When it comes to pediatric orthodontics, selecting the right type of archwire is crucial for effective dental movement and treatment success. Various types of archwires are commonly used, each with its unique properties and applications.
The first type is the stainless steel archwire. Renowned for its strength and durability, stainless steel archwires are often used in the initial stages of treatment. They provide the necessary force to move teeth into their desired positions. Their rigidity ensures that they can withstand the stresses of orthodontic treatment, making them a reliable choice for young patients.
Another popular option is the nickel-titanium (NiTi) archwire. Known for its flexibility and shape memory, NiTi archwires are particularly useful in the early phases of treatment. They exert a gentle, continuous force on the teeth, which helps in aligning them gradually. This makes NiTi archwires ideal for younger patients who may have more sensitive teeth and gums.
Copper nickel-titanium (CuNiTi) archwires are another variation worth mentioning. These archwires combine the flexibility of NiTi with the added benefit of copper, which can enhance the wire's properties. CuNiTi archwires are often used in cases where a bit more force is needed to achieve the desired tooth movement.
Lastly, there are beta-titanium (TMA) archwires. These are known for their excellent flexibility and formability. TMA archwires are typically used in the later stages of treatment when more precise tooth movements are required. Their resilience makes them suitable for fine-tuning the positions of teeth.
In summary, the choice of archwire in pediatric orthodontics depends on the specific needs of the patient and the stage of treatment. Stainless steel, NiTi, CuNiTi, and TMA archwires each play a vital role in ensuring that young patients achieve the best possible outcomes in their orthodontic journey.
Certainly! Here's a short essay on how archwires apply force to move teeth during orthodontic treatment, focusing on their influence on dental movement:
Orthodontic treatment often involves the use of archwires, which play a crucial role in applying the necessary forces to move teeth into their desired positions. Understanding how these archwires work is essential for both patients and practitioners.
Archwires are thin, flexible metal wires that are attached to the brackets placed on the teeth. They serve as the medium through which the orthodontist applies controlled forces to the teeth. These forces are carefully calibrated to ensure that teeth move gradually and safely into alignment.
When an archwire is placed in the brackets, it exerts pressure on the teeth. This pressure creates a force that is transmitted through the periodontal ligament, a fibrous tissue that connects the tooth to the jawbone. The force applied by the archwire causes the periodontal ligament to stretch or compress, depending on the direction of the applied force.
This stretching or compressing of the periodontal ligament initiates a biological response in the surrounding bone. Osteoclasts, cells responsible for breaking down bone, become active on the side of the tooth where the ligament is compressed. Conversely, osteoblasts, cells that build new bone, are stimulated on the side where the ligament is stretched. This process, known as bone remodeling, allows the tooth to move gradually through the jawbone.
The type of movement achieved with archwires can vary. For example, round wires are often used in the initial stages of treatment to level and align the teeth. As treatment progresses, rectangular wires may be introduced to exert more precise control over tooth movement, allowing for tipping, rotation, and bodily movement of the teeth.
Moreover, the material of the archwire can influence the type and magnitude of force applied. Stainless steel wires provide strong, consistent forces, while nickel-titanium wires offer a more flexible and gentle force, which is beneficial in the early stages of treatment.
In summary, archwires are instrumental in orthodontic treatment, applying controlled forces to move teeth through the process of bone remodeling. The choice of wire type and material is tailored to the specific needs of each patient, ensuring effective and efficient dental movement.
The importance of proper archwire selection for effective dental movement in children is a critical aspect of orthodontic treatment. This process involves choosing the right type of archwire to achieve the desired tooth movement while ensuring patient comfort and treatment efficiency.
Firstly, the material of the archwire plays a significant role. Commonly used materials include stainless steel, nickel-titanium, and beta-titanium. Stainless steel archwires are known for their strength and formability, making them ideal for the final stages of treatment where precise tooth positioning is crucial. Nickel-titanium archwires, on the other hand, offer excellent flexibility and are often used in the initial stages to align teeth gently. Beta-titanium archwires provide a balance between flexibility and strength, making them suitable for various stages of treatment.
Secondly, the cross-sectional dimensions of the archwire-whether round, rectangular, or square-affect the type of tooth movement. Round wires are typically used in the early stages to initiate tooth alignment due to their flexibility. Rectangular wires offer more control over tooth rotation and torque, which are essential in the later stages of treatment.
Moreover, the sequence of archwires used throughout the treatment is vital. Starting with a more flexible wire and gradually transitioning to stiffer ones allows for gradual and controlled tooth movement. This staged approach minimizes discomfort and reduces the risk of root resorption, a potential complication in orthodontic treatment.
In conclusion, the careful selection of archwires based on material, dimensions, and sequence is fundamental to achieving effective dental movement in children. It ensures not only the success of the orthodontic treatment but also the overall well-being and comfort of the young patient.
Certainly! When it comes to using archwires in young patients for orthodontic treatment, there are several common challenges and considerations that practitioners must keep in mind. Archwires play a crucial role in guiding the movement of teeth to achieve the desired alignment and bite correction. However, working with younger patients introduces unique factors that can influence the effectiveness and efficiency of treatment.
One of the primary challenges is the ongoing growth and development of a child's jaw and facial structure. Unlike adults, whose skeletal growth is largely complete, young patients experience continuous changes in their jaw size and shape. This dynamic environment can affect how teeth respond to the forces applied by the archwire. Orthodontists must carefully plan treatments that accommodate these growth patterns to ensure optimal results.
Another consideration is the cooperation and compliance of young patients. Orthodontic treatment requires regular adjustments and maintenance, which can be more challenging with children who may not fully understand the importance of adhering to the treatment plan. Ensuring that both the child and their parents are well-informed and motivated is essential for the success of the treatment.
Comfort and oral hygiene are also significant factors. Younger patients may experience more sensitivity and discomfort as their teeth move, which can lead to reluctance in wearing the archwires as prescribed. Additionally, maintaining good oral hygiene can be more difficult with braces, and young patients may need extra guidance and encouragement to keep their teeth and appliances clean to prevent issues like decalcification and gum disease.
Lastly, the psychological impact of wearing braces cannot be overlooked. Young patients may feel self-conscious about their appearance, which can affect their confidence and social interactions. Orthodontists should address these concerns empathetically, providing support and reassurance throughout the treatment process.
In conclusion, using archwires in young patients presents unique challenges that require careful consideration of growth patterns, patient cooperation, comfort, oral hygiene, and psychological well-being. By addressing these factors, orthodontists can help ensure a successful and positive orthodontic experience for their young patients.
Certainly! Here's a short essay on the role of orthodontists in monitoring and adjusting archwires throughout treatment:
Orthodontists play a crucial role in the dynamic process of monitoring and adjusting archwires throughout orthodontic treatment. This continuous oversight ensures that the treatment progresses effectively and achieves the desired dental alignment and bite correction.
From the initial stages of treatment, orthodontists carefully select the appropriate type and size of archwire based on the patient's specific dental needs and the stage of treatment. As the treatment advances, regular appointments are scheduled to assess the progress and make necessary adjustments.
During these appointments, orthodontists evaluate the tension and position of the archwires. They look for signs of effective tooth movement, such as gradual alignment and proper spacing. If the teeth are not moving as expected, the orthodontist may need to replace the archwire with a different type or size to apply the correct amount of force.
Moreover, orthodontists are vigilant about patient comfort. They ensure that the archwires are not causing excessive discomfort or irritation. If a patient reports pain or if the orthodontist notices signs of irritation, adjustments are made promptly to alleviate any issues.
In addition to physical adjustments, orthodontists also provide guidance and education to patients about proper oral hygiene practices. This is essential because archwires can complicate cleaning routines, and maintaining good oral health is vital throughout the treatment process.
In summary, the role of orthodontists in monitoring and adjusting archwires is fundamental to the success of orthodontic treatment. Their expertise ensures that each patient receives personalized care, leading to optimal dental movement and a healthy, beautiful smile.
In orthodontic treatment, the influence of archwires on dental movement is profound. However, achieving successful outcomes also relies heavily on patient compliance and the maintenance of archwires. These elements are crucial, as they directly affect the efficacy of the orthodontic intervention.
Patient compliance refers to the degree to which a patient follows the recommendations and guidelines provided by their orthodontist. This includes attending scheduled appointments, adhering to prescribed adjustments, and maintaining good oral hygiene. Compliance is vital because it ensures that the treatment progresses as planned. When patients fail to comply, it can lead to delays, complications, or even the need for additional treatment.
One of the key aspects of patient compliance is the maintenance of archwires. Archwires are instrumental in applying the necessary forces to move teeth into their desired positions. However, these wires can become bent, broken, or dislodged if not properly cared for. Patients must be diligent in avoiding hard or sticky foods that can damage the wires and must also be cautious during oral hygiene routines to prevent accidental bending or displacement.
Regular check-ups are essential for monitoring the condition of the archwires and making necessary adjustments. During these visits, the orthodontist can ensure that the wires are functioning correctly and make any needed modifications to keep the treatment on track. Additionally, patients should be educated on recognizing signs of wire issues, such as discomfort or changes in fit, and be encouraged to report these promptly.
In conclusion, while archwires play a critical role in dental movement, the success of orthodontic treatment is equally dependent on patient compliance and the diligent maintenance of these wires. By fostering a collaborative relationship between the patient and orthodontist and emphasizing the importance of these practices, we can enhance the likelihood of achieving optimal treatment outcomes.
| Crossbite | |
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| Unilateral posterior crossbite | |
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In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]
An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).
An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.
An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.
Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.
An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]
Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to
Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child
A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.
One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]
Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]
Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]
Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]
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| Part of a series on Patients |
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A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care provider.
The word patient originally meant 'one who suffers'. This English noun comes from the Latin word patiens, the present participle of the deponent verb, patior, meaning 'I am suffering', and akin to the Greek verb πάσχειν (paskhein 'to suffer') and its cognate noun πάθος (pathos).
This language has been construed as meaning that the role of patients is to passively accept and tolerate the suffering and treatments prescribed by the healthcare providers, without engaging in shared decision-making about their care.[1]
An outpatient (or out-patient) is a patient who attends an outpatient clinic with no plan to stay beyond the duration of the visit. Even if the patient will not be formally admitted with a note as an outpatient, their attendance is still registered, and the provider will usually give a note explaining the reason for the visit, tests, or procedure/surgery, which should include the names and titles of the participating personnel, the patient's name and date of birth, signature of informed consent, estimated pre-and post-service time for history and exam (before and after), any anesthesia, medications or future treatment plans needed, and estimated time of discharge absent any (further) complications. Treatment provided in this fashion is called ambulatory care. Sometimes surgery is performed without the need for a formal hospital admission or an overnight stay, and this is called outpatient surgery or day surgery, which has many benefits including lowered healthcare cost, reducing the amount of medication prescribed, and using the physician's or surgeon's time more efficiently. Outpatient surgery is suited best for more healthy patients undergoing minor or intermediate procedures (limited urinary-tract, eye, or ear, nose, and throat procedures and procedures involving superficial skin and the extremities). More procedures are being performed in a surgeon's office, termed office-based surgery, rather than in a hospital-based operating room.
An inpatient (or in-patient), on the other hand, is "admitted" to stay in a hospital overnight or for an indeterminate time, usually, several days or weeks, though in some extreme cases, such as with coma or persistent vegetative state, patients can stay in hospitals for years, sometimes until death. Treatment provided in this fashion is called inpatient care. The admission to the hospital involves the production of an admission note. The leaving of the hospital is officially termed discharge, and involves a corresponding discharge note, and sometimes an assessment process to consider ongoing needs. In the English National Health Service this may take the form of "Discharge to Assess" - where the assessment takes place after the patient has gone home.[2]
Misdiagnosis is the leading cause of medical error in outpatient facilities. When the U.S. Institute of Medicine's groundbreaking 1999 report, To Err Is Human, found up to 98,000 hospital patients die from preventable medical errors in the U.S. each year,[3] early efforts focused on inpatient safety.[4] While patient safety efforts have focused on inpatient hospital settings for more than a decade, medical errors are even more likely to happen in a doctor's office or outpatient clinic or center.[citation needed]
A day patient (or day-patient) is a patient who is using the full range of services of a hospital or clinic but is not expected to stay the night. The term was originally used by psychiatric hospital services using of this patient type to care for people needing support to make the transition from in-patient to out-patient care. However, the term is now also heavily used for people attending hospitals for day surgery.
Because of concerns such as dignity, human rights and political correctness, the term "patient" is not always used to refer to a person receiving health care. Other terms that are sometimes used include health consumer, healthcare consumer, customer or client. However, such terminology may be offensive to those receiving public health care, as it implies a business relationship.
In veterinary medicine, the client is the owner or guardian of the patient. These may be used by governmental agencies, insurance companies, patient groups, or health care facilities. Individuals who use or have used psychiatric services may alternatively refer to themselves as consumers, users, or survivors.
In nursing homes and assisted living facilities, the term resident is generally used in lieu of patient.[5] Similarly, those receiving home health care are called clients.
The doctor–patient relationship has sometimes been characterized as silencing the voice of patients.[6] It is now widely agreed that putting patients at the centre of healthcare[7] by trying to provide a consistent, informative and respectful service to patients will improve both outcomes and patient satisfaction.[8]
When patients are not at the centre of healthcare, when institutional procedures and targets eclipse local concerns, then patient neglect is possible.[9] Incidents, such as the Stafford Hospital scandal, Winterbourne View hospital abuse scandal and the Veterans Health Administration controversy of 2014 have shown the dangers of prioritizing cost control over the patient experience.[10] Investigations into these and other scandals have recommended that healthcare systems put patient experience at the center, and especially that patients themselves are heard loud and clear within health services.[11]
There are many reasons for why health services should listen more to patients. Patients spend more time in healthcare services than regulators or quality controllers, and can recognize problems such as service delays, poor hygiene, and poor conduct.[12] Patients are particularly good at identifying soft problems, such as attitudes, communication, and 'caring neglect',[9] that are difficult to capture with institutional monitoring.[13]
One important way in which patients can be placed at the centre of healthcare is for health services to be more open about patient complaints.[14] Each year many hundreds of thousands of patients complain about the care they have received, and these complaints contain valuable information for any health services which want to learn about and improve patient experience.[15]
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