Prevention in Orthodontics

what are risks and benefits if ortho

ortho is not without potential risks

always make sure risks does not outweigh benefit

what are the aims of ortho

improve function, dental health and aesthetics and psychological wellbeing

what is demineralisation

white and brown marking with eventual cavitation

fixed appliances predispose to plaque accumulation

number of teeth and extent varies with each patient

found on labial side on fixed pts and palatal surfaces on removeable teeth

can occur on lingual surfaces on the fixed

what is aetiology of demineralisation

poor OH

attack by acid by products of plaque metabolism

plaque

carb diet

susceptible tooth surfaces

contact time with the tooth

how do we treat pt with demineralisation

before - diet and OH has to be good or it wotn start

during - may necessitate a short tx plan or stop tx

after - may necessitate measures to remineralise lesion ot approve appearance

how do we prevent demienralisation

OHI

diet

flouride mouthwash for tx

identify prevent or remove stganation areas

reduce flash around brackets

use glass ionomer cement on bands due to flouride release

what do we do with demineralisation after debond

if white spots detected on debond - non cavitated lesions can remineralise in 6-12 weeks

use of high flouride contraindicated - can inhibit remineralisation

what is root resorption

all pts should be warned during consent process

average 2mm at each ortho

incisors most affected

some pts are more suscweptible

rarely affects longevity of teeth

what are risk factors of root resorption

pt with resorption pre tx

previous trauma

familyhx

how do we prevent resoprtion

detection - dental anf fam hx

radiographs - opt and lat ceph to review pre tx roots

light forces during rx and minimise tx time

if at risj, repeat radiographs in 6 months

what is pulp damage in ortho

due to pulpal ischaemia as tooth movement starts

death/damage of pulp is very uncommon

tooth movement may be responsible fpr flare up of pre existing periapical area

pain is likely and happens 2-7 days

paracetamol or ibuprofen reccomended

PA abcess is more likely with heavy resotred teeth in ortho

what are risk factors of pulp ischaemia

prevously traumatised teeth at risk of pulpitis

if happens during tx - do vitality test

care taken when using rotary

what is perio/gingivitis in ortho

increases inflammation due to reduced access for cleaninf

give single tufted out

apical migration of perio attachment and alveolar bony support during tx

adults may seek tx due to perio drift - consider tx mechanics

attachment and bone loss alters soft tissues and balance between tongue and lips

what is soft tissue damage in ortho

traumatic ulceration

friction against components of appliance

archwire ends not tucked out the way

clumsys instrumentation

be careful with instruments, archiwre ends tucked in or cut flush with the tube

what is SLS toothpaste

helps people with ulcers as it has sodium lauryl sulphate missing

what other risk factors are important in ortho

anchorage reinfircement

- headgear and implants

allergic reactions

burns

TMJ dyfsunction

prolonged tx

relapse

what are headgear injuries

common but can be dangerous

bow can be displaced

is sharp but also covered in bacteria and has punctured eye and can lose it

BOS safety incorporated - one for facebow,

what are micro screw/ temp anchorage device

no oesseous integration so poorer success

risk of perforation of roots or infection

simple to place

what are allergies

latex is becoming common allergy

nickel is common

5-12 x nickel conc to give mucosal lesions compared to skin

how can we prevent burns

etch - chemical

physical - thermal form overheating handpiece or cinching ends

prevention - when operating always weare saftey

what causes prolonged tx

pts FTA

poor compliance - not wearing elastics, not removeable appliances

not looking after appliance , breaking or lost it

what are soft tissues in ortho

teeth in psoition for soft tissue balance

facial growth - plan for any future growth

supporting tissue - allows bone to mature and perio fbres to reorganise

occlusal facroes

EXAM STUFF

demineralisation stuff

root resorption prevention

gingivitis and perio problems

soft tissue damage