Young smiles, straight talk

/Home/Specific Dental and Oral Health Concerns/Children and Dental Care

Young smiles, straight talk
November 2006
By Eileen White

DPR World


Pediatric and orthodontic caseloads have remained anchored for GPs. Nearly half (48%) of our survey respondents said their pediatric patient base has remained constant for the past five years, while more than one-quarter (28%) said their orthodontic caseload has increased over the same time period, likely due in part to advances in tooth-movement protocol. Two recent reader surveys, issued in 2006, covered these disciplines.

THE DPR POLL
Pediatrics

Baby bottle caries

How often do you see baby bottle decay in patients under 12 years of age?

Rarely 56%
Sometimes 30%
Never 8%
Frequently 5%
No response 1%

Source: Nov. 2006 Pediatrics Survey, e-mailed on Nov. 20, 2006 to 4,165 U.S. GPs; 258 responses receivedÛa 6% response rate.

THE DPR POLL
Orthodontic Census

Crooked caseload
GPs are straightening patientsÌ smiles more frequently than ever.*

Top ortho services by GPs

1) Space maintainers 86%
2) Removable appliances 49%
3) Invisible aligner treatments 33%
4) Early intervention ortho treatments 32%
5) Others 19%

*Multiple responses accepted. Source: Nov. 2006 DPR Orthodontics Survey, e-mailed on Nov. 20, 2006 to 4,165 U.S. GPs; 258 responses receivedÛa 6% response rate.


IMPLANT ORTHODONTICS

What it is: The use of implants to help anchor a tooth or group of teeth. Implants are applied and anchored directly into the bone, providing absolute anchorage for cases including molar distalization and uprighting, single- or multiple-tooth mesialization, and correcting scissors bite or asymmetric occlusal plane.

Why: Placement is easy: In many cases, the procedure takes an estimated 5 to 15 minutes from start to finish, and only topical anesthesia is necessary; some patients require local anesthesia. Patients reportedly may feel some discomfort, but rarely Ïpain.Ó The implant many times can be loaded immediately, if the force is 300 grams or less. They offer a good alternative to headgear and intermaxillary elastics, do not require patient compliance, and are well-tolerated by the patient. Clinicians also have more control over treatment, and, in many instances, the implants can reduce treatment time.
Where: Depending on treatment, insertion sites include in the maxilla, the area below the nasal spine, the palate, the alveolar process, the retromolar area, and the symphysis. Check with company for recommendations.
Who: Although many refer to oral surgeons or periodontists, implants can be placed by knowledgeable GPs or orthodontists. In addition to manufacturer guidelines, contraindications are active intraoral infection, inadequate bone quality/quantity, metal sensitivity, active periodontitis, or a history of metabolic disorders or radiation therapy regimen.
Removal: Because they are not osseointegrated, implants are easily removed by unscrewing until removal is complete. In most cases no anesthesia is necessary.
Cost: Fees depend on overall treatment planning. Currently, a few reimbursement codes can be used. As the implants become a mainstream option, more carriers likely will simplify reimbursement.

Pediatric issues

More than half the GP survey respondents report approximately 6%-20% of their patients are under the age of 12 years÷and only 3% report they treat no patients under this age. And, for the most part, the ones who do treat children seem to like it (63% of the respondents disagreed with the statement, ÏI would prefer to treat adult patients only.Ó).

Issues covering infancy through adolescence were brought forth in the survey, including baby bottle caries, sealants, and malocclusion.


Baby bottle caries

Open a parenting magazine or newspaper health section, and youÌre likely to see an article on baby bottle caries and the dangers of putting a child to bed with a bottle full of juice. At first glance, it seems the message may be heard, because only 35% of the respondents have indicated seeing baby bottle caries either frequently or sometimes in children under 12 years old.

55% of general practitioners say they wouldlike to incorporate more orthodontic services into their practices.
However, Dr. Joel Berg, of the Department of Pediatric Dentistry at the University of Washington School of Dentistry, believes that early childhood caries (ECC) actually is relatively common among preschoolers. Different children have different biofilm combinations in their mouths that result in differing abilities to create acid when confronted with a sugar challenge, so ECC also is aggravated by poor oral hygiene, unrestricted bottle use, and inadequate fluoride. Dr. Berg believes that the modest reflection of baby bottle caries in the survey actually indicates Ïthe relatively low number of GPs who see the youngest children on a routine basis.Ó

Sealants

Placing sealants on all pediatric patients is endorsed by just 57% of our survey respondents. Nonetheless, their use is important.

ÏSealants are exceptionally effective when used in the right circumstances and when placed properly,Ó Dr. Berg said, adding the reasons for their lower regard in the survey may include the technique precisionÛsealants can be difficult to place; their perceived lower-than-ideal reimbursement; and the overall perception among many practitioners that sealants ÏdonÌt work.Ó Sealants do work, he maintained, when they are used properly Ïas a preventive measure in high-risk pits and fissures.Ó Most insurance policies cover them.

Malocclusion

More than 8 out of 10 GPs reported seeing thumbsucking or pacifier malocclusion in their pediatric patients. Dr. Berg said such non-nutritive sucking is normal for young children, and typically is not problematic for occlusion unless it continues. He recommended that thumbsucking habits be managed ÏawayÓ during the early pre-school years, well before eruptionof the permanent teeth. Pacifiers are neither as habit-forming nor as detrimental as thumbsucking.

Orthodontics

Malocclusion in pediatric patients often leads to the need for orthodontic attention. Space maintainers are being offered by 86% of GPs surveyed, and early intervention orthodontic treatment is offered by nearly one-third of those surveyed (see ÏCrooked caseload,Ó above).

The desire for more orthodontics education in general also seems reflected in the survey: More than nine out of 10 respondents believe that simple tooth movement and early intervention techniques should be taught in dental school, and more than half expressed a desire to incorporate more orthodontics into their practices.

However, when it comes to improving their own orthodontic education, fewer than half of those surveyed said they have pursued a CE course in orthodontics within the past two years.

AGD spokesperson Dr. Maharukh Kravich commented on the discrepancy. She noted that while orthodontics CE programs are available in large cities and in dental schools, it can be hard for full-time GPs who live and practice elsewhere to travel to these cites. Also, doing ortho often involves taking more than a single course.

Esthetics during treatment

Adult orthodontics has grown exponentially. One-third of GPs who responded to the survey indicated they offer invisible aligner treatment (see ÏCrooked Caseload,Ó page 100). Dr. Kravich sees this number increasing in the future, as more GPs seek the education necessary for treatment. Currently, four manufacturers offer invisible aligners (see chart ÏKeeping in line,Ó left). Another recent option focusing on patient esthetics is iBraces by Lingual Care Inc. Also, two new orthodontic products introduced at press time will be featured in upcoming issues of DPR: Clarity SL Braces by 3M Unitek and SpeedAligner appliance by Orthodontic Technologies Inc.

Also on the cutting-edge is implant-retained orthodontics, a concept that is finding a new use for mini-implants (see ÏImplant orthodontics,Ó page 98). Although orthodontists and oral surgeons currently are the chief practitioners of this technique, it can be performed by GPs who have proper training. Coursework is offered by the respective manufacturers.

In fact, level of education and comfort with the latest techniques are key for the GP when it comes to practicing any orthodontics.

ÏCase selection is very important, as the GPÌs own level of comfort will determine whether the case should be done in-house or referred to a specialist. Each practice and GP must evaluate their own knowledge base to offer their patients the best treatment available,Ó Dr. Kravich said.