For many pediatric patients, the notion of getting a full set of braces is an exciting process. Many of their friends are undergoing treatment, and they want to be a part of the experience. Initially, this excitement is met with a great desire to care for their teeth. Yet as time goes by and home-care procedures become more tedious, many pediatric patients begin to taper off on good oral hygiene care.
ALSO BY LISA MAISONET |Orthodontic treatment: assessing patient readiness
Patients in active orthodontics are scheduled for routine appointments every six to eight weeks. This is a great opportunity for the orthodontic team to assess home care and determine if there are any imminent problems with tooth health. It is imperative for the orthodontic team to have an understanding of the caries process in order to avert its effects.
Implementing a system that allows for a measure of home-care procedures is good practice. This allows the technicians to assess plaque control and gingival health, and address less than adequate plaque removal with both patients and their parents. Many pediatric patients are driven by rewards systems, so creating an incentive program that rewards a patient for good oral hygiene can be a great tool for inspiring them to follow home-care recommendations. (Fig. 1)
Fig. 1: Sample incentive card that can be used as a motivational tool
While these ideas may be effective for some patients, an orthodontic practice must have a plan in place for those who fail to keep a healthy oral environment. After several visits of inadequate home care, a recommendation of more frequent intervals with a preventive specialist must be made. This will allow the hygienists to work hand in hand to guide the patient on implementing techniques that can aid in plaque and food removal. If, after several visits, the patient remains stagnant in his or her efforts and oral conditions do not improve, the decision to continue with orthodontic care must be heavily weighed. (Fig. 2)
Fig. 2: Patient presenting with poor oral hygiene at every visit
The decision to discontinue orthodontic care is not an easy one to make. However, when the balance of remineralization and demineralization is more heavily balanced toward the disease process, the health of the teeth should become a practitioner’s number one priority. Discontinuing treatment will allow the practitioner and patient to concentrate on the natural repair process of the teeth. The patient will be able to master the art of plaque removal, which, in turn, will aid in the healing process.
ADDITIONAL READING | Braces: the good, the bad, and the ugly
Continuous evaluation of home-care procedures in orthodontic patients should remain a number one priority in the orthodontic practice. When the decision is made to remove orthodontic appliances due to poor oral hygiene, treatment modalities should be implemented to help enhance the remineralization process. Once the oral environment has shifted from disease to health, an assessment can be made about the patient’s readiness to follow through with their care. If dental professionals unite in implementing a preventive mentality within our practices, we will help promote a healthy oral environment in the pediatric patients we treat.
