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BDS4 Orthodontics > Risks and benefits of orthodontic treatment > Flashcards

Risks and benefits of orthodontic treatment Flashcards

1
Q

What are the benefits of orthodontic treatment

A
  • improvement in appearance
  • improvement in function
  • improvement in dental health
  • psychological benefits
  • reduced risk of teasing and stereotyping
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2
Q

What are the appearance changes from orthodontic

A

dental and facial
facial is more for severe

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3
Q

How does orthodontics improve function

A

o Improvement in mastication is associated with more severe malocclusions
o Speech is rarely improved by ortho due to when speech development occurs

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4
Q

What are the malocclusions that impact mastication

A

 Large anterior open bites
 Severe increased overjet
 Marked reverse overjet

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5
Q

What is IOTN

A

o IOTN measures the dental health component and determines the benefit the patient would experience if they were to undergo orthodontic treatment
o 1 & 2 are a no need or low need so minimal benefit
o 3 is a borderline need and so there is some benefit
o 4 & 5 are a high need so there is benefit

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6
Q

What are the psychological benefits of orthodontic treatment

A

o Severe malocclusions affect facial attractiveness
o People with unattractive faces are perceived unfavourably
o Correction may improve self esteem & psychological well-being
o Impact on minor malocclusions is more variable
o Quality of life is improved

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7
Q

What is the IOTN pneumonic

A

MOCDO

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8
Q

What is M

A

missing teeth

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9
Q

What can result in missing teeth

A

impaction
hypodontia

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10
Q

What are the risks of impaction

A

 Can cause root resorption of other teeth
 Associated with cyst formation
 Can prevent eruption

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11
Q

What IOTN score is associated with impacted teeth

A

5i
remember i for impaction

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12
Q

What OJ measurement has increased risk of trauma

A

> 6mm
o Risk made worse if incompetent lips

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13
Q

What IOTN score represents OJ

A

o IOTN a represents hypodontia
o 4a = OJ >6mm

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14
Q

What IOTN socre represents crossbite

A

4c is the highest with >2mm discrepancy between RCP and ICP

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15
Q

What are the risks of anterior crossbite

A

 Risk of recession and loss of periodontal support
 Can result in tooth wear
 If crossbite results in displacement then can result in TMJ problems long term
 Crossbites are treated in mixed dentition stage

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16
Q

What are the risks of posterior crossbite

A

 A significant displacement can result in asymmetry
 Requires early correction in mixed dentition

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17
Q

What is displacement of contact points aka

A

crowding

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18
Q

What is the risk of crowding

A

o Hypothetical caries risk  difficulty with OH can increase caries risk

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19
Q

What is the IOTN score for crowding

A

o 4d is highest IOTN score, >4mm contact point displacement

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20
Q

What are the risks of overbite

A

o Deep traumatic overbites can result in gingival stripping on labial surfaces which can result in loss of periodontal support

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21
Q

What is the IOTN of overbite

A

o 4F = overbite with trauma
o F = overbites in IOTN

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22
Q

What malocclusions are associated with TMJ dysfunction

A

o Crossbite with displacement
o Class II with retrusive mandible
o Class III
o AOB
o No guarantee that correction will improve TMD

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23
Q

Should ortho be used to treat TMD

A
  • Orthodontic treatment should never be offered to improve TMD in isolation
  • If malocclusions per se does not warrant treatment, orthodontics will not be offered to patients with TMD
  • Conservative treatment must be offered before any orthodontics
  • Orthodontic treatment could aggravate existing TMD e.g use of intermaxillary elastics
24
Q

What are the risks of orthodontic treatment

A

decalcification
root resorption
relapse
soft tissue trauma
recession
periodontal health
headgear injuries
enamel fracture and tooth wear
loss of vitality
allergy
poor/failed treatment

25
What is the risk of decalcification
o Enamel weakened o Can get staining which are hard to deal with o Can get frank cavitation o Upper teeth more effected as lower teeth most likely saved by salivary buffering
26
How do we prevnet decalcification
* good case selection * maintaining OH * dietary advice * fluoride
27
What is good case selection to prevent decalcification
* Good OH pre treatment * Low caries risk * Treatment need * Patient motivation (are they concerned about their malocclusion)
28
How do we maintain good OH to prevent decal
* Before, during and after * Interdental brushes help for cleaning around appliances * Brush teeth after every meal * Disclosing tablets are an aid for those who struggle * Superfloss
29
What dietary advice do we give to prevent decal
* Low cariogenic diet * Reduce frequency
30
What fluoride can we give to prevent decal
* Spit don’t rinse * 2800ppm for high risk patient * Fluoride 0.05% mouthwash, should be used in between brushing not after * Fluoride varnish 3-4 times a year
31
What is root resorption
o Inevitable consequence of tooth movement o Average is approximately 1mm over 2 years of fixed appliances
32
What teeth are most effected by root resorption
upper incisors > lower incisors > 6s
33
What pecrentage have severe root resorption
1-5%
34
What are the risk factors for root resorption
type of tooth movement rot form previous trauma nail biting
35
What types of tooth movement increase risk of root resorption
* Prolonged high force * Intrusion * Large movements * Torque (root movement)
36
What root forms are at increased risk of root resorption
* Blunt * Pipette * Resorbed already
37
What is relapse defined as
the return of features of the original malocclusion following correction
38
What features are prone to relapse
 Lower incisors are particularly prone to relapse  Rotations  Instanding 2s  Spaces and diastemas  Class 2 division 2  Anterior open bites  Reduced periodontal support/short roots
39
What should we consider when selecing cases with relapse in mind
* Accept mild malocclusions
40
What are the disadvantages of fixed retainers
 Prone to plaque & calculus build up  Can break and not notice  Need excellent oral hygiene  Require more care long term maintenance
41
What are the advantages of fixed retainers
 In situ for life
42
What are the advantages of removable retainers
 Remove for OH  Can wear part time  Patient control  Easy to spot problem
43
What can soft tissue trauma result in
pain ulceration
44
What is the advice for soft tissue trauma pain
analgesia
45
What is the advice for ulceration
 Jaggy wire appears as teeth move  Use orthodontix wax to tie them over  Cheese wax can also be used
46
When is recession most common
o Unpredictable o More common when proclining lower incisors, can push through the buccal bone
47
How do we manage recession
 Correct tx planning, avoid overexpansion  Look out for thin gingival biotypes, more prone to recession * Delicate, highly scalloped and translucent in appearance  Warn patients  Gingival graft if required
48
How can orthodontics increase risk of periodontal health
o Gingivitis o Recession o Active periodontal disease o Loss of periodontal support
49
Why must periodontal disease be stabilized prior to tx
 Any periodontal disease prior to treatment can accelerate bone loss
50
How should headgear injuries be prevented
 2 safety mechanisms: snap away traction spring & nitom facebow
51
How can enamel fracture/tooth wear occur
o Tooth vs bracket o Greater risk with ceramic brackets o Ceramic is harder than enamel o Enamel fracture during debonding of ceramic, sheets of enamel can come off with the bracket
52
Who is at risk of loss of vitality
o Rare o Higher risk if previous trauma or compromised tooth o Warn the patient if this is the case o Look out for discoloration (first signs) o Avoid excessive force
53
How can clinicians be to blame for poor/failed tx
 Poor diagnosis  Poor treatment planning  Operator technique error
54
How can patients be to blame for poor/failed tx
 Unfavourable growth  Poor cooperation
55
What does chances of tx success increase with
* Severity of malocclusion * Motivation of patient * Operator expertise

BDS4 Orthodontics (10 decks)

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