Practice | Published:

Adults seeking orthodontic treatment: expectations, periodontal and TMD issues

BDJ volume 218, pages 111117 (13 February 2015) | Download Citation

Abstract

The growth in adult orthodontics presents new challenges to both the general dental practitioner and the orthodontist. Although many of the main objectives of orthodontic treatment are similar for adults, young adults and children, adult patients frequently bring significant challenges in several areas not often seen in the younger patient group. In areas such as planning realistic treatment outcomes, it is paramount that the patient's expectations are identified, respected and managed where appropriate. The adult patient's dental health often dictates deviation from the ideal treatment plan and periodontal problems are a common example. Based on current evidence, this paper presents an overview of some of the difficulties in the management of these issues, as well as highlighting developments with regard to pain conditions and their relevance to orthodontic treatment and its effects on temporomandibular joint disorders (TMD) management.

Key points

  • Highlights that treatment planning for adult orthodontic cases is often more complex than for adolescent patients.

  • Suggests that patients should be assessed for TMDs pre-treatment.

  • Points out that TMDs may get worse, better or stay the same, regardless of braces treatment.

  • Highlights that periodontal screening of potential orthodontic patients is necessary before considering treatment.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    , , . Adult orthodontics – who's doing what? J Orthod 2010; 37: 107–117.

  2. 2.

    , , , . JCO Orthodontic Practice Study. Part 1 Trends. J Clin Orthod 2013; 47: 661–680.

  3. 3.

    American Association of Orthodontists. Smiles are in style. New study says adults are seeking orthodontic treatment in record numbers. (accessed January 2015).

  4. 4.

    , , . Assessment of motivation and psychological characteristics of adult orthodontic patients. Am J Orthod Dentofacial Orthop 2011; 140: e263–272.

  5. 5.

    , , . Factors to consider when treatment planning for patients seeking comprehensive aesthetic dental treatment. Dent Update 2013; 40: 526–533.

  6. 6.

    , . Great expectations: what do patients expect and how can expectations be managed? J Orthod 2013; 40: 112–117.

  7. 7.

    , . Body dysmorphic disorder in adult orthodontic patients. Am J Orthod Dentofacial Orthop 2006; 130: 569–574.

  8. 8.

    , , , , , . Body dysmorphic disorder screening in maxillofacial outpatients presenting for orthognathic surgery. Int J Oral Maxillofac Surg 2008; 130: 385–391.

  9. 9.

    Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. Nice Guidelines CG31, Novmber 2005. Clinical Guideline 31 (2005).

  10. 10.

    , , , , . Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res 2012; 91: 914–920.

  11. 11.

    . It's worse than we thought! Am J Orthod Dentofacial Orthop 2013; 143: 155.

  12. 12.

    , , , , . Simplified basic periodontal examination (BPE) in children and adolescents: a guide for general dental practice. Dent Update 2014; 41: 328–377.

  13. 13.

    British Society of Periodontology. Basic Periodontal Examination (BPE). 2011 Online information available at (accessed 27 April 2014).

  14. 14.

    . Oral diagnosis and treatment planning: part 3. Periodontal disease and assessment of risk. Br Dent J 2012; 213: 111–121.

  15. 15.

    , . Lower arch crowding in the third decade. Eur J Orthod 1998; 20: 597–607.

  16. 16.

    , . Orofacial pain management: current perspectives. J Pain Res 2014; 7: 99–115.

  17. 17.

    , . On the management of temporomandibular disorders: a plea for a low-tech, high-prudence therapeutic approach. J Orofac Pain 1999; 13: 255–261.

  18. 18.

    International Association for Dental Research. Policy statement: temporomandibular disorders (TMD) 2010. (accessed 6 April 2014).

  19. 19.

    , , , . Functional imaging of an illusion of pain. Nature 1996; 384: 258–260.

  20. 20.

    , , , , . The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin 2007; 133: 581–624.

  21. 21.

    , . The painful consequences of neonatal nociceptive input. Pain 2010; 150: 220–221.

  22. 22.

    . How do you feel? Interoception: the sense of the physiological condition of the body. Nat Rev Neurosci 2002; 3: 655–666.

  23. 23.

    . A new view of pain as a homeostatic emotion. Trends in Neurosciences 2003; 26: 303–307.

  24. 24.

    , , et al. Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Hum Mol Genet 2005; 14: 135–143.

  25. 25.

    , , , , . Defining comorbidity: implications for understanding health and health services. Ann Fam Med 2009; 7: 357–363.

  26. 26.

    , , , . Pain maps from facial pain patients indicate a broad pain geography. J Dent Res 1998; 77: 1465–1472.

  27. 27.

    , , , . Back pain in relation to musculoskeletal disorders in the jaw-face: a matched case–control study. Pain 2007; 131: 311–319.

  28. 28.

    , , , , , , , , . Influence of psychological factors on risk of temporomandibular disorders. J Dent Res 2007; 86: 1120–1125.

  29. 29.

    . A heuristic approach to the management of muscle-related temporomandibular disorders. Faculty Dent J 2013; 4: 112–117.

  30. 30.

    , . Bruxism is mainly regulated centrally, not peripherally. J Oral Rehabil 2001; 28: 1085–1091.

  31. 31.

    , , . Orthodontics for treating temporomandibular joint (TMJ) disorders. Cochrane Database Syst Rev 2010; CD006541.

  32. 32.

    Orthodontics and the temporomandibular joint: where are we now? Part 1. Orthodontic treatment and temporomandibular disorders. Angle Orthod 1998; 68: 295–304.

  33. 33.

    Orthodontics and the temporomandibular joint: where are we now? Part 2. Functional occlusion, malocclusion, and TMD. Angle Orthod 1998; 68: 305–318.

  34. 34.

    TMD and occlusion part I. Damned if we do? Occlusion: the interface of dentistry and orthodontics [Erratum appears in Br Dent J 2007; 202: 474]. Br Dent J 2007; 202: E2, discussion 38–39.

  35. 35.

    TMD and occlusion part II. Damned if we don't? Functional occlusal problems: TMD epidemiology in a wider context. [Erratum appears in Br Dent J 2007; 202: 474). Br Dent J 2007; 202: E3, discussion 38–39.

  36. 36.

    , , et al. TMD in relation to malocclusion and orthodontic treatment. A systematic review. Angle Orthod 2007; 77: 542–548.

  37. 37.

    , . The role of orthodontics in temporomandibular disorders. J Oral Rehabil 2010; 37: 411–429.

  38. 38.

    , . The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations. J Oral Rehabil 2012; 39: 502–512.

  39. 39.

    British Orthodontic Society Advice Sheet. Temporomandibular disorders (TMDs) and the orthodontic patient. 2012.

  40. 40.

    , , , , , . Developing effective and efficient care pathways in chronic pain: DEEP study protocol. BMC Oral Health 2014; 14: 6. (accessed 11-5-14).

Download references

Author information

Affiliations

  1. Specialist in Orthodontics, 69–71 Banbury Road, Oxford, OX2 6PE

    • L. Christensen
  2. Consultant and Honorary Senior Clinical Lecturer in Orthodontics, Charles Clifford Dental Hospital (Sheffield Teaching Hospitals NHS Foundation Trust), 76 Wellesley Road, Sheffield, S10 2SZ

    • F. Luther

Authors

  1. Search for L. Christensen in:

  2. Search for F. Luther in:

Corresponding author

Correspondence to L. Christensen.

About this article

Publication history

Accepted

Published

DOI

https://doi.org/10.1038/sj.bdj.2015.46

Refereed Paper

Further reading