The prevalence of dental caries, the levels of oral hygiene and the periodontal treatment requirements were assessed in 3562 handicapped children and 1344 randomly selected normal children attending schools in Birmingham, UK. The effect of different types of handicapping condition on these parameters was also evaluated. This investigation showed that there were few differences in caries prevalence when comparing handicapped children with children attending normal schools. However, the provision of dental care showed significant differences, with the handicapped children receiving less restorative treatment. There were also significantly poorer levels of oral hygiene and a greater prevalence of periodontal disease in the handicapped children attending special schools. The type of handicapping condition had a significant effect on the periodontal problems observed; those children with mental retardation having the poorest levels of oral hygiene and the greatest periodontal treatment requirements.
Occlusal features and the need for orthodontic treatment are difficult to assess objectively. Methods of assessment which have been devised for public health purposes are different from those which are needed for clinical purposes. A study was carried out on 1000 children, aged 11 to 12 years, to assess certain occlusal features and the need for orthodontic treatment in clinical terms, and to determine which occlusal features brought about the need for treatment. The criteria for assessment are defined. The population was found to have a high prevalence of dental arch crowding and of Class 2 dental arch relationship. The features were each present in more than half the population. Other findings regarding occlusal features are outlined. There was little difference between the sexes for the occlusal and aetiological features studied. No orthodontic treatment was found to be necessary in 40·1 per cent of the population. Treatment by planned extraction of teeth only was necessary in 22·0 per cent, and active tooth movement with appliances, either with or without extraction of teeth, in 37·9 per cent. Crowding of the dentition and Class 2 dental arch relationship were found to be the main cause of the need for orthodontic treatment. In this population, more than 50 per cent of the necessary appliance treatment would be involved in treating Class 2 Division 1 occlusion. There were no significant differences between the sexes in the need for orthodontic treatment.
A longitudinal study was undertaken to assess the persistance of occlusal features of the primary dentition at five years into the permanent dentition at 12 years. It was found that although there was a broad measure of predictability there was variation in detail which made forecasting unreliable in the individual patient. Generally speaking, incisal overjet and overbite changed very little between the two dentitions, but those changes which occurred were in both directions, and the direction of change could not be predicted. The sagittal relationships of the dental arch were also relatively stable, but where change occurred it tended to be in a Class II direction, with the mandibular arch becoming more retroposed in relation to the maxillary arch. The prediction of crowding of the permanent dentition from a simple count of spaces in the primary dentition, while generally reliable, was not accurate in every individual patient.
The use of intracephalic reference lines in cephalometric assessment is valid only if these lines bear some constant relationship to the true horizontal and to each other. Otherwise, the use of a true horizontal would give the benefit that cephalometric assessment would be based on the same standards as clinical judgment. In using a true horizontal, however, the radiograph must be taken with the head in a reproducible natural posture. A study was carried out to assess the reproducibility of a natural head posture using a simple positioning method in a standard cephalostat, and to assess the variation in the relationship of the sella-nasion, Frankfort, maxillary and mandibular reference lines, to a true horizontal and to each other. Though in their mean inclinations the Frankfort and the maxillary reference lines were almost parallel to each other and to the true horizontal, the range of variation for all the reference lines was considerable. The range of variation in the reference lines was greater than the error of reproduction of head position, and the range of variation of the slope of the mandibular line was no greater than that for the slope of each of the other three lines. The sella-nasion line was reproduced more accurately that the other reference lines, using a digitizer. The possibilities of a simple cephalometric analysis based on a true horizontal are outlined.
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