Ortho Flashcards
My child’s top teeth seem to stick out more than their bottom teeth. What does that mean?
“That sounds like it could be a Class II molar relationship, where the upper jaw and teeth are positioned a bit forward. It’s often called an overbite. We’ll take a closer look to determine the severity and discuss possible treatment options
The dentist said my child has a Class I malocclusion, but their teeth still look a bit crooked. Why is that?
“A Class I malocclusion simply means the molars are in the ideal position. However, there can still be other issues like crowding, spacing, or rotations of individual teeth. We’ll monitor this and refer to an orthodontist if needed.”
What’s the difference between a Class II Division I and Division II?
“Both involve an overbite, but in Division I, the front teeth typically slant outwards, making the overbite more pronounced. In Division II, the front teeth tilt inwards, which can sometimes mask the overbite.”
I’m worried my child might have an underbite. How can you tell?
: “An underbite, or Class III relationship, is when the lower jaw is positioned forward. We’ll examine how your child’s top and bottom teeth fit together and assess their jaw alignment to determine if there’s an issue.” [cite: 102, 51]
- What causes a Class III malocclusion, and how is it treated?
“Several factors can contribute to a Class III malocclusion, including genetics, habits, and jaw growth patterns. Treatment often involves a combination of orthodontics and possibly even surgery in severe cases.”
My child’s baby molars seem to be positioned differently. Does that affect their adult teeth?
: “Yes, the position of baby molars can influence how the permanent molars erupt. We’ll keep an eye on their development and refer to an orthodontist if we see any potential concerns.”
What is a “flush terminal plane,” and is it a good thing?
A flush terminal plane means the back of your child’s upper and lower baby molars are aligned. It’s a good starting point, but it doesn’t always guarantee that the permanent molars will erupt perfectly. We’ll continue to monitor their bite.”
- What does it mean if my child has a “mesial step”? Should I be worried?
A mesial step means the lower baby molar is slightly ahead of the upper one. It could lead to a Class I or Class III molar relationship in the future. We’ll monitor this closely and refer to an orthodontist if necessary.”
- What can be done if my child has a “distal step”?
“A distal step means the lower baby molar is behind the upper one. This often leads to a Class II relationship (overbite). Early treatment options might include space maintainers or growth modification appliances.”
- I’ve heard that thumb-sucking can affect my child’s teeth. Is that true?
: Yes, it’s true. Prolonged thumb-sucking can cause the teeth to shift out of place and create an open bite, where the front teeth don’t meet. It can also affect the growth of the jaws.
- My child’s baby teeth are a bit crooked. Should I be worried?
: It’s normal for baby teeth to have some crowding. However, it’s still important to monitor them and address any concerns with an orthodontist. Early detection can prevent more serious issues later on.
- What is a crossbite, and how is it treated?
A crossbite is when the upper teeth fit inside the lower teeth, rather than outside. It can affect one or more teeth and may cause the jaw to shift. Treatment usually involves widening the upper jaw or aligning the teeth with braces.
- When should I take my child to the orthodontist for the first time?
The Australian Dental Association recommends that children first see an orthodontist around age 7. By this age, most children have a mix of baby and adult teeth, making it easier to detect potential problems.
- What are the signs that my child might need braces?
Some signs include crowded or crooked teeth, difficulty chewing or biting, thumb-sucking, mouth breathing, and teeth that don’t meet properly. If you notice any of these, it’s a good idea to consult with an orthodontist.
- How long does orthodontic treatment usually take?
Treatment time varies depending on the severity of the issue and the type of treatment used. On average, it can range from 12 to 36 months.
For each scenario, determine whether a referral to an orthodontist is necessary based on the NBMLHD Referral Guidelines. Provide an explanation to the parent as to why you would or would not refer.
1. Overjet
- Scenario A: A 9-year-old patient presents with an 8mm overjet.
- Scenario B: A 7-year-old patient presents with a 4mm overjet.
Answer:
- Scenario A: Refer “Your child’s overjet is quite significant, and we want to address it before it causes any problems with their bite or self-confidence. I’ll provide you with a referral to an excellent orthodontist.”
- Scenario B: Do not refer “Your child’s overjet is still within the normal range, so we’ll continue to monitor it at their regular checkups. No need to worry at this stage!”
Overbite
- Scenario A: A 10-year-old patient has an overbite that completely covers the lower incisors.
- Scenario B: An 8-year-old patient has an overbite with 30% coverage of the lower incisors.
Answer:
- Scenario A: Refer “Your child’s overbite is quite deep, and it could potentially lead to issues with their gums or jaw joint. It’s best to have an orthodontist evaluate it and discuss treatment options.”
- Scenario B: Do not refer “Your child’s overbite is within the normal range for their age. We’ll keep an eye on it as they grow, but there’s no need for a referral at this time.”
3. Crowding
- Scenario A: Crowding of 10mm per arch is observed in a 12-year-old patient.
- Scenario B: A 6-year-old patient presents with 3mm crowding per arch.
Answer:
- Scenario A: Refer “Your child’s teeth are quite crowded, which can make it difficult to keep them clean and increase the risk of decay. An orthodontist can help create more space and straighten their teeth.”
- Scenario B: Do not refer “It’s normal for young children to have some crowding as their permanent teeth come in. We’ll monitor it closely, but it’s unlikely to need treatment at this stage.”
Crossbite
- Scenario A: An 11-year-old patient has an anterior crossbite with noticeable enamel loss.
- Scenario B: A 9-year-old patient has a posterior crossbite of 1-2 teeth with no functional shift.
Answer:
- Scenario A: Refer “I’ve noticed some wear on your child’s teeth due to their crossbite. It’s important to correct this to prevent further damage and ensure proper jaw development. I’ll refer you to an orthodontist.”
- Scenario B: Do not refer “Your child’s crossbite is minor and doesn’t seem to be affecting their bite or jaw function. We’ll continue to monitor it, but it’s unlikely to need treatment at this point.”
Reverse Overjet
- Scenario A: An 8-year-old patient presents with a reverse overjet and an edge-to-edge bite.
Scenario A: Refer for opinion “Your child’s bite is a bit unusual, with their lower teeth sitting in front of their upper teeth. It’s best to have an orthodontist evaluate this and advise on the best course of action.”
Hypodontia
- Scenario A: A 10-year-old patient is missing multiple teeth, requiring significant orthodontic intervention.
- Scenario B: A 7-year-old patient is missing one tooth with minor orthodontic implications.
Answer:
- Scenario A: Refer “Because your child is missing several teeth, it could affect the alignment of their other teeth and their bite. An orthodontist can discuss options for replacing the missing teeth and ensuring proper oral development.”
- Scenario B: Refer for opinion “While your child is only missing one tooth, it’s still a good idea to have an orthodontist assess the situation. They can advise on whether any intervention is needed to prevent future problems.”
Open Bite
- Scenario A: A 12-year-old patient presents with a 5mm anterior open bite.
- Scenario B: An 8-year-old patient has a 1mm posterior open bite.
Answer:
- Scenario A: Refer “Your child’s front teeth aren’t meeting when they bite down, which can affect their chewing and speech. An orthodontist can help correct this with appropriate treatment.”
- Scenario B: Do not refer “Your child has a very small open bite, which is unlikely to cause any problems. We’ll monitor it at their checkups, but there’s no need for a referral at this stage.”’
dx ranges for OJ, ROJ, OB, Crowding
dx ranges for CB, OP, other
let’s talk about your overjet – the horizontal overlap of your upper front teeth.”
Diagnosis (Choose ONE):
Severe (>7mm): “Your overjet is [Measurement]mm, which is significant. This can sometimes cause [briefly mention potential issues]. You’re eligible for treatment, which we’ll discuss.”
Moderate (5-7mm): “Your overjet is [Measurement]mm. We recommend a specialist orthodontic opinion to determine the best approach.”
Mild (<5mm): “Your overjet is [Measurement]mm, which is normal. No treatment is usually needed, but we’ll monitor it.”
t’s a common misconception to equate “more than 9mm of crowding” directly with needing 9mm of additional space. Let’s clarify:
Crowding means the teeth don’t fit properly in the available space. It’s a lack of space, not a need for more.
9mm of crowding (or any specific measurement) represents the discrepancy between the space available and the space required by the teeth. It’s how much the teeth are “off” from ideal alignment.
Think of it like this:
Imagine you have a bookshelf that’s 100cm wide. You have books that, when placed neatly, require 109cm of space.
You have a 9cm discrepancy (109cm needed - 100cm available = 9cm).
This 9cm represents the crowding. The books are overlapping, leaning, or sticking out.
You don’t need 9cm of additional shelf space. You need 9cm of existing shelf space to be rearranged so the books fit. Or, you might need to get rid of some books (extract teeth in the dental analogy).
In the dental context:
9mm of crowding means the teeth are overlapping, rotated, or out of position because there’s a 9mm deficit in space.
It doesn’t mean you need to magically add 9mm to the jawbone.
Treatment aims to redistribute the available space (e.g., through expansion, reshaping teeth, or removing teeth) so the teeth fit properly.
Why 9mm is often considered significant:
A discrepancy of 9mm is often enough to cause noticeable crowding and potentially affect function, aesthetics, and long-term oral health. It often suggests a more complex treatment plan may be needed.
Key takeaway: Crowding is about a lack of space, and the measurement (like 9mm) reflects the degree of that lack, not a need for additional space to be created.
