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FDA Consumer magazine

January-February 2005 Issue

The Last Word

Keeping--Or Creating--a Beautiful Smile

By Terry R. Pracht, D.D.S., M.S.

Teeth are meant to last a lifetime. Dental disease or loss of teeth is, in many cases, avoidable. Through careful attention at home, including brushing, flossing, and good food choices, plus regular visits to the family dentist and treatment when appropriate by dental specialists, such as orthodontists, teeth can indeed last a lifetime.

A century into the dental specialty of orthodontics, we know that properly aligned teeth and jaws contribute to the health of the mouth and general well-being. The advantages of orthodontic treatment are many, including improved function and higher self-esteem. Straight teeth are easier to keep clean, leading to fewer cavities and reduced risk of gum (periodontal) disease.

Research suggests potential links between the bacteria that cause periodontal disease and systemic diseases, so prevention of periodontal disease through orthodontic treatment can be an important step in maintaining overall health. Periodontal disease can dissolve the bone tissue supporting teeth. Healthy gums imply healthy bone tissue, to hold the teeth in place. A healthy smile makes people feel better about themselves.

Good dental care starts at a young age. The American Dental Association recommends the first dental visit no later than 12 months of age. These early visits will include oral health education for parents, noting the child's developmental needs, and information on reducing the risk of early childhood tooth decay. Even baby teeth are vulnerable to decay.

Similarly, the American Association of Orthodontists (AAO) recommends all children have a checkup by an orthodontic specialist no later than age 7. Around age 7, most children have their "six year" molars. By observing how these teeth meet, the orthodontist can diagnose existing irregularities in the teeth and jaws (malocclusions), or can reliably predict whether there is a malocclusion in the making.

Not all malocclusions demand treatment upon discovery. The orthodontist will recommend the most appropriate treatment at the most appropriate time, based upon factors such as the malocclusion to be corrected and the child's expected growth. In some cases, immediate intervention is in the best interest of the patient. For other cases, watchful waiting is indicated. Photos of several problems orthodontists prefer to see by about age 7 so they can plan for treatment can be seen on www.braces.org. Click on "About Orthodontics" and "Problems to Watch for in Growing Children."

The ability to make judgment calls on when to treat comes from the orthodontist's extensive training. After dental school an orthodontist must successfully complete a minimum of two academic years in an accredited orthodontic residency program. Only those who have successfully completed this rigorous training may call themselves orthodontists.

The orthodontist works closely with each patient's dentist, keeping the dentist abreast of the patient's progress. Orthodontic care is a partnership in the truest sense of the word. This partnership consists of the dentist, the patient or the patient's parents for children, and the orthodontist. The dentist is often the first professional to diagnose a malocclusion and will refer the patient to an orthodontist for necessary care. The patient is a crucial part of the equation because of the responsibilities in brushing, flossing, and diet choices as prescribed by the orthodontist.

Most orthodontic patients begin treatment between the ages of 9 and 14. However, many adults seek treatment today. Early in my career, treatment of people 18 and older was an exception to the rule. Now, through research and practice, we can successfully move adults' teeth. Fully 1 of 5 patients treated by orthodontists today is an adult. From 1989 to 2000, the population of adult patients grew by 14.2 percent, according to AAO Patient Census Surveys. Adults may opt for treatment for a variety of reasons--to correct something that's bothered them all their lives, because they were pleased with their child's treatment, or because they want to do all they can to keep their natural teeth. It's never too late to move healthy teeth.

Regardless of age, the nicest side effect of orthodontic treatment is a healthy, beautiful smile. Orthodontists and their dental partners strive to give each patient a smile to proudly share when meeting the world face-first--a smile to last a lifetime.

Terry R. Pracht, D.D.S., M.S., is president of the American Association of Orthodontists.

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