16 - IOTN and referral to specialist

Question 1

Question 2

What is an orthodontic index?

Answer 2

Question 3

Ideal requirements of an index

Answer 3

Question 4

List 4 orthodontic indices

Answer 4

Question 5

Index of treatment need (IOTN)

What are the 2 components?

Answer 5

Question 6

Aesthetic component

Answer 6

Question 7

Dental health componenet

Answer 7

Question 8

IOTN ruler -

What is this?

Answer 8

Eg used to measure overjet to place into correct grad

Question 9

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?

Answer 9

Radiograph would be IOTN 5H- missing laterals and premolars therefore more than one missing tooth

Question 10

Overjet

What is overjet?
How do we measure overjet?
How do we use overjet to identify need for treatment?
Referral?

Answer 10

6-9mm = IOTN 4a

Question 11

Reverse overjet

What is this?
How do we measure this?
Referral?

Answer 11

Question 12

Crossbites

How do we measure crossbites?

Answer 12

Question 13

Contact point displacement / crowding

How do we measure this?

Answer 13

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

Question 14

Deep overbite

What is an overbite?
How do we asses need?

Answer 14

Normally should be able to see middle third of lower incisors

Question 15

Open bite

What is open bite?
How do we measure Need for treatment?

Answer 15

Question 16

Who should be treated with NHS

Answer 16

AC = aesthetic component

Question 17

Keep this in your practice so you know how to refer appropriately

Question 18

Keep this in your practice so you know how to refer appropriately

Question 19

Summary IOTN

Answer 19

Aesthetic component and dental component
Measure one trait - most severe - of malocclusion

MOCDO acronym

Question 20

Summary of referral grades IOTN 4 and 5

List the 12 features of malocclusion that Would need to be referred including precise values

Answer 20

Extra - open bite at front = anterior open bite
Open bite at back = lateral open bite

OB = overbite
CLP = cleft lip palate

Question 21

Referral pathway for GDP

What are the 5 questions when referring?

Answer 21

Question 22

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:

Answer 22

Question 23

Where should you refer a patient for assessment?

Options for adults?

How do you make a referral?

Answer 23

Question 24

Answer 24

5i
Impacted and Unerupted

Yes

Question 25

Answer 25

Es are submerged YES - to hospital as teeth need to be surgically removed

Question 26

Answer 26

Class 2 profile with a retrusive mandible Would measure distance between Point A and B - more than 2-3mm discrepancy suggest skeletal 2

Question 27

Answer 27

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

Question 28

Answer 28

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

Question 29

Peer assessment rating index (PAR) What is this used to assess? Why?

Answer 29

Look at **study models** before and after Score each feature of malocclusion to get cumulative score to work out difference between start and end

Question 30

Peer assessment rating index (PAR) How is it done Standards

Answer 30

Question 31

PAR - how to score

Answer 31

Question 32

Assessing improvement PAR -what percentages suggest: greatly improved, improved, no difference/worse

Answer 32

Or can use nomogram

Question 33