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BDS4 CDS Ortho > risks and benefits of ortho tx > Flashcards

risks and benefits of ortho tx Flashcards

1
Q

benefits of orthodontics

3

A
  1. Appearance
    * Dental
    * Facial
  2. Function
  3. Dental health
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2
Q

appearance can be

A

dental
facial - all 3 planes of space

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3
Q

psychological benefits of ortho tx

4

A

Severe malocclusions affect facial attractiveness

People with unattractive faces perceived unfavourably

Correction may improve self-esteem & psychological wellbeing – difficult to measure

Impact on minor malocclusions is more variable & debatable

    • Quality of Life (QoL) improvement – is used to measure benefits now over psychological improvement (which is hard
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4
Q

what is used to measure psychological benefit

A

Quality of Life (QoL) improvement – is used to measure benefits now over psychological improvement (which is hard)

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5
Q

ortho tx can improve what

other than attractiveness and psychological benefit

A

function
* mastication
* speech* (but rarely speech defects)*

Improvement in function when associated with severe malocclusion
* Large anterior open bites
* Severe inc OJ
* Marked reverse OJ (class III)

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6
Q

IOTN dental health components categories

A

1 & 2 No Need/Low Need (min benefit)
3 borderline need (some benefit)
4 & 5 Need/High Need (significant benefit)

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7
Q

MOCDO acronym

A

MISSING TEETH
OVERJET
CROSSBITES
DISPLACEMENT of contact points
OVERBITES

used for IOTN

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8
Q

impacted teeth can cause

3 issues

A
  • Can cause resorption
  • Can be associated with cyst formation
  • Supernumery teeth can prevent normal eruption
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9
Q

overjet (inc >6mm) can cause

2 issues

A

Risk of trauma to upper incisors increases with size of OJ
Worse with incompetent lips

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10
Q

anterior crossbites can cause

2 issues

A

loss of perio support
tooth wear

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11
Q

posterior crossbites can cause

A

A significant displacement may lead to Asymmetry

Early correction on prevents displacement establishing in permanent dentition

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12
Q

posterior crossbite causing a significant displacement needs

A

early correction to prevent establishment in permanent dentition

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13
Q

crowding and caries connection

A

Crowding per se not directly linked to increased risk to caries
* Caries is more to do with diet and fluoride

Crowded teeth are more difficult to clean and take longer.

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14
Q

crowding and periodontal disease connection

A

Weak association between irregular teeth & periodontal disease.

Crowding can make surfaces less accessible and harder to clean

Individual motivation rather than tooth alignment has greater effect on effective brushing.

Better OH/ awareness in Pts with previous ortho

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15
Q

deep traumatic overbites can cause

A

gingival stripping
* leading to loss in peiro support

More common to have palatal gingivae trauma than labial
Improvement of palatal gingiva after surgery (lower photos)

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16
Q

TMJ dysfunction and ortho tx

A

TMD is multifactorial

Orthodontics/TMD - evidence is very weak
* Small association between TMD and some malocclusions:- Crossbite with displacement (functional shifts), Class II with retrusive mandible, Class III, AOB BUT no guarantee correction will improve TMD.

**Ortho Tx should never be offered to improve TMD in isolation **
* If malocclusion per se does not warrant tx - ortho will not be offered to pts with TMD
* Conservative tx must be offered before any ortho

Ortho Tx could aggravate existing TMD eg using intermaxillary elastics

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17
Q

potential problems due to
missing/ectopic teeth

2

A

root resorption
cyst formation

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18
Q

potential problems due to
overjets (>6mm)

1

A

upper incisor trauma

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19
Q

potential problems due to
crossbites with displacment

3

A

tooth wear
gingival recession
asymmetric growth

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20
Q

potential problems due to
displacements with crowding

2

A

limited thread with caries and perio disease

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21
Q

potential problems due to
overbites

2

A

trauma
gingival damage

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22
Q

possible dental issues which can be addressed by ortho tx

5

A

missing/ectopic teeth
overjets >6mm
crossbites with displacment
displacment (crowding)
overbites

MOCDO

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23
Q

ortho tx is

for the pt

A

elective mostly

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24
Q

when are benefits of ortho tx seen

A

at the end of tx

can get worse during course

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25
benefits Vs risks
benefits must outweigh risks
26
risks of ortho tx | 11
**Decalcification Root resorption Relapse Soft tissue trauma** Others * Recession * Loss of periodontal support * Headgear injuries * Enamel fracture & tooth wear * Loss of vitality * Allergy * Poor/failed treatment
27
what is decalcification
weakens the enamel to caries
28
prevention of decalcification | 4
Case selection Oral hygiene Diet advice Fluoride
29
good case selection to prevent decal characteristics | 3
Motivated patient Good OH pre-treatment Low caries risk
30
high risk of decal indicated by | 3
* Pre-existing decalcification * Erosion * Caries history If low or borderline need - no tx
31
oral hygiene to prevent decal
Before start and during Inter-dental brush OHI * minimum twice per day VERY thoroughly * after every meals * disclosing tablets * target gingival margins and around each bracket with toothbrushing * interdental clean | GDPs help
32
OHI to prevent decal
* minimum twice per day VERY thoroughly * after every meals * disclosing tablets * target gingival margins and around each bracket with toothbrushing * interdental clean
33
diet advice to prevent decal
Encouraging a non-cariogenic diet Sugar amount and frequency * avoid snacks between meal * avoid fizzy, diluting drinks etc * sports drinks * lollipop type sweets, haribos ! Sugar free gum - stimulate salivary buffers
34
fluoride exposure to prevent decal | options (3 main)
toothpaste * at least twice daily * spit don’t rinse * switch to adult toothpaste *(infant 500-1000ppm; adult 1450ppm)* * high risk pts - duraphat 2800ppm or 5000ppm; twice daily, use ordinary toothpaste at other times mouthwash * daily 0.05% fluoride mouthwash (225ppm) * **use in between brushing, not after** * beneficial but low compliance * Price may be prohibitive – cheaper options – supermarket brand antiseptic m/w with F duraphat varnish * 22,600ppm Fluoride * 4 monthly, for high risk pt *others (F releasing GIC)*
35
root resorption due to ortho | prevalence
Inevitable consequence of tooth movement Average approx. 1mm over 2 yrs fixed appliances Any teeth but UI > LI > 6s Mostly unnoticed * Severe in 1-5%
36
root resorption risk factors | 3 main
**Type of tooth movement ** * Prolonged, high force * Intrusion * Large movements * Torque (root movement) **Root form ** * blunt, pipette, resorbed already **Previous trauma** Nail biting ?
37
relapse is
the return of the features of the original malocclusion following correction Very common problem Unpredictable Treat all cases as if potential to relapse *lower incisors particularly prone to relapse*
38
features more prone to relapse | 7
* Lower incisor crowding * Rotations * Instanding 2’s * Spaces & diastemas * Class II div 2 * Anterior open bites * Reduced perio support/short roots
39
how to manage relapse | /prevent 2
Case selection / informed consent * Tx severe malocclusion * Accept the mild *(NHS funding from 6 onwards)* Retainers * Fixed * Removable
40
types of removable retainers | 4
Clear Occlusal retainer (COR) Pressure or vacuum formed (PFRs/VFRs) Essix Hawley type
41
pros of removable retainers | 4
* Remove for OH * Can wear part time * Patient control * Easy to spot problem After discharge, GDPs to provide replacements
42
fixed retainers cons | 3
* Prone to plaque & calculus build up * Can break and not notice * Need excellent OH * require long-term maintenance/more care
43
con of removable retainers
wear through them reliant on pt wearing them
44
what are fixed retainers
Wire in incisal 1/3 not by dental papillae/gingival margin leave in situ for life vacuum formed retainer often made to sit over
45
how to manage pain/discomfort from soft tissue trauma of ortho appliance
analgesics
46
how to manage ulceration due to ortho appliance
wax - ortho or babybel
47
recession due to ortho tx | prevalance
Increasing problem Expansion, more adult treatment May not manifest until years after
48
how to manage recession and ortho
Correct tx planning - teeth within bone, avoid overexpansion Thin biotype Warn Pt Gingival graft
49
periodontal health and ortho
Gingivitis – common Recession Active perio disease *** Must be treated, stabilised, maintained before ortho tx starts ** * During ortho tx – accelerates alveolar bone loss and perio destruction * Treated as priority over continuing tx Loss of perio support
50
headgear trauam prevention | 2
Safety mechanisms * Snap away traction spring * Nitom facebow | minimum
51
headgear trauam prevention | 2
Safety mechanisms * Snap away traction spring * Nitom facebow | minimum
52
tooth wear/enamel fracture in ortho | how
Tooth vs bracket * Greater risk with ceramic brackets *Ceramic harder than enamel! * Enamel fracture during debond
53
loss of vitality in ortho
Rare * More risk if previous trauma or compromised tooth Warn patient - Discolouration or darkened, come in Cause * Excess force ? * idiopathic cause
54
allergies to be aware of | 3
Latex Nickel Adhesive – colophony
55
factors in poor/failed ortho tx | 5
The clinician * Poor dx * Poor tx plan * Operator technique error The pt * Unfavourable growth * Poor cooperation - With appliance wear/Repeated breakages/Non-attendance
56
clinician factors in poor/failed ortho tx | 3
* Poor dx * Poor tx plan * Operator technique error
57
pt factors in poor/failed ortho tx | 2
Unfavourable growth Poor cooperation * With appliance wear * Repeated breakages * Non-attendance
58
chance of ortho tx success increases with | 3
* Severity of malocclusion * Motivation of pt * Operator expertise
59
short term ortho/cosmetic quick fixes deals with | six month smiles etc
* Mild problems * Unrealistic patient expectations * Informed choice * Relapse potential Litigation prone in hands of inexperienced operator
60
summary of benefits of ortho | 3 categories
Improve appearance * Dentofacial aesthetics * QoL Improve function * Mastication Improve dental health * Trauma * Resorption
61
what to remember when discussing ortho risks/benefits with pt
Malocclusion seldom carries a health risk Orthodontics treatment mostly elective Risks throughout full course of Tx and beyond Benefits more apparent at the end of Tx **Therefore the benefits of treatment must outweigh the risks** *“Patients with the most to gain are those with severe malocclusions treated by experts” “Patients with mild malocclusions have most to lose and least to gain”*

BDS4 CDS Ortho (9 decks)

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