Orthodontics - Risk vs Benefit Flashcards
What are the benefits of orthodontic tx? (5)
Improvement in;
* Dental & facial Appearance
- masticatory Function: marked improvement in those with severe AOB, OJ (increased&reversed)
(Speech rarely improved with ortho - tx not carried out if this is the only/main complaint) - Dental health (IOTN)
Prevents;
- Trauma
- resorption
List IOTN 1-5 and the treatment need associated with each.
1 and 2 = No/low need & minimum benefit
3 = borderline & some benefit (3.6 is the cut off for NHS treatment)
4 and 5 = high need & significant benefit
List the psychological benefits of orthodontic tx. (3)
Improving appearance = improves psychological well being
- Severe malocclusions affect facial attractiveness = unfavourable perception
- Correction may improve self-esteem and psychological well-being
- Improves quality of life as less teasing and children aren’t sterotyped
Children with normal dental appearance as perceived as more intelligent, friendly, more desirable as a friend and less aggressive)
If a px’s main complaint is speech will orthodontic tx be provided?
Speech rarely improved with ortho tx - tx not carried out if this is the only/main complaint
What acronym is used to simplify IOTN?
M = Missing teeth/imoacted/supernumerary
O = Overjet
C = Crossbites
D = Displacement of contact points (i.e. crowding)
O=overbites
What are the risks associated with missing/ectopic/impacted teeth? (3)
- Root resorption
- Cyst formation
- Supernumeraries = prevent normal eruption
What are the risks associated with overjets >6mm ? (1)
Increased risk of trauma to upper incisors
Worsened by incompetent lips
What are the risks associated with Anterior and Posterior crossbites (+ displacement)? (4)
Anterior
- Gingival recession (Loss of periodontal support)
- Tooth wear
Posterior:
- if there is significant displacement = Asymmetric growth
If there is displacement in either anterior or posterior crossbite there is a TMD risk.
What are the risks associated with displacement/crowding? (2)
Caries (limited threat)
- Teeth harder to clean (reduced fluoride contact)
- Take longer to clean
Perio (weak association & limited threat)
- Teeth harder to clean as the surfaces are less accessible
motivation more of a concern
What are the risks associated with overbites? (2)
- Gingival stripping & Loss of perio support
Palatal stripping more common than labial - Trauma
In what malocclusions are there small associations with TMD? (4)
Not always the case!
- Crossbite with displacement (functional shifts)
- Class II with retrusive mandible
- Class III
- AOB
If a patient’s main complaint is TMD alone, should ortho tx be provided?
what is a risk of carrying out ortho on a TMD patient?
No guarantee that correction will improve TMD therefore ortho should never be provided to correct TMD in isolation i.e. if px has no malocclusion.
- Conservative tx must be offered before
Ortho can aggravate existing TMD e.g. intermaxillary elastics
what are the 4 main risks of ortho tx? (4)
list other less significant risks. (7)
- Decalcification
- Root resorption
- Relapse
- Soft tissue trauma
- Recession
- Loss of perio support
- Headgear injuries
- Enamel fracture/toothwear
- Allergy
- Loss of vitality
- Poor/failed tx
What is the GDP’s role is reducing the risk of decalcification? (4)
- Case selection of pxs for ortho
- good OH prior to tx, motivated and low caries risk
- Oral hygiene instruction (before and during)
- Diet advice
- Encourage non-cariogenic diet, Educate impacts of sugar, advise using free gum to stimulate saliva
- Fluoride
- Toothpastes (Can provide 2800/5000ppm toothpastes for HR), Mouthwash, fluoride varnish and GIC.
What are the tx options for a high risk patient with poor oral hygiene? (2)
consider continuing treatment with high risks
or consider if the tx should be discontinued and take brackets off.
