Orthodontics Flashcards
Name 4 fluoride supplements you would give to a patient to prevent decalcification, naming dose and frequency.
Fluoride toothpaste - depending on age, 1450ppm, 2800ppm (under 16); 5000ppm (16+)
Fluoride varnish - 22,600ppm 4x annually
Fluoride tablets - 1mg 1x daily
Fluoride MW - 225ppm 1x daily
Other than fluoride supplements, what are ways to prevent decalcification from orthodontic treatment?
OHI - teach toothbrushing technique/interdental cleaning beneath wires/around brackets 2x daily and after meals
Diet advice - avoid sugary items, encourage to eat them with meals, best to drink water between meals
Fissure sealants
Regular hygiene appts at GDP
List 8 potential risks of orthodontic treatment other than decalcification.
Root resorption
Relapse
Wear of adjacent teeth
Loss of periodontal support
Loss of vitality
Gingival recession
Ulceration
TMJD
How would you assess a patients skeletal AP relationship?
Visually - Frankfort plane parallel to the ground
Clinically (Palpation) - FP parallel to ground and palpate soft tissue point A and B
Lateral Cephalogram - SNA-SNB = ANB
What are the classes of AP relationship?
Class I - Maxilla sits 2-3mm anterior to the mandible (ANB - 2-4 degrees)
Class II - Maxilla sits >2-3mm anterior of the mandible (ANB equal or more than 4 degrees)
Class III = Mandible in front of maxilla (ANB =-2)
Name 4 special investigation an orthodontist may carry out when considering treatment?
Radiograph - OPT; Lateral Ceph
Clinical photos
Study models
Sensibility testing
Describe a Class III incisor relationship
Lower incisors edges occlude anteriorly to the cingulum plateau of the upper central incisors
The OJ may be reduced or reversed
Name 4 I/O features a patient may present with when they have a class III incisor maloclussion
Proclined upper incisors, retroclined lower incisors
Reverse OJ with anterior and posterior buccal crossbite
May have an OB
Maxilla often crowded with mandible aligned or spaced
What systemic condition may a patient have if his mandible keeps growing?
Acromegaly
How is a class III malocclusion managed?
Accept and monitor in mild cases where the patient has no concerns
Intercept early with URAs for correction of incisor relationship and anterior crossbite
Growth modification - Functional appliance (reverse twin block/Frankel III), chin cup, head gear with RME to reduce and redirect mandibular growth and encourage maxillary growth
Camouflage - accept underlying skeletal relationship and correct incisors to class I
Combined orthognathic and orthodontic treatment for functional, mastication or profile concerns
Pt attends with anterior crossbite involving 21
When is the best time to begin treatment?
Intercept as soon as it is detected with URA
Patient attends with anterior crossbite involving 21
What 3 features of the malocclusion would make it amenable to treatment with a URA?
Tooth in crossbite palatally tipped
Good overbite - aids stability
Adequate space to move the teeth forwards
Design a URA for fixing an anterior crossbite involving 21
A - z spring on 11 0.5mm HSSW
R - adams clasps 16, 26 - 0.7mm HSSW
URD, ULD - 0.6mm HSSW
A - Yes
B - Self cure PMMA with posterior bite plane
Define hypodontia
The congenital absence of one or more teeth excluding the 8s
It can be associated with microdontia and generally affects the lower 5’s, upper 2’s and upper 5’s
Seen more in females
How is hypodontia diagnosed?
OPT Radiograph coupled with clinical examination
What are 3 syndromes associated with hypodontia?
Cleft-lip-palate
Downs syndrome
Ectodermal dysplasia
How may hypodontia present to you as a GDP?
Delayed or asymmetric eruption
Retained or infra-occluded deciduous teeth
Ectopic canines
Absence of deciduous teeth
Tooth malformation
What are the treatment options for hypodontia?
Refer as soon as noticed - allocated to hypodontia clinic
Accept and monitor
Restorative alone - composite bonding, veneers
Orthodontics alone
Orthodontics and restoration - close space (simple or space closure plus) or open space (RBB; autotransplantation; implant; removable/fixed pros)
Name 4 members of the MDT involved with hypodontia
Paediatric dentist
Orthodontist
Restorative dentist
Prosthodontist
Oral Surgeon
Speech/Language therapist
Clinical psychologist
What 4 factors make early loss of primary teeth worse?
Age of the patient
If the arch is already crowded as there will be marked space loss in crowded patients
Losing Es - issues with permanent 6
If it occurs in maxilla as more space is lost in upper than lower
When might you consider balancing a primary tooth extraction?
Balancing is the extraction of a tooth from the opposite side of the same arch
Balance Cs to prevent centre line drift in crowded arch
Consider balancing of lower Ds if arch is crowded`
Give 4 reasons for an unerupted 1?
Supernumerary (usually tuberculate)
Trauma to A - dilaceration
Crowding
Pathology - dentigerous cyst
What are your treatment options for an unerupted 1?
Surgical exposure with or without bonding using a gold chain
XLA of supernumerary if there is one present
Orthodontic traction used if over 9y
Fixed appliance use then bonded retainer
What is the BSI classification of class II div I?
Lower incisor edges lie posterior to the cingulum of the upper incisors
OJ increased
Upper central incisors may be proclined or of average inclination
What are the dental features in class II div I patients?
Proclined upper incisors
Increased OJ
Class 2 molars and canines
What soft tissue problems are associated with Class II div I malocclusions?
Often incompetent lips due to prominence of upper incisors and/or underlying skeletal pattern
Inability to achieve anterior oral seal
May have lip trap and tongue thrusts
