Orthodontics and Pediatric Dentistry
Growth and diagnosis
Class I, II and III describe sagittal skeletal and dental relationships; record overjet, overbite, crowding, centre lines and molar/canine relationships. Cephalometric norms (SNA ≈82°, SNB ≈80°, ANB ≈2°) are guides, not diagnoses. In the mixed dentition the leeway space (about 1.5 mm per side maxillary, 2.5 mm mandibular) and intercanine growth provide space; Tanaka–Johnston or Moyers analyses predict arch length requirements. Assess dental developmental stage and likely compliance before choosing interceptive, functional or fixed appliances.
Mechanics and retention
Optimal orthodontic force is light and continuous, roughly 50–150 g per tooth. Anchorage - intraoral, extraoral or skeletal - controls unwanted reciprocal movement. Aligners suit mild-to-moderate crowding and depend on compliance; complex rotations and extrusion are their weakness. Retention is lifelong in principle: bonded lingual retainers plus a removable overlay.
Paediatric dentistry
First dental visit by 12 months or within six months of the first tooth. Early childhood caries is driven by frequent sugar exposure and night-time bottles; fluoride varnish (5% NaF, 22,600 ppm) every 3–6 months for high-risk children. A pulpotomy removes coronal pulp; a pulpectomy is required when the radicular pulp is involved. A stainless steel crown is the restoration of choice for a multi-surface primary molar. Space maintainers preserve arch length after premature loss. Use tell–show–do for behaviour management.
Worked example
A 7-year-old with a carious 75 and signs of radicular involvement needs a pulpectomy or extraction with a space maintainer - not a pulpotomy, because the procedure changes once the radicular pulp is affected.
Traps
- Confusing leeway space with primate space.
- Applying adult force levels to primary teeth.
- Placing a space maintainer without confirming the permanent successor is present.
- Overlooking the effect of non-nutritive sucking on the developing occlusion.