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
What points about patients and gingivitis?
Nearly all patients will get gingivitis
Patients with poor oral hygiene pre treatment are often uncooperative patients during treatment
What can you do to determine access to ortho treatment?
Use plaque scores
What’s important about the patients and gingivitis?
Rarely leads to loss of attachment
Prevention of gingivitis?
- Oral hygiene instruction
- Particular attention to gingival areas above brackets
Single tufted brushes for below arch wires
Periodontitis and progression?
Progression to periodontitis is rare in children and adults
Periodontitis and pre-ortho treatment?
Important to assess the periodontal health of adult patients before commencing orthodontic treatment
How
BPE
–loss of attachment
–plaque indices
–BLEEDING ON PROBING*
- radiographs
What could be an red flag from radiographs
Low bone levels
Orthodontic treatment effect periodontal disease?
- Orthodontic tooth movement in the presence
of active periodontal breakdown will increase the rapidity of periodontal destruction
What should you do therefore?
Ensure the control of periodontal inflammation before active treatment ie.
- **no bleeding on probing
- High standard of oral hygiene
How to ensure best prognosis with ortho treatment in a patient who has periodontal disease?
(Appliances, Tx, other)
- Keep appliances simple
- Bond molars rather than place bands
- Regular professional cleaning and scaling every 3 months
during treatment - Reinforce OHI
- Warn patient re. Possible LOA and bone loss
. Permanent retention
What do we know about external apical root resorption (EARR)
EARR)?
* High prevalence but low morbidity (only 5 % > 5 mm)
* More common in upper incisors
* Resorption ceases when appliances removed
* Aetiology?
. Long term consequences?
Aetiology of EARR?
Multi factorial- treatment factors and patient factors (dentoskeletal features and individual susceptibility)
Treatment factors contributing to external apical root resorption?
Class II elastics
Duration of treatment
Duration of incisor retraction
Standard edgewise> SWA
Dentoskelatal factors affecting EARR
Narrow roots
Crown invagination
Agenisis
Patient/other (individual suseptibility)?
Age
History of trauma
What could a pre-op anterior occlusal show?
Abnormal roots pre-treatment
How much of the variation is explained?
And what does this show
64 percent unexplained and 36 percent explained
Ie if 10mm is lost form an incisor root we explain why 3mm was lost but we do not know why the other 7mm was lost
What do we know in terms of the proportion of the root that is lost (resorted)?
Apical third is known
Coronal two thirds is unknown
Management of root resorption?
- Informed consent
- Pre-treatment radiographs
- Radiograph 6-9 months into treatment
–evidence of resorption indicates high risk of severe root
resorption - Debond early in severe cases
- Fixed retainers or splinting in severe cases
Other adverse effect of ortho treatment?
Loss of vitality
Soft tissue trauma and ulceration from appliances
Headgear injuries (extra-oral or intra-oral)
Burns from acid etchant
