Adapting Hygiene Routines for Clear Aligner Users

Adapting Hygiene Routines for Clear Aligner Users

* Maintaining the corrected tooth alignment achieved during braces.

Adapting Hygiene Routines for Clear Aligner Users: Challenges Kids Face with Aligner Hygiene


Okay, so your kiddo just got clear aligners. Awesome! Straight teeth, confident smile, the whole shebang. But let's be real, the "invisible" part doesn't mean the hygiene challenges are invisible too, especially for kids. Getting them to actually wear the aligners for the recommended time is one battle. Getting them to keep those aligners, and their teeth, sparkling clean? That's a whole different ballgame.


Braces help correct misaligned teeth in children Dental braces for children pediatric dentistry.

One of the biggest hurdles is simply remembering. Kids are, well, kids. They're thinking about recess, video games, and what's for dinner, not necessarily about meticulously cleaning their aligners after every snack. Suddenly, they're supposed to remove them before eating, brush their teeth, clean the aligners, and then pop them back in. That's a lot of steps, and it's easy for one (or more!) to get skipped, especially when they're rushed or distracted.


Then there's the whole "yuck" factor. Leftover food particles trapped under the aligners? Not pleasant. And if they're not diligent about cleaning, those aligners can start to smell a little funky. This can lead to them avoiding wearing them altogether, defeating the whole purpose. We're talking about pre-teen and teen years here; social anxieties are high, and nobody wants to be known as the kid with the stinky aligners.


Manual dexterity can also be a problem. Snapping those aligners in and out can be tricky for younger kids, and they might end up damaging them in the process. Cleaning them requires gentle brushing, and they need to learn the right technique to avoid scratches that can trap even more bacteria. Think about how many kids struggle with regular brushing and flossing! Adding another layer of complexity can be overwhelming.


Finally, let's not forget the drinks! Sugary sodas and juices are a big no-no with aligners in, but convincing a kid to stick to water all day long? Good luck with that. And even seemingly harmless drinks like sports drinks can stain the aligners, making them less "invisible" and more "noticeably yellow."


So, while clear aligners are a fantastic option for straightening teeth, it's crucial to address these hygiene challenges head-on. It's all about finding ways to make the routine simple, memorable, and maybe even a little bit fun. Because a straight smile is great, but a healthy smile is even better.

Okay, so you've embraced the clear aligner life! Congrats, you're on your way to a straighter smile. But let's be real, those aligners are little havens for bacteria if you don't keep them squeaky clean. Adapting your hygiene routine is key, and a big part of that is knowing what cleaning tools and products are your best friends in this journey.


Think of it this way: you brush your teeth regularly, right? Your aligners need the same kind of love. A soft-bristled toothbrush is your go-to. Don't use the same one you use for your teeth, though! Designate a separate brush just for your aligners. Gently scrub all surfaces, inside and out.


Now, for cleaning products, simple is often best. Mild dish soap, like the kind you use to wash your dishes, can work wonders. Just a tiny drop is enough. Rinse thoroughly with cool water afterwards. Avoid colored or scented soaps, as they can potentially stain or leave a weird taste.


Then there are the dedicated aligner cleaning products. You'll find cleaning crystals or tablets specifically formulated for clear aligners. These are great for a deeper clean and can help remove stubborn stains or plaque buildup. Follow the instructions on the packaging, and always rinse well after soaking.


Avoid toothpaste! Many toothpastes contain abrasive ingredients that can scratch the clear plastic, making them dull and more susceptible to staining. Also, stay away from harsh chemicals like bleach or mouthwash. These can damage the aligners and potentially release harmful substances.


Finally, keep in mind that consistency is key. Aim to clean your aligners every time you take them out to eat. It's a small step that makes a big difference in keeping your aligners clear, your breath fresh, and your smile sparkling. A little effort in the cleaning department means a more comfortable and successful aligner experience. Good luck!

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* Protecting the investment made in orthodontic treatment.

Okay, so you've got those clear aligners, huh? Smart move. Straight teeth without the metal mouth look, nice. But let's be real, keeping those things clean is crucial, and it's not just about avoiding bad breath (though, yeah, that's a big part of it). We're talking about keeping your teeth healthy and making sure your aligners actually work the way they're supposed to. Think of it this way: those aligners are snug against your teeth all day and night. Anything trapped in there – food, plaque, whatever – is basically marinating against your enamel. Not good.


So, here's the lowdown on keeping your aligners sparkling, and it's simpler than you might think. Step one: rinse those babies every single time you take them out. Seriously. Don't just toss them on the counter or in a case and forget about them. A quick rinse under lukewarm water gets rid of loose debris before it has a chance to harden.


Next, daily cleaning. Think of it like brushing your teeth, but for plastic. Use a soft-bristled toothbrush (separate from the one you use on your teeth, trust me) and a mild, clear soap or denture cleaner. Avoid toothpaste! It can be abrasive and scratch the aligners, creating tiny grooves where bacteria love to hide. Gently scrub all the surfaces, inside and out.


Now, for a deeper clean, consider soaking them a couple of times a week. There are special aligner cleaning tablets you can buy, or you can use a solution of equal parts water and white vinegar. Just don't soak them for too long – usually 15-30 minutes is plenty. Always rinse thoroughly after soaking to get rid of any lingering taste or smell.


And finally, a few don'ts. Don't use hot water – it can warp the plastic. Don't use mouthwash with alcohol, as it can discolor the aligners. And definitely don't put them in the dishwasher! I know, tempting, but trust me, it's a disaster waiting to happen.


Keeping your aligners clean is just part of the deal with clear aligner treatment. It's a small effort for a big payoff: a healthy smile and a straight one too. Just make it part of your routine, and you'll be golden.

* Protecting the investment made in orthodontic treatment.

* Ensuring the long-term stability of the bite and smile.

So, you've embarked on the clear aligner journey – congratulations! You're on your way to a straighter smile, and that's fantastic. But let's talk about keeping things sparkling clean while those aligners are doing their work. Proper oral hygiene with aligners isn't just about aesthetics; it's about preventing problems like cavities, gum disease, and that dreaded aligner odor.


Think of your aligners as little shields that trap everything against your teeth. Food particles, plaque, bacteria – they all get cozy under there. That's why brushing and flossing become even MORE crucial. Before you pop your aligners back in after eating, give your teeth a thorough brush. Don't skip the floss! Those tiny spaces between your teeth are prime real estate for bacteria to set up shop.


And it's not just your teeth that need attention. Your aligners themselves require a clean sweep. Rinse them every time you take them out, and consider a dedicated aligner cleaner or even just some mild soap and water. Avoid harsh chemicals or hot water, as they can warp or damage the plastic.


Basically, adapting your hygiene routine for clear aligners is about being proactive. A little extra effort each day goes a long way in ensuring a healthy and confident smile throughout your treatment. Treat your mouth like a VIP – because it is! Keep it clean, keep it healthy, and enjoy the process of achieving the smile you've always wanted.

* Supporting proper jaw growth and development in younger children.

Adapting Hygiene Routines for Clear Aligner Users: Encouraging kids to maintain consistent hygiene habits.


Okay, so your kiddo's got clear aligners. Great! Straight teeth are awesome, but let's be real, getting kids to brush regularly can be a battle even without extra hardware in their mouths. Now we're adding aligners to the mix, and suddenly, hygiene goes from something you nag about to something that directly impacts their treatment progress and overall health. No pressure, right?


The key is making it less of a chore and more of a routine they understand and, dare I say, even participate in willingly. Forget the lectures on bacteria and gingivitis (they'll tune you out faster than you can say "plaque"). Instead, focus on the immediate benefits they'll actually care about.


Think about it: no one wants stinky breath or discolored aligners. Explain to them, in kid-friendly terms, that brushing after every meal and before putting the aligners back in keeps their breath fresh and their aligners clear. Maybe even let them pick out a fun, new toothbrush and toothpaste flavor. Making it a little more appealing can go a long way.


Consistency is king (or queen!). Help them create a checklist or visual reminder to brush, floss, and clean their aligners after each meal. A laminated chart on the bathroom mirror with stickers they can add after completing each task can work wonders, especially for younger kids. For older kids and teens, an app on their phone with reminders might be more effective.


Lead by example. Let them see you taking care of your own oral hygiene. If they see you flossing and brushing, they're more likely to follow suit. Make it a family affair!


Finally, be patient and understanding. There will be days when they forget or just don't feel like it. Don't get discouraged. Gently remind them of the importance of good hygiene and offer encouragement. Celebrate their successes, even the small ones. A little positive reinforcement can go a long way in building healthy habits that will last a lifetime, long after those aligners are off. After all, a healthy smile is a happy smile, and that's something worth encouraging.

* Avoiding the need for future, potentially more extensive, orthodontic intervention.

Okay, so you're rocking clear aligners, that's awesome! Straight teeth are, well, straight awesome. But let's be real, it also throws a little wrench into your regular hygiene habits. It's not rocket science, but it's worth talking about. We're talking about some pretty common hygiene hiccups that pop up with these things, and how to dodge them.


First up, plaque. Plaque loves hiding in sneaky spots, and those aligners create more sneaky spots. Food particles get trapped, bacteria throws a party... you get the picture. The solution? Ramp up your brushing. Not just a quick swipe, but a thorough clean after every meal. Think of it as evicting the bacteria before they set up camp. And floss, floss, floss! Get between those teeth, even with the aligners in (if you can manage it).


Then there's the aligners themselves. They get gross. Period. Saliva, food, all that stuff builds up. So, clean them! Rinsing them every time you take them out is a bare minimum. Ideally, give them a proper brush with a soft toothbrush and mild soap, or a cleaning solution designed specifically for aligners. Think of it like washing your dishes; you wouldn't eat off a dirty plate, right?


Bad breath? Yeah, that's a thing. All that bacteria hanging around can lead to some funky breath. The solutions we already talked about – brushing, flossing, cleaning aligners – are key. But also, don't forget to brush your tongue! That's where a lot of the odor-causing bacteria hang out. And maybe consider a mouthwash, but make sure it's alcohol-free, as alcohol can damage the aligners.


Finally, don't ignore pain or discomfort. If you're noticing sores, bleeding gums, or anything that just doesn't feel right, talk to your dentist or orthodontist. It could be a sign of something more serious, or it could just be a simple adjustment that needs to be made. Remember, these aligners are an investment in your smile, so take care of your teeth and gums while you're wearing them. It's worth the extra effort for that perfect grin!

* Contributing to overall oral health by preventing crowding and misalignment.

Okay, so your kid's got aligners. Good for them! Straight teeth are a confidence booster, but let's be real, clear aligners are work. And for younger kids especially, that work often falls on you, the parent. You're not just paying for the treatment; you're essentially co-managing it, especially the hygiene part. Think of yourself as their aligner hygiene coach.


First, get educated. Understand why aligner hygiene is so crucial. Trapped food and plaque? Not good. That's a breeding ground for bacteria that can lead to cavities, gum disease, and even stain those sparkly clear aligners. Nobody wants that.


Then, make it a routine. Brushing after every meal becomes non-negotiable. Not just a quick swipe, but a thorough brushing of both teeth and aligners. You might need to supervise, especially in the beginning, to make sure they're actually getting the job done. Think of it like teaching them to tie their shoes, but with more minty toothpaste.


Next, aligner care. Rinsing them every time they take them out is key. Encourage them to use a soft toothbrush and mild soap (not toothpaste!) to gently clean the aligners. Soaking them regularly in a cleaning solution specifically designed for aligners is also a good idea. Remember, you're helping them avoid that dreaded cloudy aligner look.


Finally, be a cheerleader. It can be tedious, this whole aligner thing. Remind them why they're doing it. Celebrate their progress. And most importantly, lead by example. If you're enthusiastic about their oral hygiene, they're more likely to be enthusiastic too. It's a team effort, and a little parental support goes a long way in ensuring a successful, and healthy, aligner journey.

This article is about the branch of medicine. For the journal, see Pediatrics (journal). For the branch of dentistry, see Pedodontics.

 

Pediatrics
A pediatrician examines a neonate.
Focus Infants, Children, Adolescents, and Young Adults
Subdivisions Paediatric cardiology, neonatology, critical care, pediatric oncology, hospital medicine, primary care, others (see below)
Significant diseases Congenital diseases, Infectious diseases, Childhood cancer, Mental disorders
Significant tests World Health Organization Child Growth Standards
Specialist Pediatrician
Glossary Glossary of medicine

Pediatrics (American English) also spelled paediatrics (British English), is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, pediatrics covers many of their youth until the age of 18.[1] The American Academy of Pediatrics recommends people seek pediatric care through the age of 21, but some pediatric subspecialists continue to care for adults up to 25.[2][3] Worldwide age limits of pediatrics have been trending upward year after year.[4] A medical doctor who specializes in this area is known as a pediatrician, or paediatrician. The word pediatrics and its cognates mean "healer of children", derived from the two Greek words: παá¿–ς (pais "child") and á¼°ατρÏŒς (iatros "doctor, healer"). Pediatricians work in clinics, research centers, universities, general hospitals and children's hospitals, including those who practice pediatric subspecialties (e.g. neonatology requires resources available in a NICU).

History

[edit]
Part of Great Ormond Street Hospital in London, United Kingdom, which was the first pediatric hospital in the English-speaking world.

The earliest mentions of child-specific medical problems appear in the Hippocratic Corpus, published in the fifth century B.C., and the famous Sacred Disease. These publications discussed topics such as childhood epilepsy and premature births. From the first to fourth centuries A.D., Greek philosophers and physicians Celsus, Soranus of Ephesus, Aretaeus, Galen, and Oribasius, also discussed specific illnesses affecting children in their works, such as rashes, epilepsy, and meningitis.[5] Already Hippocrates, Aristotle, Celsus, Soranus, and Galen[6] understood the differences in growing and maturing organisms that necessitated different treatment: Ex toto non sic pueri ut viri curari debent ("In general, boys should not be treated in the same way as men").[7] Some of the oldest traces of pediatrics can be discovered in Ancient India where children's doctors were called kumara bhrtya.[6]

Even though some pediatric works existed during this time, they were scarce and rarely published due to a lack of knowledge in pediatric medicine. Sushruta Samhita, an ayurvedic text composed during the sixth century BCE, contains the text about pediatrics.[8] Another ayurvedic text from this period is Kashyapa Samhita.[9][10] A second century AD manuscript by the Greek physician and gynecologist Soranus of Ephesus dealt with neonatal pediatrics.[11] Byzantine physicians Oribasius, Aëtius of Amida, Alexander Trallianus, and Paulus Aegineta contributed to the field.[6] The Byzantines also built brephotrophia (crêches).[6] Islamic Golden Age writers served as a bridge for Greco-Roman and Byzantine medicine and added ideas of their own, especially Haly Abbas, Yahya Serapion, Abulcasis, Avicenna, and Averroes. The Persian philosopher and physician al-Razi (865–925), sometimes called the father of pediatrics, published a monograph on pediatrics titled Diseases in Children.[12][13] Also among the first books about pediatrics was Libellus [Opusculum] de aegritudinibus et remediis infantium 1472 ("Little Book on Children Diseases and Treatment"), by the Italian pediatrician Paolo Bagellardo.[14][5] In sequence came Bartholomäus Metlinger's Ein Regiment der Jungerkinder 1473, Cornelius Roelans (1450–1525) no title Buchlein, or Latin compendium, 1483, and Heinrich von Louffenburg (1391–1460) Versehung des Leibs written in 1429 (published 1491), together form the Pediatric Incunabula, four great medical treatises on children's physiology and pathology.[6]

While more information about childhood diseases became available, there was little evidence that children received the same kind of medical care that adults did.[15] It was during the seventeenth and eighteenth centuries that medical experts started offering specialized care for children.[5] The Swedish physician Nils Rosén von Rosenstein (1706–1773) is considered to be the founder of modern pediatrics as a medical specialty,[16][17] while his work The diseases of children, and their remedies (1764) is considered to be "the first modern textbook on the subject".[18] However, it was not until the nineteenth century that medical professionals acknowledged pediatrics as a separate field of medicine. The first pediatric-specific publications appeared between the 1790s and the 1920s.[19]

Etymology

[edit]

The term pediatrics was first introduced in English in 1859 by Abraham Jacobi. In 1860, he became "the first dedicated professor of pediatrics in the world."[20] Jacobi is known as the father of American pediatrics because of his many contributions to the field.[21][22] He received his medical training in Germany and later practiced in New York City.[23]

The first generally accepted pediatric hospital is the Hôpital des Enfants Malades (French: Hospital for Sick Children), which opened in Paris in June 1802 on the site of a previous orphanage.[24] From its beginning, this famous hospital accepted patients up to the age of fifteen years,[25] and it continues to this day as the pediatric division of the Necker-Enfants Malades Hospital, created in 1920 by merging with the nearby Necker Hospital, founded in 1778.[26]

In other European countries, the Charité (a hospital founded in 1710) in Berlin established a separate Pediatric Pavilion in 1830, followed by similar institutions at Saint Petersburg in 1834, and at Vienna and Breslau (now WrocÅ‚aw), both in 1837. In 1852 Britain's first pediatric hospital, the Hospital for Sick Children, Great Ormond Street was founded by Charles West.[24] The first Children's hospital in Scotland opened in 1860 in Edinburgh.[27] In the US, the first similar institutions were the Children's Hospital of Philadelphia, which opened in 1855, and then Boston Children's Hospital (1869).[28] Subspecialties in pediatrics were created at the Harriet Lane Home at Johns Hopkins by Edwards A. Park.[29]

Differences between adult and pediatric medicine

[edit]

The body size differences are paralleled by maturation changes. The smaller body of an infant or neonate is substantially different physiologically from that of an adult. Congenital defects, genetic variance, and developmental issues are of greater concern to pediatricians than they often are to adult physicians. A common adage is that children are not simply "little adults". The clinician must take into account the immature physiology of the infant or child when considering symptoms, prescribing medications, and diagnosing illnesses.[30]

Pediatric physiology directly impacts the pharmacokinetic properties of drugs that enter the body. The absorption, distribution, metabolism, and elimination of medications differ between developing children and grown adults.[30][31][32] Despite completed studies and reviews, continual research is needed to better understand how these factors should affect the decisions of healthcare providers when prescribing and administering medications to the pediatric population.[30]

Absorption

[edit]

Many drug absorption differences between pediatric and adult populations revolve around the stomach. Neonates and young infants have increased stomach pH due to decreased acid secretion, thereby creating a more basic environment for drugs that are taken by mouth.[31][30][32] Acid is essential to degrading certain oral drugs before systemic absorption. Therefore, the absorption of these drugs in children is greater than in adults due to decreased breakdown and increased preservation in a less acidic gastric space.[31]

Children also have an extended rate of gastric emptying, which slows the rate of drug absorption.[31][32]

Drug absorption also depends on specific enzymes that come in contact with the oral drug as it travels through the body. Supply of these enzymes increase as children continue to develop their gastrointestinal tract.[31][32] Pediatric patients have underdeveloped proteins, which leads to decreased metabolism and increased serum concentrations of specific drugs. However, prodrugs experience the opposite effect because enzymes are necessary for allowing their active form to enter systemic circulation.[31]

Distribution

[edit]

Percentage of total body water and extracellular fluid volume both decrease as children grow and develop with time. Pediatric patients thus have a larger volume of distribution than adults, which directly affects the dosing of hydrophilic drugs such as beta-lactam antibiotics like ampicillin.[31] Thus, these drugs are administered at greater weight-based doses or with adjusted dosing intervals in children to account for this key difference in body composition.[31][30]

Infants and neonates also have fewer plasma proteins. Thus, highly protein-bound drugs have fewer opportunities for protein binding, leading to increased distribution.[30]

Metabolism

[edit]

Drug metabolism primarily occurs via enzymes in the liver and can vary according to which specific enzymes are affected in a specific stage of development.[31] Phase I and Phase II enzymes have different rates of maturation and development, depending on their specific mechanism of action (i.e. oxidation, hydrolysis, acetylation, methylation, etc.). Enzyme capacity, clearance, and half-life are all factors that contribute to metabolism differences between children and adults.[31][32] Drug metabolism can even differ within the pediatric population, separating neonates and infants from young children.[30]

Elimination

[edit]

Drug elimination is primarily facilitated via the liver and kidneys.[31] In infants and young children, the larger relative size of their kidneys leads to increased renal clearance of medications that are eliminated through urine.[32] In preterm neonates and infants, their kidneys are slower to mature and thus are unable to clear as much drug as fully developed kidneys. This can cause unwanted drug build-up, which is why it is important to consider lower doses and greater dosing intervals for this population.[30][31] Diseases that negatively affect kidney function can also have the same effect and thus warrant similar considerations.[31]

Pediatric autonomy in healthcare

[edit]

A major difference between the practice of pediatric and adult medicine is that children, in most jurisdictions and with certain exceptions, cannot make decisions for themselves. The issues of guardianship, privacy, legal responsibility, and informed consent must always be considered in every pediatric procedure. Pediatricians often have to treat the parents and sometimes, the family, rather than just the child. Adolescents are in their own legal class, having rights to their own health care decisions in certain circumstances. The concept of legal consent combined with the non-legal consent (assent) of the child when considering treatment options, especially in the face of conditions with poor prognosis or complicated and painful procedures/surgeries, means the pediatrician must take into account the desires of many people, in addition to those of the patient.[citation needed]

History of pediatric autonomy

[edit]

The term autonomy is traceable to ethical theory and law, where it states that autonomous individuals can make decisions based on their own logic.[33] Hippocrates was the first to use the term in a medical setting. He created a code of ethics for doctors called the Hippocratic Oath that highlighted the importance of putting patients' interests first, making autonomy for patients a top priority in health care.[34]  

In ancient times, society did not view pediatric medicine as essential or scientific.[35] Experts considered professional medicine unsuitable for treating children. Children also had no rights. Fathers regarded their children as property, so their children's health decisions were entrusted to them.[5] As a result, mothers, midwives, "wise women", and general practitioners treated the children instead of doctors.[35] Since mothers could not rely on professional medicine to take care of their children, they developed their own methods, such as using alkaline soda ash to remove the vernix at birth and treating teething pain with opium or wine. The absence of proper pediatric care, rights, and laws in health care to prioritize children's health led to many of their deaths. Ancient Greeks and Romans sometimes even killed healthy female babies and infants with deformities since they had no adequate medical treatment and no laws prohibiting infanticide.[5]

In the twentieth century, medical experts began to put more emphasis on children's rights. In 1989, in the United Nations Rights of the Child Convention, medical experts developed the Best Interest Standard of Child to prioritize children's rights and best interests. This event marked the onset of pediatric autonomy. In 1995, the American Academy of Pediatrics (AAP) finally acknowledged the Best Interest Standard of a Child as an ethical principle for pediatric decision-making, and it is still being used today.[34]

Parental authority and current medical issues

[edit]

The majority of the time, parents have the authority to decide what happens to their child. Philosopher John Locke argued that it is the responsibility of parents to raise their children and that God gave them this authority. In modern society, Jeffrey Blustein, modern philosopher and author of the book Parents and Children: The Ethics of Family, argues that parental authority is granted because the child requires parents to satisfy their needs. He believes that parental autonomy is more about parents providing good care for their children and treating them with respect than parents having rights.[36] The researcher Kyriakos Martakis, MD, MSc, explains that research shows parental influence negatively affects children's ability to form autonomy. However, involving children in the decision-making process allows children to develop their cognitive skills and create their own opinions and, thus, decisions about their health. Parental authority affects the degree of autonomy the child patient has. As a result, in Argentina, the new National Civil and Commercial Code has enacted various changes to the healthcare system to encourage children and adolescents to develop autonomy. It has become more crucial to let children take accountability for their own health decisions.[37]

In most cases, the pediatrician, parent, and child work as a team to make the best possible medical decision. The pediatrician has the right to intervene for the child's welfare and seek advice from an ethics committee. However, in recent studies, authors have denied that complete autonomy is present in pediatric healthcare. The same moral standards should apply to children as they do to adults. In support of this idea is the concept of paternalism, which negates autonomy when it is in the patient's interests. This concept aims to keep the child's best interests in mind regarding autonomy. Pediatricians can interact with patients and help them make decisions that will benefit them, thus enhancing their autonomy. However, radical theories that question a child's moral worth continue to be debated today.[37] Authors often question whether the treatment and equality of a child and an adult should be the same. Author Tamar Schapiro notes that children need nurturing and cannot exercise the same level of authority as adults.[38] Hence, continuing the discussion on whether children are capable of making important health decisions until this day.

Modern advancements

[edit]

According to the Subcommittee of Clinical Ethics of the Argentinean Pediatric Society (SAP), children can understand moral feelings at all ages and can make reasonable decisions based on those feelings. Therefore, children and teens are deemed capable of making their own health decisions when they reach the age of 13. Recently, studies made on the decision-making of children have challenged that age to be 12.[37]

Technology has made several modern advancements that contribute to the future development of child autonomy, for example, unsolicited findings (U.F.s) of pediatric exome sequencing. They are findings based on pediatric exome sequencing that explain in greater detail the intellectual disability of a child and predict to what extent it will affect the child in the future. Genetic and intellectual disorders in children make them incapable of making moral decisions, so people look down upon this kind of testing because the child's future autonomy is at risk. It is still in question whether parents should request these types of testing for their children. Medical experts argue that it could endanger the autonomous rights the child will possess in the future. However, the parents contend that genetic testing would benefit the welfare of their children since it would allow them to make better health care decisions.[39] Exome sequencing for children and the decision to grant parents the right to request them is a medically ethical issue that many still debate today.

Education requirements

[edit]

Aspiring medical students will need 4 years of undergraduate courses at a college or university, which will get them a BS, BA or other bachelor's degree. After completing college, future pediatricians will need to attend 4 years of medical school (MD/DO/MBBS) and later do 3 more years of residency training, the first year of which is called "internship." After completing the 3 years of residency, physicians are eligible to become certified in pediatrics by passing a rigorous test that deals with medical conditions related to young children.[citation needed]

In high school, future pediatricians are required to take basic science classes such as biology, chemistry, physics, algebra, geometry, and calculus. It is also advisable to learn a foreign language (preferably Spanish in the United States) and be involved in high school organizations and extracurricular activities. After high school, college students simply need to fulfill the basic science course requirements that most medical schools recommend and will need to prepare to take the MCAT (Medical College Admission Test) in their junior or early senior year in college. Once attending medical school, student courses will focus on basic medical sciences like human anatomy, physiology, chemistry, etc., for the first three years, the second year of which is when medical students start to get hands-on experience with actual patients.[40]

Training of pediatricians

[edit]
Pediatrics
Occupation
Names
  • Pediatrician
  • Paediatrician
Occupation type
 Specialty
Activity sectors
 Medicine
Description
Education required
  • Doctor of Medicine
  • Doctor of Osteopathic Medicine
  • Bachelor of Medicine, Bachelor of Surgery (MBBS/MBChB)
Fields of
employment
 Hospitals, Clinics

The training of pediatricians varies considerably across the world. Depending on jurisdiction and university, a medical degree course may be either undergraduate-entry or graduate-entry. The former commonly takes five or six years and has been usual in the Commonwealth. Entrants to graduate-entry courses (as in the US), usually lasting four or five years, have previously completed a three- or four-year university degree, commonly but by no means always in sciences. Medical graduates hold a degree specific to the country and university in and from which they graduated. This degree qualifies that medical practitioner to become licensed or registered under the laws of that particular country, and sometimes of several countries, subject to requirements for "internship" or "conditional registration".

Pediatricians must undertake further training in their chosen field. This may take from four to eleven or more years depending on jurisdiction and the degree of specialization.

In the United States, a medical school graduate wishing to specialize in pediatrics must undergo a three-year residency composed of outpatient, inpatient, and critical care rotations. Subspecialties within pediatrics require further training in the form of 3-year fellowships. Subspecialties include critical care, gastroenterology, neurology, infectious disease, hematology/oncology, rheumatology, pulmonology, child abuse, emergency medicine, endocrinology, neonatology, and others.[41]

In most jurisdictions, entry-level degrees are common to all branches of the medical profession, but in some jurisdictions, specialization in pediatrics may begin before completion of this degree. In some jurisdictions, pediatric training is begun immediately following the completion of entry-level training. In other jurisdictions, junior medical doctors must undertake generalist (unstreamed) training for a number of years before commencing pediatric (or any other) specialization. Specialist training is often largely under the control of 'pediatric organizations (see below) rather than universities and depends on the jurisdiction.

Subspecialties

[edit]

Subspecialties of pediatrics include:

(not an exhaustive list)

  • Addiction medicine (multidisciplinary)
  • Adolescent medicine
  • Child abuse pediatrics
  • Clinical genetics
  • Clinical informatics
  • Developmental-behavioral pediatrics
  • Headache medicine
  • Hospital medicine
  • Medical toxicology
  • Metabolic medicine
  • Neonatology/Perinatology
  • Pain medicine (multidisciplinary)
  • Palliative care (multidisciplinary)
  • Pediatric allergy and immunology
  • Pediatric cardiology
    • Pediatric cardiac critical care
  • Pediatric critical care
    • Neurocritical care
    • Pediatric cardiac critical care
  • Pediatric emergency medicine
  • Pediatric endocrinology
  • Pediatric gastroenterology
    • Transplant hepatology
  • Pediatric hematology
  • Pediatric infectious disease
  • Pediatric nephrology
  • Pediatric oncology
    • Pediatric neuro-oncology
  • Pediatric pulmonology
  • Primary care
  • Pediatric rheumatology
  • Sleep medicine (multidisciplinary)
  • Social pediatrics
  • Sports medicine

Other specialties that care for children

[edit]

(not an exhaustive list)

  • Child neurology
    • Addiction medicine (multidisciplinary)
    • Brain injury medicine
    • Clinical neurophysiology
    • Epilepsy
    • Headache medicine
    • Neurocritical care
    • Neuroimmunology
    • Neuromuscular medicine
    • Pain medicine (multidisciplinary)
    • Palliative care (multidisciplinary)
    • Pediatric neuro-oncology
    • Sleep medicine (multidisciplinary)
  • Child and adolescent psychiatry, subspecialty of psychiatry
  • Neurodevelopmental disabilities
  • Pediatric anesthesiology, subspecialty of anesthesiology
  • Pediatric dentistry, subspecialty of dentistry
  • Pediatric dermatology, subspecialty of dermatology
  • Pediatric gynecology
  • Pediatric neurosurgery, subspecialty of neurosurgery
  • Pediatric ophthalmology, subspecialty of ophthalmology
  • Pediatric orthopedic surgery, subspecialty of orthopedic surgery
  • Pediatric otolaryngology, subspecialty of otolaryngology
  • Pediatric plastic surgery, subspecialty of plastic surgery
  • Pediatric radiology, subspecialty of radiology
  • Pediatric rehabilitation medicine, subspecialty of physical medicine and rehabilitation
  • Pediatric surgery, subspecialty of general surgery
  • Pediatric urology, subspecialty of urology

See also

[edit]
  • American Academy of Pediatrics
  • American Osteopathic Board of Pediatrics
  • Center on Media and Child Health (CMCH)
  • Children's hospital
  • List of pediatric organizations
  • List of pediatrics journals
  • Medical specialty
  • Pediatric Oncall
  • Pain in babies
  • Royal College of Paediatrics and Child Health
  • Pediatric environmental health

References

[edit]
  1. ^ "Paediatrics" (PDF). nhs.uk. Archived (PDF) from the original on 13 July 2020. Retrieved 2 July 2020.
  2. ^ "Choosing a Pediatrician for Your New Baby (for Parents) - Nemours KidsHealth". kidshealth.org. Archived from the original on 14 July 2020. Retrieved 13 July 2020.
  3. ^ "Age limits of pediatrics". Pediatrics. 81 (5): 736. May 1988. doi:10.1542/peds.81.5.736. PMID 3357740. S2CID 245164191. Archived from the original on 19 April 2017. Retrieved 18 April 2017.
  4. ^ Sawyer, Susan M.; McNeil, Robyn; Francis, Kate L.; Matskarofski, Juliet Z.; Patton, George C.; Bhutta, Zulfiqar A.; Esangbedo, Dorothy O.; Klein, Jonathan D. (1 November 2019). "The age of paediatrics". The Lancet Child & Adolescent Health. 3 (11): 822–830. doi:10.1016/S2352-4642(19)30266-4. ISSN 2352-4642. PMID 31542355. S2CID 202732818.
  5. ^ a b c d e Duffin, Jacalyn (2010). History of Medicine, Second Edition: A Scandalously Short Introduction. University of Toronto Press.
  6. ^ a b c d e Colón, A. R.; Colón, P. A. (January 1999). Nurturing children: a history of pediatrics. Greenwood Press. ISBN 978-0-313-31080-5. Retrieved 20 October 2012.
  7. ^ Celsus, De Medicina, Book 3, Chapter 7, § 1.
  8. ^ John G. Raffensperger. Children's Surgery: A Worldwide History. McFarland. p. 21.
  9. ^ David Levinson; Karen Christensen. Encyclopedia of modern Asia. Vol. 4. Charles Scribner's Sons. p. 116.
  10. ^ Desai, A.B. Textbook Of Paediatrics. Orient blackswan. p. 1.
  11. ^ Dunn, P. M. (1995). "Soranus of Ephesus (Circa AD 98-138) and perinatal care in Roman times". Archives of Disease in Childhood. Fetal and Neonatal Edition. 73 (1): F51 – F52. doi:10.1136/fn.73.1.f51. PMC 2528358. PMID 7552600.
  12. ^ Elgood, Cyril (2010). A Medical History of Persia and The Eastern Caliphate (1st ed.). London: Cambridge. pp. 202–203. ISBN 978-1-108-01588-2. By writing a monograph on 'Diseases in Children' he may also be looked upon as the father of paediatrics.
  13. ^ U.S. National Library of Medicine, "Islamic Culture and the Medical Arts, Al-Razi, the Clinician" [1] Archived 5 January 2018 at the Wayback Machine
  14. ^ "Achar S Textbook Of Pediatrics (Third Edition)". A. B. Desai (ed.) (1989). p.1. ISBN 81-250-0440-8
  15. ^ Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  16. ^ Lock, Stephen; John M. Last; George Dunea (2001). The Oxford illustrated companion to medicine. Oxford University Press US. p. 173. ISBN 978-0-19-262950-0. Retrieved 9 July 2010. Rosen von Rosenstein.
  17. ^ Roberts, Michael (2003). The Age of Liberty: Sweden 1719–1772. Cambridge University Press. p. 216. ISBN 978-0-521-52707-1. Retrieved 9 July 2010.
  18. ^ Dallas, John. "Classics of Child Care". Royal College of Physicians of Edinburgh. Archived from the original on 27 July 2011. Retrieved 9 July 2010.
  19. ^ Duffin, Jacalyn (29 May 2010). History of Medicine, Second Edition: A Scandalously Short Introduction. University of Toronto Press.
  20. ^ Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  21. ^ "Broadribb's Introductory Pediatric Nursing". Nancy T. Hatfield (2007). p.4. ISBN 0-7817-7706-2
  22. ^ "Jacobi Medical Center - General Information". Archived from the original on 18 April 2006. Retrieved 6 April 2006.
  23. ^ Kutzsche, Stefan (8 April 2021). "Abraham Jacobi (1830–1919) and his transition from political to medical activist". Acta Paediatrica. 110 (8): 2303–2305. doi:10.1111/apa.15887. ISSN 0803-5253. PMID 33963612. S2CID 233998658. Archived from the original on 7 May 2023. Retrieved 7 May 2023.
  24. ^ a b Ballbriga, Angel (1991). "One century of pediatrics in Europe (section: development of pediatric hospitals in Europe)". In Nichols, Burford L.; et al. (eds.). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. Vol. 22. New York: Raven Press. pp. 6–8. ISBN 0-88167-695-0.
  25. ^ official history site (in French) of nineteenth century paediatric hospitals in Paris
  26. ^ "Introducing the Necker-Enfants Malades Hospital". Hôpital des Necker-Enfants Malades.
  27. ^ Young, D.G. (August 1999). "The Mason Brown Lecture: Scots and paediatric surgery". Journal of the Royal College of Surgeons Edinburgh. 44 (4): 211–5. PMID 10453141. Archived from the original on 14 July 2014.
  28. ^ Pearson, Howard A. (1991). "Pediatrics in the United States". In Nichols, Burford L.; et al. (eds.). History of Paediatrics 1850–1950. Nestlé Nutrition Workshop Series. Vol. 22. New York: Raven Press. pp. 55–63. ISBN 0-88167-695-0.
  29. ^ "Commentaries: Edwards A Park". Pediatrics. 44 (6). American Academy of Pediatrics: 897–901. 1969. doi:10.1542/peds.44.6.897. PMID 4903838. S2CID 43298798.
  30. ^ a b c d e f g h O'Hara, Kate (2016). "Paediatric pharmacokinetics and drug doses". Australian Prescriber. 39 (6): 208–210. doi:10.18773/austprescr.2016.071. ISSN 0312-8008. PMC 5155058. PMID 27990048.
  31. ^ a b c d e f g h i j k l m Wagner, Jonathan; Abdel-Rahman, Susan M. (2013). "Pediatric pharmacokinetics". Pediatrics in Review. 34 (6): 258–269. doi:10.1542/pir.34-6-258. ISSN 1526-3347. PMID 23729775.
  32. ^ a b c d e f Batchelor, Hannah Katharine; Marriott, John Francis (2015). "Paediatric pharmacokinetics: key considerations". British Journal of Clinical Pharmacology. 79 (3): 395–404. doi:10.1111/bcp.12267. ISSN 1365-2125. PMC 4345950. PMID 25855821.
  33. ^ Katz, Aviva L.; Webb, Sally A.; COMMITTEE ON BIOETHICS; Macauley, Robert C.; Mercurio, Mark R.; Moon, Margaret R.; Okun, Alexander L.; Opel, Douglas J.; Statter, Mindy B. (1 August 2016). "Informed Consent in Decision-Making in Pediatric Practice". Pediatrics. 138 (2): e20161485. doi:10.1542/peds.2016-1485. ISSN 0031-4005. PMID 27456510. S2CID 7951515.
  34. ^ a b Mazur, Kate A.; Berg, Stacey L., eds. (2020). Ethical Issues in Pediatric Hematology/Oncology. pp. 13–21. doi:10.1007/978-3-030-22684-8. ISBN 978-3-030-22683-1. S2CID 208302429.
  35. ^ a b Stern, Alexandra Minna; Markel, Howard (2002). Formative Years: Children's Health in the United States, 1880-2000. University of Michigan Press. pp. 23–24. doi:10.3998/mpub.17065. ISBN 978-0-472-02503-9. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  36. ^ Friedman, Lainie Ross (2004). Children, families, and health care decision making. Clarendon Press. ISBN 0-19-925154-1. OCLC 756393117.
  37. ^ a b c Martakis, K.; Schröder-Bäck, P.; Brand, H. (1 June 2018). "Developing child autonomy in pediatric healthcare: towards an ethical model". Archivos Argentinos de Pediatria. 116 (3): e401 – e408. doi:10.5546/aap.2018.eng.e401. ISSN 0325-0075. PMID 29756714. S2CID 46889502.
  38. ^ Schapiro, Tamar (1 July 1999). "What Is a Child?". Ethics. 109 (4): 715–738. doi:10.1086/233943. ISSN 0014-1704. S2CID 170129444. Archived from the original on 30 November 2021. Retrieved 30 November 2021.
  39. ^ Dondorp, W.; Bolt, I.; Tibben, A.; De Wert, G.; Van Summeren, M. (1 September 2021). "'We Should View Him as an Individual': The Role of the Child's Future Autonomy in Shared Decision-Making About Unsolicited Findings in Pediatric Exome Sequencing". Health Care Analysis. 29 (3): 249–261. doi:10.1007/s10728-020-00425-7. ISSN 1573-3394. PMID 33389383. S2CID 230112761.
  40. ^ "What Education Is Required to Be a Pediatrician?". Archived from the original on 7 June 2017. Retrieved 14 June 2017.
  41. ^ "CoPS". www.pedsubs.org. Archived from the original on 18 September 2013. Retrieved 14 August 2015.

Further reading

[edit]
  • BMC Pediatrics - open access
  • Clinical Pediatrics
  • Developmental Review - partial open access
  • JAMA Pediatrics
  • The Journal of Pediatrics - partial open access
[edit]
Wikimedia Commons has media related to Pediatrics.
 
Wikibooks has a book on the topic of: Pediatrics
 
Look up paediatrics or pediatrics in Wiktionary, the free dictionary.
  • Pediatrics Directory at Curlie
  • Pediatric Health Directory at OpenMD
 
 

 

 

  • Sub-Millimeter Surgical Dexterity
  • Knowledge of human health, disease, pathology, and anatomy
  • Communication/Interpersonal Skills
  • Analytical Skills
  • Critical Thinking
  • Empathy/Professionalism
  • Private practices
  • Primary care clinics
  • Hospitals
  • Physician
  • dental assistant
  • dental technician
  • dental hygienist
  • various dental specialists
Dentistry
A dentist treats a patient with the help of a dental assistant.
Occupation
Names
  • Dentist
  • Dental Surgeon
  • Doctor

[1][nb 1]
Occupation type
 Profession
Activity sectors
 Health care, Anatomy, Physiology, Pathology, Medicine, Pharmacology, Surgery
Description
Competencies  
Education required
 Dental Degree
Fields of
employment
  
Related jobs
  
ICD-9-CM 23-24
MeSH D003813
[edit on Wikidata]
An oral surgeon and dental assistant removing a wisdom tooth

Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of the mouth, most commonly focused on dentition (the development and arrangement of teeth) as well as the oral mucosa.[2] Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint. The practitioner is called a dentist.

The history of dentistry is almost as ancient as the history of humanity and civilization, with the earliest evidence dating from 7000 BC to 5500 BC.[3] Dentistry is thought to have been the first specialization in medicine which has gone on to develop its own accredited degree with its own specializations.[4] Dentistry is often also understood to subsume the now largely defunct medical specialty of stomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions. However, some specialties such as oral and maxillofacial surgery (facial reconstruction) may require both medical and dental degrees to accomplish. In European history, dentistry is considered to have stemmed from the trade of barber surgeons.[5]

Dental treatments are carried out by a dental team, which often consists of a dentist and dental auxiliaries (such as dental assistants, dental hygienists, dental technicians, and dental therapists). Most dentists either work in private practices (primary care), dental hospitals, or (secondary care) institutions (prisons, armed forces bases, etc.).

The modern movement of evidence-based dentistry calls for the use of high-quality scientific research and evidence to guide decision-making such as in manual tooth conservation, use of fluoride water treatment and fluoride toothpaste, dealing with oral diseases such as tooth decay and periodontitis, as well as systematic diseases such as osteoporosis, diabetes, celiac disease, cancer, and HIV/AIDS which could also affect the oral cavity. Other practices relevant to evidence-based dentistry include radiology of the mouth to inspect teeth deformity or oral malaises, haematology (study of blood) to avoid bleeding complications during dental surgery, cardiology (due to various severe complications arising from dental surgery with patients with heart disease), etc.

Terminology

[edit]

The term dentistry comes from dentist, which comes from French dentiste, which comes from the French and Latin words for tooth.[6] The term for the associated scientific study of teeth is odontology (from Ancient Greek: á½€δούς, romanized: odoús, lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.

Dental treatment

[edit]

Dentistry usually encompasses practices related to the oral cavity.[7] According to the World Health Organization, oral diseases are major public health problems due to their high incidence and prevalence across the globe, with the disadvantaged affected more than other socio-economic groups.[8]

The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth, extraction or surgical removal of teeth, scaling and root planing, endodontic root canal treatment, and cosmetic dentistry[9]

By nature of their general training, dentists, without specialization can carry out the majority of dental treatments such as restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays), and diagnosis. Dentists can also prescribe medications used in the field such as antibiotics, sedatives, and any other drugs used in patient management. Depending on their licensing boards, general dentists may be required to complete additional training to perform sedation, dental implants, etc.

Irreversible enamel defects caused by an untreated celiac disease. They may be the only clue to its diagnosis, even in absence of gastrointestinal symptoms, but are often confused with fluorosis, tetracycline discoloration, acid reflux or other causes.[10][11][12] The National Institutes of Health include a dental exam in the diagnostic protocol of celiac disease.[10]

Dentists also encourage the prevention of oral diseases through proper hygiene and regular, twice or more yearly, checkups for professional cleaning and evaluation. Oral infections and inflammations may affect overall health and conditions in the oral cavity may be indicative of systemic diseases, such as osteoporosis, diabetes, celiac disease or cancer.[7][10][13][14] Many studies have also shown that gum disease is associated with an increased risk of diabetes, heart disease, and preterm birth. The concept that oral health can affect systemic health and disease is referred to as "oral-systemic health".

Education and licensing

[edit]
Main article: Dentistry throughout the world
A sagittal cross-section of a molar tooth; 1: crown, 2: root, 3: enamel, 4: dentin and dentin tubules, 5: pulp chamber, 6: blood vessels and nerve, 7: periodontal ligament, 8: apex and periapical region, 9: alveolar bone
Early dental chair in Pioneer West Museum in Shamrock, Texas

John M. Harris started the world's first dental school in Bainbridge, Ohio, and helped to establish dentistry as a health profession. It opened on 21 February 1828, and today is a dental museum.[15] The first dental college, Baltimore College of Dental Surgery, opened in Baltimore, Maryland, US in 1840. The second in the United States was the Ohio College of Dental Surgery, established in Cincinnati, Ohio, in 1845.[16] The Philadelphia College of Dental Surgery followed in 1852.[17] In 1907, Temple University accepted a bid to incorporate the school.

Studies show that dentists that graduated from different countries,[18] or even from different dental schools in one country,[19] may make different clinical decisions for the same clinical condition. For example, dentists that graduated from Israeli dental schools may recommend the removal of asymptomatic impacted third molar (wisdom teeth) more often than dentists that graduated from Latin American or Eastern European dental schools.[20]

In the United Kingdom, the first dental schools, the London School of Dental Surgery and the Metropolitan School of Dental Science, both in London, opened in 1859.[21] The British Dentists Act of 1878 and the 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.[22][23] However, others could legally describe themselves as "dental experts" or "dental consultants".[24] The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry.[25] The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally.[22] Dentists in the United Kingdom are now regulated by the General Dental Council.

In many countries, dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. In a few countries, to become a qualified dentist one must usually complete at least four years of postgraduate study;[26] Dental degrees awarded around the world include the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) in North America (US and Canada), and the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) in the UK and current and former British Commonwealth countries.

All dentists in the United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree. This schooling is followed by four years of dental school to qualify as a "Doctor of Dental Surgery" (DDS) or "Doctor of Dental Medicine" (DMD). Specialization in dentistry is available in the fields of Anesthesiology, Dental Public Health, Endodontics, Oral Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Pathology, Orthodontics, Pediatric Dentistry (Pedodontics), Periodontics, and Prosthodontics.[27]

Specialties

[edit]
Main article: Specialty (dentistry)
A modern dental clinic in Lappeenranta, Finland

Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include:

  • Anesthesiology[28] – The specialty of dentistry that deals with the advanced use of general anesthesia, sedation and pain management to facilitate dental procedures.
  • Cosmetic dentistry – Focuses on improving the appearance of the mouth, teeth and smile.
  • Dental public health – The study of epidemiology and social health policies relevant to oral health.
  • Endodontics (also called endodontology) – Root canal therapy and study of diseases of the dental pulp and periapical tissues.
  • Forensic odontology – The gathering and use of dental evidence in law. This may be performed by any dentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.
  • Geriatric dentistry or geriodontics – The delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.
  • Oral and maxillofacial pathology – The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases.
  • Oral and maxillofacial radiology – The study and radiologic interpretation of oral and maxillofacial diseases.
  • Oral and maxillofacial surgery (also called oral surgery) – Extractions, implants, and surgery of the jaws, mouth and face.[nb 2]
  • Oral biology – Research in dental and craniofacial biology
  • Oral Implantology – The art and science of replacing extracted teeth with dental implants.
  • Oral medicine – The clinical evaluation and diagnosis of oral mucosal diseases
  • Orthodontics and dentofacial orthopedics – The straightening of teeth and modification of midface and mandibular growth.
  • Pediatric dentistry (also called pedodontics) – Dentistry for children
  • Periodontology (also called periodontics) – The study and treatment of diseases of the periodontium (non-surgical and surgical) as well as placement and maintenance of dental implants
  • Prosthodontics (also called prosthetic dentistry) – Dentures, bridges and the restoration of implants.
    • Some prosthodontists super-specialize in maxillofacial prosthetics, which is the discipline originally concerned with the rehabilitation of patients with congenital facial and oral defects such as cleft lip and palate or patients born with an underdeveloped ear (microtia). Today, most maxillofacial prosthodontists return function and esthetics to patients with acquired defects secondary to surgical removal of head and neck tumors, or secondary to trauma from war or motor vehicle accidents.
  • Special needs dentistry (also called special care dentistry) – Dentistry for those with developmental and acquired disabilities.
  • Sports dentistry – the branch of sports medicine dealing with prevention and treatment of dental injuries and oral diseases associated with sports and exercise.[29] The sports dentist works as an individual consultant or as a member of the Sports Medicine Team.
  • Veterinary dentistry – The field of dentistry applied to the care of animals. It is a specialty of veterinary medicine.[30][31]

History

[edit]
See also: History of dental treatments
A wealthy patient falling over because of having a tooth extracted with such vigour by a fashionable dentist, c. 1790. History of Dentistry.
Farmer at the dentist, Johann Liss, c. 1616–17

Tooth decay was low in pre-agricultural societies, but the advent of farming society about 10,000 years ago correlated with an increase in tooth decay (cavities).[32] An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry,[33] although a 2017 study suggests that 130,000 years ago the Neanderthals already used rudimentary dentistry tools.[34] In Italy evidence dated to the Paleolithic, around 13,000 years ago, points to bitumen used to fill a tooth[35] and in Neolithic Slovenia, 6500 years ago, beeswax was used to close a fracture in a tooth.[36] The Indus valley has yielded evidence of dentistry being practised as far back as 7000 BC, during the Stone Age.[37] The Neolithic site of Mehrgarh (now in Pakistan's south western province of Balochistan) indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead-crafters.[3] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.[38] The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500 years ago.[39] Dentistry was practised in prehistoric Malta, as evidenced by a skull which had a dental abscess lanced from the root of a tooth dating back to around 2500 BC.[40]

An ancient Sumerian text describes a "tooth worm" as the cause of dental caries.[41] Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the Homeric Hymns,[42] and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.[43]

Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus, Kahun Papyri, Brugsch Papyrus, and Hearst papyrus of Ancient Egypt.[44] The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws.[44][45] In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment.[46] Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics.[47] However, it is possible the prosthetics were prepared after death for aesthetic reasons.[44]

Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.[48] Use of dental appliances, bridges and dentures was applied by the Etruscans in northern Italy, from as early as 700 BC, of human or other animal teeth fastened together with gold bands.[49][50][51] The Romans had likely borrowed this technique by the 5th century BC.[50][52] The Phoenicians crafted dentures during the 6th–4th century BC, fashioning them from gold wire and incorporating two ivory teeth.[53] In ancient Egypt, Hesy-Ra is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.[54] The earliest dental amalgams were first documented in a Tang dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528.[55][56]

During the Islamic Golden Age Dentistry was discussed in several famous books of medicine such as The Canon in medicine written by Avicenna and Al-Tasreef by Al-Zahrawi who is considered the greatest surgeon of the Middle Ages,[57] Avicenna said that jaw fracture should be reduced according to the occlusal guidance of the teeth; this principle is still valid in modern times. Al-Zahrawi invented over 200 surgical tools that resemble the modern kind.[58]

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac most probably invented the dental pelican[59] (resembling a pelican's beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key[60] which, in turn, was replaced by modern forceps in the 19th century.[61]

Dental needle-nose pliers designed by Fauchard in the late 17th century to use in prosthodontics

The first book focused solely on dentistry was the "Artzney Buchlein" in 1530,[48] and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685.[23]

In the United Kingdom, there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921.[62]

Modern dentistry

[edit]
A microscopic device used in dental analysis, c. 1907

It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend (c. 1656 pub. 1690) made an early dental observation with characteristic humour:

The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein 'tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head.

The French surgeon Pierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watchmakers, jewelers and even barbers, that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities. He asserted that sugar-derived acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth and in the gums could appear in the later stages of tooth decay.[63][64]

Panoramic radiograph of historic dental implants, made 1978

Fauchard was the pioneer of dental prosthesis, and he invented many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone. He also introduced dental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery".[63][64]

A modern dentist's chair

After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter. In 1763, he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that the chances of a successful tooth transplant (initially, at least) would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable achievement for the period.[65]

Major advances in science were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK, the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time.[66]

Hazards in modern dentistry

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Main article: Occupational hazards in dentistry

Long term occupational noise exposure can contribute to permanent hearing loss, which is referred to as noise-induced hearing loss (NIHL) and tinnitus. Noise exposure can cause excessive stimulation of the hearing mechanism, which damages the delicate structures of the inner ear.[67] NIHL can occur when an individual is exposed to sound levels above 90 dBA according to the Occupational Safety and Health Administration (OSHA). Regulations state that the permissible noise exposure levels for individuals is 90 dBA.[68] For the National Institute for Occupational Safety and Health (NIOSH), exposure limits are set to 85 dBA. Exposures below 85 dBA are not considered to be hazardous. Time limits are placed on how long an individual can stay in an environment above 85 dBA before it causes hearing loss. OSHA places that limitation at 8 hours for 85 dBA. The exposure time becomes shorter as the dBA level increases.

Within the field of dentistry, a variety of cleaning tools are used including piezoelectric and sonic scalers, and ultrasonic scalers and cleaners.[69] While a majority of the tools do not exceed 75 dBA,[70] prolonged exposure over many years can lead to hearing loss or complaints of tinnitus.[71] Few dentists have reported using personal hearing protective devices,[72][73] which could offset any potential hearing loss or tinnitus.

Evidence-based dentistry

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Main article: Evidence-based dentistry

There is a movement in modern dentistry to place a greater emphasis on high-quality scientific evidence in decision-making. Evidence-based dentistry (EBD) uses current scientific evidence to guide decisions. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on the latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.[74] It was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. It is part of the larger movement toward evidence-based medicine and other evidence-based practices, especially since a major part of dentistry involves dealing with oral and systemic diseases. Other issues relevant to the dental field in terms of evidence-based research and evidence-based practice include population oral health, dental clinical practice, tooth morphology etc.

A dental chair at the University of Michigan School of Dentistry

Ethical and medicolegal issues

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Dentistry is unique in that it requires dental students to have competence-based clinical skills that can only be acquired through supervised specialized laboratory training and direct patient care.[75] This necessitates the need for a scientific and professional basis of care with a foundation of extensive research-based education.[76] According to some experts, the accreditation of dental schools can enhance the quality and professionalism of dental education.[77][78]

See also

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  • Dental aerosol
  • Dental instrument
  • Dental public health
  • Domestic healthcare:
    • Dentistry in ancient Rome
    • Dentistry in Canada
    • Dentistry in the Philippines
    • Dentistry in Israel
    • Dentistry in the United Kingdom
    • Dentistry in the United States
  • Eco-friendly dentistry
  • Geriatric dentistry
  • List of dental organizations
  • Pediatric dentistry
  • Sustainable dentistry
  • Veterinary dentistry
 

Notes

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  1. ^ Whether Dentists are referred to as "Doctor" is subject to geographic variation. For example, they are called "Doctor" in the US. In the UK, dentists have traditionally been referred to as "Mister" as they identified themselves with barber surgeons more than physicians (as do surgeons in the UK, see Surgeon#Titles). However more UK dentists now refer to themselves as "Doctor", although this was considered to be potentially misleading by the British public in a single report (see Costley and Fawcett 2010).
  2. ^ The scope of oral and maxillofacial surgery is variable. In some countries, both a medical and dental degree is required for training, and the scope includes head and neck oncology and craniofacial deformity.

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