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News Bulletin : ADA News Bulletin August 2011
34 AUGUST 2011 In the Australian Dental Journal last year, (ADJ 2010;55:111) Professor Mark Bartold wrote in his Editorial, ‘Personalized Dentistry’ that in Dental School, students are taught ‘how to’ but not often ‘why so’. That is so true. One of the most common conditions seen in young children in the early mixed dentition stage is lingually-positioned lower lateral incisors. Most clinicians will diagnose lingually-positioned lower lateral incisors as a sign of crowding and will decide on a plan to correct it instead of first finding out why the lower lateral incisors are usually positioned lingually in most children. The clinician will decide whether to expand the dental arch or to extract the primary cuspids. The majority of operators will decide on extracting the primary cuspids because they believe that will relieve the crowding problem. As we all know, removing the primary cuspids will undoubtedly improve the alignment of the lateral incisors. But then that will eventually result in imminent crowding of the permanent cuspids which will then result in the need for extractions of the premolars, usually the first premolars. This is what is commonly known as serial extractions. Extractions of premolars, especially lower premolars, will result in unfavourable angulation of teeth adjacent to the extraction site. To improve or correct the angulations of the affected teeth will then require mechanotherapy treatment. We need to ask the question whether extracting the primary cuspids actually corrected the crowding problem or did it just shift the crowding from the lateral incisors to the permanent cuspids, then necessitating the extractions of premolars so as to accommodate the permanent canines? Since most children, if not all, have the lower lateral incisors positioned lingually in the early mixed dentition stage, shouldn’t that condition be considered normal? If so, then why is treatment the question that neeDS tO Be ASKeD opinion page Fig 1. necessary? Or in other words, “why so”, as according to Professor Bartold. Most children under the age of five are not able to touch their ear by putting their hand over the top of the head. By about the age of eight or nine, most children are able to touch their ear as shown in the photograph of three children whose ages are four, six and eight (Fig 1). It can clearly be seen that the youngest in the middle, aged four years, cannot touch his ear by putting his hand over the top of his head – this is perfectly normal. Since that child can’t touch his ear, does that mean his neck is too long and he needs treatment in the form of ‘neck-ectomy’ (i.e. total removal of the neck) or ‘neck-otomy’ (partial removal of the neck) to allow the child to be able to touch his ear? Fig 2. Lower lateral incisors are positioned lingually prior to eruption.(Courtesy of Prof. Dr Frans Van Der Linden and Harper and Row Publishers, Inc.) “we need to ask the question whether extracting the primary cuspids actually corrected the crowding problem or did it just shift the crowding from the lateral incisors to the permanent cuspids...?”
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ADA News Bulletin September 2011