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rest a tubercular gland. The mother stated that the child used to thrust
the lower jaw forward in an effort to relieve irritation from this collar.
4. Obstructions: These include swellings in the pharynx,
naso-pharynx, posterior and anterior nares and in the buccal cavity,
e.g., large tongue or fraenum. Although it is felt in some quarters that
adenoids are not responsible for malocclusion, I cannot help but take
the opposite view. In most cases adenoids cause mouth breathing
which in turn produces an open mouth habit. That bone will develop
more readily towards areas of least resistance had, I think, been proved
beyond doubt. In open mouth cases the pressure exerted laterally
by the cheeks on the developing maxilla, with the lack of pressure
anteriorly, cannot help but produce a long and narrow palatal aspect of
this bone. Open bite may also be produced by this same set of
circumstances.
5. Imperfect Nutrition: Probably due to psychological causes,
many children have food fads. Unfortunately many seem to dislike
good proteins such as meat, fish or cheese. In these days of restricted
diet it is extremely important that a growing organism should receive
all the first grade proteins and fats available. Regarding bones and
teeth, parents often seem to be much more worried about the child's
intake of calcium, which I understand is present in sufficient quantities
in any reasonable diet.
6. Genetic Factors: Seeing the children with their parents
proves beyond doubt that the potential size of the jaws and teeth and
their shape is strongly governed by genetic factors.
7. Endocrine disfunction or over-function: Detection of these
cases is not easy; the diagnosis and prognosis of malocclusions
associated with these conditions is difficult. Where a case is suspected,
the advice of an endocrinologist should be sought.
The above classification is set out primarily to show what an insignificant
role is played by the specialist orthodontist in detecting and
preventing malocclusion.
1 and 2 are entirely the responsibility of the dental officer ; 3 the
dental officer, medical officer and health visitor, not forgetting the parent
and the child, without whose co-operation all efforts are useless ; 4 and
5 should be taken care of by the advice of the medical and dental officers ;
7 is the domain of the endocrinologist, whilst 6 no one can direct.
A specialist orthodontist has to take cases selected by another
officer who has not necessarily received any special training in orthodontics.
A dental surgeon who devotes his time entirely to the treatment
of children is surely a specialist officer. A dental surgeon who
treats mostly adult patients carries out prosthetic work. In my opinion
the dental surgeon who specialises in children's dentistry should practise
crthodontics to a certain degree as part of his general dental work,
having received some post-graduate instruction in the subject. He
should have at hand the advice of an experienced orthodontic specialist
when possible to whom cases requiring more complicated appliances
could be referred.
Preventative orthodontics and treatment with "functional"
appliances, e.g., the oral screen and the Andresen appliance, together
with removable expansion appliances and those with simple springs and