Prevention is not only better than cure but more stable and cheaper as well.
What is the ideal time to start orthodontic treatment?
Graber: preventive orthodontics as the action taken to preserve the integrity of what appears to be a normal occlusion at a specific time.
• Profitt and Ackermann -has defined as prevention of potential interference with occlusal development.
Interceptive orthodontics• that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex.
Preventive procedures: in anticipation of development of problemInterceptive procedures:after the problem is manifested
• The importance of deciduous dentition• Awareness about the preservation of primary teeth• The impact of primary teeth integrity on permanent teeth
• The responsibility of pedodontists• General practioners• Orthodontists
Preventive procedures1. Caries control2. Parent counselling/education3. Space maintenance4. Exfoliation of deciduous teeth5. Abnormal frenal attachments6. Treatment of locked permanent first molars7. Abnormal oral musculature and related habits8. Supernumeraries management9. Management of ankylosed teeth.
Research shows• possible corelationship between the mothers poor oraI hygiene and premature births.
Prenatal counseling may involve the following:i. The importance of oral hygiene maintenance by the mother.ii. How irregular eating and hunger pangs by the mother can result in herdeveloping decayed teeth, which can be quite painful on pulpalinvolvement, especially during the third trimester of pregnancy.ill. Recent studies have indicated a possible corelationship between the motherspoor oraI hygiene and premature births.iv. A mother suffering from pregnancy induced diabetes mellitus, would be moredifficult to manage during the pregnancy period especially if her oral hygiene ispoor.v. The increased risk of a mother suffering from poor oral hygiene transmittingthe strains of caries inducing bacteria to the baby on sharing the same feedingspoon or on tasting the food with the same are high.
Six months to One-year of AgeThis is the most important period of counseling. Theparents are made aware of:i. Teething and the associated irritation, slight loose motions are possible inmildly elevated febrile condition.ii. Most of the parents are appalled on seeing the deciduous teeth erupting inrotated positions. Awareness to be brought about as to how they are in thatposition and that they would eventually straighten out on erupting fully.iii. No sugar addition to bottle milk, however mothers milk is preferred and thebest for the TMJdevelopment as well as for non- development of tonguethrusting habits.iv. Brushing with the help of a finger brush during bathing should be introduced.Cleaning of the deciduous dentition with a clean, soft cotton cloth dipped inwarm saline is also recommended, to prevent the initiation of nursingor rampantcariesv. Child should be initiated to drinking from a glass by one year of age.
Two years of Agei. Bottle-feeding if previously initiated should never be given during the passage tosleep. Bottlefeeding to be withdrawn completely by 18 to 24months of age. These would decrease the chances of initiation of decay and thepotential for nursingcaries.ii. Brushing to be initiated post-breakfast and post dinner.iii, Clinical examination to assess any incipient decay and eruption status of teeth.
Three years of Agei. Clinical examination-generally the full compliment of deciduousdentition should have erupted by now. To assess the occlusion, molarand caninerelationships and if there is the presence of any discrepancies awayfrom the normal, e.g. unilateral cross bite ,supernumerary teeth,missing teeth, fused teeth, etc.ii. Oral habits such as thumb sucking, lip sucking, oral breathing, etc.and their effects on the development of occlusion should beconsidered.iii. To assess clinically for incomplete eruption of deciduous secondmolars/pericoronal flaps may lead to decay on the same.iv. Child to be encouraged to begin brushing on hisown at least once aday-preferably postbreakfast.
Five to Six years of Agei. Parents to be informed about the initiation of exfoliation of deciduous teeth and that it would go up to 12 to 13 years of age.ii. Clinical examination.iii. The need for constant review and recall on aregular basis.iv. In case of extraction of deciduous teeth due todecay, etc. the need, advantages and importance ofspace maintainers should be explained.
Caries controlCaries initiation can be prevented by diet counseling,topical fluoride application,pit and fissure sealantsand educating parents (prenatal counseling and postnatal counseling).
EXFOLIATION OF DECIDUOUS TEETHGenerally the deciduous teeth should exfoliate in about 3 months ofexfoliation of the one in the contralateral arch. Any delay more than thatshould be considered with suspicion and the following should be ruledout:a. Over-retained deciduous/root stumps.b. Fibrous gingivae.c. Ankylosed/submerged deciduous teeth to beassessed radiographically.d. Restoration overhangs of the adjacent tooth.e. Presence of any supernumerary tooth.
ABNORMAL FRENAL ATTACHMENTSMay cause the development of diastemas/excess spacing between theteeth, which in turn may not allow the eruption of succedaneousteeth. Surgical correction of the high frenal attachments is thereforeadvised .The tongue should also be assessed for ankyloglossia/ tongue-tie
LOCKED PERMANENT FIRST MOLARSThe permanent first molars may get locked distal to thedeciduous second molars, at times. Slight distal (proximal)stripping of the deciduous second molar allows thepermanent first molar to erupt in their proper place.
ABNORMAL ORAL MUSCULATUREa. Tongue thrusting habits or retained infantile swallow patterns are related to prolonged breast feeding or bottle feeding by the mother. The same should be withdrawn by 18-24 months of age.b. Hyperactive mentalis action results in the lingual inclination of mandibularincisors resulting in decreased arch length and an increased chance for thedeveloping anterior crowding. Oral habits suchas:i. Thumb/digit/lip sucking the child can be distracted from indulgingin the same.ii. Mouth breathing-the child can be given adequate medical attention, regardingrecurrent upper respiratory tract infection. Oral screens and the recentlyintroduced myofunctional appliances such as the pre-orthodontic trainers trainthe child to breathe through the nose, thus allowing the proper development ofnasal passage, regression of adenoid mass and the development of ashallow, broad palate.