Risks & Benefits of Orthodontics Flashcards
What are the potential benefits of orthodontics?
- appearance
- dental
- facial
- function
- dental health
What are the psychological benefits of orthodontics?
- 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
- children with normal dentition seen as:
What are the functional benefits of orthodontics?
- mastication
- improvement with severe malocclusion
- large anterior open bite
- severe increased overjet
- marked reverse overjet
- improvement with severe malocclusion
- speech
- rarely improves speech defects
- never carry out just for speech
- rarely improves speech defects
What are the dental health benefits to orthodontics?
- prevention of consequences
- difficult to describe
How is the orthodontic dental health need of a patient assessed?
- 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
What acronym is used to assess IOTN?
- MOCDO
- Missing teeth
- Overjet
- Crossbite
- Displacement of contact points
- Overbites
Why are impacted teeth considered a high orthodontic treatment need?
- can cause resorption
- supernumeraries can prevent eruption
- can be associated with cyst formation
What size of overjet is considered a high treatment need and why?
- increased >6mm
- risk of trauma to upper incisors
- increases with size of overjet
- increases with incompetent lips
Why are anterior crossbites considered a high treatment need?
- loss of periodontal support
- toothier
Why are posterior crossbites considered a high treatment need?
- significant displacement can lead to
- asymmetry
- requires early correction
What is the link between crowding and caries?
- crowding is not directly linked to an increased
- crowded teeth are more difficult to clean and take longer
What is the link between crowding and periodontal disease?
- 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
Why is a deep traumatic overbite considered a high treatment need?
- can cause gingival stripping
- loss of perio support
Is orthodontic treatment used to treat TMJ dysfunction?
- 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
- crossbite with displacement
- no guarantee correction will improve TMD
- ortho never offered in isolation
- conservative treatment always first
- ortho can aggravate existing TMD
- inter maxillary elastics
What are the 4 main risks of orthodontics?
- decalcification
- root resorption
- relapse
- soft tissue trauma
What are the less common associated risks of orthodontic treatment?
- recession
- loss of periodontal support
- headgear injuries
- enamel fractures and toothwear
- loss of vitality
- allergy
- poor or failed treatment
Describe decalcification as a risk of orthodontic treatment
- weakened enamel to caries
- unsightly staining
- frank cavitation
- gross caries
- orthodontic appliances act as plaque retentive factor
- difficult to clean
What are the 4 ways in which decalcification can be prevented?
- case selection
- oral hygiene
- diet advice
- fluoride
What does case selection to prevent decalcification as a result of ortho involve?
- 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
What does oral hygiene to prevent decalcification as a result of ortho involve?
- toothbrushing instruction
- twice daily thoroughly
- after every meal
- disclosing tables
- identify target areas
- gingival margins and brackets
- interdental brush use
What does dietary advice to prevent decalcification as a result of ortho involve?
- 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
Describe root resorption as a risk of orthodontic treatment
- inevitable consequence of tooth movement
- apron 1mm over 2 years fixed appliance
- any teeth affected
- UI>LI>6s
- mostly unnoticed
- severe in 1-5%
What does fluoride to prevent decalcification as a result of ortho involve?
- 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
- once daily
- fluoride varnish
- Duraphat 22,600ppmF
- 4 monthly
What are the risk factors for root resorption as a result of orthodontic treatment?
- 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
Describe relapse as a risk factor of orthodontic treatment
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
What features of a malocclusion are particularly prone to relapse?
- lower incisor crowding
- crowding
- rotations
- instanding laterals
- spaces and diastemas
- class II div 2
- anterior open bites
- reduced perio support/short roots
In what particular cases should a retainer be fitted immediately after debond?
- bridgework
- fit retainer after cementation
What 3 factors should be considered for managing relapse?
- case selection
- informed consent
- retainers
- fixed
- removable
How can relapse be prevented?
- retention for life
- removable retainers
- fixed retainers
Describe removable retainers and their advantages and disadvantages
- removable retainers
- clear occlusal retainer
- COR
- pressure or vacuum formed
- PFR/VFR
- Essix
- Hawley type
- clear occlusal retainer
- advantages
- removal for OH
- can wear part time
- patient control
- easy to spot problem
- disadvantages
- after discharge from ortho
- GDP replacement fee
- after discharge from ortho
Describe fixed retainers and their advantages and disadvantages
- 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
Describe soft tissue trauma as a risk of orthodontic treatment
- pain and discomfort
- managed with analgesics
- ulceration
- place wax over area causing trauma
Describe recession as a risk of orthodontic treatment
- increasing problem
- can manifest years later
- expansion cases
- mostly adults
How can gingival recession as a result of orthodontic treatment be managed?
- correct treatment planning
- teeth within bone
- avoid over expansion
- thin gingival biotype
- warn patient of risk
- informed consent
- gingival graft
What periodontal conditions may be seen in association with orthodontic treatment
- 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
Describe headgear trauma as a risk of orthodontic treatment
- ocular injury
- 2 safety mechanisms required
- snapaway traction spring
- nitom facebow
- masel strap
Describe toothwear and enamel fracture as a risk of orthodontic treatment
- tooth in contact with bracket
- greater risk with ceramic brackets
- ceramic harder than enamel
- greater risk with ceramic brackets
- enamel fracture during debond
Describe loss of vitality as a risk of orthodontic treatment
- rare
- increased risk with previous trauma
- tooth compromised
- warn patient
- discoloured or darkened tooth
- force
- idiopathic cause
Describe allergies as a risk of orthodontic treatment
- latex
- nickel
- low Ni in NiTi
- Ni free options available
- adhesive
- colophony
- Type 4 sensitivity
- colophony
Describe poor or failed treatment as a risk of orthodontic treatment
- 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
