Orthodontics deals with deviations from normal occlusion. A malocclusion is a variation from an accepted norm, not a disease. Planning is therefore rarely a yes/no decision: it means weighing a range of options to find the most appropriate one for each patient.
An ideal occlusion is the exception
An ideal static occlusion combines class I molar and incisor relationships with well-aligned teeth. Yet an acceptable occlusion develops naturally in only about 30–40% of the population in Western societies. Its development depends on several factors: jaw size and the relationship of the jaws to each other; the size, number and shape of the teeth; and the form and behaviour of the lips, tongue and perioral muscles.
Who needs treatment?
Because there is no disease threshold, orthodontists themselves often disagree about when treatment becomes necessary (Richmond et al., 1994). Public health systems such as those in the UK and Scandinavia therefore use orthodontic indices to ration care, based mainly on aesthetic and dental-health impairment (Brook and Shaw, 1989).
Why patients ask for treatment
- The main motivation is a wish to improve dental appearance (Shaw et al., 1991).
- Malocclusion can expose children to teasing and bullying, with psychosocial consequences (Shaw et al., 1980; Seehra et al., 2011).
- Treatment may bring psychosocial benefits and better oral-health-related quality of life; combined orthodontic–surgical treatment has been linked to improved self-esteem (Arndt et al., 1986).
The method of this course
These benefits depend on a sound diagnosis. As in any other field of medicine, it rests on three steps:
- History: motivation, dental, family and medical history.
- Clinical examination: extra-oral, then intra-oral.
- Special tests: radiographs and cephalometric analysis (covered in the companion course).
Each step ends with a quiz built on short clinical cases.
Main source: Cobourne MT, Fleming PS, DiBiase AT, Ahmad S. Clinical Cases in Orthodontics. Wiley-Blackwell, 2012, chapter 1.