That’s what you can do in your Medical Intervention of Orthodon-tic Treatment! The Second Factor: The Human Body Existing in its Envi-ronment, Nature Our human bodies are not capa-ble of regulating themselves, like “physiologic islands” but each body rather, exists and is regulated -or not -in tandem with trillions of microorganisms, hosted by the body. As science discovers and reports this amazing interplay of bacterial life and the human body, we begin to be awed and quite frankly, stymied by how to best reduce risks and control the “bad bugs,” and allow the “good bugs” to flourish. If they do not, the human body does not survive. You have heard the idea of ingesting “good bugs” called “probiotics,” which are micro organisms that keep us healthy and alive. The National Institute for Health, NIH, Human Microbiome Project defined normal bacterial makeup of the body, and reported that microbes inhabit almost every part of the human body, including the skin, the GI tract and respira-tory tract. Most of the time these bacteria live in harmony with the body and provide necessary func-tions for human survival, includ-ing major immune and anti-inflammation functions. These microbes outnumber human cells in your body by ten times. Remember, there are trillions of them in your body, though the microbes are much smaller than human cells, so they are only about 1-3 percent of your body weight -about as much as your brain. In a 200-pound man, that would be 2-6 pounds of weight of bacteria. The project calculated that more than 10,000 different micro-bial species are in human bodies, and the researchers believe they have identified 81-99 percent of those microbes. What do the friendly bugs do for us? They provide enzymes so we can digest our own food, and absorb what we need. They produce vitamins and anti-inflam-“Because white spot lesions appear much more frequently in males than in females, (the Tufekci study showed 76% of patients with such damage were male) observation with appropriate referral to Pediatric Dentist or Gp for regular evaluative and preventive care is especially important in boys, and appropriate encouragement of adjunctive therapies, as above, should be considered especially in boys with higher plaque levels.” matories that we cannot. They help pregnant women prepare for birth, changing the vaginal microbial population to a healthy one for the baby to pass through, and provide the baby with its first dose of microbes that the baby will need. The friendly bugs help your body deal with the unfriendly bugs. Researchers found that almost everyone routinely carries pathogens or “bad bugs.” In healthy people, they cause no disease, and just co-exist with the body (their host) and its total microbiome. However, these pathogens are etiologic in disease states such as infections, heart disease and cancers. Additionally, nutrition and diet are critical parts of the body’s interaction with its envi-ronment, as frequent snacking and high carbohydrates and sugars help the pathogens over-take the friendly microbes. In dentistry we are most aware of the potential pathologic bacte-ria-host interactions that cause gingivitis, decay, periodontal disease and other oral pathology. This is a factor about which you, as the doctor, can contribute little to reduce the risk of white spot lesions. The most healthful lifestyles and habits are up to the patient. Your encouragement might be helpful -but often the lifestyles and habits do not change. Finally, the third factor which is the patient’s (and, for a child patient, the parents’) degree of participation, again, offer your encouragement. But expend your energy on the medical intervention -your treatment -and consider terminating treatment if it is appro-priate to help the patient whose participation is inadequate. A word about prevention -if before treat-ment is begun, a parent says to you, “My child won’t…” -the parent is right. Save yourself the headache, save the parent and child the angst, and don’t start treatment. As you consider the interplay between these three areas that determine the risk and actuality of damage during orthodontic treat-ment, you can know where you can impact the risks and how you can do so. Once you determine these, you can then happily provide orthodontic treatment that transforms lives, including your own, and help people have beauti-ful smiles, the best possible self-view, and the most comfortable and functional occlusion possible. References 1. www.relianceorthodontics.com 2. Lapenaite E, Lopatiene K, Ragauskaite A. Prevention and treat-ment of white spot lesions during orthodontic treatment: A systematic literature review Stomatologija, Baltic Dental and Maxillofacial Jour-nal, 18: 3-8, 2016, 3. www.speareducation.com/spear-review/2013/06/how-to-manage-white-spot-lesions. 4. Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011 Mar; 81(2):206-10. doi: 10.2319/051710-262.1. 5. Maxfield BJ, Hamdan AM, Tüfekçi E, Shroff B, Best AM, Lindauer SJ. Development of white spot lesions during orthodontic treatment: Perceptions of patients, parents, orthodontists, and general dentists. Am J Orthod Dentofacial Orthop, March 2012. V 141: (3), 337–44. 6. Tufekci E, Dixon JS, GunsolleyJC, and Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. The Angle Orthodontist: March 2011, Vol. 81, No. 2, pp. 206 210.https:// doi.org/10.2319/051710-262.1 16 Winter 2018 JAOS
Journal of the American Orthodontic Society Winter 2018: Page 16
