When faced with extracting a primary tooth, practitioners must decide whether to extract the contralateral tooth for balance or a tooth in the opposing arch for compensation. This document provides guidelines for these decisions based on clinical opinion and available research. It recommends that balance extractions may be needed for early loss of primary canines or first molars in crowded arches to minimize centerline shift. Compensation is generally not recommended. Space maintainers should be considered for early loss of primary second molars or in severely crowded arches to prevent space loss and drifting of permanent teeth. More research is still needed on the consequences of early primary tooth loss.
it explain need for extraction, choice of teeth for extraction, Wilkinson extraction, extraction of permanent teeth without appliance therapy, balance extractions, compensating extractions, additional factor to consider in extraction of teeth.
it explain need for extraction, choice of teeth for extraction, Wilkinson extraction, extraction of permanent teeth without appliance therapy, balance extractions, compensating extractions, additional factor to consider in extraction of teeth.
Dental factors affecting occlusal development
The final form of the occlusion and position of the teeth exhibits a wide range of variation. The main factors responsible for producing this variation can be divided into two groups, the first group containing major factors which have a general effect on the occlusion and which play a part in the development of every occlusion.General factors affecting occlusal development 1 Skeletal factors. The size, shape and relative positions of the upper and lower jaws. 2 Muscle factors. The form and function of the muscles which surround the teeth, i.e. the muscles of the lips, cheeks and tongue. 3 Dental factors. The size of the dentition in relation to the size of the jaws.
The size of the dentition in relation to jaw size The third major factor affecting the development of the occlusion of the teeth is the relationship between the size of the dentition and the size of the jaws which have to accommodate the teeth. Ideally, there should be adequate space for the teeth to erupt into the mouth without crowding or overlap. In the primary dentition, actual overlapping of the teeth is unusual, and a disproportion between jaw size and tooth size is usually manifested as a lack of spacing rather than as actual crowding.In the permanent dentition, however, crowding of the teeth is much more common.
The etiology of dental arch crowding has been the subject of several theories. It has been suggested that there is an evolutionary trend towards a diminution in size of the jaws without a corresponding diminution in tooth dimensions. It has also been suggested that dietary factors may be involved, the modern diet needing less chewing and therefore providing less stimulus to jaw growth than the more primitive diets. There is little evidence to support this theory. A further theory postulates that present-day populations represent a mixture of peoples from various ethnic backgrounds, and such interbreeding of people with different physical characteristics leads to skeletal and dental disharmonies.
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
This presentation describe the evaluation of badly damaged teeth for crowning before starting RCT treatment, because the treatment of such teeth is always achieved by crowning otherwise they will end for extraction. All the necessary procedures to save the damaged teeth are discussed in the context of restoring function, aesthetic and mechanical qualities. Evaluation of any case based on scientific data will insure durability and patient satisfaction.
Autotransplantation of Tooth in Children with Mixed DentitionAbu-Hussein Muhamad
Autotransplantation of tooth in children is the surgical movement of a tooth from one place in the mouth to another
in the similar individual. Once thought to be uncertain, autotransplantation has achieved high success rates and is an
outstanding option for tooth replacement in children. Although the indications for autotransplantation are narrow, careful
patient assortment coupled with a suitable method can lead to exceptional esthetic and useful results. One benefit of
this procedure is that placement of an implant-supported prosthesis or other form of prosthetic tooth replacement is
not needed. A review of the recommended surgical technique as well as success rates is also discussed.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Extraction of primary teeth balance and compensation
1. EXTRACTION OF PRIMARY TEETH - BALANCE AND COMPENSATION
Introduction
When a practitioner is faced with enforced extraction of a primary tooth it is often a
dilemma whether to merely remove the unsaveable tooth , to extract a contralateral tooth
from the same arch (balance), or to extract a tooth from the opposing arch
(compensation). The following guidelines are intended to assist in making such a
decision and to minimise the effect of space loss on the developing dentition. There have
been no properly controlled prospective randomised studies into the consequences of
early loss of primary teeth, probably due to the difficulty of recruiting subjects for such
studies and the need to follow them for up to 10 years. The recommendations given are
therefore based partly upon current clinical opinion, although this is supported where
possible by the best available research data. There is a need for more research in the
area.
Consideration must always be given to the overall dental health and history of the child,
which may over-ride purely orthodontic advice.
1. Definitions
1.1 Balance enforced extractions
A balancing extraction is a tooth from the opposite side of the same arch,
designed to minimise centreline shift.
1.2 Compensate enforced extractions
Compensation means extraction of a tooth from the opposing quadrant to the
enforced extraction. It is designed to minimise occlusal interferance by allowing
teeth to maintain occlusal relationships as they drift. It is more difficult to justify
compensation than balance, especially when it would involve removal of a tooth
from an intact arch.
2. Recommendations
C> 2.1 Radiographic screening is highly desirable before extracting primary molars to
check for the presence, position and correct formation of the crowns and roots of
successional teeth. Potential problems indicate the need to seek an orthodontic
opinion before teeth are removed.
2.2 Loss of primary incisors – Early loss of primary incisors has little effect upon the
B> permanent dentition although it does detract from appearance. It is not necessary
to balance or compensate the loss of a primary incisor.
2. 2.3 Loss of primary canines and first molars – Early loss of a primary canine in all
but spaced dentitions is likely to have most effect on centre lines. The more
B> crowded the dentition, the more the need for balance.
With regard to a primary first molar, a balancing extraction may be needed in a
crowded arch1
. Compensation is not needed. In the event that unbalanced
extraction of a primary canine or first molar has already occurred, one of three
situations will apply.
• No centreline shift. Do not balance.
• Centreline shift with complete space closure. Delay balancing until a full
orthodontic assessment is made.
• Centreline shift with spacing remaining mesial to the extraction site. Monitor to
determine whether tooth movement is continuing: if so seek orthodontic advice.
2.4 Loss of primary second molars – There is no need to balance the loss of a
primary second molar because this will have no appreciable effect on centreline
B> coincidence3
. However this extraction may allow serious forward movement and
tilting of the adjacent first permanent molar. Therefore when a primary
second molar has to be extracted consideration should be given to fitting
a space maintainer.
B> 2.5 Space maintainer - A tooth is the ideal space maintainer and every effort should
be made to retain primary molars until the proper time for their natural loss. The
decision to fit a space maintainer after enforced extraction must be arrived at by
balancing the occlusal disturbance that may result if one is not used against the
plaque accumulation and caries that the appliance may cause and poor oral
hygiene is a contraindication . Space maintenance is most valuable in two
situations.
• Loss of a primary first molar where crowding is severe, i.e. more than 3.5mm
(half a unit) per quadrant. In this situation space loss due to drift may be so
severe that the extraction of one premolar may be insufficient to relieve resultant
crowding so that subsequent orthodontic treatment is more difficult.
• Loss of a primary second molar, except in spaced arches.
2.5.1 Types of space maintainer
A tooth - even badly decayed primary molars can often be restored for a
few years2
.
Band and loop - the design of choice for a single tooth space.
Lingual or palatal arch - best for bilateral spaces. Studies have shown a lingual
arch to be very effective for maintaining arch perimeter 4,5
.
Upper removable appliance - avoid unless the appliance can be used also for
active orthodontic treatment.
3. Explanatory Notes
1. Normal Occlusal Development
1.1 The teeth of the first dentition are sometimes described as temporary or deciduous
teeth, to be shed like the leaves of a tree and therefore of only passing importance.
This is incorrect and short-sighted since the primary teeth, have a vital role to
play in maintaining the dimensions and form of the dental arches during eruption
of the permanent dentition.
1.2 The primary dentition
There is much natural variation in occlusal development. However three features
indicative of good development are incisor spacing 6
, anthropoid spaces mesial
to the maxillary primary canines and distal to the mandibular canines7
and
straight or mesial step primary second molar occlusion8,9
.
1.3 First permanent molar eruption
A> Class I molar relationship is the basis upon which a fully intercuspated Class I
occlusion is built 10,11
. Development of Class 1 occlusion depends on the primary
molars remaining in position until the correct time so that unwanted movements
of permanent teeth are prevented.
2. Effects of Premature Tooth Loss
Early loss of a primary incisor has little effect upon the permanent dentition
although it does detract from appearance.
Early loss of primary canines or molars is more serious, since space loss may
A> follow. In each quadrant the primary canine and molars together are larger than
the succeeding permanent canine and premolars, the difference in tooth sizes
between the two dentitions being the Leeway space 11
. This can be assessed
with reasonable accuracy by the size difference between first and second primary
molars, since the primary first molar is equal in size to the premolar that will
replace it, while the primary second molar is much larger than the second
premolar. For this reason the Leeway space is also known as the E space.
Extraction of a primary canine or molar may cause mesial drift of teeth behind the
space and distal drift of anterior teeth, with resultant displacement of permanent
teeth and centreline disturbance.
4. 2.1 Factors affecting space loss
Three factors are important.
• Degree of crowding is directly related to the rate and extent of space loss after
primary tooth extractions.
• Type of tooth lost. Loss of one primary canine may cause centreline shift. Loss
of a primary molar, especially the second may allow mesial drift of the first
permanent molar.
• Age of child. The earlier a tooth is lost, the greater the opportunity for drift.
3. Space Analysis
British dentists have a rather casual attitude to the possible consequences of the
extraction of primary molars. In the United States the approach to space
management is more careful and standard American textbooks stress the
importance of space analysis when planning treatment in the mixed dentition 6,12
.
Methods include:
• Observation of erupting permanent incisors. By the time that the permanent
incisors reach full eruption the space available to accommodate them is at its
greatest. In particular intercanine width is fixed so that incisor crowding can only
worsen 13
.
• Exfoliation of a primary canine during eruption of the permanent lateral incisor
is a sign of severe crowding.
• Mixed dentition analysis (MDA). This is quick and easy to do and gives an
accurate assessment of future crowding by using the sizes of the erupted lower
permanent incisors to predict those of the unerupted permanent canines and
premolars 8
.
5. References
1. Proffit WR (1993) Contemporary orthodontics 2nd edn. Mosby Year Book Inc,
p197-204
2. Roberts JF (1996) Treatment of vital and non-vital primary molar teeth by one
stage formocresol pulpotomy: clinical success and effect upon age of exfoliation.
International Journal of Paediatric Dentistry 6: 111-116.
3. Avramaki E and Stephens CD (1988) The effect of balanced and unbalanced
extraction of primary molars on the relationship of incisor centre lines- A pilot
study. Journal of Paediatric Dentistry 4: 9-12.
4. Foster TD and Hamilton MC (1969) Occlusion in the primary dentition. British
Dental Journal 126: 76-79
5. Baume LJ (1950) Physiological tooth migration and its significance to the
development of occlusion. Journal of Dental Research 29:132-133, 331-348, 440-
447.
6. Ravn JJ (1975) Occlusion in the primary dentition in three year old children.
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