Management of Lower Incisor Crowding: The Effect of Specialty Training on Treatment Decisions

Objectives: The purpose of this study was to investigate treatment approaches for management of mandibular incisor crowding in the transitional dentition between general dentists (GP), pediatric dentists (PD) and orthodontists (OR).
Methods: An online survey depicting five different scenarios of lower incisor crowding in the transitional dentition was sent by email to 300 GP, 300 PD and 300 OR randomly selected from the AAPD, AAO, and AGD membership directories. The scenarios consisted of a single mandibular occlusal photograph and five treatment options that were the same in each scenario. Descriptive statistics were used to characterize the survey respondents within each practitioner group along with their treatment approaches to each clinical scenario.
Results: Responses were obtained from 20 GP, 35 PD, 30 OR and 8 others. Statistically significant differences in treatment approaches between GP, PD and OR groups (p=0.0001; Fisher’s Exact Test) were noted in the clinical scenario describing early loss of a single lower deciduous canine. Fifty-five percent of GP respondents recommended no treatment or observation, while the majority of OR (90%) and PD (60%) respondents recommended treatment. All other clinical scenarios demonstrated similar treatment approaches from each of the three practitioner groups. Location of dental training, location of specialty training or years of practice had no effect on treatment recommendations for all cases.
Conclusions: A difference exists in treatment approaches for management of mandibular incisor crowding between different practitioner groups. Location of training and years of practice had no effect on the treatment recommendations.