What should Orthodontic Patients know?

1. Nasir Al-Hamlan BDS, MPH, MSc, FDS RCSEd, FDS RCSEd, MOrth RCSEd, FICD
Consultant and Assistant Professor, Orthodontics
King Saud bin Abdulaziz University for Health Sciences
Riyadh, Saudi Arabia
@nhalhamlan
@saudibraces
nasiralhamlan
@nasiralhamlan
Keynote for Orthodontic Patient

2. When Should a Child First See an
Orthodontist?

3. - American Association of Orthodontics recommends that an
Orthodontist examine a child’s teeth by the time they are 7 years old
- But, when child is born with any type of Craniofacial deformity, then
child should be seen on the first days of his/her life
When Should a Child First See an Orthodontist?

4. Third Molar

5. Third Molar
Third Molar Impaction and Agenesis: influence on anterior crowding.
(Esan and Schepartz, 2017)
Aim:To evaluate the relationship among impaction, agenesis and crowding in black
South African males. Subjects and method Mandibles and maxillae of 535 black South
African males were examined for anterior crowding and third molar Agenesis and
impaction.
Dental crowding was determined using Little's irregularity index. Results Individuals
with impaction showed more moderate-to-extreme crowding than those with Agenesis.
Bilateral third molar presence was more frequently associated with ideal-to-minimal
crowding. Weak positive but significant correlations between crowding and impaction
were found.
Conclusion:
- Third molar impaction plays a role in anterior crowding.
- Third molar presence was not associated with anterior crowding, while agenesis did
not explain absence of crowding.
Literature - Overview

6. Third Molar Literature - Overview
Influence of third molar space on angulation and dental arch crowding
(Hasegawa et.al., 2013)
OBJECTIVES:
The purpose of this study was to ascertain whether, in Mongolian subjects, the
lower third molar can affect anterior crowding and/or the inclination of teeth in the
lower lateral segments.
CONCLUSION:
The angulation of the third molar appears not to cause anterior crowding.

7. Third Molar Literature - Overview
Effects of Lower Third Molar Angulation and Position on Lower Arch Crowding
(Selmani et.al., 2016)
OBJECTIVES:
The aim of this study was to determine the relationship between lower arch crowding
and the presence of angulation and position of lower third molar.
CONCLUSION:
It can be concluded that there was a strong relationship between angulation and
position of third molars and lower arch crowding.

8. Third Molar Literature - Overview
Do wisdom teeth induce lower anterior teeth crowding? A systematic literature
review.
(Stanaityte et.al., 2014)
OBJECTIVE:
The purpose of this article is to find out if the lower third molars are the main reason
of crowding in the lower dental arch. As well to find out other factors which can
influence the lower incisors crowding.
CONCLUSION:
The results are quite contradictory: some authors support the opinion that lower third
molars cause teeth crowding, the others confirm conversy. Exist other factors
affecting the mandibular incisors crowding: dental (teeth crown size, dental arch
length loss, poor periodontal status and primary teeth loss), skeletal (growth of
the jaws and malocclusion) and general (age and gender).

9. Third Molar Literature - Overview
Impact of third molars on mandibular relapse in post-orthodontic patients:
A meta-analysis.
(Cheng et.al., 2018)
PURPOSE:
The present study systematically reviewed and meta-analyzed the available
literature, and assessed the impact of third molar removal on the relapse of
mandibular dental arch alignment after orthodontic treatment.
CONCLUSION:
Removal of the mandibular third molars is recommended for alleviating or
preventing long-term incisor irregularity.

10. Third Molar Literature - Overview
Does mandibular third molar have an impact on dental mandibular anterior
crowding? A literature review.
(Genest-Beucher et.al., 2018)
Abstract
Mandibular dental anterior crowding is a common multi-factorial phenomenon. The
involvement of the lower third molar remains unclear. These pending questions led us
to conduct a literature review to evaluate the impact of the lower third molar on
mandibular dental anterior crowding.
In total, 83% of articles (n=10/12) did not find any significant relationship between
lower third molar and mandibular dental anterior crowding. However, methods and
designs of these studies being questionable, a definite conclusion on the impact of
mandibular third molar on mandibular dental anterior crowding cannot be set.

11. Third Molar Literature - Overview
The role of mandibular third molars on lower anterior teeth crowding and relapse
after orthodontic treatment: a systematic review.
(Zawawi and Melis, 2014)
AIMS:
To evaluate the role of third molars in the development of crowding or relapse after
orthodontic treatment in the anterior segment of the dental arch.
CONCLUSION:
Definitive conclusions on the role of the third molars in the development of anterior tooth
crowding cannot be drawn. A high risk of bias was found in most of the trials, and the
outcomes were not consistent. However, most of the studies do not support a cause and
effect relationship; therefore, third molar extraction to prevent anterior tooth
crowding or post-orthodontic relapse is not justified.

12. Third Molar Literature - Overview
The relationship between jaw injury, third molar removal,
and orthodontic treatment and TMDsymptoms in university students in Japan.
(Akhter et.al., 2008)
AIMS:
To determine the association between Temporomandibular disorders (TMD) and
experiences of jaw injury, third molar removal, and orthodontic treatment.
METHODS:
First-year university students (n = 2,374)
RESULTS:
- Of the 2,374 students, 715 students were TMD symptom-positive.
- Experience of third molar removal was significantly associated with TMD.
- No association was found between orthodontic experience and TMD.
CONCLUSION:
Experiences of jaw injury and third molar removal might be cumulative
and precipitating events in TMD.

13. TMD

14. TMD
TMD, describes a group of conditions
characterized by pain and dysfunction of the
TMJ and/or the muscles surrounding it.
It's not always so easy to figure out exactly
what's causing these symptoms.

15. TMD
Factors and Causes of TMD
The TMJ can be subject to orthopedic disorder including:
- Inflammation,
- Sore Muscles,
- Strained Tendons and Ligaments,
- Disk Disorder.
Factor:
TMD is influenced by:
- Genes
- Gender (women appear to be more),
- Age
- Physical and psychological stress can also be a factor.
- In some cases, jaw pain may be related to a more widespread, pain-inducing
medical condition such as Fibromyalgia.

16. TMD
Signs and Symptoms of TMD
Clicking Sounds:
- Some people with TMD hear a clicking, popping or grating sound coming from
the TMJ when opening or closing the mouth. This is usually caused by a shifting
of the disk inside the joint.
Muscle Pain:
- This can be felt in the Masseter and Temporalis muscles where the two big pairs of
jaw-closing muscles are located.
- If soreness and stiffness upon waking up in the morning, it's often related to
habits such as clenching and/or grinding the teeth at night.
Joint Pain:
- Pain that's actually coming from one or both jaw joints technically would be
described as arthritis of the TMJ. When we look at radiographs (x-ray pictures)
we find that some people have arthritic-looking TMJs but no symptoms of pain or
dysfunction; others have significant symptoms of pain and dysfunction but their
joints look normal on radiographs.

17. TMD
Management
Mild TMD
- Sometimes a temporary change to a softer diet can reduce stress on the muscles
and joints.
- Ice and/or moist heat can help relieve soreness and inflammation. Muscles in
spasm can also be helped with gentle stretching exercises.
- Non-steroidal anti-inflammatory medications and muscle relaxants can also
provide relief.
Severe TMD
- Severe TMD cases may require more complex forms of treatment, which might
include orthodontics, dental restorations like bridgework, or minor procedures
inside the joint such as cortisone injections or lavage (flushing) of the joint.
- It's rare for major surgery ever to be necessary in a case of TMD.
- it's important to try the wide range of conservative, reversible treatments
available, and give them enough time to work as they almost always prove
effective.

18. TMD

19. TMD
Relationship Between Orthodontics and Temporomandibular Disorders: A Prospective
Study.
(Ortega et.al., 2016)
AIMS:
To investigate the possible relationship between the orthodontic treatment of Class II
malocclusion and the development of Temporomandibular disorders (TMD).
METHODS:
A total of 40 patients was evaluated at four time points: the day before the start of treatment
employing bilateral Class II elastics (baseline), as well as at 24 hours, 1 week, and 1 month
after the start of treatment. The development of TMD pain complaints in the orofacial
region and changes in the range of mouth opening were assessed at these times.
RESULTS:
The treatment produced pain of a transitory, moderate intensity, but there was no
significant change from baseline after 1 month. There were no restrictions in the range of
jaw motion or any evidence of limitations in mouth opening.
CONCLUSION:
Orthodontic treatment with bilateral Class II elastics does not cause significant orofacial
pain or undesirable changes in the range of mouth opening. Furthermore, this modality of
orthodontic treatment was not responsible for inducing TMD.
Literature - Overview

20. TMD
Evaluation of temporomandibular disorder symptoms and oral health-related quality
of life in adolescent orthodontic patients with different dental malocclusions.
(Karaman and Buyuk, 2019)
Objective:
To estimate the prevalence of Temporomandibular disorders in adolescent orthodontic
patients with different dental malocclusions and to assess the relationship between oral
health-related quality of life.
Conclusion:
Scores of Class III groups were found to be significantly higher.
Literature - Overview

21. TMD
Investigation of the association between orthodontic treatment and
temporomandibular joint pain and dysfunction in the South Korean population
(Sim et.al., 2019)
OBJECTIVE:
This study investigated the relationship between orthodontic treatment and
Temporomandibular disorders (TMD) in South Korean population.
CONCLUSIONS:
Temporomandibular joint pain and dysfunction was not associated
with orthodontic treatment.
Literature - Overview

22. TMD
Prevalence of malocclusion, oral parafunctions and temporomandibular disorder-pain in
Italian schoolchildren: An epidemiological study.
(Perrotta et.al., 2019)
OBJECTIVES:
To investigate the prevalence of malocclusion, self-reported oral parafunctions and TMD-pain
in Italian schoolchildren and to assess the association between the examined factors.
METHODS:
A total of 700 children aged 9-11 years old.
Molar relationship, overjet, overbite and cross-bite were assessed
RESULTS:
-Molar Class I was the most frequently, followed by Class II, subdivision and Class III.
-Increased overjet was more common than negative overjet.
-Posterior cross-bite was observed in 12% of children.
-TMD-pain was recorded in 14.7% of subjects.
-High frequency of oral parafunctions was reported in 21.3% of subjects.
-A significant association was found between TMD-pain and negative overbite.
-Cross-bite and high frequency of oral parafunctions were associated with TMD-pain.
CONCLUSION:
Some occlusal factors and high frequency of oral parafunctions might be associated with
TMD-pain.
Literature - Overview

23. Orthodontic Retention

24. Orthodontic Retention
Orthodontic Retainers: A Contemporary Overview
(Alassiry, 2019)
AIM:
The aim of this article is to provide an insight into the various modalities
of retention and types of appliance used in achieving this objective.
CONCLUSION:
Currently, there is insufficient high-quality evidence in favor of a
particular retention appliance/regime or protocol. There is a need for further evidence
based high quality studies/randomize controlled trial studies (RCTs) to evaluate
different orthodontic retention appliances and regime after the orthodontic treatment.
CLINICAL SIGNIFICANCE:
Irrespective of the appliance, the patients should be prepared for a long-term or
indefinite retention phase following orthodontic treatment to prevent relapse.

25. Orthodontic Retention
Dentists, hygienists, and orthodontists need to inform
patients that retention should be indefinite regardless of the
pre-existing malocclusion, the treatment modality, or length
of time they were in treatment. Since we have no way of
determining who will develop lower crowding relapse, the
retainer will act as insurance indefinitely.

26. Oral Health

27. Oral Health
The Role of Genes with Periodontium

28. Oral Health
The Role of Genes with Periodontium
- Despite the fact that 90% of Periodontitis cases could be
linked directly to poor Oral Hygiene associated with
bacterial biofilm, about 10% of Periodontitis patients are
victims to Genetic predisposition associated with severe
loss of Periodontal support, sometimes even at
childhood.
- Researchers have found that having higher levels of the
FAM5C Gene may play a role in developing Periodontal
Disease (Carvalho et.al., 2010)

29. Oral Health
“‫الداء‬ ‫بيت‬ ‫املعدة‬”
‫ـلى‬‫ص‬ ‫اهلل‬ ‫ـول‬‫س‬‫ر‬ ‫ـمعت‬‫س‬ :‫ـال‬‫ق‬ ،‫ـرب‬‫ك‬ ‫ـعدي‬‫م‬ ‫ـن‬‫ب‬ ‫ـقدام‬‫م‬ ‫ـن‬‫ع‬ ‫ـحيحه‬‫ص‬ ‫ـي‬‫ف‬ ‫ـذي‬‫م‬‫ـتر‬‫ل‬‫ا‬ ‫روى‬
‫ـالت‬‫ـ‬‫ـ‬‫ـ‬‫ك‬‫أ‬ ‫آدم‬ ‫ـن‬‫ـ‬‫ـ‬‫ـ‬‫ب‬‫ا‬ ‫ـب‬‫ـ‬‫ـ‬‫ـ‬‫س‬‫بح‬ ،ٍ‫ـطن‬‫ـ‬‫ـ‬‫ـ‬‫ب‬ ‫ـن‬‫ـ‬‫ـ‬‫ـ‬‫م‬ ‫ا‬ًّ‫ر‬‫ـ‬‫ـ‬‫ـ‬‫ـ‬‫ش‬ ً‫ء‬‫ـا‬‫ـ‬‫ـ‬‫ـ‬‫ع‬‫و‬ ‫ـي‬‫ـ‬‫ـ‬‫ـ‬‫م‬‫آد‬ ‫ـأل‬‫ـ‬‫ـ‬‫ـ‬‫م‬ ‫ـا‬‫ـ‬‫ـ‬‫ـ‬‫م‬) :‫ـقول‬‫ـ‬‫ـ‬‫ـ‬‫ي‬ ‫ـلم‬‫ـ‬‫ـ‬‫ـ‬‫س‬‫و‬ ‫ـليه‬‫ـ‬‫ـ‬‫ـ‬‫ع‬ ‫اهلل‬
(‫ه‬ َ‫س‬َ‫ف‬َ‫ن‬‫ل‬ ‫ث‬ُ‫ل‬ُ‫ث‬‫و‬ ،‫لشرابه‬ ‫ث‬ُ‫ل‬ُ‫ث‬‫و‬ ،‫لطعامه‬ ‫ث‬ُ‫ل‬ُ‫ث‬‫ف‬ ،‫حالة‬َ‫م‬ ‫ال‬ ‫كان‬ ‫فإن‬ ،‫لبه‬ ُ‫ص‬ ‫قمن‬ُ‫ي‬
‫السنني‬ ‫مئات‬ ‫قبل‬ ‫العرب‬ ‫طبيب‬ ‫كلدة‬ ‫بن‬ ‫قالها الحارث‬ ‫جملة‬

30. Oral Health

31. Sleep Apnea

32. Sleep Apnea
Sleep apnea is a potentially serious sleep disorder in which breathing repeatedly
stops and starts.
The main types of sleep apnea are:
• Obstructive sleep apnea, the more common form that occurs when throat muscles
relax
• Central sleep apnea, which occurs when your brain doesn't send proper signals to
the muscles that control breathing
• Complex sleep apnea syndrome, also known as treatment-emergent central sleep
apnea, which occurs when someone has both obstructive sleep apnea and central
sleep apnea.

33. Sleep Apnea
Symptoms
The signs and symptoms of obstructive and central sleep apneas overlap, sometimes
making it difficult to determine which type you have. The most common signs and
symptoms of obstructive and central sleep apneas include:
• Loud snoring
• Episodes in which you stop breathing during sleep — which would be reported by
another person
• Gasping for air during sleep
• Awakening with a dry mouth
• Morning headache
• Difficulty staying asleep (Insomnia)
• Excessive daytime sleepiness (Hypersomnia)
• Difficulty paying attention while awake
• Irritability

34. Orthodontic SchoolS
Orthodontic SchoolS

35. Orthodontic SchoolS
Orthodontic
SchoolS
Orthodontic
SchoolS
Orthodontic
SchoolS
Orthodontic
SchoolS
Orthodontic
SchoolS
Orthodontic
SchoolS
Orthodontic
SchoolS
rthodontic
choolS
Orthodontic
SchoolS

36. Thank YOU
@saudibraces
@nhalhamlan
nasiralhamlan