Periodontal pathogen levels in adolescents before, during, and after fixed orthodontic appliance therapy.

INTRODUCTION: This purpose of this study was to document and investigate changes in periodontal pathogen levels before, during, and after orthodontic treatment in adolescents. METHODS: DNA gene probe analysis was used to quantify the levels of 8 periodontal pathogens before, during, and after treatment with fixed orthodontic appliances in 190 concurrently treated adolescent orthodontic patients. The 8 pathogens examined were Actinobacillus actinomycetemcomitans (AA), Porphyromonas gingivalis (PG), Prevotella intermedia (PI), Tannerella forsythia (TF), Eikenella corrodens (EC), Fusobacterium nucleatum (FN), Treponema denticola (TD), and Campylobacter rectus (CR). Chi-square tests were used to determine whether the percentages of subjects with high counts significantly changed over time. Logistic regression analyses were also performed to derive the relative risk of higher counts of pathogenic bacteria with fixed appliances at the various time intervals studied. RESULTS: For 6 (PI, TF, EC, FN, TD, CR) of the 8 pathogens, the percentages of subjects with high pathogen counts increased significantly after 6 months of fixed appliance treatment, but these returned to pretreatment levels by 12 months of orthodontic treatment. No pathogen level was significantly higher after 12 months of orthodontic treatment, and orthodontic treatment was found to be significantly protective for half of the pathogens (EC, FN, TD, CR) posttreatment. CONCLUSIONS: Orthodontic treatment with fixed appliances does not increase the risk of high levels of these periodontal pathogens.

The American Board of Orthodontics: Diplomate recertification.

Although some specialty certifying boards began recommending or requiring recertification of their "boarded" specialists as early as 1986, recertification is a relatively new concept for the specialty of orthodontics. In the mid 1990s, the American Board of Orthodontics (ABO) recognized that many other medical and dental specialty boards had already established voluntary or mandatory recertification policies and decided to establish its own time-limited certifying policy. After a series of field tests involving former directors, council members of the College of Diplomates of the ABO, and volunteer diplomates, the ABO instituted a recertification policy for candidates who applied for initial certification after January 1, 1998. Since then, the total number of diplomates who have been recertified has steadily increased. Surveys of successfully recertified diplomates reflect a positive feeling about the process. When medical and dental specialists are expected to be more accountable, recertification has been shown to be a valid method to help ensure continued competency. The ABO believes that the formulation of educational and certifying processes to document a diplomate's clinical competency throughout his or her career will help to serve the public welfare. The ABO is attempting to make initial certification and periodic recertification attainable for more orthodontists and, in so doing, to provide a standard by which we exist as a specialty.

The ABO discrepancy index: a measure of case complexity.

A criterion for determining the acceptability of a case presented for the American Board of Orthodontics (ABO) Phase III clinical examination is case difficulty. Case difficulty can often be subjective; however, it is related to case complexity, which can be quantifiable. Over the past 5 years, the ABO has developed and field-tested a discrepancy index, made up of various clinical entities that are measurable and have generally accepted norms. These entities summarize the clinical features of a patient's condition with a quantifiable, objective list of target disorders that represent the common elements of an orthodontic diagnosis: overjet, overbite, anterior open bite, lateral open bite, crowding, occlusion, lingual posterior crossbite, buccal posterior crossbite, ANB angle, IMPA, and SN-GoGn angle. The greater the number of these conditions in a patient, the greater the complexity and the greater the challenge to the orthodontist. The ABO is considering several options for applying the discrepancy index to the Phase III clinical examination.