Access and financial impacts of public orthodontic provision on global health systems: integrative review / Acesso e impactos financeiros da provisão ortodôntica pública nossistemas de saúde mundiais: revisão integrativa / Acceso e impactos financieros de la provisión pública de ortodoncia en los sistemas de salud globales: revisión integradora

Introduction:The supply of public orthodontic services is still unable to meet the demand for treatment of malocclusions. The resources available are sometimes mismanaged and significant financial impacts contribute to limited access to the services. Objective:To carry out an integrative review regarding the access and financial impacts of public orthodontic service among the various health systems worldwide, considering social inequalities and the referral and counter-referral systems for services. Methodology:A survey was conducted using the BVS (Biblioteca Virtual em Saúde / Virtual Health Library), PubMed, and Cochrane databases, including articles available from 1970 to 2019, which elucidated the guiding question "How does access work and what are the financial impacts of the provision of orthodontic services in different public health systems worldwide?". Results:211 articles were found, of which 20 were analyzed. The chronological distribution was relatively uniform. The topic 'access to orthodontic services' was most frequently reported and there was a predominance of studies addressing the provision of treatment for children and adolescents. Conclusions:There are significant financial impacts and demographics have a strong influence on access to services. The provision of orthodontic treatments by the private sector predominates, preventive approaches are scarce, and an optimization in the use of available resources is necessary. Primary Care has much to contribute in increasing access, reducing costs, and making the referral / counter-referral system effective (AU).

Introdução:A oferta de serviços ortodônticos públicos ainda não consegue suprir a demanda de tratamento de má oclusões. Os recursos disponíveis, por vezes, mal alocados e os impactos financeiros significativos contribuem para a restrição do acesso aos serviços.Objetivo:Realizar uma revisão integrativa pertinente ao acesso e aos impactos financeiros da provisão ortodôntica pública nos diversos sistemas de saúde mundiais, sob a luz das iniquidades sociais e dos sistemas de referência e contrarreferência de serviços.Metodologia:Foi realizado um levantamento nas bases de dados BVS (Biblioteca Virtual em Saúde), PubMed e Cochrane Reviews, incluindo os artigos disponíveis no período de 1970 a 2019, que elucidavam a questão norteadora "Como se dá a provisão de serviços ortodônticos nos diversos sistemas públicos de saúde mundiais?".Resultados:Foram encontrados 211 registros, dos quais 20foram analisados. A distribuição temporal foi relativamente uniforme. A temática "acesso aos serviços ortodônticos" foi mais frequentemente relatada e houve um predomínio de estudos abordando a oferta de tratamentos a crianças e adolescentes. Conclusões:Há impactos financeiros significativos e os determinantes sociais exercem forte influência sobre o acesso aos serviços. Predomina a oferta de tratamentos ortodônticos pelo setor privado, abordagens preventivas são escassas e é necessária uma otimização no uso de recursos disponíveis. A Atenção Básica tem muito a contribuir para aumento do acesso, diminuição de custos e efetivação do sistema dereferência/contrarreferência dos serviços (AU).

Introducción: La provisión de servicios públicos de ortodoncia aún no puede satisfacer la demanda de tratamientos de maloclusión. Los recursos disponibles a veces están mal asignados y los impactos financieros significativos contribuyen a restringir el acceso a los servicios.Objetivo: Realizar una revisiónintegradora pertinente al acceso y los impactos económicos de la provisión pública de ortodoncia en los diferentes sistemas de salud a nivel mundial, a la luz de las inequidades sociales y los sistemas de derivación y contrarreferencia de servicios.Metodología: Se realizó una encuesta en las bases de datos de la BVS (Virtual Health Library), PubMed y Cochrane Reviews, incluidos los artículos disponibles desde 1970 hasta 2019, que dilucidó la pregunta orientadora "¿Cómo es la prestación de servicios de ortodoncia en los diferentes sistemas públicos?".Resultados: Se encontraron 211registros, de los cuales se analizaron 20.La distribución temporal fue relativamente uniforme. El tema "acceso a servicios de ortodoncia" fue el que se informó con mayor frecuencia y hubo un predominio de estudios que abordan la provisión de tratamientos a niños y adolescentes.Conclusiones: Hay impactos económicos significativos y los determinantes sociales tienen una fuerte influencia en el acceso a los servicios. Predomina la oferta de tratamientos de ortodoncia por parte del sector privado, los abordajes preventivos son escasos y es necesario optimizar el uso de los recursos disponibles. La Atención Primaria tiene mucho que contribuir para aumentar el acceso, reducir costos e implementar el sistema de derivación / contrarreferencia de servicios (AU).

Baby-Risk of malocclusion assessment index: An assessment tool for preventive orthodontic treatment needs in a selected population of children in southeast of Iran.

CONTEXT: Preventive orthodontic treatments are performed in the primary or mixed dentition period and provide a proper development of occlusion to avoid dentofacial anomalies. AIMS: This study aims to evaluate the Baby-Risk of Malocclusion Assessment Index (ROMA) index regarding ease of use, reproducibility, and the epidemiological assessment of major orthodontic problems in children aged 4-6-year-old in Kerman (Iran) kindergartens. SETTING AND DESIGN: This cross-sectional study was conducted on 1000 children aged 4-6 in Kerman (Iran) kindergartens, selected by cluster sampling, and data were collected using the Baby-ROMA index. METHODS: After recording a demographic data collection form, the clinical examination of the teeth was carried out by a dental student. The data were analyzed with SPSS 18 using t-test, analysis of variance, Chi-squared test, and Mann-Whitney test at a significance level of P < 0.05. RESULTS: In this study, the most common cause of malocclusion was dental caries (7.5%), followed by crossbite (6.1%). Furthermore, 31.6% of the subjects had one type of malocclusion, and 20.5% needed monitoring the occlusion before the growth spurt, while 11.1% needed immediate orthodontic treatment (mostly 6-year-old children). Moreover, 15.3% of the subjects had systemic problems; 3.4% had craniofacial, 22% had dental, and 2% had functional problems. The prevalence of class I canine relationship in the right canines was 82.32%, with 82.5% on the left side. The prevalence of open bite was higher in females with thumb-sucking habit. CONCLUSION: The Baby-ROMA index presented good reliability and ease of use for evaluating early orthodontic treatment needs in primary and mixed dentition periods.

Avaliação das dimensões do arco dentário superior decorrentes do uso de aparelho parcial fixo 4 x 2 na fase da dentição mista / Assessment of the dimensions of an upper dental arch after using 2 x 4 fixed partial appliance in the stage of mixed dentition

A dentição mista é suscetível a uma diversidade de fatores que podem alterar as dimensões do arco dentário, dificultando a erupção dos dentes permanentes. Este trabalho teve como objetivo avaliar as alterações nas dimensões do arco dentário superior, decorrentes do uso de aparelho parcial fixo 4 x 2. A amostra total foi composta por 48 pacientes, dos gêneros masculino e feminino, na faixa etária de 8 a 11 anos, com boa saúde periodontal, dentição mista no período intertransitório do desenvolvimento da oclusão, com presença dos incisivos centrais, laterais e primeiros molares permanentes, ausência dos segundos molares permanentes, que apresentavam falta de espaço para irromper caninos e pré-molares, relação classe II de molar, os quais foram divididos igualmente em dois grupos. No grupo experimental (G1), 24 pacientes foram tratados na clínica de Ortodontia Preventiva da Faculdade de Odontologia da Universidade de São Paulo, com aparelho parcial fixo 4 x 2, associado a fios ortodônticos expandidos de CuNiTi e molas abertas de NiTi. O grupo controle (G2) foi composto por 24 pacientes, os quais não foram tratados e foram avaliados quanto às alterações decorrentes do crescimento, sem intervenção ortodôntica, no mesmo período de tempo do grupo experimental. Foram realizadas moldagens em alginato no início, em cada consulta de ativação e no final do tratamento ortodôntico preventivo e os modelos em gesso foram escaneados e medidos. As telerradiografias laterais foram obtidas no início (T1) e ao final (T5) do tratamento com aparelho parcial fixo 4 x 2 e suas medidas avaliadas. No grupo controle (G2), os modelos e as radiografias foram escaneados e medidos no início (T1) e ao final (T2) do período de observação. Os resultados encontrados no grupo experimental (G1) mostraram aumento médio significativo no perímetro (p= 0) e na profundidade da arcada (p= 0), no entanto não houve alteração significativa na distância intermolares (p= 0.14). Ocorreu aumento não significativo (p= 0.37) da distância da coroa do incisivo central superior à linha Sela perpendicular (Sperp), e do ângulo 1 . Plano palatino, também não significativo (p= 0.13), entre os tempos (T1 e T5). Ocorreu diminuição média significativa da distância da coroa e da raiz do molar à linha Sperp, p= 0 e p= 0.004, respectivamente, assim como do ângulo 6 . Plano palatino (p= 0.03). Após análise dos resultados, concluímos que o aparelho parcial fixo 4 x 2 promoveu aumento no perímetro e na profundidade do arco dentário, distalização de corpo do molar superior (com distalização da coroa, da raiz e com controle da inclinação) e controlou a inclinação vestibular dos incisivos superiores.

Preventive and interceptive orthodontic needs among Syrian children.

BACKGROUND: Preventing or intercepting a developing malocclusion in a public health program requires identifying or measuring the degree of malocclusion. The present study aimed to quantify the proportion of Syrian children in Damascus who would benefit from preventive and interceptive orthodontic treatment. MATERIALS AND METHODS: In total, 1096 children (431 boys and 665 girls) of grade 1 up to grade 3 from 16 government elementary schools in Damascus city were evaluated using the index for preventive and interceptive orthodontic need (IPION). On the basis of IPION, the overall scores of children were distributed into three groups - no treatment need, moderate treatment need, and definite treatment need. According to dental development, children were divided into two groups - IPION-6 and IPION-9. RESULTS: Of the enrolled children, 15.4% showed no treatment need, 26.7% showed moderate treatment need, and 57.9% showed definite treatment need. Comparison between male and female children indicated no significant effect on the overall treatment need distribution (P=0.439). The IPION groups had a significant effect on treatment distribution (6 vs. 9, P=0.038); the IPION-9 scores were significantly higher than the IPION-6 scores. CONCLUSION AND RECOMMENDATIONS: The prevalence of preventive and interceptive orthodontic needs is unsatisfactorily high in Syrian children, which emphasizes the importance of including preventive and interceptive orthodontic treatment in the local dental healthcare program.

[Preventive and interceptive orthodontics in the primary health care network of the Brazilian Unified Health System: the viewpoint of the dental surgeons of Florianopolis City Hall]. / Ortodontia preventiva e interceptativa na rede de atenção básica do SUS: perspectiva dos cirurgiões-dentistas da Prefeitura Municipal de Florianópolis, Brasil.

The scope of this exploratory study was to understand the viewpoint of the dental surgeons of the Primary Health Care (PHC) network in Florianópolis regarding the need, feasibility and interest in broadening preventive orthodontic services and in the implementation of interceptive orthodontics. A structured questionnaire was used to establish the viewpoint of all the primary care dental surgeons who perform clinical care in the network. The results indicate that: the majority are in favor provided that there is an appropriate structure to attend the needs of the population; the professionals consider themselves unqualified to perform the requisite procedures, so training would be necessary; there would be no need to deploy other orthodontic procedures in primary care than those analyzed; and the main difficulties that might be encountered were related to excess demand and the lack of human resources. Despite these obstacles, the majority of the professionals consider it positive and feasible to introduce this service, which could increase the comprehensiveness of health care and bolster primary care, thereby improving the health of the population.

Ortodontia preventiva e interceptativa na rede de atencao basica do SUS: perspectiva dos cirurgioes-dentistas da Prefeitura Municipal de Florianopolis, Brasil / Preventive and interceptive orthodontics in the primary health care network of the Brazilian Unified Health System: the viewpoint of the dental surgeons of Florianopolis City Hall

O objetivo deste estudo exploratório foi conhecer a perspectiva dos cirurgiões-dentistas da rede de atenção básica à saúde de Florianópolis acerca da necessidade, viabilidade e interesse quanto à ampliação dos serviços de ortodontia preventiva e à implementação dos de ortodontia interceptativa nas Unidades Básicas de Saúde do município. Empregou-se um questionário estruturado para coletar as opiniões de todos os cirurgiões-dentistas da atenção básica que realizam atendimento clínico na rede. Os resultados demonstraram que: a maioria deles é favorável desde que haja uma estruturação adequada para atender à necessidade da população; que os profissionais se consideram despreparados para realizar os procedimentos necessários, de modo que haveria a necessidade de capacitações; que não haveria a necessidade de se implantar outros procedimentos de ortodontia na atenção básica além dos analisados; e que as principais dificuldades que seriam enfrentadas estariam relacionadas ao excesso de demanda e à falta de recursos humanos. Apesar destes obstáculos, a maioria dos profissionais encara como positiva e viável a ampliação/introdução desse serviço, o que favoreceria a integralidade da atenção à saúde e fortaleceria a atenção básica, melhorando assim a saúde da população.

The scope of this exploratory study was to understand the viewpoint of the dental surgeons of the Primary Health Care (PHC) network in Florianópolis regarding the need, feasibility and interest in broadening preventive orthodontic services and in the implementation of interceptive orthodontics. A structured questionnaire was used to establish the viewpoint of all the primary care dental surgeons who perform clinical care in the network. The results indicate that: the majority are in favor provided that there is an appropriate structure to attend the needs of the population; the professionals consider themselves unqualified to perform the requisite procedures, so training would be necessary; there would be no need to deploy other orthodontic procedures in primary care than those analyzed; and the main difficulties that might be encountered were related to excess demand and the lack of human resources. Despite these obstacles, the majority of the professionals consider it positive and feasible to introduce this service, which could increase the comprehensiveness of health care and bolster primary care, thereby improving the health of the population.

Unmet dental and orthodontic need of children with special healthcare needs in West Virginia.

INTRODUCTION: Of children aged 0-17 years in the USA, an estimated 11 203 616 (15.1%; 95% CI: 14.8, 15.3) are Children with Special Health Care Needs (CSHCN). The state of West Virginia, the heart of Appalachia, has a land mass which is 97.65% rural with previously identified high overall dental need and oral health disparities. It is home to an estimated 70 609 CSHCN, or 18.5% (95% CI: 17.0, 19.9) of the state's children in 2009-2010. The purpose of this study was to determine the parent/guardian's perceived unmet dental care need of CSHCN in West Virginia. METHODS: Data from the National Survey of Children with Special Health Care Needs was used to determine prevalence. A telephone survey of 59 941 parents/guardians of CSHCN (1149 from West Virginia) for the dental interview was conducted in 2009-2010. RESULTS: Nationwide, 26.7% (25.9, 27.5) of parents/guardians reported their CSHCN had dental care or orthodontia needs other than preventive care. In West Virginia, the perceived dental care or orthodontia needs other than preventive dental care need was 26.5% (22.2, 30.0). Unmet national dental care need other than preventive dental care was 5.4% (5.0, 5.9) and in West Virginia 5.0% (2.4, 7.5). CONCLUSIONS: CSHCN have significant unmet dental needs. Parents/guardians in West Virginia reported similar unmet need compared with national reporting. Policies to address the health care of CSHCN should include dental needs. The clinical implications are that CSHCN have a variety of needs, including orthodontia. The benefits of orthodontic referrals should be considered in treatment planning options for CSHCN.

Quality of life and economic burdens of malocclusion in U.S. patients enrolled in Medicaid.

BACKGROUND: Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. METHODS: The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. RESULTS: Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. CONCLUSIONS: Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. CLINICAL IMPLICATIONS: Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.

Tabla para analizar necesidad de tratamiento de ortodoncia en dos poblaciones escolares: modelo experimental / A table to analize the orthodontic treatment needs in two schoolchildren populations: an experimental model

La importancia de la detección precoz de las maloclusiones dentomaxilares y funcionales ya fue más de una vez revisada en la bibliografía mundial. Esta información planetó la necesidad de sistematizar y simplificar el diagnóstico preventivo y la orientación hacia las diversas terapéuticas que debe seguir no sólo el especialista en ortodoncia, sino el odontólogo generalista y el odontopediatra. Se confeccionó una tabla y se aplicó a 2 poblaciones escolares de la Argentina, una de la provincia de Buenos Aires y otra de la provincia de Tierra del Fuego. Las observaciones fueron realizadas por 2 odontólogas ortodoncistas entrenadas y calibradas previamente en la Asociación Civil CEVI.

Preventive and interceptive orthodontic treatment needs of an inner-city group of 6- and 9-year-old Canadian children.

OBJECTIVE: Early recognition of developing malocclusions and the potential for uncomplicated orthodontic treatment procedures can minimize or eliminate future costly treatment. This study was designed to assess the potential for this approach in children living in a limited-income environment. A modified index for preventive and interceptive orthodontic needs (IPION) was used to determine the need for such treatment in schoolchildren aged 6 and 9 years. METHODS: Two calibrated examiners examined each child independently and assessed several components of his or her occlusion, including molar relationship, crossbite, open bite, overbite and overjet. Dental variables such as presence of caries and early loss of teeth were also noted. Informed consent was obtained and all children present at school on the day of the field study were included. A total of 395 children were divided into 2 groups, aged 6 and 9 years. RESULTS: A high prevalence of caries in the deciduous dentition (30.4% for 6 year olds; 20.6% for 9 year olds) and early loss of primary teeth (11.9% for 6 year olds; 29.4% for 9 year olds) was observed. A large percentage of children had crossbite in the anterior or posterior segments, or both. Open bites were also a common finding. Future orthodontic problems were identified in 28% of this population by using the modified IPION. No statistically significant differences (p > 0.05) were found between sexes or age groups using the chi2 test. CONCLUSIONS: Most of the developing malocclusions identified in this study would be amenable to interceptive orthodontics, consisting of space maintenance, crossbite correction and arch expansion.

Avaliação cefalométrica de pacientes submetidos ao tratamento com posicionadores tipo Trainer - T4k / Cephalomeric assessment of of patients after treatment with Trainer positioners - T4k

O objetivo deste estudo foi avaliar o efeito dos posicionadores tipo Trainer - T4K sobre três grandezas cefalométricas. Trinta e quatro crianças, com idades entre 7 e 10 anos, foram selecionadas para a utilização ao longo de doze meses, e delas obtiveram-se duas telerradiografias, uma ao início e outra ao final do tratamento. Sobre elas foram confeccionados cefalogramas e compararam-se as grandezas Condíleo-A; Condíleo-Gnatio e Espinha Nasal Anterior-Mentoniano. Entre o grupo testado e o controle advindo da literarura, pôde-se observar o aumento estatisticamente validado das grandezas Co-Gn, (grupo masculino com p valor = 0,0000 e feminino = 0,003); Co-A (masculino com p = 0,0009 e feminino p = 0,314) e ENA-Me (masculino p = 0,0000 e feminino p = 0,0000). Conclui-se que o uso do aparelho não tem efeito na restrição do crescimento da maxila, mas parece provocar o aumento efetivo do crescimento da mandíbula e da dimensão vertical. É necessário o aprofundamento dos estudos para uma melhor indicação desta terapêutica.

Need for preventive/interceptive orthodontic treatment among 7-10-year-old children in Ibadan, Nigeria: an epidemiological survey.

The aim of this epidemiological survey was to assess the level of needs for preventive/interceptive orthodontics among 7-10-year-old children in Ibadan, Nigeria, which is the second vigilance period in the study of developing occlusions. The sample consisted of 493 school children--237 (48.1%) boys and 256 (51.9%) girls randomly selected from various schools and different socio-economic groups. They were all examined in their school environments under natural illumination and the findings entered into a pre-structured form. The study revealed that about 27% of the children had need for one form of preventive/interceptive orthodontic treatment or the other with some having multiple needs. Some of the needs detected were as follows: prolonged retention of primary teeth (6.9%), cross bite (10.3%), early loss of primary teeth (4.3%), oral habits (7.3%), over jet of more than 6mm (4.9%), carious lesions (14.8%) crowding (18.9%) and clinically missing upper lateral incisors (3.7%). The relationship between observed occlusal discrepancies and oral habits was found very statistically significant (p=0.001). No gender differences were noted among the children with preventive/interceptive needs (p>0.05). Children from the working class accounted for 55.2% of the study sample, while 44.8% were from the middle class families. It was concluded that over one third of these children would benefit from preventive interceptive orthodontics and that such care should be encouraged in our environment due to their known numerous benefits especially in a country like Nigeria where many can not afford the cost of comprehensive orthodontic services.

A randomized prospective clinical trial of the effect of infant orthopedics in unilateral cleft lip and palate: prevention of collapse of the alveolar segments (Dutchcleft).

OBJECTIVE: To study the effect of infant orthopedics (IO) on maxillary arch form and position of the alveolar segments. DESIGN: Prospective two-arm randomized, controlled trial in parallel with three participating academic cleft palate centers. Treatment was assigned by means of a computerized balanced allocation method. SETTING: Cleft palate centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. PATIENTS, PARTICIPANTS: Infants with complete unilateral cleft lip and palate and no other malformations. INTERVENTIONS: One group (IO+) wore passive maxillary plates during the first year of life; the other group (IO-) did not. All other interventions were the same. MAIN OUTCOME MEASURE(S): The presence of contact and/or overlap (collapse) between the maxillary segments at maxillary casts made shortly after birth, at 15, 24, 48, 58, and 78 weeks. Survival experience of contact and collapse with time as well as the frequencies of different arch forms and severity of collapse were evaluated. RESULTS: Comparable arch forms with no contact or overlap of the maxillary segments were seen at birth in both groups. With time the frequency of collapse increased, with no significant differences between groups. No significant group differences were found with respect to the survival experience of contact and collapse or for the severity of collapse at the end of the observational period. CONCLUSIONS: Infant orthopedics does not prevent collapse and can be abandoned as a tool to improve maxillary arch form.

El equipo basico de salud escolar y su participación en programa de prevención de maloclusiones, en el distrito sanitario 4, Secretaria de Salud de la AlcaldÝa Metropolitana de Caracas, 1999 / The basic school health team and its participation in a malocclusion prevention program in the sanitary district 4, Health Secretary of Caracas Metropolitan Country, 1999

La alta prevalencia de maloclusiones en niños, en un paÝs donde mßs del 78,2 por ciento (Fundacredesa 1994) de la población vive en estado de pobreza, trae como consecuencia la necesidad de realizar programas institucionales de educación, donde se integre el odontólogo, la asistente dental y el maestro, y asÝ poder llegar a los padres e hijos en las escuelas y ambulatorios, mediante la aplicación de niveles de prevención en ortodoncia, y asÝ evitar o interferir en la evolución de la enfermedad. Se comienza desde temprana edad para que no se acumulen y agraven las alteraciones previamente existentes, donde influyen factores como estado psicológico, hßbitos, caries dental, pÚrdida prematura de dientes, entre otros. Como respuesta a estas necesidades, desde 1997 existe un programa ipiloto de prevención-intercepción de maloclusiones en el distrito sanitario 4, adscrito a la SecretarÝa de Salud de la AlcaldÝa Metropolitana de Caracas, donde se cuenta con el recurso humano con capacitación acadÚmica en el ßrea que atiende de manera integral a niños desde los 3 años; ademßs se establecen consultas intra e interdisciplinarias, lo que despierta el interÚs de estudiarlo en forma conjunta

Preventive and interceptive orthodontic demand for malocclusion.

Orthodontic unit, University College Hospital, Ibadan is young and in need of baseline data for effective planning. The main aim of this study was to determine the nature of orthodontic demands in the unit that could benefit from preventive and interceptive treatment so as to enhance treatment planning, teaching and further research. Consecutive patients who presented for treatment in the Unit between May 1997 and November 1999 were included in the study. The patients aged 5-19 years with mean age of 8.8 +/- 0.82 years. One hundred and twenty-one (60.5%) of the orthodontic cases that presented for treatment needed one form of preventive and interceptive treatment or the other such as extraction of retained primary teeth, use of upper removable orthodontic appliances to correct teeth in cross bite, extraction of erupted supernumerary teeth and fabrication of oral habit breaking appliances such as goal post appliance. Ninety-three (76.9%) of these children had retained primary anterior teeth while 9.1% had proclination of maxillary anterior teeth with moderate spacing. Based on dental history and clinical examination, nine (7.4%) children were involved with oral habits, seven (5.8%) and one (0.8%) had anterior crossbite and supernumerary teeth, respectively. The remaining 39.5% needed full-blown orthodontic treatments. No sex predilection was found in relation to the various needs (P > 0.05). We suggest a need for more emphasis on preventive and interceptive orthodontic treatment in our environment due to the relatively high prevalence ofthese presenting needs.

Need for preventive and interceptive orthodontic treatment in 3-5 year-old Nigerian children in two major cities.

There is a growing emphasis world-wide for early orthodontic treatment but in Nigeria there is very little information regarding the occlusal development in pre-school children reported. The need for preventive and interceptive intervention for malocclusion was studied in a sample of 563 Nigerian children (289 boys and 274 girls) aged 3-5 years. Orthodontic intervention was estimated to be needed in 12.8% of the children due to cross bite of the anterior or lateral segments. Education was needed in 12.5% of the children in cases of digit sucking, lip sucking and tongue thrusting. Extraction was indicated in 0.4% of children in cases of retained primary incisors causing displacement of the erupting successors. The need for further follow-up of occlusal development was noted in 1.4% of the children due to double primary teeth (0.4%), numerical variation of primary teeth (0.4%), crown dilaceration of a tooth (0.2%) and true class III skeletal malocclusion (0.4%).

Avaliaçäo clínico-radiográfica da prevençäo de espaço na dentiçäo mista / Clinical and radiographic assessment of space maintenance in the mixed dentition

A proposta básica deste estudo foi avaliar e comparar a eficácia de dois procedimentos clínicos distintos na preservaçäo de espaço para dentes permanentes posteriores que possuíam uma direçäo de erupçäo alterada. Realizou-se controle clínico-radiográfico de um grupo que utilizou o mantenedor de espaço tipo banda-alça, comparado com um grupo em que o dente decíduo permaneceu funcionando como um mantenedor de espaço natural