Adverse Effects of Orthodontics

Question 1

Adverse effects

Answer 1

Enamel damage
Periodontal disease
Root damage

Question 2

Enamel Damage

Answer 2

Decalcification
Enamel wear - esp lower incisors ceramic brackets damaging upper incisors
Enamel fracture – debonding

Question 3

WSL

Answer 3

Precursor of enamel caries
accumulation of plaque adjacent to brackets
deep and rapid demineralisation can occur in as little as 4 weeks
during tx there is an increase in streptococci, lactobacilli and anaerobes

Question 4

Prevention of decalcification

Answer 4

Appliance design – simple as possible
Fluoride mouthrinse
OHI
Diet advice
Chlorhexidine

Question 5

Fluoride

Answer 5

Increases enamel hardness
Inhibits bacterial glycolysis
Remineralises early lesions
0.05% daily mouthrinse
13% of orthodontic pts are using fluoride mouthrinses regularly despite being advised to do so.

Question 6

Chlorhexidine Mouthrinse

Answer 6

0.12% effective
Staining is a problem

Question 7

Tx of WSL

Answer 7

Tends to improve with time
Don’t use fluoride varnish on anterior teeth –> causes rapid surface remineralisation –> prevents slow remineralisation of subsurface lesions
Hydrofluoric acid and pumice microabrasion –> only suitable for superficial lesions

Question 8

Gingivitis

Answer 8

Nearly all patients
Pts with poor OH pre Tx are often uncooperative pts during Tx
Rarely progresses to LOA

Question 9

Periodontitis

Answer 9

progression to periodontitis rare in children and adolescents
important to assess perio health of adult pts before commencing Tx
BPE
- LOA
- Plaque indices
- BOP
- Radiographs

Question 10

Orthodontic and Periodontal disease

Answer 10

ortho tooth movement in the presence of active periodontal breakdown will increase the rapidity of periodontal destruction.
ensure control of periodontal inflammation before active Tx
- no BOP
- high standard of OH

Question 11

EARR

Answer 11

High prevalence but low morbidity (only 5% > 5mm)
more common in upper incisors
resorption ceases when appliances removed

Question 12

Management of root resorption

Answer 12

Informed consent
pre tx radiographs
radiographs 6-9 months into tx (evidence of resorption indicates high risk of severe root resorption)
debond early in severe cases
fixed retainers or splinting in severe cases

Question 13

Other adverse effect