Pregnant women |
1.The orthodontist may request radiographic examinations of pregnant patients. |
In non-emergency situations, requests for radiographies between the 10th and 17th week of pregnancy should be avoided, as this is the period of greatest sensitivity of the embryo’s central nervous system. |
TOPPENBERG et al. (1999) Safety of radiographic imaging during pregnancy.Am Fam Physician. |
Answer: I do not agree nor disagree |
2. Even with the orthodontic documentation ready, the patient cannot begin orthodontic treatment if they are in the first trimester of pregnancy. |
Orthodontic treatment can be performed during pregnancy, once both patient and orthodontist are aware of the importance of maintaining oral hygiene as well as prophylactic and treatment strategies for managing gingival health during pregnancy. |
SACHAN et al. (2013)2. Sachan A, Verma VK, Panda S, Singh K. Considerations for the orthodontic treatment during pregnancy. J Orthop Res. 2013;1(3):103. https://doi.org/10.4103/2321-3825.123321 https://doi.org/10.4103/2321-3825.123321...
Considerations for the orthodontic treatment during pregnancy. https://doi.org/10.4103/2321-3825.123321 |
Answer: Disagree |
3. During orthodontic treatment, communication between the orthodontist and the pregnant woman’s obstetrician/gynecologist is mandatory. |
Communication between gynaecologists and orthodontists is crucial and relevant to the care of pregnant women during the prenatal period. |
GOVINDASAMY et al. (2018) Knowledge, awareness, and practice among gynecologists, medical practitioners and dentists in Madurai regarding association between periodontitis and pregnancy outcomes. https://doi.org/10.4103/jisp.jisp_164_18; PATIL et al. (2013)23. Patil S, Thakur R, K M, Paul ST, Gadicherla P. Oral health coalition: knowledge, attitude, practice behaviours among gynaecologists and dental practitioners. J Int Oral Health. 2013 Feb;5(1):8-15. Oral Health Coalition: Knowledge, Attitude, Practice Behaviours among Gynaecologists and Dental Practitioners. |
Answer: Disagree |
4. Women in the third trimester of pregnancy who are not intaking the adequate amount of calcium and who report constant pain in the lower back are able to put on orthodontic appliances. |
There is an increasing demand for calcium in the pregnant women’s body for fetal development and this process interferes with calcium homeostasis and bone remodelling. |
CROSS et al. (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. https://doi.org/10.1093/ajcn/61.3.514; KOVACS et al. (2005) Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia. https://doi.org/10.1016/j.ecl.2011.08.002 |
Answer: Disagree |
5. During orthodontic treatment in pregnant women, the orthodontist should check if the patients are supplementing calcium. |
Calcium insufficiency and deficiency have not been sufficiently studied in humans to establish what levels of supplementation are necessary or optimal, but adequate pregnant women’s vitamin D supplementation should be maintained during pregnancy. |
HOLLIS et al. (2004) Assessment of dietary vitamin D requirements during pregnancy and lactation. https://doi.org/10.1093/ajcn/79.5.717; KALKWARF et al. (1997) The effect of calcium supplementation on bone density during lactation and after weaning. https://doi.org/ 10.1056/NEJM199708213370803 |
Answer: Agree |
6. Pregnant and undergoing orthodontic treatment patients should perform prophylactic procedures more frequently to prevent the occurrence of gingivitis gravidarum. |
Studies have shown that orthodontists should be more aware of the oral health of their patients, with an emphasis on guidance, maintenance of oral hygiene and prophylactic strategies for maintaining gingival health, since orthodontic appliances can act as a source of plaque retention and aggravate inflammatory reactions. |
BERLIN-BRONER et al. (2012) Awareness of orthodontists regarding oral hygiene performance during active orthodontic treatment. Eur Arch Paediatr Dent.; SACHAN et al. (2013)2. Sachan A, Verma VK, Panda S, Singh K. Considerations for the orthodontic treatment during pregnancy. J Orthop Res. 2013;1(3):103. https://doi.org/10.4103/2321-3825.123321 https://doi.org/10.4103/2321-3825.123321...
Considerations for the orthodontic treatment during pregnancy. https://doi.org/10.4103/2321-3825.123321 |
Answer: Agree |
7. The demand for calcium remains unchanged in the pregnant woman’s body. |
There is an increasing demand for calcium during all trimesters of pregnancy. |
CROSS et al. (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study. https://doi.org/10.1093/ajcn/61.3.514; KOVACS et al. (2005) Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. https://doi.org/10.1152/physrev.00027.2015 |
Answer: Disagree |
8. After the gestation period, women may have transient gestational osteoporosis. |
An osteoporosis in the hip associated with pregnancy may occur, and this event is rare and transitory. |
KOVACS et al. (2005) Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. https://doi.org/10.1152/physrev.00027.2015 |
Answer: Agree |
Lactating women |
1. The orthodontist may perform orthodontic treatment in lactating patients. |
The orthodontist should be aware that mechanical force-induced bone remodelling is increased during the lactation period. |
MACARI et al. (2018)10. Macari S, Sharma LA, Wyatt A, Silva JM, Dias GJ, Silva TA, et al. Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. Bone. 2018 May;110:160-9. https://doi.org/10.1016/j.bone.2018.01.032 https://doi.org/10.1016/j.bone.2018.01.0...
Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. https://doi.org/10.1016/j.bone.2018.01.032 |
Answer: Agree |
2. During orthodontic treatment in lactating women, the orthodontist should check if the patients are supplementing calcium. |
Supplementation of lactating patients is believed to have the following purposes: to increase the patient’s vitamin D nutritional status and thereby improve vitamin D nutrition. |
CROSS et al. (1995) Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. https://doi.org/10.1002/jbmr.5650100907; KALKWARF et al. (1997) The effect of calcium supplementation on bone density during lactation and after weaning. https://doi.org/ 10.1056/NEJM199708213370803 |
Answer: Agree |
3. During the lactation period, women have a high demand for calcium, for both maintaining bone mineral homeostasis and milk production. |
The demand for bone mineral from women’s skeleton is considered a normal outcome of lactation. |
CROSS et al. (1995) Calcium homeostasis and bone metabolism during pregnancy, lactation, and postweaning: a longitudinal study.https://doi.org/10.1093/ajcn/61.3.514; KOVACS et al. (2005) Maternal Mineral and Bone Metabolism During Pregnancy, Lactation, and Post-Weaning Recovery. https://doi.org/10.1152/physrev.00027.2015 |
Answer: Agree |
4. Lactating patients should undergo prophylactic procedures more often, especially if they are undergoing orthodontic treatment. |
Lactating patients should undergo prophylactic procedures more often, as orthodontic appliances can act as a source of plaque retention and aggravate inflammatory reactions. |
BERLIN-BRONER et al. (2012) Awareness of orthodontists regarding oral hygiene performance during active orthodontic treatment. Eur Arch Paediatr Dent.; SACHAN et al. (2013)2. Sachan A, Verma VK, Panda S, Singh K. Considerations for the orthodontic treatment during pregnancy. J Orthop Res. 2013;1(3):103. https://doi.org/10.4103/2321-3825.123321 https://doi.org/10.4103/2321-3825.123321...
Considerations for the orthodontic treatment during pregnancy. https://doi.org/10.4103/2321-3825.123321 |
Answer: I do not agree nor disagree |
5. Lactating women lose 1 to 3% of their bone mineral content per month. |
This loss is an expected consequence of the lactation process. |
CROSS et al. (1995) Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. https://doi.org/10.1002/jbmr.5650100907 |
Answer: I do not agree nor disagree |
6. During lactation, the acceleration of orthodontic tooth movement may occur associated with transient bone loss, which is characteristic of this stage. |
This event occurs due to the increased differentiation of osteoclasts and osteoblasts during lactation. |
MACARI et al. (2018)10. Macari S, Sharma LA, Wyatt A, Silva JM, Dias GJ, Silva TA, et al. Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. Bone. 2018 May;110:160-9. https://doi.org/10.1016/j.bone.2018.01.032 https://doi.org/10.1016/j.bone.2018.01.0...
ST2 regulates bone loss in a site-dependent and estrogen-dependent manner. https://doi.org/10.1002/jcb.27080 |
Answer: Agree |
Postmenopausal women |
1. Postmenopausal women are more likely to develop osteoporosis. |
Osteoporosis is a prevalent disease in female patients and is associated with the postmenopausal period. |
TARITY et al. (2013) Mortality in centenarians with hip fractures. https://doi.org/10.3928/01477447-20130222-15 |
Answer: Agree |
2. A woman who performs physical activities and eats properly loses bone density after 40 years of age. |
Adequate nutrition associated with physical activity has the ability to maintain bone homeostasis by increasing osteoblastic activity, bone mineral density and trabecular bone volume in the alveolar bone. |
OLIVEIRA et al. (2020)11. Oliveira MC, Pieters BC, Guimarães PB, Duffles LF, Heredia JE, Silveira AL, et al. Bovine milk extracellular vesicles are osteoprotective by increasing osteocyte numbers and targeting rankl/opg system in experimental models of bone loss. Front Bioeng Biotechnol. 2020 Jul;8:891. https://doi.org/10.3389/fbioe.2020.00891 https://doi.org/10.3389/fbioe.2020.00891...
Bovine Milk Extracellular Vesicles Are Osteoprotective by Increasing Osteocyte Numbers and Targeting RANKL/OPG System in Experimental Models of Bone Loss. https://doi.org/10.3389/fbioe.2020.00891; PASQUALINI et al. (2019) Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass. https://doi.org/10.1007/s00198-019-04908-9; |
Answer: Disagree |
3. During orthodontic treatment in postmenopausal women, the orthodontist should check if the patients are undergoing hormonal replacement. |
The effect of female hormones, such as prolactin and estrogen, on bone remodelling and their influence on the craniofacial complex. |
CLÉMENT-LACROIX et al. (1999) Osteoblasts are a new target for prolactin: analysis of bone formation in prolactin receptor knockout mice. https://doi.org/10.1210/endo.140.1.6436; MACARI et al. (2016)9. Macari S, Ajay Sharma L, Wyatt A, Knowles P, Szawka RE, Garlet GP, et al. Osteoprotective effects of estrogen in the maxillary bone depend on eralpha. J Dent Res. 2016 Jun;95(6):689-96. https://doi.org/10.1177/0022034516633154 https://doi.org/10.1177/0022034516633154...
Osteoprotective effects of estrogen in the maxillary bone depend on ERα. https://doi.org/10.1177/0022034516633154 |
Answer: Agree |
4. Postmenopausal estrogen-deficient patients show reduced risk of root resorption during orthodontic treatment. |
Estrogen deficiency accelerates orthodontic movement and may interfere with clinical outcomes. |
AMARO et al. (2020) Estrogen protects dental roots from orthodontic-induced inflammatory resorption. |
Answer: Disagree |
|
5. Multiple tooth loss and low mandibular bone density may be intraoral signs in women already presenting osteoporosis. |
The dentist can be the first health professional to early diagnose osteoporosis, a decrease in alveolar bone even with proper hygiene may indicate the need for further systemic screening of bone mineral density. |
KINALSKI et al. (2019) The accuracy of panoramic radiography as a screening of bone mineral density in women: a systematic review. https://doi.org/10.1259/dmfr.20190149; LEITE et al. (2015) Systematic review with hierarchical clustering analysis for the fractal dimension in assessment of skeletal bone mineral density using dental radiographs. https://doi.org/10.1007/s11282-014-0188-y; STEWART et al. (2012) Building osteoporosis prevention into dental practice. |
Answer: Agree |
6. Osteopenia can be understood as the stage that precedes osteoporosis, occurring when bone resorption is greater than bone neoformation. |
Many women experience a long period of osteopenia before being considered as being affected by osteoporosis. |
PASCO et al. (2006) The population burden of fractures originates in women with osteopenia, not osteoporosis. https://doi.org/10.1007/s00198-006-0135-9 |
Answer: Agree |
7. Early menopause, such as having the ovaries removed before the age of 50, reduces the chances of developing osteoporosis. |
Hormone replacement, proper nutrition and physical activity, among other factors, can reduce the likelihood of developing osteoporosis. |
PASQUALINI et al. (2019) Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass. https://doi.org/10.1007/s00198-019-04908-9 |
Answer: Disagree |
8. Osteoporosis is caused by decreased calcium absorption. |
The abrupt drop in female hormones can lead to osteoporosis. |
WINDAHL et al. (2002)8. Windahl SH, Andersson G, Gustafsson JA. Elucidation of estrogen receptor function in bone with the use of mouse models. Trends Endocrinol Metab. 2002 Jul;13(5):195-200. https://doi.org/10.1016/S1043-2760 (02)00594-5 https://doi.org/10.1016/S1043-2760 (02)0...
Elucidation of estrogen receptor function in bone with the use of mouse models. |
Answer: Disagree |
9. Accelerated loss of bone mass is observed in osteoporosis. |
Postmenopausal women with osteoporosis lose 1 to 3% of their bone mineral content per year. |
CROSS et al. (1995) Changes in bone mineral density and markers of bone remodeling during lactation and postweaning in women consuming high amounts of calcium. https://doi.org/10.1002/jbmr.5650100907 |
Answer: Agree |
10. Dental radiographs are ineffective in the diagnose patients with suspect of osteoporosis. |
The most effective method for diagnosing osteoporosis is bone densitometry. |
HAILEY et al. (1996) The effectiveness of bone density measurement and associated treatments for prevention of fractures: an international collaborative review. |
Answer: Disagree |
11. At present, the most acceptable method for diagnosing osteoporosis is bone densitometry (DEXA). |
Bone densitometry has diagnostic and prognostic capability. |
HAILEY et al. (1996) The effectiveness of bone density measurement and associated treatments for prevention of fractures: an international collaborative review. |
Answer: Agree |
12. Postmenopausal women with osteoporosis who do not perform physical activities, do not eat properly, and do not undergo hormone replacement therapy can lose bone mineral content. |
Accelerated loss of bone mass is observed in women with osteoporosis and without proper management of calcium intake and hormone replacement. |
FESKANICH et al. (2003) Calcium, vitamin D, milk consumption, and hip fractures: a prospective study among postmenopausal women. https://doi.org/10.1093/ajcn/77.2.504 |
Answer: Agree |
13. Bisphosphonates, widely used in the treatment of osteoporosis, are associated with the occurrence of osteonecrosis of the jaws. |
Bisphosphonates are the first-line drugs used to treat women who develop postmenopausal osteoporosis, but there is an increased incidence of osteonecrosis of the jaw as a side effect. |
HELLSTEIN et al. (2011) Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs. https://doi.org/10.14219/jada.archive.2011.0108 |
Answer: Agree |
14. Bisphosphonates do not interfere with neither the planning nor the outcome of orthodontic treatment. |
The administration of bisphosphonates may be associated with increased treatment time and moderate changes such as remodelling in tooth roots and surrounding tissues in orthodontic patients. |
SIDIROPOULOU-CHATZIGIANNIS et al. (2007) The effect of osteoporosis on periodontal status, alveolar bone and orthodontic tooth movement. A literature review. |
Answer: Disagree |
15. Hormone replacement after menopause reduces the likelihood of bone fracture. |
Hormone replacement is important for the maintenance bone structure. |
MACARI et al. (2015) Oestrogen regulates bone resorption and cytokine production in the maxillae of female mice. https://doi.org/10.1016/j.archoralbio.2014.11.010 |
Answer: Agree |
16. The sharp reduction of estrogen levels in postmenopausal women is directly associated to bone loss and development of osteoporosis. |
Hormonal deficiency is directly related to bone loss and the development of osteoporosis. |
MACARI et al. (2018)10. Macari S, Sharma LA, Wyatt A, Silva JM, Dias GJ, Silva TA, et al. Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. Bone. 2018 May;110:160-9. https://doi.org/10.1016/j.bone.2018.01.032 https://doi.org/10.1016/j.bone.2018.01.0...
ST2 regulates bone loss in a site-dependent and estrogen-dependent manner. https://doi.org/10.1002/jcb.27080 |
Answer: Agree |
17. Estrogen deficiency during the post-menopause period accelerates orthodontic tooth movement. |
Estrogen deficiency accelerates orthodontic movement, interfering with the treatment approach and clinical outcomes. |
MACARI et al. (2016)9. Macari S, Ajay Sharma L, Wyatt A, Knowles P, Szawka RE, Garlet GP, et al. Osteoprotective effects of estrogen in the maxillary bone depend on eralpha. J Dent Res. 2016 Jun;95(6):689-96. https://doi.org/10.1177/0022034516633154 https://doi.org/10.1177/0022034516633154...
Osteoprotective effects of estrogen in the maxillary bone depend on ERα. https://doi.org/10.1177/0022034516633154; MACARI et al. (2018)10. Macari S, Sharma LA, Wyatt A, Silva JM, Dias GJ, Silva TA, et al. Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. Bone. 2018 May;110:160-9. https://doi.org/10.1016/j.bone.2018.01.032 https://doi.org/10.1016/j.bone.2018.01.0...
Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. https://doi.org/10.1016/j.bone.2018.01.032 |
Answer: I do not agree nor disagree |
18. Physical activity and diet are not important factors in maintaining bone health in postmenopausal women. |
Appropriate nutrition associated with physical activity has the ability to maintain bone homeostasis. |
OLIVEIRA et al. (2020)11. Oliveira MC, Pieters BC, Guimarães PB, Duffles LF, Heredia JE, Silveira AL, et al. Bovine milk extracellular vesicles are osteoprotective by increasing osteocyte numbers and targeting rankl/opg system in experimental models of bone loss. Front Bioeng Biotechnol. 2020 Jul;8:891. https://doi.org/10.3389/fbioe.2020.00891 https://doi.org/10.3389/fbioe.2020.00891...
Bovine Milk Extracellular Vesicles Are Osteoprotective by Increasing Osteocyte Numbers and Targeting RANKL/OPG System in Experimental Models of Bone Loss. https://doi.org/10.3389/fbioe.2020.00891; PASQUALINI et al. (2019) Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass. https://doi.org/10.1007/s00198-019-04908-9 |
Answer: Disagree |
General knowledge |
1. Orthodontists should always take notes of the medications used by their patients. |
The orthodontist must always be aware of the systemic condition and medical history of their patients, as well as record all medications used by their patients throughout the treatment. |
PATIL et al. (2013)23. Patil S, Thakur R, K M, Paul ST, Gadicherla P. Oral health coalition: knowledge, attitude, practice behaviours among gynaecologists and dental practitioners. J Int Oral Health. 2013 Feb;5(1):8-15. Oral Health Coalition: Knowledge, Attitude, Practice Behaviours among Gynaecologists and Dental Practitioners. |
Answer: Agree |
2. Calcium and vitamin D have the effect of preserving bone mass in women. |
Both calcium and vitamin D take part in maintaining bone density. |
KALKWARF et al. (1997); KOVACS et al. (2005) |
Answer: Agree |
3. Some hormones, such as parathyroid hormone, estrogen, glucocorticoids and vitamin D3, play an insignificant role in the bone remodelling process. |
Female hormones play a key role in the bone remodelling process. |
MACARI et al. (2016)9. Macari S, Ajay Sharma L, Wyatt A, Knowles P, Szawka RE, Garlet GP, et al. Osteoprotective effects of estrogen in the maxillary bone depend on eralpha. J Dent Res. 2016 Jun;95(6):689-96. https://doi.org/10.1177/0022034516633154 https://doi.org/10.1177/0022034516633154...
Osteoprotective effects of estrogen in the maxillary bone depend on ERα. https://doi.org/10.1177/0022034516633154; MACARI et al. (2018)10. Macari S, Sharma LA, Wyatt A, Silva JM, Dias GJ, Silva TA, et al. Lactation induces increases in the RANK/RANKL/OPG system in maxillary bone. Bone. 2018 May;110:160-9. https://doi.org/10.1016/j.bone.2018.01.032 https://doi.org/10.1016/j.bone.2018.01.0...
ST2 regulates bone loss in a site-dependent and estrogen-dependent manner. https://doi.org/10.1002/jcb.27080 |
Answer: Disagree |
4. Cytokines and growth factors also act in the control of bone cell activity. |
Local factors such as cytokines and growth factors also play a role in the control of bone cell activity. |
FENG et al. (2011) Disorders of bone remodeling. https://doi.org/10.1146/annurev-pathol-011110-130203 |
Answer: Agree |
5. The bone is a dynamic tissue that undergoes constant physiological remodelling to maintain its structural integrity and mineral homeostasis. |
The bone is in constant physiological remodelling to maintain structural integrity and mineral homeostasis. |
BOYCE et al. (2012) The osteoclast, bone remodelling and treatment of metabolic bone disease. https://doi.org/10.1111/j.1365-2362.2012.02717.x; RAGGATT et al. (2010) Cellular and molecular mechanisms of bone remodeling. |
Answer: Agree |
6. Bone loss in postmenopausal women is irreversible. |
Hormone replacement, proper nutrition and regular physical activities are able to maintain bone homeostasis. |
PASQUALINI et al. (2019) Effects of a 3-month weight-bearing and resistance exercise training on circulating osteogenic cells and bone formation markers in postmenopausal women with low bone mass. https://doi.org/10.1007/s00198-019-04908-9 |
Answer: Disagree |
7. In order for the orthodontic treatment to be successful in women, it is of the utmost importance that the orthodontist is aware of the hormonal effects during the various stages of female life. |
It is necessary that the health professionals gather knowledge about the systemic condition of their patients so that the best diagnosis and prognosis for each specific situation can be established. |
VILELLA et al. (2016) The Association of Oral Health Literacy and Oral Health Knowledge with Social Determinants in Pregnant Brazilian Women. https://doi.org/10.1007/s10900-016-0186-6 |
Answer: Agree |
8. A special orthodontic care protocol is required for pregnant, lactating and postmenopausal women. |
It is important that the care provided is in accordance with the need and systemic condition of each patient at their time to undergo treatment. That assistance takes place in an individualized, personalized, and integral way. |
GOVINDASAMY et al. (2018) Knowledge, awareness, and practice among gynecologists, medical practitioners and dentists in Madurai regarding association between periodontitis and pregnancy outcomes. https://doi.org/10.4103/jisp.jisp_164_18; LEE et al. (2010) Dentists’ perceptions of barriers to providing dental care to pregnant women. Womens Health Issues. https://doi.org/10.1016/j.whi.2010.05.007; STEWART et al. (2012) Building osteoporosis prevention into dental practice; VILELLA et al. (2016) The Association of Oral Health Literacy and Oral Health Knowledge with Social Determinants in Pregnant Brazilian Women. https://doi.org/10.1007/s10900-016-0186-6 |
Answer: Agree |
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