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BDS4 Orthodontics > Risks & Benefits of Orthodontics > Flashcards

Risks & Benefits of Orthodontics Flashcards

1
Q

What are the potential benefits of orthodontics?

A
  • appearance
    • dental
    • facial
  • function
  • dental health
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2
Q

What are the psychological benefits of orthodontics?

A
  • severe malocclusions affect facial attractiveness
    • perceived unfavourably
  • correction can improve self-esteem and psychological wellbeing
    • difficult to measure
  • quality of life improvement
  • reduced teasing
    • often experienced with increased overjet
  • reduced stereotyping
    • children with normal dentition seen as:
      • more intelligent
      • more friendly
      • more desirable as a friend
      • less aggressive
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3
Q

What are the functional benefits of orthodontics?

A
  • mastication
    • improvement with severe malocclusion
      • large anterior open bite
      • severe increased overjet
      • marked reverse overjet
  • speech
    • rarely improves speech defects
      • never carry out just for speech
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4
Q

What are the dental health benefits to orthodontics?

A
  • prevention of consequences
  • difficult to describe
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5
Q

How is the orthodontic dental health need of a patient assessed?

A
  • Index of Orthodontic Treatment Need
    • IOTN
  • IOTN 1&2
    • no/low treatment need
    • minimum benefit
  • IOTN 3
    • borderline treatment need
    • some benefit
  • IOTN 4&5
    • need/high treatment need
    • significant benefit
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6
Q

What acronym is used to assess IOTN?

A
  • MOCDO
    • Missing teeth
    • Overjet
    • Crossbite
    • Displacement of contact points
    • Overbites
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7
Q

Why are impacted teeth considered a high orthodontic treatment need?

A
  • can cause resorption
  • supernumeraries can prevent eruption
  • can be associated with cyst formation
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8
Q

What size of overjet is considered a high treatment need and why?

A
  • increased >6mm
  • risk of trauma to upper incisors
    • increases with size of overjet
    • increases with incompetent lips
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9
Q

Why are anterior crossbites considered a high treatment need?

A
  • loss of periodontal support
  • toothier
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10
Q

Why are posterior crossbites considered a high treatment need?

A
  • significant displacement can lead to
    • asymmetry
    • requires early correction
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11
Q

What is the link between crowding and caries?

A
  • crowding is not directly linked to an increased
  • crowded teeth are more difficult to clean and take longer
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12
Q

What is the link between crowding and periodontal disease?

A
  • weak association between crowding and periodontal disease
  • crowding can make surfaces less accessible and harder to clean
    • individual motivation more important
    • better OH awareness in previous ortho
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13
Q

Why is a deep traumatic overbite considered a high treatment need?

A
  • can cause gingival stripping
  • loss of perio support
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14
Q

Is orthodontic treatment used to treat TMJ dysfunction?

A
  • TMD is multifactorial
    • ortho treatment evidence is weak
  • small associations with TMD and malocclusion
    • crossbite with displacement
      • functional shifts
    • class II with retrusive mandible
    • class III
    • AOB
  • no guarantee correction will improve TMD
    • ortho never offered in isolation
    • conservative treatment always first
  • ortho can aggravate existing TMD
    • inter maxillary elastics
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15
Q

What are the 4 main risks of orthodontics?

A
  • decalcification
  • root resorption
  • relapse
  • soft tissue trauma
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16
Q

What are the less common associated risks of orthodontic treatment?

A
  • recession
  • loss of periodontal support
  • headgear injuries
  • enamel fractures and toothwear
  • loss of vitality
  • allergy
  • poor or failed treatment
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17
Q

Describe decalcification as a risk of orthodontic treatment

A
  • weakened enamel to caries
    • unsightly staining
    • frank cavitation
    • gross caries
  • orthodontic appliances act as plaque retentive factor
    • difficult to clean
18
Q

What are the 4 ways in which decalcification can be prevented?

A
  1. case selection
  2. oral hygiene
  3. diet advice
  4. fluoride
19
Q

What does case selection to prevent decalcification as a result of ortho involve?

A
  • motivated patient
  • good OH pre-treatment
  • low caries risk
  • high risk of decalcification indicated by:
    • caries history
    • pre-existing calcification
    • erosion
  • if low or borderline need
    • avoid treatment
20
Q

What does oral hygiene to prevent decalcification as a result of ortho involve?

A
  • toothbrushing instruction
    • twice daily thoroughly
    • after every meal
    • disclosing tables
      • identify target areas
    • gingival margins and brackets
  • interdental brush use
21
Q

What does dietary advice to prevent decalcification as a result of ortho involve?

A
  • encourage low cariogenic diet
  • sugar amount and frequency
    • avoid snacks between meals
    • avoid fizzy, diluting drinks etc.
    • avoid sports drinks
    • avoid lollipop and gummy type sweets
  • sugar free gum recommended
    • stimulate salivary buffers
22
Q

Describe root resorption as a risk of orthodontic treatment

A
  • inevitable consequence of tooth movement
    • apron 1mm over 2 years fixed appliance
  • any teeth affected
    • UI>LI>6s
  • mostly unnoticed
    • severe in 1-5%
23
Q

What does fluoride to prevent decalcification as a result of ortho involve?

A
  • toothpaste
    • twice daily at least
    • spit don’t rinse
    • use adult toothpaste
    • high risk use high fluoride
      • 2,800ppmF
      • twice daily
  • mouthwash
    • once daily
      • in between brushing, not after
    • beneficial but low compliance
    • 0.05% fluoride mouthwash
      • 225ppmF
  • fluoride varnish
    • Duraphat 22,600ppmF
    • 4 monthly
24
Q

What are the risk factors for root resorption as a result of orthodontic treatment?

A
  • type of tooth movement
    • prolonged high force
    • intrusion
    • large movement
    • torque
      • root movement
  • root form
    • blunt
    • pipette
    • previous resorption
    • idiopathic short roots
  • previous trauma
  • nail biting
25
Q

Describe relapse as a risk factor of orthodontic treatment

A

relapse is the return of the features of the original malocclusion following correction

  • very common problem
  • unpredictable
    • treat all cases as more prone to relapse
26
Q

What features of a malocclusion are particularly prone to relapse?

A
  • lower incisor crowding
  • crowding
  • rotations
  • instanding laterals
  • spaces and diastemas
  • class II div 2
  • anterior open bites
  • reduced perio support/short roots
27
Q

In what particular cases should a retainer be fitted immediately after debond?

A
  • bridgework
    • fit retainer after cementation
28
Q

What 3 factors should be considered for managing relapse?

A
  1. case selection
  2. informed consent
  3. retainers
    • fixed
    • removable
29
Q

How can relapse be prevented?

A
  • retention for life
    • removable retainers
    • fixed retainers
30
Q

Describe removable retainers and their advantages and disadvantages

A
  • removable retainers
    • clear occlusal retainer
      • COR
    • pressure or vacuum formed
      • PFR/VFR
    • Essix
    • Hawley type
  • advantages
    • removal for OH
    • can wear part time
    • patient control
    • easy to spot problem
  • disadvantages
    • after discharge from ortho
      • GDP replacement fee
31
Q

Describe fixed retainers and their advantages and disadvantages

A
  • fixed bonded retainer
    • wire and composite
  • advantages
    • cannot be removed
    • left in situ for life
    • can use VFR on top
  • disadvantages
    • prone to plaque and calculus build up
    • can break and not notice
    • requires excellent oral hygiene
    • require care and long term maintenance
32
Q

Describe soft tissue trauma as a risk of orthodontic treatment

A
  • pain and discomfort
    • managed with analgesics
  • ulceration
    • place wax over area causing trauma
33
Q

Describe recession as a risk of orthodontic treatment

A
  • increasing problem
    • can manifest years later
  • expansion cases
    • mostly adults
34
Q

How can gingival recession as a result of orthodontic treatment be managed?

A
  • correct treatment planning
    • teeth within bone
    • avoid over expansion
  • thin gingival biotype
  • warn patient of risk
    • informed consent
  • gingival graft
35
Q

What periodontal conditions may be seen in association with orthodontic treatment

A
  • gingivitis
    • common
  • active periodontal disease
    • must be treated and stabilised
    • maintained before treatment start
    • ortho accelerates alveolar bone loss
      • increased perio destruction
  • loss of perio support
    • light forces
  • necrotising periodontitis
    • remove wire and elastics
    • debride
    • do not continue treatment until resolved
36
Q

Describe headgear trauma as a risk of orthodontic treatment

A
  • ocular injury
  • 2 safety mechanisms required
    • snapaway traction spring
    • nitom facebow
    • masel strap
37
Q

Describe toothwear and enamel fracture as a risk of orthodontic treatment

A
  • tooth in contact with bracket
    • greater risk with ceramic brackets
      • ceramic harder than enamel
  • enamel fracture during debond
38
Q

Describe loss of vitality as a risk of orthodontic treatment

A
  • rare
  • increased risk with previous trauma
    • tooth compromised
    • warn patient
  • discoloured or darkened tooth
    • force
    • idiopathic cause
39
Q

Describe allergies as a risk of orthodontic treatment

A
  • latex
  • nickel
    • low Ni in NiTi
    • Ni free options available
  • adhesive
    • colophony
      • Type 4 sensitivity
40
Q

Describe poor or failed treatment as a risk of orthodontic treatment

A
  • the clinician
    • poor diagnosis
    • poor treatment planning
    • operator technique error
      • poor mechanics
  • the patient
    • unfavourable growth
    • poor cooperation
      • appliance wear
      • repeated breakages
      • poor attendance
  • factors influencing success
    • severity of malocclusion
    • motivation of patient
    • operator expertise

BDS4 Orthodontics (8 decks)

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