16 - IOTN and referral to specialist Flashcards
What is an orthodontic index?
Ideal requirements of an index
List 4 orthodontic indices
Index of treatment need (IOTN)
What are the 2 components?
Aesthetic component
Dental health componenet
IOTN ruler -
What is this?
Eg used to measure overjet to place into correct grad
Missing teeth / Spacing
What IOTN are the following:
Ectopic teeth / Impacted teeth
Spacing - congenital absence / traumatic loss
One missing tooth
More than one missing tooth
Need for referral?
Radiograph would be IOTN 5H- missing laterals and premolars therefore more than one missing tooth
Overjet
What is overjet?
How do we measure overjet?
How do we use overjet to identify need for treatment?
Referral?
6-9mm = IOTN 4a
Reverse overjet
What is this?
How do we measure this?
Referral?
Crossbites
How do we measure crossbites?
Contact point displacement / crowding
How do we measure this?
Measure the distance between the contact points as shown by the blue arrow either use ruler and measure mm OR use the regular and the area shown in blue
Deep overbite
What is an overbite?
How do we asses need?
Normally should be able to see middle third of lower incisors
Open bite
What is open bite?
How do we measure Need for treatment?
Who should be treated with NHS
AC = aesthetic component
Keep this in your practice so you know how to refer appropriately
Keep this in your practice so you know how to refer appropriately
Summary IOTN
Aesthetic component and dental component
Measure one trait - most severe - of malocclusion
MOCDO acronym
Summary of referral grades IOTN 4 and 5
List the 12 features of malocclusion that Would need to be referred including precise values
Extra - open bite at front = anterior open bite
Open bite at back = lateral open bite
OB = overbite
CLP = cleft lip palate
Referral pathway for GDP
What are the 5 questions when referring?
Who is eligible for NHS for orthodontic treatment?
When to refer a patient for assessment - when are most referred? What is the exception?
3 situations you avoid referral:
Where should you refer a patient for assessment?
Options for adults?
How do you make a referral?
5i
Impacted and Unerupted
Yes
Es are submerged
YES - to hospital as teeth need to be surgically removed
Class 2 profile with a retrusive mandible
Would measure distance between Point A and B - more than 2-3mm discrepancy suggest skeletal 2
Right pic - no as contact point displacement not greater than 4mm
Left pic - YES -> contact point displacement between UR1 and UR2 greater than 4mm
Closer inspection - missing teeth so need DPT to identify where the missing premolar is and if you identify there’s an impacted tooth then pt is a 5i rather than 4d
Sometimes just looking at patient is not enough to give IOTN and you need DPT
LEFT PIC
Reverse overjet - use ruler + if measurement is -3 then would qualify and ask pt secondary question of if they have speech or masticatory difficulty
This pt refer to hospital as quire severe class III malocclusion - most likely would benefit from orthonagthic treament
Right pic
Mild reverse overjet
Need to see if teeth can get edge to edge and if there’s a mandibular displacement
If the mandibular displacement is due to premature contact and greater than 2mm then would benefit from ortho treatment
Peer assessment rating index (PAR)
What is this used to assess?
Why?
Look at study models before and after
Score each feature of malocclusion to get cumulative score to work out difference between start and end
Peer assessment rating index (PAR)
How is it done
Standards
PAR - how to score
Assessing improvement PAR -what percentages suggest: greatly improved, improved, no difference/worse
Or can use nomogram
