Perio and orthodontics Flashcards
Why is periodontitis less of a concern for children with fixed appliances?
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
What happens when children and adolescents develop gingivitis in response to orthodontic appliances?
Never extends to periodontitis
What happens before orthodontic treatment is offered?
Course of structured dental hygiene instruction is offered
What happens at each of the 3 dental hygiene sessions?
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
What are the most difficult areas to clean in patients with fixed appliances?
The mesial and distal area of the tooth between the brackets
and the gingival margin below the bracket
What special aids can be used for plaque control during treatment?
- interproximal brush
- Standard interspace brush
- Powered rotary brush
- Superfloss/floss threader
Special grooved orthodontic brushes are of no advantage
What features do periodontal patients have that would want ortho treatment?
lost bone support
Teeth are spaced
Have an increased overjet
Is there contraindication to treating adults who have periodontal disease?
No, as long as the disease is brought under control before orthodontic treatment
What needs to bein place if have perio disease and having ortho treatment?
Need a regular support and maintenance programme in place to prevent the disease coming back
How much of the population does periodontitis affect?
40% of the adult population over 40
More adults are seeking ortho treatment - more perio disease wanting ortho
What can combined perio and ortho treatment enhance?
Periodontal health and dentofacial aesthetics
What are the common orthodontic problems found in periodontally compromised patients?
Proclination of maxillary anterior teeth irregular interdental spacing Rotation of teeth Overeruption Migration/loss of teeth Traumatic occlusion
What happens if inflammation is not brought under control?
A combination of inflammation, orthodontic forces and occlusal trauma produce a more rapid destruction of bone that would occur with inflammation alone
What may happen to adults with teeth that did not have healthy periodontal tissues during ortho treatment?
May experience breakdown and tooth loss due to abscesses during treatment
How can you identify active disease?
Persistent bleeding on probing is the best indicator of active and progressive disease
What are the 3 groups at risk of periodontal disease?
- Those with minimal disease and no progression despite gingival inflammation (10%)
- Those with moderate progression
- Those with rapid progression
What must be done once all pre-existing perio diease is brought under control?
A period of observation will allow complete healing and ensure that there is adequate control - need regular assessment
What perio treatment is performed before and after the ortho treatment?
Remove supra gingival calculus
RSD with or without gingival flaps
Osseus surgery and repositioned flaps
What can be done to reduce the micro-organisms in patients that have perio disease and ortho treatment?
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
What can periodontal drifting be treated with?
Fixed appliances
What do you have to be prepared for with perio patients having ortho treatment?
Disease brought under control before treatment, and must be maintained throughout
Must be aware of unexpected bone loss
What periodontal treatment may be needed for ortho patitents?
OHI
Surgery - crown lengthening if the gingiva covers the crown
Can have perio involvement when attatched gingiva has been compromised by movement of teeth
How can ortho cause localised gingival recession?
Preservation of attached gingiva is essential,
Arch expansion can lead to recession
How can labial movement of lower incisors put the supporting tissues at risk?
Generally gingival recession follows alveolar degiscence if the overlying tissues are stressed
Recession can procede rapidly if there is little attached gingiva
