Week 2

Question 1

What country values orthodontic esthetics the most?

Answer 1

The USA

Question 2

Limitations of clear aligners

Answer 2

Tooth movements (translation, rotation, and extrusion. Not as effective.

Extra fee charged to orthodontist

Speed: individual movements are slower, but able to do multiple different movements on different teeth at once.

Question 3

What is required to submit for Invisalign?

Answer 3

Impression (PVS or digital) upper and lower
Photographs (intro and extraoral)
Prescription form

All moving online

Question 4

Invisalign Treatment Options

Express
Full
Teen
Assist

Answer 4

Express: maximum of 10 trays (with restrictions: no more than 5mm of extrusion, 2mm of crowding, an no AP corrections)

Full: unlimited stages, 3 refinements/ midcourse corrections available

Teen: compliance indicators, lost tray replacement, and eruption tabs

Assist: can reboot treatment or have more checkpoints

Question 5

What wire does Invisalign act similar to?

Answer 5

Flexible archwire

-it’s distorted when placed on the teeth, which creates an opposing force in the teeth

Question 6

What is the purpose of the composite attachments on the teeth used for Invisalign treatment?

Answer 6

They help to direct forces in the desired direction.

Question 7

How do clear aligners extrude teeth?

Answer 7

Pushing force on composite tabs. (Can’t pull)

Question 8

Him far can each tray move a tooth? How long do you keep each tray in?

Answer 8

.25 mm per tray,
2 weeks per tray
That equals .5 mm/month

Conventional braces are 2x faster in that regard

Question 9

What is the Apnea Hypopnea Index?

Answer 9

(#of Apnea’s and Hyponeas)/hours of sleep

less than 5: normal
5-14: mild
15-30: moderate
More than 30: severe

Remember there are PER HOUR

Question 10

What is required for a diagnosis of Obstructive Sleep Apnea?

Answer 10

AHI of more than 5

AND daytime somnolence

Question 11

What is an Apnea?

Answer 11

Cessation if breathing for at least 10 sec

Question 12

What is a hypopnea

Answer 12

Decreased airflow ass. with decreased 02 saturation of 3-4%

Question 13

What causes OSAS?

Answer 13

Anatomical airway narrowing due to a loss of muscle tone when sleeping, and insufficient dilator muscle contraction

Question 14

Where does obstruction happen most frequently?

Answer 14

The oropharynx

Question 15

How are stroke and OSAS associated?

Answer 15

People with OSAS are at 2x risk for a fatal stroke

Question 16

How is OSAS associated with type 2 diabetes?

Answer 16

It is an independent risk factor

Question 17

How is obesity associated with OSAS?

Answer 17

Obesity is HUGELY associated. It is a risk factor that increases the rate of progression of the disease.

Question 18

Risk factors for OSAS

Answer 18

Obesity
Smoking 
Cranio-facial disorders
Retrognathic mandible
Endocrine abnormalities
Genetic diseases (Down syndrome)
Post menopause
Polycystic ovarian disease 
Macroglossia
Tonsilar hypertrophy

Question 19

What is the primary cause of sleep apnea in kids 2-8years old?

Answer 19

Tonsils and adenoids.

Other risks are preterm birth and obesity.

Males are at equal risk as females until puberty

1-5% of kids have it

Question 20

What are important daytime symptoms of OSAS in kids?

Answer 20

Failure to thrive (low GH being secreted at night due to disturbed sleep)
Mouth breathing
Poor school performance/concentration
Irritable

Does NOT present with daytime sleepiness

Question 21

What is the most common cause of excessive daytime sleepiness? (EDS)

Answer 21

Chronic insufficient sleep

Question 22

What is STOP BANG and what does it stand for?

Answer 22

A medical screening instrument.

S: snoring loudly
T: tired during daytime?
O: has anyone observed you stop breathing?
P: Blood Pressure (high?)

B: BMI over 30?
A: Age - over 50?
N: Neck circumference greater than 16?
G: gender - are you male?

AHI greater than 5 plus Yes to 3-5 or more? Likely have OSAS.

Question 23

What do you do if you suspect patient has OSAS?

Answer 23

Refer to primary care/ sleep specialist. You don’t diagnose, and you don’t treat until they are diagnosed. Get a sleep study.

Question 24

Behavioral interventions of OSAS

Answer 24

Loose weight
Avoid alcohol
Avoid sleep deprivation
Avoid supine sleep position 
Stop smoking behavior cognitive therapy

Question 25

What is the primary treatment for OSAS?

Answer 25

CPAP

Question 26

Biggest problem with CPAP

Answer 26

Compliance.

Question 27

Surgical treatment of OSAS

Answer 27

UPPP: chop off the uvula. Very painful recovery. Limited success

Hyoid Fixation: pulls hyoid forward

Genioglossus advancement:

Orthognathic surgery: advancement of mandible

Question 28

Are oral appliances as good as CPAP?

Answer 28

They are less efficacious, but more effective.

Question 29

Side effects of oral appliances

Answer 29

Changes in occlusion. Requires a 1lb of force on the teeth to hold the jaw forward, which is transferred to the teeth. Could use Invisalign during the day, oral appliance by night

TMJ discomfort

Doesn’t lower high blood pressure

Question 30

How is effectiveness calculated?

Answer 30

Efficacy x adherence

Question 31

Define sleep

Answer 31

An active biological imperative - reversible behavioral state of disengagement from and unresponsiveness to the environment

Question 32

Physiology of Sleep

Answer 32

Decrease symp
Increases parasymp
Reduced HR, BP, metabolic rate
Increase endocrine secretion (GH, prolactin)
Cleaning debris from brain
Increase of extracellular space in brain
Increase CSF (20%)

Question 33

Three states of being

Answer 33

Wake

Non-REM (75% of Sleep)

REM: 25% of Sleep

Question 34

Epworth sleepiness scale

Uses and scores

Answer 34

Measures Somnolence

0-10: normal
10-12: borderline
12-24: abnormal

Question 35

Mechanical benefit of Invisalign over traditional braces

Answer 35

No unwanted extrusion if Posterior teeth