Ortho Level 4 unit D Flashcards
How should patients be examined?
First evaluate the face carefully for symmetry.
Then evaluate the vertical proportions of the face.
Then evaluate the lateral view of the face.
Then examine occlusion and alignment of teeth in 3 planes: Transverse, A-P, and vertical
What should be considered before referring patients to an orthodontist?
What types of problems warrant referral?
When should the child be referred?
How should patients be triaged?
1) Evaluate facial proportions and symmetry for a craniofacial syndrome. Refer to team that deals with syndrome or asymmetry asymmetry should be referred
2) Examine facial profile. A-P skeletal class II/III or vertical jaw discrepancy (short/long face). Ceph analysis and probably growth guidance are indicated. Refer to ortho
3) Examine the dentition and dental (panoramic) radiographs for signs of abnormal development. Refer cases where supernumerary teeth are in complicated positions and multiple supernumerary teeth are present. In cases where not so complicated and can be extracted easily no need for referral.
4) Space analysis. In cases of normal dental development and jaw relationships. Small amounts of space regaining is fine, large space discrepancy should be referred because it requires comprehensive treatment.
What can make it hard to detect asymmetries?
Jaw deviation from initial contact of teeth to full occlusion.
Often children with asymmetry tilt their head to compensate for it.
What problem can supernumerary teeth cause?
Congenitally missing permanent teeth and failure of eruption of multiple teeth, which fortunately is rare, are severe problems. because surgical removal can be complex, and multiple teeth may have to be repositioned after the supernumeraries are removed.
What are the explicit guidelines on who should be referred?
1) Children with skeletal problems in general, and those with facial asymmetry problems in particular, are candidates for referral.
2) The more severe the crowding and protrusion, the greater the chance that referral to a specialist will be good judgment.
At what age should you refer?
Class II + vertical skeletal problems during adolescent growth spurt. (By the beginning of adolescence)
Class I crowding: End of the mixed dentition beginning as the second primary molars are ready to exfoliate. Don’t wait until second primary molars exfoliate.
What types of patients should be referred in the early mixed dentition, well before the beginning of adolescence?
In general, those for whom there are special concerns:
Psychologic difficulties from being teased at school, as children with protruding teeth often are (most but not all are able to cope with this during preadolescent years)
Trauma to the teeth or soft tissues (image 1)
Skeletal Class III problems
A particular indication for early referral is a Class III problem due to deficient growth of the maxilla. A child with obvious maxillary deficiency, like the boy shown in image 2, should be referred at age 6 or 7 if possible, because the window of opportunity to change growth of the upper jaw without surgery begins to close at about age 8.
In general also, treatment for children who have both vertical and a-p jaw discrepancies (the short face Class II child, for instance) may be more effective if it starts prior to adolescence.
How should a referral be managed? What needs to happen for a referral?
The style of referral will vary depending on that personal relationships, but three things need to happen:
A discussion with the parents as to why and to whom you are making the referral
Communication with the orthodontist in advance, so that any pertinent records from your office are available when the orthodontist sees the child
Feedback from the orthodontist to you as to what he or she is recommending, and why
What would the orthodontist like to know from me prior to seeing a child i have referred?
Whether there are special problems with this child/family (including the social setting)
Whether there have been any problems with other dental treatment, especially problems that might affect future orthodontic treatment
Whether you have taken radiographs recently that would be useful during the orthodontic evaluation. If so, of course, copies of those radiographs are needed and should be sent in advance if possible.
What radiographs would be useful for orthodontic treatment?
An OPG recent and previous.
PA radiographs that are availabel (eruption problems/pathology)
Send copies of radiographs in advance if possible.
What should you expect as feedback from the initial visits to the orthodontist?
A report of the findings from the patient’s evaluation and the recommendations for treatment or recall in the specialty practice. This typically goes to both the referring dentist and the parents.
Suggestions for related treatment that you should perform (for example, the removal of primary teeth, placement of a lingual arch to maintain space, etc.).
Copies of radiographs made as part of the orthodontic evaluation that would be useful in your practice (for example, the panoramic radiograph that would be needed if primary teeth are to be removed early).
How is communication commonly done now between dentist and orthodontist?
Increasingly, instead of a formal letter, communication is in the form of an e-mail message with images attached (images 3 and 4)—which has the advantage of getting the information from one office to another instantly and provides it in digital form that makes it easy to add both text and images to a digital chart.
What Does the Orthodontist Expect from You?
Regular recalls in your office to monitor the patient’s health status
Treatment as needed for any non-orthodontic problems (for instance, placement of sealants in deep occlusal grooves of second molars as they erupt)
Communication about who is to do what. For example, if a fluoride rinse or chlorhexidine application to control decalcification is needed, there should be no doubt about who is providing it and supervising its effectiveness.
How is treatment coordinated between dentist and orthodontist?
1) Control of caries and decalcification
2) Timing and Management of Necessary Tooth Extractions
3) Retainers and Restorations
How can ortho and dentist control caries/decalcification?
Orthodontist tells children and parents to keep teeth really clean.
Topical fluoride application by dentist/paediatric dentist. Extraction of retained primary teeth often is required, and the family practitioner or pediatric dentist should expect to be asked to do this for many child patients.
