Orthodontics

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Orthodontics is a specialty of dentistry that is concerned with the study and treatment of malocclusions (improper bites), which may be a result of tooth irregularity, disproportionate jaw relationships, or both.

Orthodontic treatment can focus on dental displacement only, or can deal with the control and modification of facial growth. In the latter case it is better defined as "dentofacial orthopedics". Orthodontic treatment can be carried out for purely aesthetic reasons - improving the general appearance of patients' teeth and face for cosmetic reasons- but treatment is often prescribed for practical reasons, providing the patient with a functionally improved bite (occlusion).

1 History
2 Treatments
3 Orthodontists
4 Diagnosis and treatment planning
- 4.1 Occlusion and Malocclusion
- 4.2 Malocclusion is not a disease
5 Training
6 References
7 See also
8 External links

[edit] History

[edit] Treatments

If the main goal of the treatment is the dental displacement, most commonly a fixed multibracket therapy is used. In this case orthodontic wires are inserted into dental braces, which can be made from stainless steel or a more esthetic ceramic material.

Dental braces, with a powerchain, removed after completion of treatment. Administered by Dr. Leonard Weiss, Toronto.

Also removable appliances, or "plates", headgear, expansion appliances, and many other devices can be used to move teeth. Functional and orthopaedics appliances are used in growing patients (age 5 to 13) with the aim to modify the jaw dimensions and relationship if these are altered. (See Prognathism.) This therapy is frequently followed by a fixed multibracket therapy to align the teeth and refine the occlusion.

Image:ClockFace Retainers.jpg

After a course of active orthodontic treatment, patients will often wear retainers, which will maintain the teeth in their improved position whilst the surrounding bone reforms around them. The retainers are generally worn full-time for a short period, perhaps 6 months to a year, and then worn periodically (typically nightly during sleep) for as long as the orthodontist recommends. It is possible for the teeth to stay aligned without regular retainer wear. However, there are many reasons teeth will crowd as a person ages; thus there is no guarantee that teeth, orthodontically treated or otherwise, will stay aligned without retention. For this reason, many orthodontists recommend periodic retainer wear for many years (or indefinitely) after orthodontic treatment.

[edit] Orthodontists

An orthodontist is a dentist who specializes in diagnosing and treating malocclusions, which are mis-alignments of the teeth, jaws, or both. Following dental school, an orthodontist completes 2-3 years of full-time additional training under the direct supervision of experienced orthodontists. If they pass the training, they receive a specialty certificate in orthodontics. In many orthodontic training programs, students can also earn a master's degree (Master of Science - MS; Master of Dental Science - MDS, Master of Science in Dentistry - MSD, Master of Medical Science - MMSc in addition to a specialty certificate.

The orthodontist will align the teeth with respect to the surrounding soft tissues, with or without movement of the underlying bones, which can be moved either through growth modification in children or jaw surgery in adults. Several appliances are utilized for growth modification; including functional appliances, headgear, and facemasks. These "orthopedic appliances" may influence the development of an adolescent's profile and give an improved aesthetic and functional result.

One of the most common situations leading to orthodontic treatment is crowding of the teeth. In this situation, there is insufficient room for the normal complement of adult teeth, which can sometimes result in teeth being extracted. Crowding of teeth is recognised as an affliction that stems in part from a modern western lifestyle. We do not know for sure whether it is due to the consistency of western diets; a result of mouthbreathing; or the result of an early loss of deciduous (milk, baby) teeth due to decay. It is also possible that Homo sapiens have evolved smaller jaws without a reduction in the number of teeth they will house happening at the same time. Orthodontics is not always for aesthetic purposes. Braces may be prescribed in cases of so-called "overbite" to help prevent teeth being knocked out in an accident, for example, hockey or skating.

Much has been made in the media of links between tooth extraction and temporo-mandibular joint dysfunction (problems, including clicking and jamming, of the jaw joint). No research has shown a definitive link between orthodontic treatment, extraction of teeth and jaw joint problems. Most temporo-mandibular joint problems are multifactorial in origin (that is having a number of possible etiologic agents).

[edit] Diagnosis and treatment planning

In diagnosis and treatment planning, the orthodontist must (1) recognize the various characteristics of malocclusion and dentofacial deformity; (2) define the nature of the problem, including the etiology if possible; and (3) design a treatment strategy based on the specific needs and desires of the individual. (4) present the treatment strategy to the patient in such a way that the patient fully understands the ramifications of his/her decision. <ref>T. M. Graber, R.L. Vanarsdall, Orthodontics, Current Principles and Techniques, "Diagnosis and Treatment Planning in Orthodontics", D. M. Sarver, W.R. Proffit, J. L. Ackerman, Mosby, 2000 </ref>

[edit] Occlusion and Malocclusion

A major goal of comprehensive orthodontic treatment is improving the patient's bite, or occlusion. "Occlusion of the teeth means the meeting together of upper and lower teeth." [J.W. Osborn, Dental Anatomy and Embryology, p.299, Blackwell Scientific Publications,1981, Vol. 1, Book 2.]

Malocclusion is the term used to describe states in which the bite departs from the normal and this may occur in any one or more of three planes of space. The best known classification system for describing malocclusion is that of E.H. Angle, but his terminology is limited to one plane of space (the anterior-posterior dimension). In Angle's classification, an occlusion is normal if and only if the molars are in "Class I" positions.

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[edit] Malocclusion is not a disease

Malocclusion is not a disease, but it might be associated with various dysfunctions of the head and neck, known as Cranio-Mandibular Dysfunctions, or CMD. Dysfunction of an organ or organ system is defined as disease. Some dentists, therefore, believe that orthodontists can prevent or treat certain diseases of the head and neck by means of treating specific occlusal dysfunctions.

[edit] Training

Various countries have their own systems for training and registering specialist orthodontists; generally a period of full-time post-graduate study is required for a dentist to qualify as an orthodontist. The orthodontic specialty is the earliest dental specialty.

[edit] Canada

Currently, specialty programs in orthodontics (3 year M.Sc. or M.Cl.D.) are offered at five Canadian universities: the Université de Montréal, the University of Manitoba, University of Toronto, the University of Alberta, and the University of Western Ontario. Students are trained to handle complex cases while completing a research project in orthodontics. The programs are accredited by the Council on Education of the Canadian Dental Association. Certification requirements set by the Royal College of Dental Surgeons of Ontario and the Royal College of Dentists of Canada are also met by these three programs. Post-graduate orthodontic studies in Canada requires at least two years and most orthodontic programs offer a three-year Master program.

[edit] United Kingdom and Europe

In the United Kingdom, this training period lasts three years, after completion of a membership from a Royal College. A further two years is then completed to train to consultant level, after which a fellowship examination from the Royal College is sat. In Europe a similar pattern is followed. It is always worth contacting the professional body responsible for registering orthodontists to ensure that the orthodontist you wish to consult is a recognized specialist.

[edit] United States

A number of medical and dental schools in the United States offer advanced education in the specialty of Orthodontics to dentists seeking postgraduate education. The courses range from two to three years of full-time classes and clinical work in the clinical and theoretical aspects of orthodontics. Generally, admission is based on an application process followed by an extensive interviewing process by the institution, in order to select the best candidate. Candidates usually have to contact the individual school directly for the application process. A list of orthodontic schools can be obtained from the American Association of Orthodonitists[1].