Orthodontic Management in Pandemic

Dr Akshay Gupta

Covid -19 has been an unforeseen event that has shaken the world to its roots, every one of us are undergoing tumultuous phase. It’s redefining our lifestyle, and professional life.
We know that sunflowers turn according to the position of the sun and this “chasing the light” phenomenon is called Heliotropism. What happens when it is cloudy or dark? Does the sunflower turn its head towards the ground? No…. they turn to east, anticipating the Sun’s return. Nature has so much to teach us. This is what has happened in this moment of crisis. People have developed sunflower traits to look on the sunny side with hope for a new dawn.
Like all events, the WOHD 2020 is drastically different from how it is celebrated every year and the whole Orthodontic World is marking this day in their respective place and reaching globally via virtual platforms. This year too, Students and Interns of Department of Orthodontics IGGDC Jammu have played pivotal role by preparing posters and models for public education, but all this amid lockdown and within the confines of their home.
The main aim of celebrating this day – May 15th every year as the “World Orthodontic Health Day” is to create the awareness of ill effects of malocclusion and to promote the science of Orthodontics to solve this problem. Malocclusion means that teeth are out of their normal positions in an individual, malocclusion can manifest in a wide range in the dental arch like – spacing/crowding/protrusion/ retrusion /rotation and so forth.
Malocclusion effects dental & facial aesthetics, compromises the functions of the oral cavity i.e. chewing, breathing. Loss of tooth substance (attrition) leading to hypersensitivity of teeth, increased susceptibility to trauma, more prone to dental diseases, obstructive sleep apnoea & difficulty in articulation leading to lack of clarity of certain words. All these adversely affect the quality of life leading to poor social image and psychological disturbances.
Improved smile/facial aesthetics, Improved oral functions, Better dental health, Positive psychological outlook; Reduction of Obstructive sleep apnoea are some of the benefits of orthodontic treatment
Depending upon the age and severity of the problem, the various treatment options available to the patients are: Removable appliances, Preventive appliances, Functional & Orthopaedic appliances, Invisalign/Aligners -and Fixed Orthodontic appliances (Braces)
Usually fixed orthodontic treatment commences at the age of 12-13yrs, i.e when all the permanent teeth have emerged in the mouth. But there are instances when the preliminary treatment is initiated as early as 8-9yrs.
The types of fixed braces are -Metal braces, Ceramic braces and Lingual braces- placed on the inner aspect of the teeth
Orthodontic Management during the Pandemic
Orthodontists must be cognizant of the available evidence to provide a safe environment for themselves and their patients and should strictly adhere to the most up to-date recommendations from health governing authorities. In the current stage of the COVID-19 pandemic, most authorities have suggested that all elective and routine dental procedures should be suspended and that only emergency dental treatment may be provided.
Orthodontic emergencies may include, wire pricking in the soft tissues, the embedment of an orthodontic appliance into the gingival or oral mucosa, TPA,TADs, class11 correctors which are likely to be ingested , or conditions where a lack of management would be harmful to the Patient.
Key steps are recommended
* Provide active patients with recommendations on treatment progression (eg, when to stop turning an expander, what to do when the patient has reached their final aligner, etc)
* Provide a means of communication (phone number or email) to patients to allow them to contact for any questions or concerns, and send problem related intraoral mobile-phone digital images.
* If appropriate, an over-the-counter analgesic may be prescribed for mild pain.
* Use phone calls or, where possible, video-calling or appropriate tele dentistry facilities to assist patients in resolving any emergent orthodontic problem that can be managed at home and to determine which patients need in-person
When a patient needs to be seen clinically
* It is recommended that the patient enter the clinic with a maximum of one accompanying person
* Washing hands with soap, or alcohol based hand rub is recommended
* After recording the temperature of every person entering the registration area, a screening questionnaire should be completed
* Where possible, only the patient should be allowed to enter the clinical/operatory area
* Covid-19 is vulnerable to oxidation; therefore, pre-procedural mouth rinse containing 1% hydrogen peroxide or 0.2% povidone-iodine is advised.
During the pandemic, practitioners should refrain from performing any procedures that lead to aerosols. It is recommended that N95 masks, eye protection, a gown, and gloves should be used for any aerosol producing procedure that must be completed, and that they should ideally take place in an AIIR, as asymptomatic individuals can transmit COVID-19.
During the provision of emergency treatment, the practitioner must be careful to do only what is necessary to resolve the emergency and to take the patient to a position of safety.
We are in this together – and we will get through this together
(The author is Professor & Head,
Department Of Orthodontics I.G.
Govt. Dental College Jammu)