Adverse effects of orthodontic treatment Flashcards
What are the adverse effects of orthodontic treatment
- Enamel damage
. Periodontal disease
. Root damage
. Other
Informed consent
- Patient and parent should be
warned of risks - Information leaflet
- Written record of warnings in
notes
. Pre-treatment records
Enamel damage
- Decalcification
- Enamel wear
–ceramic brackets - Enamel fracture
–debonding - rare
The white spot lesion
- Precursor of enamel caries
- Accumulation of plaque adjacent to brackets
- Deep and rapid demineralisation can occur in
as little as 4 weeks - During treatment there is an increase in
streptococci, lactobacilli, and anaerobes
Describe frequency of strep mutants before during and after treatment
Before- slightly lower than after
During- significantly higher
After- slightly higher than before
Describe prevalence of white spot lesions in orthodontic patients compared to non ortho patients
Higher
Where is most susceptible for plaque build up?
Gingival lesions
What often happens beneath a band?
Decalcification
Generally in ortho
How do you prevent decalcification?
- Appliance design
- Fluoride Mouthrinse
- Oral Hygiene Instruction
- Diet Advice
. Chlorhexadine
How do you prevent decalcification in terms of appliance design?
- Keep appliances as simple as possible
- Check for loose bands at each visit
- Glass ionomer band cement
- Fluoride releasing elastomeric modules & chain
How does fluoride help decalcification with appliance wear?
- Increases enamel hardness
- inhibits bacterial glycolysis
- remineralises early lesions
How to give fluoride to ortho patients to prevent decalcification with appliance wear?
0.05 percent daily mouthrinse
What’s the problem with fluoride mouthrinses?
studies have shown only 13 % of
orthodontic patients are using fluoride mouthrinses regularly despite being advised to do so
Negatives of chlorhexadine mouthwashes for decalcification with ortho appliances?
12% effective:
* Little additional benefit
* Staining is a problem
* Not routinely used by orthodontists
* N.B. Effectiveness of chlorohexidine is reduced by fluoride mouthwash- do not use at the same time!
How to prevent decalcification with ortho appliances?
Toothbrushing+ diet+
Fluoride mouthwash
(Plus TePes, single tufted brushes sand sensodyne)
What to do when decalcification occurs?
- Inform patient
- Reinforce previous advice
- Finish treatment as soon as possible and remove
appliances
What about the progression of white spot lesions?
Progression of white spot lesions will stop once the
cariogenic challenge has ceased
Treatment of white spot lesions- key points?
Tends to improve with time
Don’t use fluoride on anterior teeth
Hydroflouric acid and pumice microabrasion
Tends to improve with time …if what is done?
(3)
–slow remineralisation from saliva and toothpaste
–1 cm of TP contains 500 micrograms of Fluoride
–maximum improvement achieved in 6 months
Don’t use fluoride varnish on anterior teeth-why
- causes rapid surface remineralisation
–prevents slow remineralisation of subsurface lesions
- Hydrofluoric acid & pumice microabrasion
Only suitable for superficial lesions
What happens when you apply high fluoride dose to an established white spot lesion?
The flouride cannot penetrate the enamel surface and access the subsurface demineralised area
(It just sits on the top of the enamel surface)
Why should you therefore apply low flouride dose to the established white spot lesion?
Because the flouride can penetrate the enamel surface and cause remineralisation
What is another complication of ortho appliances?
Periodontal complications ie
Gingivitis
Periodontitis
