Article
Primum non nocere – first do no harm, is one of the fundamental principles of any healthcare provision. In orthodontics we have the possibilities of doing harm to our patients almost on a visit by visit basis and it takes significant effort from all concerned parties: the clinicians, the therapists, the nurses, the patients and their parents to minimize this risk.
We are given a timely reminder in this issue by Vanet and co-workers of the fundamental risks all of our patients face on a daily basis – that of developing caries. In part 1 of their series they discuss aetiology, prevalence and prevention and remind us about the need for selecting only those patients for active treatment who can demonstrate a good diet and exemplary oral hygiene. If only the entire profession would stick to this basic philosophy we could significantly reduce iatrogenic disease, which unfortunately is seen in up to three quarters of our patients. This simple measure, along with the appropriate use of supplementary fluoride, could make a massive difference.
The other iatrogenic problem that can be seen in nearly a fifth of our patients is root resorption. Patient-related risk factors are discussed by Fahey and Stephenson and suggestions are made as to what should be recorded in the notes and how the problem should be managed once it has been identified.
With the increased complexity in imaging technology the onus is on all of us to familiarize ourselves with all the modern techniques and also to ensure that all images are interpreted correctly. An unusual appearance spotted on a lateral cephalometric radiograph led to further clinical examination and radiographic review, before deciding that no further action was required. Attard and colleagues discuss the need for careful review of all medical imaging to ensure that we best serve our patients.
Rapid maxillary expansion is becoming a commonly used technique and the biomechanical effects of the various appliances in current use are discussed by Dr Almuzian and co-workers in some detail, and there is also a comprehensive literature review of this entire subject. Another surgical approach that is gaining popularity is ‘Surgery First’ whereby the main aspects of the malocclusion are corrected at the very early stages of treatment and the bulk of the orthodontics is carried out post-surgically. This approach discussed by Lahoti et al has been show to reduce the overall active treatment time significantly, which will be an extremely attractive proposition to some of our patients.
With this interesting mix of ongoing problems with which we are all too familiar, and new technologies and surgical techniques, I hope we have offered something for everyone in this summer issue of Orthodontic Update.