ORTHODONTIC THERAPY

-By Carrie Porter

 WHAT IS ORTHODONTIC THERAPY?

• A dental specialty that deals with the recognition, prevention, and

treatment of conditions involving irregularities of the teeth, jaws, and face
• These conditions have an influence on the physical and mental health of an
individual.
• Dental hygienists play a large role in identifying malocclusions that can be
corrected by orthodontics
• This includes guiding and educating patients before, during, and after
orthodontic therapy treatment, as well as helping patients maintain
periodontal health indefinitely
• All dentition (primary, mixed, permanent) are evaluated/treated
 WHAT ARE THE GOALS OF
ORTHODONTICS?

• Establish and maintain a normal functioning occlusion

• Establish the best possible physiologic position of the jaw (condyle and
temporomandibular joint)
• Improve if needed and/or to help maintain good facial aesthetics
• Promote long-term stability
• Establish optimal periodontal health
 POPULATION AFFECTED/
DIAGNOSTIC CRITERIA

• Any individual who obtains malocclusion according to Angle’s Classification

of Occlusion is considered for orthodontic treatment in permanent dentition
• Malocclusions are assessed further to determine skeletal discrepancies
caused by the position of the jaw
• In most cases it is a combination of both skeletal and dental discrepancies
• Other determining factors include anterior open-bite, cross-bite, over-bite,
and over-jet
• Optimal age for initial orthodontic referral is age seven
 COMMON TREATMENT OPTIONS
• Metal Braces aka Traditional Braces
• Most teens get this because they are the least expensive and are the fastest way of
moving the teeth
• Ceramic Braces
• Alternative to metal brackets; popular due to the same color and texture as teeth
which makes it more difficult to see; more costly than traditional
• Lingual Braces
• These brackets are placed on the lingual side of teeth instead of the facial making
them not visible; these are harder to keep clean and can make it difficult to speak
(learning curve involved)
• Self-Ligating
• Makes use of the brackets and wire system with a specialized clip in place which
eliminate the need for elastic ties putting less pressure on the tooth
• Invisalign
• Most common and most effective system of clear orthodontic treatment on the
market today; they are more comfortable and able to be removed for good hygiene
 ORAL SIGNS AND SYMPTOMS
• Crowding
• Underbite/overbite
• Overlapping
• Mesial/distal rotation
• Lingoversion/buccoversion
• Jaw misalignment
• Occlusal wear
• Crepidus
• Subluxation
• Lateral Deviation
• Frequent headaches radiating to the ears or neck
 RISKS THAT MAY INCREASE ORAL
DISEASE
• Age groups
• Many ortho patients are in their preteen and teenage years when the incidence
of gingivitis is high
• Adult ortho patients may be taking medications or have systemic conditions that
may complicate therapy
• Risk factor for caries and periodontal disease increase with all patients while
treatment
• Gingivitis
• Biofilm retention by orthodontic appliances leads to slight to severe gingivitis,
particularly the interdental papillae
• Gingival enlargement may occur covering the appliance
• Position of teeth
• Irregularly positioned teeth are difficult to clean allowing the retention of
bacterial deposits
 MEDICATIONS USED/
POTENTIAL SIDE AFFECTS
• Prescriptions for management of hypertension (Nifedipine, Procardia),
epilepsy (Phenytoin, Dilantin), organ transplants (Cyclosporine) cause risk for
gingival enlargement that may lead to increased plaque retention, gingival
inflammation, and caries
• Osteoporosis and its treatment may cause bone remodeling to occur at a
slower rate
• Corticosteroids and nonsteroidal anti-inflammatory agents, as well as
Indomethacin (prostaglandin inhibitor) may reduce the response of the
teeth to orthodontic forces
• Tricyclic antidepressants, antiarrhythmic agents, antimalarial agents,
methylxanthines (COPD), and some tetracyclines (dental infections) may
influence prostaglandin levels and reduce the response of the teeth to
orthodontic forces
 SPECIAL CONSIDERATIONS
• Orthodontics are used to treat facial abnormalities and birth defects
• Treatment of patients with cleft palate may start as early as 3 years of age
• Each stage of surgery and other treatment may require orthodontic
intervention and follow-up (cleft palate)
• Final and formal orthodontic treatment for realigning the teeth and gaining
a functional occlusion may start during the mixed dentition years or later
• Orthodontic treatment is often completed prior to implants, veneers, and
crowns
• Implants contain a fixed position, crowns/veneer will require the removal of
less tooth structure if the teeth are aligned correctly prior to treatment
• Health history, caries clearance, periodontal clearance
 DIFFICULTIES AND CHALLENGES
WITH HOME CARE
• Parental support and education is crucial to the success of children, pre-
teens, and teens receiving orthodontic therapy
• Problems with appliances
• Orthodontic appliances retain biofilm and debris
• Accidents may cause a bracket to become detached
• Self-care is difficult
• Maintaining oral cleanliness is difficult even for those who try
• Difficulty adapting toothbrushes or other devices around appliances used for
biofilm control
• IP care is challenging with arch wire
• Fluoride is strongly advised for daily use; Clinpro 5000 TP, Trays with fl2 gel 1.1%
 ASSISTING WITH PATIENT
MOTIVATION AND SUPPORT
• Help the patient find the most effective therapeutic aid that works for them, keeping
the entire system simple
• When suggesting a new aid, make sure to eliminate one that did not work
• Present before and after pictures of patients with poor oral homecare
(decalcification, gingivitis, inflammation)
• A reward system for maintaining good oral homecare from orthodontic office
• Parental reward system (child-focused)
• Compliance form (adult-focused)
• Health history, caries clearance, and periodontal clearance are needed prior to tx
 FACTORS TO TEACH THE PATIENT
• Power TB is recommended for patients in ortho (Sonicare/Oral-B)
• Soft filaments, light pressure, specialized brush-heads, and low speed power
brushes are effective in maintaining gingival health and cleaning around
appliances
• Water-pik water flossers helps reduce plaque, gingivitis, pocket depth, and
loose dental biofilm; it pulsate streams of water that flushes and irrigates
debris in common hard to reach areas (can add Chlorahexidine/Act MR
w/Fl2)
• Oral irrigation before brushing is recommended, removing loose plaque will
provide access to enamel surfaces to allow fluoride penetration
• The recommended brushing method: Charters, Stillmans, and Sulcular
• Call orthodontic office with broken brackets, pokey wire, or concerns
 APPOINTMENT PREPARATION

• Schedule regular recall appointments with your general dentist/hygienists

• Coordinate appointments with orthodontist and general dentist for removal
of wire bands for optimal cleaning, as well as to achieve diagnosable
radiographs
• Bring removable appliances to each appointment to ensure proper fit
• Hygienists: Best to use Prohy-jet polisher and brush instead of prophy cup due
to effective loose plaque removal; cup gets torn by brackets
 BARRIERS OF ACCESS TO CARE

• Financial costs
• Racial and ethnic minorities
• Physical or mental disabilities
• Lack of education/knowledge/perception of need
• Cultural or language barriers
 REFERENCES
Darby, M. L., & Walsh, M. M. (2010). Dental hygiene: Theory and practice. St.
Louis, Mo: Saunders/Elsevier
Wilkins, Esther M. Wyche, Charlotte J. (2013). Clinical practice of the dental
hygienist/ Philadelphia : Wolters Kluwer Health/Lippincott Williams & Wilkins
Weinberg, M.A., Theile, C.M.W., Froum, S.J., Segelnick, S.L. (2014).
Comprehensive periodontics for the dental hygientist. New Jersey: Pearson
http://www.ada.org/en/public-programs/action-for-dental-health/access-to-
care
http://www.nature.com/bdj/journal/v187/n3/full/4800224a.html?foxtrotcallba
ck=true