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BDS4 Orthodontics > Benefits and Risks of Orthodontics > Flashcards

Benefits and Risks of Orthodontics Flashcards

1
Q

What are the benefits of orthdontics?

A

Improvement in:
1. Appearance
– Dental
– Facial
- Psychological

  1. Function
  2. Dental Health
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2
Q

What are the psychological benefits of orthodontic treatment?

A

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)

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3
Q

Which stereotypes have been found to be associated with patients with malocclusion?

A
  • Less intelligent
  • Less friendly
  • Less desirable as a friend
  • More aggressive
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4
Q

What are the functional benefits of Ortho?

A

Mastication- unlikely to be a problem if minor malocclusion

Speech- rarely fixed by Ortho

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5
Q

Which malocclusions are associated with deficits in masticatory function?

A
  • large anterior open bites
  • severe increased OJ
  • marked reverse OJ
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6
Q

How is the dental health component of IOTN graded?

A

1+2= No Need/Low Need
(min benefit)

3= Borderline Need
(some benefit)

4+5= Need/High Need
(significant benefit)

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7
Q

What is the hierarchal scale used in IOTN?

A

MOCDO:
* MISSING TEETH
* OVERJET
* CROSSBITES
* DISPLACEMENT of contact points (crowding)
* OVERBITES

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8
Q

What are the dental health issues with impacted teeth?

A

Resorption

Cyst formation

Supernumery teeth can prevent normal eruption

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9
Q

What are the issues with increased OJ of over 6mm in terms of dental health?

A

Risk of trauma to upper incisors increases with size of OJ
-> worse with incompetent lips

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10
Q

What are the dental health issues associated with anterior crossbites?

A

 Loss of periodontal support and recession

 Tooth wear is possible

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11
Q

What are the dental health issues associated with posterior crossbites?

A

Can result in displacement which can result in asymmetry and TMD

-> requires earlier treatment

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12
Q

How is crowding related to caries? (no direct link)

A

Makes teeth more difficult to clean and it takes longer

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13
Q

How is crowding related to periodontal disease? (weak association)

A

Can make tooth surfaces harder to access and more difficult to clean

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14
Q

What are the issues with traumatic OB?

A

Can cause gingival stripping and trauma

Loss of periodontal support

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15
Q

Which malocclusions have been associated with TMD?

A

– Crossbite with displacement (functional shifts)
– Class II with retrusive mandible
– Class III
– AOB

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16
Q

What are the issues with TMD and orthodontics?

A
  • 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)
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17
Q

What are the main risks of orthodontic treatment?

A

Decalcification

Root resorption

Relapse

Soft tissue trauma

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18
Q

What are some of the other risks of orthodontic treatment?

A
  • Recession
  • Soft tissue trauma
  • Loss of periodontal support
  • Headgear injuries
  • Enamel fracture & tooth wear
  • Loss of vitality
  • Allergy
  • Poor/failed treatment
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19
Q

What are the issues with decalcification as a result of orthodontic treatment?

A

 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

20
Q

How is decalcification prevented?

A

Good case selection

OH

Diet advice

Fluoride Supplements

21
Q

What are the features of a good case to select for orthodontic treatment?

A

High levels of motivation

Good pre-treatment OH

Low caries risk

22
Q

What are the features of a case with high risk of decalcification?

A

Pre-existing decal (often at cervical margins due to poor brushing)

Erosion

Caries history

23
Q

What OHI is given to patients undergoing orthodontic treatment to prevent decalcification?

A

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

24
Q

Which diet advice is given to patients undergoing orthodontic treatment to prevent decalcification?

A

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

25
Q

Which fluoride supplements can be used to prevent decalcification?

A

Toothpaste- 2800/5000ppmF Duraphat
-> warn about overdose
-> twice daily

Mouthwash in between brushing- 0.5% 225ppmF

FV- 22600ppmF if high risk

26
Q

What is the average amount of root resorption in orthodontic patients?

A

1mm in 24 months treatment
-> mostly unnoticed but severe in 1-5%

27
Q

What are the risk factors for root resorption in orthodontic treatment?

A

Type of tooth movement
- Prolonged, high force
- Intrusion
- Large movements
- Torque (root movement)

Root form - blunt, pipette, resorbed already

Previous trauma

Nail biting

28
Q

Which roots are the most prone to resorption?

A

Upper incisors

Lower incisors

6s

29
Q

What is relapse?

A

The return of the features of the original malocclusion following correction

-> treat all cases as if there is risk of relapse

30
Q

Which features of malocclusions are most prone to relapse?

A

– Lower incisor crowding
– Rotations
– Instanding 2’s
– Spaces & diastemas
– Class II div 2
– Anterior open bites
– Reduced perio support/short roots

31
Q

How is relapse managed?

A

Case selection- might decide to accept mild disease

Informed consent

Retainers- fixed or removable

32
Q

What are the types of removable retainer?

A

– Clear Occlusal retainer (COR)
– Pressure or vacuum formed (PFRs/VFRs)
– Essix
– Hawley type

33
Q

What are the issues with fixed retainers?

A
  • 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
34
Q

Which damage to soft tissue may occur due to orthodontic treatment? What can be done to combat this?

A

Pain /discomfort - analgesics

Ulceration – ortho wax

35
Q

Which type of orthodontic treatment is most likely to cause recession?

A

Expansion treatment (as opposed to extraction)
-> Teeth moved out of bone

36
Q

How is recession due to orthodontics managed?

A

– Correct tx planning
-> teeth within bone, avoid overexpansion

– Thin biotype

– Warn Pt

– Gingival graft

37
Q

What are the periodontal health risks associated with Ortho treatment?

A

Gingivitis- more prone to necrotising forms

Recession

Periodontal disease- accelerated bone loss and alveolar destruction

Loss of Periodontal support

38
Q

Which safety mechanisms have been added to head gear to reduce risk of trauma?

A

Snap away traction spring

Nitom facebow

39
Q

When is loss of vitality due to orthodontic treatment more likely?

A

If previous trauma or compromised tooth (heavily restored)

40
Q

How do teeth that have lost vitality appear?

A

Darkened and discoloured

-> commonly occurs in laterals

41
Q

What are the causes of loss of vitality during Ortho?

A

Idiopathic

Excess force

42
Q

What aspects of orthodontic treatment may lead to tooth wear or fracture?

A

Ceramic brackets can result in increase tooth wear as it is harder than enamel

Enamel fracture may occur when deboning brackets

43
Q

What allergies may present an issue with patient accepting orthodontic treatment?

A

Latex

Nickel

Adhesive - colophony

44
Q

What are the causes of poor or failed orthodontic treatment on the part of the clinician?

A

Poor diagnosis

Poor treatment planning

Operator technique error

45
Q

What are the causes of poor or failed orthodontic treatment on the part of the patient?

A

Unfavourable growth

Poor cooperation
– with appliance wear
– repeated breakages
– Non-attendance

46
Q

Which factors increase chances of successful orthodontic treatment?

A

– severity of malocclusion

– motivation of patient

– operator expertise

47
Q

What are the risks of cosmetic quick fixes?

A

Only suitable for mild cases

Unrealistic patient expectations

Lack of informed choice

Relapse

Litigation prone in hands of inexperienced operator

BDS4 Orthodontics (14 decks)

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