Australian Dental Journal, August, 1978
usually ask one to speak to the child. Maybe the dental profession should support recent trends of law-carbohydrate dieting (e.g., “Dr Aiken’s Diet Revolution”). It is my experience that if an orthodontist consistently insists on a low caries experience before undertaking mechanotherapy, he does not lose many friends either within the profession or the community because it can be strongly painted out, by an analogy, that it is more economic in time and money to get the mouth healthy beforehand. Still on the subject of cements, it is strange that those with stannous fluoride have not gained wider acceptance. Possibly this is due to the facts that tests on one of the earlier products indicated it did not have top physical qualities and that clinicians are wary of the staining properties. Logically, the European trend t o re-introduce heavy metals such as copper into cements for their apparent bacteriostatic effects is worthwhile following in view of the unfortunate experience with the bland carboxylates. As you suggest, sodium fluoride can be added to chlorhexidine, and up to two per cent without a deterioration of taste. However, even small concentrations of acidulated fluoride render it unacceptable for oral use. Chlorhexidine administered by toothbrush each visit (i.e., once per month) has not produced a sensitivity case in more than five years of use in my practice, nor has staining been
a problem at this frequency. It would be interesting
to know if the fluoride and chlorhexidine act synergistically on the bacterial population of the plaque. Certainly, the gingivae looks excellent two or three days after a chlorhexidine-fluoride toothbrushing. However, despite these clinical aids, the rash of home-application products coming on the market, and the most conscientious selection of patients for mechanotherapy, there are always a few who lose interest within treatment (which means less co-operation and increased treatment time) and cease maintaining good oral hygiene (which is said to hasten the breakdown of cements); such that the orthodontist has a perplexing problem as to whether to cease or continue treatment. “Nothing succeeds like success” and, for the sake of one’s reputation orthodontically, the decision is often made to press on since previous experience has shown that interest can be rekindled. Nevertheless, in most of these cases, the ravages are more gingival than caries with the use of fluorides mentioned earlier, and even this gingival condition improves immensely following removal of appliances.
B. MQLLENHAUER. 299 Upper Heidelberg Road, Ivanhoe. Vic.. 3079. June 7, ‘1978.-
UNERUPTED THIRD MOLARS
Sir, May I use your columns to air an old controversy? In general practice one is constantly faced with the problem of treatment planning for young teenagers who have all their permanent teeth erupted except the third molars, but with mild to moderate crowding already present. Many of these young patients decline active orthodontic treatment. So the problem then becomes - is it helpful to extract their unerupted eights? In the past, I have confidently recommended such extractions (or removal of lower eights and upper sevens, where radiographs show the unerupted eight should eventually erupt into the vacated seven position). My advice has been on the lines that this won’t make the crowding any better but it should prevent it getting worse. Over the years, I have certainly gained the impression that the patients who have had these extractions done mostly suffer no further anterior crowding; whilst similar patients, who do not have
them carried out, become more crowded. Young patients themselves sometimes tell me that their anterior teeth became crowded as their wisdom teeth erupted. Some even claim they feel pressure symptoms in their lower incisors as their eights erupt. So I have been led to the belief that eruption of third molars can cause anterior crowding - or at least can exacerbate the crowding already present. Yet I am assured by many colleagues that this is not so. I understand the scientific studies reveal no relationship between imbricated lower incisors and the presence or absence of lower third molars. It is a “myth”, I am told, that removing unerupted third molars in young teenagers can prevent imbrication of their incisors. So I write in the hope of sparking discussion of this perennial problem and thereby gleaning more information. DAVIDR. HANNAH. 452 Riverton Drive East, Riverton, W.A., 6155. June 8, 1978.