adverse effects of orthodontic treatment Flashcards
what are the main adverse affects of orthodontic treatment?
> Enamel Damage
> Periodontal Disease
> Root Damage
before starting any orthodontist treatment what is important to gain off the patient/ parent?
> informed consent
how is informed consent delivered to the patient/ parent?
> Patient and parent should be warned of risks
> Information leaflet
> Written record of warnings in notes
> Pre-treatment records
how is the enamel damaged during orthodontic care?
> Decalcification
> Enamel wear
- ceramic brackets
> Enamel fracture
- debonding
- rare
what is a white spot lesion a precursor for?
> enamel caries
how can a white spot lesion occur during orthodontic treatment?
> Accumulation of plaque adjacent to brackets on labial surface
> Deep and rapid demineralisation can occur in as little as 4 weeks
> During treatment there is an increase in streptococci, lactobacilli, and anaerobes
how do we prevent decalcification during orthodontic treatment?
> Appliance design
> Fluoride Mouthrinse
> Oral Hygiene Instruction
> Diet Advice
> (Chlorhexidine)
what can we do with appliances to prevent decalcification?
> Keep appliances as simple as possible
> Check for loose bands at each visit
> Glass ionomer band cement
> Fluoride releasing elastomeric modules & chain
what areas are most susceptible to decalcification during orthodontic treatment ?
> gingival areas
how does fluoride help with prevention of decalcification?
> Increases enamel hardness
> inhibits bacterial glycolysis
> remineralises early lesions
what can the orthodontist provide/advise to use which contains fluoride to aid in preventing decalcification?
> 0.05% daily mouthrinse to be used during the day at different times to brushing
> Problem - compliance - studies have shown only 13 % of orthodontic patients are using fluoride mouthrinses regularly despite being advised to do so
what shouldn’t you use at the same time as a fluoride mouth rinse?
> chlorhexidine mouth rinses
> not routinely used by orthodontists
what is the problem with chlorhexidine mouth rinse?
> staining is a problem
what do you do white spot lesions occur during orthodontic treatment?
> Inform patient
> Reinforce previous advice
> Finish treatment as soon as possible and remove appliances
> Progression of white spot lesions will stop once the cariogenic challenge has ceased: Artun & Thystrup (1986)
how do we treat white spot lesions?
> Tends to improve with time
- 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
- causes rapid surface remineralisation
- prevents slow remineralisation of subsurface lesions. Ogaard (1998)
> Hydrofluoric acid & pumice microabrasion –
- only suitable for superficial lesions
what periodontal problems can be caused by orthodontic treatment?
> gingivitis
> periodontitis
what is common for nearly all patients to experience during orthodontic treatment?
> gingivitis
> Patients with poor oral hygiene pre-Tx are often uncooperative patients during treatment
what can you use to assess orthodontic treatment affect on the periodontal tissues?
> record plaque scores before, during and after
> however, gingivitis during orthodontic treatment rarely progresses to loss of attachment
how do we prevent gingivitis during orthodontic treatment?
> Oral hygiene instruction
> Particular attention to gingival areas above brackets
> Single tufted brushes for below archwires
what is important to carry out on adult patients before commencing treatment?
> assess the periodontal health
> Progression to periodontitis rare in children and adolescents
> carry out a BPE, measure attachment loss, BOP, and take radiographs
is there a link between orthodontic treatment and periodontal disease?
> YES
> Orthodontic tooth movement in the presence of active periodontal breakdown will increase the rapidity of periodontal destruction
what is important to ensure in a patient with periodontal problems before starting treatment ?
> Ensure control of periodontal inflammation before active treatment
- no bleeding on probing
- high standard of oral hygiene
how can we keep the risk of periodontal problems to their lowest during orthodontic treatment?
> 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 due to poor bone support
what is known about external apical root resorption during orthodontic treatment?
> High prevalence but low morbidity (only 5 % > 5 mm)
> common - up to 25% of patient will have some kind
> More common in upper incisors
> Resorption ceases when appliances removed
> aetiology - not fully known
> long term consequences - mobility
with regards to root resorption what are the 3 main categories which are thought to be the cause during orthodontic treatment?
> TREATMENT FACTORS
> PATIENT DENTOSKELEAL FEATURES
> INDIVIDUAL SUSCEPTIBILTY
what treatment factors can cause root resorption?
> rectangular arch wires
> class II elastics
> duration of treatment
> amount of root movement
> root against palatal cortex
> duration of incisor retraction
> standard edgewise > SWA
what patient dent-skeletal features could be a cause of root resorption?
> short roots pre treatment
> long roots pre treatment
> . abnormal roots pre treatment
> narrow roots
> large overjet
> crown invagination
> anagenesis
> lip Tonge dysfunction
> impacted canine
what individual susceptibilities can cause root resorption?
> age
> history of trauma
> gender = M>F
how much of the variation of patients with root resorption is the cause understood?
> 1/3
> if more than 1/3 is resorbed the cause is unknown
what is the management of root resorption?
> Informed consent pre treatment
> Pre-treatment radiographs
> Radiograph 6-9 months into treatment
- evidence of resorption indicates high risk of severe root resorption (Levander & Malmgren, 1988)
> Debond early in severe cases
> Fixed retainers or splinting in severe cases post treatment
what other adverse effects can be caused by orthodontic treatment?
> Loss of vitality
> Soft tissue trauma and ulceration from appliances
> Headgear injuries
- extra-oral or intra-oral
> Burns from acid etchant
