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