Orthodontic treatment with orthopedic appliances may result in failure because of lack of patients'cooperation unless they are used after sufficient motivation.We encountered a patient who developed school refusal after treatment with a maxillary forward protractor at a dental clinic without adequate motivation.
The patient was a girl aged 10 years and 2 month at her first visit to our department.She had consulted a dentist due to reverse occlusion, and was prescribed to wear a maxillary forward protractor, which is of the largest dimensions among orthodontic appliances.However, this appiance was poorly accepted by the patient, and as it induced bullying by her school mates, she began to refuse to go to school.This condition was not relieved even after discontinuation of the use of the appliance, and the patient was referred to our Department of Orthodontics.
Our examination suggested that there was no malpractice by the dentist but that his explanation was inadequate.After repeated consultations with the patient and her parents, we considered that correction of occlusion by application of a chin cap and an inter-maxillary anchorage will yield better results.The treatment was initiated immediately, and occlusion could be improved in 2 months.
The patient gradually began to go to school from immediately after this with more selfconfidence due to marked improvement in her appearance associated with the improvement of occlusion, and school refusal was resolved about 5 months after the initiation of the treatmemt. Presently, a chin cap is applied as a retainer during sleep for growth of the mandible.
This patient demonstrated that careless use of an orthodontic appliance which is poorly accepted by the patient causes considerable psychological as well as physical stress especially in children and adolescents even if the treatment is correct.
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