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Orthodontics > Orthodontic Emergencies > Flashcards

Orthodontic Emergencies Flashcards

1
Q

Type of problems

A
  • Patient discomfort
  • Fixed appliance problems
  • Removable appliance problems
  • Retainer Problems
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2
Q

Why might orthodontic emergencies occur?

A
  • Patient factors
  • Operator factors
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3
Q

What are Potential problems with irregular attendance?

A
  • Unwanted tooth movements
  • Relapse of tx changes
  • Elongated treatment time
  • Pain/ swelling - soft tissue injury
  • Reduced complaince
  • Delcalcification/ periodontal disease/ tooth wear/ root resorption.
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4
Q

How do we aim to limit the number of emergency visits?

A
  • Patient factors
  • Operator factors
  • Practice / department factors
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5
Q

Management of different types of orthodontic emergencies

        1- Patient discomfort
A
  • Discomfort is expected for first 3-5 days after braces fitted
  • Pain is usually worse at 24 hours after braces are fitted
  • Discomfort common for first 3 days after any adjustment
  • Providing reassurance helps reduce anxiety
  • Analgesics advice and provision of orthodontic wax
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6
Q

2- Fixed appliance problems

A
  • Soft tissue trauma
  • Lost bracket / molar tube
  • Archwire
  • lost module or auxillary
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7
Q

2.1 Soft tissue why happens?

A
  • Excess wire distally -
  • Wire displaced out of molar tube
  • Brace digging in cheek or lip
  • dislodged auxiliary digging in cause of brushing
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8
Q

Wire digging in at the back ? Cause ? Treatment and prevention ?

A
  • Due to wire sticking out of molar attachment
  • Wire turn into one side
  • Wire dislodged from attachment or lying over and under attachment

Treatment: - if wire has turn into one side or become dialodged - remove all o-rings place wire at correct position with Adam’s and replace o-ring
- if wire too long cut it with distal end cutter.
- Smooth the end of thick wire with green stone .
- If distal end cutter not available. Use wire cutter with cotton roll to cut wire to hold wire.
Advice - reassure patient that this is common emergency

Prevention : - careful placement of Correct archwire length
- when using self ligating bracket place o- ring to stop wire swivelling.
- Protecting light wires with Lacebacks will help to prevent these problems.
- If patient is wearing powerchain / elastics ,Long wire is good sign that spaces are closing.
- Wire

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9
Q

Regualr Oral ulcers

A
  • if repeated ulcers check MH
  • Advise appt with GMP if regular
  • Take photos + measuring and record site of ulcers.
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10
Q

Debonded bracket

A

Cause: can be operator / patient factors dietary advise after treatment, prolong tx,

Treatment:
- Do no remove module
- Remove other modules and archwire
- Remove composite + etch + Bond + rebond bracket
- Replace wire - same size or drop down size

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11
Q

Loose Molar band

A

Cause: May be Patient factor- dietary advise - can prolonge treatment time.

Tx:
- Remove modules and archwire
- Remove loose band with band remover
- Remove residual cement with hand instrument/ slow speed with tungsten carbide bur
- Choose New band and cement with GIC

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12
Q

Archwire Fracture:

A

Cause - Patient factor , diet , habbit ( nail biting, pen chewing. Advise given to patient. Prolong treatment, inhalation, ingestion

Tx:
- Remove modules and loose fragment of af archwire
- If length of wire missing question patient
- Replace new archwire and ligate.

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13
Q

Loose module/ powerchain or auxiliary

A

Cause - auxiliary dislodged during brushing, eating or broken,
- Opertor factor- single tooth module can be composite on tie wing of bracket

Tx-
- Loose wire remove it.
- Tuck in sharp end with Mitchell’s trimmer, flatplastic, ortho tucker
- Module - replace module, ideally replace power chain if it’s possible to see where it was connected.

Prevention:
- Show pt how to tuck in similar hooks may get untucked
- Remove flesh of composite properly.

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14
Q

Issues of with Quadhelix or Transpalatal arch with Nance button

A

Cause : May dig into soft tissue

TX:
Orthodontist only
- Pt should contact orthodontist asap
- Orthodontist/ therapist can recement component.
- If cutting wire use high speed with diamond bur if digging in but hold it with Mathiau for patient safety.
- Cutting component - Extra appt and remake - last resort
- If component removed . Smooth with green stone rough edges. Orthodontist will be able to adjust and lift the component away from palate.

Prevention: Suggest to use mouthwash or super floss to clean under palate and advise to see orthodontist.

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15
Q

Removable appliance problems

A

-Loose removable appliance
- Soft tissue trauma
- Fractured acrylic
- Fractured wire
- Fracuted screw

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16
Q

Loose appliance no longer fits

A
  • Cause - cribs or clasps fractured or distorted by clicking it in and out.
    -Patient has not worn appliance for prolonged time.
  • May occur permanent tooth has erupted after appliance fitted

Tx : adjust reamaining cribs to Improve retention using Adam’s plier.
- Remove fractured cribs using heavy duty wire cutter pliers and smooth with green stone.
- remake
- discontinue require prescription

Prevention: Why wires distort and break because of clicked up and down in similar way repeatedly bending paper clip wire. Recommend keep wearing the appliance if possible.

17
Q

Soft tissue trauma by removable appliance

Fracture acrylic

A

Cause: Excellent wear of appliance, or dropping or standing on appliance

Tx:
- Smooth acrylic with acrylic bur and trimming bur if still fits. Pt continue to wear it if possible until see orthodontist
- Repair acrylic may require in situ with their orthodontist.
- remake

18
Q

Retainers problem:

Removable retainer .lost or fracture

A

Cause: Pt chewed it , dog chewed it

Tx: Remake new one with replacement charge.

Advise: retention of 2 nights per week indefinitely is recommended for all pt who had orthodontic treatment .

If relapse occurred explained retainer will maintain current position of teeth only not correct it.

19
Q

Bonded Retainers fractured

A

Cause- Operator / pt not adhering to adhere to diet.

Tx:
- If wire is still in place then it may be possible to etch + bond + add composite to create smooth surface.

  • If wire distorted . It will require replacement and the fractured piece can be removing wire cutter and green stone to smooth remaining composite.
  • Care is needed if reattached distorted wire can move teeth into unwanted position.

Advice: Pt must wear retainer VFR every night until take new impression for bonded retainer .
, repair /replacement charges,

20
Q

If Patient comes with broken elastic chain and missing close spring?

A
  • If notes are clear , replacing it would be ideal
21
Q

What if old crown will become loose/ tooth fracture/ chip when Debonding?

A
  • Inform patient
  • Call orthodontist - may need temp fit crown
  • Refer to GDP for management
  • Document it + photos.
22
Q

Headgear issues

A
  • Soft tissue and optical trauma
  • If issue with fit - Advise pt to stop wear and book appt.
  • If there is optical trauma- Attend A&e
23
Q

Workplace policy and protocol for emergency appt.

A
  • You will have system in place where you work

-Personal perspective
- Geographic considerations
- Patient co operation

24
Q

Inshalation and Ingestion of Foreign Bodies.

Is the object still visible in mouth and oropharynx?

A
  • It iş - Attempt should be made to remove it by suction ideally with patient reclined.
  • Failing this- ask patient to roll side and encourage to cough up the object.
25
Q

What has been inhaled or ingested?

A

What’smissing ? - Is it bracket, band, archwire or auxillary?

Determine ? - important to know size, shape, likely flexibllity, and radio- opacity.

  • Check surrounding , floor, cloth , suction tip , distal end cutter.
26
Q

Inhalation clicnical sign and symptoms of inhalation?

A
  • Respiratory obstruction and cough
  • Choking or Stridor ?
  • Management: BLS- call for help
  • Administer 5 back blow following 5 abdominal thrust.
  • CPR

-Send hospital with information of object missing ( size, shape, flexiblity and radiopaque)

  • Chest Xray Bronchoscopy)
  • Inhaled - likely RHS lung
27
Q

Ingestion

A
  • Inform pt
  • Ask to monitor stool.
  • May be no immediate symptoms.
  • possible symptoms- Vomiting , pain over 6 days.
  • Chest / abdominal xray / Fibre optic endoscopy.
28
Q

Ingestion object

A
  • If object less than 5cm reach stomach 90% chance it will pass GIT in 7-10 days . Ask to monitor stool it will pass over 6 days.
  • if object more than 5cm is unlikely to pass duodenum
    Management :
  • Infrom patient
  • Ask to monitor stool
  • Warn vomiting and pain over 6 days.
29
Q

When should be refer to hospital ?

A
  • Object has been inhaled
  • Object swallowed >5cm in length
  • Patient symptoms occur.
30
Q

Prevention is better than cure.

A
  • Careful instrumentation with bracket , piece of wire, auxillaries
  • Work under good lighting
  • Idientify high risk patients
  • Use appropriate and well maintained equipment
31
Q

Example of appropriate and well maintained Instruments?

A
  • Tweezer that meet at their tips
  • Sharp distal end cutters
  • Distal end cutters and cotton wool.
  • Protective gauze / floss for RME (Rapid maxillary expansion) keys
  • Keep nurses high speed suction available to hand

Orthodontics (53 decks)

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