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orthodontics 4th year > adverse effects of orthodontic treatment > Flashcards

adverse effects of orthodontic treatment Flashcards

1
Q

what are the main adverse affects of orthodontic treatment?

A

> Enamel Damage

> Periodontal Disease

> Root Damage

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2
Q

before starting any orthodontist treatment what is important to gain off the patient/ parent?

A

> informed consent

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3
Q

how is informed consent delivered to the patient/ parent?

A

> Patient and parent should be warned of risks

> Information leaflet

> Written record of warnings in notes

> Pre-treatment records

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4
Q

how is the enamel damaged during orthodontic care?

A

> Decalcification

> Enamel wear
- ceramic brackets

> Enamel fracture
- debonding
- rare

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5
Q

what is a white spot lesion a precursor for?

A

> enamel caries

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6
Q

how can a white spot lesion occur during orthodontic treatment?

A

> 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

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7
Q

how do we prevent decalcification during orthodontic treatment?

A

> Appliance design

> Fluoride Mouthrinse

> Oral Hygiene Instruction

> Diet Advice

> (Chlorhexidine)

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8
Q

what can we do with appliances to prevent decalcification?

A

> Keep appliances as simple as possible

> Check for loose bands at each visit

> Glass ionomer band cement

> Fluoride releasing elastomeric modules & chain

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9
Q

what areas are most susceptible to decalcification during orthodontic treatment ?

A

> gingival areas

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10
Q

how does fluoride help with prevention of decalcification?

A

> Increases enamel hardness

> inhibits bacterial glycolysis

> remineralises early lesions

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11
Q

what can the orthodontist provide/advise to use which contains fluoride to aid in preventing decalcification?

A

> 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

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12
Q

what shouldn’t you use at the same time as a fluoride mouth rinse?

A

> chlorhexidine mouth rinses

> not routinely used by orthodontists

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13
Q

what is the problem with chlorhexidine mouth rinse?

A

> staining is a problem

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14
Q

what do you do white spot lesions occur during orthodontic treatment?

A

> 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)

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15
Q

how do we treat white spot lesions?

A

> 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

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16
Q

what periodontal problems can be caused by orthodontic treatment?

A

> gingivitis

> periodontitis

17
Q

what is common for nearly all patients to experience during orthodontic treatment?

A

> gingivitis

> Patients with poor oral hygiene pre-Tx are often uncooperative patients during treatment

18
Q

what can you use to assess orthodontic treatment affect on the periodontal tissues?

A

> record plaque scores before, during and after

> however, gingivitis during orthodontic treatment rarely progresses to loss of attachment

19
Q

how do we prevent gingivitis during orthodontic treatment?

A

> Oral hygiene instruction

> Particular attention to gingival areas above brackets

> Single tufted brushes for below archwires

20
Q

what is important to carry out on adult patients before commencing treatment?

A

> assess the periodontal health

> Progression to periodontitis rare in children and adolescents

> carry out a BPE, measure attachment loss, BOP, and take radiographs

21
Q

is there a link between orthodontic treatment and periodontal disease?

A

> YES

> Orthodontic tooth movement in the presence of active periodontal breakdown will increase the rapidity of periodontal destruction

22
Q

what is important to ensure in a patient with periodontal problems before starting treatment ?

A

> Ensure control of periodontal inflammation before active treatment
- no bleeding on probing
- high standard of oral hygiene

23
Q

how can we keep the risk of periodontal problems to their lowest during orthodontic treatment?

A

> 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

24
Q

what is known about external apical root resorption during orthodontic treatment?

A

> 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

25
Q

with regards to root resorption what are the 3 main categories which are thought to be the cause during orthodontic treatment?

A

> TREATMENT FACTORS

> PATIENT DENTOSKELEAL FEATURES

> INDIVIDUAL SUSCEPTIBILTY

26
Q

what treatment factors can cause root resorption?

A

> rectangular arch wires

> class II elastics

> duration of treatment

> amount of root movement

> root against palatal cortex

> duration of incisor retraction

> standard edgewise > SWA

27
Q

what patient dent-skeletal features could be a cause of root resorption?

A

> short roots pre treatment

> long roots pre treatment

> . abnormal roots pre treatment

> narrow roots

> large overjet

> crown invagination

> anagenesis

> lip Tonge dysfunction

> impacted canine

28
Q

what individual susceptibilities can cause root resorption?

A

> age

> history of trauma

> gender = M>F

29
Q

how much of the variation of patients with root resorption is the cause understood?

A

> 1/3

> if more than 1/3 is resorbed the cause is unknown

30
Q

what is the management of root resorption?

A

> 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

31
Q

what other adverse effects can be caused by orthodontic treatment?

A

> Loss of vitality

> Soft tissue trauma and ulceration from appliances

> Headgear injuries
- extra-oral or intra-oral

> Burns from acid etchant

orthodontics 4th year (12 decks)

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