Benefits and Risks of Orthodontics Flashcards
What are the benefits of orthdontics?
Improvement in:
1. Appearance
– Dental
– Facial
- Psychological
- Function
- Dental Health
What are the psychological benefits of orthodontic treatment?
Correction of severe malocclusion can increase facial attractiveness may improve self esteem & psychological well- being
Less likely to be teased or stereotyped
-> difficult to measure (so look at QoL benefits)
Which stereotypes have been found to be associated with patients with malocclusion?
- Less intelligent
- Less friendly
- Less desirable as a friend
- More aggressive
What are the functional benefits of Ortho?
Mastication- unlikely to be a problem if minor malocclusion
Speech- rarely fixed by Ortho
Which malocclusions are associated with deficits in masticatory function?
- large anterior open bites
- severe increased OJ
- marked reverse OJ
How is the dental health component of IOTN graded?
1+2= No Need/Low Need
(min benefit)
3= Borderline Need
(some benefit)
4+5= Need/High Need
(significant benefit)
What is the hierarchal scale used in IOTN?
MOCDO:
* MISSING TEETH
* OVERJET
* CROSSBITES
* DISPLACEMENT of contact points (crowding)
* OVERBITES
What are the dental health issues with impacted teeth?
Resorption
Cyst formation
Supernumery teeth can prevent normal eruption
What are the issues with increased OJ of over 6mm in terms of dental health?
Risk of trauma to upper incisors increases with size of OJ
-> worse with incompetent lips
What are the dental health issues associated with anterior crossbites?
Loss of periodontal support and recession
Tooth wear is possible
What are the dental health issues associated with posterior crossbites?
Can result in displacement which can result in asymmetry and TMD
-> requires earlier treatment
How is crowding related to caries? (no direct link)
Makes teeth more difficult to clean and it takes longer
How is crowding related to periodontal disease? (weak association)
Can make tooth surfaces harder to access and more difficult to clean
What are the issues with traumatic OB?
Can cause gingival stripping and trauma
Loss of periodontal support
Which malocclusions have been associated with TMD?
– Crossbite with displacement (functional shifts)
– Class II with retrusive mandible
– Class III
– AOB
What are the issues with TMD and orthodontics?
- Ortho Tx should never be offered to improve TMD in isolation
- If malocclusion per se does not warrant tx – ortho will not be offered to pts with TMD
- Conservative tx – must be offered before any ortho
- Ortho Tx could aggravate existing TMD- using intermaxillary elastics (posturing of mandible)
What are the main risks of orthodontic treatment?
Decalcification
Root resorption
Relapse
Soft tissue trauma
What are some of the other risks of orthodontic treatment?
- Recession
- Soft tissue trauma
- Loss of periodontal support
- Headgear injuries
- Enamel fracture & tooth wear
- Loss of vitality
- Allergy
- Poor/failed treatment
What are the issues with decalcification as a result of orthodontic treatment?
Can result in white and unsightly dark/yellow marks or frank cavitation
Weakens enamel making it more prone to caries
Can mean that orthodontist may need to debond brackets early
How is decalcification prevented?
Good case selection
OH
Diet advice
Fluoride Supplements
What are the features of a good case to select for orthodontic treatment?
High levels of motivation
Good pre-treatment OH
Low caries risk
What are the features of a case with high risk of decalcification?
Pre-existing decal (often at cervical margins due to poor brushing)
Erosion
Caries history
What OHI is given to patients undergoing orthodontic treatment to prevent decalcification?
Very thorough brushing twice per day
-> focussing on gingival margin and around bracket
-> spit don’t rinse
Inter bracket cleaning after every meal
Use of disclosing tablets if required
Which diet advice is given to patients undergoing orthodontic treatment to prevent decalcification?
Encourage non- cariogenic diet
Limit sugar and dietary frequency
-> avoid snacks between meals
-> Avoid fizzy, diluting, fruit and sports drinks
Encourage use of sugar free gum to help buffer saliva
Which fluoride supplements can be used to prevent decalcification?
Toothpaste- 2800/5000ppmF Duraphat
-> warn about overdose
-> twice daily
Mouthwash in between brushing- 0.5% 225ppmF
FV- 22600ppmF if high risk
What is the average amount of root resorption in orthodontic patients?
1mm in 24 months treatment
-> mostly unnoticed but severe in 1-5%
What are the risk factors for root resorption in orthodontic treatment?
Type of tooth movement
- Prolonged, high force
- Intrusion
- Large movements
- Torque (root movement)
Root form - blunt, pipette, resorbed already
Previous trauma
Nail biting
Which roots are the most prone to resorption?
Upper incisors
Lower incisors
6s
What is relapse?
The return of the features of the original malocclusion following correction
-> treat all cases as if there is risk of relapse
Which features of malocclusions are most prone to relapse?
– Lower incisor crowding
– Rotations
– Instanding 2’s
– Spaces & diastemas
– Class II div 2
– Anterior open bites
– Reduced perio support/short roots
How is relapse managed?
Case selection- might decide to accept mild disease
Informed consent
Retainers- fixed or removable
What are the types of removable retainer?
– Clear Occlusal retainer (COR)
– Pressure or vacuum formed (PFRs/VFRs)
– Essix
– Hawley type
What are the issues with fixed retainers?
- Prone to plaque & calculus build up
- Can break and not notice
- Need excellent OH
- Tend to leave in situ for life
- Require more care/ long-term maintenance
Which damage to soft tissue may occur due to orthodontic treatment? What can be done to combat this?
Pain /discomfort - analgesics
Ulceration – ortho wax
Which type of orthodontic treatment is most likely to cause recession?
Expansion treatment (as opposed to extraction)
-> Teeth moved out of bone
How is recession due to orthodontics managed?
– Correct tx planning
-> teeth within bone, avoid overexpansion
– Thin biotype
– Warn Pt
– Gingival graft
What are the periodontal health risks associated with Ortho treatment?
Gingivitis- more prone to necrotising forms
Recession
Periodontal disease- accelerated bone loss and alveolar destruction
Loss of Periodontal support
Which safety mechanisms have been added to head gear to reduce risk of trauma?
Snap away traction spring
Nitom facebow
When is loss of vitality due to orthodontic treatment more likely?
If previous trauma or compromised tooth (heavily restored)
How do teeth that have lost vitality appear?
Darkened and discoloured
-> commonly occurs in laterals
What are the causes of loss of vitality during Ortho?
Idiopathic
Excess force
What aspects of orthodontic treatment may lead to tooth wear or fracture?
Ceramic brackets can result in increase tooth wear as it is harder than enamel
Enamel fracture may occur when deboning brackets
What allergies may present an issue with patient accepting orthodontic treatment?
Latex
Nickel
Adhesive - colophony
What are the causes of poor or failed orthodontic treatment on the part of the clinician?
Poor diagnosis
Poor treatment planning
Operator technique error
What are the causes of poor or failed orthodontic treatment on the part of the patient?
Unfavourable growth
Poor cooperation
– with appliance wear
– repeated breakages
– Non-attendance
Which factors increase chances of successful orthodontic treatment?
– severity of malocclusion
– motivation of patient
– operator expertise
What are the risks of cosmetic quick fixes?
Only suitable for mild cases
Unrealistic patient expectations
Lack of informed choice
Relapse
Litigation prone in hands of inexperienced operator
