Risk Benefit in Orthodontics Flashcards
what are the general benefits of orthodontics?
- Appearance [Dental & Facial]
- Function
- Dental health
Improvement in Dental appearance photographs
What are the psychological benefits of orthodontics?
- severe malocclusions affects facial attractiveness
- People with unattractive faces perceived unfavourably
- correction MAY improve self esteem & psychological wellbeing
- Quality of Life improvement
Improvement in facial appearance photographs
what are the functional benefits of ortho?
- mastication
- speech
Improvement when associated with severe malocclusions
What are the values & meanings of the DENTAL HEALTH COMPONENT of IOTN?
1 & 2 - No need/low need
3 - Borderline need
4 & 5 - Need/High need
What does MOCDO acronym stand for?
M - missing & ectopic teeth
O - overjet
C - crossbites
D - displacement of contact points
O - overbites
What problems can impacted teeth cause?
- resorption
- associated with cyst formation
- supernumerary teeth can prevent normal eruption
What problems can overjets cause (especially is >6mm)?
- risk of trauma to upper incisors increases with size of OJ
- worse with incompetent lips
What problems can ANTERIOR crossbites cause?
- loss of periodontal support
- tooth wear
What problems can POSTERIOR crossbites cause?
- mandibular displacement
What are the associations of Crowding with Caries & periodontal disease?
Crowding = harder & take longer to clean
Poor cleaning results in caries & periodontal disease
What problems can DEEP overbites cause?
- gingival stripping IF traumatic
- loss of periodontal support
What are the links with TMD & orthodontic malocclusions/ortho in general?
- Small association between TMD & some malocclusions
- In general evidence is VERY WEAK
- Ortho should never be offered to improve TMD in isolation
how can you prevent the chances of decalcification & caries in a patient receiving ortho tx?
- Case selection
- Oral hygiene
- diet advice
- fluoride
when preventing decalcification & caries, what are the pt factors which MAKE GOOD CASE SELECTION?
- motivated pt
- good OH pre tx
- low caries risk
high risk of decalcification indicated by preexisting decalcification, erosion, caries history
how does a pt maintain good OH to prevent decalcification?
- Toothbrushing target areas (brackets & arch wires)
- ID brushes
OHI:
- min x2 day, VERY thoroughly
- after eating
- disclosing tablets
what diet advice would be given for preventing decalcification?
- encouraging non-cariogenic diet (sweets, sticky foods)
- sugar amount & frequency (both are bad, frequency is worse)
- sugar free gum (stimulate salivary buffers for acid)
what toothpaste instructions would be given for normal patients AND high risk pts?
- F exposure is GOOD
- x2 daily (minimum)
[Spit dont rinse]
High risk:
- Duraphat (2800 & 5000ppmF)
what MW instructions are to be given to help prevent decalcification?
- use IN BETWEEN brushing, NOT after - dilutes
- Better than nothing
- may be expensive, regular brushing just as effective
what is root resorption and what causes it in ortho?
- INEVITABLE consequence of tooth movement
- approx 1mm of resorption over 2 years fixed appliances
- any teeth subject to it, upper incisors most common
- usually unnoticed
- SEVERE RESORPTION 1-5% pts
what are risk factors for root resorption?
Type of tooth movement:
- prolonged, high force
- intrusion
- LARGE movements
- Torque (root movement)
Root form
Previous trauma?
Possible nail biting??
in ortho, relapse is a risk, what is meant by relapse?
+
What area is most prone to relapse?
Return of the features of the original malocclusion FOLLOWING CORRECTION
Lower incisors particularly prone to relapse
how do you manage relapse and the risk of it happening?
- very common problem + unpredictable
- treat all cases as potential to relapse
- some features more PRONE (Lower incisors, rotations)
MANAGING:
RETAINERS (FIXED OR REMOVEABLE)
whats the best way to prevent relapse?
- retainers for life
(pressure/vacuum formed are ideal - clear and most aesthetic)
GDP manages retainers if broken/lost
negatives of fixed retainers?
- prone to plaque & calculus buildup - can break and not notice
- need excellent OH
what sort of soft tissue trauma can occur as a result of orthodontic tx?
- pain/discomfort from brackets
- ulceration - friction (cover cause with some wax)
What are the less common risks from ortho tx?
- recession
- gingivitis/loss of periodontal support
- headgear injuries
- enamel fracture (if bracket debonds)
- loss of vitality (rare)
- allergy (nickel allergy)
- failed tx
what are the benefits of ortho?
Improve appearance
- dentofacial aesthetics
- quality of life
Improve function
- mastication
Improve dental health
- trauma
- resoprtion
what are the general risks of ortho tx?
Decalcification
root resorption
relapse
soft tissue damage
Others:
- recession
- loss of periodontal support
- headgear injuries
- enamel fractures
- loss of vitality
- allergy (Nickel??)
- Failed tx
what are some general points to remember about ortho?
- Malocclusion RARELY carries health risk
- ortho tx mostly (OPTIONAL)
- Risks are present throughout full course of tx & beyond (benefits more obvious at end of tx)
- Benefits MUST outweigh risks
