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Potential Hazards of Orthodontic Treatment – What Your Patient Should Know

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Potential Hazards of Orthodontic Treatment – What Your Patient Should Know This is a repository copy of Potential Hazards of Orthodontic Treatment – What Your Patient Should Know. White Rose Research Online URL for this paper: http://eprints.whiterose.ac.uk/401/ Article: Ellis, P.E. and Benson, P.E. (2002) Potential Hazards of Orthodontic Treatment – What Your Patient Should Know. Dental Update, 29. pp. 492-496. ISSN 0305-5000 Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version - refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher’s website. Takedown If you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing [email protected] including the URL of the record and the reason for the withdrawal request. [email protected] https://eprints.whiterose.ac.uk/ ORTHODONTICSORTHODONTICS Potential Hazards of Orthodontic Treatment – What Your Patient Should Know PAMELA E. ELLIS AND PHILIP E. BENSON Enamel Damage Abstract: Orthodontic treatment carries with it the risks of tissue damage, treatment Reports of the prevalence of enamel failure and an increased predisposition to dental disorders. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to damage after orthodontic treatment have proceed with orthodontic treatment. This paper outlines the potential hazards and varied (Figure 1). In one cross-sectional suggests how they may be avoided or minimized. study, 50% of individuals undergoing orthodontics had a non-developmental Dent Update 2002; 29: 492–496 enamel opacity, compared with 25% of controls.1 Another study found that, Clinical Relevance: A high proportion of adolescent patients are considering or undergoing orthodontic treatment. It is important that they understand the potential even 5 years after treatment, orthodontic risks of wearing an orthodontic appliance. patients had a significantly higher incidence of enamel opacities than untreated controls.2 The most important means of preventing demineralization is to ensure that the patient’s oral hygiene is of a lthough orthodontic treatment has involved can he or she make a fully high standard throughout treatment. A recognized benefits, including informed choice and consent to go Fluoride is a well established anti- improvements in dental health, function, ahead. cariogenic agent and several methods of appearance and self-esteem, orthodontic Some patients are more at risk than applying fluoride have been used during appliances can cause harm. The decision others; they need to be identified early orthodontic treatment to minimize the whether to proceed with orthodontics and managed appropriately to avoid risk of demineralization. requires comparison of the potential adverse sequelae. The GDP’s risks with the potential benefits. contribution is crucial, even if he or she Topical Application It is important that general dental does not fit orthodontic appliances, in Daily use of 0.05% sodium fluoride practitioners (GDPs), even if they do not helping to ensure that braces are properly mouthrinse has been shown to be undertake orthodontic treatment maintained by reinforcing oral hygiene effective,3 although only about 50% of themselves, are aware of these risks. and preventive measures. The GDP may patients complied with daily rinsing. The The GDP usually initiates the also help in an emergency if a wire or worst compliers are often those patients orthodontic referral and a patient will bracket is causing soft-tissue damage. with poor oral hygiene who are most in often seek their reassurance, after the The potential hazards of orthodontic consultation with an orthodontist, about treatment are three-fold: whether to go ahead with treatment. Only when the patient is informed about l tissue damage; the reason for treatment and the risks l treatment failure; l greater predisposition to dental disorders. Pamela E. Ellis, BDS, MSc, FDS, MOrth, Specialist Registrar in Orthodontics, and Philip E Benson, PhD, FDS (Orth), Senior Lecturer/Honorary TISSUE DAMAGE Consultant in Orthodontics, Orthodontic Both intra-oral and extra-oral tissues are Department, Charles Clifford Dental Hospital, at risk of damage during orthodontic Sheffield. Figure 1. Generalized enamel demineralization treatment. following orthodontic treatment. 492 Dental Update – December 2002 ORTHODONTICS they deteriorate rapidly in the mouth15 (Figure 2). Other devices have been developed that release small amounts of fluoride over a sustained period of time, possibly up to 6 months, before having to be replaced.16 Enamel Fractures Figure 2. Appearance of a fluoride-releasing Occasionally small cracks in the enamel Figure 4. A patient with previous periodontal elastomeric ligature (upper right lateral incisor) surface are seen following removal of disease seeking orthodontic treatment to correct after 6 weeks in the mouth. orthodontic brackets. Such cracks the drifted incisors. The periodontal disease is now under control and oral hygiene is excellent. provide stagnation areas for the need of mouthrinse. development of caries, cause partial Other topical applications, including tooth fracture, or may discolour.17 stannous fluoride mouthrinse,4 Zachrisson et al.17 found that the stannous fluoride gel5 and fluoride prevalence of pronounced cracks in varnish,6 have been employed but each relation to the total number of cracks was requires adequate compliance from the 6% for debonded/banded teeth and 4% patient to work. for untreated teeth. There were appreciably more cracks with chemically Fluoride-releasing Materials bonded ceramic brackets.18 Given the poor compliance with patient- applied measures, attempts have been made to use materials that release Periodontium fluoride over a period of time. Fluoride- Following placement of a fixed appliance containing composite resins have not there is gingival inflammation in almost all been found to be effective at reducing orthodontic patients (Figure 3). 7–9 10 demineralization, but both compomer Fortunately, this inflammation is usually Figure 5. Radiograph of anterior teeth and glass-ionomer cements11 have. transient and does not lead to attachment during orthodontic treatment showing However, glass-ionomers are weaker than loss.19–21 Gingival hyperplasia can be a blunting of the lateral incisor apex, which is composite resin and consequently there problem around orthodontic bands, characteristic of orthodontic-induced root is a higher number of bracket failures with leading to pseudo-pocketing and giving resorption. such materials.12 This problem may be the illusion of attachment loss; however, solved with the development of stronger this usually resolves within weeks of resin-reinforced glass-ionomer materials. debanding.22 contraindicated in this group, provided Evidence suggests that fluoride- Adult patients may be at risk of the disease is controlled and the patient releasing elastomeric ligatures may periodontal problems, particularly is sufficiently motivated and dextrous to reduce the prevalence of patients who seek orthodontic treatment maintain excellent oral hygiene during demineralization,13,14 although the because of pre-existing periodontal treatment.23 Three-monthly periodontal addition of fluoride to elastics may disease (for example drifting incisors; checks and routine scaling and polishing affect their physical properties so that Figure 4). Orthodontic treatment is not are advisable. The orthodontist will often modify the mechanics for these patients by keeping the forces light in view of the shortened root support. Other patients a b who require particular attention are those with systemic diseases such as diabetes or epilepsy, particularly poorly controlled diabetics and the epileptics whose seizures are controlled by phenytoin- based drugs, which can cause gingival hyperplasia. Particular periodontal problems can occur with certain types of treatment – Figure 3. Oral hygiene, which was excellent before treatment (a), has deteriorated (b): plaque accumulation and marginal gingivitis can be seen. for example, in the Class III patient who has appliances prior to orthognathic Dental Update – December 2002 493 ORTHODONTICS severe root resorption by good A penetrating eye injury may not cause pretreatment assessment of root shape immediate pain, but the oral bacteria and length. For at-risk individuals, multiply and the eye can be lost due to precautions can be taken either before overwhelming infection.32 To minimize treatment to modify the plan or during the risk of injury, headgear now has treatment to change the mechanics used. safety features that stop it being accidentally displaced or recoiling back into the face or eyes (Figure 7). Patients Pulp Damage should be given both verbal and written Figure 6. Mucosal trauma caused by a Orthodontic patients may suffer from safety instructions after fitting removable appliance component. transient pulp ischaemia, causing pain headgear.33 and discomfort in the first few days after adjustment of an appliance. This usually surgery, the lower incisors are often settles within a week, although
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