Emergency orthodontics

Question 1

whenever a pt present with an ortho problem what should we carry out ?

Answer 1

• mh
• full history of problem
• history of tx
• thorough examination

Question 2

what are the 5 ortho appliances that usually cause problems ?

Answer 2

• Fixed
• Removable
• functional
• Retainers
• headgear

Question 3

what are the problems going on here with this fixed retainer ?

Answer 3

• wire sinking into mucosa causing discomfort and ulceration

Question 4

what problems occur with fixed retainers occur? (6)

Answer 4

1. c/o: wire sticking out distally to molar tube/band
   * Causes: ends of wire not trimmed
   * Management: cut with distal end pliers
   or
   * Causes: archwire has moved around (one side too short )
   * Management: re-position archwire
2. c/o: wire sticking out mesial to molar
   * Causes: wire out
   * Management: ensure wire not sharp and appt as soon as possible to see orthodontist
3. c/o: bracket has debonded
   Causes:
   * Bracket in traumatic occlusion
   * Achwire over-activated to engage bracket
   * Patient has knocked bracket off
   Management:
   * remove bracket off wire
   * Appointment with orthodontist to replace bracket

4.* c/o: band loose
Causes:
* Band is too big for tooth
* Patient is eating sticky foods
Management:
* Re-cement band with glass ionomer cement
* If band too big, remove loose band and cut long wire
* Appointment with orthodontist

5* c/o: teeth feel loose
* Causes: a slight increase in mobility is normal with
orthodontic treatment
* Management:
* check the mobility of affected teeth
* Reassure patient

6. c/o: teeth are painful
   * Causes: some discomfort is normal following
   adjustment of fixed appliances
   * Management:
   * Reassure
   * Advise patient on analgesia

Question 5

What problems occur with removable appliances occur? (6)

Answer 5

1.c/o: mouth watering
* Causes: occurs when appliance first fitted
* Management: reassure patient and explain that it will
resolve as patient gets used to appliance

2. c/o: problems with speech
   * Causes:
   * When appliance first fitted
   * Signs of non-compliance
   * Management: reassure the patient that with time the
   speech will improve
3. c/o: appliance loose
   * Causes:
   * Poor design
   * Clasps not retentive
   * Management: adjust clasps with adams pliers

4* c/o: clasp fractured
* Causes: constant application of stress by patient
putting appliance in and out
* Management:
* cut fractured clasp for patient comfort. The appliance
should still be retentive
* Appointment with orthodontist

*5. c/o: fractured acrylic
* Causes: trauma to removable appliance
* Management:
* depends on the amount of acrylic that has fractured
* Smooth fractured portion

*6. c/o: redness on the roof of mouth
* Causes:
* candida induced stomatitis
* Trauma from poorly fitting appliance
* Management
* Oral hygiene instruction in relation to removable appliance
* Prescription of anti-fungal

Question 6

what problems occur with functional appliances? (1)

Answer 6

• Removable appliance problems also apply to
  functional appliances

1* c/o: jaws ache with appliance in place
* Causes: common occurrence during initial stages due
appliance posturing jaw forward
* Management:
* reassure the patient
* Painkillers if required

Question 7

what are some problems that occur with head gears ?

Answer 7

1. CO= face bow come out of the tubes at night
   causes = problems with the locking mechanism or ill fitting face bow
   management= inform pt to stop wearing headgear and see ortho for further advice and tx ASAP
2. CO= headgear feels tight at back teeth
   causes = force caused by headgear
   management= reassure pt
3. CO= unable to fit headgear
   causes = various
   management = pt need to make appt with ortho ASAP

Question 8

what are some problems that can occur with retainers?

Answer 8

1 * c/o: retainers don’t fit
- Causes: Relapse of teeth due to patient not wearing the retainers
regularly, deformation to retainers
* Management: Take alginate impression and remake retainers

2. • c/o: fractured retainers
     * Causes: various
     Management: Impression to repair, New impression for a remake

3.* c/o: lost retainers
* Causes: Carelessness
* Management: Take alginate impression and make new retainers

4.* c/o: bonded retainer feels loose
* Causes: failure of composite bond
* Management: If one or two teeth debonded:
Remove existing composite and repair using flowable composite
- if wire deformed and unable to repair bonded retainer make pt comfortable and refer to ortho

5.* c/o: bonded retainer fallen off
* Causes: bond failure
* Management: Ensure patient has removable retainer, If not, then impression for new retainer, Referral/ liaise with orthodontist