Lecture 1

Question 1

what are 3 types of problems caused by protruding, irregular, or maloccluded teeth?

Answer 1

1. psychosocial - due to facial and dental appearance
2. problems with oral function
3. greater susceptibility to trauma, periodontal disease, and tooth decay

Question 2

what are 3 problems with oral function caused by malocclusion?

Answer 2

1. difficulties in jaw movement, mastication, and swallowing
2. temporomandibular joint dysfunction (muscle coordination - spasms, fatigue, and pain)
3. speech

Question 3

severe malocclusion is typically viewed as a social ___, whereas well-aligned teeth and a symmetrical skeletal pattern carry a ___ status at all social levels

Answer 3

• social handicap

- positive

Question 4

what is the correlation between teacher expectations for children with and without well-aligned teeth?

Answer 4

studies show that teachers expectations are higher for students with well-aligned teeth

Question 5

what are some examples of physical differences in the mouth that can, but don’t always, have an affect on how sounds are made?

Answer 5

• open bite
• underbite
• overbite
• crossbite
• missing teeth

Question 6

patients with a skeletal class III malocclusion sometimes have difficulty pronouncing which two sounds?

Answer 6

F and V sounds

Question 7

children with articulation disorders can be known to do one or more of what 4 things? why is this an issue?

Answer 7

• delete sounds
• substitute sounds
• add sounds
• distort sounds
• older children and even adults who pronounce sounds incorrectly can be stereotyped as less intelligent or less capable than others; this can limit adults to career choices and can also distract listeners, causing communication breakdowns

Question 8

what is the major reason people seek orthodontic treatment?

Answer 8

• psychosocial problems

- others seek ortho treatment for malocclusion and TMD

Question 9

T or F:

it appears that malocclusion usually affects function by making it impossible for the patient to function

Answer 9

• false
• it makes it more difficult for the patient to function, ie the patient may have to use extra effort to masticate to compensate for their anatomic deformity, or they may settle for less masticated food, which can result in poor digestion

Question 10

what are the two types of occlusion?

Answer 10

physiologic occlusion and pathologic occlusion

Question 11

which type of occlusion is when a patient does not necessarily have an ideal class I occlusion, but their occlusion adapts to the stress of function and can be maintained indefinitely?

Answer 11

physiologic occlusion

Question 12

which type of occlusion is when a patient cannot function without contributing to the destruction of the dentition and oral facial complex?

Answer 12

pathologic occlusion

Question 13

what ways can pathologic occlusion manifest itself?

Answer 13

• excessive wear
• TMJ problems
• pulpal changes ranging from pulpitis to necrosis
• periodontal problems

Question 14

tooth movement caused by pathologic conditions is termed ___

Answer 14

pathologic tooth movement

Question 15

malocclusion places more stress and strain on the entire dental facial complex, including what 4 things?

Answer 15

• TMJ
• musculature
• dentition
• supporting bone and periodontium

Question 16

TMD is manifested as pain in and around the TMJ, which may result from ___, but more often is caused by ___

Answer 16

• pathologic changes within the joint

- muscle fatigue and spasm (which can be initiated by malocclusion)

Question 17

which malocclusion class places a distalizing effect on the mandible which can impinge on the retro-discal tissues of the TMJ, causing pain?

Answer 17

class II malocclusion (deep anterior bite)

Question 18

is TMD a reason for orthodontic treatment?

Answer 18

• the relationship between dental occlusion and TMD is highly controversial
• whether or not ortho treatment can cure TMD varies from patient to patient

Question 19

patients with TMD are classified as being in one or more of which four large groups?

Answer 19

1. masticatory muscle disorders
2. TMJ disorders
3. chronic mandibular hypomobility
4. growth disorders
   * from the perspective of potential ortho treatment in adults, differentiating between groups 1 and 2 is particularly important

Question 20

TMD symptoms arise from which two major causes? of the two causes, which is generally helped by orthodontics?

Answer 20

1. muscle spasm and fatigue - may be helped by orthodontic treatment, but simpler methods like splint therapy should be attempted first
2. internal joint pathology - ortho alone is rarely useful

Question 21

degenerative joint disease can be seen through what three conditions?

Answer 21

1. arthritic involvement
2. disc displacement - trauma or aging of the ligaments that oppose the action of the lateral pterygoid muscle are stretched or torn, so when the muscle contracts, the ligaments cannot return the disc to its proper position, and a resulting pop upon opening and/or closing is seen
3. myofascial pain - develops when muscles are overly fatigued and tend to go into spasm

Question 22

T or F:

TMD is no more prevalent in patients with severe malocclusion than in the general population

Answer 22

true

Question 23

what are some non-surgical treatments for TMD?

Answer 23

• stress control
• stop gum
• educate the patient about clenching and grinding throughout the day
• anti-inflammatory drugs (ibuprofen, indomethacin, celecoxib)
• splint therapy

Question 24

___ is used to help identify if the malocclusion is a possible cause of the patients TMD

Answer 24

splint therapy

Question 25

why is it important for splints to be full coverage of all teeth, either maxillary or mandibular?

Answer 25

because partial occlusal splint therapy can cause malocclusion, resulting in the need for orthodontic treatment

Question 26

what is the goal of splint therapy?

Answer 26

to create a bite plane where the patient can function by removing any abnormal occlusal interferences

Question 27

if a patient responds well to splint therapy, there is a good chance that the patient will respond well to altering the occlusion through ___

Answer 27

orthodontic treatment

Question 28

drastic alteration of the occlusion, by either restorative dental procedures or orthodontics, is logical only if ___

Answer 28

the less invasive stress-controlled approaches have failed (may involve orthognathic surgery)

Question 29

orthodontic treatment to alter the occlusion may be necessary so that the patient can better tolerate ___

Answer 29

parafunctional habits

Question 30

T or F: those who have had symptoms of TMD in the past are always at risk of having their symptoms recur, whether splint therapy was used prior to ortho treatment or not

Answer 30

true

Question 31

T or F: | orthodontics is capable of changing both the occlusion and the TMJ

Answer 31

- false | - it is only capable of changing the occlusion

Question 32

many TMD patients suffer from what disorders?

Answer 32

- anxiety - depression - mental illness - ADHD - bi-polar disorders

Question 33

what are some examples of treatments which claim to help with TMD?

Answer 33

splint therapy devices, LED therapy, massage, ultrasonic, TMJ wedge, therabite, TMJ injections, arthrocentesis (remove joint fluids), surgery, etc.

Question 34

malocclusion, particularly protruding maxillary incisors, can increase the likelihood of ___ to the teeth

Answer 34

- injury - there is about a 1 in 3 chance that a child with untreated class II malocclusion will experience trauma to the upper incisors (usually minor chips to the enamel, but sometimes more severe damage)

Question 35

what damage can be caused in a patient with an extreme overbite, where the lower incisors contact the palate?

Answer 35

- significant tissue damage and bone loss to the lingual aspect of the maxillary incisors - this can lead to early loss of the upper incisors - this type of malocclusion can also result in extreme wear of the mandibular incisors

Question 36

crossbites and traumatic occlusions can cause what 4 things?

Answer 36

1. extreme wear 2. gingival recession 3. bone loss on the misaligned teeth 4. stress on the TMJ (can also influence growth of the TMJ)

Question 37

situations caused by crossbites and traumatic occlusions can be avoided by ___

Answer 37

early orthodontic intervention

Question 38

in what ways can malocclusion contribute to both dental decay and periodontal disease?

Answer 38

- it is harder to care for the teeth properly | - however, the patient's willingness and motivation determine oral hygiene much more than how well the teeth are aligned

Question 39

the presence or absence of ___ is the major determinant of the health of both the hard and soft tissues of the mouth

Answer 39

- dental plaque | - however, bone loss and periodontal support can occur with teeth that are severely overlapped

Question 40

what is the correlation between orthodontic treatment and periodontal problems?

Answer 40

- long term studies show no indication that ortho treatment increased the chance of later perio problems - but there is a greater risk of decay and white spot decalcification lesions around the braces during ortho treatment