontic treatment in Taranaki 12-13-year-olds.

OBJECTIVES: To describe the occurrence of malocclusion and the uptake of orthodontic treatment among 12-13-year-olds in the province of Taranaki, New Zealand. DESIGN: Cross-sectional descriptive study using a random sample of 12-13-year-olds attending Intermediate schools. METHODS: Parents or caregivers completed a postal questionnaire. Children (N = 430; participation rate 74.1 percent) completed a questionnaire and were dentally examined. MAIN OUTCOME MEASURES: Malocclusion, using the Dental Aesthetic Index, or DAI (Cons et al, 1986), recorded by a single calibrated examiner, and the use of orthodontic services as reported by parents or caregivers. RESULTS: The mean DAI score was 28.3 (sd = 7.8). Females and non-Maori had greater mean DAI scores than males and Maori, respectively. A high proportion of the children needed orthodontic treatment (60.5 percent in the "definite", "severe" or "handicapping" categories), and 17 percent had a "handicapping" malocclusion. While over one-third of the children had been advised to seek an orthodontic consultation, a proportion (23.4 percent) did not. Of those who did, a similar proportion did not proceed with care because of financial considerations. Children of low socio-economic status (SES) were disproportionately represented in these groups. Children with "severe" or "handicapping" malocclusions who did not proceed with treatment came predominantly from low-SES households and high-deprivation areas. CONCLUSIONS: Cost was a barrier to orthodontic treatment for low-SES, high-deprivation children and Maori. Social and ethnic inequalities exist in orthodontic treatment need in Taranaki. The utilisation of orthodontic treatment appeared to be largely neither equitable nor rational.

Adolescent↗
PubMed2006

[A survey of the therapeutic reason of orthodontic patients in Luzhou].

OBJECTIVE: To investigate the therapeutic reason of orthodontic patients in Luzhou. METHODS: A questionnaire investigation was made for the following randomly chosen people: 452 teenage patients from orthodontic department of stomatology hospital affiliated to Luzhou Medical College were brought into treatment group. 600 students from Luzhou No. 2 Middle School were brought into non-treatment group. The questionnaire investigation was conducted to two groups. The results were statistically analysed with SPSS 10.0. RESULTS: (1) The main aim for orthodontic treatment was to align the teeth. (2) 37.39% of the patients accepted orthodontic treatment for parent's demand. (3) 76.1% of the patients expected to align the dentition. (4) Most people in treatment group could accept the time and expenses in the orthodontic treatment, but most people of non-treatment group could not accept the expenses in the orthodontic treatment. (5) Most people thought appearance was important. CONCLUSION: Aesthetic is the main reason for orthodontic patients.

Adolescent↗
PubMed2006

Orthodontic objectives in orthognathic surgery: state of the art today.

In treating jaw discrepancies, camouflage and surgery have different treatment modalities, often involving opposite orthodontic mechanics and different extraction decisions. Pretreatment identification of surgical patients is therefore essential. Esthetics, function, stability, and treatment time have to be considered and patients provided the information they need to be part of the decision-making process. The goal of presurgical orthodontics is to position the teeth, allowing an optimal skeletal correction at surgery. While intra-arch alignment is similar to conventional orthodontics, leveling is not carried out automatically in surgical patients. In open-bite cases, steps within the arches are an indication for segmental surgery. Orthodontic leveling will be limited to the segments, and segments will be leveled with differential intrusion at surgery. In deep-bite/short-face cases, leveling a severe curve of Spee should be done after the occlusion is unlocked by surgery. Anteroposteriorly, dental compensations are removed by ideally positioning the teeth relative to their apical bases. This will make the malocclusion look worse presurgically, but it will unravel the true magnitude of the skeletal problem, thus allowing an optimal correction at surgery. It is important to recognize if a transverse problem is skeletal or dental in nature and if the correction should be done orthodontically, by segmental surgery, or by surgically assisted palatal expansion. No orthodontic expansion should be done presurgically in a patient who will have surgical expansion. Any tooth movement with relapse potential should be avoided presurgically. Postsurgical orthodontics will bring teeth into position and proper intercuspation within a reasonable time period.

Decision Making↗
PubMed2004

[Orthodontic treatment needs and indications assessed with IONT].

The aim of this work was to determine the usefulness of the Index of Orthodontic Treatment Need (IOTN) in epidemiological studies undertaken to assess orthodontic treatment need of a given population, as well as in the process of defining indications to orthodontic treatment in individual cases with regard to objective treatment need and expressed demand for treatment. The correlation of the Aesthetic Component of IOTN (AC degree) with demand for treatment, usefulness of IOTN for screening studies, necessary modifications to make IOTN more acceptable to Polish orthodontists, and value of IOTN as a diagnostic and measuring tool for the assessment of orthodontic treatment need were addressed. The correlation between AC and demand for treatment, as well as the usefulness of IOTN in epidemiological studies were investigated with questionnaires and clinical examination using both components of IOTN (Figs. 1, 2, 3). The study group consisted of 264 schoolchildren aged 12 years. The results show that poor dental aesthetics is the main motivating factor to undertake orthodontic treatment (Tab. 1) and that demand for orthodontic treatment exceeds treatment need determined by IOTN (Tab. 2, 3). A regular distribution of AC degrees relative to the demand for treatment was obtained (Fig. 4) revealing the necessity to modify treatment need categories of this component in order to identify individuals with significant subjective treatment need. The modified aesthetic component would comprise the following treatment need categories: Grades (photographs) 1-2--"no demand for treatment"; 3-4--"borderline demand for treatment"; 5-10--"great demand for treatment". Excellent reproducibility of the Index (high values according to Kappa statistics), its universality, usefulness for various purposes, and simplicity in practice make the Index valuable for screening studies and assessment of treatment need in a given population. In order to test the reliability of the Dental Health Component of IOTN (the degree of conformity of this component with treatment tendencies among orthodontists), DHC criteria and subjective evaluation of treatment need were compared. This part of the study was carried out in a group of six orthodontists. 50 pairs of plaster casts covering a wide range of occlusal anomalies were analyzed. The subjective need for orthodontic treatment was stated for each case taking into account treatment priority and occlusal features determining treatment need. The results reveal a moderate conformity of DHC criteria with the orthodontist's opinion (Tab. 4 A, B) and a tendency among orthodontists to qualify for treatment also cases without treatment need according to IOTN recommendations. The discrepancy between the orthodontist's assessment of treatment need and DHC criteria applies mainly to cases with reverse overjet, front open bite, front or total crossbite and crowding in buccal segments of dental arches (Tab. 4 A, B). Matching the dental health component with opinions of Polish orthodontists requires shifting of some criteria from the moderate treatment need to the great treatment need category (Fig. 5).

Age Factors↗
PubMed1991

[Preprosthetic orthodontic preparation and Brånemark implants].

The patient presented an important bone loss in the edentulous area 21 to 23. The 11 had a temporary crown and a removable prosthesis has replaced the anterior missing teeth. The orthodontic treatment of this class II division 1 was to be undertaken in order to reduce the maxillary proalveolie and to line up the mandibular incisors. The difficulty of the orthodontic treatment was due to the importance of the anterior edentulous area which did not allow a continuous multiring treatment but a bilateral one and a succession of anterior removable prosthesis as anchoring points. The temporary crowns on osseointegrated fixtures replacing 22 and 23 were used to obtain the final orthodontic movements needed in the orthodontic preprosthetic treatment. However, if the fixtures had been placed at the beginning of the treatment in order to use them among other anchoring points, the complete orthodontic treatment would have been faster and much easier. At that time, our major handicap was to determine the ideal position of the fixtures which would allow the orthodontic application as well as a successful cosmetic fixed prosthesis. The use of scanner, three dimensional reconstruction Scanlam, surgical stents and fixed prosthesis with inlay cores would have brought the solution to this problem. Today, the use of osseointegrated fixtures can be applied in much more complex orthodontic movements.

Adult↗
PubMed1990

Orthodontic treatment in general dental practice in South Africa.

There is an increased demand for orthodontic treatment in South Africa and the general practitioner is showing increasing interest in implementing orthodontic treatment in private practice. The present study investigated the scope of orthodontics undertaken by the private practitioner in South Africa, in order to study the desirability of more comprehensive undergraduate training in orthodontics and continuing education for general practitioners. A questionnaire was completed by 1,012 dental practitioners. The data were analysed statistically by means of the SAS software. The results indicated that general practitioners are engaged in a wider range of orthodontic treatment modalities. The competence of the general practitioner to treat the spectrum of dental malocclusions and the ability of continuing education courses to produce "instant general-practitioner orthodontists", remains a cause for concern. Curricular restructuring requires realistic surveying of sociodemographics, including changes in birthrate and the need and demand for orthodontics in the unique South African situation, if it is to be the goal of the profession to strive for the highest standards. The educational institutions in South Africa should give attention to realistic orthodontic curricular restructuring in view of the changing dental treatment patterns currently being experienced in this country.

Education, Dental, Continuing↗
PubMed1990

[Early orthodontic treatment].

Early orthodontic treatment has recently become a subject of great interest among orthodontists since it is the result of the closest approach between the American and the European orthodontic trends. The early orthodontic treatment emerged from the better knowledge and deeper study of the philosophy of the functional, orthopedic and removable appliances as well as from the verification of their effectiveness, especially during childhood. An analysis of the term "Early orthodontic treatment" is being done in this study in contrast to the term "Early orthodontic management". Timing of orthodontic management of dentofacial deformities is quoted. The main points of a successful early orthodontic treatment as well as advantages and disadvantages, positive and negative criteria of it are mentioned.

Age Factors↗