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Or Thodontic Dialogue 105040 10/2/01 10:28 PM Page 1 ORTHODONTIC FIG. 2 unilateral involvement - Fig. 4), treatment options involving considered potential carriers of FIG. 5 A patient for whom an and signs and symptoms of maxillary surgery and genioplasty blood-borne viral infections, and the unconventional anterior temporomandibular joint should be considered when possible.2 orthodontist is obligated to take Cyclosporine induced gingival hyper- maxillary osteotomy was dysfunction. These may include necessary precautions for infection plasia in a patient who has had a undertaken after the difficulty in wide mouth opening, HEMOPHILIA control. renal transplant (a). Gingivectomies extraction of her canines pain on mandibular movements and This bleeding disorder occurs in were required prior to commencing to resolve the severe over- joint sounds. Erosion of the cortical one out of 7,500 males and is marked SICKLE CELL SYNDROMES orthodontic treatment and during treatment with fixed appliances (b). C jet and safeguard her outline in the TMJ is the most by common bleeding episodes, which These hereditary disorders are the precariously proclined common radiographic finding, increase in frequency with increasing result of the presence of an abnormal maxillary incisors. followed by flattening with or severity of deficiency of the clotting Hemoglobin (Hb S) in the red blood (a-c) Pre-treatment without erosion, and the complete mechanism. The most common sites cells. There are two main types of A B A B (d-f) Post-surgery loss of the condylar head in the very of bleeding are joints, muscles and presentations of this condition. severely affected patients. skin, and important complications Children affected by Sickle Cell A multidisciplinary approach include arthritis and degenerative Trait, the heterozygous form, oral changes, such as gingival oozing, the dentist are important for caries during routine orthodontic seizures, strabismus and speech is usually required for the joint disease secondary to recurrent generally do not exhibit anemic petechiae, hematomas, ulcerations, control and fluoride prophylaxis, and appointments is the use of an problems may accompany the management of various components bleeding. Mouth lacerations are a symptoms unless exposed to low gingival pain, gingival hypertrophy, to keep a close guard on situations oral rinse of chlorhexidine solution neurological problems. A wide of juvenile rheumatoid arthritis. common cause of bleeding with all oxygen pressure conditions. mucosal pallor, pharyngitis and that could lead to infection. Once a prior to the procedure. The virtue of range of neuromuscular dysfunction Medical treatment involves severities of hemophilia, and Orthodontic treatment can be lymphadenopathy, should raise the patient has completed antineoplastic maintaining a high standard of oral is seen, which presents as spasticity, steroidal and non-steroidal anti- persistent oral bleeding is seen in undertaken for them with only a clinician’s index of suspicion. treatment and has at least a two-year hygiene for patients at risk for dyskinesia, ataxia or a mixture of D E F inflammatory agents, while gold salts, about 14 percent of all hemophilic moderately higher risk than in Referral to a physician should be event-free survival, orthodontic infective endocarditis cannot be 2 these. These children also may d penicillamine and cytotoxic drugs patients. Early recognition of the unaffected patients. The less made for a patient exhibiting these treatment can be restarted.5 overemphasized. If the patient’s suffer from abnormalities of the surgery for reducing the hyperplasia decalcification around fixed may be required for select patients. developing malocclusion is frequently occurring homozygous oral symptoms without evidence oral hygiene lapses during treatment cervical spine. They lack intraoral, may be required to facilitate orthodontic appliance attachments. Temporomandibular therapy is important in the orthodontic form, Sickle Cell Anemia, is of local causative factors.5 Chemo- HEART DISEASE AND and does not rapidly improve, then perioral and masticatory muscle orthodontic treatment. When undertaking orthodontic aimed at reducing pain and management of the hemophilic child characterized by chronic anemia, therapy is now the mainstay of CHILDREN REQUIRING discontinuing orthodontic therapy coordination and have limited treatment, precautions should be dysfunction in the masticatory as selective guidance can diminish or delayed wound healing and retarded therapy, with radiation and surgery ANTIBIOTIC PROPHYLAXIS and removal of fixed appliances control of the neck muscles, which CYSTIC FIBROSIS taken to avoid the possibility of the system, restoring and maintaining eliminate developing complex dental development. Blood playing a smaller role than earlier. Infective endocarditis is a rare but may be in the best interest of the contributes to the risk of head roll Cystic fibrosis, which has an patient aspirating infective material. mandibular mobility to correct and orthodontic problems.3 Orthodontic transfusions are required during Once a diagnosis of malignancy has very serious complication of dental patient’s safety. in the supine position. occurrence of one in 2,000 births, For this reason, and also to avoid prevent occlusion problems and treatment is certainly not con- acute episodes, with a resultant been made, the goal of the dental treatment.6 Patients with congenital Children with congenital heart Children with cerebral palsy is the most common lethal genetic restricting their already diminished deformities, and at stimulating traindicated, but caution should be increased risk of iron overload. A team, including the orthodontist, heart disease, cardiac damage from disease are often quite small, and often have severe attrition due to disorder in Caucasians.3 Children lung volume, these children should mandibular growth. Therapeutic exercised to avoid any lacerations vaso-occlusive or aplastic crisis may should be to first eliminate oral rheumatic fever or other causes, a extraction of permanent teeth to bruxism, and a higher frequency of with cystic fibrosis have progressive be treated in a more upright rather exercises against resistance and during procedures. Direct bonding be triggered due to infection or infection. It must be remembered prosthetic heart valve, a previous relieve the crowding may be required periodontal disease and gingival obstructive lung disease and are at a than fully reclined position. chewing training are beneficial to of attachments rather than fitting trauma, leading to significant that infection due to the com- history of endocarditis or recent more frequently than in some other hyperplasia that is related to both high risk of infection. Antibiotic However, since longevity in affected increase muscle strength and bands helps to reduce these risks. morbidity and mortality. There is a promised immune status is the cardiovascular surgery require types of patients. local factors and anticonvulsant administration is the mainstay of children varies widely among mandibular mobility. Occlusal splints Care should be taken to ensure that generalized osteoporosis of the jaws leading cause of death. Xerostomia antibiotic prophylaxis to prevent Children with organ transplants therapy. They frequently have a therapy for pulmonary disease in individual patients, an evaluation by or passive activators may be helpful there are no sharp edges or wires related to the degree of hyperplasia and mucositis are common side infective endocarditis whenever there are immunosuppressed, and their marked overjet, open bite, posterior patients with cystic fibrosis. New the patient’s physician of the to decrease the load on the TMJ and protruding from the orthodontic of the bone marrow, which in some effects resulting from antineoplastic is a chance of bacteremia from dental transplants are at greater risk for cross bite, and are more susceptible and potent antibiotics, more severity of the problem and life reduce masticatory muscle tension. appliances. The orthodontist should patients may cause enlargement and therapy. Oral infections by treatment. Patients at risk can infection. Therefore, they should also to trauma to the anterior maxilla, aggressive antibiotic treatment and expectancy should be included Children with juvenile carefully weigh the advantages of protrusion of the maxillary alveolar opportunistic organisms may potentially undergo orthodontic receive antibiotic prophylaxis prior to thus implicating the need for multiple routes of administration while planning possible orthodontic rheumatoid arthritis should have functional appliances in these ridge. Orthodontic treatment should also occur. treatment, but the patient’s the above mentioned procedures. orthodontic treatment. Depending have contributed to improved treatment.2 annual orthodontic examinations, children against the potential of have definitive goals for such Due to the impaired regenerative cardiologist should be consulted They frequently have gingival on the severity of neuromuscular survival among cystic fibrosis which should include a functional bleeds due to tissue irritation, as well children and should preferably be of capability of the mucous membrane, before starting treatment to assess hyperplasia as a result of the dysfunction, specific goal-oriented patients. Oral implications JUVENILE RHEUMATOID evaluation of the masticatory system, as in the temporomandibular joint. limited duration. Orthognathic orthodontic appliances can cause the
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