PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

Oral hygiene


Appliance therapy is inappropriate for patients whose oral hygiene is poor and in
general this should be improved before referring for orthodontic treatment. However,
this should not be at the expense of excessive delay in referring those patients with
more severe malocclusions who may gain some benefit from simple interceptive
measures.


Prognosis of teeth


The family dentist is in a much better position than the orthodontist to estimate the
prognosis of restored or traumatized teeth.


Radiographs


Any relevant radiographs should be forwarded with the referral to avoid unnecessary
repetition.


Key Points
Screening



  • All children should be screened for malocclusion from 8 years of age.

  • Judge the need for treatment using the Index of Treatment Need (IOTN): dental
    health and aesthetics.

  • Check the oral hygiene and attitude to treatment.

  • Refer in good time and give as much background information as possible.


14.3 EXTRACTIONS IN THE MIXED DENTITION


14.3.0 Introduction


The extraction of teeth in children may be needed as part of orthodontic treatment, or
may be necessary because of caries, trauma, or developmental anomalies. The
extraction of teeth in the mixed dentition for purely orthodontic reasons, usually
crowding, can sometimes be helpful, but managing the enforced extraction of carious
or poor quality teeth is a matter of trying to minimize disruption of the developing
dentition.


14.3.1 Extraction of primary teeth


In general, where a child has a tendency to dental crowding, the extraction of primary
teeth will worsen this as it allows the adjacent teeth to drift into the resulting space.
Usually, it is the teeth distal to the extraction that migrate forwards as a result of
mesial drift. This drifting is generally unhelpful where the extraction is enforced, but
in some situations it can be harnessed to help with the management of dental
crowding.


As there is a significant increase in the size of the arches during the mixed dentition
stage, decisions about the treatment of crowding should be deferred until the
permanent incisors have erupted for at least a year, usually at about 8 1/2 - 9 years of
age. Where there is severe crowding, the extraction of primary teeth may be

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