PREVENTIVE ORTHODONTICS

Question 1

Define preventive ortho

Answer 1

Graber (1966)—has defined 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 (1980)—has defined it as prevention of potential interference with occlusal development.

Question 2

Right time to initiate preventive ortho

Answer 2

ideally during prenatal counselling

Question 3

What are some measures undertaken?

Answer 3

1. Caries control
2. Parent counseling
3. Space maintenance
4. Exfoliation of deciduous teeth (Maintain quadrant wise tooth shedding time)
5. Abnormal frenula attachments
6. Treatment of locked permanent first molars
7. Abnormal oral musculature and related habits Parent Education (and habit breaking appliance if necessary)
8. Extraction of supernumerary teeth

Question 4

What caries control measures should you apply in the following?
1. Proximal decay

Answer 4

restored accurately at early stage.

Question 5

What caries control measures should you apply in the following?
2. Pulpal involvement

Answer 5

Partial pulpectomy
pulpotomy
- followed by placement of stainless steel crown.

Question 6

What caries control measures should you apply in the following?
3. Caries initiation

Answer 6

diet counselling
topical fluoride application
pit and fissure sealants
educating parents (prenatal & postnatal)

Question 7

Explain what happens in proximal decay of deciduous teeth.

Answer 7

there is loss of arch length due to adjacent teeth shifting into proximal decay area.
( there are less problems or better prognosis if arch length loss is equal to or less then the Leeway space of nance)

Question 8

generally when should deciduous teeth on the contralateral arch exfoliate?

Answer 8

in about 3months

Question 9

What suspicions should be ruled out if teeth does not exfoliate within 3months?

Answer 9

a. Over-retained deciduous/root stumps.
b. Fibrous gingivae.
c. Ankylosed/submerged deciduous teeth to be assessed radiographically.
d. Restoration overhangs of the adjacent tooth.
e. Presence of any supernumerary tooth.

Question 10

Abnormal frenal attachments problems?

Answer 10

Diastemas and excess spacing between teeth.

surgically corrected

Question 11

What should be done in a case of locked 1st perm molar?

Answer 11

Slight distal (proximal) stripping of the deciduous second molar allows the permanent first molar to erupt in their proper place.

Question 12

How can abnormal Musculature be prevented?

Answer 12

a. 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 mandibular incisors resulting in decreased arch length and an increased chance for the developing anterior crowding.

Question 13

How can oral habits be dealt with?

Answer 13

i. Thumb/digit/lip sucking —the child can be distracted from indulging in the same.
ii. Mouth breathing—the child can be given adequate medical attention, regarding recurrent upper respiratory tract infection. Oral screens and the recently introduced myofunctional appliances such as the pre-orthodontic trainers, train the child to breathe through the nose, thus allowing the proper development of nasal passage, regression of adenoid mass and the development of a shallow, broad palate.