The impact of changing patterns in dental diseases on the practice of orthodontics.

The caries decline occurring in most industrialized countries has undoubtedly had an impact on the dental care of children and adolescents. Such an epidemiological change is of consequence both for the undergraduate and the postgraduate training of dentists. It raises questions about the relevance to present needs of specialists in paedodontics and in orthodontics. Although high levels of skill have been reached in these two fields, such skills cannot always be applied to the full benefit of the child. This refers not so much to the care of the individual but rather to group care within the framework of school programmes. Whilst the caries decline is evident there is no conclusive evidence of a parallel reduction in dentofacial anomalies by preventive measures within the population, although there has been some demonstration of this in the 'International Collaborative Study of Dental Manpower Systems' (ICS-I) of the WHO. The decline in total childhood treatment demand will set free, in the first instance, the working capacity of the paedodontist and enable him to embrace new tasks, including the prevention of dentofacial anomalies by interceptive measures. In those countries where separate specialties of paedodontics and orthodontics exists, such as in the USA and the German Democratic Republic, their gradual merging should be considered. The epidemiological change in oral diseases will require that in future one specialist shall provide comprehensive dental care for the child. For the relatively few complicated dentofacial anomalies which will still exist a super specialist service will be needed for individual cases.