Perio and Ortho

Question 1

Relationship between adolescents/ children and gingival disease?

Answer 1

Tissue resistance appears to be higher in young people

Most plaque related acute gingival disease resolve on removal

Question 2

Relationship between gingivitis and fixed appliance?

Answer 2

If gingivitis develops in response to orthodox appliance almost never extends to periodontitis

Question 3

What is the prevalence of periodontal disease and age?

Answer 3

% pt w/ pockets >5mm increase w/ age

Mucogingival problems peak then decrease w/ age

Question 4

How should pt w/ fixed appliances control plaque?

Answer 4

Adequate cleaning is possible w/ standard brush

Special aids can be useful: inter proximal brush, standard interspace brush, powered rotary brush, superfluous

Question 5

Where is hardest for those with fixed appliances to clean?

Answer 5

1. Mesial and distal area of each tooth between bracket

2. Gingival margin below bracket

Question 6

Should adults w/ perio have ortho?

Answer 6

No contraindications as long as disease under control before and during tx
Combined perio and ortho tx can enhance perio health and dentofacial aesthetics

Question 7

How much of population does perio affect?

Answer 7

40% over 40 years

Question 8

What orthodontics problems bother pt?

Answer 8

Proclination anterior maxillary teeth, irregular interdental space, rotation teeth migration teeth, traumatic occlusion

Question 9

What happens if inflammation not controlled during ortho tx?

Answer 9

Combination inflammation, orthodontic forces and occlusal trauma produce more rapid destruction

Question 10

Evidence on perio and ortho?

Answer 10

See RVC notes

Question 11

How tx pt w/ minimal periodontal involvement?

Answer 11

Before tx offered - course structured hygiene instruction

All ortho pt must take extra care w/ hygiene

Question 12

How tx pt w/ moderate periodontal involvement?

Answer 12

Disease control

1. All pre-existing disease controlled and maintained/monitored (sub/supra gingival cleaning)
2. Complete healing and ensure adequate control

Maintenance Therapy

1. Increase freq. cleaning and scaling
2. Recall 2-4 months

Question 13

How can we reduce microorganisms?

Answer 13

Molar bonding may be advantageous in perio case as bands can make marginal cleaning difficult
Elastomeric rings have higher levels of microorganisms - wire ligatures or self-ligating bracket may be preferred