Preventive orthodontic

 Contents
 Preventive orthodontic
 Why the need for preventive
orthodontic ?
 The procedures undertaken in
preventive orthodontics

 Preventive orthodontic
Is that part of orthodontic practice which is concerned with
patient and parents education , supervision of growth and
development of dentition and craniofacial structures , the
diagnostic procedures undertaken to predict of malocclusion and
treatment procedures instituted to prevent the onset of
malocclusion

Why the need for preventive orthodontics ?

Preventive orthodontic provide dental professionals with a way to identify and
intercept teeth problems in children , that when caught early enough , help to
avoid more aggressive treatment later on

The procedure undertaken in preventive orthodontics

 Parent education
 Caries control
 Care of deciduous dentition
 Extraction of supernumerary teeth
 Occlusal equilibration
 Maintenance of tooth shedding time
 Management of ankylosed teeth
 Management of abnormal frenal attachment
 oral habit check up
 Deeply locked permanent first molars
 Space maintenance
 Parents education
Knowledge of preventive dentistry for the parents especially mothers should
ideally begin during prenatal period as this is the time they are most encouraged
about the well being of the un born child and should continue till at least 6 years
of age after which focus shift on child dental education

7. Prenatal education

Postnatal education
This is the more age specific and can be divided into 4 types :- 
Birth to one years of age:-
This is the most important period of counseling
 Stress on brest feeding
 Bottle feeding with high sugar exposures should be avoided

Soon after birth the mother should be educated on proper nursing and care of
the child . It is thought that breast feeding may be beneficial for jaw
development , as sucking involves mandibular movement and the tongue
exerting upward and outward forces on the mother’s breast, which the infant’s
pre maxillary region,

while posterior acting forces of the buccinators during

bottle feeding , pacifier use and digit sucking oppose
forward acting forces of sucking during breast feeding

 In case the child is being bottle fed , the mother is

advised on the use of physiologic nipple and not the
conventional nipple
 Gum pads and newly erupted teeth should be cleaned with clean , soft cotton
cloth dipped in warm saline
 Gradual progression should be made from cloth cleaning to finger brush
without the use of dentifrices
 One to three years of age :-
 Importance of weaning
 Bottle feeding should be withdrawn completely by 18 to 24 months of age
 Brushing should be initiated twice in a day
 Parents should be taught the correct method of brushing the teeth as this age
they have to brush their children’s teeth
  3-6 years of age :-
 The parent should informed about the effect of oral habits on the
development of malocclusion
 The parents should encourage the child to begin brushing on his own at least
once a day

  6 years onward of age :-

 The parents should be informed about the initiation of exfoliation of
deciduous teeth and eruptive pattern of permanent teeth
 Parents should be educated about the need for constant review and recall on
regular basis
 In case of extraction of deciduous teeth due to decay or any other cause then
the importance of space maintainers should be explained to the parents

 Caries control Caries in proximal surface of deciduous teeth if not restored lead
to loss of arch length by movement of adjacent teeth into the space

 Caries control
Diet counseling
Topical fluoride
Pit and fissure sealant

Care of deciduous teeth

 All effort should be made to prevent early loss of deciduous dentition by the
way of caries prevention and timely restoration of caries teeth
 Deciduous teeth by themselves act as natural space maintainer , which not
only maintain the space for their succeeding permanent teeth but also guide the
teeth in their proper position in dental arch

Consequence of premature loss of deciduous teeth

Extraction of supernumerary teeth
 Their prevalence range between 0.3 and 0.8 percent in primary dentition and
0.1- 3.8 percent in the permanent dentition with more predilection in male and
anterior region
Occlusal Equilibration All functional prematurities should be eliminated as they
can lead to deviations the mandibular path of closure and also predispose to
bruxism
Management of deeply locked permanent first molar
The deciduous second molars occasionally have prominent distal bulge which
prevent the eruption of first permanent molars
Maintenance of tooth shedding time table

There should not be more than 3 months difference in shedding of deciduous

teeth and eruption of permanent teeth in one quadrant as compared to other
quadrants , delay in eruption may be due to one of the following factors:-

Management of ankylosed teeth

Management of abnormal frenal attachement
The presence of a thick and fleshy maxillary labial frenum that is attached
relatively low prevent the maxillary central incisor from approximating each
other

28. Presence of ankyloglossia or tongue tie prevent normal functional

development due to lowered position of the tongue and abnormalities in speech
and swallowing
29. Surgical correction of tongue tie
30. Oral habit check up and education

31. Space Maintainers
32. Objective of space maintenance
 Preservation of space
 Preservation of the integrity of dental arches
 Preservation of normal occlusal plane
 In case of anterior space maintenance , it should aid in esthetics and
phonetics
33.  Time elapsed since loss of tooth:- Maximum loss of space occurs within 2
weeks to 6 months of the premature loss of deciduous tooth

34.  Stage of root formation :- The developing tooth buds begins to erupt
actively if root is three-fourth formed

35.  Thickness of bone covering the unerupted teeth:- According to Mc

Donald 1mm of bone resorbs in 4 to 5 months and so if the bone is present over
the succedaneous tooth it is an indication for space maintainer
36.  Delayed eruption of permanent teeth:- Over retained or ankylosed
primary teeth or impacted permanent teeth, can result in delay of eruption
process with the removal of these types of primary teeth an appliance may be
needed to hold the space until the permanent tooth erupt

37. Types of space maintainers  Removable

 38. Fix space maintainers

39. Thank you
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