03 April 2015

Adult Orthodontics – An update by Farhad Moshiri, D.M.D., M.S.

Adult  Orthodontics – An update


The preceding 100 year history of American orthodontics has witnessed cyclic trends in the attitude toward, and the practice of, the treatment of the adult patient. Whatever popular opinion may hold, however, adult orthodontics is a fact of life. In the 30 years following , the number of 12-year-old patients per practicing orthodontist has decreased by almost 80%. Additionally, according to a 1970 AAQ poll, 90% of responding orthodontists reported treating patients over 21 years of age. With the adult patient, treatment is quite different than with the typical adolescent. As the patient has been the proud owner of his dentition for a longer period of time, it undoubtedly presents in a somewhat more altered state (periodontally, restoratively, etc.). Treatment must be de- signed in a problem-oriented approach to achieve an improvement of the presenting condition rather than the “ideal” result sought in the younger patient. Our adult patients are physiologically and psychologically less adaptive, forcing us to proceed more cautiously both in treatment and the preparation for treatment. It is rec- ommended that prior to any orthodontic therapy, the adult patient receive a comprehensive periodontal ex- amination and evaluation of TMJ status with particular reference to the presence of symptoms in relation to the presenting problem. Accurate determinations of chief complaint, medical history, and patient expectations are critical elements that must occur prior to reaching far the separators. Many patients are presenting for consultation as a result of the wide publicity lingual treatment has received in the popular press. The limited applicability, increased cost, and difficulty of patient adaptation are all factors mitigating against this regimen meeting every adult’s preoccupation with esthetics during treatment…

Joseph Carastro IV, D.M.D., M.P.H. U.S. Army Dental Corps Fort Knox, Ky.

Farhad Moshiri, D.M.D., M.S.
Clinical Associate Professor Department of Orthodontics,
University of Louisville Private practice, St. Louis, MO.


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