Orthodontic considerations for gingival health during pregnancy: a review

Abstract:  Gingivitis is caused by several known systemic and local factors. Among systemic factors, the role of hormonal changes during pregnancy is well established. While presence of fixed orthodontic appliances alone may not cause gingivitis, factors such as pregnancy and poor oral hygiene combined together could precipitate acute gingival inflammation that may progress to a periodontal condition in a patient receiving orthodontic therapy. There has been an increase in the number of adult patients who are receiving orthodontic treatment. Orthodontic appliances could act as a potential plaque retentive source and aggravate inflammatory reactions that are seen during pregnancy. There is a lack of awareness regarding oral healthcare issues among patients who are pregnant and choose to seek orthodontic treatment. In addition, there is a need in the literature to outline management guidelines for patients who want to receive orthodontic treatment during pregnancy, with or without pre-existing gingival conditions. This review focuses on the aetiology of pregnancy gingivitis and the management of orthodontic patients during pregnancy. Our emphasis is on patient education, oral hygiene maintenance, preventive and treatment strategies for the management of gingival health in orthodontic patients during pregnancy. We also highlight some of the possible complications of initiating orthodontic treatment during pregnancy.     

Current Products and Practice Section

Abstract

There are potential religious, cultural and ethical dilemmas facing patients who are undergoing orthodontic treatment. Opinions were collected from religious and cultural leaders, as well as from non-religious groups who take an ethical standpoint on certain medical or dental treatment. Factors relating to ingredients in orthodontic products, timing of orthodontic appointments, and the effects of religious fasting are all discussed. It is important to recognize all patients’ opinions and beliefs when planning and undertaking orthodontic treatment.     

Current products and practice section: religious,cultural, and ethical dilemmas in orthodontics

There are potential religious, cultural and ethical dilemmas facing patients who are undergoing orthodontic treatment. Opinions were collected from religious and cultural leaders, as well as from non-religious groups who take an ethical standpoint on certain medical or dental treatment. Factors relating to ingredients in orthodontic products, timing of orthodontic appointments, and the effects of religious fasting are all discussed. It is important to recognize all patients' opinions and beliefs when planning and undertaking orthodontic treatment.     

应用Andrews六要素对矫治结束病例的疗效评价研究

目的 使用Andrews六要素与美国正畸学会客观评分系统(ABO-OGS)对正畸结束病例进行评价,探讨Andrews六要素能否作为矫治结束病例新的评价体系.方法 在2015—2019年经昆明医科大学附属口腔医院正畸科医生采用直丝弓矫治技术治疗完成的错(牙合)畸形病例中,随机选择完成错(牙合)治疗的160例患者作为研究对...     

The orthodontic implications of traumatized upper incisor teeth

With the demand for orthodontic treatment increasing, it is inevitable that the practitioner will see a significant number of patients with previously traumatized teeth who require orthodontic treatment. The possible risks and guidelines for the management of these teeth during active tooth movements are discussed. The use of orthodontic appliances in the management of incisors traumatized during active orthodontic treatment is also discussed.     

Evaluation of long-term satisfaction with orthodontic treatment for skeletal class III individuals

The aim of this study was to investigate the long-term satisfaction rate among skeletal class III patients following orthodontic treatment. Questionnaires were sent to 315 post-retention (between 5 to 22.5 years) patients who had received orthodontic treatment without any type of surgery for the correction of skeletal class III malocclusion. The questionnaire contained 28 questions: 10 regarding orthodontic treatment, 13 regarding satisfaction with orthodontic treatment outcomes, and five regarding psychosocial benefits of orthodontic treatment. The frequency of each variable was calculated and chi-squared test was used to determine gender correlations. The survey response rate was 15.8% (n = 40). Most patients were satisfied with their facial appearance (92.5%) and final esthetic profile (95%). Of the 5% who were dissatisfied with their final profiles, prognathic mandible was given as the reason. Most patients (90%) were satisfied with the overall treatment results. Moreover, patient perceptions of psychosocial benefits of treatment were mainly positive, with the majority (72.5%) stating their social communication had improved following orthodontic treatment. Chi-squared test indicated almost no variations in response by gender. In conclusion, the majority of skeletal class III patients in the long-term post-retention period who had received orthodontic treatment were satisfied with the overall treatment outcome.     

Clinical study on the prevalence of temporomandibular joint dysfunction in orthodontic patients

The percentage of potential TMJ dysfunction is high in orthodontic patients. The prevalence of TMJ dysfunction during orthodontic treatment and the correlation between TMJ dysfunction occurrence and orthodontic appliances were studied. One hundred and twenty-five male and 183 female orthodontic patients between 7.2 and 38.3 years of age with a mean age of 13.1 years without TMJ dysfunction at first examination were examined for clinical symptoms. TMJ dysfunction was found in 26 patients (8.6%). The frequency of occurrence of TMJ dysfunction in patients treated with a chin cap appliance was 10.9% (14/129) and 6.7% (7/105) for those treated with a multibracket appliance. Chin cap appliance treatment was begun after the pubertal growth peak in eight patients, during the peak in three patients, and before the peak in three patients. Clinical symptoms continued in four patients who continued to use the appliance under the same conditions, and nine patients who were treated with proper countermeasures became free from clinical symptoms.     

Discontinuation of orthodontic treatment: a study of the contributing factors

The article reports on a project to determine the percentage of orthodontic patients who failed to complete orthodontic treatment at the Eastman Dental Hospital, London, and to identify factors that appeared to influence this. Records of patients who had undergone active orthodontic treatment which concluded either with successful completion, or early termination due to poor attendance, inadequate oral hygiene, or appliance maintenance, were studied and analysed statistically.     

正畸治疗前后患者颜面美的感知变化及相关因素研究

目的探讨接受正畸治疗的患者对颜面美的感知变化及相关影响因素,用于指导临床治疗提高患者的满意度。方法选取12例矫治完成的病例图像制作调查问卷。随机选择于山东大学口腔医院接受正畸治疗的患者100例,分别在其正畸治疗前(对照组)及治疗一年半后(治疗组),评价问卷中病例颜面美的改变,并进行统计学分析。结果接受正畸治疗的患者对颜面美的感知度显著提高。其中文化水平较高的中年女性患者对颜面美的感知度提高最为显著,而高中以下的少年男性患者对颜面美的感知度提高不明显。拔牙及不拔牙患者对颜面美的感知度均提高,但提高的程度无显著差异。结论患者对颜面美的感知会随着正畸治疗的进行而提高,正畸治疗中要注重患者的审美心理及行为的变化,适时调整矫治方案,加强同患者的沟通,提高患者的满意度。     

Optimizing orthodontic treatment in patients taking bisphosphonates

Bisphosphonates have unique pharmacological characteristics unlike those of any other drug group. Millions of adults take oral bisphosphonates for long-term treatment of osteoporosis and osteopenia; some of these people will most likely also seek orthodontic treatment. Adverse dental effects from bisphosphonates have been reported, including decreased tooth movement, impaired bone healing, and osteonecrosis in the mandible and the maxilla. Osteonecrosis has been rarely observed after bisphosphonate use for osteoporosis. However, adverse drug effects might occur more frequently in orthodontic patients, and they would probably be noted before the end-stage pathology of osteonecrosis. Adverse effects during orthodontic treatment, including decreased tooth movement, could last for years after the drug therapy is stopped. Successful orthodontic treatment requires optimal bone healing to prevent excessive tooth mobility. Bisphosphonates appear to have two bone elimination rates - a fast elimination of weeks from the bone surface and a slow elimination of years after incorporation into the bone structure. This article presents methods to clinically and radiographically monitor orthodontic patients who are taking oral bisphosphonates. Efforts to minimize adverse effects and optimize orthodontic procedures with physician-approved drug holidays are discussed. The orthodontic treatment results of three patients who received bisphosphonate therapy are reported.     

口腔固定矫治对患者生活质量影响的分析

目的：探讨口腔正畸固定矫治对患者日常生活质量的影响。方法：对410名门诊口腔正畸复诊患者,采用”口腔治疗影响日常行为量表”（OIDP）进行问卷调查,比较在不同日常行为方面影响程度的大小,并按不同疗程、不同年龄、不同性别对患者进行分组比较。所得数据采用秩和检验和x。检验进行统计处理。结果：正畸固定矫治对患者各项日常行为活动的影响程度大小不一致（P〈0．01）,其中对口腔清洁影响最大,体育运动影响最小。疗程在19～30个月者相比疗程在7～18个月者（P=0．046）以及疗程大于31个月者（P=0．027）,更能感觉正畸固定矫治对日常生活的影响。青少年组患者感受影响的程度是成年组的1．815倍,两者间有显著性差异（P=0．014）。不同性别之间患者的感受程度无显著性差异（P=0．751）。结论：口腔正畸医师要关注患者,尤其是关注影响相对较重的患者,在正畸治疗过程中的心理变化,加强心理疏导,保证临床治疗顺利进行。     

The emotional impact of orthognathic surgery and conventional orthodontics

Previous research by the authors has pointed to depressive reactions among orthognathic surgery patients during the fixation-removal stage and up to 9 months later. However, less is known about emotional shifts among persons who choose to undergo conventional orthodontic treatment after considering surgical orthodontics. In the current study, a standard measure of mood states was applied to 90 surgical patients and 66 who had considered surgery but decided against it. Of these, 33 were undergoing orthodontic treatment and 33 were having no treatment. The mood scale and measures of personality were first applied before surgery and then during orthodontic treatment, just after surgery, at fixation removal, and 6 months after surgery. Nonsurgical respondents completed questionnaires at the same time as their matched surgical respondents. Scores on tension and fatigue increased significantly among surgical patients from before surgery to immediately after surgery and dropped to presurgical levels when fixation was removed. Anger-hostility increased at fixation removal but declined within 5 months. Postsurgical discomfort, pain, and paresthesia, and interpersonal and oral function problems were correlated with postsurgery emotional state. On the later questionnaires, which corresponded to the later periods of orthodontic treatment, patients who had opted for conventional orthodontic treatment reported that they experienced greater depression, anger, and tension. These patients may be particularly vulnerable to emotional problems because their orthodontic treatment may be more complex and of longer duration than that of the typical orthodontic patient. These results point to the importance of continued psychological support for both orthodontic and surgical patients throughout their course of treatment.     

成人错患者矫正动机的调查

目的 阐明成人错(牙合)患者的矫正动机,以丰富我们对成人矫正治疗的知识。方法 对219名年龄在18岁以上的成人错(牙合)畸形患者进行问卷调查,得出有关数据。结果 成人患者女性明显多于男性,开始矫正的动机主要为“牙齿排列不齐”、“注意自己的口型、面型、认为自己的形象不好”等,而“没有矫正治疗的机会”、“不知道能不能矫正”成为成人患者开始矫正的障碍。结论 成人患者不仅关心牙齿排列和颜面的美观,也关心口腔健康和功能;还应加强错(牙合)畸形及其矫治知识的宣教工作,使矫正治疗更普及、更社会化。     

Occurrence and distribution of interdental gingival clefts following orthodontic movement into bicuspid extraction sites.

Forty patients in active retention following orthodontic tooth movement into premolar extraction sites were examined for the occurrence and distribution of interdental gingival clefts, defined as an invagination of interproximal tissue with definite mesial and distal peaks having a depth of at least 1 mm. Fourteen of the forty orthodontic patients demonstrated clefts in one or more of the premolar extraction sites. No clefts were observed in premolar areas of orthodontic patients who did not require premolar extraction or in patients without previous orthodontic treatment. Interdental clefts occurred most frequently at the buccal aspect of mandibular first premolar extraction sites. The presence of the cleft appears to have clinical implications, both in terms of orthodontic relapse, and maintenance of gingival health.     

The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.     

The use of low-tack chewing gum for individuals wearing orthodontic appliances

A clinical study was carried out to determine the acceptability of a sugar-free, low-tack chewing gum by orthodontic patients undergoing fixed appliance treatment. Twenty-five orthodontic and 25 non-orthodontic control subjects were questioned on their preference between regular-tack and low-tack chewing gum. The orthodontic subjects showed a strong preference for the low-tack gum compared with the regular-tack gum. It was concluded that low-tack, sugar-free chewing gum can be used by orthodontic patients to increase saliva flow, with the potential to promote remineralization and help reduce white spot lesion formation related to fixed orthodontic appliances. This gum should also be of value in patients being treated for xerostomia who are wearing a partial denture.     

拔除上颌切牙病例的正畸治疗

目的探讨拔除上颌切牙及下颌双尖牙进行正畸治疗病例的正畸治疗特点。方法采用回顾性研究的方法，对11名由于各种原因需要拔除上颌切牙并同时需要拔除下颌双侧第一双尖牙进行正畸治疗的患者进行研究。用电子游标卡尺进行模型测量，通过模型测量计算Bolton指数分析该类患者拔牙治疗后上下颌牙量的协调性。并通过患者的正畸治疗总结该类患者的治疗特点及矫治要点。结果：该类患者治疗后的Bolton指数分别为前牙比79．71％、后牙比91．75％，虽大于正常均数，但差异不大。11名患者上下颌牙量的不调量在0．5—2．82mm间。结论：拔除上颌切牙及下颌双尖牙治疗的患者，上下颌牙量基本协调，恰当的正畸矫治可以使患者获得良好的矫治效果。     

正畸牙齿龈沟液中白介素-17含量的研究

目的检测正畸牙加力前、加力后压力侧和张力侧龈沟液中白介素-17（IL-17）的含量。方法选择拔除4个第一双尖牙拉尖牙远移正畸患者20例,用滤纸条法收集加力前、加力1个月后上颌尖牙压力侧及张力侧龈沟液,采用双抗夹心酶联免疫吸附法（ELISA）检测龈沟液中IL-17的浓度。结果加力前、加力后压力侧和张力侧龈沟液中IL-17的浓度有显著性差异,压力侧龈沟液中IL-17的浓度明显高于加力前和张力侧（P〈0.05）。结论正畸力作用下,压力侧龈沟液中IL-17表达高于加力前和张力侧。IL-17可能参与了正畸力诱导的破骨细胞分化和牙槽骨吸收的过程。     

Demand and referral pattern for orthodontic care at University College Hospital, Ibadan, Nigeria

OBJECTIVE: To assess the demand and pattern of referral for orthodontic services at University College Hospital, Ibadan, Nigeria. DESIGN: A 21-month prospective clinic-based study of consecutive orthodontic patients. SETTING AND SAMPLE POPULATION: The orthodontic clinic of University College Hospital, Ibadan, Nigeria. One hundred and seventy-eight (178) consecutive patients, consisting of 79 (44.4%) males and 99 (55.6%) females with mean age of 16.21+/-7.81 years were studied. RESULTS: 80% of subjects were 20 years of age or younger, while less than 2% were over 40 years of age. More females sought orthodontic care than males. Over 43% of the patients needed removable orthodontic appliances while close to 17% required treatment with fixed appliances. Extractions of retained primary teeth and other grossly malpositioned teeth accounted for 9.6% while 24.7% needed observation of occlusal developments before any treatment decisions could be made. Dentists were noted to be the main referrers of these patients, accounting for over 49% of the referrals, followed by 25.4% who were self referred, and 18.3% who attended under parental influence. CONCLUSION: More girls than boys demanded orthodontic care and dentists were the major referrers of orthodontic patients.     

牙周序列治疗在牙周炎患者正畸过程中的临床疗效观察

目的：评价牙周序列治疗在牙周炎患者正畸治疗中所起的作用。方法：选择26例要求正畸治疗的成人牙周炎患者,在正畸治疗前开始牙周序列治疗并持续至正畸治疗结束,记录治疗前和牙周治疗后1个月、正畸治疗结束时的PLI、PD、BI、CAL。结果：成人牙周炎患者经过序列治疗和正畸治疗后各项牙周检查指标较治疗前差别均有统计学意义（P〈0.05）。结论：牙周炎患者在牙周序列治疗控制炎症后进行正畸治疗可以达到较好的效果。