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Oral health by almuzian

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  • 1. UNIVERSITY OF GLASGOW Oral Health & Orthodontics Personal notes Mohammed Almuzian 5/2/2013 A decision to undertake orthodontic treatment is based on Best functional, Best aesthetic Optimal oral health needs. The benefits of treatment must outweigh the risks.
  • 2. List of Contents Definition ............................................................................................................2 Relevant of oral health to orthodontics...............................................................2 Signs & symptoms related to poor oral health....................................................2 Assessment of oral health ...................................................................................3 1. History.............................................................................................................3 2. Pre-treatment Assessment...............................................................................3 A.Caries detection and caries risk ......................................................................3 1. Definition ........................................................................................................3 2. Stages of detection of dental caries.................................................................3 3. Caries risk .......................................................................................................4 B.Periodontal Examination.................................................................................4 1. Basic Periodontal Examination (BPE)............................................................5 2. Plaque assessment...........................................................................................6 3. Bleeding ..........................................................................................................7 4. Labial gingivae................................................................................................7 C.Smoking cessation ..........................................................................................8 3. During orthodontic treatment Assessment......................................................9 1. Ulceration........................................................................................................9 2. Oral hygiene....................................................................................................9 3. Dietary counselling.........................................................................................9 4. Fluoride.........................................................................................................10
  • 3. Oral Health & Orthodontics Definition The absence of any pathology relating to • The teeth • Their supporting structures • The soft tissues of the mouth. Relevant of oral health to orthodontics A decision to undertake orthodontic treatment is based on • Best functional, • Best aesthetic • Optimal oral health needs. The benefits of treatment must outweigh the risks. Signs & symptoms related to poor oral health (Determined clinically and radiographically) 1. Gingival inflammation 2. Periodontal pocketing 3. Caries & decalcification 4. Crown fractures - in heavily restored teeth? Due to trauma or extensive restoration? 5. Root pathology 6. Soft tissue pathology e.g ulceration, signs indicating systemic disease 7. Ectopic and impacted teeth
  • 4. 8. Asymmetry due to premature teeth loss. Assessment of oral health 1. History It should involve:  Oral hygiene regime  Dietary habits  History of trauma to any teeth 2. Pre-treatment A. Caries detection and caries risk Definition Caries is a chronic infectious disease involving a series of complex chemical and microbiological processes involving the dental biofilm that result in the destruction of tooth tissue. Stages of detection of dental caries by Pitts and Fyffe (1988), I. Grade 0  Sound surface  No evidence of treated or untreated clinical caries.  Slight staining may be present in an otherwise sound fissure II. Grade D1  Initial caries  No clinically detectable loss of tooth substance.  Staining, discoloration or rough spots in fissure that do not catch probe may be present.  There may be loss of lustre and white opaque patches on smooth surfaces III. Grade D2
  • 5.  Enamel caries  Demonstrable loss of tooth substance in pits, fissures and smooth surfaces but no softened floor, walls or undermined enamel.  The texture of the material in the cavity may be chalky and white but there is no evidence that the cavitation has penetratedinto dentine IV. Grade D3  Dentine caries  Detectable softened floor, wall or undermined enamel.  Temporary dressing may be present.  A proximal lesions detectable with probe V. Grade D4  Pulpal involvement  Deep cavity with probable pulp involvement.  Usually included in D3 category Caries risk  Li and Wang (2002) attempted to predict caries in the permanent teeth from studying caries in the deciduous dentition through an eight-year cohort study. Of children who developed caries in permanent teeth, 94% experienced caries in the primary teeth and of children who did not have caries in their primary teeth, 83% remained caries free by the age of 12.  If a child had caries in the primary teeth, they were 3 times more likely to develop caries in the permanent teeth. B. Periodontal Examination It should be remembered that the following groups of patients are at higher risk of periodontal disease: • Patients with poor oral hygiene • Patients with a previous history of periodontal disease • Diabetics
  • 6. • Smokers • Patients with osteoporosis • The immune-compromised or immunosuppressed Basic Periodontal Examination (BPE) • The periodontal probe should have a ball end of 0.5 mm diameter and a coloured band from 3.5 mm to 5.5 mm. • The total extent of the crevice should be explored by “walking” the probe around the crevice. • At least six areas in each tooth should be examined: mesiofacial, midfacial, distofacial, and the corresponding lingual and palatal areas. • The mouth is examined in sextants; the division between sextants is between the first premolar and canine. • For each sextant with one or more teeth or implants, only the highest score is recorded. An X is recorded if the sextant is edentulous. • The CPITN includes: A. Code 0  No bleeding or pocketing detected  No treatment required B. Code 1  Bleeding on probing;  no pockets >3.5 mm  OHI and prophylaxis C. Code 2  Plaque retentive factors present (includes calculus);  No pockets > 3.5 mm.  OHI; removal of calculus and plaque retentive margins on restorations D. Code 3  Pockets > 3.5 mm and < 5.5 mm in depth
  • 7.  Treatment involves OHI, prophylaxis, removal of plaque retentive factors and root planning  Plaque and bleeding scores should be collected at the start and end of treatment and to monitor treatment progress E. Code 4  Pockets > 5.5 mm in depth  Detailed charting involving plaque and bleeding scores, loss of attachment (pockets, gingival recession and furcation involvement).  Treatment involves OHI, prophylaxis, removal of plaque retentive factors and root planning and periodontal surgery. F. Code * Added to sextant score when clinical abnormalities are present such as furcation involvement, mobility, mucogingival problems or recession > 3.5 mm a comprehensive periodontal examination and charting is normally necessary to determine an appropriate treatment plan. Plaque assessment • The presence of visible plaque or debris pretreatment is an indication that the patient’s oral hygiene requires improvement before starting active orthodontic treatment. • A simple plaque index is therefore all that is required at the screening appointment. Each tooth in a sextant is examined and scored using the soft debris and calculus scores of Greene and Vermilion (1964). The worst score in a sextant is recorded. For active orthodontic treatment, scores should be mainly zeros with perhaps the occasionally score of . A more complex index such as the Simplified Oral Hygiene Index (OHI-S) of Greene and Vermilion (1964) may sometimes be helpful to demonstrate a baseline position and subsequent improvement in oral hygiene in the light of
  • 8. treatment. This involves calculating the Debris Index (DI-S) and the Calculus Index (CI-S) and adding them together to produce the OHI-S. For Debris: • 0 = no debris • 1= debris covering up to 1/3 of the crown • 2 = debris covering between 1/3 and 2/3 of the crown • 3 = debris covering > 2/3 of the crown For calculus: • 0 = no calculus • 1= calculus covering up to 1/3 of the crown • 2 = calculus covering between 1/3 and 2/3 of the crown • 3 = calculus covering > 2/3 of the crown Each score (DI-S and CI-S) is calculated by dividing the scored deposits by the number of tooth surfaces scored and the two scores added together. Scores are graded as follows:  excellent = 0  good = 0.1 to 0.6  fair = 0.7 to 1.8  poor = 1.9 to 3.0 Bleeding • The Gingival Bleeding Index of Ainamo and Bay (1975) is simple and only requires the noting of the presence or absence of bleeding. • Each tooth has four points of measurement: facial, mesioproximal, lingual and distoproximal. Labial gingivae • Allais and Melsen (2003). This investigated whether labial movement of the lower incisors influenced the level of the gingival margin by creating recession. This study investigated 150 patients with a mean age of 33 years who had a mean increase in arch length of 3.4 mm during treatment. This study came
  • 9. about because of the lack of difference in long-term stability in published studies of on extraction and extraction treatment. The average difference in recession between the treatment group and the untreated control group was 0.14 mm (0.36 mm- 0.22 mm). The authors concluded that although the difference in recession was statistically significant, it was not clinically significant and that therefore controlled increase in arch length could be successfully achieved without significant risk of recession in the presence of good oral hygiene, enough gingival biofilm and Symphysis. In fact, new recession occurred in 10% of patients and the risk factors for this need to clarify. • In 2005, the same two authors (Melsen and Allais), carried out a study to try and identify factors of importance in the development of labial dehiscences. In a study of 150 adult patients pre- and posttreatment, they concluded that gingival recession did not increase during orthodontic treatment and that in 5% of cases, recession improved. Risk factors for the development of dehiscences were thin gingival biotype, visible plaque and the presence of inflammation. C. Smoking cessation Given the effects of smoking on general health and on the periodontium and oral mucosa in particular, it is sensible for the orthodontist to strongly support smoking cessation. Indeed, Options for Change suggests that smoking cessation should be part of the oral health assessment. The four A’s model is helpful: • asking about smoking and the desire to stop • advising of the value of stopping • assisting the patient to stop through appropriate support • arranging follow-up support
  • 10. 3. During orthodontic treatment 1. Ulceration • Most patients will have some oral ulceration immediately after fitting the appliance. If the ulceration appears excessive or abnormal, then it is certainly worthwhile screening patients for haematinic deficiencies (FBC, plasma ferritin, red cell or whole blood folate and serum vitamin B12). • Typically 20 - 30% of patients will have an underlying deficiency state which is a significant predisposing factor. If these tests are all within normal limits then the options are symptomatic treatment such as chlorhexidine or Difflam and of course to minimise any further trauma. 2. Oral hygiene • Monitoring oral hygiene during orthodontic treatment is important but difficult. The conditions in the mouth have changed and conventional plaque indices are not appropriate. • The most difficult area to clean has shifted from the cervical margin to the area under the archwire. • However there is some complicated index like Jackson index for this purpose but it is complicated. • OH measure including mechanical and pharmaceutical are important. 3. Dietary counselling The best advice for reducing caries risk in orthodontic patients is to: 1. Avoid sugar containing and acidic foods close to bedtime 2. To reduce amount of sugar and acidic containing food and drinks 3. To limit the consumption of sugar containing and acidic food and drinks to mealtimes only 4. Encourage consumption of foods that do not cause, or are known to protect against, dental decay and erosion such as staple starchy foods (bread, potatoes,
  • 11. pasta and rice), fresh fruit and vegetables and milk and water rather than soft drinks and fruit juices 5. Advice patients to read manufacturers' labels and follow the instructions for the dilution of squashes 4. Fluoride • Fluoride for orthodontic patients is locally or topically applied. Fluoride mouth rinses are often prescribed to patients undergoing orthodontic treatment and are usually daily use of 0.025% -0.05% sodium fluoride or weekly fluoride rinse of 0.2% is also available. • However, the patients most in need of fluoride rinses tend to be the worst compliers. • Cochrane review by Benson in 2008 show the effectiveness of daily use of 0.05% fluoride but other method difficult to assess and need more detailed study.

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