13 History



Table 13.1 The orthodontic significance of some medical conditions.

Medical condition Orthodontic significance
Bleeding disorders (e.g. von Willibrand’s disease, haemophilia, renal disease)
  • Avoid extraction treatment if possible
  • Minimise risk of mucosal injury from fixed appliances, e.g. avoid steel ligatures/ties, use low-profile brackets, turn down archwire ends
  • Ensure epilepsy is well controlled before commencing treatment
  • Risk of dental/mucosal injury or aspiration of broken appliances during fits
Latex allergy
  • Confirm allergy with doctor
  • Treat at beginning of day to minimise exposure to environmental latex
  • Use latex-free gloves, elastomeric modules and elastics
Nickel allergy
  • Confirm allergy with doctor
  • Oral mucosal reactions are rare even in sensitised individuals
  • Safe to use stainless steel within mouth as little nickel release
  • Use plastic-coated headgear to avoid skin reaction
  • Avoid nickel-titanium archwires. Alternative materials: stainless steel, titaniummolybdenum alloy and gold

Table 13.2 Orthodontic management of patients at high, moderate and low risk of infective endocarditis.

  Before orthodontics During orthodontics (once level of risk confirmed)
High risk
  • Consult cardiologist
  • Ensure good dental health
  • Ensure good oral hygiene (OH)
  • Avoid gingival trauma
  • Use bonded attachments on molars if possible (i.e. avoid bands and separators)
  • Chlorhexidine (0.2%) rinse before adjustments
  • Antibiotic cover for banding, debanding, separators, extractions, scaling and polishing
  • Regularly reinforce OH
Moderate risk As above As above
Low risk As above No special precautions

Table 13.4 Syndromes with oro-facial features impacting on orthodontic treatment.

Syndrome Orthodonic features Medical features
Down syndrome Maxillary hypoplasia, Class III, anterior openbite (AOB), crossbites, hypodontia, microdontia, periodontal disease, macroglossia and cleft lip and palate Learning disability, congenital heart defects, epilepsy, atlantoaxial immobility, immunodeficiency
Ectodermal dysplasia Anodontia/hypodontia, microdontia, xerostomia and Class III malocclusion Hypohidrosis (↓ sweating) and hypotrichosis (↓ hair).
Cleidocranial dysplasia Multiple supernumeraries, persi/>

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Jan 1, 2015 | Posted by in Orthodontics | Comments Off on 13 History
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