Article Type : Research Article
Authors : Azhar Kharsa
Keywords : Orthodontist, Periodontitis, Achondroplasia
In this article the author focuses of the most
common ten diseases and anomalies that come across our daily practice in the
Dental Department of AHT-SA Hospital. The author depended on the statistics,
cases reports and active cases of his daily practice. The most registered
anomaly considered disease in the Orthodontic Department has been the
Malocclusion. It’s found out that 94% of the patient who visited the
Orthodontic Clinic of A.H. Hospital have had a sort of Mal-Occlusion [1]. The
other diseases that had been registered had been: the Dental Caries,
Periodontitis, Cleft-Lip and Palate, Ectodermal Dysplasia, Dentigerous Cysts,
Impacted Third Molars, Mouth breathing and Snoring, Diabetes and its dental
aftermaths and Finally Achondroplasia.
This study has used the files, the notes and all the
registrations and statistics of the hospital [2]. Despite that the diseases
differ in their advent according to the region, the ethnic considerations and
the patients’ habits, however, the author tries in summarize the highest
registered cases during the period of the latest 18 months within the Hospital.
Malocclusion
According to 1084 registered patients who visited the Orthodontic Clinic during the period of the study, it is found out that 1019 patients have shown a sort of Malocclusion, whose percentage is 94% of the whole patient’s number. The Malocclusion is any abnormality in the maxillofacial structures, either of the Skeletal or Dental Aspects. The reasons of Malocclusion are complicated and mostly there is no specific reason for the Malocclusion (Profit et al.), as the hereditary interacts with the acquired reasons to effect the malocclusion (Figure 1). The treatments of malocclusion depend according to the age, evaluation and its grade [3]. The potential malocclusion of the growing child may be treated by the Orthodontic Growth Modification Appliances, like functional and extra-oral appliances. The Skeletal Malocclusion cases can by treated by the orthognathic approaches that include the three steps procedures of a- Presurgical Orthodontic Phase. b- Surgery. c- Postsurgical Orthodontic Phase. However, the most part of the Orthodontic Cases are within the range of Dental and Camouflaging approaches [4].
Figure
1: A
Case of malocclusion, Class II D1 subdivision left side.
Dental
Caries
The Dental Decay is the second common disease within the Orthodontic Clinic, as 976 of the patients who visited the Orthodontic Clinic about 90% showed dental caries at least once in their medical history. The reasons of Dental Caries include the bacterial and diet ones. The mean bacteria that contribute in the sequence of the dental caries may include the Lactic Bacilli and S.Mutans (Figure 2).
Figure 2: The dental Cary was the
cause to destroy #16 as it looks as remaining roots.
In addition to the diet that must include that
high dose of Glucose and “Starch”. The dental caries treatments include the
restoration process after the proper “cleaning” of the decayed tissues.
The Periodontitis “Periodontal Lesions”
The Periodontal Lesions are common in the Orthodontic
Clinics, as well. In the Statistics of A.H. Hospital of Tabuk it is found that
859 patients complained of a degree pertinent to the Periodontitis what forms
79.24% of the screened patients. The periodontal diseases simultaneously to
dental caries etiology have bacterial and food accumulation reasons. The main
bacteria that contribute to the Periodontitis are Streptococci and
Staphylococci, however, the aforementioned bacteria need the appropriate
environment for proliferation (Figure 3). The bacterial clusters start to be
irremovable after 8-12 hours of their formation, what’s called the Plaque. The
more time passes of the bacterial colonies’ formation, the more difficult their
removal be. The next phase is the calculus formation when the Calcium Hydroxide,
food debris and blood transudation. The Calculus increase the virulence of the
periodontitis and becomes a hub of sequential bacterial accumulation. The
treatment of the periodontitis starts by scaling, curettage and oral hygiene
improvement for the long run prognosis. Failure of periodontal lesions
treatments may cause very negative sequelae on the affected teeth prognosis.
Figure 3: Gingival Hyperplasia as a result of Periodontitis.
Cleft-Lip
and Palate
Cleft lip and cleft palate are openings or splits in the upper lip, the roof of the mouth palate or both (Figure 4). Its rate ranging from 1/1000 to 2.69/1000 amongst different parts of the world McLeod, Saeed, & Arana- Urioste, 2004.
However the patient who visited the orthodontics clinic with any pertinent features of Cleft lip and Palate had been 18 for the study time duration, with percentage of 1.66% of the total patients’ numbers. Cleft lip and cleft palate result when facial structures that are developing in an unborn baby don't close completely. Cleft lip and cleft palate are among the most common birth defects. They most commonly occur as isolated birth defects but are also associated with many inherited genetic conditions or syndrome [5]. The treatments are surgical and orthodontic approaches according to the patient’s age and chronicle phase (Figure 5).
Figure 5: A Case of Bilateral Cleft Lip & Palate, before and after its
Orthodontic Correction.
Ectodermal
Dysplasia “Anhidrotic Ectodermal Dysplasia”
Anhidrotic ectodermal dysplasia abnormal tooth
development resulting in missing teeth or growth of teeth that are peg-shaped
or pointed. Tooth enamel is also defective. The patient who visited with this
aforementioned disease has been 9 during the time of this study, what forms
0.83% of the total patients. Dental treatment is necessary and children as
young as two years may need dentures.
Dentigerous
Cysts
Dentigerous cyst, also known as follicular cyst is an
epithelial-lined developmental cyst formed by accumulation of fluid between the
reduced enamel epithelium and crown of an unerupted tooth. It is formed when
there is an alteration in the reduced enamel epithelium and encloses the crown
of an unerupted tooth at the cemento-enamel junction. The advent of this
aforementioned disease has been 8 patients for the time of the study what forms
0.73 of the total patients’ numbers. The treatment is surgical.
Impacted
Third Molars
Impacted third molars Wisdom teeth are the third and last molars on each side of the upper and lower jaws. They are also the final teeth to erupt; they usually appear when a person is in their late teens or early twenties. Impacted wisdom teeth don't always cause symptoms. However, when an impacted wisdom tooth becomes infected, damages other teeth or causes other dental problems, you may experience some of these signs or symptoms:
The registered cases as “Impacted Third Molars” have been 176 cases what is about 16.24% of the total numbers of the patients whom this study registered. The treatment is most probably surgical, in other word, surgical extraction(s) of the involved tooth “teeth”.
Mouth
breathing “and snoring”
Chronic mouth breathing may adversely affect
craniofacial development in children and may result in anatomical changes that
directly impact the stability and collapsibility of the upper airway during
sleep. Mouth breathing during sleep also presents additional problems that may
make snoring worse. When you are breathing via your mouth instead of your nose,
it causes the airway at the back of the throat to become drier. This can make
your snoring even louder. The registered cases as “Mouth breathing and snoring”
have been 98 cases what is about 9.04% of the total numbers of the patients
whom this study registered. The treatment may be possible by a Removable
Appliance Called De Luke Appliance.
Diabetes
and its dental aftermaths
Unfortunately, many diabetic patients are unaware of
the association between DM and oral health, and only a small percentage of them
visit the dentist for routine dental check-ups. Changes in lifestyles control
of blood glucose levels and self-care practices, regular dental check-ups with
emphasis on periodontal assessment, and reinforcement of oral health
instructions can effectively prevent oral aftermaths of the Diabetes. Orthodontic
treatments are available under severe restrictions and according to the
instructions of the endocrinologist, provided high standards of Oral Hygiene be
insured during the whole treatment period. The registered cases as “diabetic
cases” in orthodontic clinic have been 9 cases what is about 0.83% of the total
numbers of the patients whom this study registered.
Achondroplasia
It is considered as a form of skeletal dysplasia
dwarfism that manifests with stunted stature and disproportionate limb
shortening [6]. Development of achondroplasia is due to the mutation of FGFR3
gene, which disrupts the maturation of chondrocytes found in the growth plate
[7]. Orthodontics and dentofacial orthopaedics can cause speech and respiratory
alterations and pathology. The registered cases as “achondroplasia” in
orthodontic clinic have been 3 cases what is about 0.27% of the total numbers
of the patients whom this study registered (Figure 6).
Figure
6: A
Case of achondroplasia.
The statistics show that the Orthodontist has to be
prepared to get along with all kinds of anomalies and diseases [8].The more the
orthodontists are well prepared to deal with the Dental, Maxillofacial and
Systemic Diseases, the better results they have [9]. We should keep in mind
that we are all doctors, health care practitioners that we must do our best in
diagnosis, treatments and avoiding the side-effects.