Understanding Relapse in Orthodontic Treatment

Understanding Relapse in Orthodontic Treatment

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

Understanding relapse in orthodontic treatment is crucial for both orthodontists and patients, especially when it comes to children whose dental structures are still developing. Relapse refers to the return of teeth to their original positions after orthodontic treatment, undermining the efforts and investment put into achieving a straighter, healthier smile. Several common causes can lead to relapse in orthodontic treatment for children, and being aware of these can help in preventing or minimizing their impact.


One of the primary causes of relapse is the lack of consistent use of retainers. After the active phase of orthodontic treatment, retainers are essential to hold teeth in their new positions while the surrounding bone and tissues adapt. Proper oral hygiene is crucial during orthodontic treatment Youth orthodontic correction mouth. Children, often distracted by school and play, may forget to wear their retainers as prescribed, leading to gradual shifting of teeth.


Another significant factor is growth and development. Children's jaws and facial bones continue to grow until their late teens, and this natural growth can alter the alignment of teeth that were previously straightened. Orthodontists must account for this growth during treatment planning, but unexpected growth spurts can still cause shifts.


Poor compliance with orthodontic instructions also plays a critical role in relapse. This includes not only wearing retainers but also maintaining good oral hygiene and avoiding habits that can affect dental alignment, such as thumb sucking or tongue thrusting. These habits can exert pressure on teeth, causing them to move back to their original positions.


Lastly, the complexity of the original orthodontic problem can influence the likelihood of relapse. Severe misalignments or bite issues may require more extensive treatment and longer retention periods to stabilize the results. In some cases, even with diligent care, the nature of the dental issue might predispose a child to relapse.


In conclusion, relapse in orthodontic treatment for children can stem from various factors, including non-compliance with retainer use, ongoing growth and development, poor adherence to orthodontic instructions, and the inherent complexity of the dental issues being treated. By understanding these common causes, parents and orthodontists can work together to implement strategies that help maintain the beautiful smiles achieved through orthodontic care.

In the world of orthodontic treatment, the journey to a perfect smile doesn't end when the braces come off. The crucial phase of retention and compliance plays a pivotal role in preventing relapse, ensuring the hard work and dedication invested in the treatment don't go to waste.


Relapse in orthodontic treatment refers to the tendency of teeth to shift back to their original positions after the braces are removed. This phenomenon can be frustrating for both patients and orthodontists, as it can undo months or even years of progress. To combat this, orthodontists employ retention strategies, which involve the use of retainers to hold teeth in their new positions while the surrounding bone and tissues adapt.


The effectiveness of retention, however, heavily relies on patient compliance. Wearing retainers as prescribed by the orthodontist is essential to maintain the results achieved during treatment. Non-compliance, such as not wearing retainers regularly or skipping appointments, significantly increases the risk of relapse. It's a shared responsibility between the patient and the orthodontist to ensure the success of the treatment.


Orthodontists play a crucial role in educating patients about the importance of retention and compliance. They must communicate clearly and effectively, explaining the potential consequences of relapse and the benefits of adhering to the prescribed retention protocol. Patients, on the other hand, must take an active role in their treatment by following instructions diligently and maintaining open communication with their orthodontist.


The type and duration of retention can vary depending on individual cases. Some patients may require removable retainers, while others might need fixed retainers bonded to the back of their teeth. The orthodontist will determine the most suitable approach based on factors such as the severity of the initial misalignment, the patient's age, and their compliance history.


In conclusion, the role of retention and compliance cannot be overstated when it comes to preventing relapse in orthodontic treatment. By working together, patients and orthodontists can ensure the long-term success of the treatment, maintaining the beautiful, healthy smile achieved through months of dedication and effort. It's a journey that requires patience, commitment, and a shared understanding of the importance of retention in preserving the results of orthodontic treatment.

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

Understanding relapse in orthodontic treatment is crucial, especially for young patients who have just embarked on their journey to a perfect smile. Relapse, or the tendency of teeth to return to their original positions after braces or aligners are removed, can be disheartening for both patients and orthodontists. However, with the right strategies in place, the risk of relapse can be significantly minimized.


First and foremost, the use of retainers is paramount. After the active phase of orthodontic treatment, wearing a retainer is essential to maintain the new position of the teeth. Young patients should be encouraged to wear their retainers as prescribed by their orthodontist, typically full-time initially and then transitioning to nightly wear. It's important to instill the habit of wearing retainers consistently, as irregular use can lead to relapse.


Another effective strategy is to educate young patients and their parents about the importance of oral hygiene and regular dental check-ups. Good oral health practices, such as brushing and flossing, help prevent issues like gum disease, which can contribute to tooth movement and relapse. Regular visits to the dentist allow for early detection of any orthodontic issues, enabling timely intervention.


Moreover, it's beneficial to engage young patients in discussions about their treatment goals and the importance of their role in maintaining the results. When patients understand the 'why' behind wearing retainers and practicing good oral hygiene, they are more likely to adhere to the recommended protocols. This sense of ownership and responsibility can be a powerful motivator in preventing relapse.


In some cases, additional orthodontic appliances or procedures may be necessary to stabilize the results. For instance, fixed retainers, which are bonded to the back of the teeth, can provide long-term stability for certain cases. Orthodontists may also recommend overcorrection during the active treatment phase to account for potential relapse, ensuring that the final position of the teeth is slightly beyond the ideal alignment.


Lastly, it's important to consider the psychological aspect of orthodontic treatment. Young patients may feel a sense of relief when their braces come off, but it's crucial to remind them that the journey isn't over yet. Positive reinforcement, support from family and friends, and regular follow-ups with the orthodontist can help keep young patients motivated and committed to their post-treatment care.


In conclusion, minimizing the risk of relapse in young patients undergoing orthodontic treatment requires a multifaceted approach. From consistent retainer wear and good oral hygiene to patient education and psychological support, these strategies work together to help young patients maintain their beautiful smiles for years to come. By working closely with their orthodontist and following the recommended care plan, young patients can enjoy the long-lasting benefits of their orthodontic treatment.

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

Understanding relapse in orthodontic treatment is a critical aspect of orthodontics, particularly when considering the impact of growth and development on orthodontic stability in children. Relapse refers to the tendency of teeth to return to their original positions after orthodontic treatment, which can undermine the success and longevity of the treatment outcomes.


Children are in a constant state of growth and development, which significantly influences the stability of orthodontic corrections. As a child grows, changes in jaw size, facial structure, and dental alignment can occur, potentially leading to shifts in tooth position. These natural growth processes can either support or challenge the stability of orthodontic results.


One key factor in this dynamic is the timing of orthodontic treatment. Early intervention during the mixed dentition phase (when children have both baby and permanent teeth) can help guide the growth and development of the jaws and teeth. However, it is often necessary to follow up with a second phase of treatment once all permanent teeth have erupted. This phased approach can enhance the stability of the final orthodontic outcome by accommodating the child's growth patterns.


Moreover, the retention phase following active orthodontic treatment is crucial for maintaining stability. Children may require longer retention periods than adults due to their ongoing growth. Retainers help to hold teeth in their new positions while the surrounding bone and tissues adapt to the changes. Compliance with wearing retainers is essential, as premature discontinuation can increase the risk of relapse.


Another consideration is the genetic predisposition and individual growth patterns of each child. Some children may have a stronger tendency towards relapse due to their genetic makeup or specific growth trajectories. Orthodontists must consider these factors when planning treatment and communicating with patients and their families about the potential for relapse.


In conclusion, the impact of growth and development on orthodontic stability in children is a complex interplay of biological processes and orthodontic management. Understanding these dynamics is essential for orthodontists to minimize the risk of relapse and achieve long-lasting results. Effective orthodontic care for children involves not only the technical aspects of treatment but also a deep appreciation of the growth and development stages that can influence the stability of the outcomes.

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

Long-term monitoring and follow-up care are crucial components in managing potential relapse following orthodontic treatment. Relapse in orthodontics refers to the tendency of teeth to move back to their original positions after braces or aligners are removed. This phenomenon underscores the importance of a vigilant approach to post-treatment care.


After completing orthodontic treatment, patients are often fitted with retainers, which are designed to hold teeth in their new positions. However, the effectiveness of these devices relies heavily on consistent use and regular check-ups. Long-term monitoring involves periodic visits to the orthodontist, typically spanning several years, to assess the stability of the teeth and the integrity of the retainers.


During these follow-up appointments, orthodontists can detect early signs of relapse, such as slight shifts in tooth alignment or changes in bite. Early detection is key, as minor adjustments can be made promptly to prevent more significant issues down the line. Additionally, these visits provide an opportunity to reinforce the importance of retainer wear and to address any patient concerns or difficulties with the device.


The commitment to long-term follow-up care extends beyond the orthodontist's office. Patients play a pivotal role in their own care by adhering to the prescribed retainer regimen and promptly reporting any issues. Open communication between the patient and the orthodontist fosters a collaborative approach to managing relapse risks.


In essence, long-term monitoring and follow-up care are indispensable for maintaining the results of orthodontic treatment. By staying proactive and engaged in their care, patients can enjoy the benefits of a straight, healthy smile for years to come.

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

Understanding relapse in orthodontic treatment is crucial for both children and their parents. Relapse refers to the tendency of teeth to move back to their original positions after orthodontic appliances, such as braces or aligners, are removed. This phenomenon can undo the progress made during treatment, leading to frustration and additional costs. Educating families about the risks and prevention of relapse is essential for maintaining a healthy, aligned smile long-term.


Firstly, it's important for parents and children to understand that relapse is a common issue. Even with the best orthodontic care, some degree of movement is natural. However, being aware of this risk can motivate families to adhere to post-treatment protocols. Regular dental check-ups are vital, as dentists can monitor the alignment of teeth and intervene early if signs of relapse appear.


Prevention strategies should be clearly communicated. Wearing retainers as prescribed is perhaps the most critical step. Retainers help maintain the new positions of teeth, and consistent use can significantly reduce the risk of relapse. Parents should help their children establish a routine for wearing retainers, whether it's during sleep or for a specified number of hours each day.


Additionally, maintaining good oral hygiene and avoiding habits that can affect tooth alignment, such as thumb sucking or excessive use of pacifiers, are important preventive measures. Parents can support their children by reinforcing these habits and providing positive reinforcement.


Understanding the signs of relapse is also key. If teeth start to feel crowded or if gaps reappear, it's important to consult an orthodontist promptly. Early intervention can often correct minor shifts before they become major issues.


In conclusion, educating children and parents about the risks and prevention of relapse in orthodontic treatment empowers them to take an active role in maintaining the results of their orthodontic journey. With proper care and attention, the beautiful smile achieved through orthodontics can last a lifetime.

Infants may use pacifiers or their thumb or fingers to soothe themselves
Newborn baby thumb sucking
A bonnet macaque thumb sucking

Thumb sucking is a behavior found in humans, chimpanzees, captive ring-tailed lemurs,[1] and other primates.[2] It usually involves placing the thumb into the mouth and rhythmically repeating sucking contact for a prolonged duration. It can also be accomplished with any organ within reach (such as other fingers and toes) and is considered to be soothing and therapeutic for the person. As a child develops the habit, it will usually develop a "favourite" finger to suck on.

At birth, a baby will reflexively suck any object placed in its mouth; this is the sucking reflex responsible for breastfeeding. From the first time they engage in nutritive feeding, infants learn that the habit can not only provide valuable nourishment, but also a great deal of pleasure, comfort, and warmth. Whether from a mother, bottle, or pacifier, this behavior, over time, begins to become associated with a very strong, self-soothing, and pleasurable oral sensation. As the child grows older, and is eventually weaned off the nutritional sucking, they can either develop alternative means for receiving those same feelings of physical and emotional fulfillment, or they can continue experiencing those pleasantly soothing experiences by beginning to suck their thumbs or fingers.[3] This reflex disappears at about 4 months of age; thumb sucking is not purely an instinctive behavior and therefore can last much longer.[4] Moreover, ultrasound scans have revealed that thumb sucking can start before birth, as early as 15 weeks from conception; whether this behavior is voluntary or due to random movements of the fetus in the womb is not conclusively known.

Thumb sucking generally stops by the age of 4 years. Some older children will retain the habit, which can cause severe dental problems.[5] While most dentists would recommend breaking the habit as early as possible, it has been shown that as long as the habit is broken before the onset of permanent teeth, at around 5 years old, the damage is reversible.[6] Thumb sucking is sometimes retained into adulthood and may be due to simply habit continuation. Using anatomical and neurophysiological data a study has found that sucking the thumb is said to stimulate receptors within the brain which cause the release of mental and physical tension.[7]

Dental problems and prevention

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Alveolar prognathism, caused by thumb sucking and tongue thrusting in a 7-year-old girl.

Percentage of children who suck their thumbs (data from two researchers)

Age Kantorowicz[4] Brückl[8]
0–1 92% 66%
1–2 93%
2–3 87%
3–4 86% 25%
4–5 85%
5–6 76%
Over 6 9%

Most children stop sucking on thumbs, pacifiers or other objects on their own between 2 and 4 years of age. No harm is done to their teeth or jaws until permanent teeth start to erupt. The only time it might cause concern is if it goes on beyond 6 to 8 years of age. At this time, it may affect the shape of the oral cavity or dentition.[9] During thumbsucking the tongue sits in a lowered position and so no longer balances the forces from the buccal group of musculature. This results in narrowing of the upper arch and a posterior crossbite. Thumbsucking can also cause the maxillary central incisors to tip labially and the mandibular incisors to tip lingually, resulting in an increased overjet and anterior open bite malocclusion, as the thumb rests on them during the course of sucking. In addition to proclination of the maxillary incisors, mandibular incisors retrusion will also happen. Transverse maxillary deficiency gives rise to posterior crossbite, ultimately leading to a Class II malocclusion.[10]

Children may experience difficulty in swallowing and speech patterns due to the adverse changes. Aside from the damaging physical aspects of thumb sucking, there are also additional risks, which unfortunately, are present at all ages. These include increased risk of infection from communicable diseases, due to the simple fact that non-sterile thumbs are covered with infectious agents, as well as many social implications. Some children experience social difficulties, as often children are taunted by their peers for engaging in what they can consider to be an “immature” habit. This taunting often results the child being rejected by the group or being subjected to ridicule by their peers, which can cause understandable psychological stress.[11]

Methods to stop sucking habits are divided into 2 categories: Preventive Therapy and Appliance Therapy.[10]

Examples to prevent their children from sucking their thumbs include the use of bitterants or piquant substances on their child's hands—although this is not a procedure encouraged by the American Dental Association[9] or the Association of Pediatric Dentists. Some suggest that positive reinforcements or calendar rewards be given to encourage the child to stop sucking their thumb.

The American Dental Association recommends:

  • Praise children for not sucking, instead of scolding them when they do.
  • If a child is sucking their thumb when feeling insecure or needing comfort, focus instead on correcting the cause of the anxiety and provide comfort to your child.
  • If a child is sucking on their thumb because of boredom, try getting the child's attention with a fun activity.
  • Involve older children in the selection of a means to cease thumb sucking.
  • The pediatric dentist can offer encouragement to the child and explain what could happen to the child's teeth if he/she does not stop sucking.
  • Only if these tips are ineffective, remind the child of the habit by bandaging the thumb or putting a sock/glove on the hand at night.
  • Other orthodontics[12] for appliances are available.

The British Orthodontic Society recommends the same advice as ADA.[13]

A Cochrane review was conducted to review the effectiveness of a variety of clinical interventions for stopping thumb-sucking. The study showed that orthodontic appliances and psychological interventions (positive and negative reinforcement) were successful at preventing thumb sucking in both the short and long term, compared to no treatment.[14] Psychological interventions such as habit reversal training and decoupling have also proven useful in body focused repetitive behaviors.[15]

Clinical studies have shown that appliances such as TGuards can be 90% effective in breaking the thumb or finger sucking habit. Rather than use bitterants or piquants, which are not endorsed by the ADA due to their causing of discomfort or pain, TGuards break the habit simply by removing the suction responsible for generating the feelings of comfort and nurture.[16] Other appliances are available, such as fabric thumb guards, each having their own benefits and features depending on the child's age, willpower and motivation. Fixed intraoral appliances have been known to create problems during eating as children when removing their appliances may have a risk of breaking them. Children with mental illness may have reduced compliance.[10]

Some studies mention the use of extra-oral habit reminder appliance to treat thumb sucking. An alarm is triggered when the child tries to suck the thumb to stop the child from this habit.[10][17] However, more studies are required to prove the effectiveness of external devices on thumb sucking.

Children's books

[edit]
  • In Heinrich Hoffmann’s Struwwelpeter, the "thumb-sucker" Konrad is punished by having both of his thumbs cut off.
  • There are several children's books on the market with the intention to help the child break the habit of thumb sucking. Most of them provide a story the child can relate to and some coping strategies.[18] Experts recommend to use only books in which the topic of thumb sucking is shown in a positive and respectful way.[19]

See also

[edit]
  • Stereotypic movement disorder
  • Prognathism

References

[edit]
  1. ^ Jolly A (1966). Lemur Behavior. Chicago: University of Chicago Press. p. 65. ISBN 978-0-226-40552-0.
  2. ^ Benjamin, Lorna S.: "The Beginning of Thumbsucking." Child Development, Vol. 38, No. 4 (Dec., 1967), pp. 1065–1078.
  3. ^ "About the Thumb Sucking Habit". Tguard.
  4. ^ a b Kantorowicz A (June 1955). "Die Bedeutung des Lutschens für die Entstehung erworbener Fehlbildungen". Fortschritte der Kieferorthopädie. 16 (2): 109–21. doi:10.1007/BF02165710. S2CID 28204791.
  5. ^ O'Connor A (27 September 2005). "The Claim: Thumb Sucking Can Lead to Buck Teeth". The New York Times. Retrieved 1 August 2012.
  6. ^ Friman PC, McPherson KM, Warzak WJ, Evans J (April 1993). "Influence of thumb sucking on peer social acceptance in first-grade children". Pediatrics. 91 (4): 784–6. doi:10.1542/peds.91.4.784. PMID 8464667.
  7. ^ Ferrante A, Ferrante A (August 2015). "[Finger or thumb sucking. New interpretations and therapeutic implications]". Minerva Pediatrica (in Italian). 67 (4): 285–97. PMID 26129804.
  8. ^ Reichenbach E, Brückl H (1982). "Lehrbuch der Kieferorthopädie Bd. 1962;3:315-26.". Kieferorthopädische Klinik und Therapie Zahnärzliche Fortbildung. 5. Auflage Verlag. JA Barth Leipzig" alıntı Schulze G.
  9. ^ a b "Thumbsucking - American Dental Association". Archived from the original on 2010-06-19. Retrieved 2010-05-19.
  10. ^ a b c d Shetty RM, Shetty M, Shetty NS, Deoghare A (2015). "Three-Alarm System: Revisited to treat Thumb-sucking Habit". International Journal of Clinical Pediatric Dentistry. 8 (1): 82–6. doi:10.5005/jp-journals-10005-1289. PMC 4472878. PMID 26124588.
  11. ^ Fukuta O, Braham RL, Yokoi K, Kurosu K (1996). "Damage to the primary dentition resulting from thumb and finger (digit) sucking". ASDC Journal of Dentistry for Children. 63 (6): 403–7. PMID 9017172.
  12. ^ "Stop Thumb Sucking". Stop Thumb Sucking.org.
  13. ^ "Dummy and thumb sucking habits" (PDF). Patient Information Leaflet. British Orthodontic Society.
  14. ^ Borrie FR, Bearn DR, Innes NP, Iheozor-Ejiofor Z (March 2015). "Interventions for the cessation of non-nutritive sucking habits in children". The Cochrane Database of Systematic Reviews. 2021 (3): CD008694. doi:10.1002/14651858.CD008694.pub2. PMC 8482062. PMID 25825863.
  15. ^ Lee MT, Mpavaenda DN, Fineberg NA (2019-04-24). "Habit Reversal Therapy in Obsessive Compulsive Related Disorders: A Systematic Review of the Evidence and CONSORT Evaluation of Randomized Controlled Trials". Frontiers in Behavioral Neuroscience. 13: 79. doi:10.3389/fnbeh.2019.00079. PMC 6491945. PMID 31105537.
  16. ^ "Unique Thumb with Lock Band to Deter Child from Thumb Sucking". Clinical Research Associates Newsletter. 19 (6). June 1995.
  17. ^ Krishnappa S, Rani MS, Aariz S (2016). "New electronic habit reminder for the management of thumb-sucking habit". Journal of Indian Society of Pedodontics and Preventive Dentistry. 34 (3): 294–7. doi:10.4103/0970-4388.186750. PMID 27461817. S2CID 22658574.
  18. ^ "Books on the Subject of Thumb-Sucking". Thumb-Heroes. 9 December 2020.
  19. ^ Stevens Mills, Christine (2018). Two Thumbs Up - Understanding and Treatment of Thumb Sucking. ISBN 978-1-5489-2425-6.

Further reading

[edit]
  • "Duration of pacifier use, thumb sucking may affect dental arches". The Journal of the American Dental Association. 133 (12): 1610–1612. December 2002. doi:10.14219/jada.archive.2002.0102.
  • Mobbs E, Crarf GT (2011). Latchment Before Attachment, The First Stage of Emotional Development, Oral Tactile Imprinting. Westmead.
[edit]
  • "Oral Health Topics: Thumbsucking". American Dental Association. Archived from the original on 2010-06-19.
  • "Pacifiers & Thumb Sucking". Canadian Dental Association.

 

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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  83. ^ Katz, Ilan; Katz, Carmit; Andresen, Sabine; Bérubé, Annie; Collin-Vezina, Delphine; Fallon, Barbara; Fouché, Ansie; Haffejee, Sadiyya; Masrawa, Nadia; Muñoz, Pablo; Priolo Filho, Sidnei R.; Tarabulsy, George; Truter, Elmien; Varela, Natalia; Wekerle, Christine (June 2021). "Child maltreatment reports and Child Protection Service responses during COVID-19: Knowledge exchange among Australia, Brazil, Canada, Colombia, Germany, Israel, and South Africa". Child Abuse & Neglect. 116 (Pt 2): 105078. doi:10.1016/j.chiabu.2021.105078. ISSN 0145-2134. PMC 8446926. PMID 33931238.
  84. ^ Oates, Kim (July 2013). "Medical dimensions of child abuse and neglect". Child Abuse & Neglect. 37 (7): 427–429. doi:10.1016/j.chiabu.2013.05.004. ISSN 0145-2134. PMID 23790510.
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  87. ^ Child Custody & Domestic Violence: A Call for Safety and Accountability. Thousand Oaks, California: SAGE Publications, Inc. 2003. doi:10.4135/9781452231730. ISBN 978-0-7619-1826-4.
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  89. ^ Nixon, Kendra L.; Tutty, Leslie M.; Weaver-Dunlop, Gillian; Walsh, Christine A. (December 2007). "Do good intentions beget good policy? A review of child protection policies to address intimate partner violence". Children and Youth Services Review. 29 (12): 1469–1486. doi:10.1016/j.childyouth.2007.09.007. ISSN 0190-7409.
  90. ^ Holland, S. (1 January 2004). "Liberty and Respect in Child Protection". British Journal of Social Work. 34 (1): 21–36. doi:10.1093/bjsw/bch003. ISSN 0045-3102.
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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

 

 

  • Sub-Millimeter Surgical Dexterity
  • Knowledge of human health, disease, pathology, and anatomy
  • Communication/Interpersonal Skills
  • Analytical Skills
  • Critical Thinking
  • Empathy/Professionalism
  • Private practices
  • Primary care clinics
  • Hospitals
  • Physician
  • dental assistant
  • dental technician
  • dental hygienist
  • various dental specialists
Dentistry
A dentist treats a patient with the help of a dental assistant.
Occupation
Names
  • Dentist
  • Dental Surgeon
  • Doctor

[1][nb 1]

Occupation type
Profession
Activity sectors
Health care, Anatomy, Physiology, Pathology, Medicine, Pharmacology, Surgery
Description
Competencies  
Education required
Dental Degree
Fields of
employment
 
Related jobs
 
ICD-9-CM 23-24
MeSH D003813
[edit on Wikidata]
An oral surgeon and dental assistant removing a wisdom tooth

Dentistry, also known as dental medicine and oral medicine, is the branch of medicine focused on the teeth, gums, and mouth. It consists of the study, diagnosis, prevention, management, and treatment of diseases, disorders, and conditions of the mouth, most commonly focused on dentition (the development and arrangement of teeth) as well as the oral mucosa.[2] Dentistry may also encompass other aspects of the craniofacial complex including the temporomandibular joint. The practitioner is called a dentist.

The history of dentistry is almost as ancient as the history of humanity and civilization, with the earliest evidence dating from 7000 BC to 5500 BC.[3] Dentistry is thought to have been the first specialization in medicine which has gone on to develop its own accredited degree with its own specializations.[4] Dentistry is often also understood to subsume the now largely defunct medical specialty of stomatology (the study of the mouth and its disorders and diseases) for which reason the two terms are used interchangeably in certain regions. However, some specialties such as oral and maxillofacial surgery (facial reconstruction) may require both medical and dental degrees to accomplish. In European history, dentistry is considered to have stemmed from the trade of barber surgeons.[5]

Dental treatments are carried out by a dental team, which often consists of a dentist and dental auxiliaries (such as dental assistants, dental hygienists, dental technicians, and dental therapists). Most dentists either work in private practices (primary care), dental hospitals, or (secondary care) institutions (prisons, armed forces bases, etc.).

The modern movement of evidence-based dentistry calls for the use of high-quality scientific research and evidence to guide decision-making such as in manual tooth conservation, use of fluoride water treatment and fluoride toothpaste, dealing with oral diseases such as tooth decay and periodontitis, as well as systematic diseases such as osteoporosis, diabetes, celiac disease, cancer, and HIV/AIDS which could also affect the oral cavity. Other practices relevant to evidence-based dentistry include radiology of the mouth to inspect teeth deformity or oral malaises, haematology (study of blood) to avoid bleeding complications during dental surgery, cardiology (due to various severe complications arising from dental surgery with patients with heart disease), etc.

Terminology

[edit]

The term dentistry comes from dentist, which comes from French dentiste, which comes from the French and Latin words for tooth.[6] The term for the associated scientific study of teeth is odontology (from Ancient Greek: á½€δούς, romanized: odoús, lit. 'tooth') – the study of the structure, development, and abnormalities of the teeth.

Dental treatment

[edit]

Dentistry usually encompasses practices related to the oral cavity.[7] According to the World Health Organization, oral diseases are major public health problems due to their high incidence and prevalence across the globe, with the disadvantaged affected more than other socio-economic groups.[8]

The majority of dental treatments are carried out to prevent or treat the two most common oral diseases which are dental caries (tooth decay) and periodontal disease (gum disease or pyorrhea). Common treatments involve the restoration of teeth, extraction or surgical removal of teeth, scaling and root planing, endodontic root canal treatment, and cosmetic dentistry[9]

By nature of their general training, dentists, without specialization can carry out the majority of dental treatments such as restorative (fillings, crowns, bridges), prosthetic (dentures), endodontic (root canal) therapy, periodontal (gum) therapy, and extraction of teeth, as well as performing examinations, radiographs (x-rays), and diagnosis. Dentists can also prescribe medications used in the field such as antibiotics, sedatives, and any other drugs used in patient management. Depending on their licensing boards, general dentists may be required to complete additional training to perform sedation, dental implants, etc.

Irreversible enamel defects caused by an untreated celiac disease. They may be the only clue to its diagnosis, even in absence of gastrointestinal symptoms, but are often confused with fluorosis, tetracycline discoloration, acid reflux or other causes.[10][11][12] The National Institutes of Health include a dental exam in the diagnostic protocol of celiac disease.[10]

Dentists also encourage the prevention of oral diseases through proper hygiene and regular, twice or more yearly, checkups for professional cleaning and evaluation. Oral infections and inflammations may affect overall health and conditions in the oral cavity may be indicative of systemic diseases, such as osteoporosis, diabetes, celiac disease or cancer.[7][10][13][14] Many studies have also shown that gum disease is associated with an increased risk of diabetes, heart disease, and preterm birth. The concept that oral health can affect systemic health and disease is referred to as "oral-systemic health".

Education and licensing

[edit]
A sagittal cross-section of a molar tooth; 1: crown, 2: root, 3: enamel, 4: dentin and dentin tubules, 5: pulp chamber, 6: blood vessels and nerve, 7: periodontal ligament, 8: apex and periapical region, 9: alveolar bone
Early dental chair in Pioneer West Museum in Shamrock, Texas

John M. Harris started the world's first dental school in Bainbridge, Ohio, and helped to establish dentistry as a health profession. It opened on 21 February 1828, and today is a dental museum.[15] The first dental college, Baltimore College of Dental Surgery, opened in Baltimore, Maryland, US in 1840. The second in the United States was the Ohio College of Dental Surgery, established in Cincinnati, Ohio, in 1845.[16] The Philadelphia College of Dental Surgery followed in 1852.[17] In 1907, Temple University accepted a bid to incorporate the school.

Studies show that dentists that graduated from different countries,[18] or even from different dental schools in one country,[19] may make different clinical decisions for the same clinical condition. For example, dentists that graduated from Israeli dental schools may recommend the removal of asymptomatic impacted third molar (wisdom teeth) more often than dentists that graduated from Latin American or Eastern European dental schools.[20]

In the United Kingdom, the first dental schools, the London School of Dental Surgery and the Metropolitan School of Dental Science, both in London, opened in 1859.[21] The British Dentists Act of 1878 and the 1879 Dentists Register limited the title of "dentist" and "dental surgeon" to qualified and registered practitioners.[22][23] However, others could legally describe themselves as "dental experts" or "dental consultants".[24] The practice of dentistry in the United Kingdom became fully regulated with the 1921 Dentists Act, which required the registration of anyone practising dentistry.[25] The British Dental Association, formed in 1880 with Sir John Tomes as president, played a major role in prosecuting dentists practising illegally.[22] Dentists in the United Kingdom are now regulated by the General Dental Council.

In many countries, dentists usually complete between five and eight years of post-secondary education before practising. Though not mandatory, many dentists choose to complete an internship or residency focusing on specific aspects of dental care after they have received their dental degree. In a few countries, to become a qualified dentist one must usually complete at least four years of postgraduate study;[26] Dental degrees awarded around the world include the Doctor of Dental Surgery (DDS) and Doctor of Dental Medicine (DMD) in North America (US and Canada), and the Bachelor of Dental Surgery/Baccalaureus Dentalis Chirurgiae (BDS, BDent, BChD, BDSc) in the UK and current and former British Commonwealth countries.

All dentists in the United States undergo at least three years of undergraduate studies, but nearly all complete a bachelor's degree. This schooling is followed by four years of dental school to qualify as a "Doctor of Dental Surgery" (DDS) or "Doctor of Dental Medicine" (DMD). Specialization in dentistry is available in the fields of Anesthesiology, Dental Public Health, Endodontics, Oral Radiology, Oral and Maxillofacial Surgery, Oral Medicine, Orofacial Pain, Pathology, Orthodontics, Pediatric Dentistry (Pedodontics), Periodontics, and Prosthodontics.[27]

Specialties

[edit]
A modern dental clinic in Lappeenranta, Finland

Some dentists undertake further training after their initial degree in order to specialize. Exactly which subjects are recognized by dental registration bodies varies according to location. Examples include:

  • Anesthesiology[28] – The specialty of dentistry that deals with the advanced use of general anesthesia, sedation and pain management to facilitate dental procedures.
  • Cosmetic dentistry – Focuses on improving the appearance of the mouth, teeth and smile.
  • Dental public health – The study of epidemiology and social health policies relevant to oral health.
  • Endodontics (also called endodontology) – Root canal therapy and study of diseases of the dental pulp and periapical tissues.
  • Forensic odontology – The gathering and use of dental evidence in law. This may be performed by any dentist with experience or training in this field. The function of the forensic dentist is primarily documentation and verification of identity.
  • Geriatric dentistry or geriodontics – The delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal aging and age-related diseases as part of an interdisciplinary team with other health care professionals.
  • Oral and maxillofacial pathology – The study, diagnosis, and sometimes the treatment of oral and maxillofacial related diseases.
  • Oral and maxillofacial radiology – The study and radiologic interpretation of oral and maxillofacial diseases.
  • Oral and maxillofacial surgery (also called oral surgery) – Extractions, implants, and surgery of the jaws, mouth and face.[nb 2]
  • Oral biology – Research in dental and craniofacial biology
  • Oral Implantology – The art and science of replacing extracted teeth with dental implants.
  • Oral medicine – The clinical evaluation and diagnosis of oral mucosal diseases
  • Orthodontics and dentofacial orthopedics – The straightening of teeth and modification of midface and mandibular growth.
  • Pediatric dentistry (also called pedodontics) – Dentistry for children
  • Periodontology (also called periodontics) – The study and treatment of diseases of the periodontium (non-surgical and surgical) as well as placement and maintenance of dental implants
  • Prosthodontics (also called prosthetic dentistry) – Dentures, bridges and the restoration of implants.
    • Some prosthodontists super-specialize in maxillofacial prosthetics, which is the discipline originally concerned with the rehabilitation of patients with congenital facial and oral defects such as cleft lip and palate or patients born with an underdeveloped ear (microtia). Today, most maxillofacial prosthodontists return function and esthetics to patients with acquired defects secondary to surgical removal of head and neck tumors, or secondary to trauma from war or motor vehicle accidents.
  • Special needs dentistry (also called special care dentistry) – Dentistry for those with developmental and acquired disabilities.
  • Sports dentistry – the branch of sports medicine dealing with prevention and treatment of dental injuries and oral diseases associated with sports and exercise.[29] The sports dentist works as an individual consultant or as a member of the Sports Medicine Team.
  • Veterinary dentistry – The field of dentistry applied to the care of animals. It is a specialty of veterinary medicine.[30][31]

History

[edit]
A wealthy patient falling over because of having a tooth extracted with such vigour by a fashionable dentist, c. 1790. History of Dentistry.
Farmer at the dentist, Johann Liss, c. 1616–17

Tooth decay was low in pre-agricultural societies, but the advent of farming society about 10,000 years ago correlated with an increase in tooth decay (cavities).[32] An infected tooth from Italy partially cleaned with flint tools, between 13,820 and 14,160 years old, represents the oldest known dentistry,[33] although a 2017 study suggests that 130,000 years ago the Neanderthals already used rudimentary dentistry tools.[34] In Italy evidence dated to the Paleolithic, around 13,000 years ago, points to bitumen used to fill a tooth[35] and in Neolithic Slovenia, 6500 years ago, beeswax was used to close a fracture in a tooth.[36] The Indus valley has yielded evidence of dentistry being practised as far back as 7000 BC, during the Stone Age.[37] The Neolithic site of Mehrgarh (now in Pakistan's south western province of Balochistan) indicates that this form of dentistry involved curing tooth related disorders with bow drills operated, perhaps, by skilled bead-crafters.[3] The reconstruction of this ancient form of dentistry showed that the methods used were reliable and effective.[38] The earliest dental filling, made of beeswax, was discovered in Slovenia and dates from 6500 years ago.[39] Dentistry was practised in prehistoric Malta, as evidenced by a skull which had a dental abscess lanced from the root of a tooth dating back to around 2500 BC.[40]

An ancient Sumerian text describes a "tooth worm" as the cause of dental caries.[41] Evidence of this belief has also been found in ancient India, Egypt, Japan, and China. The legend of the worm is also found in the Homeric Hymns,[42] and as late as the 14th century AD the surgeon Guy de Chauliac still promoted the belief that worms cause tooth decay.[43]

Recipes for the treatment of toothache, infections and loose teeth are spread throughout the Ebers Papyrus, Kahun Papyri, Brugsch Papyrus, and Hearst papyrus of Ancient Egypt.[44] The Edwin Smith Papyrus, written in the 17th century BC but which may reflect previous manuscripts from as early as 3000 BC, discusses the treatment of dislocated or fractured jaws.[44][45] In the 18th century BC, the Code of Hammurabi referenced dental extraction twice as it related to punishment.[46] Examination of the remains of some ancient Egyptians and Greco-Romans reveals early attempts at dental prosthetics.[47] However, it is possible the prosthetics were prepared after death for aesthetic reasons.[44]

Ancient Greek scholars Hippocrates and Aristotle wrote about dentistry, including the eruption pattern of teeth, treating decayed teeth and gum disease, extracting teeth with forceps, and using wires to stabilize loose teeth and fractured jaws.[48] Use of dental appliances, bridges and dentures was applied by the Etruscans in northern Italy, from as early as 700 BC, of human or other animal teeth fastened together with gold bands.[49][50][51] The Romans had likely borrowed this technique by the 5th century BC.[50][52] The Phoenicians crafted dentures during the 6th–4th century BC, fashioning them from gold wire and incorporating two ivory teeth.[53] In ancient Egypt, Hesy-Ra is the first named "dentist" (greatest of the teeth). The Egyptians bound replacement teeth together with gold wire. Roman medical writer Cornelius Celsus wrote extensively of oral diseases as well as dental treatments such as narcotic-containing emollients and astringents.[54] The earliest dental amalgams were first documented in a Tang dynasty medical text written by the Chinese physician Su Kung in 659, and appeared in Germany in 1528.[55][56]

During the Islamic Golden Age Dentistry was discussed in several famous books of medicine such as The Canon in medicine written by Avicenna and Al-Tasreef by Al-Zahrawi who is considered the greatest surgeon of the Middle Ages,[57] Avicenna said that jaw fracture should be reduced according to the occlusal guidance of the teeth; this principle is still valid in modern times. Al-Zahrawi invented over 200 surgical tools that resemble the modern kind.[58]

Historically, dental extractions have been used to treat a variety of illnesses. During the Middle Ages and throughout the 19th century, dentistry was not a profession in itself, and often dental procedures were performed by barbers or general physicians. Barbers usually limited their practice to extracting teeth which alleviated pain and associated chronic tooth infection. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac most probably invented the dental pelican[59] (resembling a pelican's beak) which was used to perform dental extractions up until the late 18th century. The pelican was replaced by the dental key[60] which, in turn, was replaced by modern forceps in the 19th century.[61]

Dental needle-nose pliers designed by Fauchard in the late 17th century to use in prosthodontics

The first book focused solely on dentistry was the "Artzney Buchlein" in 1530,[48] and the first dental textbook written in English was called "Operator for the Teeth" by Charles Allen in 1685.[23]

In the United Kingdom, there was no formal qualification for the providers of dental treatment until 1859 and it was only in 1921 that the practice of dentistry was limited to those who were professionally qualified. The Royal Commission on the National Health Service in 1979 reported that there were then more than twice as many registered dentists per 10,000 population in the UK than there were in 1921.[62]

Modern dentistry

[edit]
A microscopic device used in dental analysis, c. 1907

It was between 1650 and 1800 that the science of modern dentistry developed. The English physician Thomas Browne in his A Letter to a Friend (c. 1656 pub. 1690) made an early dental observation with characteristic humour:

The Egyptian Mummies that I have seen, have had their Mouths open, and somewhat gaping, which affordeth a good opportunity to view and observe their Teeth, wherein 'tis not easie to find any wanting or decayed: and therefore in Egypt, where one Man practised but one Operation, or the Diseases but of single Parts, it must needs be a barren Profession to confine unto that of drawing of Teeth, and little better than to have been Tooth-drawer unto King Pyrrhus, who had but two in his Head.

The French surgeon Pierre Fauchard became known as the "father of modern dentistry". Despite the limitations of the primitive surgical instruments during the late 17th and early 18th century, Fauchard was a highly skilled surgeon who made remarkable improvisations of dental instruments, often adapting tools from watchmakers, jewelers and even barbers, that he thought could be used in dentistry. He introduced dental fillings as treatment for dental cavities. He asserted that sugar-derived acids like tartaric acid were responsible for dental decay, and also suggested that tumors surrounding the teeth and in the gums could appear in the later stages of tooth decay.[63][64]

Panoramic radiograph of historic dental implants, made 1978

Fauchard was the pioneer of dental prosthesis, and he invented many methods to replace lost teeth. He suggested that substitutes could be made from carved blocks of ivory or bone. He also introduced dental braces, although they were initially made of gold, he discovered that the teeth position could be corrected as the teeth would follow the pattern of the wires. Waxed linen or silk threads were usually employed to fasten the braces. His contributions to the world of dental science consist primarily of his 1728 publication Le chirurgien dentiste or The Surgeon Dentist. The French text included "basic oral anatomy and function, dental construction, and various operative and restorative techniques, and effectively separated dentistry from the wider category of surgery".[63][64]

A modern dentist's chair

After Fauchard, the study of dentistry rapidly expanded. Two important books, Natural History of Human Teeth (1771) and Practical Treatise on the Diseases of the Teeth (1778), were published by British surgeon John Hunter. In 1763, he entered into a period of collaboration with the London-based dentist James Spence. He began to theorise about the possibility of tooth transplants from one person to another. He realised that the chances of a successful tooth transplant (initially, at least) would be improved if the donor tooth was as fresh as possible and was matched for size with the recipient. These principles are still used in the transplantation of internal organs. Hunter conducted a series of pioneering operations, in which he attempted a tooth transplant. Although the donated teeth never properly bonded with the recipients' gums, one of Hunter's patients stated that he had three which lasted for six years, a remarkable achievement for the period.[65]

Major advances in science were made in the 19th century, and dentistry evolved from a trade to a profession. The profession came under government regulation by the end of the 19th century. In the UK, the Dentist Act was passed in 1878 and the British Dental Association formed in 1879. In the same year, Francis Brodie Imlach was the first ever dentist to be elected President of the Royal College of Surgeons (Edinburgh), raising dentistry onto a par with clinical surgery for the first time.[66]

Hazards in modern dentistry

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Long term occupational noise exposure can contribute to permanent hearing loss, which is referred to as noise-induced hearing loss (NIHL) and tinnitus. Noise exposure can cause excessive stimulation of the hearing mechanism, which damages the delicate structures of the inner ear.[67] NIHL can occur when an individual is exposed to sound levels above 90 dBA according to the Occupational Safety and Health Administration (OSHA). Regulations state that the permissible noise exposure levels for individuals is 90 dBA.[68] For the National Institute for Occupational Safety and Health (NIOSH), exposure limits are set to 85 dBA. Exposures below 85 dBA are not considered to be hazardous. Time limits are placed on how long an individual can stay in an environment above 85 dBA before it causes hearing loss. OSHA places that limitation at 8 hours for 85 dBA. The exposure time becomes shorter as the dBA level increases.

Within the field of dentistry, a variety of cleaning tools are used including piezoelectric and sonic scalers, and ultrasonic scalers and cleaners.[69] While a majority of the tools do not exceed 75 dBA,[70] prolonged exposure over many years can lead to hearing loss or complaints of tinnitus.[71] Few dentists have reported using personal hearing protective devices,[72][73] which could offset any potential hearing loss or tinnitus.

Evidence-based dentistry

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There is a movement in modern dentistry to place a greater emphasis on high-quality scientific evidence in decision-making. Evidence-based dentistry (EBD) uses current scientific evidence to guide decisions. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on the latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.[74] It was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. It is part of the larger movement toward evidence-based medicine and other evidence-based practices, especially since a major part of dentistry involves dealing with oral and systemic diseases. Other issues relevant to the dental field in terms of evidence-based research and evidence-based practice include population oral health, dental clinical practice, tooth morphology etc.

A dental chair at the University of Michigan School of Dentistry

Ethical and medicolegal issues

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Dentistry is unique in that it requires dental students to have competence-based clinical skills that can only be acquired through supervised specialized laboratory training and direct patient care.[75] This necessitates the need for a scientific and professional basis of care with a foundation of extensive research-based education.[76] According to some experts, the accreditation of dental schools can enhance the quality and professionalism of dental education.[77][78]

See also

[edit]
  • Dental aerosol
  • Dental instrument
  • Dental public health
  • Domestic healthcare:
    • Dentistry in ancient Rome
    • Dentistry in Canada
    • Dentistry in the Philippines
    • Dentistry in Israel
    • Dentistry in the United Kingdom
    • Dentistry in the United States
  • Eco-friendly dentistry
  • Geriatric dentistry
  • List of dental organizations
  • Pediatric dentistry
  • Sustainable dentistry
  • Veterinary dentistry
 

Notes

[edit]
  1. ^ Whether Dentists are referred to as "Doctor" is subject to geographic variation. For example, they are called "Doctor" in the US. In the UK, dentists have traditionally been referred to as "Mister" as they identified themselves with barber surgeons more than physicians (as do surgeons in the UK, see Surgeon#Titles). However more UK dentists now refer to themselves as "Doctor", although this was considered to be potentially misleading by the British public in a single report (see Costley and Fawcett 2010).
  2. ^ The scope of oral and maxillofacial surgery is variable. In some countries, both a medical and dental degree is required for training, and the scope includes head and neck oncology and craniofacial deformity.

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Frequently Asked Questions

Relapse in orthodontic treatment refers to the movement of teeth back to their original positions after the braces or aligners have been removed. It can undo the progress made during treatment.
Relapse can occur due to several factors, including the natural growth and development of a childs jaw, failure to wear retainers as instructed, or genetic predispositions that influence tooth positioning.
To prevent relapse, its crucial for your child to wear their retainers as prescribed by the orthodontist. Regular follow-up appointments and good oral hygiene practices also play a significant role in maintaining the results of the treatment.
If you notice any signs of relapse, such as shifting teeth or changes in bite, contact your orthodontist immediately. They can assess the situation and recommend adjustments to the treatment plan, which may include wearing retainers more frequently or considering additional orthodontic intervention.