The role of the dental hygienist in orthodontics

During the period that a patient has to deal with orthodontics, the work of the dental hygienist becomes more difficult. Dr. André de Villiers gave a lecture on this subject during the Quality Practice Theme Day.

Brackets
The work of a dental hygienist is not easy for a patient with a lockeses bracket. Typically, more plaque and gingivitis are present with the brackets. Keeping the gingiva healthy is a difficult period. Splints afterwards also provide extra accumulation of tartar. It is more difficult to keep the teeth clean at the brackets. That is why it is necessary to brush more often and for longer, preferably with an electric brush in combination with raging under the wire. For the use of a flushing agent, there is still a lot of discussion about whether this can be useful during brackets. For patients with braces, there is therefore work to be done for the dental hygienist. Certainly in the case of periodontitis, the dental hygienist must ensure stability; before, during and after the brackets.

Lack of space
It is sometimes said that orthodontics by definition causes recessions in the lower jaw, but it is not that black and white. If there is a lack of space and a bracket is placed, the incisives will find the way of the least resistance. They then come to the fore to a greater or lesser extent. Proposition and protrusion arises. The recessions only appear in the years after wearing the brackets.

The degree of lack of space among other things determines the decision whether or not to extract better. The position of the underlying teeth prior to ortho treatment must also be determined. If elements are positioned a bit further forward in the jaw, there is a high risk that the elements will come out unfavorably and that they will be pressed through the cortex. If the jaw bone is a lot thinner than average, there is also more risk. Even fenestrations on the lingual side are then possible. Sometimes it is better to extract to ensure that the elements stay in the process. Extraction certainly does not always lead to a sunken mouth.

Splints
Splints can only consist of loose threads that are twisted around each other. If there are too few wires, ‘winding’ can occur, which means that there is again an active bracket. The twistflex is an example of a twisted wire. Recesses can occur if the thread becomes active. Usually, new clasps are needed to reverse this effect. Nowadays rectangular wires are often used as splint, but this also has a disadvantage. By definition, this thread does not follow the linguistic plane, so more composite is needed in one place than in the other, which is unfavorable. The 3D printing of splints may offer a solution in the long term. As a result, the same degree of composite can ultimately be applied everywhere.

Another disadvantage of splints is that tartar can accumulate on it. Functionally, no splints need to be placed. They are purely for the preservation of aesthetics. Splints are placed because the patient wants to keep straight teeth. Splints are no longer removed nowadays.

Periodontal benefits
It is less well known that dental hygienists can also benefit from orthodontics in the periodontal tract. This is the case with recessions, angular defects and black triangles.

Recessions
Recessions can be reduced through orthodontics. After this, surgery can possibly be applied (transplantation). The speaker does not want to say that the gingiva can grow back, because it goes against all literature, but he still sees this happening clinically after the elements with the roots have been placed back in the alveolaris processus

Angular defects
Bracing with active periodontitis is not wise. A healthy reduced periodontium must first be obtained. But if there are still one or two defects, it is usually possible. One must be very careful with the direction and degree of forces. Angular defects can be solved by extrusion of a dental element. If this is done in a controlled and careful manner, the gingiva and bone can grow with it. The element can then be ground and awarded. The process can take at least three months.

Black triangle lessons
With intensive periodontal therapy, black triangles (black triangles) may arise. These are not beautiful. By interdental sanding the enamel (max. 0.3 mm per dental floss) and then smoothing the surface, the patient has a nice mouth again without creating an increased risk of caries.

Orthodontic treatment Cape Town for the best African dissertation of the past 5 years in the field of orthodontics.

Dental hygienist, for dental INFO of the lecture by Dr. André de Villiers, during the Quality Practice Theme Day.