Editor’s Choice

CONTENTS

Editor’s Choice

Psychiatry in orthodontics: Part 1. Typicaladolescent psychiatric disorders and theirrelevance to orthodontic practice; Part 2.Substance abuse among adolescents andits relevance to orthodontic practiceBy Wendell W. Neeley II, Thomas Kluemper, andLon R. Hays

Our cover story in this issue is a unique two-partreview of the psychiatric and substance abuse issuesthat can afflict young people. Adolescence is a time ofrapid physical and mental development, and it is a timewhen many psychiatric diseases are first noticed. InPart 1, the authors review the psychiatric problems thatare most often noted during the teen years. Does thefact that orthodontic treatment occurs regularly over thecourse of several years—including the teen years—bestow any special responsibility on clinicians? What isthe orthodontist’s responsibility for recognizing prob-lems and making referrals?

Part 2 of this article examines various types ofsubstance abuse, and looks at diagnosis, options forreferral, and potential orthodontic implications. Onceagain, what is the role of the orthodontic practitionerwhen recent data show that nearly 40% of all tenthgraders across the United States will try an illicit drug?It is imperative that the orthodontist become familiarwith the statistics of drug use, be aware of which drugsare “popular” at the moment, learn to detect signs ofsubstance abuse, and know what steps to take to helppatients who might have a substance abuse problem.

Orthodontists and sleep-disorderedbreathingBy Alan Lowe

As our profession recognizes the importance of interac-tions between craniofacial form and overall health, orthodon-tists might be expected to become proficient in a broaderrange of health care issues. Under Canadian guidelines,patients who require oral appliances for treatment of snoring

Am J Orthod Dentofacial Orthop 2006;129:10A0889-5406/$32.00Copyright © 2006 by the American Association of Orthodontists.

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or obstructive sleep apnea are referred directly to an orth-odontist. Are orthodontists uniquely equipped to manage themore than 80 different oral appliances currently available totreat snoring and sleep apnea? If not, is this becoming anunmet need within the larger community? Alan Lowe’scommentary introduces 4 original research reports related tosleep apnea treatment.

In a 2-part article, Almeida et al documented someof the changes observed in the dentition after long-termwear of oral appliances. It appears that the occlusalchanges are predominantly dental in nature and occurafter more than 2 or 3 years of wear. Marklund found areduction in overjet over time associated with initialbite depth, type of device, and nasal congestion. Otsukadocumented a better response to therapy in thoseposttitration subjects who exhibited a more anteriorvelopharyngeal wall, a larger radius of curvature of theairway, and an increase in velopharyngeal size.

Orthodontists who treat patients with sleep-disorderedbreathing are often surprised at how grateful their patientsare after only a few nights of uninterrupted sleep. Sub-stantially changing the quality of a patient’s life with anoral appliance can be a very rewarding experience.

Factors influencing treatment time inorthodontic patientsBy Kirsty J. Skidmore, Karen J. Brook,W. Murray Thomson, and Winifred J. Harding

At the end of an extended period of treatment,reviewing a patient’s chart will usually reveal the reasonstreatment was delayed. What factors are typically relatedto excessive time in braces? And how valuable would it beto your practice if you could more accurately predicttreatment time by using a small number of personalcharacteristics and treatment decisions?

This study is a retrospective analysis of meticu-lously maintained treatment notes kept by a singlepracticing orthodontist. Factors found to adverselyinfluence treatment time included maxillary crowdingof 3 mm or more, a Class II molar relationship, anddelayed extractions. Variables associated with patientcooperation included poor oral hygiene, poor elasticwear, bracket breakage, and brackets rebonded forrepositioning. Every practitioner can find something for