1. PREVENTION IN ORTHODONTICS

2. PREVENTION IN ORTHODONTICS
In all medical branches the great attention is directed to prevention and prophylaxy. However in orthodontics the situation is slightly different.
The considerable variability in dentofacial development seen in child populations is the result of tissue adaptations to complex interactions of a great number of aetiological factors. The causes of malocclusion may be classified in many ways, but two major groups of aetiological factors may be distinguished:
genetic factors
non – genetic ( enviromental ) factors

3. PREVENTION IN ORTHODONTICS
It is commonly accepted that the etiology of any problem should be contained in the diagnosis.
As regards malocclusion, it is a developmental problem, not a pathologic one, and although we can say that both hereditary and enviromental factors are important influences on development, often we are not able to ascertain which malocclusions are determined largely on a genetic basis, which result largely from enviromental factors, and which are combination of hereditary and enviromental factors

4. PREVENTION IN ORTHODONTICS
The majority of patients are not easily placed in one of these categories, because a single clearly identificable agent is not apparent.
It is recognized now that multifactorial causes must be considered and sometimes the development of maocclusions may be the result of factors which are not recognizable with our present knowledge.
Therefore the prevention in orthodontic is very difficult and limited.

5. PREVENTION IN ORTHODONTICS
Prevention in orthodontics means such arrangements contributing to favourable development of the face, jaws, teeth and establishment of normal dentofacial relations.
It involves both prenatal and postnatal stages of development

6. PRENATAL PREVENTION
It consist of general arrangements providing for healthy development of the foetus.
Mother should be protected from chemicals, radiation, infections and other agents capable of damaging the embryo. These factors if given at a critical time may cause severe dentofacial defects, among which the cleft lip and palate is the most common orthodontic problem. Improper diet, faulty position of the foetus in utero or birth injury could also adversely affect the postnatal development

7. POSTNATAL PREVENTION
The majority of enviromenat causes of malocclusion are those appearing after birth.
Dental caries is an important cause of localized malocclusion. Interproximal caries which decreases the mesiodistal widths of deciduous molars may result in a forward drifting of the first permanent molars and shortening of the dental arch

8. POSTNATAL PREVENTION

9. POSTNATAL PREVENTION
More extreme carious lesions may necessitate early extraction of deciduous teeth.
This often result in pronounced migration of adjacent teeth into the extraction space and substantial loss of space for the permanent teeth. The degree and type of migration is related to:
the type of deciduous tooth extracted
the patient´s age when deciduous tooth or teeth are lost
the relative space in the dental arch
the quality of intercuspation of the molar teeth

10. POSTNATAL PREVENTION
With regard to the type of the tooth, it has been found that extraction of the second deciduous molar result in loss of space in the posterior part of the dental arch due to a mesial migration and inclination of the first permanent molar. This is more accentuated in the maxilla than in mandible

11. POSTNATAL PREVENTION
When a deciduous first molar or canine is lost prematurely, there is also tendency for the space to close.
In this case, however, space closure seems to occur primarily through distal drift of the permanent incisors.
This result not only in a tendency to crowding, but also to an asymmetry in the occlusion due to a drift of the midline to the side of tooth loss.

13. POSTNATAL PREVENTION

14. POSTNATAL PREVENTION
As regards the age factor, it has been shown that premature loss of deciduous molars after the age of 8 years only affects dental arch space to a minor degree.
If the dental arch is spaced the effects of early loss are minor, whereas if there is crowding space loss may be severe

15. POSTNATAL PREVENTION
Prevention should involve general prevention of the dental caries:
Dental hygiene training should start right after eruption of the teeth.
Right nutrition, fluoridation are also of great importance.
Where possible, carious deciduous molars, second molars in particular, should be adequately restored.
Where one first deciduous molar or deciduous canine is lost, the simplest treatment is to balance this by extraction of the corresponding tooth on the opposite side of that arch. This will prevent a shift of midline which is often one of the greatest long term problems following early loss of such a tooth. Balancing extraction for the loss of second deciduous molar is not usually indicated.

16. POSTNATAL PREVENTION
The premature loss of deciduous molars immediately leads to consideration of space maintenance.
Using space maintainers is dependent on a thorough diagnosis, and it may be modified with subsequent treatment planning.
Space maintainers may be removable or fixed.

17. POSTNATAL PREVENTION
There are number of problems associated with the use of space maintainers:
the danger of increased food stagnation and
lack of patient cooperation,
so they should be fitted only in selected cases where they will be of positive benefit to the patient.
Their use should be confined to the good, dentaly aware patient who has lost one or perhaps two deciduous molars and where it is felt that orthodontic treatment might be avoided or considerably simplified by the prevention of space loss.

18. POSTNATAL PREVENTION Thus space maintainers are not indicated for:
the patient with spacing – where space loss will not occur anyway, or
with moderate crowding – when extraction of permanent teeth and orthodontic treatment will be needed.
Where it is estimated that there is
just sufficient room for all permanent teeth or
in severely crowded case, where the extraction of the one permanent tooth from each quadrant will provide just enough space
space maintainers may offer definite advantages.

19. POSTNATAL PREVENTION

20. POSTNATAL PREVENTION
Prolonged retention of deciduous teeth can delay the eruption of its permanent successor or deviate the permanent successor from its normal course of eruption. Deflection of the permanent teeth is most commonly seen in the anterior region, where it may cause permanent incisors to erupt labially or lingually of the dental arch. In order to prevent it, the deciduous tooth should be extracted as soon as possible.

21. POSTNATAL PREVENTION

22. POSTNATAL PREVENTION Habits:
A light force applied to teeth over a prolonged period of time will change their position and alter the configuration of the alveolar process.
Such forces produced by thumb, finger or dummy sucking, lip biting, nail biting, and other habits and pressures, can displaced teeth in an unfavourable way and create malocclusion.
The severity of malocclusion is determined by the duration, frequency, and intensity of the habit and partly by the individual developmental pattern.

23. POSTNATAL PREVENTION
Dummy sucking and thumb sucking are very common in the infant but no attempt should be made to control them at this stage.
Important is the shape of the dummy. Long dummy is not suitable. In order to prevent further irregularities short dummy or dummy of special shape called NUK is preferable. This shape of the dummy beter imitate the conditions during the breast feeding. Using the dummy through day is normal in that age.
Should the habit persist into the period of deciduous dentition, a malocclusion may result

24. POSTNATAL PREVENTION
The sucking habit may involve other fingers, or the fingers may be placed in many different ways. All these variations produce their own characteristic form of dental irregularity.
Dummy sucking is less harmfull than thumb sucking as it rarely persist at the age of six when permanent incisor erupt. While thumb sucking usualy persist longer ( till the age of permanent dentition ), the pressure is greater so it may cause severe open bite. Therefore very early stop of using of a dummy is not recomended, because of risk that young and imatured child substitutes the dummy by more harmfull thumb.

25. POSTNATAL PREVENTION
The typical malocclusion seen in cases of thumb sucking is
anterior open bite
proclination of the upper incisors
a lengthening of the maxillary dental arch
anterior displacement of the maxilla and
lateral crossbite.
This habit may also obstruct the normal anterior development of lower dental arch relative to the upper, which result in distocclusion.

26. POSTNATAL PREVENTION

27. POSTNATAL PREVENTION
The anterior open bite produced by a sucking habit may initiate habitual thrusting of the tongue into the space between the upper and lower teeth.
Even if the sucking habit is terminated the unfavourable posture of the tongue may persist in these patients and preserve the vertical malocclusion.
As an adaptation to an existing malocclusion abnormal swallowing ( sometimes incorrectly refered to as infantile swallowing ) may develop. The presence of a large overjet and open bite force tongue to place between separated anterior teeth in order to perform a deglutition without food and liquids escaping from the mouth.

28. POSTNATAL PREVENTION

29. POSTNATAL PREVENTION
In these cases the active orthodontic treatment is indicated to correct the open bite. Correction of the malocclusion is usually followed by a normalisation of the swallowing pattern.

30. POSTNATAL PREVENTION
Early termination of the sucking habit means that normal dentofacial growth without interference from dummy or thumb is re-established long befor eruption of premolars and canines and open bite correct itself spontaneously.
If the child over 7 years of age persists in thumb sucking an attempt should be made to stop the habit.
As a first step, encouragement should be tried and is often successful.
Should this fail, and provided that the child is keen to stop, a simple removable appliance is often sufficient to break the habit

31. POSTNATAL PREVENTION
Oral screen is a thin shield of acrylic which lies in the buccal sulcus. In its active form it contacts only the upper incisor and contribute to correction of their proclination.
Also other kinds of removable appliances can be used.
There must be no coercion but the presence of the appliance makes the habit less satisfying.

32. POSTNATAL PREVENTION