Risk Benefit in Orthodontics

Question 1

what are the general benefits of orthodontics?

Answer 1

1. Appearance [Dental & Facial]
2. Function
3. Dental health

Question 2

Improvement in Dental appearance photographs

Answer 2

Question 3

What are the psychological benefits of orthodontics?

Answer 3

• severe malocclusions affects facial attractiveness
• People with unattractive faces perceived unfavourably
• correction MAY improve self esteem & psychological wellbeing
• Quality of Life improvement

Question 3

Improvement in facial appearance photographs

Answer 3

Question 3

what are the functional benefits of ortho?

Answer 3

• mastication
• speech

Improvement when associated with severe malocclusions

Question 4

What are the values & meanings of the DENTAL HEALTH COMPONENT of IOTN?

Answer 4

1 & 2 - No need/low need

3 - Borderline need

4 & 5 - Need/High need

Question 5

What does MOCDO acronym stand for?

Answer 5

M - missing & ectopic teeth
O - overjet
C - crossbites
D - displacement of contact points
O - overbites

Question 6

What problems can impacted teeth cause?

Answer 6

• resorption
• associated with cyst formation
• supernumerary teeth can prevent normal eruption

Question 7

What problems can overjets cause (especially is >6mm)?

Answer 7

• risk of trauma to upper incisors increases with size of OJ
• worse with incompetent lips

Question 8

What problems can ANTERIOR crossbites cause?

Answer 8

• loss of periodontal support
• tooth wear

Question 9

What problems can POSTERIOR crossbites cause?

Answer 9

• mandibular displacement

Question 10

What are the associations of Crowding with Caries & periodontal disease?

Answer 10

Crowding = harder & take longer to clean

Poor cleaning results in caries & periodontal disease

Question 11

What problems can DEEP overbites cause?

Answer 11

• gingival stripping IF traumatic
• loss of periodontal support

Question 12

What are the links with TMD & orthodontic malocclusions/ortho in general?

Answer 12

• Small association between TMD & some malocclusions
• In general evidence is VERY WEAK
• Ortho should never be offered to improve TMD in isolation

Question 13

how can you prevent the chances of decalcification & caries in a patient receiving ortho tx?

Answer 13

1. Case selection
2. Oral hygiene
3. diet advice
4. fluoride

Question 14

when preventing decalcification & caries, what are the pt factors which MAKE GOOD CASE SELECTION?

Answer 14

• motivated pt
• good OH pre tx
• low caries risk

high risk of decalcification indicated by preexisting decalcification, erosion, caries history

Question 15

how does a pt maintain good OH to prevent decalcification?

Answer 15

• Toothbrushing target areas (brackets & arch wires)
• ID brushes

OHI:
- min x2 day, VERY thoroughly
- after eating
- disclosing tablets

Question 16

what diet advice would be given for preventing decalcification?

Answer 16

• encouraging non-cariogenic diet (sweets, sticky foods)
• sugar amount & frequency (both are bad, frequency is worse)
• sugar free gum (stimulate salivary buffers for acid)

Question 17

what toothpaste instructions would be given for normal patients AND high risk pts?

Answer 17

• F exposure is GOOD
• x2 daily (minimum)

[Spit dont rinse]

High risk:
- Duraphat (2800 & 5000ppmF)

Question 18

what MW instructions are to be given to help prevent decalcification?

Answer 18

• use IN BETWEEN brushing, NOT after - dilutes
• Better than nothing
• may be expensive, regular brushing just as effective

Question 19

what is root resorption and what causes it in ortho?

Answer 19

• 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

Question 20

what are risk factors for root resorption?

Answer 20

Type of tooth movement:
- prolonged, high force
- intrusion
- LARGE movements
- Torque (root movement)

Root form

Previous trauma?

Possible nail biting??

Question 21

in ortho, relapse is a risk, what is meant by relapse?
+
What area is most prone to relapse?

Answer 21

Return of the features of the original malocclusion FOLLOWING CORRECTION

Lower incisors particularly prone to relapse

Question 22

how do you manage relapse and the risk of it happening?

Answer 22

• very common problem + unpredictable
• treat all cases as potential to relapse
• some features more PRONE (Lower incisors, rotations)

MANAGING:
RETAINERS (FIXED OR REMOVEABLE)

Question 23

whats the best way to prevent relapse?

Answer 23

• retainers for life
  (pressure/vacuum formed are ideal - clear and most aesthetic)

GDP manages retainers if broken/lost

Question 24

negatives of fixed retainers?

Answer 24

• prone to plaque & calculus buildup - can break and not notice
• need excellent OH

Question 25

what sort of soft tissue trauma can occur as a result of orthodontic tx?

Answer 25

• pain/discomfort from brackets
• ulceration - friction (cover cause with some wax)

Question 26

What are the less common risks from ortho tx?

Answer 26

• recession
• gingivitis/loss of periodontal support
• headgear injuries
• enamel fracture (if bracket debonds)
• loss of vitality (rare)
• allergy (nickel allergy)
• failed tx

Question 27

what are the benefits of ortho?

Answer 27

Improve appearance
- dentofacial aesthetics
- quality of life

Improve function
- mastication

Improve dental health
- trauma
- resoprtion

Question 28

what are the general risks of ortho tx?

Answer 28

Decalcification
root resorption
relapse
soft tissue damage

Others:
- recession
- loss of periodontal support
- headgear injuries
- enamel fractures
- loss of vitality
- allergy (Nickel??)
- Failed tx

Question 29

what are some general points to remember about ortho?

Answer 29

• 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