Week 2 Flashcards
What country values orthodontic esthetics the most?
The USA
Limitations of clear aligners
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.
What is required to submit for Invisalign?
Impression (PVS or digital) upper and lower
Photographs (intro and extraoral)
Prescription form
All moving online
Invisalign Treatment Options
Express
Full
Teen
Assist
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
What wire does Invisalign act similar to?
Flexible archwire
-it’s distorted when placed on the teeth, which creates an opposing force in the teeth
What is the purpose of the composite attachments on the teeth used for Invisalign treatment?
They help to direct forces in the desired direction.
How do clear aligners extrude teeth?
Pushing force on composite tabs. (Can’t pull)
Him far can each tray move a tooth? How long do you keep each tray in?
.25 mm per tray,
2 weeks per tray
That equals .5 mm/month
Conventional braces are 2x faster in that regard
What is the Apnea Hypopnea Index?
(#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
What is required for a diagnosis of Obstructive Sleep Apnea?
AHI of more than 5
AND daytime somnolence
What is an Apnea?
Cessation if breathing for at least 10 sec
What is a hypopnea
Decreased airflow ass. with decreased 02 saturation of 3-4%
What causes OSAS?
Anatomical airway narrowing due to a loss of muscle tone when sleeping, and insufficient dilator muscle contraction
Where does obstruction happen most frequently?
The oropharynx
How are stroke and OSAS associated?
People with OSAS are at 2x risk for a fatal stroke
How is OSAS associated with type 2 diabetes?
It is an independent risk factor
How is obesity associated with OSAS?
Obesity is HUGELY associated. It is a risk factor that increases the rate of progression of the disease.
Risk factors for OSAS
Obesity Smoking Cranio-facial disorders Retrognathic mandible Endocrine abnormalities Genetic diseases (Down syndrome) Post menopause Polycystic ovarian disease Macroglossia Tonsilar hypertrophy
What is the primary cause of sleep apnea in kids 2-8years old?
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
What are important daytime symptoms of OSAS in kids?
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
What is the most common cause of excessive daytime sleepiness? (EDS)
Chronic insufficient sleep
What is STOP BANG and what does it stand for?
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.
What do you do if you suspect patient has OSAS?
Refer to primary care/ sleep specialist. You don’t diagnose, and you don’t treat until they are diagnosed. Get a sleep study.
Behavioral interventions of OSAS
Loose weight Avoid alcohol Avoid sleep deprivation Avoid supine sleep position Stop smoking behavior cognitive therapy
