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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
Q

What is the risk of decalcification

A

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
Q

How do we prevnet decalcification

A
  • good case selection
  • maintaining OH
  • dietary advice
  • fluoride
27
Q

What is good case selection to prevent decalcification

A
  • Good OH pre treatment
  • Low caries risk
  • Treatment need
  • Patient motivation (are they concerned about their malocclusion)
28
Q

How do we maintain good OH to prevent decal

A
  • 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
Q

What dietary advice do we give to prevent decal

A
  • Low cariogenic diet
  • Reduce frequency
30
Q

What fluoride can we give to prevent decal

A
  • 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
Q

What is root resorption

A

o Inevitable consequence of tooth movement
o Average is approximately 1mm over 2 years of fixed appliances

32
Q

What teeth are most effected by root resorption

A

upper incisors > lower incisors > 6s

33
Q

What pecrentage have severe root resorption

A

1-5%

34
Q

What are the risk factors for root resorption

A

type of tooth movement
rot form
previous trauma
nail biting

35
Q

What types of tooth movement increase risk of root resorption

A
  • Prolonged high force
  • Intrusion
  • Large movements
  • Torque (root movement)
36
Q

What root forms are at increased risk of root resorption

A
  • Blunt
  • Pipette
  • Resorbed already
37
Q

What is relapse defined as

A

the return of features of the original malocclusion following correction

38
Q

What features are prone to relapse

A

 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
Q

What should we consider when selecing cases with relapse in mind

A
  • Accept mild malocclusions
40
Q

What are the disadvantages of fixed retainers

A

 Prone to plaque & calculus build up
 Can break and not notice
 Need excellent oral hygiene
 Require more care long term maintenance

41
Q

What are the advantages of fixed retainers

A

 In situ for life

42
Q

What are the advantages of removable retainers

A

 Remove for OH
 Can wear part time
 Patient control
 Easy to spot problem

43
Q

What can soft tissue trauma result in

A

pain
ulceration

44
Q

What is the advice for soft tissue trauma pain

A

analgesia

45
Q

What is the advice for ulceration

A

 Jaggy wire appears as teeth move
 Use orthodontix wax to tie them over
 Cheese wax can also be used

46
Q

When is recession most common

A

o Unpredictable
o More common when proclining lower incisors, can push through the buccal bone

47
Q

How do we manage recession

A

 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
Q

How can orthodontics increase risk of periodontal health

A

o Gingivitis
o Recession
o Active periodontal disease
o Loss of periodontal support

49
Q

Why must periodontal disease be stabilized prior to tx

A

 Any periodontal disease prior to treatment can accelerate bone loss

50
Q

How should headgear injuries be prevented

A

 2 safety mechanisms: snap away traction spring & nitom facebow

51
Q

How can enamel fracture/tooth wear occur

A

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
Q

Who is at risk of loss of vitality

A

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
Q

How can clinicians be to blame for poor/failed tx

A

 Poor diagnosis
 Poor treatment planning
 Operator technique error

54
Q

How can patients be to blame for poor/failed tx

A

 Unfavourable growth
 Poor cooperation

55
Q

What does chances of tx success increase with

A
  • Severity of malocclusion
  • Motivation of patient
  • Operator expertise

BDS4 Orthodontics (10 decks)

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