Clinical examination Flashcards
List the four components of the clinical exam
- Interview ( C/C, Hx and motivation)
- Extraoral examination (frontal, profile and anterior aesthetics)
- Intraoral examination
- Screening
List the three steps that are followed during the interview process
- Patient’s chief concern is taken
- History is collected
- Sources of motivation are analysed
Explain the step of “patient’s chief concern” during the interview process
We tend to focus on teeth/ misalignments, but the C/C can be more than that e.g. getting rid of a gummy smile
Explain the step of “history collection” during the interview process (5)
- FHx: Some races have different facial forms, sometimes FHx of orthodontic problems can be a factor
- DHx: Mouth breathing, early loss of deciduous teeth, habits, inherited patterns
- MHx: Gingival health, bone turnover, allergies (metal/ latex), trauma to condyles/ teeth, puberty and growth: for girls, menstruation mark the end of growth.
- Medications can induce xerostomia, gingival enlargement, slow or speed bone turnover.
- Mode of respiration: Nasal, mouth or mixed (obstructive sleep apnoea)
Explain the step of “analysing sources of motivation” during the interview process
Do they have internal motivation, or external, or mixed? (to get the things required done)
List the three components of the extra oral exam
- Frontal exam (height and width of face, facial thirds, facial symmetry, alar base and lip competency)
- Profile (convexity, concavity, nose size and nasolabial angle, mandibular plane angle, e- line, labiomental fold, malar base and soft tissue pogonion)
- Anterior aesthetics (smile arc, buccal corridor, incisor and gingival display and dental midline)
Frontal exam: Explain the examination of height and width by defining the following: - Brachyfacial - Mesofacial - Dolichofacial
- Brachyfacial: wide face (cheek to cheek)
- Mesofacial: proportionate (height and width of face is equal
- Dolichofacial: long face (forehead to chin)
Frontal exam: Explain the examination of facial thirds by defining the boundaries of: - Upper 1/3 - Middle 2/3 - Lower 1/3
- The hairline to the eyebrows = upper 1/3
- Eyebrows to bottom of nose = middle 2/3
- Bottom of nose to chin = lower 1/3
Frontal exam:
Explain the examination of facial symmetry by stating which boundaries determine symmetry
- Symmetry is marked by the mid sagittal plane and the pupillary line (goes through the eyes)
- At times, there can be a deviation of the nose or the chin
Note: A small degree of bilateral facial ASYMMETRY exists in all normal individuals
Frontal exam:
Define the “alar base”
The width between the beginning of the nostril to the end of the nostril
Frontal exam:
Define “lip competency” and what constitutes “incompetence”
Definition:
• Ability to close lips at rest
Incompetence:
• More than 3-4 mm apart at rest
• When brought together excessive circumoral muscle activity is needed (strained)
Profile exam:
Define profile convexity (what it is characteristic of) and how it is measured
Characteristic of:
• An overbite
How it is measured:
• Measured from lower border of nose down to the most forward part of chin
• Lips fall ahead of the chin
Profile exam:
Define profile concavity (what it is characteristic of) and how it is measured
Characteristic of:
• An underbite
How it is measured:
• Measured from lower border of nose down to the most forward part of chin
• Upper lips falls behind the chin
Profile exam:
State what the nasolabial angle is
Nasolabial angle
• The angle measured from the tip of the nose makes down to the upper lip
Profile exam:
State what the mandibular plane angle is
• Measured from corner of mandible to the chin (jaw bone)
Profile exam:
State what the e- line is
- Imaginaryline, drawn from the tip of the nose to the tip of the chin in profile
- The lips try to fall into this line (or just behind) where possible
Profile exam:
State what the labiomental fold is
- How deep the chin under the lower lip is
* Can be normal, deep or shallow (almost no dip)
Profile exam:
State what the malar base is
- Refers to the prominence of the zygomatic bone in the side profile
- Can be protrusive or retrusive
Profile exam:
State what soft tissue pogonion is
- The most anterior point on the contour of the chin (pointy chin!)
- In cases of underbites, this can be very prominent
Anterior aesthetics:
Define the smile arcs and list the three types
Definition:
• The line the maxillary anterior’s incisal edges make in relation to the curvature of the bottom lip when smiling
Three types:
• Flat
• Reverse (upside down u)
• Consonant
Anterior aesthetics:
Define the buccal corridor
- The visual separation between the cheeks and the buccal surfaces of the posterior teeth, seen when a person smiles
- Some people might have a very slight one, while others would have an increased buccal corridor
Anterior aesthetics:
Define incisal and gingival display
- How much the incisors and gums are shown at rest and during a smile
- Can be enhanced by a gummy smile
Anterior aesthetics:
Define the dental midline
• The maxillary and mandibular midlines should be within the mid- sagittal plane of the face
List the three things that are examined at the “screening” stage
- Periodontal and gingival screening
- Functional assessment
- Sleep disordered breathing
Describe what is monitored during the periodontal and gingival screening and when referrals take place
- Monitors plaque control, periodontal probing and radiographs before, during and after orthodontic treatment
- Referral to specialists in case of bone loss or pathological pockets
Explain what is looked at during the functional assessment stage
• Checks for TMJ abnormalities, whether there is incisive or canine guidance, parafunctional habits
List the two types of sleep disordered tests, who they are used for and when referral to a specialist is required for the two tests
Conduct one of the following:
• Brunni Questionnaire: children under 12:
• If the sum for Questions 13-14-15 > 7, REFER
- Ephworth sleepiness scale: above 12 and adults:
- If the total sum is > 9 REFER
• Refer to Sleep Specialist and/or ENT Specialist
