Orthodontic Care for the Person with Special Needs: An Overview

By Koidin, Michael B. | The Exceptional Parent, May 2002 | Go to article overview

Orthodontic Care for the Person with Special Needs: An Overview


Koidin, Michael B., The Exceptional Parent


At first consideration, orthodontic care for the child or adolescent with special needs may appear to be superfluous in light of all the other parameters governing such an individual's daily existence. After all, dally lifestyle maintenance issues such as feeding, dressing and mobility should take precedence over the seemingly superficial importance of having "straight teeth." However, if one looks beyond the vanity factor fostered by our society's valuation of the beautiful smile, the importance of overall orthodontic health for the special needs population becomes apparent.

The incidence of malocclusion (unaligned or "bad" bite) in people with developmental disabilities is markedly higher than in the rest of the population, as has been shown in several studies done in Europe and the United States. This increased frequency of orthodontic problems is certainly multifactorial, ranging from inherent growth and development anomalies common to many syndromes, such as cross-bites in people with Down syndrome, to malocclusions. These may develop as a result of dental neglect and lack of professional supervision; for example, premature loss of primary (baby) teeth can lead to drifting and crowding of permanent teeth. Therefore, an orthodontic examination and assessment should be considered an integral aspect of dental care for every person with special needs.

Early orthodontic care, often termed preventive or interceptive treatment, is generally intended to avoid and/or minimize potentially harmful patterns. Such an approach of early intervention is particularly important for a person with a developmental disability who may not be able to tolerate braces or similar traditional orthodontic treatment. An important aspect of preventive orthodontics includes good restorative care of both primary and permanent teeth since space loss, crowding and even tooth impaction can result from dental decay and its consequences.

Another aspect of interceptive orthodontics is the timely removal of primary teeth so that they do not block or deflect the underlying permanent teeth from their proper eruptive paths. When these baby teeth are overretained--when they are not shed on schedule--the result can be harmful cross-bite positions or impactions, which can become difficult orthodontic therapeutic challenges in a person with special needs.

Correction of functional asymmetries by early treatment intervention is also important to the orthodontic health of people with special needs. The promotion of symmetrical jaw growth in the young child is often essential in minimizing future orthodontic problems. Treatment may range from selected extractions of either primary or permanent teeth to rather complex orthodontic/orthopedic appliances designed to stimulate and/or favorably redirect bone growth. In many cases, especially with people exhibiting dentofacial anomalies (see the December 2001 and February 2002 issues of EXCEPTIONAL PARENT for descriptions), a team approach is used, with disciplines ranging from plastic surgery to oral surgery to orthodontics involved in the overall treatment. Therapy may be staged over many years; for example, corrective treatment for people with cleft lip/cleft palate may begin shortly after birth and can often continue into early adulthood.

As a dual-trained pediatric dentist and orthodontist, it has been my basic philosophy to offer all aspects of treatment--from preventive to restorative to orthodontic treatment--to everyone I see in my practice. It is our office's goal to provide every person with optimal-dental health, functionally and cosmetically, irrespective of any disability. …

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