Orthodontics Flashcards
(162 cards)
Patients undergoing orthodontic
treatment may commonly experience discomfort for a few days after the appliance is fitted or adjusted.
why
This is a result of the physiological changes occurring within the periodontal ligament (PDL). As forces are applied to the teeth during orthodontic treatment, the PDL is compressed and stretched. These changes cause the cells within the PDL to release chemical messengers that initiate an inflammatory cascade to cause the pattern of bone resorption and deposition required for tooth
Unfortunately, these chemical
messengers, coupled with the reduced blood flow due to compression of the PDL, stimulates pain.
Anti-inflammatory analgesics,
such as Ibuprofen, have been proven to be effective at reducing pain. 4,5 However, as many of these medications work by inhibiting chemical messengers involved in the inflammatory response that causes pain,
why might this be a problem during orthodontic treatment
they have the potential to affect the inflammatory process required for tooth movement.
Fortunately, this is not seen when such analgesics are used in low doses and for short durations, as is usually the case when managing orthodontic related pain. 3 Therefore anti-inflammatories, such as Ibuprofen
400 mg taken three time daily, are still the most commonly used and recommended method of orthodontic-related pain relie
The use of orthodontic appliances
is associated with oral lesions, such as erosions and ulcers. The irritation from the appliance can either precipitate or exacerbate such
relief is achievable with the use of
relief is achievable with the use of topical anaesthetic directly applied to the site with a microbrush. The patient can then be advised to re-apply topical anaesthetic to the lesion as required
Antiseptic mouthwashes, such
as chlorhexidine, may be a useful aid in managing ulcerations
what is this and why is it used
orthodontic wax
pliable material that can be used to cover prominent components of the orthodontic appliance to prevent it from irritating the soft tissue
how do you manage trapped food in orthodontic appliance
This is easily treated using dental floss or an interdental brush to gently remove the food from between the tooth and the appliance.
Patients may report that their
braces are irritating the lips/cheeks; this often occurs soon after the appliance is initially fitted and is usually more pronounced when the patient is eating. Treatment involves placing
placing non-medicated relief wax over the area causing irritation
Ligatures are the small wires
or elastic bands that hold the archwire to the bracket. When an elastic ligature becomes loose it can be repositioned using tweezers. If a wire ligature becomes loose, do not attempt to
do not attempt to replace it.
If a ligature is lost then the
archwire is not secured within the bracket and may result in a reduction in the effectiveness of the appliance on the tooth. Therefore, the orthodontist should be
notified so that he/she can advise when the patient should arrange for it to be replaced
Sometimes the end of the
archwire protruding distal to the last bracket/ band can start to irritate the patient’s mouth. The wire should be
The wire should be bent so that it is flat against the tooth and not protruding into the soft tissues. This can be done with wire benders or a flat plastic. If this is not possible, then the end of the wire can be covered in relief wax and the orthodontist should be informed
. In situations where the protruding wire is causing significant discomfort and the patient will not be able to see his/her orthodontist urgently, then the wire can be clipped using sharp wire cutters or distal-end cutters. Alternatively, the whole wire can be removed by first removing the ligatures then removing the wire, however, this should be a very last resort. It is important to avoid inhalation or ingestion of the small piece of wire after it has been cut. This can be achieved by using gauze around the area and/or distal end-cutters which grip the snipped piece of wire after it has been cut
Occasionally, removable
appliances break. If this happens, the orthodontist should be informed as soon as possible and will then take the appropriate
action. The patient should be advised to stop using the appliance if the damage renders the appliance a potential
airway risk or will cause marked trauma.
Components, such as a
palatal/lingual arch or a molar band, can fracture or become loose causing irritation or trauma to the patient. If the component is not mobile, it should be covered with
orthodontic relief wax and a review appointment arranged with the orthodontist. However, if the component is very mobile or loose, it can carefully be removed with tweezers whilst protecting the airway to prevent inhalation
Orthodontic retainers are either
fixed or removable and their purpose is to hold the teeth in their new position after
active treatment is complete. It is now widely accepted that patients should wear their retainers long term to prevent relapse, which can be for many decades. However, patients are usually discharged from their orthodontist 12 months after the active treatment has been completed. Therefore, patients may present to their GDP if they have lost or broken their retainer.
Removable retainers can easily be repaired if the damage is minor. An accurate impression of the arch should be taken and sent to the laboratory with the broken appliance. However, if the damage is more extensive, or the appliance is lost, a new retainer will need to be made. To do this, an accurate impression of the arch is required and the type and design of the retainer should be clearly stated on the laboratory ticket
Fixed retainers are bonded to
the palatal/lingual surface of teeth and are used where even minimal amounts of tooth movement are deemed unacceptable by the patient
If a fixed retainer de-bonds from a tooth but is securely attached to adjacent teeth and lies passively on the tooth in question, it can be re-bonded. This is done by carefully removing any residual composite, preparing the tooth surface with acid etch and bond and replacing the composite to secure the wire without distorting it.
The most common allergy in orthodontics is to
Nickel
Owing to the popularity of nickel-containing jewellery and body piercings, many patients have been exposed to nickel before undergoing orthodontic treatment and may be sensitized to the metal. This can precipitate a Type IV delayed hypersensitivity immune response when they are re-exposed to nickel in orthodontic appliances.
s not usually immediate but develops after a few days or weeks so that patients may present to a GDP first. The intra-oral clinical signs and symptoms can be quite varied but may include
include gingivitis not caused by plaque, gingival hyperplasia, labial desquamation, burning sensation, metallic taste, angular cheilitis, numbness/altered sensation, labial swelling or soreness of the tongue
Fortunately, the majority of
patients who are sensitized to nickel can still wear nickel-containing orthodontic appliances without eliciting a response, as it is thought that a much
higher concentration of nickel is needed to produce a response in the oral mucosa than is required on the skin.
Airway obstruction
A true emergency arises when
a loose component or small removable appliance obstructs the airway. If the object is still visible in the mouth, attempts should be made to remove it with the patient reclined, otherwise the patient should be encouraged to cough the object out. If this is not successful immediately, call for help and call an ambulance
Ingestion of an orthodontic
component or appliance is not uncommon, and is usually asymptomatic and causes no injury to the patient, therefore requiring no treatment besides monitoring the stool to check that the component has passed naturally. However, if the component becomes lodged in the oesophagus or oropharynx, the patient may experience pain or vomiting. In such situations, the patient should immediately
be sent to hospital for advice and management, ideally with an example of the component that has been ingested. If the component has not yet reached the stomach it can be removed via fibre-optic endoscopy.
Regardless of the symptoms,
a patient should always be referred to the Accident and Emergency (A+E) department at a local hospital when the ingested component is more than how many cm long
component is more than 5 cm long as there is a higher risk of obstruction and perforation of the gastrointestinal tract, so removal may be advised instead of allowing the component to pass naturally. It is important when a patient is sent to the hospital that the referral letter includes information about the component, such as its size, shape, flexibility and radio-opacity, as well as information about the incident, such as when the object was swallowed. This will help in locating the component and predicting the outcome.
