|
 
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| REVIEW ARTICLES |
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| Year : 2021 | Volume
: 9
| Issue : 3 | Page : 113-115 |
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Is age related to orthodontic treatment?
Suma Shekar1, BR Chandrashekar2
1 Department of Orthodontics, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, Mysore, Karnataka, India
2 Department of Public Health Dentistry, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, Mysore, Karnataka, India
| Date of Submission | 24-Mar-2021 |
| Date of Decision | 24-Jun-2021 |
| Date of Acceptance | 02-May-2021 |
| Date of Web Publication | 11-May-2022 |
Correspondence Address:
Suma Shekar
Department of Orthodontics, JSS Dental College and Hospital, Jagadguru Sri Shivarathreeshwara University, JSS Medical Institutions Campus, SS Nagar, Mysore, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/dypj.dypj_15_21
In recent times, there is an increase in orthodontic patients due to changing trends in esthetic demand, improved socioeconomic status, and more social recognition. It can also be correlated with circulation of knowledge through the cyberspace, social media, and mass media. With increase in awareness toward orthodontic treatment, nowadays, there is an increase in adult patients seeking orthodontic treatment. Considering increase in demand for adult orthodontics, this paper aims to correlate age and orthodontic treatment. Keywords: Adult, age, orthodontic, treatment
How to cite this article:
Shekar S, Chandrashekar B R. Is age related to orthodontic treatment?. D Y Patil J Health Sci 2021;9:113-5 |
| Introduction | |  |
Beautiful is good, which implies that physically attractive people will be accepted more by the society than unattractive individuals. Many researches have been conducted regarding the same and they conclude that the individuals with attractive physical appearance were rated more favorably than unattractive persons on 12 of the 15 characteristics. The results of the same also confirm that a “Beautiful is good” stereotype also exists in health professionals.[1] Hence, orthodontics is a branch which deals with esthetic component and smile in particular which contributes much to the beauty of an individual.
Conceivably, the most prominent and perceptible benefit of receiving orthodontic treatment in overall dental practice is to get better appearance. It has been proven scientifically that being better and confident in the appearance will help in improving emotional state and mental alertness, thereby increasing the general health of an individual. In addition to raising the self-esteem of an individual, it also provides an opportunity to improve interpersonal relationship, academic performance, and professional success.
In recent times, there is an increase in orthodontic patients due to changing trends in esthetic demand, improved socioeconomic status, and more social recognition. It can also be correlated with circulation of knowledge through the cyberspace, social media, and mass media.[2] With increase in awareness toward orthodontic treatment, nowadays, there is an increase in adult patients seeking orthodontic treatment. Considering increase in demand for adult orthodontics, this paper aims to correlate age and orthodontic treatment.
| Factors to Consider during Orthodontic Treatment with Different Age Groups | | |
Medical disorders
Majority of the orthodontic treatments are elective procedures, and clinicians should ensure a satisfactory risk–benefit ratio for each patient. If it is inappropriate to start the treatment, one should not hesitate to postpone until the medical problem diminishes. The usual medical concerns in treating young patients include acute lymphoblastic leukemia, hemophilia (care to be taken during extraction), asthma, cystic fibrosis, epilepsy or seizure disorders, juvenile idiopathic arthritis, allergies, and eating disorders. The medical concerns in adults include infective endocarditis, sickle cell anemia, liver disorders such as hepatitis B, C, and D, diabetes mellitus, chronic renal failure, osteoporosis, side effect to medications, eating disorders, and allergies. The concerns pertaining mainly in adult female patients include pregnancy, anemia osteoporosis, and conditions related to hormonal imbalance.[3],[4] In general, a correlation between medical conditions which hinder orthodontic treatment is relatively less, but the prevalence is likely to increase as the age of the patient increases. To conclude, as there is an increase in risk of medical concerns in adult patients compared to younger patients during orthodontic procedures, proper evaluation of medical history and certain precautionary measures are essential in treating such individuals.
| Psychological Considerations | | |
The success of any treatment significantly depends on good interaction between patients and doctors. Even orthodontic treatment demands a good doctor–patient relationship as it is influenced by number of variables. These variables may directly influence the treatment outcome; such variables related to patient compliance include pain perception and discomfort, oral hygiene maintenance, treatment satisfaction, psychological acceptance to treatment, and habits.[5] Among these habits and oral hygiene maintenance will be the main priority in treating young/child patients, which further may require psychologist/counselor help in achieving compliance for treatment. On the contrary, adult patients require more attention for psychological acceptance for the treatment and pain perception. For this, an orthodontist has to think of esthetic appliances like lingual orthodontics, ceramic brackets, and Invisalign as a treatment option. Further, the studies have reported that nearly 50% of adult patients who have undergone orthodontic treatment will be dissatisfied with the final outcome of the treatment.
| Motivation and Cooperation of the Patient Toward Treatment | | |
Motivation and cooperation are key factors in the success of orthodontic patients. The patient’s internal motivation toward orthodontic treatment is a must before the start of treatment. Whereas, patient’s cooperation is critical in timely and successful treatment outcome, as the length of orthodontic treatment is longer. In this regard, the role of an orthodontist is also vital, where adequate information has to be given to the patient as well as to parents in case of young patients. Many studies concluded that the parents were more motivated than the children who were supposed to undergo treatment. They have also concluded that motivation was more in parents who have undergone previous treatment.[6] Further studies have revealed that the around 20.2% of patients aged 10–14 years and 42.7% of patients older than 18 years were discontinued the orthodontic treatment in various stages.[7] To conclude, the orthodontic patients who are internally motivated will have better cooperation toward the treatment.
| Biological Differences | | |
The orthodontic treatment is mainly an inflammatory response to the applied force. The inflammatory response involves bone resorption and deposition which happens in the presence of good blood supply. However, many studies have confirmed that as the age advances, there is an decrease in the tissue’s blood supply/cell turnover and may lead to the delay in orthodontic tooth movement.[8] With the use of these findings, it can be concluded that younger patients will have sufficient tissue blood supply compared to adult patients which makes a lower risk for orthodontically induced iatrogenic apical root resorption. Further, we can also observe less amount of root resorption because of partially formed roots with open apices.
| Lack of Growth | | |
The goal of orthodontic treatment is to achieve functional efficacy, esthetic harmony, and structural balance. To achieve this orthodontist will mold patient’s face, for this extensive knowledge about growth is very important to diagnose and assess the case and plan the best treatment plan possible for the patient. While treating young patients, we have an additional advantage of utilizing growth, whereas in adult patients, which will be lacking.[9] It has also been reported that orthodontic treatment changes achieved during growth period will have less chances of relapse. It can be concluded that there is a lack of growth in adults; due to this, there will be a different metabolic activity which, in turn, causes different orthodontic responses and outcomes when compared to younger patients.
| Periodontal Health Considerations | | |
The sound bone and good periodontal ligament will provide a suitable environment to achieve desired orthodontic tooth movement. Tooth loading causes local hypoxia and fluid flow, initiating an aseptic inflammatory cascade culminating in osteoclast resorption in areas of compression and osteoblast deposition in areas of tension. Compression and tension are associated with particular signaling factors, establishing local gradients to regulate remodeling of the bone and periodontal ligament for tooth displacement. Many studies have shown that periodontal tissue destruction is less when compared to adult patients. As the periodontal destruction is more in adult patients, we can observe an alteration in the equilibrium which leads to drifting/tilting or rotation of teeth. To increase the success rate of orthodontic treatment, initial periodontal treatment can be undertaken as an adjunctive procedure.[10]
| Treatment Mechanics | | |
The application of optimum orthodontic force is vibrant in success of orthodontic treatment. The amount of orthodontic force depends on the type of tooth movement, age of the patient, bone morphology, and periodontal condition. While treating adult patients, orthodontic force should be as low as possible to achieve controlled tooth movement. In the treatment mechanics, it is advisable to use thermoelastic nickel–titanium archwire in initial alignment stage as it applies lesser force which helps in maintaining the integrity of periodontal health. The extraoral appliances for the purpose of anchorage reinforcement can be used in younger patients, but the use of the same is limited in adult patients where acceptance is limited in adult patients. Whereas, Temporary Anchorage Devices can be used in adult patients to reinforce anchorage. When it comes to space closure, the amount of force should very low and continuous in case of adults, especially in lower arch when the extraction is historical and the alveolus is necked.[7]
| Esthetic Considerations | | |
The adult patients will have a lot of expectation in the orthodontic treatment outcome. However, these patients are also conscious in the appliance selection for esthetic purpose. During selection of appliances for adults, we should give special consideration to esthetics; for the same, we can give an option like ceramic brackets, lingual orthodontic appliance, or clear aligners.
| Retention and Relapse | | |
The various factors which influence the relapse include age and maturity of the patient, type of orthodontic treatment, type of malocclusion, type of the retainer given, and compliance of the patient. As we have discussed in the earlier part, the changes which are done during growth will have less tendency to relapse. This indicates special care needs to be taken in adult patients regarding retention plan. Majority of the adult patients require permanent retentive appliance using multistranded wires which allow some physiological tooth movement.[11]
| Conclusion | | |
Even though the basic treatment mechanics remain common for both adolescent and adult patients, the biological, psychological, esthetic, and periodontal aspects need special attention in treating adult patients. Whereas, in younger patients, we have an added advantage of utilizing growth.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 9. | Trivedi H, Tandon R, Singh K, Chandra P, Kulshrestha R, Gupta A, et al. Growth and growth studies in orthodontics-A review. J Dent Oral Care 2016;2:1-5. |
| 10. | Türkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S Archwire ligation techniques, microbial colonization, and periodontal status in orthodontically treated patients. Angle Orthod 2005;75:231-6. |
| 11. | Johnston C, Littlewood S Retention in orthodontics. Br Dent J 2015;218:119-22. |
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