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Fig. 1.10 An 8‐year‐old child exhibits an unerupted maxillary left central incisor with two supernumerary teeth superimposed, pointing in opposite directions. The permanent incisor is developed adequately for eruption (retarded eruption) and the deciduous incisor is over‐retained.

Patient motivation and the orthodontic option

      Angle’s class II malocclusion is to be found in 20–25% of the child population in most countries of the Western world [17, 18]. However, this is not reflected in an orthodontic practitioner’s office, where one finds that up to 75% of patients are being treated for this malocclusion. The reason for this incongruity in seeking treatment is entirely facial appearance, since the visible manifestation of the condition causes the patient’s appearance to be adversely affected to a much greater extent than by most other conditions. In other words, appearance plays an extremely large part in the initiative and motivation of the parent to seek treatment for the child and for the child to be ready to be treated.

      Most of the other patients on the orthodontist’s roster are being treated for additional (though arguably less unsightly) conditions (such as crowding, single ectopic teeth, open bites or class III relationships). It follows that relatively few patients with acceptable appearance have been referred for strictly health reasons, which may not normally be apparent to the patient. This small number of patients will have agreed to orthodontic treatment only after being motivated by the careful and persuasive explanations of a general or paediatric dentist, orthodontist, periodontist, prosthodontist or oral surgeon, who will have warned them of the ills that are otherwise likely to befall them and their dentition.

      Aside from maxillary central incisors, most impactions are symptomless and do not usually present an obviously abnormal appearance. The natural result is that motivation for treatment in symptom‐less cases is minimal and much time has to be spent in explanations to patients before they accept that treatment is appropriate and before they are prepared to accept the constraints entailed in its execution.

However, the story does not end there, since most patients require periodic ‘pep talks’ to maintain their cooperation and their resolve to complete the treatment. Many patients may not maintain the required standard of oral hygiene, thus rendering the continuation of treatment difficult if not impossible. On the other hand, it is just as difficult to remove appliances from a patient in the middle of treatment, when impacted teeth have partially erupted and large spaces are already present in the dental arch. For these reasons, although ambitious and innovative treatment plans are in order, it is essential to take into account the aspect of motivation before advising lengthy and complicated treatment, since the risk of the treatment being prematurely aborted may be high.

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