Orthodontics

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Orthodontics

Orthodontics (or orthodontia) is a specialty of dentistry that is concerned with the study and treatment of malocclusions, 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 "Dento-Facial Orthopaedics". 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).

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. 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 14) 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 ocllusion.

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 and 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

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, Master of Public Policy - MPP or Master of Public Health - MPH)) in addition to a specialty certificate.

The orthodontist will align teeth with respect to the surrounding soft tissues, with or without movement of the underlying bones (which can be moved either through orthopedic or orthognathic movements). Orthopedic movement of the jaws is attained through growth modification of one or both jaws of growing children only. Several applainces are utilized for this; including functional appliances, headgear, facemasks, and elastics. Orthopedic appliances can influence the development of an adolescent's profile and give an improved aesthetic and functional result.

Orthognathic movement of the jaws is achieved by surgery. This repositioning of the jaw(s) is performed on patients who have completed their growth. Such surgical treatment is carried out by maxillofacial surgeons who work closely with the orthodontic team.

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 fitted in the case of an overbite to help prevent the occurrence of 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 of multifactorial in origin (that is having a number of possible etiologic agents).

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.

In the United Kingdom, this training period lasts three years, after completion of a fellowship diploma from a Royal College. 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.

Canada

Currently, speciatly 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.

Pakistan

Orthodontic education in Pakistan is run under the Semi-autonomus organization College of Physicians and Surgeons they confer a fellowship degree after three years of training under an accredited supervisor in an approved institution.

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^*.