Linking Orthodontics with Periodontal Health

Linking Orthodontics with Periodontal Health

* The interplay between orthodontic forces and periodontal tissues in young patients.

Okay, let's talk about how braces and gums get along in kids and teens. It's a crucial relationship, really. When we're moving teeth with braces, we're applying force, right? That force doesn't just act on the tooth itself. It also affects the stuff around the tooth – the gums, the bone, the ligaments that hold everything in place. We call all that "periodontal tissues."


Orthodontic expanders can create more space in the mouth for teeth Child-friendly orthodontic solutions mouth.

Now, in younger patients, these tissues are still developing and adapting. That's good, because it means teeth can move more easily. But it also means they're more vulnerable. If the forces from the braces are too strong, or if oral hygiene isn't great, we can run into problems. Gums can get inflamed, bone can resorb, and we can even end up with gum recession or bone loss. Nobody wants that!


So, orthodontists have to be super careful. We need to use the right amount of force, in the right direction, for the right amount of time. And equally important, we need to educate our young patients (and their parents!) about keeping their teeth and gums squeaky clean. Brushing, flossing, regular check-ups – it all matters.


Basically, it's a balancing act. We want to move the teeth to create a beautiful smile, but we also want to keep the gums and bone healthy and happy. When orthodontists understand this interplay between force and tissue, and when patients are committed to good oral hygiene, we can achieve amazing results without compromising periodontal health. It's a team effort, and a really important one for a lifetime of healthy smiles.

Okay, let's talk about how braces and gums get along, especially in kids. You know, getting braces is a big deal for a lot of kids. Straight teeth, confident smiles – it's all good stuff. But sometimes, that journey to a perfect smile can hit a few bumps in the road, especially when it comes to their gums.


Think about it. Braces create all these little nooks and crannies where food and plaque can hide out. And kids, bless their hearts, aren't always the best at brushing every single speck away, even without the added challenge of wires and brackets. So, what happens?


Well, common periodontal (gum) issues start popping up. Things like gingivitis, which is basically inflamed and irritated gums. You might see some redness, swelling, and maybe even a little bleeding when brushing. It's usually reversible with better oral hygiene, but if it's not taken care of, it can lead to more serious problems down the line.


Another thing we see is gum recession, where the gums start to pull back from the teeth. This can make the teeth look longer and can sometimes lead to sensitivity. Orthodontic movement itself, especially if it's too fast or too forceful, can sometimes contribute to recession, particularly if there's already thin gum tissue there.


And, rarely, we might see something called periodontitis, which is a more advanced form of gum disease that can actually damage the bone supporting the teeth.

Linking Orthodontics with Periodontal Health - wire

  1. child
  2. Align Technology
  3. ceramic
This is less common in kids, but it's definitely something to be aware of, especially if there's a family history of gum disease or if oral hygiene is consistently poor.


The key takeaway is that keeping gums healthy during orthodontic treatment is super important. Regular check-ups with the dentist and orthodontist are crucial. And, of course, good brushing and flossing habits are non-negotiable. It's a team effort between the child, their parents, and their dental professionals to make sure that beautiful, straight smile is sitting on a foundation of healthy gums.

More about us:

Social Media:

Facebook About Us:


Citations and other links

* Preventive measures to maintain periodontal health during orthodontic treatment.

Okay, so you're getting braces, which is awesome for straightening your teeth and giving you that killer smile. But here's the thing: all those brackets and wires create extra nooks and crannies where plaque and bacteria just love to hang out. And that's where periodontal (gum) problems can sneak in. Trust me, you don't want inflamed, bleeding gums messing with your orthodontic journey – or your overall health, for that matter.


So, what can you do? Think of it as upping your oral hygiene game. Brushing becomes a real art form. You need to get around each bracket, making sure you're removing all that plaque. An electric toothbrush can be a huge help here. Flossing? Oh yeah, you gotta floss. Maybe invest in floss threaders or interdental brushes to get under the wires. And don't forget your tongue scraper!


Beyond the basics, your orthodontist and dentist are your best allies. They'll keep a close eye on your gums during your appointments, looking for any signs of trouble. Regular professional cleanings are non-negotiable; they can get to the plaque and tartar that you just can't reach at home. Your dentist might also recommend fluoride treatments or antimicrobial mouthwashes to give you an extra layer of protection.




Linking Orthodontics with Periodontal Health - dentistry

  1. medical specialty
  2. molar
  3. Stanford University School of Medicine

Basically, keeping your gums healthy during orthodontics is all about being proactive. It's a team effort between you, your orthodontist, and your dentist. Put in the extra effort now, and you'll not only have perfectly aligned teeth, but also a healthy, happy smile that lasts a lifetime. It's totally worth it!

* The role of oral hygiene instructions for children and parental involvement.

Okay, let's talk about kids, braces, and healthy gums. It's a trio that needs a bit of attention! When we're thinking about straightening teeth, it's super easy to get caught up in the aesthetics – the perfect smile, the before-and-after pictures. But what about the health of the gums that are holding those teeth in place? That's where the link between orthodontics and periodontal health comes in, and it's especially important for children.


Think about it: braces create all sorts of new nooks and crannies where plaque can hide. For kids, who are still developing their brushing habits, this can be a recipe for trouble. That's why clear, age-appropriate oral hygiene instructions are absolutely crucial when a child is in orthodontic treatment. We're not just talking about "brush twice a day." We're talking about demonstrating how to effectively clean around brackets and wires, maybe even recommending special tools like interdental brushes or floss threaders. It's about empowering them to take control of their oral health.


And this is where parents come in. Parental involvement isn't just a nice-to-have; it's a need-to-have. Kids often need reminders, encouragement, and even supervision to make sure they're cleaning thoroughly. Parents can help by making oral hygiene a part of the daily routine, monitoring brushing habits, and even making it a family affair. Think of it as a team effort to protect that beautiful, soon-to-be-straight smile.


Ultimately, good oral hygiene instructions and active parental involvement are the cornerstones of preventing periodontal problems during orthodontic treatment in children. It's about setting them up for a lifetime of healthy teeth and gums, long after the braces come off. It's about more than just a straight smile; it's about a healthy one.

* Early detection and management of periodontal problems during orthodontic care.

Orthodontic treatment, while focused on aligning teeth, can sometimes inadvertently stir up trouble in the gum department. That's where the early detection and management of periodontal problems come in as a crucial piece of the puzzle. Think of it like this: you're carefully rearranging furniture in a room, but you need to make sure you're not accidentally damaging the floorboards in the process.


Moving teeth around, applying forces, can potentially exacerbate existing gum issues or even create new ones. Things like inflammation, bleeding gums, or even the dreaded bone loss can rear their ugly heads if we're not vigilant. So, before, during, and after braces, a keen eye needs to be kept on the health of the gums and supporting structures.


Catching problems early is key. It means simpler solutions, like better oral hygiene instructions tailored to the patient's orthodontic appliances, professional cleanings, or maybe even adjusting the orthodontic treatment plan slightly.

Linking Orthodontics with Periodontal Health - wire

  1. retainer
  2. dentistry
  3. wire
Ignoring these early signs can lead to more serious and complex periodontal disease that could compromise the long-term success of both the orthodontic treatment and the patient's overall oral health. Basically, a healthy foundation of gums and bone is essential for teeth to stay put and function well after the braces come off. It's all about a team effort between the orthodontist and the patient to ensure a beautiful smile sits atop a healthy, happy mouth.

* Collaboration between orthodontists and periodontists for optimal outcomes.

Alright, let's talk about teamwork. Specifically, the kind of teamwork that happens in your mouth, or rather, the kind that should be happening between the professionals who care for it. I'm talking about orthodontists and periodontists. You might think of them as working on separate floors of the dental building, one straightening teeth, the other dealing with gums. But the truth is, they're much more effective when they're collaborating, playing on the same team for a common goal: a healthy, beautiful smile that lasts.


Think of it this way: orthodontics is like building a beautiful house (your perfectly aligned teeth). But you can't build a house on a shaky foundation. That's where the periodontist comes in, ensuring the "ground" beneath the house – your gums and supporting bone – is strong and stable. If the foundation is weak due to periodontal disease (gum disease), moving teeth with braces can actually make things worse, potentially leading to bone loss and even tooth loss.


A good orthodontist will always assess your periodontal health before even thinking about starting treatment. And a smart periodontist will understand that sometimes, aligning teeth can make it easier to maintain good oral hygiene and prevent future gum problems. They'll communicate, share records, and develop a treatment plan that addresses both the alignment and the supporting tissues.


So, linking orthodontics with periodontal health isn't just a nice-to-have; it's essential for achieving truly optimal results. It's about looking at the whole picture, understanding how the position of your teeth impacts your gums and vice versa, and working together to create a smile that's not just pretty, but healthy and strong for years to come. It's really just common sense, and good dentistry.

Malocclusion
Malocclusion in 10-year-old girl
Specialty Dentistry Edit this on Wikidata

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864;[1] Edward Angle (1855–1930), the "father of modern orthodontics",[2][3][need quotation to verify] popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.  If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal.[4] However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definition of malocclusion, then treatment may not be necessary. It is estimated that nearly 30% of the population have malocclusions that are categorised as severe and definitely benefit from orthodontic treatment.[5]

Causes

[edit]

The aetiology of malocclusion is somewhat contentious, however, simply put it is multifactorial, with influences being both genetic[6][unreliable source?] and environmental.[7] Malocclusion is already present in one of the Skhul and Qafzeh hominin fossils and other prehistoric human skulls.[8][9] There are three generally accepted causative factors of malocclusion:

  • Skeletal factors – the size, shape and relative positions of the upper and lower jaws. Variations can be caused by environmental or behavioral factors such as muscles of mastication, nocturnal mouth breathing, and cleft lip and cleft palate.
  • Muscle factors – the form and function of the muscles that surround the teeth.  This could be impacted by habits such as finger sucking, nail biting, pacifier and tongue thrusting[10]
  • Dental factors – size of the teeth in relation to the jaw, early loss of teeth could result in spacing or mesial migration causing crowding, abnormal eruption path or timings, extra teeth (supernumeraries), or too few teeth (hypodontia)

There is not one single cause of malocclusion, and when planning orthodontic treatment it is often helpful to consider the above factors and the impact they have played on malocclusion. These can also be influenced by oral habits and pressure resulting in malocclusion.[11][12]

Behavioral and dental factors

[edit]

In the active skeletal growth,[13] mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches.[14][15][16][17][18] Pacifier sucking habits are also correlated with otitis media.[19][20] Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions.

Primary vs. secondary dentition

[edit]

Malocclusion can occur in primary and secondary dentition.

In primary dentition malocclusion is caused by:

  • Underdevelopment of the dentoalvelor tissue.
  • Over development of bones around the mouth.
  • Cleft lip and palate.
  • Overcrowding of teeth.
  • Abnormal development and growth of teeth.

In secondary dentition malocclusion is caused by:

  • Periodontal disease.
  • Overeruption of teeth.[21]
  • Premature and congenital loss of missing teeth.

Signs and symptoms

[edit]

Malocclusion is a common finding,[22][23] although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of craniofacial anomalies, may require orthodontic and sometimes surgical treatment (orthognathic surgery) to correct the problem.

The ultimate goal of orthodontic treatment is to achieve a stable, functional and aesthetic alignment of teeth which serves to better the patient's dental and total health.[24] The symptoms which arise as a result of malocclusion derive from a deficiency in one or more of these categories.[25]

The symptoms are as follows:

  • Tooth decay (caries): misaligned teeth will make it more difficult to maintain oral hygiene. Children with poor oral hygiene and diet will be at an increased risk.
  • Periodontal disease: irregular teeth would hinder the ability to clean teeth meaning poor plaque control. Additionally, if teeth are crowded, some may be more buccally or lingually placed, there will be reduced bone and periodontal support. Furthermore, in Class III malocclusions, mandibular anterior teeth are pushed labially which contributes to gingival recession and weakens periodontal support.
  • Trauma to anterior teeth: Those with an increased overjet are at an increased risk of trauma. A systematic review found that an overjet of greater than 3mm will double the risk of trauma.
  • Masticatory function: people with anterior open bites, large increased & reverse overjet and hypodontia will find it more difficult to chew food.
  • Speech impairment: a lisp is when the incisors cannot make contact, orthodontics can treat this. However, other forms of misaligned teeth will have little impact on speech and orthodontic treatment has little effect on fixing any problems.  
  • Tooth impaction: these can cause resorption of adjacent teeth and other pathologies for example a dentigerous cyst formation.  
  • Psychosocial wellbeing: malocclusions of teeth with poor aesthetics can have a significant effect on self-esteem.

Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. Such skeletal disharmonies often distort sufferer's face shape, severely affect aesthetics of the face, and may be coupled with mastication or speech problems. Most skeletal malocclusions can only be treated by orthognathic surgery.[citation needed]

Classification

[edit]

Depending on the sagittal relations of teeth and jaws, malocclusions can be divided mainly into three types according to Angle's classification system published 1899. However, there are also other conditions, e.g. crowding of teeth, not directly fitting into this classification.

Many authors have tried to modify or replace Angle's classification. This has resulted in many subtypes and new systems (see section below: Review of Angle's system of classes).

A deep bite (also known as a Type II Malocclusion) is a condition in which the upper teeth overlap the lower teeth, which can result in hard and soft tissue trauma, in addition to an effect on appearance.[26] It has been found to occur in 15–20% of the US population.[27]

An open bite is a condition characterised by a complete lack of overlap and occlusion between the upper and lower incisors.[28] In children, open bite can be caused by prolonged thumb sucking.[29] Patients often present with impaired speech and mastication.[30]

Overbites

[edit]

This is a vertical measurement of the degree of overlap between the maxillary incisors and the mandibular incisors. There are three features that are analysed in the classification of an overbite:

  • Degree of overlap: edge to edge, reduced, average, increased
  • Complete or incomplete: whether there is contact between the lower teeth and the opposing teeth/tissue (hard palate or gingivae) or not.
  • Whether contact is traumatic or atraumatic

An average overbite is when the upper anterior teeth cover a third of the lower teeth. Covering less than this is described as ‘reduced’ and more than this is an ‘increased’ overbite. No overlap or contact is considered an ‘anterior open bite’.[25][31][32]

Angle's classification method

[edit]
Class I with severe crowding and labially erupted canines
Class II molar relationship

Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar.[33] According to Angle, the mesiobuccal cusp of the upper first molar should align with the buccal groove of the mandibular first molar. The teeth should all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.

  • Class I (Neutrocclusion): Here the molar relationship of the occlusion is normal but the incorrect line of occlusion or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.
  • Class II (Distocclusion (retrognathism, overjet, overbite)): In this situation, the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar. Instead it is anterior to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:
    • Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.
    • Class II Division 2: The molar relationships are Class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.
  • Class III: (Mesiocclusion (prognathism, anterior crossbite, negative overjet, underbite)) In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually seen as when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

Review of Angle's system of classes and alternative systems

[edit]

A major disadvantage of Angle's system of classifying malocclusions is that it only considers two dimensions along a spatial axis in the sagittal plane in the terminal occlusion, but occlusion problems can be three-dimensional. It does not recognise deviations in other spatial axes, asymmetric deviations, functional faults and other therapy-related features.

Angle's classification system also lacks a theoretical basis; it is purely descriptive. Its much-discussed weaknesses include that it only considers static occlusion, it does not account for the development and causes (aetiology) of occlusion problems, and it disregards the proportions (or relationships in general) of teeth and face.[34] Thus, many attempts have been made to modify the Angle system or to replace it completely with a more efficient one,[35] but Angle's classification continues be popular mainly because of its simplicity and clarity.[citation needed]

Well-known modifications to Angle's classification date back to Martin Dewey (1915) and Benno Lischer (1912, 1933). Alternative systems have been suggested by, among others, Simon (1930, the first three-dimensional classification system), Jacob A. Salzmann (1950, with a classification system based on skeletal structures) and James L. Ackerman and William R. Proffit (1969).[36]

Incisor classification

[edit]

Besides the molar relationship, the British Standards Institute Classification also classifies malocclusion into incisor relationship and canine relationship.

  • Class I: The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
  • Class II: The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
    • Division 1 – the upper central incisors are proclined or of average inclination and there is an increase in overjet
    • Division 2 – The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
  • Class III: The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

Canine relationship by Ricketts

[edit]
  • Class I: Mesial slope of upper canine coincides with distal slope of lower canine
  • Class II: Mesial slope of upper canine is ahead of distal slope of lower canine
  • Class III: Mesial slope of upper canine is behind to distal slope of lower canine

Crowding of teeth

[edit]

Dental crowding is defined by the amount of space that would be required for the teeth to be in correct alignment. It is obtained in two ways: 1) by measuring the amount of space required and reducing this from calculating the space available via the width of the teeth, or 2) by measuring the degree of overlap of the teeth.

The following criterion is used:[25]

  • 0-4mm = Mild crowding
  • 4-8mm = Moderate crowding
  • >8mm = Severe crowding

Causes

[edit]

Genetic (inheritance) factors, extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of crowding. Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are also known to cause crowding.[26] Tumors of the mouth and jaw, thumb sucking, tongue thrusting, pacifier use beyond age three, and prolonged use of a bottle have also been identified.[26]

Lack of masticatory stress during development can cause tooth overcrowding.[37][38] Children who chewed a hard resinous gum for two hours a day showed increased facial growth.[37] Experiments in animals have shown similar results. In an experiment on two groups of rock hyraxes fed hardened or softened versions of the same foods, the animals fed softer food had significantly narrower and shorter faces and thinner and shorter mandibles than animals fed hard food.[37][39][failed verification]

A 2016 review found that breastfeeding lowers the incidence of malocclusions developing later on in developing infants.[40]

During the transition to agriculture, the shape of the human mandible went through a series of changes. The mandible underwent a complex shape changes not matched by the teeth, leading to incongruity between the dental and mandibular form. These changes in human skulls may have been "driven by the decreasing bite forces required to chew the processed foods eaten once humans switched to growing different types of cereals, milking and herding animals about 10,000 years ago."[38][41]

Treatment

[edit]

Orthodontic management of the condition includes dental braces, lingual braces, clear aligners or palatal expanders.[42] Other treatments include the removal of one or more teeth and the repair of injured teeth. In some cases, surgery may be necessary.[43]

Treatment

[edit]

Malocclusion is often treated with orthodontics,[42] such as tooth extraction, clear aligners, or dental braces,[44] followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgical intervention is used only in rare occasions. This may include surgical reshaping to lengthen or shorten the jaw. Wires, plates, or screws may be used to secure the jaw bone, in a manner like the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth with most problems being minor that do not require treatment.[37]

Crowding

[edit]

Crowding of the teeth is treated with orthodontics, often with tooth extraction, clear aligners, or dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.[39]

Class I

[edit]

While treatment is not crucial in class I malocclusions, in severe cases of crowding can be an indication for intervention. Studies indicate that tooth extraction can have benefits to correcting malocclusion in individuals.[45][46] Further research is needed as reoccurring crowding has been examined in other clinical trials.[45][47]

Class II

[edit]

A few treatment options for class II malocclusions include:

  1. Functional appliance which maintains the mandible in a postured position to influence both the orofacial musculature and dentoalveolar development prior to fixed appliance therapy. This is ideally done through pubertal growth in pre-adolescent children and the fixed appliance during permanent dentition .[48] Different types of removable appliances include Activator, Bionatar, Medium opening activator, Herbst, Frankel and twin block appliance with the twin block being the most widely used one.[49]
  2. Growth modification through headgear to redirect maxillary growth
  3. Orthodontic camouflage so that jaw discrepancy no longer apparent
  4. Orthognathic surgery – sagittal split osteotomy mandibular advancement carried out when growth is complete where skeletal discrepancy is severe in anterior-posterior relationship or in vertical direction. Fixed appliance is required before, during and after surgery.
  5. Upper Removable Appliance – limited role in contemporary treatment of increased overjets. Mostly used for very mild Class II, overjet due to incisor proclination, favourable overbite.

Class II Division 1

[edit]

Low- to moderate- quality evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth (class II division 1) is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence.[50] There do not appear to be any other advantages of providing early treatment when compared to late treatment.[50] Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances is effective for reducing the prominence of upper front teeth.[50]

Class II Division 2

[edit]

Treatment can be undertaken using orthodontic treatments using dental braces.[51] While treatment is carried out, there is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment in children.[51] A 2018 Cochrane systematic review anticipated that the evidence base supporting treatment approaches is not likely to improve occlusion due to the low prevalence of the condition and the ethical difficulties in recruiting people to participate in a randomized controlled trials for treating this condition.[51]

Class III

[edit]

The British Standard Institute (BSI) classify class III incisor relationship as the lower incisor edge lies anterior to the cingulum plateau of the upper incisors, with reduced or reversed over jet.[52] The skeletal facial deformity is characterized by mandibular prognathism, maxillary retrognathism or a combination of the two. This effects 3-8% of UK population with a higher incidence seen in Asia.[53]

One of the main reasons for correcting Class III malocclusion is aesthetics and function. This can have a psychological impact on the person with malocclusion resulting in speech and mastication problems as well. In mild class III cases, the patient is quite accepting of the aesthetics and the situation is monitored to observe the progression of skeletal growth.[54]

Maxillary and mandibular skeletal changes during prepubertal, pubertal and post pubertal stages show that class III malocclusion is established before the prepubertal stage.[55] One treatment option is the use of growth modification appliances such as the Chin Cap which has greatly improved the skeletal framework in the initial stages. However, majority of cases are shown to relapse into inherited class III malocclusion during the pubertal growth stage and when the appliance is removed after treatment.[55]

Another approach is to carry out orthognathic surgery, such as a bilateral sagittal split osteotomy (BSSO) which is indicated by horizontal mandibular excess. This involves surgically cutting through the mandible and moving the fragment forward or backwards for desired function and is supplemented with pre and post surgical orthodontics to ensure correct tooth relationship. Although the most common surgery of the mandible, it comes with several complications including: bleeding from inferior alveolar artery, unfavorable splits, condylar resorption, avascular necrosis and worsening of temporomandibular joint.[56]

Orthodontic camouflage can also be used in patients with mild skeletal discrepancies. This is a less invasive approach that uses orthodontic brackets to correct malocclusion and try to hide the skeletal discrepancy. Due to limitations of orthodontics, this option is more viable for patients who are not as concerned about the aesthetics of their facial appearance and are happy to address the malocclusion only, as well as avoiding the risks which come with orthognathic surgery. Cephalometric data can aid in the differentiation between the cases that benefit from ortho-surgical or orthodontic treatment only (camouflage); for instance, examining a large group of orthognathic patient with Class III malocclusions they had average ANB angle of -3.57° (95% CI, -3.92° to -3.21°). [57]

Deep bite

[edit]

The most common corrective treatments available are fixed or removal appliances (such as dental braces), which may or may not require surgical intervention. At this time there is no robust evidence that treatment will be successful.[51]

Open bite

[edit]

An open bite malocclusion is when the upper teeth don't overlap the lower teeth. When this malocclusion occurs at the front teeth it is known as anterior open bite. An open bite is difficult to treat due to multifactorial causes, with relapse being a major concern. This is particularly so for an anterior open bite.[58] Therefore, it is important to carry out a thorough initial assessment in order to obtain a diagnosis to tailor a suitable treatment plan.[58] It is important to take into consideration any habitual risk factors, as this is crucial for a successful outcome without relapse. Treatment approach includes behavior changes, appliances and surgery. Treatment for adults include a combination of extractions, fixed appliances, intermaxillary elastics and orthognathic surgery.[30] For children, orthodontics is usually used to compensate for continued growth. With children with mixed dentition, the malocclusion may resolve on its own as the permanent teeth erupt. Furthermore, should the malocclusion be caused by childhood habits such as digit, thumb or pacifier sucking, it may result in resolution as the habit is stopped. Habit deterrent appliances may be used to help in breaking digit and thumb sucking habits. Other treatment options for patients who are still growing include functional appliances and headgear appliances.

Tooth size discrepancy

[edit]

Identifying the presence of tooth size discrepancies between the maxillary and mandibular arches is an important component of correct orthodontic diagnosis and treatment planning.

To establish appropriate alignment and occlusion, the size of upper and lower front teeth, or upper and lower teeth in general, needs to be proportional. Inter-arch tooth size discrepancy (ITSD) is defined as a disproportion in the mesio-distal dimensions of teeth of opposing dental arches. The prevalence is clinically significant among orthodontic patients and has been reported to range from 17% to 30%.[59]

Identifying inter-arch tooth size discrepancy (ITSD) before treatment begins allows the practitioner to develop the treatment plan in a way that will take ITSD into account. ITSD corrective treatment may entail demanding reduction (interproximal wear), increase (crowns and resins), or elimination (extractions) of dental mass prior to treatment finalization.[60]

Several methods have been used to determine ITSD. Of these methods the one most commonly used is the Bolton analysis. Bolton developed a method to calculate the ratio between the mesiodistal width of maxillary and mandibular teeth and stated that a correct and harmonious occlusion is possible only with adequate proportionality of tooth sizes.[60] Bolton's formula concludes that if in the anterior portion the ratio is less than 77.2% the lower teeth are too narrow, the upper teeth are too wide or there is a combination of both. If the ratio is higher than 77.2% either the lower teeth are too wide, the upper teeth are too narrow or there is a combination of both.[59]

Other conditions

[edit]
Open bite treatment after eight months of braces.

Other kinds of malocclusions can be due to or horizontal, vertical, or transverse skeletal discrepancies, including skeletal asymmetries.

Increased vertical growth causes a long facial profile and commonly leads to an open bite malocclusion, while decreased vertical facial growth causes a short facial profile and is commonly associated with a deep bite malocclusion. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking) and likewise for deep bites.[61][62][63]

The upper or lower jaw can be overgrown (macrognathia) or undergrown (micrognathia).[62][61][63] It has been reported that patients with micrognathia are also affected by retrognathia (abnormal posterior positioning of the mandible or maxilla relative to the facial structure).[62]  These patients are majorly predisposed to a class II malocclusion. Mandibular macrognathia results in prognathism and predisposes patients to a class III malocclusion.[64]

Most malocclusion studies to date have focused on Class III malocclusions. Genetic studies for Class II and Class I malocclusion are more rare. An example of hereditary mandibular prognathism can be seen amongst the Hapsburg Royal family where one third of the affected individuals with severe class III malocclusion had one parent with a similar phenotype [65]

The frequent presentation of dental malocclusions in patients with craniofacial birth defects also supports a strong genetic aetiology. About 150 genes are associated with craniofacial conditions presenting with malocclusions.[66]  Micrognathia is a commonly recurring craniofacial birth defect appearing among multiple syndromes.

For patients with severe malocclusions, corrective jaw surgery or orthognathic surgery may be carried out as a part of overall treatment, which can be seen in about 5% of the general population.[62][61][63]

See also

[edit]
  • Crossbite
  • Elastics
  • Facemask (orthodontics)
  • Maximum intercuspation
  • Mouth breathing
  • Occlusion (dentistry)

References

[edit]
  1. ^ "malocclusion". Oxford English Dictionary (Online ed.). Oxford University Press. (Subscription or participating institution membership required.)
  2. ^ Bell B (September 1965). "Paul G. Spencer". American Journal of Orthodontics. 51 (9): 693–694. doi:10.1016/0002-9416(65)90262-9. PMID 14334001.
  3. ^ Gruenbaum T (2010). "Famous Figures in Dentistry". Mouth – JASDA. 30 (1): 18.
  4. ^ Hurt MA (2012). "Weedon D. Weedon's Skin Pathology. 3rd ed. London: Churchill Livingstone Elsevier, 2010". Dermatology Practical & Conceptual. 2 (1): 79–82. doi:10.5826/dpc.0201a15. PMC 3997252.
  5. ^ Borzabadi-Farahani, A (2011). "An Overview of Selected Orthodontic Treatment Need Indices". In Naretto, Silvano (ed.). Principles in Contemporary Orthodontics. IntechOpen Limited. pp. 215–236. doi:10.5772/19735. ISBN 978-953-307-687-4.
  6. ^ "How genetics can affect your teeth". Orthodontics Australia. 2018-11-25. Retrieved 2020-11-16.
  7. ^ Corruccini RS, Potter RH (August 1980). "Genetic analysis of occlusal variation in twins". American Journal of Orthodontics. 78 (2): 140–54. doi:10.1016/0002-9416(80)90056-1. PMID 6931485.
  8. ^ Sarig, Rachel; Slon, Viviane; Abbas, Janan; May, Hila; Shpack, Nir; Vardimon, Alexander Dan; Hershkovitz, Israel (2013-11-20). "Malocclusion in Early Anatomically Modern Human: A Reflection on the Etiology of Modern Dental Misalignment". PLOS ONE. 8 (11): e80771. Bibcode:2013PLoSO...880771S. doi:10.1371/journal.pone.0080771. ISSN 1932-6203. PMC 3835570. PMID 24278319.
  9. ^ Pajević, Tina; Juloski, Jovana; Glišić, Branislav (2019-08-29). "Malocclusion from the prehistoric to the medieval times in Serbian population: Dentoalveolar and skeletal relationship comparisons in samples". Homo: Internationale Zeitschrift für die vergleichende Forschung am Menschen. 70 (1): 31–43. doi:10.1127/homo/2019/1009. ISSN 1618-1301. PMID 31475289. S2CID 201203069.
  10. ^ Moimaz SA, Garbin AJ, Lima AM, Lolli LF, Saliba O, Garbin CA (August 2014). "Longitudinal study of habits leading to malocclusion development in childhood". BMC Oral Health. 14 (1): 96. doi:10.1186/1472-6831-14-96. PMC 4126276. PMID 25091288.
  11. ^ Klein ET (1952). "Pressure Habits, Etiological Factors in Malocclusion". Am. J. Orthod. 38 (8): 569–587. doi:10.1016/0002-9416(52)90025-0.
  12. ^ Graber TM. (1963). "The "Three m's": Muscles, Malformation and Malocclusion". Am. J. Orthod. 49 (6): 418–450. doi:10.1016/0002-9416(63)90167-2. hdl:2027.42/32220. S2CID 57626540.
  13. ^ Björk A, Helm S (April 1967). "Prediction of the age of maximum puberal growth in body height" (PDF). The Angle Orthodontist. 37 (2): 134–43. PMID 4290545.
  14. ^ Brucker M (1943). "Studies on the Incidence and Cause of Dental Defects in Children: IV. Malocclusion" (PDF). J Dent Res. 22 (4): 315–321. doi:10.1177/00220345430220041201. S2CID 71368994.
  15. ^ Calisti LJ, Cohen MM, Fales MH (1960). "Correlation between malocclusion, oral habits, and socio-economic level of preschool children". Journal of Dental Research. 39 (3): 450–4. doi:10.1177/00220345600390030501. PMID 13806967. S2CID 39619434.
  16. ^ Subtelny JD, Subtelny JD (October 1973). "Oral habits--studies in form, function, and therapy". The Angle Orthodontist. 43 (4): 349–83. PMID 4583311.
  17. ^ Aznar T, Galán AF, Marín I, Domínguez A (May 2006). "Dental arch diameters and relationships to oral habits". The Angle Orthodontist. 76 (3): 441–5. PMID 16637724.
  18. ^ Yamaguchi H, Sueishi K (May 2003). "Malocclusion associated with abnormal posture". The Bulletin of Tokyo Dental College. 44 (2): 43–54. doi:10.2209/tdcpublication.44.43. PMID 12956088.
  19. ^ Wellington M, Hall CB (February 2002). "Pacifier as a risk factor for acute otitis media". Pediatrics. 109 (2): 351–2, author reply 353. doi:10.1542/peds.109.2.351. PMID 11826228.
  20. ^ Rovers MM, Numans ME, Langenbach E, Grobbee DE, Verheij TJ, Schilder AG (August 2008). "Is pacifier use a risk factor for acute otitis media? A dynamic cohort study". Family Practice. 25 (4): 233–6. doi:10.1093/fampra/cmn030. PMID 18562333.
  21. ^ Hamish T (1990). Occlusion. Parkins, B. J. (2nd ed.). London: Wright. ISBN 978-0723620754. OCLC 21226656.
  22. ^ Thilander B, Pena L, Infante C, Parada SS, de Mayorga C (April 2001). "Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development". European Journal of Orthodontics. 23 (2): 153–67. doi:10.1093/ejo/23.2.153. PMID 11398553.
  23. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  24. ^ "5 reasons you should see an orthodontist". Orthodontics Australia. 2017-09-27. Retrieved 2020-08-18.
  25. ^ a b c Oliver RG (December 2001). "An Introduction to Orthodontics, 2nd edn". Journal of Orthodontics. 28 (4): 320. doi:10.1093/ortho/28.4.320.
  26. ^ a b c Millett DT, Cunningham SJ, O'Brien KD, Benson PE, de Oliveira CM (February 2018). "Orthodontic treatment for deep bite and retroclined upper front teeth in children". The Cochrane Database of Systematic Reviews. 2 (3): CD005972. doi:10.1002/14651858.cd005972.pub4. PMC 6491166. PMID 29390172.
  27. ^ Brunelle JA, Bhat M, Lipton JA (February 1996). "Prevalence and distribution of selected occlusal characteristics in the US population, 1988-1991". Journal of Dental Research. 75 Spec No (2 Suppl): 706–13. doi:10.1177/002203459607502S10. PMID 8594094. S2CID 30447284.
  28. ^ de Castilho LS, Abreu MH, Pires e Souza LG, Romualdo LT, Souza e Silva ME, Resende VL (January 2018). "Factors associated with anterior open bite in children with developmental disabilities". Special Care in Dentistry. 38 (1): 46–50. doi:10.1111/scd.12262. PMID 29278267. S2CID 42747680.
  29. ^ Feres MF, Abreu LG, Insabralde NM, Almeida MR, Flores-Mir C (June 2016). "Effectiveness of the open bite treatment in growing children and adolescents. A systematic review". European Journal of Orthodontics. 38 (3): 237–50. doi:10.1093/ejo/cjv048. PMC 4914905. PMID 26136439.
  30. ^ a b Cambiano AO, Janson G, Lorenzoni DC, Garib DG, Dávalos DT (2018). "Nonsurgical treatment and stability of an adult with a severe anterior open-bite malocclusion". Journal of Orthodontic Science. 7: 2. doi:10.4103/jos.JOS_69_17. PMC 5952238. PMID 29765914.
  31. ^ Houston, W. J. B. (1992-02-01). "Book Reviews". The European Journal of Orthodontics. 14 (1): 69. doi:10.1093/ejo/14.1.69.
  32. ^ Hamdan AM, Lewis SM, Kelleher KE, Elhady SN, Lindauer SJ (November 2019). "Does overbite reduction affect smile esthetics?". The Angle Orthodontist. 89 (6): 847–854. doi:10.2319/030819-177.1. PMC 8109173. PMID 31306077.
  33. ^ "Angle's Classification of Malocclusion". Archived from the original on 2008-02-13. Retrieved 2007-10-31.
  34. ^ Sunil Kumar (Ed.): Orthodontics. New Delhi 2008, 624 p., ISBN 978-81-312-1054-3, p. 127
  35. ^ Sunil Kumar (Ed.): Orthodontics. New Delhi 2008, p. 123. A list of 18 approaches to modify or replace Angle's system is given here with further references at the end of the book.
  36. ^ Gurkeerat Singh: Textbook of Orthodontics, p. 163-170, with further references on p. 174.
  37. ^ a b c d Lieberman, D (May 2004). "Effects of food processing on masticatory strain and craniofacial growth in a retrognathic face". Journal of Human Evolution. 46 (6): 655–77. doi:10.1016/s0047-2484(04)00051-x. PMID 15183669.
  38. ^ a b Ingervall B, Bitsanis E (February 1987). "A pilot study of the effect of masticatory muscle training on facial growth in long-face children" (PDF). European Journal of Orthodontics. 9 (1): 15–23. doi:10.1093/ejo/9.1.15. PMID 3470182.
  39. ^ a b Rosenberg J (2010-02-22). "Malocclusion of teeth". Medline Plus. Retrieved 2012-02-06.
  40. ^ Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, Murch S, Sankar MJ, Walker N, Rollins NC (January 2016). "Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect". Lancet. 387 (10017): 475–90. doi:10.1016/s0140-6736(15)01024-7. PMID 26869575.
  41. ^ Quaglio CL, de Freitas KM, de Freitas MR, Janson G, Henriques JF (June 2011). "Stability and relapse of maxillary anterior crowding treatment in class I and class II Division 1 malocclusions". American Journal of Orthodontics and Dentofacial Orthopedics. 139 (6): 768–74. doi:10.1016/j.ajodo.2009.10.044. PMID 21640883.
  42. ^ a b "Dental Crowding: Causes and Treatment Options". Orthodontics Australia. 2020-06-29. Retrieved 2020-11-19.
  43. ^ "Malocclusion of teeth: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2021-04-07.
  44. ^ "Can Buck Teeth Be Fixed? Causes & Treatment Options". Orthodontics Australia. 2021-07-01. Retrieved 2021-10-11.
  45. ^ a b Alam, MK (October 2018). "Treatment of Angle Class I malocclusion with severe crowding by extraction of four premolars: a case report". Bangladesh Journal of Medical Science. 17 (4): 683–687. doi:10.3329/bjms.v17i4.38339.
  46. ^ Persson M, Persson EC, Skagius S (August 1989). "Long-term spontaneous changes following removal of all first premolars in Class I cases with crowding". European Journal of Orthodontics. 11 (3): 271–82. doi:10.1093/oxfordjournals.ejo.a035995. PMID 2792216.
  47. ^ von Cramon-Taubadel N (December 2011). "Global human mandibular variation reflects differences in agricultural and hunter-gatherer subsistence strategies". Proceedings of the National Academy of Sciences of the United States of America. 108 (49): 19546–51. Bibcode:2011PNAS..10819546V. doi:10.1073/pnas.1113050108. PMC 3241821. PMID 22106280.
  48. ^ Nayak KU, Goyal V, Malviya N (October 2011). "Two-phase treatment of class II malocclusion in young growing patient". Contemporary Clinical Dentistry. 2 (4): 376–80. doi:10.4103/0976-237X.91808. PMC 3276872. PMID 22346172.
  49. ^ "Treatment of class ii malocclusions". 2013-11-14.
  50. ^ a b c Pinhasi R, Eshed V, von Cramon-Taubadel N (2015-02-04). "Incongruity between affinity patterns based on mandibular and lower dental dimensions following the transition to agriculture in the Near East, Anatolia and Europe". PLOS ONE. 10 (2): e0117301. Bibcode:2015PLoSO..1017301P. doi:10.1371/journal.pone.0117301. PMC 4317182. PMID 25651540.
  51. ^ a b c d Batista KB, Thiruvenkatachari B, Harrison JE, O'Brien KD (March 2018). "Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents". The Cochrane Database of Systematic Reviews. 2018 (3): CD003452. doi:10.1002/14651858.cd003452.pub4. PMC 6494411. PMID 29534303.
  52. ^ CLASSIFICATION OF SKELETAL AND DENTAL MALOCCLUSION: REVISITED; Mageet, Adil Osman (2016). "Classification of Skeletal and Dental Malocclusion: Revisited". Stomatology Edu Journal. 3 (2): 205–211. doi:10.25241/2016.3(2).11.
  53. ^ Esthetics and biomechanics in orthodontics. Nanda, Ravindra,, Preceded by (work): Nanda, Ravindra. (Second ed.). St. Louis, Missouri. 2014-04-10. ISBN 978-0-323-22659-2. OCLC 880707123.cite book: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  54. ^ Eslami S, Faber J, Fateh A, Sheikholaemmeh F, Grassia V, Jamilian A (August 2018). "Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics". Progress in Orthodontics. 19 (1): 28. doi:10.1186/s40510-018-0218-0. PMC 6070451. PMID 30069814.
  55. ^ a b Uner O, Yüksel S, Uçüncü N (April 1995). "Long-term evaluation after chincap treatment". European Journal of Orthodontics. 17 (2): 135–41. doi:10.1093/ejo/17.2.135. PMID 7781722.
  56. ^ Ravi MS, Shetty NK, Prasad RB (January 2012). "Orthodontics-surgical combination therapy for Class III skeletal malocclusion". Contemporary Clinical Dentistry. 3 (1): 78–82. doi:10.4103/0976-237X.94552. PMC 3341765. PMID 22557903.
  57. ^ Borzabadi Farahani A, Olkun HK, Eslamian L, Eslamipour F (2024). "A retrospective investigation of orthognathic patients and functional needs". Australasian Orthodontic Journal. 40: 111–120. doi:10.2478/aoj-2024-0013.
  58. ^ a b Atsawasuwan P, Hohlt W, Evans CA (April 2015). "Nonsurgical approach to Class I open-bite malocclusion with extrusion mechanics: a 3-year retention case report". American Journal of Orthodontics and Dentofacial Orthopedics. 147 (4): 499–508. doi:10.1016/j.ajodo.2014.04.024. PMID 25836010.
  59. ^ a b Grauer D, Heymann GC, Swift EJ (June 2012). "Clinical management of tooth size discrepancies". Journal of Esthetic and Restorative Dentistry. 24 (3): 155–9. doi:10.1111/j.1708-8240.2012.00520.x. PMID 22691075. S2CID 11482185.
  60. ^ a b Cançado RH, Gonçalves Júnior W, Valarelli FP, Freitas KM, Crêspo JA (2015). "Association between Bolton discrepancy and Angle malocclusions". Brazilian Oral Research. 29: 1–6. doi:10.1590/1807-3107BOR-2015.vol29.0116. PMID 26486769.
  61. ^ a b c Harrington C, Gallagher JR, Borzabadi-Farahani A (July 2015). "A retrospective analysis of dentofacial deformities and orthognathic surgeries using the index of orthognathic functional treatment need (IOFTN)". International Journal of Pediatric Otorhinolaryngology. 79 (7): 1063–6. doi:10.1016/j.ijporl.2015.04.027. PMID 25957779.
  62. ^ a b c d Posnick JC (September 2013). "Definition and Prevalence of Dentofacial Deformities". Orthognatic Surgery: Principles and Practice. Amsterdam: Elsevier. pp. 61–68. doi:10.1016/B978-1-4557-2698-1.00003-4. ISBN 978-145572698-1.
  63. ^ a b c Borzabadi-Farahani A, Eslamipour F, Shahmoradi M (June 2016). "Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN)". Journal of Plastic, Reconstructive & Aesthetic Surgery. 69 (6): 796–801. doi:10.1016/j.bjps.2016.03.008. PMID 27068664.
  64. ^ Purkait, S (2011). Essentials of Oral Pathology 4th Edition.
  65. ^ Joshi N, Hamdan AM, Fakhouri WD (December 2014). "Skeletal malocclusion: a developmental disorder with a life-long morbidity". Journal of Clinical Medicine Research. 6 (6): 399–408. doi:10.14740/jocmr1905w. PMC 4169080. PMID 25247012.
  66. ^ Moreno Uribe LM, Miller SF (April 2015). "Genetics of the dentofacial variation in human malocclusion". Orthodontics & Craniofacial Research. 18 Suppl 1 (S1): 91–9. doi:10.1111/ocr.12083. PMC 4418210. PMID 25865537.

Further reading

[edit]
  • Peter S. Ungar, "The Trouble with Teeth: Our teeth are crowded, crooked and riddled with cavities. It hasn't always been this way", Scientific American, vol. 322, no. 4 (April 2020), pp. 44–49. "Our teeth [...] evolved over hundreds of millions of years to be incredibly strong and to align precisely for efficient chewing. [...] Our dental disorders largely stem from a shift in the oral environment caused by the introduction of softer, more sugary foods than the ones our ancestors typically ate."
[edit]

 

 

International children in traditional clothing at Liberty Weekend

A child (pl.children) is a human being between the stages of birth and puberty,[1][2] or between the developmental period of infancy and puberty.[3] The term may also refer to an unborn human being.[4][5] In English-speaking countries, the legal definition of child generally refers to a minor, in this case as a person younger than the local age of majority (there are exceptions like, for example, the consume and purchase of alcoholic beverage even after said age of majority[6]), regardless of their physical, mental and sexual development as biological adults.[1][7][8] Children generally have fewer rights and responsibilities than adults. They are generally classed as unable to make serious decisions.

Child may also describe a relationship with a parent (such as sons and daughters of any age)[9] or, metaphorically, an authority figure, or signify group membership in a clan, tribe, or religion; it can also signify being strongly affected by a specific time, place, or circumstance, as in "a child of nature" or "a child of the Sixties."[10]

[edit]
Children playing ball games, Roman artwork, 2nd century AD

In the biological sciences, a child is usually defined as a person between birth and puberty,[1][2] or between the developmental period of infancy and puberty.[3] Legally, the term child may refer to anyone below the age of majority or some other age limit.

The United Nations Convention on the Rights of the Child defines child as, "A human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier."[11] This is ratified by 192 of 194 member countries. The term child may also refer to someone below another legally defined age limit unconnected to the age of majority. In Singapore, for example, a child is legally defined as someone under the age of 14 under the "Children and Young Persons Act" whereas the age of majority is 21.[12][13] In U.S. Immigration Law, a child refers to anyone who is under the age of 21.[14]

Some English definitions of the word child include the fetus (sometimes termed the unborn).[15] In many cultures, a child is considered an adult after undergoing a rite of passage, which may or may not correspond to the time of puberty.

Children generally have fewer rights than adults and are classed as unable to make serious decisions, and legally must always be under the care of a responsible adult or child custody, whether their parents divorce or not.

Developmental stages of childhood

[edit]

Early childhood

[edit]
Children playing the violin in a group recital, Ithaca, New York, 2011
Children in Madagascar, 2011
Child playing piano, 1984

Early childhood follows the infancy stage and begins with toddlerhood when the child begins speaking or taking steps independently.[16][17] While toddlerhood ends around age 3 when the child becomes less dependent on parental assistance for basic needs, early childhood continues approximately until the age of 5 or 6. However, according to the National Association for the Education of Young Children, early childhood also includes infancy. At this stage children are learning through observing, experimenting and communicating with others. Adults supervise and support the development process of the child, which then will lead to the child's autonomy. Also during this stage, a strong emotional bond is created between the child and the care providers. The children also start preschool and kindergarten at this age: and hence their social lives.

Middle childhood

[edit]

Middle childhood begins at around age 7, and ends at around age 9 or 10.[18] Together, early and middle childhood are called formative years. In this middle period, children develop socially and mentally. They are at a stage where they make new friends and gain new skills, which will enable them to become more independent and enhance their individuality. During middle childhood, children enter the school years, where they are presented with a different setting than they are used to. This new setting creates new challenges and faces for children.[19] Upon the entrance of school, mental disorders that would normally not be noticed come to light. Many of these disorders include: autism, dyslexia, dyscalculia, and ADHD.[20]: 303–309  Special education, least restrictive environment, response to intervention and individualized education plans are all specialized plans to help children with disabilities.[20]: 310–311 

Middle childhood is the time when children begin to understand responsibility and are beginning to be shaped by their peers and parents. Chores and more responsible decisions come at this time, as do social comparison and social play.[20]: 338  During social play, children learn from and teach each other, often through observation.[21]

Late childhood

[edit]

Preadolescence is a stage of human development following early childhood and preceding adolescence. Preadolescence is commonly defined as ages 9–12, ending with the major onset of puberty, with markers such as menarche, spermarche, and the peak of height velocity occurring. These changes usually occur between ages 11 and 14. It may also be defined as the 2-year period before the major onset of puberty.[22] Preadolescence can bring its own challenges and anxieties. Preadolescent children have a different view of the world from younger children in many significant ways. Typically, theirs is a more realistic view of life than the intense, fantasy-oriented world of earliest childhood. Preadolescents have more mature, sensible, realistic thoughts and actions: 'the most "sensible" stage of development...the child is a much less emotional being now.'[23] Preadolescents may well view human relationships differently (e.g. they may notice the flawed, human side of authority figures). Alongside that, they may begin to develop a sense of self-identity, and to have increased feelings of independence: 'may feel an individual, no longer "just one of the family."'[24]

Developmental stages post-childhood

[edit]

Adolescence

[edit]
An adolescent girl, photographed by Paolo Monti

Adolescence is usually determined to be between the onset of puberty and legal adulthood: mostly corresponding to the teenage years (13–19). However, puberty usually begins before the teenage years (10—11 for girls and 11—12 for boys). Although biologically a child is a human being between the stages of birth and puberty,[1][2] adolescents are legally considered children, as they tend to lack adult rights and are still required to attend compulsory schooling in many cultures, though this varies. The onset of adolescence brings about various physical, psychological and behavioral changes. The end of adolescence and the beginning of adulthood varies by country and by function, and even within a single nation-state or culture there may be different ages at which an individual is considered to be mature enough to be entrusted by society with certain tasks.

History

[edit]
Playing Children, by Song dynasty Chinese artist Su Hanchen, c. 1150 AD.

During the European Renaissance, artistic depictions of children increased dramatically, which did not have much effect on the social attitude toward children, however.[25]

The French historian Philippe Ariès argued that during the 1600s, the concept of childhood began to emerge in Europe,[26] however other historians like Nicholas Orme have challenged this view and argued that childhood has been seen as a separate stage since at least the medieval period.[27] Adults saw children as separate beings, innocent and in need of protection and training by the adults around them. The English philosopher John Locke was particularly influential in defining this new attitude towards children, especially with regard to his theory of the tabula rasa, which considered the mind at birth to be a "blank slate". A corollary of this doctrine was that the mind of the child was born blank, and that it was the duty of the parents to imbue the child with correct notions. During the early period of capitalism, the rise of a large, commercial middle class, mainly in the Protestant countries of the Dutch Republic and England, brought about a new family ideology centred around the upbringing of children. Puritanism stressed the importance of individual salvation and concern for the spiritual welfare of children.[28]

The Age of Innocence c. 1785/8. Reynolds emphasized the natural grace of children in his paintings.

The modern notion of childhood with its own autonomy and goals began to emerge during the 18th-century Enlightenment and the Romantic period that followed it.[29][30] Jean Jacques Rousseau formulated the romantic attitude towards children in his famous 1762 novel Emile: or, On Education. Building on the ideas of John Locke and other 17th-century thinkers, Jean-Jaques Rousseau described childhood as a brief period of sanctuary before people encounter the perils and hardships of adulthood.[29] Sir Joshua Reynolds' extensive children portraiture demonstrated the new enlightened attitudes toward young children. His 1788 painting The Age of Innocence emphasizes the innocence and natural grace of the posing child and soon became a public favourite.[31]

Brazilian princesses Leopoldina (left) and Isabel (center) with an unidentified friend, c. 1860.

The idea of childhood as a locus of divinity, purity, and innocence is further expounded upon in William Wordsworth's "Ode: Intimations of Immortality from Recollections of Early Childhood", the imagery of which he "fashioned from a complex mix of pastoral aesthetics, pantheistic views of divinity, and an idea of spiritual purity based on an Edenic notion of pastoral innocence infused with Neoplatonic notions of reincarnation".[30] This Romantic conception of childhood, historian Margaret Reeves suggests, has a longer history than generally recognized, with its roots traceable to similarly imaginative constructions of childhood circulating, for example, in the neo-platonic poetry of seventeenth-century metaphysical poet Henry Vaughan (e.g., "The Retreate", 1650; "Childe-hood", 1655). Such views contrasted with the stridently didactic, Calvinist views of infant depravity.[32]

Armenian scouts in 1918

With the onset of industrialisation in England in 1760, the divergence between high-minded romantic ideals of childhood and the reality of the growing magnitude of child exploitation in the workplace, became increasingly apparent. By the late 18th century, British children were specially employed in factories and mines and as chimney sweeps,[33] often working long hours in dangerous jobs for low pay.[34] As the century wore on, the contradiction between the conditions on the ground for poor children and the middle-class notion of childhood as a time of simplicity and innocence led to the first campaigns for the imposition of legal protection for children.

British reformers attacked child labor from the 1830s onward, bolstered by the horrific descriptions of London street life by Charles Dickens.[35] The campaign eventually led to the Factory Acts, which mitigated the exploitation of children at the workplace[33][36]

Modern concepts of childhood

[edit]
Children play in a fountain in a summer evening, Davis, California.
An old man and his granddaughter in Turkey.
Nepalese children playing with cats.
Harari girls in Ethiopia.

The modern attitude to children emerged by the late 19th century; the Victorian middle and upper classes emphasized the role of the family and the sanctity of the child – an attitude that has remained dominant in Western societies ever since.[37] The genre of children's literature took off, with a proliferation of humorous, child-oriented books attuned to the child's imagination. Lewis Carroll's fantasy Alice's Adventures in Wonderland, published in 1865 in England, was a landmark in the genre; regarded as the first "English masterpiece written for children", its publication opened the "First Golden Age" of children's literature.

The latter half of the 19th century saw the introduction of compulsory state schooling of children across Europe, which decisively removed children from the workplace into schools.[38][39]

The market economy of the 19th century enabled the concept of childhood as a time of fun, happiness, and imagination. Factory-made dolls and doll houses delighted the girls and organized sports and activities were played by the boys.[40] The Boy Scouts was founded by Sir Robert Baden-Powell in 1908,[41][42] which provided young boys with outdoor activities aiming at developing character, citizenship, and personal fitness qualities.[43]

In the 20th century, Philippe Ariès, a French historian specializing in medieval history, suggested that childhood was not a natural phenomenon, but a creation of society in his 1960 book Centuries of Childhood. In 1961 he published a study of paintings, gravestones, furniture, and school records, finding that before the 17th century, children were represented as mini-adults.

In 1966, the American philosopher George Boas published the book The Cult of Childhood. Since then, historians have increasingly researched childhood in past times.[44]

In 2006, Hugh Cunningham published the book Invention of Childhood, looking at British childhood from the year 1000, the Middle Ages, to what he refers to as the Post War Period of the 1950s, 1960s and 1970s.[45]

Childhood evolves and changes as lifestyles change and adult expectations alter. In the modern era, many adults believe that children should not have any worries or work, as life should be happy and trouble-free. Childhood is seen as a mixture of simplicity, innocence, happiness, fun, imagination, and wonder. It is thought of as a time of playing, learning, socializing, exploring, and worrying in a world without much adult interference.[29][30]

A "loss of innocence" is a common concept, and is often seen as an integral part of coming of age. It is usually thought of as an experience or period in a child's life that widens their awareness of evil, pain or the world around them. This theme is demonstrated in the novels To Kill a Mockingbird and Lord of the Flies. The fictional character Peter Pan was the embodiment of a childhood that never ends.[46][47]

Healthy childhoods

[edit]

Role of parents

[edit]

Children's health

[edit]

Children's health includes the physical, mental and social well-being of children. Maintaining children's health implies offering them healthy foods, insuring they get enough sleep and exercise, and protecting their safety.[48] Children in certain parts of the world often suffer from malnutrition, which is often associated with other conditions, such diarrhea, pneumonia and malaria.[49]

Child protection

[edit]

Child protection, according to UNICEF, refers to "preventing and responding to violence, exploitation and abuse against children – including commercial sexual exploitation, trafficking, child labour and harmful traditional practices, such as female genital mutilation/cutting and child marriage".[50] The Convention on the Rights of the Child protects the fundamental rights of children.

Play

[edit]
Dancing at Mother of Peace AIDs orphanage, Zimbabwe

Play is essential to the cognitive, physical, social, and emotional well-being of children.[51] It offers children opportunities for physical (running, jumping, climbing, etc.), intellectual (social skills, community norms, ethics and general knowledge) and emotional development (empathy, compassion, and friendships). Unstructured play encourages creativity and imagination. Playing and interacting with other children, as well as some adults, provides opportunities for friendships, social interactions, conflicts and resolutions. However, adults tend to (often mistakenly) assume that virtually all children's social activities can be understood as "play" and, furthermore, that children's play activities do not involve much skill or effort.[52][53][54][55]

It is through play that children at a very early age engage and interact in the world around them. Play allows children to create and explore a world they can master, conquering their fears while practicing adult roles, sometimes in conjunction with other children or adult caregivers.[51] Undirected play allows children to learn how to work in groups, to share, to negotiate, to resolve conflicts, and to learn self-advocacy skills. However, when play is controlled by adults, children acquiesce to adult rules and concerns and lose some of the benefits play offers them. This is especially true in developing creativity, leadership, and group skills.[51]

Ralph Hedley, The Tournament, 1898. It depicts poorer boys playing outdoors in a rural part of the Northeast of England.

Play is considered to be very important to optimal child development that it has been recognized by the United Nations Commission on Human Rights as a right of every child.[11] Children who are being raised in a hurried and pressured style may limit the protective benefits they would gain from child-driven play.[51]

The initiation of play in a classroom setting allows teachers and students to interact through playfulness associated with a learning experience. Therefore, playfulness aids the interactions between adults and children in a learning environment. “Playful Structure” means to combine informal learning with formal learning to produce an effective learning experience for children at a young age.[56]

Even though play is considered to be the most important to optimal child development, the environment affects their play and therefore their development. Poor children confront widespread environmental inequities as they experience less social support, and their parents are less responsive and more authoritarian. Children from low income families are less likely to have access to books and computers which would enhance their development.[57]

Street culture

[edit]
Children in front of a movie theatre, Toronto, 1920s.

Children's street culture refers to the cumulative culture created by young children and is sometimes referred to as their secret world. It is most common in children between the ages of seven and twelve. It is strongest in urban working class industrial districts where children are traditionally free to play out in the streets for long periods without supervision. It is invented and largely sustained by children themselves with little adult interference.

Young children's street culture usually takes place on quiet backstreets and pavements, and along routes that venture out into local parks, playgrounds, scrub and wasteland, and to local shops. It often imposes imaginative status on certain sections of the urban realm (local buildings, kerbs, street objects, etc.). Children designate specific areas that serve as informal meeting and relaxation places (see: Sobel, 2001). An urban area that looks faceless or neglected to an adult may have deep 'spirit of place' meanings in to children. Since the advent of indoor distractions such as video games, and television, concerns have been expressed about the vitality – or even the survival – of children's street culture.

Geographies of childhood

[edit]

The geographies of childhood involves how (adult) society perceives the idea of childhood, the many ways adult attitudes and behaviors affect children's lives, including the environment which surrounds children and its implications.[58]

The geographies of childhood is similar in some respects to children's geographies which examines the places and spaces in which children live.[59]

Nature deficit disorder

[edit]

Nature Deficit Disorder, a term coined by Richard Louv in his 2005 book Last Child in the Woods, refers to the trend in the United States and Canada towards less time for outdoor play,[60][61] resulting in a wide range of behavioral problems.[62]

With increasing use of cellphones, computers, video games and television, children have more reasons to stay inside rather than outdoors exploring. “The average American child spends 44 hours a week with electronic media”.[63] Research in 2007 has drawn a correlation between the declining number of National Park visits in the U.S. and increasing consumption of electronic media by children.[64] The media has accelerated the trend for children's nature disconnection by deemphasizing views of nature, as in Disney films.[65]

Age of responsibility

[edit]

The age at which children are considered responsible for their society-bound actions (e. g. marriage, voting, etc.) has also changed over time,[66] and this is reflected in the way they are treated in courts of law. In Roman times, children were regarded as not culpable for crimes, a position later adopted by the Church. In the 19th century, children younger than seven years old were believed incapable of crime. Children from the age of seven forward were considered responsible for their actions. Therefore, they could face criminal charges, be sent to adult prison, and be punished like adults by whipping, branding or hanging. However, courts at the time would consider the offender's age when deliberating sentencing.[citation needed] Minimum employment age and marriage age also vary. The age limit of voluntary/involuntary military service is also disputed at the international level.[67]

Education

[edit]
Children in an outdoor classroom in Bié, Angola
Children seated in a Finnish classroom at the school of Torvinen in Sodankylä, Finland, in the 1920s

Education, in the general sense, refers to the act or process of imparting or acquiring general knowledge, developing the powers of reasoning and judgment, and preparing intellectually for mature life.[68] Formal education most often takes place through schooling. A right to education has been recognized by some governments. At the global level, Article 13 of the United Nations' 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) recognizes the right of everyone to an education.[69] Education is compulsory in most places up to a certain age, but attendance at school may not be, with alternative options such as home-schooling or e-learning being recognized as valid forms of education in certain jurisdictions.

Children in some countries (especially in parts of Africa and Asia) are often kept out of school, or attend only for short periods. Data from UNICEF indicate that in 2011, 57 million children were out of school; and more than 20% of African children have never attended primary school or have left without completing primary education.[70] According to a UN report, warfare is preventing 28 million children worldwide from receiving an education, due to the risk of sexual violence and attacks in schools.[71] Other factors that keep children out of school include poverty, child labor, social attitudes, and long distances to school.[72][73]

Attitudes toward children

[edit]
Group of breaker boys in Pittston, Pennsylvania, 1911. Child labor was widespread until the early 20th century. In the 21st century, child labor rates are highest in Africa.

Social attitudes toward children differ around the world in various cultures and change over time. A 1988 study on European attitudes toward the centrality of children found that Italy was more child-centric and the Netherlands less child-centric, with other countries, such as Austria, Great Britain, Ireland and West Germany falling in between.[74]

Child marriage

[edit]

In 2013, child marriage rates of female children under the age of 18 reached 75% in Niger, 68% in Central African Republic and Chad, 66% in Bangladesh, and 47% in India.[75] According to a 2019 UNICEF report on child marriage, 37% of females were married before the age of 18 in sub-Saharan Africa, followed by South Asia at 30%. Lower levels were found in Latin America and Caribbean (25%), the Middle East and North Africa (18%), and Eastern Europe and Central Asia (11%), while rates in Western Europe and North America were minimal.[76] Child marriage is more prevalent with girls, but also involves boys. A 2018 study in the journal Vulnerable Children and Youth Studies found that, worldwide, 4.5% of males are married before age 18, with the Central African Republic having the highest average rate at 27.9%.[77]

Fertility and number of children per woman

[edit]

Before contraception became widely available in the 20th century, women had little choice other than abstinence or having often many children. In fact, current population growth concerns have only become possible with drastically reduced child mortality and sustained fertility. In 2017 the global total fertility rate was estimated to be 2.37 children per woman,[78] adding about 80 million people to the world population per year. In order to measure the total number of children, scientists often prefer the completed cohort fertility at age 50 years (CCF50).[78] Although the number of children is also influenced by cultural norms, religion, peer pressure and other social factors, the CCF50 appears to be most heavily dependent on the educational level of women, ranging from 5–8 children in women without education to less than 2 in women with 12 or more years of education.[78]

Issues

[edit]

Emergencies and conflicts

[edit]

Emergencies and conflicts pose detrimental risks to the health, safety, and well-being of children. There are many different kinds of conflicts and emergencies, e.g. wars and natural disasters. As of 2010 approximately 13 million children are displaced by armed conflicts and violence around the world.[79] Where violent conflicts are the norm, the lives of young children are significantly disrupted and their families have great difficulty in offering the sensitive and consistent care that young children need for their healthy development.[79] Studies on the effect of emergencies and conflict on the physical and mental health of children between birth and 8 years old show that where the disaster is natural, the rate of PTSD occurs in anywhere from 3 to 87 percent of affected children.[80] However, rates of PTSD for children living in chronic conflict conditions varies from 15 to 50 percent.[81][82]

Child protection

[edit]
 

Child protection (also called child welfare) is the safeguarding of children from violence, exploitation, abuse, abandonment, and neglect.[83][84][85][86] It involves identifying signs of potential harm. This includes responding to allegations or suspicions of abuse, providing support and services to protect children, and holding those who have harmed them accountable.[87]

The primary goal of child protection is to ensure that all children are safe and free from harm or danger.[86][88] Child protection also works to prevent future harm by creating policies and systems that identify and respond to risks before they lead to harm.[89]

In order to achieve these goals, research suggests that child protection services should be provided in a holistic way.[90][91][92] This means taking into account the social, economic, cultural, psychological, and environmental factors that can contribute to the risk of harm for individual children and their families. Collaboration across sectors and disciplines to create a comprehensive system of support and safety for children is required.[93][94]

It is the responsibility of individuals, organizations, and governments to ensure that children are protected from harm and their rights are respected.[95] This includes providing a safe environment for children to grow and develop, protecting them from physical, emotional and sexual abuse, and ensuring they have access to education, healthcare, and resources to fulfill their basic needs.[96]

Child protection systems are a set of services, usually government-run, designed to protect children and young people who are underage and to encourage family stability. UNICEF defines[97] a 'child protection system' as:

"The set of laws, policies, regulations and services needed across all social sectors – especially social welfare, education, health, security and justice – to support prevention and response to protection-related risks. These systems are part of social protection, and extend beyond it. At the level of prevention, their aim includes supporting and strengthening families to reduce social exclusion, and to lower the risk of separation, violence and exploitation. Responsibilities are often spread across government agencies, with services delivered by local authorities, non-State providers, and community groups, making coordination between sectors and levels, including routine referral systems etc.., a necessary component of effective child protection systems."

— United Nations Economic and Social Council (2008), UNICEF Child Protection Strategy, E/ICEF/2008/5/Rev.1, par. 12–13.

Under Article 19 of the UN Convention on the Rights of the Child, a 'child protection system' provides for the protection of children in and out of the home. One of the ways this can be enabled is through the provision of quality education, the fourth of the United Nations Sustainable Development Goals, in addition to other child protection systems. Some literature argues that child protection begins at conception; even how the conception took place can affect the child's development.[98]

Child abuse and child labor

[edit]

Protection of children from abuse is considered an important contemporary goal. This includes protecting children from exploitation such as child labor, child trafficking and child selling, child sexual abuse, including child prostitution and child pornography, military use of children, and child laundering in illegal adoptions. There exist several international instruments for these purposes, such as:

  • Worst Forms of Child Labour Convention
  • Minimum Age Convention, 1973
  • Optional Protocol on the Sale of Children, Child Prostitution and Child Pornography
  • Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse
  • Optional Protocol on the Involvement of Children in Armed Conflict
  • Hague Adoption Convention

Climate change

[edit]
 
A child at a climate demonstration in Juneau, Alaska

Children are more vulnerable to the effects of climate change than adults. The World Health Organization estimated that 88% of the existing global burden of disease caused by climate change affects children under five years of age.[99] A Lancet review on health and climate change lists children as the worst-affected category by climate change.[100] Children under 14 are 44 percent more likely to die from environmental factors,[101] and those in urban areas are disproportionately impacted by lower air quality and overcrowding.[102]

Children are physically more vulnerable to climate change in all its forms.[103] Climate change affects the physical health of children and their well-being. Prevailing inequalities, between and within countries, determine how climate change impacts children.[104] Children often have no voice in terms of global responses to climate change.[103]

People living in low-income countries experience a higher burden of disease and are less capable of coping with climate change-related threats.[105] Nearly every child in the world is at risk from climate change and pollution, while almost half are at extreme risk.[106]

Health

[edit]

Child mortality

[edit]
World infant mortality rates in 2012.[107]

During the early 17th century in England, about two-thirds of all children died before the age of four.[108] During the Industrial Revolution, the life expectancy of children increased dramatically.[109] This has continued in England, and in the 21st century child mortality rates have fallen across the world. About 12.6 million under-five infants died worldwide in 1990, which declined to 6.6 million in 2012. The infant mortality rate dropped from 90 deaths per 1,000 live births in 1990, to 48 in 2012. The highest average infant mortality rates are in sub-Saharan Africa, at 98 deaths per 1,000 live births – over double the world's average.[107]

See also

[edit]
Listen to this article (3 minutes)
 
Spoken Wikipedia icon
This audio file was created from a revision of this article dated 24 June 2008 (2008-06-24), and does not reflect subsequent edits.
  • Outline of childhood
  • Child slavery
  • Childlessness
  • Depression in childhood and adolescence
  • One-child policy
  • Religion and children
  • Youth rights
  • Archaeology of childhood

Sources

[edit]
  •  This article incorporates text from a free content work. Licensed under CC-BY-SA IGO 3.0 (license statement/permission). Text taken from Investing against Evidence: The Global State of Early Childhood Care and Education​, 118–125, Marope PT, Kaga Y, UNESCO. UNESCO.
  •  This article incorporates text from a free content work. Licensed under CC-BY-SA IGO 3.0 (license statement/permission). Text taken from Creating sustainable futures for all; Global education monitoring report, 2016; Gender review​, 20, UNESCO, UNESCO. UNESCO.

References

[edit]
  1. ^ a b c d "Child". TheFreeDictionary.com. Retrieved 5 January 2013.
  2. ^ a b c O'Toole, MT (2013). Mosby's Dictionary of Medicine, Nursing & Health Professions. St. Louis MO: Elsevier Health Sciences. p. 345. ISBN 978-0-323-07403-2. OCLC 800721165. Wikidata Q19573070.
  3. ^ a b Rathus SA (2013). Childhood and Adolescence: Voyages in Development. Cengage Learning. p. 48. ISBN 978-1-285-67759-0.
  4. ^ "Child". OED.com. Retrieved 11 April 2023.
  5. ^ "Child". Merriam-Webster.com. Retrieved 11 April 2023.
  6. ^ "When Is It Legal For Minors To Drink?". Alcohol.org. Retrieved 31 May 2024.
  7. ^ "Children and the law". NSPCC Learning. Retrieved 31 May 2024.
  8. ^ "23.8: Adulthood". LibreTexts - Biology. 31 December 2018. A person may be physically mature and a biological adult by age 16 or so, but not defined as an adult by law until older ages. For example, in the U.S., you cannot join the armed forces or vote until age 18, and you cannot take on many legal and financial responsibilities until age 21.
  9. ^ "For example, the US Social Security department specifically defines an adult child as being over 18". Ssa.gov. Archived from the original on 1 October 2013. Retrieved 9 October 2013.
  10. ^ "American Heritage Dictionary". 7 December 2007. Archived from the original on 29 December 2007.
  11. ^ a b "Convention on the Rights of the Child" (PDF). General Assembly Resolution 44/25 of 20 November 1989. The Policy Press, Office of the United Nations High Commissioner for Human Rights. Archived from the original (PDF) on 31 October 2010.
  12. ^ "Children and Young Persons Act". Singapore Statutes Online. Archived from the original on 3 February 2018. Retrieved 20 October 2017.
  13. ^ "Proposal to lower the Age of Contractual Capacity from 21 years to 18 years, and the Civil Law (Amendment) Bill". Singapore: Ministry of Law. Archived from the original on 26 June 2018. Retrieved 21 October 2017.
  14. ^ "8 U.S. Code § 1101 - Definitions". LII / Legal Information Institute.
  15. ^ See Shorter Oxford English Dictionary 397 (6th ed. 2007), which's first definition is "A fetus; an infant;...". See also ‘The Compact Edition of the Oxford English Dictionary: Complete Text Reproduced Micrographically’, Vol. I (Oxford University Press, Oxford 1971): 396, which defines it as: ‘The unborn or newly born human being; foetus, infant’.
  16. ^ Alam, Gajanafar (2014). Population and Society. K.K. Publications. ISBN 978-8178441986.
  17. ^ Purdy ER (18 January 2019). "Infant and toddler development". Encyclopedia Britannica. Retrieved 27 May 2020.
  18. ^ "Development In Middle Childhood".
  19. ^ Collins WA, et al. (National Research Council (US) Panel to Review the Status of Basic Research on School-Age Children) (1984). Development during Middle Childhood. Washington D.C.: National Academies Press (US). doi:10.17226/56. ISBN 978-0-309-03478-4. PMID 25032422.
  20. ^ a b c Berger K (2017). The Developing Person through the Lifespan. Worth Publishers. ISBN 978-1-319-01587-9.
  21. ^ Konner M (2010). The Evolution of Childhood. Cambridge, Massachusetts: The Belknap Press of Harvard University Press. pp. 512–513. ISBN 978-0-674-04566-8.
  22. ^ "APA Dictionary of Psychology".
  23. ^ Mavis Klein, Okay Parenting (1991) p. 13 and p. 78
  24. ^ E. Fenwick/T. Smith, Adolescence (London 1993) p. 29
  25. ^ Pollock LA (2000). Forgotten children : parent-child relations from 1500 to 1900. Cambridge University Press. ISBN 978-0-521-25009-2. OCLC 255923951.
  26. ^ Ariès P (1960). Centuries of Childhood.
  27. ^ Orme, Nicholas (2001). Medieval Children. Yale University Press. ISBN 0-300-08541-9.
  28. ^ Fox VC (April 1996). "Poor Children's Rights in Early Modern England". The Journal of Psychohistory. 23 (3): 286–306.
  29. ^ a b c Cohen D (1993). The development of play (2nd ed.). London: Routledge. p. 20. ISBN 978-1-134-86782-0.
  30. ^ a b c Reeves M (2018). "'A Prospect of Flowers', Concepts of Childhood and Female Youth in Seventeenth-Century British Culture". In Cohen ES, Reeves M (eds.). The Youth of Early Modern Women. Amsterdam University Press. p. 40. doi:10.2307/j.ctv8pzd5z. ISBN 978-90-485-3498-2. JSTOR j.ctv8pzd5z. S2CID 189343394. Retrieved 11 February 2018.
  31. ^ Postle, Martin. (2005) "The Age of Innocence" Child Portraiture in Georgian Art and Society", in Pictures of Innocence: Portraits of Children from Hogarth to Lawrence. Bath: Holburne Museum of Art, pp. 7–8. ISBN 0903679094
  32. ^ Reeves (2018), pp. 41–42.
  33. ^ a b Del Col L (September 1930). "The Life of the Industrial Worker in Ninteenth-Century [sic] England — Evidence Given Before the Sadler Committee (1831–1832)". In Scott JF, Baltzly A (eds.). Readings in European History. Appleton-Century-Crofts.
  34. ^ Daniels B. "Poverty and Families in the Victorian Era". hiddenlives.org.
  35. ^ Malkovich A (2013). Charles Dickens and the Victorian child : romanticizing and socializing the imperfect child. New York: Routledge. ISBN 978-1-135-07425-8.
  36. ^ "The Factory and Workshop Act, 1901". British Medical Journal. 2 (2139): 1871–1872. December 1901. doi:10.1136/bmj.2.2139.1871. ISSN 0959-8138. PMC 2507680. PMID 20759953.
  37. ^ Jordan TE (1998). Victorian child savers and their culture : a thematic evaluation. Lewiston, New York: Edwin Mellen Press. ISBN 978-0-7734-8289-0. OCLC 39465039.
  38. ^ Sagarra, Eda. (1977). A Social History of Germany 1648–1914, pp. 275–84
  39. ^ Weber, Eugen. (1976). Peasants into Frenchmen: The Modernization of Rural France, 1870–1914, pp. 303–38
  40. ^ Chudacoff HP (2007). Children at Play: An American History. New York University Press. ISBN 978-0-8147-1665-6.
  41. ^ Woolgar B, La Riviere S (2002). Why Brownsea? The Beginnings of Scouting. Brownsea Island Scout and Guide Management Committee.
  42. ^ Hillcourt, William (1964). Baden-Powell; the two lives of a hero. New York: Putnam. ISBN 978-0839535942. OCLC 1338723.
  43. ^ Boehmer E (2004). Notes to 2004 edition of Scouting for Boys. Oxford: Oxford University Press.
  44. ^ Ulbricht J (November 2005). "J.C. Holz Revisited: From Modernism to Visual Culture". Art Education. 58 (6): 12–17. doi:10.1080/00043125.2005.11651564. ISSN 0004-3125. S2CID 190482412.
  45. ^ Cunningham H (July 2016). "The Growth of Leisure in the Early Industrial Revolution, c. 1780–c. 1840". Leisure in the Industrial Revolution. Routledge. pp. 15–56. doi:10.4324/9781315637679-2. ISBN 978-1-315-63767-9.
  46. ^ Bloom, Harold. "Major themes in Lord of the Flies" (PDF). Archived (PDF) from the original on 11 December 2019.
  47. ^ Barrie, J. M. Peter Pan. Hodder & Stoughton, 1928, Act V, Scene 2.
  48. ^ "Children's Health". MedlinePlus. U.S. National Library of Medicine, National Institutes of Health, U.S. Department of Health and Human Services.
  49. ^ Caulfield LE, de Onis M, Blössner M, Black RE (July 2004). "Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria, and measles". The American Journal of Clinical Nutrition. 80 (1): 193–198. doi:10.1093/ajcn/80.1.193. PMID 15213048.
  50. ^ "What is child Protection?" (PDF). The United Nations Children’s Fund (UniCeF). May 2006. Archived from the original (PDF) on 17 April 2021. Retrieved 7 January 2021.
  51. ^ a b c d Ginsburg KR (January 2007). "The importance of play in promoting healthy child development and maintaining strong parent-child bonds". Pediatrics. 119 (1): 182–191. doi:10.1542/peds.2006-2697. PMID 17200287. S2CID 54617427.
  52. ^ Björk-Willén P, Cromdal J (2009). "When education seeps into 'free play': How preschool children accomplish multilingual education". Journal of Pragmatics. 41 (8): 1493–1518. doi:10.1016/j.pragma.2007.06.006.
  53. ^ Cromdal J (2001). "Can I be with?: Negotiating play entry in a bilingual school". Journal of Pragmatics. 33 (4): 515–543. doi:10.1016/S0378-2166(99)00131-9.
  54. ^ Butler CW (2008). Talk and social interaction in the playground. Aldershot: Ashgate Publishing, Ltd. ISBN 978-0-7546-7416-0.
  55. ^ Cromdal J (2009). "Childhood and social interaction in everyday life: Introduction to the special issue". Journal of Pragmatics. 41 (8): 1473–76. doi:10.1016/j.pragma.2007.03.008.
  56. ^ Walsh G, Sproule L, McGuinness C, Trew K (July 2011). "Playful structure: a novel image of early years pedagogy for primary school classrooms". Early Years. 31 (2): 107–119. doi:10.1080/09575146.2011.579070. S2CID 154926596.
  57. ^ Evans GW (2004). "The environment of childhood poverty". The American Psychologist. 59 (2): 77–92. doi:10.1037/0003-066X.59.2.77. PMID 14992634.
  58. ^ Disney, Tom (2018). Geographies of Children and Childhood. Oxford University Press. doi:10.1093/OBO/9780199874002-0193.
  59. ^ Holloway SL (2004). Holloway SL, Valentine G (eds.). Children's Geographies. doi:10.4324/9780203017524. ISBN 978-0-203-01752-4.
  60. ^ Gardner M (29 June 2006). "For more children, less time for outdoor play: Busy schedules, less open space, more safety fears, and lure of the Web keep kids inside". The Christian Science Monitor.
  61. ^ Swanbrow D. "U.S. children and teens spend more time on academics". The University Record Online. The University of Michigan. Archived from the original on 2 July 2007. Retrieved 7 January 2021.
  62. ^ Burak T. "Are your kids really spending enough time outdoors? Getting up close with nature opens a child's eyes to the wonders of the world, with a bounty of health benefits". Canadian Living. Archived from the original on 28 July 2012.
  63. ^ O'Driscoll B. "Outside Agitators". Pittsburgh City Paper. Archived from the original on 14 June 2011.
  64. ^ Pergams OR, Zaradic PA (September 2006). "Is love of nature in the US becoming love of electronic media? 16-year downtrend in national park visits explained by watching movies, playing video games, internet use, and oil prices". Journal of Environmental Management. 80 (4): 387–393. Bibcode:2006JEnvM..80..387P. doi:10.1016/j.jenvman.2006.02.001. PMID 16580127.
  65. ^ Prévot-Julliard AC, Julliard R, Clayton S (August 2015). "Historical evidence for nature disconnection in a 70-year time series of Disney animated films". Public Understanding of Science. 24 (6): 672–680. doi:10.1177/0963662513519042. PMID 24519887. S2CID 43190714.
  66. ^ RJ, Raawat (9 December 2021). "बच्चे चुनौतियों का जवाब दे सकते हैं – द समझ एन.जी.ओ." Navbharat Times Reader's Blog (in Hindi). Retrieved 13 December 2021.
  67. ^ Yun S (2014). "BreakingImaginary Barriers: Obligations of Armed Non-State Actors Under General Human Rights Law – The Case of the Optional Protocol to the Convention on the Rights of the Child". Journal of International Humanitarian Legal Studies. 5 (1–2): 213–257. doi:10.1163/18781527-00501008. S2CID 153558830. SSRN 2556825.
  68. ^ "Define Education". Dictionary.com. Dictionary.reference.com. Retrieved 3 August 2014.
  69. ^ ICESCR, Article 13.1
  70. ^ "Out-of-School Children Initiative | Basic education and gender equality". UNICEF. Archived from the original on 6 August 2014. Retrieved 3 August 2014.
  71. ^ "BBC News - Unesco: Conflict robs 28 million children of education". Bbc.co.uk. 1 March 2011. Retrieved 3 August 2014.
  72. ^ "UK | Education | Barriers to getting an education". BBC News. 10 April 2006. Retrieved 3 August 2014.
  73. ^ Melik J (11 October 2012). "Africa gold rush lures children out of school". Bbc.com – BBC News. Retrieved 3 August 2014.
  74. ^ Jones RK, Brayfield A (June 1997). "Life's greatest joy?: European attitudes toward the centrality of children". Social Forces. 75 (4): 1239–1269. doi:10.1093/sf/75.4.1239.
  75. ^ "Child brides around the world sold off like cattle". USA Today. Associated Press. 8 March 2013. Archived from the original on 8 March 2013.
  76. ^ "Child marriage". UNICEF DATA. Retrieved 27 April 2020.
  77. ^ Gastón CM, Misunas C, Cappa C (3 July 2019). "Child marriage among boys: a global overview of available data". Vulnerable Children and Youth Studies. 14 (3): 219–228. doi:10.1080/17450128.2019.1566584. ISSN 1745-0128.
  78. ^ a b c Vollset SE, Goren E, Yuan CW, Cao J, Smith AE, Hsiao T, et al. (October 2020). "Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study". Lancet. 396 (10258): 1285–1306. doi:10.1016/s0140-6736(20)30677-2. PMC 7561721. PMID 32679112.
  79. ^ a b UNICEF (2010). The State of the World's Children Report, Special Edition (PDF). New York: UNICEF. ISBN 978-92-806-4445-6.
  80. ^ Shannon MP, Lonigan CJ, Finch AJ, Taylor CM (January 1994). "Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles". Journal of the American Academy of Child and Adolescent Psychiatry. 33 (1): 80–93. doi:10.1097/00004583-199401000-00012. PMID 8138525.
  81. ^ De Jong JT (2002). Trauma, War, and Violence: Public Mental Health in Socio Cultural Context. New York: Kluwer. ISBN 978-0-306-47675-4.
  82. ^ Marope PT, Kaga Y (2015). Investing against Evidence: The Global State of Early Childhood Care and Education (PDF). Paris: UNESCO. pp. 118–125. ISBN 978-92-3-100113-0.
  83. ^ Katz, Ilan; Katz, Carmit; Andresen, Sabine; Bérubé, Annie; Collin-Vezina, Delphine; Fallon, Barbara; Fouché, Ansie; Haffejee, Sadiyya; Masrawa, Nadia; Muñoz, Pablo; Priolo Filho, Sidnei R.; Tarabulsy, George; Truter, Elmien; Varela, Natalia; Wekerle, Christine (June 2021). "Child maltreatment reports and Child Protection Service responses during COVID-19: Knowledge exchange among Australia, Brazil, Canada, Colombia, Germany, Israel, and South Africa". Child Abuse & Neglect. 116 (Pt 2): 105078. doi:10.1016/j.chiabu.2021.105078. ISSN 0145-2134. PMC 8446926. PMID 33931238.
  84. ^ Oates, Kim (July 2013). "Medical dimensions of child abuse and neglect". Child Abuse & Neglect. 37 (7): 427–429. doi:10.1016/j.chiabu.2013.05.004. ISSN 0145-2134. PMID 23790510.
  85. ^ Southall, David; MacDonald, Rhona (1 November 2013). "Protecting children from abuse: a neglected but crucial priority for the international child health agenda". Paediatrics and International Child Health. 33 (4): 199–206. doi:10.1179/2046905513Y.0000000097. ISSN 2046-9047. PMID 24070186. S2CID 29250788.
  86. ^ a b Barth, R.P. (October 1999). "After Safety, What is the Goal of Child Welfare Services: Permanency, Family Continuity or Social Benefit?". International Journal of Social Welfare. 8 (4): 244–252. doi:10.1111/1468-2397.00091. ISSN 1369-6866.
  87. ^ Child Custody & Domestic Violence: A Call for Safety and Accountability. Thousand Oaks, California: SAGE Publications, Inc. 2003. doi:10.4135/9781452231730. ISBN 978-0-7619-1826-4.
  88. ^ Editorial team, Collective (11 September 2008). "WHO Regional Office for Europe and UNAIDS report on progress since the Dublin Declaration". Eurosurveillance. 13 (37). doi:10.2807/ese.13.37.18981-en. ISSN 1560-7917. PMID 18801311.
  89. ^ Nixon, Kendra L.; Tutty, Leslie M.; Weaver-Dunlop, Gillian; Walsh, Christine A. (December 2007). "Do good intentions beget good policy? A review of child protection policies to address intimate partner violence". Children and Youth Services Review. 29 (12): 1469–1486. doi:10.1016/j.childyouth.2007.09.007. ISSN 0190-7409.
  90. ^ Holland, S. (1 January 2004). "Liberty and Respect in Child Protection". British Journal of Social Work. 34 (1): 21–36. doi:10.1093/bjsw/bch003. ISSN 0045-3102.
  91. ^ Wulcyzn, Fred; Daro, Deborah; Fluke, John; Gregson, Kendra (2010). "Adapting a Systems Approach to Child Protection in a Cultural Context: Key Concepts and Considerations". PsycEXTRA Dataset. doi:10.1037/e516652013-176.
  92. ^ Léveillé, Sophie; Chamberland, Claire (1 July 2010). "Toward a general model for child welfare and protection services: A meta-evaluation of international experiences regarding the adoption of the Framework for the Assessment of Children in Need and Their Families (FACNF)". Children and Youth Services Review. 32 (7): 929–944. doi:10.1016/j.childyouth.2010.03.009. ISSN 0190-7409.
  93. ^ Winkworth, Gail; White, Michael (March 2011). "Australia's Children 'Safe and Well'?1 Collaborating with Purpose Across Commonwealth Family Relationship and State Child Protection Systems: Australia's Children 'Safe and Well'". Australian Journal of Public Administration. 70 (1): 1–14. doi:10.1111/j.1467-8500.2010.00706.x.
  94. ^ Wulcyzn, Fred; Daro, Deborah; Fluke, John; Gregson, Kendra (2010). "Adapting a Systems Approach to Child Protection in a Cultural Context: Key Concepts and Considerations". PsycEXTRA Dataset. doi:10.1037/e516652013-176.
  95. ^ Howe, R. Brian; Covell, Katherine (July 2010). "Miseducating children about their rights". Education, Citizenship and Social Justice. 5 (2): 91–102. doi:10.1177/1746197910370724. ISSN 1746-1979. S2CID 145540907.
  96. ^ "Child protection". www.unicef.org. Archived from the original on 7 March 2023. Retrieved 18 March 2023.
  97. ^ "Economic and Social Council" (PDF). UNICEF. Archived from the original (PDF) on 23 January 2018. Retrieved 23 January 2018.
  98. ^ "Protecting Children from Violence: Historical Roots and Emerging Trends", Protecting Children from Violence, Psychology Press, pp. 21–32, 13 September 2010, doi:10.4324/9780203852927-8, ISBN 978-0-203-85292-7
  99. ^ Anderko, Laura; Chalupka, Stephanie; Du, Maritha; Hauptman, Marissa (January 2020). "Climate changes reproductive and children's health: a review of risks, exposures, and impacts". Pediatric Research. 87 (2): 414–419. doi:10.1038/s41390-019-0654-7. ISSN 1530-0447. PMID 31731287.
  100. ^ Watts, Nick; Amann, Markus; Arnell, Nigel; Ayeb-Karlsson, Sonja; Belesova, Kristine; Boykoff, Maxwell; Byass, Peter; Cai, Wenjia; Campbell-Lendrum, Diarmid; Capstick, Stuart; Chambers, Jonathan (16 November 2019). "The 2019 report of The Lancet Countdown on health and climate change: ensuring that the health of a child born today is not defined by a changing climate". Lancet. 394 (10211): 1836–1878. doi:10.1016/S0140-6736(19)32596-6. hdl:10871/40583. ISSN 1474-547X. PMID 31733928. S2CID 207976337. Archived from the original on 19 April 2021. Retrieved 17 April 2021.
  101. ^ Bartlett, Sheridan (2008). "Climate change and urban children: Impacts and implications for adaptation in low- and middle-income countries". Environment and Urbanization. 20 (2): 501–519. Bibcode:2008EnUrb..20..501B. doi:10.1177/0956247808096125. S2CID 55860349.
  102. ^ "WHO | The global burden of disease: 2004 update". WHO. Archived from the original on 24 March 2009.
  103. ^ a b Currie, Janet; Deschênes, Olivier (2016). "Children and Climate Change: Introducing the Issue". The Future of Children. 26 (1): 3–9. doi:10.1353/foc.2016.0000. ISSN 1054-8289. JSTOR 43755227. S2CID 77559783. Archived from the original on 18 April 2021. Retrieved 16 April 2021.
  104. ^ Helldén, Daniel; Andersson, Camilla; Nilsson, Maria; Ebi, Kristie L.; Friberg, Peter; Alfvén, Tobias (1 March 2021). "Climate change and child health: a scoping review and an expanded conceptual framework". The Lancet Planetary Health. 5 (3): e164 – e175. doi:10.1016/S2542-5196(20)30274-6. ISSN 2542-5196. PMID 33713617.
  105. ^ "Unless we act now: The impact of climate change on children". www.unicef.org. Archived from the original on 18 April 2021. Retrieved 16 April 2021.
  106. ^ Carrington, Damian (20 August 2021). "A billion children at 'extreme risk' from climate impacts – Unicef". The Guardian. Archived from the original on 28 August 2021. Retrieved 29 August 2021.
  107. ^ a b "Infant Mortality Rates in 2012" (PDF). UNICEF. 2013. Archived from the original (PDF) on 14 July 2014.
  108. ^ Rorabaugh WJ, Critchlow DT, Baker PC (2004). America's promise: a concise history of the United States (Volume 1: To 1877). Rowman & Littlefield. p. 47. ISBN 978-0-7425-1189-7.[permanent dead link]
  109. ^ Kumar K (29 October 2020). "Modernization – Population Change". Encyclopædia Britannica.

Further reading

[edit]
  • Cook, Daniel Thomas. The moral project of childhood: Motherhood, material life, and early children's consumer culture (NYU Press, 2020). online book see also online review
  • Fawcett, Barbara, Brid Featherstone, and Jim Goddard. Contemporary child care policy and practice (Bloomsbury Publishing, 2017) online
  • Hutchison, Elizabeth D., and Leanne W. Charlesworth. "Securing the welfare of children: Policies past, present, and future." Families in Society 81.6 (2000): 576–585.
  • Fass, Paula S. The end of American childhood: A history of parenting from life on the frontier to the managed child (Princeton University Press, 2016).
  • Fass, Paula S. ed. The Routledge History of Childhood in the Western World (2012) online
  • Klass, Perri. The Best Medicine: How Science and Public Health Gave Children a Future (WW Norton & Company, 2020) online
  • Michail, Samia. "Understanding school responses to students’ challenging behaviour: A review of literature." Improving schools 14.2 (2011): 156–171. online
  • Sorin, Reesa. Changing images of childhood: Reconceptualising early childhood practice (Faculty of Education, University of Melbourne, 2005) online.
  • Sorin, Reesa. "Childhood through the eyes of the child and parent." Journal of Australian Research in Early Childhood Education 14.1 (2007). online
  • Vissing, Yvonne. "History of Children’s Human Rights in the USA." in Children's Human Rights in the USA: Challenges and Opportunities (Cham: Springer International Publishing, 2023) pp. 181–212.
  • Yuen, Francis K.O. Social work practice with children and families: a family health approach (Routledge, 2014) online.
Preceded by
Toddlerhood
Stages of human development
Childhood
Succeeded by
Preadolescence

 

Dental braces

Dental braces (also known as orthodontic braces, or simply braces) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

Process

[edit]

The application of braces moves the teeth as a result of force and pressure on the teeth. Traditionally, four basic elements are used: brackets, bonding material, arch wire, and ligature elastic (also called an "O-ring"). The teeth move when the arch wire puts pressure on the brackets and teeth. Sometimes springs or rubber bands are used to put more force in a specific direction.[1]

Braces apply constant pressure which, over time, moves teeth into the desired positions. The process loosens the tooth after which new bone grows to support the tooth in its new position. This is called bone remodelling. Bone remodelling is a biomechanical process responsible for making bones stronger in response to sustained load-bearing activity and weaker in the absence of carrying a load. Bones are made of cells called osteoclasts and osteoblasts. Two different kinds of bone resorption are possible: direct resorption, which starts from the lining cells of the alveolar bone, and indirect or retrograde resorption, which occurs when the periodontal ligament has been subjected to an excessive amount and duration of compressive stress.[2] Another important factor associated with tooth movement is bone deposition. Bone deposition occurs in the distracted periodontal ligament. Without bone deposition, the tooth will loosen, and voids will occur distal to the direction of tooth movement.[3]

Types

[edit]
"Clear" braces
Upper and Lower Jaw Functional Expanders
  • Traditional metal wired braces (also known as "train track braces") are stainless-steel and are sometimes used in combination with titanium. Traditional metal braces are the most common type of braces.[4] These braces have a metal bracket with elastic ties (also known as rubber bands) holding the wire onto the metal brackets. The second-most common type of braces is self-ligating braces, which have a built-in system to secure the archwire to the brackets and do not require elastic ties. Instead, the wire goes through the bracket. Often with this type of braces, treatment time is reduced, there is less pain on the teeth, and fewer adjustments are required than with traditional braces.
  • Gold-plated stainless steel braces are often employed for patients allergic to nickel (a basic and important component of stainless steel), but may also be chosen for aesthetic reasons.
  • Lingual braces are a cosmetic alternative in which custom-made braces are bonded to the back of the teeth making them externally invisible.
  • Titanium braces resemble stainless-steel braces but are lighter and just as strong. People with allergies to nickel in steel often choose titanium braces, but they are more expensive than stainless steel braces.
  • Customized orthodontic treatment systems combine high technology including 3-D imaging, treatment planning software and a robot to custom bend the wire. Customized systems such as this offer faster treatment times and more efficient results.[5]
  • Progressive, clear removable aligners may be used to gradually move teeth into their final positions. Aligners are generally not used for complex orthodontic cases, such as when extractions, jaw surgery, or palate expansion are necessary.[medical citation needed][6]

Fitting procedure

[edit]
A patient's teeth are prepared for the application of braces.

Orthodontic services may be provided by any licensed dentist trained in orthodontics. In North America, most orthodontic treatment is done by orthodontists, who are dentists in the diagnosis and treatment of malocclusions—malalignments of the teeth, jaws, or both. A dentist must complete 2–3 years of additional post-doctoral training to earn a specialty certificate in orthodontics. There are many general practitioners who also provide orthodontic services.

The first step is to determine whether braces are suitable for the patient. The doctor consults with the patient and inspects the teeth visually. If braces are appropriate, a records appointment is set up where X-rays, moulds, and impressions are made. These records are analyzed to determine the problems and the proper course of action. The use of digital models is rapidly increasing in the orthodontic industry. Digital treatment starts with the creation of a three-dimensional digital model of the patient's arches. This model is produced by laser-scanning plaster models created using dental impressions. Computer-automated treatment simulation has the ability to automatically separate the gums and teeth from one another and can handle malocclusions well; this software enables clinicians to ensure, in a virtual setting, that the selected treatment will produce the optimal outcome, with minimal user input.[medical citation needed]

Typical treatment times vary from six months to two and a half years depending on the complexity and types of problems. Orthognathic surgery may be required in extreme cases. About 2 weeks before the braces are applied, orthodontic spacers may be required to spread apart back teeth in order to create enough space for the bands.

Teeth to be braced will have an adhesive applied to help the cement bond to the surface of the tooth. In most cases, the teeth will be banded and then brackets will be added. A bracket will be applied with dental cement, and then cured with light until hardened. This process usually takes a few seconds per tooth. If required, orthodontic spacers may be inserted between the molars to make room for molar bands to be placed at a later date. Molar bands are required to ensure brackets will stick. Bands are also utilized when dental fillings or other dental works make securing a bracket to a tooth infeasible. Orthodontic tubes (stainless steel tubes that allow wires to pass through them), also known as molar tubes, are directly bonded to molar teeth either by a chemical curing or a light curing adhesive. Usually, molar tubes are directly welded to bands, which is a metal ring that fits onto the molar tooth. Directly bonded molar tubes are associated with a higher failure rate when compared to molar bands cemented with glass ionomer cement. Failure of orthodontic brackets, bonded tubes or bands will increase the overall treatment time for the patient. There is evidence suggesting that there is less enamel decalcification associated with molar bands cemented with glass ionomer cement compared with orthodontic tubes directly cemented to molars using a light cured adhesive. Further evidence is needed to withdraw a more robust conclusion due to limited data.[7]

An archwire will be threaded between the brackets and affixed with elastic or metal ligatures. Ligatures are available in a wide variety of colours, and the patient can choose which colour they like. Arch wires are bent, shaped, and tightened frequently to achieve the desired results.

Dental braces, with a transparent power chain, removed after completion of treatment.

Modern orthodontics makes frequent use of nickel-titanium archwires and temperature-sensitive materials. When cold, the archwire is limp and flexible, easily threaded between brackets of any configuration. Once heated to body temperature, the arch wire will stiffen and seek to retain its shape, creating constant light force on the teeth.

Brackets with hooks can be placed, or hooks can be created and affixed to the arch wire to affix rubber bands. The placement and configuration of the rubber bands will depend on the course of treatment and the individual patient. Rubber bands are made in different diameters, colours, sizes, and strengths. They are also typically available in two versions: Coloured or clear/opaque.

The fitting process can vary between different types of braces, though there are similarities such as the initial steps of moulding the teeth before application. For example, with clear braces, impressions of a patient's teeth are evaluated to create a series of trays, which fit to the patient's mouth almost like a protective mouthpiece. With some forms of braces, the brackets are placed in a special form that is customized to the patient's mouth, drastically reducing the application time.

In many cases, there is insufficient space in the mouth for all the teeth to fit properly. There are two main procedures to make room in these cases. One is extraction: teeth are removed to create more space. The second is expansion, in which the palate or arch is made larger by using a palatal expander. Expanders can be used with both children and adults. Since the bones of adults are already fused, expanding the palate is not possible without surgery to separate them. An expander can be used on an adult without surgery but would be used to expand the dental arch, and not the palate.

Sometimes children and teenage patients, and occasionally adults, are required to wear a headgear appliance as part of the primary treatment phase to keep certain teeth from moving (for more detail on headgear and facemask appliances see Orthodontic headgear). When braces put pressure on one's teeth, the periodontal membrane stretches on one side and is compressed on the other. This movement needs to be done slowly or otherwise, the patient risks losing their teeth. This is why braces are worn as long as they are and adjustments are only made every so often.

Young Colombian man during an adjustment visit for his orthodontics

Braces are typically adjusted every three to six weeks. This helps shift the teeth into the correct position. When they get adjusted, the orthodontist removes the coloured or metal ligatures keeping the arch wire in place. The arch wire is then removed and may be replaced or modified. When the archwire has been placed back into the mouth, the patient may choose a colour for the new elastic ligatures, which are then affixed to the metal brackets. The adjusting process may cause some discomfort to the patient, which is normal.

Post-treatment

[edit]

Patients may need post-orthodontic surgery, such as a fiberotomy or alternatively a gum lift, to prepare their teeth for retainer use and improve the gumline contours after the braces come off. After braces treatment, patients can use a transparent plate to keep the teeth in alignment for a certain period of time. After treatment, patients usually use transparent plates for 6 months. In patients with long and difficult treatment, a fixative wire is attached to the back of the teeth to prevent the teeth from returning to their original state.[8]

Retainers

[edit]
Hawley retainers are the most common type of retainers. This picture shows retainers for the top (right) and bottom (left) of the mouth.

In order to prevent the teeth from moving back to their original position, retainers are worn once the treatment is complete. Retainers help in maintaining and stabilizing the position of teeth long enough to permit the reorganization of the supporting structures after the active phase of orthodontic therapy. If the patient does not wear the retainer appropriately and/or for the right amount of time, the teeth may move towards their previous position. For regular braces, Hawley retainers are used. They are made of metal hooks that surround the teeth and are enclosed by an acrylic plate shaped to fit the patient's palate. For Clear Removable braces, an Essix retainer is used. This is similar to the original aligner; it is a clear plastic tray that is firmly fitted to the teeth and stays in place without a plate fitted to the palate. There is also a bonded retainer where a wire is permanently bonded to the lingual side of the teeth, usually the lower teeth only.

Headgear

[edit]

Headgear needs to be worn between 12 and 22 hours each day to be effective in correcting the overbite, typically for 12 to 18 months depending on the severity of the overbite, how much it is worn and what growth stage the patient is in. Typically the prescribed daily wear time will be between 14 and 16 hours a day and is frequently used as a post-primary treatment phase to maintain the position of the jaw and arch. Headgear can be used during the night while the patient sleeps.[9][better source needed]

Orthodontic headgear usually consists of three major components:

Full orthodontic headgear with head cap, fitting straps, facebow and elastics
  1. Facebow: the facebow (or J-Hooks) is fitted with a metal arch onto headgear tubes attached to the rear upper and lower molars. This facebow then extends out of the mouth and around the patient's face. J-Hooks are different in that they hook into the patient's mouth and attach directly to the brace (see photo for an example of J-Hooks).
  2. Head cap: the head cap typically consists of one or a number of straps fitting around the patient's head. This is attached with elastic bands or springs to the facebow. Additional straps and attachments are used to ensure comfort and safety (see photo).
  3. Attachment: typically consisting of rubber bands, elastics, or springs—joins the facebow or J-Hooks and the head cap together, providing the force to move the upper teeth, jaw backwards.

The headgear application is one of the most useful appliances available to the orthodontist when looking to correct a Class II malocclusion. See more details in the section Orthodontic headgear.

Pre-finisher

[edit]

The pre-finisher is moulded to the patient's teeth by use of extreme pressure on the appliance by the person's jaw. The product is then worn a certain amount of time with the user applying force to the appliance in their mouth for 10 to 15 seconds at a time. The goal of the process is to increase the exercise time in applying the force to the appliance. If a person's teeth are not ready for a proper retainer the orthodontist may prescribe the use of a preformed finishing appliance such as the pre-finisher. This appliance fixes gaps between the teeth, small spaces between the upper and lower jaw, and other minor problems.

Complications and risks

[edit]

A group of dental researchers, Fatma Boke, Cagri Gazioglu, Selvi Akkaya, and Murat Akkaya, conducted a study titled "Relationship between orthodontic treatment and gingival health." The results indicated that some orthodontist treatments result in gingivitis, also known as gum disease. The researchers concluded that functional appliances used to harness natural forces (such as improving the alignment of bites) do not usually have major effects on the gum after treatment.[10] However, fixed appliances such as braces, which most people get, can result in visible plaque, visible inflammation, and gum recession in a majority of the patients. The formation of plaques around the teeth of patients with braces is almost inevitable regardless of plaque control and can result in mild gingivitis. But if someone with braces does not clean their teeth carefully, plaques will form, leading to more severe gingivitis and gum recession.

Experiencing some pain following fitting and activation of fixed orthodontic braces is very common and several methods have been suggested to tackle this.[11][12] Pain associated with orthodontic treatment increases in proportion to the amount of force that is applied to the teeth. When a force is applied to a tooth via a brace, there is a reduction in the blood supply to the fibres that attach the tooth to the surrounding bone. This reduction in blood supply results in inflammation and the release of several chemical factors, which stimulate the pain response. Orthodontic pain can be managed using pharmacological interventions, which involve the use of analgesics applied locally or systemically. These analgesics are divided into four main categories, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol and local anesthesia. The first three of these analgesics are commonly taken systemically to reduce orthodontic pain.[13]

A Cochrane Review in 2017 evaluated the pharmacological interventions for pain relief during orthodontic treatment. The study concluded that there was moderate-quality evidence that analgesics reduce the pain associated with orthodontic treatment. However, due to a lack of evidence, it was unclear whether systemic NSAIDs were more effective than paracetamol, and whether topical NSAIDs were more effective than local anaesthesia in the reduction of pain associated with orthodontic treatment. More high-quality research is required to investigate these particular comparisons.[13]

The dental displacement obtained with the orthodontic appliance determines in most cases some degree of root resorption. Only in a few cases is this side effect large enough to be considered real clinical damage to the tooth. In rare cases, the teeth may fall out or have to be extracted due to root resorption.[14][15]

History

[edit]

Ancient

[edit]
Old Braces at a museum in Jbeil, Lebanon

According to scholars and historians, braces date back to ancient times. Around 400–300 BC, Hippocrates and Aristotle contemplated ways to straighten teeth and fix various dental conditions. Archaeologists have discovered numerous mummified ancient individuals with what appear to be metal bands wrapped around their teeth. Catgut, a type of cord made from the natural fibres of an animal's intestines, performed a similar role to today's orthodontic wire in closing gaps in the teeth and mouth.[16]

The Etruscans buried their dead with dental appliances in place to maintain space and prevent the collapse of the teeth during the afterlife. A Roman tomb was found with a number of teeth bound with gold wire documented as a ligature wire, a small elastic wire that is used to affix the arch wire to the bracket. Even Cleopatra wore a pair. Roman philosopher and physician Aulus Cornelius Celsus first recorded the treatment of teeth by finger pressure. Unfortunately, due to a lack of evidence, poor preservation of bodies, and primitive technology, little research was carried out on dental braces until around the 17th century, although dentistry was making great advancements as a profession by then.[citation needed]

18th century

[edit]
Portrait of Fauchard from his 1728 edition of "The Surgical Dentist".

Orthodontics truly began developing in the 18th and 19th centuries. In 1669, French dentist Pierre Fauchard, who is often credited with inventing modern orthodontics, published a book entitled "The Surgeon Dentist" on methods of straightening teeth. Fauchard, in his practice, used a device called a "Bandeau", a horseshoe-shaped piece of iron that helped expand the palate. In 1754, another French dentist, Louis Bourdet, dentist to the King of France, followed Fauchard's book with The Dentist's Art, which also dedicated a chapter to tooth alignment and application. He perfected the "Bandeau" and was the first dentist on record to recommend extraction of the premolar teeth to alleviate crowding and improve jaw growth.

19th century

[edit]

Although teeth and palate straightening and/or pulling were used to improve the alignment of remaining teeth and had been practised since early times, orthodontics, as a science of its own, did not really exist until the mid-19th century. Several important dentists helped to advance dental braces with specific instruments and tools that allowed braces to be improved.

In 1819, Christophe François Delabarre introduced the wire crib, which marked the birth of contemporary orthodontics, and gum elastics were first employed by Maynard in 1843. Tucker was the first to cut rubber bands from rubber tubing in 1850. Dentist, writer, artist, and sculptor Norman William Kingsley in 1858 wrote the first article on orthodontics and in 1880, his book, Treatise on Oral Deformities, was published. A dentist named John Nutting Farrar is credited for writing two volumes entitled, A Treatise on the Irregularities of the Teeth and Their Corrections and was the first to suggest the use of mild force at timed intervals to move teeth.

20th century

[edit]

In the early 20th century, Edward Angle devised the first simple classification system for malocclusions, such as Class I, Class II, and so on. His classification system is still used today as a way for dentists to describe how crooked teeth are, what way teeth are pointing, and how teeth fit together. Angle contributed greatly to the design of orthodontic and dental appliances, making many simplifications. He founded the first school and college of orthodontics, organized the American Society of Orthodontia in 1901 which became the American Association of Orthodontists (AAO) in the 1930s, and founded the first orthodontic journal in 1907. Other innovations in orthodontics in the late 19th and early 20th centuries included the first textbook on orthodontics for children, published by J.J. Guilford in 1889, and the use of rubber elastics, pioneered by Calvin S. Case, along with Henry Albert Baker.

Today, space age wires (also known as dental arch wires) are used to tighten braces. In 1959, the Naval Ordnance Laboratory created an alloy of nickel and titanium called Nitinol. NASA further studied the material's physical properties.[17] In 1979, Dr. George Andreasen developed a new method of fixing braces with the use of the Nitinol wires based on their superelasticity. Andreasen used the wire on some patients and later found out that he could use it for the entire treatment. Andreasen then began using the nitinol wires for all his treatments and as a result, dental doctor visits were reduced, the cost of dental treatment was reduced, and patients reported less discomfort.

See also

[edit]
  • Mandibular advancement splint
  • Oral and maxillofacial surgery
  • Orthognathic surgery
  • Prosthodontics
  • Trismus
  • Dental implant

References

[edit]
  1. ^ "Dental Braces and Retainers". WebMD. Retrieved 2020-10-30.
  2. ^ Robling, Alexander G.; Castillo, Alesha B.; Turner, Charles H. (2006). "Biomechanical and Molecular Regulation of Bone Remodeling". Annual Review of Biomedical Engineering. 8: 455–498. doi:10.1146/annurev.bioeng.8.061505.095721. PMID 16834564.
  3. ^ Toledo SR, Oliveira ID, Okamoto OK, Zago MA, de Seixas Alves MT, Filho RJ, et al. (September 2010). "Bone deposition, bone resorption, and osteosarcoma". Journal of Orthopaedic Research. 28 (9): 1142–1148. doi:10.1002/jor.21120. PMID 20225287. S2CID 22660771.
  4. ^ "Metal Braces for Teeth: Braces Types, Treatment, Cost in India". Clove Dental. Retrieved 2025-02-06.
  5. ^ Saxe, Alana K.; Louie, Lenore J.; Mah, James (2010). "Efficiency and effectiveness of SureSmile". World Journal of Orthodontics. 11 (1): 16–22. PMID 20209172.
  6. ^ Tamer, Ä°pek (December 2019). "Orthodontic Treatment with Clear Aligners and The Scientific Reality Behind Their Marketing: A Literature Review". Turkish Journal of Orthodontics. 32 (4): 241–246. doi:10.5152/TurkJOrthod.2019.18083. PMC 7018497. PMID 32110470.
  7. ^ Millett DT, Mandall NA, Mattick RC, Hickman J, Glenny AM (February 2017). "Adhesives for bonded molar tubes during fixed brace treatment". The Cochrane Database of Systematic Reviews. 2 (3): CD008236. doi:10.1002/14651858.cd008236.pub3. PMC 6464028. PMID 28230910.
  8. ^ Rubie J Patrick (2017). "What About Teeth After Braces?" 2017 – "Health Journal Article" Toothcost Archived 2021-10-18 at the Wayback Machine
  9. ^ Naten, Joshua. "Braces Headgear (Treatments)". toothcost.com. Archived from the original on 19 October 2021.
  10. ^ Boke, Fatma; Gazioglu, Cagri; Akkaya, Sevil; Akkaya, Murat (2014). "Relationship between orthodontic treatment and gingival health: A retrospective study". European Journal of Dentistry. 8 (3): 373–380. doi:10.4103/1305-7456.137651. ISSN 1305-7456. PMC 4144137. PMID 25202219.
  11. ^ Eslamian L, Borzabadi-Farahani A, Hassanzadeh-Azhiri A, Badiee MR, Fekrazad R (March 2014). "The effect of 810-nm low-level laser therapy on pain caused by orthodontic elastomeric separators". Lasers in Medical Science. 29 (2): 559–64. doi:10.1007/s10103-012-1258-1. PMID 23334785. S2CID 25416518.
  12. ^ Eslamian L, Borzabadi-Farahani A, Edini HZ, Badiee MR, Lynch E, Mortazavi A (September 2013). "The analgesic effect of benzocaine mucoadhesive patches on orthodontic pain caused by elastomeric separators, a preliminary study". Acta Odontologica Scandinavica. 71 (5): 1168–73. doi:10.3109/00016357.2012.757358. PMID 23301559. S2CID 22561192.
  13. ^ a b Monk AB, Harrison JE, Worthington HV, Teague A (November 2017). "Pharmacological interventions for pain relief during orthodontic treatment". The Cochrane Database of Systematic Reviews. 11 (12): CD003976. doi:10.1002/14651858.cd003976.pub2. PMC 6486038. PMID 29182798.
  14. ^ Artun J, Smale I, Behbehani F, Doppel D, Van't Hof M, Kuijpers-Jagtman AM (November 2005). "Apical root resorption six and 12 months after initiation of fixed orthodontic appliance therapy". The Angle Orthodontist. 75 (6): 919–26. PMID 16448232.
  15. ^ Mavragani M, Vergari A, Selliseth NJ, Bøe OE, Wisth PL (December 2000). "A radiographic comparison of apical root resorption after orthodontic treatment with a standard edgewise and a straight-wire edgewise technique". European Journal of Orthodontics. 22 (6): 665–74. doi:10.1093/ejo/22.6.665. PMID 11212602.
  16. ^ Wahl N (February 2005). "Orthodontics in 3 millennia. Chapter 1: Antiquity to the mid-19th century". American Journal of Orthodontics and Dentofacial Orthopedics. 127 (2): 255–9. doi:10.1016/j.ajodo.2004.11.013. PMID 15750547.
  17. ^ "NASA Technical Reports Server (NTRS)". Spinoff 1979. February 1979. Retrieved 2021-03-02.
[edit]
  • Useful Resources: FAQ and Downloadable eBooks at Orthodontics Australia
  • Orthos Explain: Treatment Options at Orthodontics Australia
  • Media related to Dental braces at Wikimedia Commons