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.
What is the average root resorption during 2 years of fixed appliances?
1mm
What teeth are most affected by root resorption? (3)
any teeth can be affected however;
1. Upper incisors most commonly
2. Lower incisors
3. 6’s
what are the risk factors for root resorption? (4)
- Type of tooth movement
- Prolonged, high force
- Intrusion
- Large movements
- Torque (root movement)
- root form
- blunt
- pipette
- resorbed already
- previous trauma
- nail biting
What types of tooth movement increase the risk of root resorption? (4)
- Prolonged, high force
- Intrusion
- Large movements
- Torque (root movement)
What types of root form increase the risk of root resorption? (3)
- blunt
- pipette
- resorbed already
What is relapse?
Return of the features of the original malocclusion following the correction
what teeth/malocclusions are more prone to relapse? (8)
- Lower incisors (+ crowded)
- Crowded teeth
- Rotated teeth
- Instanding laterals
- Spaces and diastemas
- AOBs
- C2D2
- Teeth with reduced perio support/short roots
How do we manage relapse? (3)
- Case selection – treat the severe malocclusions (accept the mild)
- Informed consent – advise px this commonly occurs and esp in which cases
- Provide retainers – fixed or removable (for life)
What are the risks of fixed retainers? (2)
- Prone to plaque/calculus build up
- Beak without noticing and can lead to caries beneath
What is required if a fixed retainer is placed post ortho tx? (3)
- Excellent OH
- Lifelong use
- Long term care/maintenance
How do we manage soft tissue trauma from ortho appliances? (2)
- Analgesics for pain
- Ortho wax/babybel cheese wax for ulceration
How do we manage recession from ortho tx? (3)
- Correct tx planning by avoiding overexpansion of teeth within bone
- Consent and warn of increased risk of recession in those with a thin biotype
- Gingival graft post tx
What is the risk of treating a patient with active/unstable perio disease?
ortho tx accelerates alveolar bone loss and perio destruction in those with active disease
Who’s at risk of losing vitality of teeth during ortho tx?
Those with previous trauma/a compromised tooth
What is the first sign of loss of vitality during ortho tx?
Grey discolouration
What teeth are most commonly affected by loss of vitality during ortho tx?
lateral incisors
What can cause loss of vitality during ortho tx? (2)
- Excess orthodontic forces
- mostly an idiopathic cause
What materials are a risk for allergy during ortho tx? (3)
- Latex
- Nickel
- Adhesive – colophony (type 4 hypersensitivity)
What factors increase tx success? (3)
- Severity of malocclusion
- Patient motivation
- Operator expertise
