Approaches to Early Interceptive Orthodontics

Approaches to Early Interceptive Orthodontics

Types of Malocclusions: Overview of common types such as overbite, underbite, and crossbite in pediatric patients.

The importance of early orthodontic intervention in children cannot be overstated, particularly when considering approaches to early interceptive orthodontics. This proactive approach can significantly influence a child's dental health and overall well-being.


First and foremost, early orthodontic intervention can address and correct dental and skeletal irregularities before they become more severe. For instance, issues such as crossbites, overcrowding, and misaligned jaws can be identified and treated during the developmental stages, often leading to simpler and less invasive treatments. By intervening early, orthodontists can guide the growth of the jaw and the eruption of permanent teeth, setting the stage for a healthier smile.


Moreover, early intervention can prevent more complicated problems down the line. Without timely treatment, minor issues can escalate, requiring more extensive and costly orthodontic work in the future. Braces help correct misaligned teeth in children Orthodontics for young children dental braces. By addressing these problems early, we not only save on potential future expenses but also spare children the discomfort and longer treatment times associated with more complex orthodontic procedures.


Another crucial aspect is the psychological benefit to the child. A pleasing smile can boost a child's self-esteem and confidence, which are vital during their formative years. Early orthodontic treatment can help children feel more comfortable in social settings, reducing the likelihood of self-consciousness and bullying related to dental appearance.


In conclusion, the significance of early orthodontic intervention in children lies in its ability to correct dental issues before they worsen, prevent future complications, and enhance a child's psychological well-being. Embracing early interceptive orthodontics is a wise and beneficial approach to ensuring a lifetime of healthy smiles.

Early interceptive orthodontics is a proactive approach aimed at addressing dental issues during a child's developmental years, typically between the ages of 6 and 10. This stage of orthodontic care focuses on guiding the growth and development of the jaw and teeth, preventing more severe problems from developing later on. Some of the most common dental issues that can be effectively managed through early interceptive orthodontics include crowded teeth, protruding teeth, crossbites, and underbites.


Crowded teeth are a frequent concern among young patients. When there is insufficient space in the jaw for all the teeth to align properly, crowding can occur. Early interceptive orthodontics can help by using appliances such as palatal expanders to create more space in the jaw, allowing the teeth to emerge in a more aligned fashion. This intervention can reduce the need for more extensive orthodontic work, such as extractions, in the future.


Protruding teeth, often referred to as buck teeth, can be both a functional and aesthetic concern. When the upper front teeth extend too far forward, they are more susceptible to injury and can affect the way a child bites and chews. Early interceptive orthodontics can address this issue by using braces or other appliances to gradually reposition the teeth into a more favorable alignment.


Crossbites and underbites are other common issues that can be effectively managed through early intervention. A crossbite occurs when the upper teeth fit inside the lower teeth, while an underbite is characterized by the lower teeth protruding in front of the upper teeth. Both conditions can lead to uneven wear on the teeth and jaw pain if left untreated. Early interceptive orthodontics can use a variety of appliances, such as headgear or functional appliances, to guide the jaw into a more harmonious position, correcting these bite issues before they become more severe.


In conclusion, early interceptive orthodontics plays a crucial role in addressing common dental issues during a child's developmental years. By identifying and treating problems such as crowded teeth, protruding teeth, crossbites, and underbites early on, orthodontists can help prevent more serious complications and promote a healthier, more aligned smile for their young patients.

Citations and other links

Early Detection and Diagnosis: The importance of regular dental check-ups for identifying malocclusions in children.

In the field of orthodontics, early interceptive treatment plays a crucial role in addressing dental irregularities before they become more severe. The techniques and appliances used in early interceptive orthodontics are specifically designed to guide the growth and development of the jaws and teeth, aiming to prevent or mitigate potential orthodontic issues.


One of the primary techniques employed in early interceptive orthodontics is the use of space maintainers. These devices are particularly useful when a child loses a primary tooth prematurely. Space maintainers prevent the adjacent teeth from shifting into the vacant space, thereby preserving the necessary space for the permanent tooth to erupt correctly. This simple yet effective technique can significantly reduce the need for more complex orthodontic treatments later on.


Another commonly used appliance in early interceptive orthodontics is the palatal expander. This device is used to widen the upper jaw, which can be particularly beneficial in cases of crossbite or severe crowding. By gently applying pressure on the upper molars, the palatal expander gradually expands the palate, creating more space for the teeth to align properly. This not only improves the aesthetics of the smile but also enhances the functionality of the bite.


In addition to space maintainers and palatal expanders, orthodontists may also utilize headgear to address more complex issues related to jaw growth and tooth alignment. Headgear works by applying external force to the teeth and jaws, helping to correct overbites, underbites, and other discrepancies in jaw development. Although headgear can be more cumbersome for the patient, it is often an essential tool in achieving long-term orthodontic success.


Furthermore, removable appliances such as the bionator or the twin-block appliance are frequently used in early interceptive orthodontics. These devices are designed to guide the growth of the jaws and encourage the proper positioning of the teeth. They are particularly useful in treating Class II malocclusions, where the upper teeth significantly protrude over the lower teeth. By wearing these appliances as directed, patients can see noticeable improvements in their bite and overall facial profile.


In conclusion, the techniques and appliances used in early interceptive orthodontics are vital in addressing orthodontic issues at their earliest stages. From space maintainers to palatal expanders, headgear, and removable appliances, orthodontists have a variety of tools at their disposal to guide the growth and development of the teeth and jaws. By intervening early, these techniques can prevent more severe problems from developing, ultimately leading to healthier smiles and improved oral function.

Orthodontic Treatment Options for Kids: Discussing braces, aligners, and other corrective measures suitable for young patients.

Early orthodontic treatment, often referred to as interceptive orthodontics, is a proactive approach aimed at addressing orthodontic issues in children before they become more severe. This approach has both benefits and limitations that parents and orthodontists must consider to make informed decisions about a child's orthodontic care.


One of the primary benefits of early orthodontic treatment is the potential to prevent more serious problems from developing. By intervening early, orthodontists can guide the growth of the jaw and the alignment of teeth, which can mitigate issues such as overcrowding, misaligned bites, and improper jaw development. This can lead to a reduced need for extensive orthodontic work later in life, potentially saving time and money.


Another advantage is the psychological benefit for children. Addressing orthodontic issues early can boost a child's self-esteem and confidence, as they are less likely to feel self-conscious about their appearance. This can have a positive impact on their social interactions and overall well-being.


However, early orthodontic treatment is not without its limitations. One significant drawback is the unpredictability of a child's growth. Since children are still growing, the outcome of early treatment can be uncertain. Additional orthodontic work may still be required once the child's permanent teeth come in and their jaw fully develops.


The cost of early treatment is another consideration. Since it's an additional phase of orthodontic care, it can increase the overall expense. Parents need to weigh the immediate costs against the potential long-term savings and benefits.


Moreover, not all children will benefit from early treatment. Some orthodontic issues may not be suitable for early intervention, and in such cases, waiting until the child is older might be more effective and cost-efficient. Orthodontists must carefully assess each case to determine if early treatment is appropriate.


In conclusion, the benefits and limitations of early orthodontic treatment must be carefully evaluated. While it offers the potential to prevent more severe issues and enhance a child's confidence, it also comes with uncertainties related to growth and additional costs. Ultimately, the decision to pursue early orthodontic treatment should be made in consultation with a qualified orthodontist who can provide personalized advice based on the child's specific needs.

The Role of Parents in Orthodontic Care: How parents can support their child's orthodontic treatment and encourage good oral habits.

Early interceptive orthodontics focuses on addressing dental and skeletal irregularities in children during their developmental stages, often leading to more effective and less invasive treatments. This approach can significantly influence the growth and alignment of teeth and jaws, preventing more complex issues in adulthood. Examining case studies and examples of successful early interventions provides valuable insights into the effectiveness and benefits of this approach.


One compelling case study involves a young patient, Emma, who was referred to an orthodontist at the age of seven due to a severe anterior crossbite. Early interceptive orthodontics was employed using a removable appliance to correct the crossbite. Over six months, the appliance gently guided Emma's upper front teeth into a proper position, correcting the crossbite and preventing potential issues with jaw growth and tooth wear. This early intervention not only improved Emma's dental alignment but also boosted her confidence, as she no longer felt self-conscious about her smile.


Another example is the case of Liam, a nine-year-old boy with a significant crowding issue due to a narrow upper jaw. His orthodontist recommended early interceptive treatment using a palatal expander to widen his upper jaw. The treatment was successful in creating more space for his permanent teeth to erupt properly, reducing the need for future extractions or more extensive orthodontic work. Liam's case demonstrates how early intervention can effectively manage space and facilitate a healthier dental development.


In both cases, the key to success was the timely intervention during the growth phase, which allowed for more natural corrections and minimized the need for prolonged orthodontic treatment later in life. These examples underscore the importance of early assessment and intervention in orthodontics, highlighting how proactive measures can lead to better outcomes and improved quality of life for young patients.


In conclusion, early interceptive orthodontics offers a proactive approach to dental health, addressing issues at their onset to prevent more severe problems. The success stories of Emma and Liam illustrate the potential of early intervention to correct dental irregularities effectively, emphasizing the value of this approach in pediatric orthodontic care.

Long-term Benefits of Early Orthodontic Intervention: How treating malocclusions in childhood can prevent more serious issues in adulthood.

In the realm of early interceptive orthodontics, the role of parental guidance and cooperation cannot be overstated. This approach to orthodontic treatment, which focuses on addressing dental and skeletal issues during a child's developmental years, relies heavily on the active involvement of parents to achieve successful outcomes.


Early interceptive orthodontics is typically initiated when a child is between the ages of 6 and 10, a period during which the jaw and facial bones are still growing and developing. By intervening at this stage, orthodontists can guide the growth of the jaw, create space for permanent teeth, and address habits like thumb sucking that could lead to more severe orthodontic problems later on. However, the effectiveness of these interventions hinges on the cooperation and support of the child's parents.


Parents play a crucial role in ensuring that their child adheres to the treatment plan. This may involve supervising the use of orthodontic appliances, such as expanders or headgear, and ensuring that they are worn for the prescribed amount of time each day. Parents must also monitor their child's oral hygiene, as maintaining clean teeth and appliances is essential for preventing decay and gum disease during orthodontic treatment.


Moreover, parents serve as a source of motivation and encouragement for their child throughout the treatment process. Early orthodontic interventions can sometimes be challenging for young children, who may feel self-conscious about wearing appliances or experience discomfort. Parents can help by offering praise and rewards for compliance, explaining the importance of the treatment, and providing emotional support when needed.


In addition to their day-to-day involvement, parents also play a vital role in the decision-making process surrounding early interceptive orthodontics. They must work closely with the orthodontist to understand the potential benefits and risks of treatment, as well as the long-term implications for their child's dental health. By being informed and engaged, parents can make the best choices for their child's orthodontic care and ensure that the treatment aligns with their family's values and goals.


In conclusion, parental guidance and cooperation are essential components of early interceptive orthodontics. By working hand-in-hand with the orthodontist and supporting their child through the treatment process, parents can help lay the foundation for a lifetime of healthy smiles. As such, orthodontists must prioritize educating and empowering parents to be active participants in their child's orthodontic journey.

In the rapidly evolving field of orthodontics, early interceptive orthodontics for kids stands at the forefront of innovation and development. This approach, aimed at addressing orthodontic issues in children at an early stage, is witnessing a surge in new trends and developments that promise to enhance its effectiveness and accessibility.


One of the most notable future trends in early interceptive orthodontics is the integration of advanced technology. Digital tools, such as 3D imaging and computer-aided design (CAD), are becoming increasingly prevalent. These technologies allow orthodontists to create precise, personalized treatment plans for young patients. For instance, 3D intraoral scanners can capture detailed images of a child's teeth and jaw, enabling orthodontists to visualize and address issues more accurately than ever before.


Another significant development is the rise of teleorthodontics. This approach leverages digital communication tools to provide remote consultations and monitoring. For families in remote areas or those with busy schedules, teleorthodontics offers a convenient way to access early interceptive treatments. This trend not only improves accessibility but also encourages early intervention by removing geographical and logistical barriers.


In addition to technological advancements, there is a growing emphasis on minimally invasive techniques. The future of early interceptive orthodontics is likely to see an increase in the use of removable appliances and clear aligners specifically designed for children. These devices are less obtrusive and more comfortable for young patients, encouraging better compliance and more successful outcomes.


Moreover, research in the field is expanding our understanding of the genetic and environmental factors that contribute to orthodontic issues. This knowledge is paving the way for more predictive and preventive approaches. For example, genetic screening could help identify children at risk of developing certain orthodontic problems, allowing for earlier and more targeted interventions.


Finally, there is a shift towards a more holistic approach to early interceptive orthodontics. Orthodontists are increasingly working in collaboration with other healthcare professionals, such as pediatric dentists and speech therapists, to address the multifaceted nature of orthodontic issues. This interdisciplinary approach ensures that children receive comprehensive care that considers their overall health and development.


In conclusion, the future of early interceptive orthodontics for kids is bright, marked by technological innovation, increased accessibility, minimally invasive techniques, predictive research, and a holistic approach to care. These trends and developments are set to revolutionize the way we address orthodontic issues in children, making early intervention more effective and beneficial than ever before.

A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW)[1] is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (such as family physician, internist, obstetrician, psychiatrist, radiologist, surgeon etc.), physician assistant, registered dietitian, veterinarian, veterinary technician, optometrist, pharmacist, pharmacy technician, medical assistant, physical therapist, occupational therapist, dentist, midwife, psychologist, audiologist, or healthcare scientist, or who perform services in allied health professions. Experts in public health and community health are also health professionals.

Fields

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NY College of Health Professions massage therapy class
US Navy doctors deliver a healthy baby
70% of global health and social care workers are women, 30% of leaders in the global health sector are women

The healthcare workforce comprises a wide variety of professions and occupations who provide some type of healthcare service, including such direct care practitioners as physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, dentists, pharmacists, speech-language pathologist, physical therapists, occupational therapists, physical and behavior therapists, as well as allied health professionals such as phlebotomists, medical laboratory scientists, dieticians, and social workers. They often work in hospitals, healthcare centers and other service delivery points, but also in academic training, research, and administration. Some provide care and treatment services for patients in private homes. Many countries have a large number of community health workers who work outside formal healthcare institutions. Managers of healthcare services, health information technicians, and other assistive personnel and support workers are also considered a vital part of health care teams.[2]

Healthcare practitioners are commonly grouped into health professions. Within each field of expertise, practitioners are often classified according to skill level and skill specialization. "Health professionals" are highly skilled workers, in professions that usually require extensive knowledge including university-level study leading to the award of a first degree or higher qualification.[3] This category includes physicians, physician assistants, registered nurses, veterinarians, veterinary technicians, veterinary assistants, dentists, midwives, radiographers, pharmacists, physiotherapists, optometrists, operating department practitioners and others. Allied health professionals, also referred to as "health associate professionals" in the International Standard Classification of Occupations, support implementation of health care, treatment and referral plans usually established by medical, nursing, respiratory care, and other health professionals, and usually require formal qualifications to practice their profession. In addition, unlicensed assistive personnel assist with providing health care services as permitted.[citation needed]

Another way to categorize healthcare practitioners is according to the sub-field in which they practice, such as mental health care, pregnancy and childbirth care, surgical care, rehabilitation care, or public health.[citation needed]

Mental health

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A mental health professional is a health worker who offers services to improve the mental health of individuals or treat mental illness. These include psychiatrists, psychiatry physician assistants, clinical, counseling, and school psychologists, occupational therapists, clinical social workers, psychiatric-mental health nurse practitioners, marriage and family therapists, mental health counselors, as well as other health professionals and allied health professions. These health care providers often deal with the same illnesses, disorders, conditions, and issues; however, their scope of practice often differs. The most significant difference across categories of mental health practitioners is education and training.[4] There are many damaging effects to the health care workers. Many have had diverse negative psychological symptoms ranging from emotional trauma to very severe anxiety. Health care workers have not been treated right and because of that their mental, physical, and emotional health has been affected by it. The SAGE author's said that there were 94% of nurses that had experienced at least one PTSD after the traumatic experience. Others have experienced nightmares, flashbacks, and short and long term emotional reactions.[5] The abuse is causing detrimental effects on these health care workers. Violence is causing health care workers to have a negative attitude toward work tasks and patients, and because of that they are "feeling pressured to accept the order, dispense a product, or administer a medication".[6] Sometimes it can range from verbal to sexual to physical harassment, whether the abuser is a patient, patient's families, physician, supervisors, or nurses.[citation needed]

Obstetrics

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A maternal and newborn health practitioner is a health care expert who deals with the care of women and their children before, during and after pregnancy and childbirth. Such health practitioners include obstetricians, physician assistants, midwives, obstetrical nurses and many others. One of the main differences between these professions is in the training and authority to provide surgical services and other life-saving interventions.[7] In some developing countries, traditional birth attendants, or traditional midwives, are the primary source of pregnancy and childbirth care for many women and families, although they are not certified or licensed. According to research, rates for unhappiness among obstetrician-gynecologists (Ob-Gyns) range somewhere between 40 and 75 percent.[8]

Geriatrics

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A geriatric care practitioner plans and coordinates the care of the elderly and/or disabled to promote their health, improve their quality of life, and maintain their independence for as long as possible.[9] They include geriatricians, occupational therapists, physician assistants, adult-gerontology nurse practitioners, clinical nurse specialists, geriatric clinical pharmacists, geriatric nurses, geriatric care managers, geriatric aides, nursing aides, caregivers and others who focus on the health and psychological care needs of older adults.[citation needed]

Surgery

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A surgical practitioner is a healthcare professional and expert who specializes in the planning and delivery of a patient's perioperative care, including during the anaesthetic, surgical and recovery stages. They may include general and specialist surgeons, physician assistants, assistant surgeons, surgical assistants, veterinary surgeons, veterinary technicians. anesthesiologists, anesthesiologist assistants, nurse anesthetists, surgical nurses, clinical officers, operating department practitioners, anaesthetic technicians, perioperative nurses, surgical technologists, and others.[citation needed]

Rehabilitation

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A rehabilitation care practitioner is a health worker who provides care and treatment which aims to enhance and restore functional ability and quality of life to those with physical impairments or disabilities. These include physiatrists, physician assistants, rehabilitation nurses, clinical nurse specialists, nurse practitioners, physiotherapists, chiropractors, orthotists, prosthetists, occupational therapists, recreational therapists, audiologists, speech and language pathologists, respiratory therapists, rehabilitation counsellors, physical rehabilitation therapists, athletic trainers, physiotherapy technicians, orthotic technicians, prosthetic technicians, personal care assistants, and others.[10]

Optometry

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Optometry is a field traditionally associated with the correction of refractive errors using glasses or contact lenses, and treating eye diseases. Optometrists also provide general eye care, including screening exams for glaucoma and diabetic retinopathy and management of routine or eye conditions. Optometrists may also undergo further training in order to specialize in various fields, including glaucoma, medical retina, low vision, or paediatrics. In some countries, such as the United Kingdom, United States, and Canada, Optometrists may also undergo further training in order to be able to perform some surgical procedures.

Diagnostics

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Medical diagnosis providers are health workers responsible for the process of determining which disease or condition explains a person's symptoms and signs. It is most often referred to as diagnosis with the medical context being implicit. This usually involves a team of healthcare providers in various diagnostic units. These include radiographers, radiologists, Sonographers, medical laboratory scientists, pathologists, and related professionals.[citation needed]

Dentistry

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Dental assistant on the right supporting a dental operator on the left, during a procedure.

A dental care practitioner is a health worker and expert who provides care and treatment to promote and restore oral health. These include dentists and dental surgeons, dental assistants, dental auxiliaries, dental hygienists, dental nurses, dental technicians, dental therapists or oral health therapists, and related professionals.

Podiatry

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Care and treatment for the foot, ankle, and lower leg may be delivered by podiatrists, chiropodists, pedorthists, foot health practitioners, podiatric medical assistants, podiatric nurse and others.

Public health

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A public health practitioner focuses on improving health among individuals, families and communities through the prevention and treatment of diseases and injuries, surveillance of cases, and promotion of healthy behaviors. This category includes community and preventive medicine specialists, physician assistants, public health nurses, pharmacist, clinical nurse specialists, dietitians, environmental health officers (public health inspectors), paramedics, epidemiologists, public health dentists, and others.[citation needed]

Alternative medicine

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In many societies, practitioners of alternative medicine have contact with a significant number of people, either as integrated within or remaining outside the formal health care system. These include practitioners in acupuncture, Ayurveda, herbalism, homeopathy, naturopathy, Reiki, Shamballa Reiki energy healing Archived 2021-01-25 at the Wayback Machine, Siddha medicine, traditional Chinese medicine, traditional Korean medicine, Unani, and Yoga. In some countries such as Canada, chiropractors and osteopaths (not to be confused with doctors of osteopathic medicine in the United States) are considered alternative medicine practitioners.

Occupational hazards

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A healthcare professional wears an air sampling device to investigate exposure to airborne influenza
A video describing the Occupational Health and Safety Network, a tool for monitoring occupational hazards to health care workers

The healthcare workforce faces unique health and safety challenges and is recognized by the National Institute for Occupational Safety and Health (NIOSH) as a priority industry sector in the National Occupational Research Agenda (NORA) to identify and provide intervention strategies regarding occupational health and safety issues.[11]

Biological hazards

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Exposure to respiratory infectious diseases like tuberculosis (caused by Mycobacterium tuberculosis) and influenza can be reduced with the use of respirators; this exposure is a significant occupational hazard for health care professionals.[12] Healthcare workers are also at risk for diseases that are contracted through extended contact with a patient, including scabies.[13] Health professionals are also at risk for contracting blood-borne diseases like hepatitis B, hepatitis C, and HIV/AIDS through needlestick injuries or contact with bodily fluids.[14][15] This risk can be mitigated with vaccination when there is a vaccine available, like with hepatitis B.[15] In epidemic situations, such as the 2014-2016 West African Ebola virus epidemic or the 2003 SARS outbreak, healthcare workers are at even greater risk, and were disproportionately affected in both the Ebola and SARS outbreaks.[16]

In general, appropriate personal protective equipment (PPE) is the first-line mode of protection for healthcare workers from infectious diseases. For it to be effective against highly contagious diseases, personal protective equipment must be watertight and prevent the skin and mucous membranes from contacting infectious material. Different levels of personal protective equipment created to unique standards are used in situations where the risk of infection is different. Practices such as triple gloving and multiple respirators do not provide a higher level of protection and present a burden to the worker, who is additionally at increased risk of exposure when removing the PPE. Compliance with appropriate personal protective equipment rules may be difficult in certain situations, such as tropical environments or low-resource settings. A 2020 Cochrane systematic review found low-quality evidence that using more breathable fabric in PPE, double gloving, and active training reduce the risk of contamination but that more randomized controlled trials are needed for how best to train healthcare workers in proper PPE use.[16]

Tuberculosis screening, testing, and education

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Based on recommendations from The United States Center for Disease Control and Prevention (CDC) for TB screening and testing the following best practices should be followed when hiring and employing Health Care Personnel.[17]

When hiring Health Care Personnel, the applicant should complete the following:[18] a TB risk assessment,[19] a TB symptom evaluation for at least those listed on the Signs & Symptoms page,[20] a TB test in accordance with the guidelines for Testing for TB Infection,[21] and additional evaluation for TB disease as needed (e.g. chest x-ray for HCP with a positive TB test)[18] The CDC recommends either a blood test, also known as an interferon-gamma release assay (IGRA), or a skin test, also known as a Mantoux tuberculin skin test (TST).[21] A TB blood test for baseline testing does not require two-step testing. If the skin test method is used to test HCP upon hire, then two-step testing should be used. A one-step test is not recommended.[18]

The CDC has outlined further specifics on recommended testing for several scenarios.[22] In summary:

  1. Previous documented positive skin test (TST) then a further TST is not recommended
  2. Previous documented negative TST within 12 months before employment OR at least two documented negative TSTs ever then a single TST is recommended
  3. All other scenarios, with the exception of programs using blood tests, the recommended testing is a two-step TST

According to these recommended testing guidelines any two negative TST results within 12 months of each other constitute a two-step TST.

For annual screening, testing, and education, the only recurring requirement for all HCP is to receive TB education annually.[18] While the CDC offers education materials, there is not a well defined requirement as to what constitutes a satisfactory annual education. Annual TB testing is no longer recommended unless there is a known exposure or ongoing transmission at a healthcare facility. Should an HCP be considered at increased occupational risk for TB annual screening may be considered. For HCP with a documented history of a positive TB test result do not need to be re-tested but should instead complete a TB symptom evaluation. It is assumed that any HCP who has undergone a chest x-ray test has had a previous positive test result. When considering mental health you may see your doctor to be evaluated at your digression. It is recommended to see someone at least once a year in order to make sure that there has not been any sudden changes.[23]

Psychosocial hazards

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Occupational stress and occupational burnout are highly prevalent among health professionals.[24] Some studies suggest that workplace stress is pervasive in the health care industry because of inadequate staffing levels, long work hours, exposure to infectious diseases and hazardous substances leading to illness or death, and in some countries threat of malpractice litigation. Other stressors include the emotional labor of caring for ill people and high patient loads. The consequences of this stress can include substance abuse, suicide, major depressive disorder, and anxiety, all of which occur at higher rates in health professionals than the general working population. Elevated levels of stress are also linked to high rates of burnout, absenteeism and diagnostic errors, and reduced rates of patient satisfaction.[25] In Canada, a national report (Canada's Health Care Providers) also indicated higher rates of absenteeism due to illness or disability among health care workers compared to the rest of the working population, although those working in health care reported similar levels of good health and fewer reports of being injured at work.[26]

There is some evidence that cognitive-behavioral therapy, relaxation training and therapy (including meditation and massage), and modifying schedules can reduce stress and burnout among multiple sectors of health care providers. Research is ongoing in this area, especially with regards to physicians, whose occupational stress and burnout is less researched compared to other health professions.[27]

Healthcare workers are at higher risk of on-the-job injury due to violence. Drunk, confused, and hostile patients and visitors are a continual threat to providers attempting to treat patients. Frequently, assault and violence in a healthcare setting goes unreported and is wrongly assumed to be part of the job.[28] Violent incidents typically occur during one-on-one care; being alone with patients increases healthcare workers' risk of assault.[29] In the United States, healthcare workers experience 23 of nonfatal workplace violence incidents.[28] Psychiatric units represent the highest proportion of violent incidents, at 40%; they are followed by geriatric units (20%) and the emergency department (10%). Workplace violence can also cause psychological trauma.[29]

Health care professionals are also likely to experience sleep deprivation due to their jobs. Many health care professionals are on a shift work schedule, and therefore experience misalignment of their work schedule and their circadian rhythm. In 2007, 32% of healthcare workers were found to get fewer than 6 hours of sleep a night. Sleep deprivation also predisposes healthcare professionals to make mistakes that may potentially endanger a patient.[30]

COVID pandemic

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Especially in times like the present (2020), the hazards of health professional stem into the mental health. Research from the last few months highlights that COVID-19 has contributed greatly  to the degradation of mental health in healthcare providers. This includes, but is not limited to, anxiety, depression/burnout, and insomnia.[citation needed]

A study done by Di Mattei et al. (2020) revealed that 12.63% of COVID nurses and 16.28% of other COVID healthcare workers reported extremely severe anxiety symptoms at the peak of the pandemic.[31] In addition, another study was conducted on 1,448 full time employees in Japan. The participants were surveyed at baseline in March 2020 and then again in May 2020. The result of the study showed that psychological distress and anxiety had increased more among healthcare workers during the COVID-19 outbreak.[32]

Similarly, studies have also shown that following the pandemic, at least one in five healthcare professionals report symptoms of anxiety.[33] Specifically, the aspect of "anxiety was assessed in 12 studies, with a pooled prevalence of 23.2%" following COVID.[33] When considering all 1,448 participants that percentage makes up about 335 people.

Abuse by patients

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  • The patients are selecting victims who are more vulnerable. For example, Cho said that these would be the nurses that are lacking experience or trying to get used to their new roles at work.[34]
  • Others authors that agree with this are Vento, Cainelli, & Vallone and they said that, the reason patients have caused danger to health care workers is because of insufficient communication between them, long waiting lines, and overcrowding in waiting areas.[35] When patients are intrusive and/or violent toward the faculty, this makes the staff question what they should do about taking care of a patient.
  • There have been many incidents from patients that have really caused some health care workers to be traumatized and have so much self doubt. Goldblatt and other authors  said that there was a lady who was giving birth, her husband said, "Who is in charge around here"? "Who are these sluts you employ here".[5]  This was very avoidable to have been said to the people who are taking care of your wife and child.

Physical and chemical hazards

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Slips, trips, and falls are the second-most common cause of worker's compensation claims in the US and cause 21% of work absences due to injury. These injuries most commonly result in strains and sprains; women, those older than 45, and those who have been working less than a year in a healthcare setting are at the highest risk.[36]

An epidemiological study published in 2018 examined the hearing status of noise-exposed health care and social assistance (HSA) workers sector to estimate and compare the prevalence of hearing loss by subsector within the sector. Most of the HSA subsector prevalence estimates ranged from 14% to 18%, but the Medical and Diagnostic Laboratories subsector had 31% prevalence and the Offices of All Other Miscellaneous Health Practitioners had a 24% prevalence. The Child Day Care Services subsector also had a 52% higher risk than the reference industry.[37]

Exposure to hazardous drugs, including those for chemotherapy, is another potential occupational risk. These drugs can cause cancer and other health conditions.[38]

Gender factors

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Female health care workers may face specific types of workplace-related health conditions and stress. According to the World Health Organization, women predominate in the formal health workforce in many countries and are prone to musculoskeletal injury (caused by physically demanding job tasks such as lifting and moving patients) and burnout. Female health workers are exposed to hazardous drugs and chemicals in the workplace which may cause adverse reproductive outcomes such as spontaneous abortion and congenital malformations. In some contexts, female health workers are also subject to gender-based violence from coworkers and patients.[39][40]

 

Workforce shortages

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Many jurisdictions report shortfalls in the number of trained health human resources to meet population health needs and/or service delivery targets, especially in medically underserved areas. For example, in the United States, the 2010 federal budget invested $330 million to increase the number of physicians, physician assistants, nurse practitioners, nurses, and dentists practicing in areas of the country experiencing shortages of trained health professionals. The Budget expands loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas. This funding will enhance the capacity of nursing schools to increase the number of nurses. It will also allow states to increase access to oral health care through dental workforce development grants. The Budget's new resources will sustain the expansion of the health care workforce funded in the Recovery Act.[41] There were 15.7 million health care professionals in the US as of 2011.[36]

In Canada, the 2011 federal budget announced a Canada Student Loan forgiveness program to encourage and support new family physicians, physician assistants, nurse practitioners and nurses to practice in underserved rural or remote communities of the country, including communities that provide health services to First Nations and Inuit populations.[42]

In Uganda, the Ministry of Health reports that as many as 50% of staffing positions for health workers in rural and underserved areas remain vacant. As of early 2011, the Ministry was conducting research and costing analyses to determine the most appropriate attraction and retention packages for medical officers, nursing officers, pharmacists, and laboratory technicians in the country's rural areas.[43]

At the international level, the World Health Organization estimates a shortage of almost 4.3 million doctors, midwives, nurses, and support workers worldwide to meet target coverage levels of essential primary health care interventions.[44] The shortage is reported most severe in 57 of the poorest countries, especially in sub-Saharan Africa.

Nurses are the most common type of medical field worker to face shortages around the world. There are numerous reasons that the nursing shortage occurs globally. Some include: inadequate pay, a large percentage of working nurses are over the age of 45 and are nearing retirement age, burnout, and lack of recognition.[45]

Incentive programs have been put in place to aid in the deficit of pharmacists and pharmacy students. The reason for the shortage of pharmacy students is unknown but one can infer that it is due to the level of difficulty in the program.[46]

Results of nursing staff shortages can cause unsafe staffing levels that lead to poor patient care. Five or more incidents that occur per day in a hospital setting as a result of nurses who do not receive adequate rest or meal breaks is a common issue.[47]

Regulation and registration

[edit]

Practicing without a license that is valid and current is typically illegal. In most jurisdictions, the provision of health care services is regulated by the government. Individuals found to be providing medical, nursing or other professional services without the appropriate certification or license may face sanctions and criminal charges leading to a prison term. The number of professions subject to regulation, requisites for individuals to receive professional licensure, and nature of sanctions that can be imposed for failure to comply vary across jurisdictions.

In the United States, under Michigan state laws, an individual is guilty of a felony if identified as practicing in the health profession without a valid personal license or registration. Health professionals can also be imprisoned if found guilty of practicing beyond the limits allowed by their licenses and registration. The state laws define the scope of practice for medicine, nursing, and a number of allied health professions.[48][unreliable source?] In Florida, practicing medicine without the appropriate license is a crime classified as a third degree felony,[49] which may give imprisonment up to five years. Practicing a health care profession without a license which results in serious bodily injury classifies as a second degree felony,[49] providing up to 15 years' imprisonment.

In the United Kingdom, healthcare professionals are regulated by the state; the UK Health and Care Professions Council (HCPC) protects the 'title' of each profession it regulates. For example, it is illegal for someone to call himself an Occupational Therapist or Radiographer if they are not on the register held by the HCPC.

See also

[edit]
  • List of healthcare occupations
  • Community health center
  • Chronic care management
  • Electronic superbill
  • Geriatric care management
  • Health human resources
  • Uniform Emergency Volunteer Health Practitioners Act

References

[edit]
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  3. ^ "Classifying health workers" (PDF). World Health Organization. Geneva. 2010. Archived (PDF) from the original on 2015-08-16. Retrieved 2016-02-13.
  4. ^ "Difference Between Psychologists and Psychiatrists". Psychology.about.com. 2007. Archived from the original on April 3, 2007. Retrieved March 4, 2007.
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  11. ^ "National Occupational Research Agenda for Healthcare and Social Assistance | NIOSH | CDC". www.cdc.gov. 2019-02-15. Retrieved 2019-03-14.
  12. ^ Bergman, Michael; Zhuang, Ziqing; Shaffer, Ronald E. (25 July 2013). "Advanced Headforms for Evaluating Respirator Fit". National Institute for Occupational Safety and Health. Archived from the original on 16 January 2015. Retrieved 18 January 2015.
  13. ^ FitzGerald, Deirdre; Grainger, Rachel J.; Reid, Alex (2014). "Interventions for preventing the spread of infestation in close contacts of people with scabies". The Cochrane Database of Systematic Reviews. 2014 (2): CD009943. doi:10.1002/14651858.CD009943.pub2. ISSN 1469-493X. PMC 10819104. PMID 24566946.
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  15. ^ a b Reddy, Viraj K; Lavoie, Marie-Claude; Verbeek, Jos H; Pahwa, Manisha (14 November 2017). "Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel". Cochrane Database of Systematic Reviews. 2017 (11): CD009740. doi:10.1002/14651858.CD009740.pub3. PMC 6491125. PMID 29190036.
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  18. ^ a b c d "Testing Health Care Workers | Testing & Diagnosis | TB | CDC". www.cdc.gov. March 8, 2021.
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  21. ^ a b "Testing for TB Infection | Testing & Diagnosis | TB | CDC". www.cdc.gov. March 8, 2021.
  22. ^ "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005". www.cdc.gov.
  23. ^ Spoorthy, Mamidipalli Sai; Pratapa, Sree Karthik; Mahant, Supriya (June 2020). "Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review". Asian Journal of Psychiatry. 51: 102119. doi:10.1016/j.ajp.2020.102119. PMC 7175897. PMID 32339895.
  24. ^ Ruotsalainen, Jani H.; Verbeek, Jos H.; Mariné, Albert; Serra, Consol (2015-04-07). "Preventing occupational stress in healthcare workers". The Cochrane Database of Systematic Reviews. 2015 (4): CD002892. doi:10.1002/14651858.CD002892.pub5. ISSN 1469-493X. PMC 6718215. PMID 25847433.
  25. ^ "Exposure to Stress: Occupational Hazards in Hospitals". NIOSH Publication No. 2008–136 (July 2008). 2 December 2008. doi:10.26616/NIOSHPUB2008136. Archived from the original on 12 December 2008.
  26. ^ Canada's Health Care Providers, 2007 (Report). Ottawa: Canadian Institute for Health Information. 2007. Archived from the original on 2011-09-27.
  27. ^ Ruotsalainen, JH; Verbeek, JH; Mariné, A; Serra, C (7 April 2015). "Preventing occupational stress in healthcare workers". The Cochrane Database of Systematic Reviews. 2015 (4): CD002892. doi:10.1002/14651858.CD002892.pub5. PMC 6718215. PMID 25847433.
  28. ^ a b Hartley, Dan; Ridenour, Marilyn (12 August 2013). "Free On-line Violence Prevention Training for Nurses". National Institute for Occupational Safety and Health. Archived from the original on 16 January 2015. Retrieved 15 January 2015.
  29. ^ a b Hartley, Dan; Ridenour, Marilyn (September 13, 2011). "Workplace Violence in the Healthcare Setting". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on February 8, 2014.
  30. ^ Caruso, Claire C. (August 2, 2012). "Running on Empty: Fatigue and Healthcare Professionals". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on May 11, 2013.
  31. ^ Di Mattei, Valentina; Perego, Gaia; Milano, Francesca; Mazzetti, Martina; Taranto, Paola; Di Pierro, Rossella; De Panfilis, Chiara; Madeddu, Fabio; Preti, Emanuele (2021-05-15). "The "Healthcare Workers' Wellbeing (Benessere Operatori)" Project: A Picture of the Mental Health Conditions of Italian Healthcare Workers during the First Wave of the COVID-19 Pandemic". International Journal of Environmental Research and Public Health. 18 (10): 5267. doi:10.3390/ijerph18105267. ISSN 1660-4601. PMC 8156728. PMID 34063421.
  32. ^ Sasaki, Natsu; Kuroda, Reiko; Tsuno, Kanami; Kawakami, Norito (2020-11-01). "The deterioration of mental health among healthcare workers during the COVID-19 outbreak: A population-based cohort study of workers in Japan". Scandinavian Journal of Work, Environment & Health. 46 (6): 639–644. doi:10.5271/sjweh.3922. ISSN 0355-3140. PMC 7737801. PMID 32905601.
  33. ^ a b Pappa, Sofia; Ntella, Vasiliki; Giannakas, Timoleon; Giannakoulis, Vassilis G.; Papoutsi, Eleni; Katsaounou, Paraskevi (August 2020). "Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis". Brain, Behavior, and Immunity. 88: 901–907. doi:10.1016/j.bbi.2020.05.026. PMC 7206431. PMID 32437915.
  34. ^ Cho, Hyeonmi; Pavek, Katie; Steege, Linsey (2020-07-22). "Workplace verbal abuse, nurse-reported quality of care and patient safety outcomes among early-career hospital nurses". Journal of Nursing Management. 28 (6): 1250–1258. doi:10.1111/jonm.13071. ISSN 0966-0429. PMID 32564407. S2CID 219972442.
  35. ^ Vento, Sandro; Cainelli, Francesca; Vallone, Alfredo (2020-09-18). "Violence Against Healthcare Workers: A Worldwide Phenomenon With Serious Consequences". Frontiers in Public Health. 8: 570459. doi:10.3389/fpubh.2020.570459. ISSN 2296-2565. PMC 7531183. PMID 33072706.
  36. ^ a b Collins, James W.; Bell, Jennifer L. (June 11, 2012). "Slipping, Tripping, and Falling at Work". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on December 3, 2012.
  37. ^ Masterson, Elizabeth A.; Themann, Christa L.; Calvert, Geoffrey M. (2018-04-15). "Prevalence of Hearing Loss Among Noise-Exposed Workers Within the Health Care and Social Assistance Sector, 2003 to 2012". Journal of Occupational and Environmental Medicine. 60 (4): 350–356. doi:10.1097/JOM.0000000000001214. ISSN 1076-2752. PMID 29111986. S2CID 4637417.
  38. ^ Connor, Thomas H. (March 7, 2011). "Hazardous Drugs in Healthcare". NIOSH: Workplace Safety and Health. Medscape and NIOSH. Archived from the original on March 7, 2012.
  39. ^ World Health Organization. Women and health: today's evidence, tomorrow's agenda. Archived 2012-12-25 at the Wayback Machine Geneva, 2009. Retrieved on March 9, 2011.
  40. ^ Swanson, Naomi; Tisdale-Pardi, Julie; MacDonald, Leslie; Tiesman, Hope M. (13 May 2013). "Women's Health at Work". National Institute for Occupational Safety and Health. Archived from the original on 18 January 2015. Retrieved 21 January 2015.
  41. ^ "Archived copy" (PDF). Office of Management and Budget. Retrieved 2009-03-06 – via National Archives.
  42. ^ Government of Canada. 2011. Canada's Economic Action Plan: Forgiving Loans for New Doctors and Nurses in Under-Served Rural and Remote Areas. Ottawa, 22 March 2011. Retrieved 23 March 2011.
  43. ^ Rockers P et al. Determining Priority Retention Packages to Attract and Retain Health Workers in Rural and Remote Areas in Uganda. Archived 2011-05-23 at the Wayback Machine CapacityPlus Project. February 2011.
  44. ^ "The World Health Report 2006 - Working together for health". Geneva: WHO: World Health Organization. 2006. Archived from the original on 2011-02-28.
  45. ^ Mefoh, Philip Chukwuemeka; Ude, Eze Nsi; Chukwuorji, JohBosco Chika (2019-01-02). "Age and burnout syndrome in nursing professionals: moderating role of emotion-focused coping". Psychology, Health & Medicine. 24 (1): 101–107. doi:10.1080/13548506.2018.1502457. ISSN 1354-8506. PMID 30095287. S2CID 51954488.
  46. ^ Traynor, Kate (2003-09-15). "Staffing shortages plague nation's pharmacy schools". American Journal of Health-System Pharmacy. 60 (18): 1822–1824. doi:10.1093/ajhp/60.18.1822. ISSN 1079-2082. PMID 14521029.
  47. ^ Leslie, G. D. (October 2008). "Critical Staffing shortage". Australian Nursing Journal. 16 (4): 16–17. doi:10.1016/s1036-7314(05)80033-5. ISSN 1036-7314. PMID 14692155.
  48. ^ wiki.bmezine.com --> Practicing Medicine. In turn citing Michigan laws
  49. ^ a b CHAPTER 2004-256 Committee Substitute for Senate Bill No. 1118 Archived 2011-07-23 at the Wayback Machine State of Florida, Department of State.
[edit]
  • World Health Organization: Health workers

 

Malocclusion
Malocclusion in 10-year-old girl
Specialty Dentistry Edit this on Wikidata

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864;[1] Edward Angle (1855–1930), the "father of modern orthodontics",[2][3][need quotation to verify] popularised it. The word derives from mal- 'incorrect' and occlusion 'the manner in which opposing teeth meet'.

The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.  If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal.[4] However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definition of malocclusion, then treatment may not be necessary. It is estimated that nearly 30% of the population have malocclusions that are categorised as severe and definitely benefit from orthodontic treatment.[5]

Causes

[edit]

The aetiology of malocclusion is somewhat contentious, however, simply put it is multifactorial, with influences being both genetic[6][unreliable source?] and environmental.[7] Malocclusion is already present in one of the Skhul and Qafzeh hominin fossils and other prehistoric human skulls.[8][9] There are three generally accepted causative factors of malocclusion:

  • Skeletal factors – the size, shape and relative positions of the upper and lower jaws. Variations can be caused by environmental or behavioral factors such as muscles of mastication, nocturnal mouth breathing, and cleft lip and cleft palate.
  • Muscle factors – the form and function of the muscles that surround the teeth.  This could be impacted by habits such as finger sucking, nail biting, pacifier and tongue thrusting[10]
  • Dental factors – size of the teeth in relation to the jaw, early loss of teeth could result in spacing or mesial migration causing crowding, abnormal eruption path or timings, extra teeth (supernumeraries), or too few teeth (hypodontia)

There is not one single cause of malocclusion, and when planning orthodontic treatment it is often helpful to consider the above factors and the impact they have played on malocclusion. These can also be influenced by oral habits and pressure resulting in malocclusion.[11][12]

Behavioral and dental factors

[edit]

In the active skeletal growth,[13] mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches.[14][15][16][17][18] Pacifier sucking habits are also correlated with otitis media.[19][20] Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions.

Primary vs. secondary dentition

[edit]

Malocclusion can occur in primary and secondary dentition.

In primary dentition malocclusion is caused by:

  • Underdevelopment of the dentoalvelor tissue.
  • Over development of bones around the mouth.
  • Cleft lip and palate.
  • Overcrowding of teeth.
  • Abnormal development and growth of teeth.

In secondary dentition malocclusion is caused by:

  • Periodontal disease.
  • Overeruption of teeth.[21]
  • Premature and congenital loss of missing teeth.

Signs and symptoms

[edit]

Malocclusion is a common finding,[22][23] although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of craniofacial anomalies, may require orthodontic and sometimes surgical treatment (orthognathic surgery) to correct the problem.

The ultimate goal of orthodontic treatment is to achieve a stable, functional and aesthetic alignment of teeth which serves to better the patient's dental and total health.[24] The symptoms which arise as a result of malocclusion derive from a deficiency in one or more of these categories.[25]

The symptoms are as follows:

  • Tooth decay (caries): misaligned teeth will make it more difficult to maintain oral hygiene. Children with poor oral hygiene and diet will be at an increased risk.
  • Periodontal disease: irregular teeth would hinder the ability to clean teeth meaning poor plaque control. Additionally, if teeth are crowded, some may be more buccally or lingually placed, there will be reduced bone and periodontal support. Furthermore, in Class III malocclusions, mandibular anterior teeth are pushed labially which contributes to gingival recession and weakens periodontal support.
  • Trauma to anterior teeth: Those with an increased overjet are at an increased risk of trauma. A systematic review found that an overjet of greater than 3mm will double the risk of trauma.
  • Masticatory function: people with anterior open bites, large increased & reverse overjet and hypodontia will find it more difficult to chew food.
  • Speech impairment: a lisp is when the incisors cannot make contact, orthodontics can treat this. However, other forms of misaligned teeth will have little impact on speech and orthodontic treatment has little effect on fixing any problems.  
  • Tooth impaction: these can cause resorption of adjacent teeth and other pathologies for example a dentigerous cyst formation.  
  • Psychosocial wellbeing: malocclusions of teeth with poor aesthetics can have a significant effect on self-esteem.

Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. Such skeletal disharmonies often distort sufferer's face shape, severely affect aesthetics of the face, and may be coupled with mastication or speech problems. Most skeletal malocclusions can only be treated by orthognathic surgery.[citation needed]

Classification

[edit]

Depending on the sagittal relations of teeth and jaws, malocclusions can be divided mainly into three types according to Angle's classification system published 1899. However, there are also other conditions, e.g. crowding of teeth, not directly fitting into this classification.

Many authors have tried to modify or replace Angle's classification. This has resulted in many subtypes and new systems (see section below: Review of Angle's system of classes).

A deep bite (also known as a Type II Malocclusion) is a condition in which the upper teeth overlap the lower teeth, which can result in hard and soft tissue trauma, in addition to an effect on appearance.[26] It has been found to occur in 15–20% of the US population.[27]

An open bite is a condition characterised by a complete lack of overlap and occlusion between the upper and lower incisors.[28] In children, open bite can be caused by prolonged thumb sucking.[29] Patients often present with impaired speech and mastication.[30]

Overbites

[edit]

This is a vertical measurement of the degree of overlap between the maxillary incisors and the mandibular incisors. There are three features that are analysed in the classification of an overbite:

  • Degree of overlap: edge to edge, reduced, average, increased
  • Complete or incomplete: whether there is contact between the lower teeth and the opposing teeth/tissue (hard palate or gingivae) or not.
  • Whether contact is traumatic or atraumatic

An average overbite is when the upper anterior teeth cover a third of the lower teeth. Covering less than this is described as ‘reduced’ and more than this is an ‘increased’ overbite. No overlap or contact is considered an ‘anterior open bite’.[25][31][32]

Angle's classification method

[edit]
Class I with severe crowding and labially erupted canines
Class II molar relationship

Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar.[33] According to Angle, the mesiobuccal cusp of the upper first molar should align with the buccal groove of the mandibular first molar. The teeth should all fit on a line of occlusion which, in the upper arch, is a smooth curve through the central fossae of the posterior teeth and cingulum of the canines and incisors, and in the lower arch, is a smooth curve through the buccal cusps of the posterior teeth and incisal edges of the anterior teeth. Any variations from this resulted in malocclusion types. It is also possible to have different classes of malocclusion on left and right sides.

  • Class I (Neutrocclusion): Here the molar relationship of the occlusion is normal but the incorrect line of occlusion or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.
  • Class II (Distocclusion (retrognathism, overjet, overbite)): In this situation, the mesiobuccal cusp of the upper first molar is not aligned with the mesiobuccal groove of the lower first molar. Instead it is anterior to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:
    • Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.
    • Class II Division 2: The molar relationships are Class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.
  • Class III: (Mesiocclusion (prognathism, anterior crossbite, negative overjet, underbite)) In this case the upper molars are placed not in the mesiobuccal groove but posteriorly to it. The mesiobuccal cusp of the maxillary first molar lies posteriorly to the mesiobuccal groove of the mandibular first molar. Usually seen as when the lower front teeth are more prominent than the upper front teeth. In this case the patient very often has a large mandible or a short maxillary bone.

Review of Angle's system of classes and alternative systems

[edit]

A major disadvantage of Angle's system of classifying malocclusions is that it only considers two dimensions along a spatial axis in the sagittal plane in the terminal occlusion, but occlusion problems can be three-dimensional. It does not recognise deviations in other spatial axes, asymmetric deviations, functional faults and other therapy-related features.

Angle's classification system also lacks a theoretical basis; it is purely descriptive. Its much-discussed weaknesses include that it only considers static occlusion, it does not account for the development and causes (aetiology) of occlusion problems, and it disregards the proportions (or relationships in general) of teeth and face.[34] Thus, many attempts have been made to modify the Angle system or to replace it completely with a more efficient one,[35] but Angle's classification continues be popular mainly because of its simplicity and clarity.[citation needed]

Well-known modifications to Angle's classification date back to Martin Dewey (1915) and Benno Lischer (1912, 1933). Alternative systems have been suggested by, among others, Simon (1930, the first three-dimensional classification system), Jacob A. Salzmann (1950, with a classification system based on skeletal structures) and James L. Ackerman and William R. Proffit (1969).[36]

Incisor classification

[edit]

Besides the molar relationship, the British Standards Institute Classification also classifies malocclusion into incisor relationship and canine relationship.

  • Class I: The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors
  • Class II: The lower incisor edges lie posterior to the cingulum plateau of the upper incisors
    • Division 1 – the upper central incisors are proclined or of average inclination and there is an increase in overjet
    • Division 2 – The upper central incisors are retroclined. The overjet is usually minimal or may be increased.
  • Class III: The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The overjet is reduced or reversed.

Canine relationship by Ricketts

[edit]
  • Class I: Mesial slope of upper canine coincides with distal slope of lower canine
  • Class II: Mesial slope of upper canine is ahead of distal slope of lower canine
  • Class III: Mesial slope of upper canine is behind to distal slope of lower canine

Crowding of teeth

[edit]

Dental crowding is defined by the amount of space that would be required for the teeth to be in correct alignment. It is obtained in two ways: 1) by measuring the amount of space required and reducing this from calculating the space available via the width of the teeth, or 2) by measuring the degree of overlap of the teeth.

The following criterion is used:[25]

  • 0-4mm = Mild crowding
  • 4-8mm = Moderate crowding
  • >8mm = Severe crowding

Causes

[edit]

Genetic (inheritance) factors, extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth have been cited as causes of crowding. Ill-fitting dental fillings, crowns, appliances, retainers, or braces as well as misalignment of jaw fractures after a severe injury are also known to cause crowding.[26] Tumors of the mouth and jaw, thumb sucking, tongue thrusting, pacifier use beyond age three, and prolonged use of a bottle have also been identified.[26]

Lack of masticatory stress during development can cause tooth overcrowding.[37][38] Children who chewed a hard resinous gum for two hours a day showed increased facial growth.[37] Experiments in animals have shown similar results. In an experiment on two groups of rock hyraxes fed hardened or softened versions of the same foods, the animals fed softer food had significantly narrower and shorter faces and thinner and shorter mandibles than animals fed hard food.[37][39][failed verification]

A 2016 review found that breastfeeding lowers the incidence of malocclusions developing later on in developing infants.[40]

During the transition to agriculture, the shape of the human mandible went through a series of changes. The mandible underwent a complex shape changes not matched by the teeth, leading to incongruity between the dental and mandibular form. These changes in human skulls may have been "driven by the decreasing bite forces required to chew the processed foods eaten once humans switched to growing different types of cereals, milking and herding animals about 10,000 years ago."[38][41]

Treatment

[edit]

Orthodontic management of the condition includes dental braces, lingual braces, clear aligners or palatal expanders.[42] Other treatments include the removal of one or more teeth and the repair of injured teeth. In some cases, surgery may be necessary.[43]

Treatment

[edit]

Malocclusion is often treated with orthodontics,[42] such as tooth extraction, clear aligners, or dental braces,[44] followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgical intervention is used only in rare occasions. This may include surgical reshaping to lengthen or shorten the jaw. Wires, plates, or screws may be used to secure the jaw bone, in a manner like the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth with most problems being minor that do not require treatment.[37]

Crowding

[edit]

Crowding of the teeth is treated with orthodontics, often with tooth extraction, clear aligners, or dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults. Surgery may be required on rare occasions. This may include surgical reshaping to lengthen or shorten the jaw (orthognathic surgery). Wires, plates, or screws may be used to secure the jaw bone, in a manner similar to the surgical stabilization of jaw fractures. Very few people have "perfect" alignment of their teeth. However, most problems are very minor and do not require treatment.[39]

Class I

[edit]

While treatment is not crucial in class I malocclusions, in severe cases of crowding can be an indication for intervention. Studies indicate that tooth extraction can have benefits to correcting malocclusion in individuals.[45][46] Further research is needed as reoccurring crowding has been examined in other clinical trials.[45][47]

Class II

[edit]

A few treatment options for class II malocclusions include:

  1. Functional appliance which maintains the mandible in a postured position to influence both the orofacial musculature and dentoalveolar development prior to fixed appliance therapy. This is ideally done through pubertal growth in pre-adolescent children and the fixed appliance during permanent dentition .[48] Different types of removable appliances include Activator, Bionatar, Medium opening activator, Herbst, Frankel and twin block appliance with the twin block being the most widely used one.[49]
  2. Growth modification through headgear to redirect maxillary growth
  3. Orthodontic camouflage so that jaw discrepancy no longer apparent
  4. Orthognathic surgery – sagittal split osteotomy mandibular advancement carried out when growth is complete where skeletal discrepancy is severe in anterior-posterior relationship or in vertical direction. Fixed appliance is required before, during and after surgery.
  5. Upper Removable Appliance – limited role in contemporary treatment of increased overjets. Mostly used for very mild Class II, overjet due to incisor proclination, favourable overbite.

Class II Division 1

[edit]

Low- to moderate- quality evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth (class II division 1) is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence.[50] There do not appear to be any other advantages of providing early treatment when compared to late treatment.[50] Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances is effective for reducing the prominence of upper front teeth.[50]

Class II Division 2

[edit]

Treatment can be undertaken using orthodontic treatments using dental braces.[51] While treatment is carried out, there is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment in children.[51] A 2018 Cochrane systematic review anticipated that the evidence base supporting treatment approaches is not likely to improve occlusion due to the low prevalence of the condition and the ethical difficulties in recruiting people to participate in a randomized controlled trials for treating this condition.[51]

Class III

[edit]

The British Standard Institute (BSI) classify class III incisor relationship as the lower incisor edge lies anterior to the cingulum plateau of the upper incisors, with reduced or reversed over jet.[52] The skeletal facial deformity is characterized by mandibular prognathism, maxillary retrognathism or a combination of the two. This effects 3-8% of UK population with a higher incidence seen in Asia.[53]

One of the main reasons for correcting Class III malocclusion is aesthetics and function. This can have a psychological impact on the person with malocclusion resulting in speech and mastication problems as well. In mild class III cases, the patient is quite accepting of the aesthetics and the situation is monitored to observe the progression of skeletal growth.[54]

Maxillary and mandibular skeletal changes during prepubertal, pubertal and post pubertal stages show that class III malocclusion is established before the prepubertal stage.[55] One treatment option is the use of growth modification appliances such as the Chin Cap which has greatly improved the skeletal framework in the initial stages. However, majority of cases are shown to relapse into inherited class III malocclusion during the pubertal growth stage and when the appliance is removed after treatment.[55]

Another approach is to carry out orthognathic surgery, such as a bilateral sagittal split osteotomy (BSSO) which is indicated by horizontal mandibular excess. This involves surgically cutting through the mandible and moving the fragment forward or backwards for desired function and is supplemented with pre and post surgical orthodontics to ensure correct tooth relationship. Although the most common surgery of the mandible, it comes with several complications including: bleeding from inferior alveolar artery, unfavorable splits, condylar resorption, avascular necrosis and worsening of temporomandibular joint.[56]

Orthodontic camouflage can also be used in patients with mild skeletal discrepancies. This is a less invasive approach that uses orthodontic brackets to correct malocclusion and try to hide the skeletal discrepancy. Due to limitations of orthodontics, this option is more viable for patients who are not as concerned about the aesthetics of their facial appearance and are happy to address the malocclusion only, as well as avoiding the risks which come with orthognathic surgery. Cephalometric data can aid in the differentiation between the cases that benefit from ortho-surgical or orthodontic treatment only (camouflage); for instance, examining a large group of orthognathic patient with Class III malocclusions they had average ANB angle of -3.57° (95% CI, -3.92° to -3.21°). [57]

Deep bite

[edit]

The most common corrective treatments available are fixed or removal appliances (such as dental braces), which may or may not require surgical intervention. At this time there is no robust evidence that treatment will be successful.[51]

Open bite

[edit]

An open bite malocclusion is when the upper teeth don't overlap the lower teeth. When this malocclusion occurs at the front teeth it is known as anterior open bite. An open bite is difficult to treat due to multifactorial causes, with relapse being a major concern. This is particularly so for an anterior open bite.[58] Therefore, it is important to carry out a thorough initial assessment in order to obtain a diagnosis to tailor a suitable treatment plan.[58] It is important to take into consideration any habitual risk factors, as this is crucial for a successful outcome without relapse. Treatment approach includes behavior changes, appliances and surgery. Treatment for adults include a combination of extractions, fixed appliances, intermaxillary elastics and orthognathic surgery.[30] For children, orthodontics is usually used to compensate for continued growth. With children with mixed dentition, the malocclusion may resolve on its own as the permanent teeth erupt. Furthermore, should the malocclusion be caused by childhood habits such as digit, thumb or pacifier sucking, it may result in resolution as the habit is stopped. Habit deterrent appliances may be used to help in breaking digit and thumb sucking habits. Other treatment options for patients who are still growing include functional appliances and headgear appliances.

Tooth size discrepancy

[edit]

Identifying the presence of tooth size discrepancies between the maxillary and mandibular arches is an important component of correct orthodontic diagnosis and treatment planning.

To establish appropriate alignment and occlusion, the size of upper and lower front teeth, or upper and lower teeth in general, needs to be proportional. Inter-arch tooth size discrepancy (ITSD) is defined as a disproportion in the mesio-distal dimensions of teeth of opposing dental arches. The prevalence is clinically significant among orthodontic patients and has been reported to range from 17% to 30%.[59]

Identifying inter-arch tooth size discrepancy (ITSD) before treatment begins allows the practitioner to develop the treatment plan in a way that will take ITSD into account. ITSD corrective treatment may entail demanding reduction (interproximal wear), increase (crowns and resins), or elimination (extractions) of dental mass prior to treatment finalization.[60]

Several methods have been used to determine ITSD. Of these methods the one most commonly used is the Bolton analysis. Bolton developed a method to calculate the ratio between the mesiodistal width of maxillary and mandibular teeth and stated that a correct and harmonious occlusion is possible only with adequate proportionality of tooth sizes.[60] Bolton's formula concludes that if in the anterior portion the ratio is less than 77.2% the lower teeth are too narrow, the upper teeth are too wide or there is a combination of both. If the ratio is higher than 77.2% either the lower teeth are too wide, the upper teeth are too narrow or there is a combination of both.[59]

Other conditions

[edit]
Open bite treatment after eight months of braces.

Other kinds of malocclusions can be due to or horizontal, vertical, or transverse skeletal discrepancies, including skeletal asymmetries.

Increased vertical growth causes a long facial profile and commonly leads to an open bite malocclusion, while decreased vertical facial growth causes a short facial profile and is commonly associated with a deep bite malocclusion. However, there are many other more common causes for open bites (such as tongue thrusting and thumb sucking) and likewise for deep bites.[61][62][63]

The upper or lower jaw can be overgrown (macrognathia) or undergrown (micrognathia).[62][61][63] It has been reported that patients with micrognathia are also affected by retrognathia (abnormal posterior positioning of the mandible or maxilla relative to the facial structure).[62]  These patients are majorly predisposed to a class II malocclusion. Mandibular macrognathia results in prognathism and predisposes patients to a class III malocclusion.[64]

Most malocclusion studies to date have focused on Class III malocclusions. Genetic studies for Class II and Class I malocclusion are more rare. An example of hereditary mandibular prognathism can be seen amongst the Hapsburg Royal family where one third of the affected individuals with severe class III malocclusion had one parent with a similar phenotype [65]

The frequent presentation of dental malocclusions in patients with craniofacial birth defects also supports a strong genetic aetiology. About 150 genes are associated with craniofacial conditions presenting with malocclusions.[66]  Micrognathia is a commonly recurring craniofacial birth defect appearing among multiple syndromes.

For patients with severe malocclusions, corrective jaw surgery or orthognathic surgery may be carried out as a part of overall treatment, which can be seen in about 5% of the general population.[62][61][63]

See also

[edit]
  • Crossbite
  • Elastics
  • Facemask (orthodontics)
  • Maximum intercuspation
  • Mouth breathing
  • Occlusion (dentistry)

References

[edit]
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Further reading

[edit]
  • Peter S. Ungar, "The Trouble with Teeth: Our teeth are crowded, crooked and riddled with cavities. It hasn't always been this way", Scientific American, vol. 322, no. 4 (April 2020), pp. 44–49. "Our teeth [...] evolved over hundreds of millions of years to be incredibly strong and to align precisely for efficient chewing. [...] Our dental disorders largely stem from a shift in the oral environment caused by the introduction of softer, more sugary foods than the ones our ancestors typically ate."
[edit]

 

 

International children in traditional clothing at Liberty Weekend

A child (pl.children) is a human being between the stages of birth and puberty,[1][2] or between the developmental period of infancy and puberty.[3] The term may also refer to an unborn human being.[4][5] In English-speaking countries, the legal definition of child generally refers to a minor, in this case as a person younger than the local age of majority (there are exceptions like, for example, the consume and purchase of alcoholic beverage even after said age of majority[6]), regardless of their physical, mental and sexual development as biological adults.[1][7][8] Children generally have fewer rights and responsibilities than adults. They are generally classed as unable to make serious decisions.

Child may also describe a relationship with a parent (such as sons and daughters of any age)[9] or, metaphorically, an authority figure, or signify group membership in a clan, tribe, or religion; it can also signify being strongly affected by a specific time, place, or circumstance, as in "a child of nature" or "a child of the Sixties."[10]

[edit]
Children playing ball games, Roman artwork, 2nd century AD

In the biological sciences, a child is usually defined as a person between birth and puberty,[1][2] or between the developmental period of infancy and puberty.[3] Legally, the term child may refer to anyone below the age of majority or some other age limit.

The United Nations Convention on the Rights of the Child defines child as, "A human being below the age of 18 years unless under the law applicable to the child, majority is attained earlier."[11] This is ratified by 192 of 194 member countries. The term child may also refer to someone below another legally defined age limit unconnected to the age of majority. In Singapore, for example, a child is legally defined as someone under the age of 14 under the "Children and Young Persons Act" whereas the age of majority is 21.[12][13] In U.S. Immigration Law, a child refers to anyone who is under the age of 21.[14]

Some English definitions of the word child include the fetus (sometimes termed the unborn).[15] In many cultures, a child is considered an adult after undergoing a rite of passage, which may or may not correspond to the time of puberty.

Children generally have fewer rights than adults and are classed as unable to make serious decisions, and legally must always be under the care of a responsible adult or child custody, whether their parents divorce or not.

Developmental stages of childhood

[edit]

Early childhood

[edit]
Children playing the violin in a group recital, Ithaca, New York, 2011
Children in Madagascar, 2011
Child playing piano, 1984

Early childhood follows the infancy stage and begins with toddlerhood when the child begins speaking or taking steps independently.[16][17] While toddlerhood ends around age 3 when the child becomes less dependent on parental assistance for basic needs, early childhood continues approximately until the age of 5 or 6. However, according to the National Association for the Education of Young Children, early childhood also includes infancy. At this stage children are learning through observing, experimenting and communicating with others. Adults supervise and support the development process of the child, which then will lead to the child's autonomy. Also during this stage, a strong emotional bond is created between the child and the care providers. The children also start preschool and kindergarten at this age: and hence their social lives.

Middle childhood

[edit]

Middle childhood begins at around age 7, and ends at around age 9 or 10.[18] Together, early and middle childhood are called formative years. In this middle period, children develop socially and mentally. They are at a stage where they make new friends and gain new skills, which will enable them to become more independent and enhance their individuality. During middle childhood, children enter the school years, where they are presented with a different setting than they are used to. This new setting creates new challenges and faces for children.[19] Upon the entrance of school, mental disorders that would normally not be noticed come to light. Many of these disorders include: autism, dyslexia, dyscalculia, and ADHD.[20]: 303–309  Special education, least restrictive environment, response to intervention and individualized education plans are all specialized plans to help children with disabilities.[20]: 310–311 

Middle childhood is the time when children begin to understand responsibility and are beginning to be shaped by their peers and parents. Chores and more responsible decisions come at this time, as do social comparison and social play.[20]: 338  During social play, children learn from and teach each other, often through observation.[21]

Late childhood

[edit]

Preadolescence is a stage of human development following early childhood and preceding adolescence. Preadolescence is commonly defined as ages 9–12, ending with the major onset of puberty, with markers such as menarche, spermarche, and the peak of height velocity occurring. These changes usually occur between ages 11 and 14. It may also be defined as the 2-year period before the major onset of puberty.[22] Preadolescence can bring its own challenges and anxieties. Preadolescent children have a different view of the world from younger children in many significant ways. Typically, theirs is a more realistic view of life than the intense, fantasy-oriented world of earliest childhood. Preadolescents have more mature, sensible, realistic thoughts and actions: 'the most "sensible" stage of development...the child is a much less emotional being now.'[23] Preadolescents may well view human relationships differently (e.g. they may notice the flawed, human side of authority figures). Alongside that, they may begin to develop a sense of self-identity, and to have increased feelings of independence: 'may feel an individual, no longer "just one of the family."'[24]

Developmental stages post-childhood

[edit]

Adolescence

[edit]
An adolescent girl, photographed by Paolo Monti

Adolescence is usually determined to be between the onset of puberty and legal adulthood: mostly corresponding to the teenage years (13–19). However, puberty usually begins before the teenage years (10—11 for girls and 11—12 for boys). Although biologically a child is a human being between the stages of birth and puberty,[1][2] adolescents are legally considered children, as they tend to lack adult rights and are still required to attend compulsory schooling in many cultures, though this varies. The onset of adolescence brings about various physical, psychological and behavioral changes. The end of adolescence and the beginning of adulthood varies by country and by function, and even within a single nation-state or culture there may be different ages at which an individual is considered to be mature enough to be entrusted by society with certain tasks.

History

[edit]
Playing Children, by Song dynasty Chinese artist Su Hanchen, c. 1150 AD.

During the European Renaissance, artistic depictions of children increased dramatically, which did not have much effect on the social attitude toward children, however.[25]

The French historian Philippe Ariès argued that during the 1600s, the concept of childhood began to emerge in Europe,[26] however other historians like Nicholas Orme have challenged this view and argued that childhood has been seen as a separate stage since at least the medieval period.[27] Adults saw children as separate beings, innocent and in need of protection and training by the adults around them. The English philosopher John Locke was particularly influential in defining this new attitude towards children, especially with regard to his theory of the tabula rasa, which considered the mind at birth to be a "blank slate". A corollary of this doctrine was that the mind of the child was born blank, and that it was the duty of the parents to imbue the child with correct notions. During the early period of capitalism, the rise of a large, commercial middle class, mainly in the Protestant countries of the Dutch Republic and England, brought about a new family ideology centred around the upbringing of children. Puritanism stressed the importance of individual salvation and concern for the spiritual welfare of children.[28]

The Age of Innocence c. 1785/8. Reynolds emphasized the natural grace of children in his paintings.

The modern notion of childhood with its own autonomy and goals began to emerge during the 18th-century Enlightenment and the Romantic period that followed it.[29][30] Jean Jacques Rousseau formulated the romantic attitude towards children in his famous 1762 novel Emile: or, On Education. Building on the ideas of John Locke and other 17th-century thinkers, Jean-Jaques Rousseau described childhood as a brief period of sanctuary before people encounter the perils and hardships of adulthood.[29] Sir Joshua Reynolds' extensive children portraiture demonstrated the new enlightened attitudes toward young children. His 1788 painting The Age of Innocence emphasizes the innocence and natural grace of the posing child and soon became a public favourite.[31]

Brazilian princesses Leopoldina (left) and Isabel (center) with an unidentified friend, c. 1860.

The idea of childhood as a locus of divinity, purity, and innocence is further expounded upon in William Wordsworth's "Ode: Intimations of Immortality from Recollections of Early Childhood", the imagery of which he "fashioned from a complex mix of pastoral aesthetics, pantheistic views of divinity, and an idea of spiritual purity based on an Edenic notion of pastoral innocence infused with Neoplatonic notions of reincarnation".[30] This Romantic conception of childhood, historian Margaret Reeves suggests, has a longer history than generally recognized, with its roots traceable to similarly imaginative constructions of childhood circulating, for example, in the neo-platonic poetry of seventeenth-century metaphysical poet Henry Vaughan (e.g., "The Retreate", 1650; "Childe-hood", 1655). Such views contrasted with the stridently didactic, Calvinist views of infant depravity.[32]

Armenian scouts in 1918

With the onset of industrialisation in England in 1760, the divergence between high-minded romantic ideals of childhood and the reality of the growing magnitude of child exploitation in the workplace, became increasingly apparent. By the late 18th century, British children were specially employed in factories and mines and as chimney sweeps,[33] often working long hours in dangerous jobs for low pay.[34] As the century wore on, the contradiction between the conditions on the ground for poor children and the middle-class notion of childhood as a time of simplicity and innocence led to the first campaigns for the imposition of legal protection for children.

British reformers attacked child labor from the 1830s onward, bolstered by the horrific descriptions of London street life by Charles Dickens.[35] The campaign eventually led to the Factory Acts, which mitigated the exploitation of children at the workplace[33][36]

Modern concepts of childhood

[edit]
Children play in a fountain in a summer evening, Davis, California.
An old man and his granddaughter in Turkey.
Nepalese children playing with cats.
Harari girls in Ethiopia.

The modern attitude to children emerged by the late 19th century; the Victorian middle and upper classes emphasized the role of the family and the sanctity of the child – an attitude that has remained dominant in Western societies ever since.[37] The genre of children's literature took off, with a proliferation of humorous, child-oriented books attuned to the child's imagination. Lewis Carroll's fantasy Alice's Adventures in Wonderland, published in 1865 in England, was a landmark in the genre; regarded as the first "English masterpiece written for children", its publication opened the "First Golden Age" of children's literature.

The latter half of the 19th century saw the introduction of compulsory state schooling of children across Europe, which decisively removed children from the workplace into schools.[38][39]

The market economy of the 19th century enabled the concept of childhood as a time of fun, happiness, and imagination. Factory-made dolls and doll houses delighted the girls and organized sports and activities were played by the boys.[40] The Boy Scouts was founded by Sir Robert Baden-Powell in 1908,[41][42] which provided young boys with outdoor activities aiming at developing character, citizenship, and personal fitness qualities.[43]

In the 20th century, Philippe Ariès, a French historian specializing in medieval history, suggested that childhood was not a natural phenomenon, but a creation of society in his 1960 book Centuries of Childhood. In 1961 he published a study of paintings, gravestones, furniture, and school records, finding that before the 17th century, children were represented as mini-adults.

In 1966, the American philosopher George Boas published the book The Cult of Childhood. Since then, historians have increasingly researched childhood in past times.[44]

In 2006, Hugh Cunningham published the book Invention of Childhood, looking at British childhood from the year 1000, the Middle Ages, to what he refers to as the Post War Period of the 1950s, 1960s and 1970s.[45]

Childhood evolves and changes as lifestyles change and adult expectations alter. In the modern era, many adults believe that children should not have any worries or work, as life should be happy and trouble-free. Childhood is seen as a mixture of simplicity, innocence, happiness, fun, imagination, and wonder. It is thought of as a time of playing, learning, socializing, exploring, and worrying in a world without much adult interference.[29][30]

A "loss of innocence" is a common concept, and is often seen as an integral part of coming of age. It is usually thought of as an experience or period in a child's life that widens their awareness of evil, pain or the world around them. This theme is demonstrated in the novels To Kill a Mockingbird and Lord of the Flies. The fictional character Peter Pan was the embodiment of a childhood that never ends.[46][47]

Healthy childhoods

[edit]

Role of parents

[edit]

Children's health

[edit]

Children's health includes the physical, mental and social well-being of children. Maintaining children's health implies offering them healthy foods, insuring they get enough sleep and exercise, and protecting their safety.[48] Children in certain parts of the world often suffer from malnutrition, which is often associated with other conditions, such diarrhea, pneumonia and malaria.[49]

Child protection

[edit]

Child protection, according to UNICEF, refers to "preventing and responding to violence, exploitation and abuse against children – including commercial sexual exploitation, trafficking, child labour and harmful traditional practices, such as female genital mutilation/cutting and child marriage".[50] The Convention on the Rights of the Child protects the fundamental rights of children.

Play

[edit]
Dancing at Mother of Peace AIDs orphanage, Zimbabwe

Play is essential to the cognitive, physical, social, and emotional well-being of children.[51] It offers children opportunities for physical (running, jumping, climbing, etc.), intellectual (social skills, community norms, ethics and general knowledge) and emotional development (empathy, compassion, and friendships). Unstructured play encourages creativity and imagination. Playing and interacting with other children, as well as some adults, provides opportunities for friendships, social interactions, conflicts and resolutions. However, adults tend to (often mistakenly) assume that virtually all children's social activities can be understood as "play" and, furthermore, that children's play activities do not involve much skill or effort.[52][53][54][55]

It is through play that children at a very early age engage and interact in the world around them. Play allows children to create and explore a world they can master, conquering their fears while practicing adult roles, sometimes in conjunction with other children or adult caregivers.[51] Undirected play allows children to learn how to work in groups, to share, to negotiate, to resolve conflicts, and to learn self-advocacy skills. However, when play is controlled by adults, children acquiesce to adult rules and concerns and lose some of the benefits play offers them. This is especially true in developing creativity, leadership, and group skills.[51]

Ralph Hedley, The Tournament, 1898. It depicts poorer boys playing outdoors in a rural part of the Northeast of England.

Play is considered to be very important to optimal child development that it has been recognized by the United Nations Commission on Human Rights as a right of every child.[11] Children who are being raised in a hurried and pressured style may limit the protective benefits they would gain from child-driven play.[51]

The initiation of play in a classroom setting allows teachers and students to interact through playfulness associated with a learning experience. Therefore, playfulness aids the interactions between adults and children in a learning environment. “Playful Structure” means to combine informal learning with formal learning to produce an effective learning experience for children at a young age.[56]

Even though play is considered to be the most important to optimal child development, the environment affects their play and therefore their development. Poor children confront widespread environmental inequities as they experience less social support, and their parents are less responsive and more authoritarian. Children from low income families are less likely to have access to books and computers which would enhance their development.[57]

Street culture

[edit]
Children in front of a movie theatre, Toronto, 1920s.

Children's street culture refers to the cumulative culture created by young children and is sometimes referred to as their secret world. It is most common in children between the ages of seven and twelve. It is strongest in urban working class industrial districts where children are traditionally free to play out in the streets for long periods without supervision. It is invented and largely sustained by children themselves with little adult interference.

Young children's street culture usually takes place on quiet backstreets and pavements, and along routes that venture out into local parks, playgrounds, scrub and wasteland, and to local shops. It often imposes imaginative status on certain sections of the urban realm (local buildings, kerbs, street objects, etc.). Children designate specific areas that serve as informal meeting and relaxation places (see: Sobel, 2001). An urban area that looks faceless or neglected to an adult may have deep 'spirit of place' meanings in to children. Since the advent of indoor distractions such as video games, and television, concerns have been expressed about the vitality – or even the survival – of children's street culture.

Geographies of childhood

[edit]

The geographies of childhood involves how (adult) society perceives the idea of childhood, the many ways adult attitudes and behaviors affect children's lives, including the environment which surrounds children and its implications.[58]

The geographies of childhood is similar in some respects to children's geographies which examines the places and spaces in which children live.[59]

Nature deficit disorder

[edit]

Nature Deficit Disorder, a term coined by Richard Louv in his 2005 book Last Child in the Woods, refers to the trend in the United States and Canada towards less time for outdoor play,[60][61] resulting in a wide range of behavioral problems.[62]

With increasing use of cellphones, computers, video games and television, children have more reasons to stay inside rather than outdoors exploring. “The average American child spends 44 hours a week with electronic media”.[63] Research in 2007 has drawn a correlation between the declining number of National Park visits in the U.S. and increasing consumption of electronic media by children.[64] The media has accelerated the trend for children's nature disconnection by deemphasizing views of nature, as in Disney films.[65]

Age of responsibility

[edit]

The age at which children are considered responsible for their society-bound actions (e. g. marriage, voting, etc.) has also changed over time,[66] and this is reflected in the way they are treated in courts of law. In Roman times, children were regarded as not culpable for crimes, a position later adopted by the Church. In the 19th century, children younger than seven years old were believed incapable of crime. Children from the age of seven forward were considered responsible for their actions. Therefore, they could face criminal charges, be sent to adult prison, and be punished like adults by whipping, branding or hanging. However, courts at the time would consider the offender's age when deliberating sentencing.[citation needed] Minimum employment age and marriage age also vary. The age limit of voluntary/involuntary military service is also disputed at the international level.[67]

Education

[edit]
Children in an outdoor classroom in Bié, Angola
Children seated in a Finnish classroom at the school of Torvinen in Sodankylä, Finland, in the 1920s

Education, in the general sense, refers to the act or process of imparting or acquiring general knowledge, developing the powers of reasoning and judgment, and preparing intellectually for mature life.[68] Formal education most often takes place through schooling. A right to education has been recognized by some governments. At the global level, Article 13 of the United Nations' 1966 International Covenant on Economic, Social and Cultural Rights (ICESCR) recognizes the right of everyone to an education.[69] Education is compulsory in most places up to a certain age, but attendance at school may not be, with alternative options such as home-schooling or e-learning being recognized as valid forms of education in certain jurisdictions.

Children in some countries (especially in parts of Africa and Asia) are often kept out of school, or attend only for short periods. Data from UNICEF indicate that in 2011, 57 million children were out of school; and more than 20% of African children have never attended primary school or have left without completing primary education.[70] According to a UN report, warfare is preventing 28 million children worldwide from receiving an education, due to the risk of sexual violence and attacks in schools.[71] Other factors that keep children out of school include poverty, child labor, social attitudes, and long distances to school.[72][73]

Attitudes toward children

[edit]
Group of breaker boys in Pittston, Pennsylvania, 1911. Child labor was widespread until the early 20th century. In the 21st century, child labor rates are highest in Africa.

Social attitudes toward children differ around the world in various cultures and change over time. A 1988 study on European attitudes toward the centrality of children found that Italy was more child-centric and the Netherlands less child-centric, with other countries, such as Austria, Great Britain, Ireland and West Germany falling in between.[74]

Child marriage

[edit]

In 2013, child marriage rates of female children under the age of 18 reached 75% in Niger, 68% in Central African Republic and Chad, 66% in Bangladesh, and 47% in India.[75] According to a 2019 UNICEF report on child marriage, 37% of females were married before the age of 18 in sub-Saharan Africa, followed by South Asia at 30%. Lower levels were found in Latin America and Caribbean (25%), the Middle East and North Africa (18%), and Eastern Europe and Central Asia (11%), while rates in Western Europe and North America were minimal.[76] Child marriage is more prevalent with girls, but also involves boys. A 2018 study in the journal Vulnerable Children and Youth Studies found that, worldwide, 4.5% of males are married before age 18, with the Central African Republic having the highest average rate at 27.9%.[77]

Fertility and number of children per woman

[edit]

Before contraception became widely available in the 20th century, women had little choice other than abstinence or having often many children. In fact, current population growth concerns have only become possible with drastically reduced child mortality and sustained fertility. In 2017 the global total fertility rate was estimated to be 2.37 children per woman,[78] adding about 80 million people to the world population per year. In order to measure the total number of children, scientists often prefer the completed cohort fertility at age 50 years (CCF50).[78] Although the number of children is also influenced by cultural norms, religion, peer pressure and other social factors, the CCF50 appears to be most heavily dependent on the educational level of women, ranging from 5–8 children in women without education to less than 2 in women with 12 or more years of education.[78]

Issues

[edit]

Emergencies and conflicts

[edit]

Emergencies and conflicts pose detrimental risks to the health, safety, and well-being of children. There are many different kinds of conflicts and emergencies, e.g. wars and natural disasters. As of 2010 approximately 13 million children are displaced by armed conflicts and violence around the world.[79] Where violent conflicts are the norm, the lives of young children are significantly disrupted and their families have great difficulty in offering the sensitive and consistent care that young children need for their healthy development.[79] Studies on the effect of emergencies and conflict on the physical and mental health of children between birth and 8 years old show that where the disaster is natural, the rate of PTSD occurs in anywhere from 3 to 87 percent of affected children.[80] However, rates of PTSD for children living in chronic conflict conditions varies from 15 to 50 percent.[81][82]

Child protection

[edit]
 

Child protection (also called child welfare) is the safeguarding of children from violence, exploitation, abuse, abandonment, and neglect.[83][84][85][86] It involves identifying signs of potential harm. This includes responding to allegations or suspicions of abuse, providing support and services to protect children, and holding those who have harmed them accountable.[87]

The primary goal of child protection is to ensure that all children are safe and free from harm or danger.[86][88] Child protection also works to prevent future harm by creating policies and systems that identify and respond to risks before they lead to harm.[89]

In order to achieve these goals, research suggests that child protection services should be provided in a holistic way.[90][91][92] This means taking into account the social, economic, cultural, psychological, and environmental factors that can contribute to the risk of harm for individual children and their families. Collaboration across sectors and disciplines to create a comprehensive system of support and safety for children is required.[93][94]

It is the responsibility of individuals, organizations, and governments to ensure that children are protected from harm and their rights are respected.[95] This includes providing a safe environment for children to grow and develop, protecting them from physical, emotional and sexual abuse, and ensuring they have access to education, healthcare, and resources to fulfill their basic needs.[96]

Child protection systems are a set of services, usually government-run, designed to protect children and young people who are underage and to encourage family stability. UNICEF defines[97] a 'child protection system' as:

"The set of laws, policies, regulations and services needed across all social sectors – especially social welfare, education, health, security and justice – to support prevention and response to protection-related risks. These systems are part of social protection, and extend beyond it. At the level of prevention, their aim includes supporting and strengthening families to reduce social exclusion, and to lower the risk of separation, violence and exploitation. Responsibilities are often spread across government agencies, with services delivered by local authorities, non-State providers, and community groups, making coordination between sectors and levels, including routine referral systems etc.., a necessary component of effective child protection systems."

— United Nations Economic and Social Council (2008), UNICEF Child Protection Strategy, E/ICEF/2008/5/Rev.1, par. 12–13.

Under Article 19 of the UN Convention on the Rights of the Child, a 'child protection system' provides for the protection of children in and out of the home. One of the ways this can be enabled is through the provision of quality education, the fourth of the United Nations Sustainable Development Goals, in addition to other child protection systems. Some literature argues that child protection begins at conception; even how the conception took place can affect the child's development.[98]

Child abuse and child labor

[edit]

Protection of children from abuse is considered an important contemporary goal. This includes protecting children from exploitation such as child labor, child trafficking and child selling, child sexual abuse, including child prostitution and child pornography, military use of children, and child laundering in illegal adoptions. There exist several international instruments for these purposes, such as:

  • Worst Forms of Child Labour Convention
  • Minimum Age Convention, 1973
  • Optional Protocol on the Sale of Children, Child Prostitution and Child Pornography
  • Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse
  • Optional Protocol on the Involvement of Children in Armed Conflict
  • Hague Adoption Convention

Climate change

[edit]
 
A child at a climate demonstration in Juneau, Alaska

Children are more vulnerable to the effects of climate change than adults. The World Health Organization estimated that 88% of the existing global burden of disease caused by climate change affects children under five years of age.[99] A Lancet review on health and climate change lists children as the worst-affected category by climate change.[100] Children under 14 are 44 percent more likely to die from environmental factors,[101] and those in urban areas are disproportionately impacted by lower air quality and overcrowding.[102]

Children are physically more vulnerable to climate change in all its forms.[103] Climate change affects the physical health of children and their well-being. Prevailing inequalities, between and within countries, determine how climate change impacts children.[104] Children often have no voice in terms of global responses to climate change.[103]

People living in low-income countries experience a higher burden of disease and are less capable of coping with climate change-related threats.[105] Nearly every child in the world is at risk from climate change and pollution, while almost half are at extreme risk.[106]

Health

[edit]

Child mortality

[edit]
World infant mortality rates in 2012.[107]

During the early 17th century in England, about two-thirds of all children died before the age of four.[108] During the Industrial Revolution, the life expectancy of children increased dramatically.[109] This has continued in England, and in the 21st century child mortality rates have fallen across the world. About 12.6 million under-five infants died worldwide in 1990, which declined to 6.6 million in 2012. The infant mortality rate dropped from 90 deaths per 1,000 live births in 1990, to 48 in 2012. The highest average infant mortality rates are in sub-Saharan Africa, at 98 deaths per 1,000 live births – over double the world's average.[107]

See also

[edit]
Listen to this article (3 minutes)
 
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This audio file was created from a revision of this article dated 24 June 2008 (2008-06-24), and does not reflect subsequent edits.
  • Outline of childhood
  • Child slavery
  • Childlessness
  • Depression in childhood and adolescence
  • One-child policy
  • Religion and children
  • Youth rights
  • Archaeology of childhood

Sources

[edit]
  •  This article incorporates text from a free content work. Licensed under CC-BY-SA IGO 3.0 (license statement/permission). Text taken from Investing against Evidence: The Global State of Early Childhood Care and Education​, 118–125, Marope PT, Kaga Y, UNESCO. UNESCO.
  •  This article incorporates text from a free content work. Licensed under CC-BY-SA IGO 3.0 (license statement/permission). Text taken from Creating sustainable futures for all; Global education monitoring report, 2016; Gender review​, 20, UNESCO, UNESCO. UNESCO.

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Further reading

[edit]
  • Cook, Daniel Thomas. The moral project of childhood: Motherhood, material life, and early children's consumer culture (NYU Press, 2020). online book see also online review
  • Fawcett, Barbara, Brid Featherstone, and Jim Goddard. Contemporary child care policy and practice (Bloomsbury Publishing, 2017) online
  • Hutchison, Elizabeth D., and Leanne W. Charlesworth. "Securing the welfare of children: Policies past, present, and future." Families in Society 81.6 (2000): 576–585.
  • Fass, Paula S. The end of American childhood: A history of parenting from life on the frontier to the managed child (Princeton University Press, 2016).
  • Fass, Paula S. ed. The Routledge History of Childhood in the Western World (2012) online
  • Klass, Perri. The Best Medicine: How Science and Public Health Gave Children a Future (WW Norton & Company, 2020) online
  • Michail, Samia. "Understanding school responses to students’ challenging behaviour: A review of literature." Improving schools 14.2 (2011): 156–171. online
  • Sorin, Reesa. Changing images of childhood: Reconceptualising early childhood practice (Faculty of Education, University of Melbourne, 2005) online.
  • Sorin, Reesa. "Childhood through the eyes of the child and parent." Journal of Australian Research in Early Childhood Education 14.1 (2007). online
  • Vissing, Yvonne. "History of Children’s Human Rights in the USA." in Children's Human Rights in the USA: Challenges and Opportunities (Cham: Springer International Publishing, 2023) pp. 181–212.
  • Yuen, Francis K.O. Social work practice with children and families: a family health approach (Routledge, 2014) online.
Preceded by
Toddlerhood
Stages of human development
Childhood
Succeeded by
Preadolescence