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Periodontal disease prevention during orthodontics

Orthodontic appliances collect bacterial plaque and increase the risk of gum disease during orthodontic treatment. Teeth cleaning every 6 months or sooner is a necessary preventive measure. At the cleaning visit the dentist or hygienist should use a periodontal gum measuring probe to check for diseased gum pockets and/or gum recession. Any diagnosed periodontal gum disease should be treated before orthodontics is continued.

Root shortening resorption

Root resorption or root shortening occurs with orthodontic treatment. A minor amount such as a millimeter is not clinically significant if the roots are long pre-treatment. If one half or more of the root is resorbed, the tooth is at risk for premature tooth loss and is sensitive when chewing.

To avoid significant root resorption, your orthodontist should order initial baseline pre-treatment individual periapical x-rays of each tooth in a full mouth set of x-rays. Panorex full mouth x-rays which use an external x-ray unit often do not provide adequate detail of root length or shape.

Short, narrow or tapered roots predispose to root resorption and are a warning sign to the orthodontist to carefully monitor the patient during orthodontic treatment, particularly if treatment is extended past two years. Monitoring to prevent significant root resporption should include periodic individual periapical x-rays of the upper and lower incisor teeth which are the most vulnerable to root resorption. Also the orthodontist should check for excessive tooth mobility or looseness beyond ordinary looseness associated with orthodontic tooth movement.

If significant root resorption occurs, orthodontic treatment should be discontinued or at the very least a rest period of 3 to 4 month of no active tooth movement . When orthodontics is resumed, it should be done slowly and with monitoring x-rays of the resorped roots taken every 3 months.