Really Straight Teeth

 2016 Fox Ft Lauderdale’s Full Service Orthodontist

has developed in Interceptive Early a few areas. First, treatment in Volume 6, Issue 3 Orthodontic the full deciduous dentition seems to be Adult & Child Braces and Early Treatment inappropriate if the objective is tooth Interceptive Treatment for Ages movement. Skeletal problems (Class II 6-11 Donald M. Fox, D.D.S., M.S. or Class III), however, seem amenable Diplomate of The American Board of to correction in this group via orthopedics, but only if mechanics can Inside this Issue be devised to harness facial growth and It is true that no subject (aside from the patient cooperation. Interceptive Early need for extraction) has undergone such Orthodontic Treatment cycles in popularity among orthodontic A more complete answer to the 1 specialists than early (interceptive) question, “Can interceptive orthodontics orthodontics. Over the past 50 years, successfully alleviate a developing Can we intercept a articles have been published ?” comes with a review of Malocclusion? 1 documenting the success of early the literature on early mixed dentition orthodontic intervention in the treatment (defined as the stage where Can we avoid Extractions? correction of malocclusion. patients have permanent first molars and 2 Interestingly, the issues raised remain , and deciduous canines and the same: molars). The literature clearly supports Can we correct “Skeletal” the position that in this age group, via facial 2 1) Is it possible to intercept a skeletal correction of Class II, Class III, growth? malocclusion and thus prevent its , and open bite malocclusions Summary full expression at a later date? are very much possible. Further, it 2 dictates that such correction is best done 2) Can extractions of permanent teeth at the ages 6-9 where facial growth is About Dr. Fox and his be avoided or reduced with early plentiful and patient cooperation likely office treatment? 3 to be the greatest. 3) Can malocclusion with a skeletal Important Note By definition, interceptive treatment basis be successfully corrected cannot be accomplished with a full 3 using facial growth? complement of permanent teeth. Only

I will discuss these three views corrective treatment can now be done, individually, providing a broad and the potential for skeletal correction overview that permits the reader to view is minimal. It also takes a while to set a

the subject from practical and current case up for functional growth in my perspectives. hands. For example, a patient needing lower jaw growth often needs expansion of the arch forms and alignment of the #1: Can we intercept incisors to actually know exactly where a Malocclusion? I need to get the lower jaw to position Donald M. Fox, D.D.S., M.S., P.A. out to in a new Class I position. It is 255 SE 14th Street The subject of early interception of sort of like preparing adult orthodontic Ft Lauderdale, Florida 33316 malocclusion has been extensively cases for jaw surgery. The surgeon (954) 523-6525 reported in the dental and orthodontic needs to know where to set the lower literature for many years. A consensus

...... jaw out to, so I expand the arch forms not). Surveys of orthodontic practices towards the back of the mouth (that and move the incisors to where the today show variations from 5-10% of ends up hurting the lip profile). lower jaw will articulate out to at the cases requiring extractions to over 50%! time of surgery. Therefore, it is best to The literature would support a clear #3: Can we correct refer a child as early as age 6-7. This trend toward fewer permanent will allow me to see what is going on extractions regardless of the “school” of “Skeletal” with space requirements and jaw orthodontics a practitioner ascribes to. alignment and to see when treatment The advent of early treatment is the Malocclusions via should start or to place on recall. cause for this. But, do not get me wrong, I will call a spade a spade and facial growth? do a serial extraction if it needs to be #2: Can we avoid The third historical issue dealing with done. It is the cases that could avoid early treatment deals with what we call extractions that are the concern here. Extractions? “orthopedics.” Orthopedics is skeletal correction via growth alteration. This The second question deals with the Today, there are even cases that are area, too, has many “groups” promoting reduction of permanent teeth extraction borderline serial extraction cases that various methods. The literature would via early treatment. The controversy are best treated with interceptive support the following basic conclusion dates to the debates between Edward techniques. This is done along with a on orthopedic correction: Angle and Calvin Case in the 1890’s. serial extraction and when the need extraction, many times no Contemporary orthodontists fall into the 1) The maxilla is an incredibly extractions are needed or the 2nd Tweed School or the Begg School of adaptive bone. We can premolars can be removed instead to thought (which favor extractions), and orthopedically affect its growth in eliminate bringing the incisors too far the Bioprogressive groups (which do all three planes of space (length, width and height). Such treatment, because it requires facial growth, Example of Lower Jaw Growth Case should be done early. The below patient was presented as part of Board Certification to become a 2) Recent studies shed light on the Diplomate of the American Board of Orthodontics in 1993. Expansion was first success of lower jaw growth and done in both arches and then the overjet was corrected with braces and the 1st Class II correction done in Early molars and incisors along with special and coils. Bulky plastic growth Interceptive Treatment (Phase I). appliances (Herbst, etc.) have stopped being used to decrease enamel being Success rates in recent studies are damaged and the high success rate of growth with new techniques that have 75% or higher. been out for years. All cases are finished with gnathological learned from heavy background in prosthodontic training before going to orthodontic Summary school. To summarize, early treatment is becoming an ever larger part of the contemporary orthodontic practice, as it will allow more patients to be treated without permanent extractions. It will allow dramatic skeletal and facial improvements with minimal appliances and at an earlier age. This allows young children to mature, interact socially, and develop mentally unencumbered by disfiguring skeletal and dental malocclusions.

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Straight Teeth Oral surgeons in the area have indicated equivalent to a two-day period at the 13- . . to me recently that many patients today week of pregnancy. For this, Dr. Fox . who need jaw surgery as part of their received the American Association of . orthodontic treatment do not have Orthodontists’ highest award in 1987 insurance coverage for the surgical for the most meritorious 1st research. Important Note portion. Many oral surgeons who would get approximately $5,000 for a Dr. Fox is also recognized in Who’s The general practitioner is in an surgical case are receiving as low as Who in America. In dental school he excellent position to detect, $1,300 to do the same care. This leaves was elected into OKU and graduated #1 intercept and correct minor in class of 110. While in dental school the patient in an unusual predicament. orthodontic problems early, thus So, if there is any doubt that a patient he completed research with the oral making it unnecessary for the child should have an orthodontic exam early surgery department on the different (as recommended by the American causes of paraesthesia of the lower lip to go through complex orthodontic Association of Orthodontists at age 7) it and chin including extractions of treatment at a later date. Most would be best to have the child seen to wisdom teeth, car accident trauma to the patients who have Phase I early lower jaw and different jaw surgery provide the best future for the child treatment usually only have 12-18 dentally and economically. procedures. He helped to codify the types of paraesthesia and helped to find months of simple Phase II teenage specific findings of when to expect the braces. 5-10% never need Phase About Dr. Fox and “numbness” to go away in patients once II. Getting the child in at age 6-7 is his office paraesthesia is received. ideal; after age 10, we’re lucky if He has treated over 5,000 cases with prevention can be accomplished; Dr. Fox is one of only a few and referrals that come after age orthodontists in the entire Broward emphasis in early interceptive treatment (ages 6-9), adult orthodontic cases with County who are Diplomates of the 10 come too late for prevention or and without periodontal situations, American Board of Orthodontists. early treatment interception. While at the University of Tennessee, TMJ, and orthognathic surgery cases. His office is designed for efficiency he learned early treatment extensively REALLY STRAIGHT TEETH is along with comfortable patient care. He along with adult orthodontic treatments. published for the dental While there, he completed one of the has a totally chartless office. X-rays community as an educational and photos of any patient can be seen at largest Master’s thesis in 75 years in the service. For further information any chair in the office with each chair school’s history. It was an extensive on any of these services, study about how the facial growth is having its own computer monitor. contact: affected in the newborn from a pregnant DONALD M. FOX, D.D.S., M.S. mother taking aspirin or acetaminophen Adult & Child Braces and during pregnancy using dosages Early Interceptive Treatment For Ages 6-11

Diplomate: American Board of Orthodontics Member: American Association of Orthodontists Recognized: Who’s Who in America Recipient:: Harry Sicher Research Award of the American Association of Orthodontists Member: Broward County Dental Association

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