Need for Orthodontic Treatment

Question 1

Describe the normative need for orthodontic treatment

Answer 1

Professionally judged need following a clinical examination using a standardised clinical index such as IOTN

Question 2

Describe the subjective need for orthodontic treatment

Answer 2

Perceived need by the individual

Question 3

Describe want versus need of orthodontic treatment

Answer 3

• Demand is not necessarily the need
• Variation in what patients want
• Higher want in females and higher socioeconomic classes
• Rise in demand-led orthodontic treatment

Question 4

Describe the normative need for orthodontic treatment at age 12 and 15

Answer 4

12 years
9% children receiving orthodontic treatment
37% not in treatment but having need of treatment (IOTN)

15 years
21% children receiving orthodontic treatment
20% not in treatment but having need of treatment (IOTN)

Question 5

Describe the overall prevalence of moderate to severe malocclusion

Answer 5

Estimated to be 40-50%

Question 6

Describe 3 considerations when deciding necessity for orthodontic treatment

Answer 6

1. Is there a dental health gain?
2. Is there a psychological gain?
3. Is it purely aesthetics?

Question 7

Describe 4 clinical examples where dental health may be improved by orthodontics

Answer 7

1. Severe anterior open bite
2. Very large overjet ( >9 mm)
3. Severe crossbite
4. Severe deep overbite

Question 8

Describe how dental health may be improved by orthodontics

Answer 8

• Some evidence say straight teeth easier to clean
• Patient motivation and hygiene overriding factors in preventing gum disease
• No direct relationship between crowding and caries
• Health gain likely in severe cases

Question 9

What is oral health?

Answer 9

Standard of health which enables an individual to eat, speak and socialise without active disease, discomfort or embarrassment and which contributes to general well-being

Question 10

Describe the psychosocial gain of orthodontics

Answer 10

• Psychological well-being reflects how content we are with ourselves
• Social well-being reveals how we interact with other people and with our community

Question 11

Describe the personal considerations of orthodontic treatments

Answer 11

• Self-esteem
• Self-confidence
• Happier smile for photo / more attractive
• Straighter teeth
• Less self-conscious

Question 12

Describe the social considerations of orthodontic treatments

Answer 12

• Not teased anymore
• All my friends have braces
• Social status
• Fit in better
• “People will like me more”

Question 13

Describe teasing and bullying, and psychosocial gain of orthodontic treatment

Answer 13

• Teasing due to appearance of teeth notes in literature
• School children can be concerned when they are teased
• Orthodontic treatment can alleviate this
• Active treatment less likely to be teased

Question 14

Describe the limitations of psychosocial gain

Answer 14

• Unrealistic to expect that correction of crooked teeth will radically change psychological make-up
• Complex and subject to many influences, including the personality of the individual
• Adolescence is a difficult time as it is

Question 15

Is orthodontics purely aesthetic?

Answer 15

No - Even if motivation seems purely aesthetic the patient will tend to have a perceived benefit of the treatment in mind, which will either fall into dental health or psychological gain or both

Question 16

Name 5 examples where orthodontic treatment can have a benefit to oral health

Answer 16

1. Deep bite causing soft tissue trauma
2. Crossbite with displacement
3. Crowding with gingival recession
4. Anterior crossbite with recession on lower incisors
5. Unerupted and impacted teeth with risk to roots of adjacent teeth

Question 17

Describe dental trauma with regards to orthodontic treatment

Answer 17

• Risk of trauma doubles in patients with an overjet greater than 3mm
• Risk increases as overjet increases
• > 9 mm overjet increases risk by 45% to upper incisors
• 35% of 9 year olds have evidence of trauma

Question 18

Describe the treatment of mild / borderline malocclusions

Answer 18

• Less severe the malocclusion, the less chance of success
• Mild cases frequently fail to benefit from orthodontic treatment
• May be advisable not to treat minor or borderline malocclusions

Question 19

Name 3 major risks of orthodontic treatment

Answer 19

1. Decalcification (good oral hygiene essential)
2. Root resorption (monitor roots during treatment)
3. Relapse (stress wear of retainers)

Question 20

Describe patient expectations of orthodontic treatment

Answer 20

• Expect perfect results
• Not willing to comply with retention
• Lack of understanding of naturally occuring movement
• Orthodontists must explain realistic treatments

Question 21

Describe the role of the GDP in orthodontics

Answer 21

• Competent in carrying out assessment, including indication for treatment need and timely interceptive orthodontic treatment with referrals
• Central role in referrals as majority of referrals initiated by GDP
• Best placed to assess motivation and attitude

Question 22

Describe 2 examples of cases which are referred to specialist orthodontic practices

Answer 22

1. Routine cases

2. Complex cases

Question 23

Describe 4 examples of cases which are referred to hospital orthodontic practices

Answer 23

1. Orthognathic care
2. Restorative and surgical treatment
3. Craniofacial abnormalities e.g cleft lip and palate
4. Physical or learning disabilities

Question 24

Name 2 common orthodontic indices

Answer 24

1. Index of Orthodontic Treatment Need (IOTN)

2. Peer Assessment Rating (PAR)

Question 25

What is the IOTN used for?

Answer 25

Assess the need and eligibility of children under 18 years of age for NHS orthodontic treatment on dental health groudns

Question 26

What is PAR index?

Answer 26

• Method of quantifying severity of a malocclusion on study models
• Robust and fast way to assess the standard of orthodontic treatment an orthodontist is providing

Question 27

Name 2 components of IOTN

Answer 27

1. Dental Health Component

2. Aesthetic Component

Question 28

Describe the dental health component of IOTN

Answer 28

5 grades

• 1 and 2 not eligible for NHS treatment
• 3 is borderline
• 4 and 5 eligible for NHS treatment
• Scored by various parameters e.g size of overjet
• If graded as borderline, aesthetic components comes into play

Question 29

Describe the aesthetic component of IOTN

Answer 29

• Recognizes that many children benefit from orthodontic treatment due to the poor appearance of their teeth
• 10 grades based on scale of 10 colour photographs showing progressively poorer dental attractiveness

Question 30

Describe when there is an issue with IOTN

Answer 30

• Consent issues
• Difficulty when parent and child do not agree
• Severe malocclusion with no desire for treatment
• Minor malocclusion with great desire for treatment

Question 31

Describe adults seeking orthodontic treatment

Answer 31

• Younger adults who desired but did not receive treatment during adolescence
• Older adults who have other dental problems and could benefit from orthodontics as part of a larger treatment plan

Question 32

Name 6 complexities of treating the adult patient in orthodontics

Answer 32

1. More complex assessment
2. Frequently more restored or missing teeth / periodontal issues
3. Attachment loss and recession
4. Difficult expectations
5. Higher prevalence of TMD
6. Retention protocols

Question 33

Describe GDPs providing orthodontic treatment

Answer 33

• Practice within your competence

- Inform patients of all options i.e nothing, refer, or GDP treatment

Question 34

Why is it important for GDPs to tread carefully with regards to orthodontics?

Answer 34

• Treatment plan provided by third party such as laboratory service or another clinician, treating clinician is still responsible
• Defence societies report most complaints are regarding orthodontic treatment arise from treatment provided by non-specialists