Perio and orthodontics

Question 1

Why is periodontitis less of a concern for children with fixed appliances?

Answer 1

Tissue resistance is higher in younger patients
Most plaque related acute gingival disease is resolved on the removal of fixed appliances - doesn’t develop into periodontitis

Question 2

What happens when children and adolescents develop gingivitis in response to orthodontic appliances?

Answer 2

Never extends to periodontitis

Question 3

What happens before orthodontic treatment is offered?

Answer 3

Course of structured dental hygiene instruction is offered

Question 4

What happens at each of the 3 dental hygiene sessions?

Answer 4

Session 1: Explain plaque formation, disclose teeth and rinse, measure initial plaque score, teeth brushing technique
Session 2: Disclose and measure plaque score, Discuss nutritionand diet, brushing technique
Session 3: Disclose and measure plaque score, flossing more brushing technique

Question 5

What are the most difficult areas to clean in patients with fixed appliances?

Answer 5

The mesial and distal area of the tooth between the brackets
and the gingival margin below the bracket

Question 6

What special aids can be used for plaque control during treatment?

Answer 6

1. interproximal brush
2. Standard interspace brush
3. Powered rotary brush
4. Superfloss/floss threader
   Special grooved orthodontic brushes are of no advantage

Question 7

What features do periodontal patients have that would want ortho treatment?

Answer 7

lost bone support
Teeth are spaced
Have an increased overjet

Question 8

Is there contraindication to treating adults who have periodontal disease?

Answer 8

No, as long as the disease is brought under control before orthodontic treatment

Question 9

What needs to bein place if have perio disease and having ortho treatment?

Answer 9

Need a regular support and maintenance programme in place to prevent the disease coming back

Question 10

How much of the population does periodontitis affect?

Answer 10

40% of the adult population over 40

More adults are seeking ortho treatment - more perio disease wanting ortho

Question 11

What can combined perio and ortho treatment enhance?

Answer 11

Periodontal health and dentofacial aesthetics

Question 12

What are the common orthodontic problems found in periodontally compromised patients?

Answer 12

Proclination of maxillary anterior teeth
irregular interdental spacing 
Rotation of teeth
Overeruption
Migration/loss of teeth
Traumatic occlusion

Question 13

What happens if inflammation is not brought under control?

Answer 13

A combination of inflammation, orthodontic forces and occlusal trauma produce a more rapid destruction of bone that would occur with inflammation alone

Question 14

What may happen to adults with teeth that did not have healthy periodontal tissues during ortho treatment?

Answer 14

May experience breakdown and tooth loss due to abscesses during treatment

Question 15

How can you identify active disease?

Answer 15

Persistent bleeding on probing is the best indicator of active and progressive disease

Question 16

What are the 3 groups at risk of periodontal disease?

Answer 16

1. Those with minimal disease and no progression despite gingival inflammation (10%)
2. Those with moderate progression
3. Those with rapid progression

Question 17

What must be done once all pre-existing perio diease is brought under control?

Answer 17

A period of observation will allow complete healing and ensure that there is adequate control - need regular assessment

Question 18

What perio treatment is performed before and after the ortho treatment?

Answer 18

Remove supra gingival calculus
RSD with or without gingival flaps
Osseus surgery and repositioned flaps

Question 19

What can be done to reduce the micro-organisms in patients that have perio disease and ortho treatment?

Answer 19

Molar bonding adventageous as bands can make marginal cleansing difficult
Elastomeric rings have higher levels of micro-organisms and wire ligatures or self-ligating brackets are preferred or can adjust ligatures on a regular basis

Question 20

What can periodontal drifting be treated with?

Answer 20

Fixed appliances

Question 21

What do you have to be prepared for with perio patients having ortho treatment?

Answer 21

Disease brought under control before treatment, and must be maintained throughout
Must be aware of unexpected bone loss

Question 22

What periodontal treatment may be needed for ortho patitents?

Answer 22

OHI
Surgery - crown lengthening if the gingiva covers the crown
Can have perio involvement when attatched gingiva has been compromised by movement of teeth

Question 23

How can ortho cause localised gingival recession?

Answer 23

Preservation of attached gingiva is essential,

Arch expansion can lead to recession

Question 24

How can labial movement of lower incisors put the supporting tissues at risk?

Answer 24

Generally gingival recession follows alveolar degiscence if the overlying tissues are stressed
Recession can procede rapidly if there is little attached gingiva