PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

Key Points
Trauma



  • A space maintainer should be fitted immediately if an upper incisor is lost.

  • Traumatized teeth may resorb during orthodontic treatment. This is minimized by
    putting calcium hydroxide in the root canal and keeping orthodontic forces light.

  • Teeth with a poor prognosis serve as useful space maintainers in the short term.


14.8 COMPLICATIONS OF ORTHODONTIC TREATMENT


14.8.0 Introduction


The most common problem with orthodontic treatment is lack of co-operation by the
patient, which in some cases can lead to the treatment conferring no benefit or even
making the malocclusion worse (see 981HSection 14.2.2). Discussed below are four issues
which may concern the paediatric dentist.


14.8.1 Postorthodontic decalcification


White spots of enamel decalcification are sometimes left after orthodontic treatment if
the patient's compliance with oral hygiene and preventive advice has been poor (982HFig.
14.31 (a) and (b)). The problem is greatest with fixed appliances, with decalcification
being mostly related to areas of plaque accumulation around the brackets, and
commonly involving the labial surfaces of anterior teeth. The lesions can develop
very quickly, within a few weeks, and consist of some softening of the enamel surface
with progressive mineral loss of the subsurface layer to a depth of up to 100 um.


Prevention of the problem starts with careful patient selection, but if oral hygiene
during treatment is poor, and especially if there are signs of decalcification,
preventive measures should be implemented immediately, These include:


(1) regular reinforcement of oral hygiene (see 983HSection 14.8.2);
(2) dietary advice;
(3) prescription of daily sodium fluoride mouthwashes.


If the patient does not respond then the orthodontic treatment should be stopped as
quickly as possible, and it is often better to leave some residual malocclusion than to
continue and risk severe damage.


If white enamel lesions are present when the appliance is removed, a daily sodium
fluoride mouthwash should be started (if not already in use). This encourages
remineralization, and the chalky appearance and degree of opacity of the lesions
usually reduce during the 3 months following appliance removal. The majority of
lesions that remain unsightly respond to the hydrochloric acid-pumice microabrasion
technique (984HChapter 10), but severe lesions and those with surface breakdown may
require localized composite restorations or even veneers.

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