Orthotown June 2023 - 55

reactive-one that focuses on the diagnosis and
treatment of the etiology of the malocclusion.
From an evolutionary perspective, dental
crowding is a relatively new phenomenon that
has largely emerged over the past 300 years.
The dramatic increase in the prevalence and
severity of dental crowding in preadolescent
patients is the result not of increases in tooth
size but the narrowing of the dental arches, secondary
to environmental factors such as airway
obstruction and a soft diet. As such, when we
focus solely on addressing the crowding, we are
incorrectly taking a symptom-based approach to
treatment. Instead, we must first determine the
underlying etiology of the malocclusion and then
develop a treatment plan to address it. When we
do, we can have a profound, life-changing impact
on the physical and psychological health and
well-being of our patients.
Learning objectives
At the end of this course, you should be able to:
1. Recognize the paradigm shift occurring in
the diagnosis and treatment of malocclusion
in preadolescent patients.
2. Describe the interconnectivity of the structures
of the craniofacial complex as it pertains
to the development of malocclusion.
3. Correctly identify the etiology of dental
crowding in preadolescent patients.
4. Explain how airway obstruction can contribute
to the development of malocclusion.
5. Recognize the clinical signs of airway
obstruction in preadolescent patients.
6. Develop an etiology-based treatment plan
for a preadolescent patient who presents
with dental crowding in the early
mixed dentition.
Introduction
Thomas Kuhn, an American philosopher of
science and historian, stated that science does
not evolve gradually toward the truth. Instead,
it has a paradigm that remains constant before
going through a shift when current theories
can't explain some phenomenon and someone
proposes a new theory. Kuhn defined a paradigm
as a universally recognizable scientific
achievement that, for a time, provides model
problems and solutions to a community of
practitioners. He argued that the masses will
continue to follow the paradigm and do what
they think is true while refusing to admit that
what they're doing does not work. Further, it
takes someone to come along and show that
the old approach is no longer valid to shift
the paradigm.1
The current approach to the interceptive treatment
of crowding in the early mixed dentition
(i.e., extracting teeth, rapid maxillary expansion,
space maintenance or observation) is a paradigm
that has remained constant for decades and
continues to be followed, even though it neglects
to address the etiology of the malocclusion and
often yields less-than-ideal results.
As scientists and physicians of the oral cavity,
it is incumbent upon us to break free from the
existing symptom-based paradigm as it relates
to the interceptive treatment of preadolescent
patients. Further, we must shift the paradigm to
one that focuses on diagnosing and proactively
treating the etiology of the malocclusion.
Big teeth vs. small jaws
Dental crowding is one of the most common
issues seen in our preadolescent patients. While
crowding is technically defined as an inconsistency
between tooth size and arch dimension,
that simple definition says nothing about the
etiology of the condition. In other words, is the
crowding the result of teeth that are too big for
the dental arch, or a dental arch that is too small
to accommodate the teeth? Numerous studies
have been published over the past 60 years in
support of the latter.
In 1964, Mills concluded that the etiology of
crowding was most often narrow arches, because
little variation exists between crown diameters
of persons with and without malalignment.2
In
JUNE 2023 |
1981, McKeown reported that arch width and
55
| ORTHOTOWN.COM
http://www.ORTHOTOWN.COM
Orthotown June 2023

Table of Contents for the Digital Edition of Orthotown June 2023
