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BDS3 - Orthodontics > orthodontic assessment > Flashcards

orthodontic assessment Flashcards

1
Q

what needs to be gathered during history taking process

A
  • patients complaint
  • medical history
  • dental history
  • habit
  • physical growth status
  • patients motivation
  • socio-behavioural factors
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2
Q

what are the two types fo problems

A
  • pathological = relating to disease

- developmental = related to malocclusion

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3
Q

what medical conditions can affect ortho

A
  • epilepsy
  • latex allergy
  • nickel allergy
  • diabetes
  • heart defects with a risk of IE
  • bleeding disorder
  • asthma
  • learning difficulties
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4
Q

how can epilepsy affect ortho

A
  • needs to be under control before starting treatment
  • extra-oral headgear may present an unacceptably high risk
  • stress may induce seizure
  • antiseptic phenytoin may cause gingival hyperplasia
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5
Q

how can latex allergy affect rotho

A
  • need to use alternative products and gloves
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6
Q

how can nickel allergy affect ortho

A
  • intra-oral reactions are very rare
  • use plastic coated headgear to avoid contact with skin
  • if intra-oral allergy is confirmed, then use nickel free products
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7
Q

how can diabetes affect ortho

A
  • patient may be more prone to intra-oral infections and periodontal problems
  • be aware of risk of hypoglycaemia
  • treatment should be avoided if poorly controlled diabetes
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8
Q

how can heart defects affect ortho

A
  • AB cover used to be prescribed routinely but not anymore

- clinician should refer to patients doctor and cardiologist

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9
Q

how does bleeding disorders affect ortho

A
  • precautions should be taken
  • generally doesnt affect orhto
  • avoiding trauma to soft tissues is important
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10
Q

how does asthma affect ortho

A
  • steroidal inhalers mey predispose to candida infections so need to have excellent OH
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11
Q

how does Bisphosphonates affect ortho

A
  • predispose to osteonecrosis and affect bone turnover

- patients physician should be contacted

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12
Q

what does dental history tell us

A
  • previous dental experiences
  • gives an idea of their attitudes/compliance
  • need to know nay on-going dental problems
  • also need to know history of problems
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13
Q

what do we need to know about habits

A
  • patient should be asked about digit sucking
  • need to know duration of habits
  • nail biting can also predispose to an increased root resorption
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14
Q

what 3 dimensions must you clinically examine the face

A
  • anteroposteriorly (AP)
  • vertically
  • transversely
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15
Q

what do you examine in AP

A
  • extra oral = maxilla to mandible - Class I, II or III

- intra-oral = incisor classification, overjet, canine relationship, molar relationship, anterior cross bite

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16
Q

what do you examine in vertical

A
  • extra oral = facial thirds, angle of lower border of mandible to maxilla
  • intra oral = overbite, anterior open bite, or lateral open bite
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17
Q

what do you examine in transverse

A
  • extra oral = facial asymmetry

- intra oral = centre lines, posterior cross bite

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18
Q

what views does patient need to be examined in

A
  • frontal view = to assess vertical and transverse planes

- profile view = to assess vertical and AP planes

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19
Q

how is the AP assessment done

A
  • assess relationship between maxilla and mandible to each other and cranial base
  • assess relationship of lips to vertical line known as zero mediation
  • palpate intra-oral anterior portion of maxilla and mandible
  • assess convexity of the face by determining the angle between the middle and lower thirds of the face in profile
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20
Q

how is the vertical assessment done

A
  • in 2 ways = measuring angle of lower border of mandible to maxilla OR using rule of thirds
  • thirds = face split into thirds and any discrepancy in the thirds can suggest a facial disharmony
  • angle = place a finger on lower border of mandible to give an idea of the angle
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21
Q

how is the transverse assessment done

A
  • examined from frontal view but also looking down on face
  • any significant asymmetry should be noted
  • the soft tissue nasion, middle part of upper lip at vermilion border, and the chin should all be aligned
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22
Q

what would a normal smile look like

A
  • whole height of upper incisors should be visible with only interproximal gingiva shown
  • smile line 1-2mm higher in females
  • upper incisors edges parallel to lower lip
  • margins of central incisors and canines should be level
  • width of smile should be such that buccal corridors are seen
  • symmetrical dental arrangement
  • upper dental midline should coincide with midline of face
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23
Q

what do you need to assess about lips

A
  • are they competent, potentially competent, or incompetent

- nasolabial angle

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24
Q

what is competent, potentially competent and incompetent lips

A
  • competent = meet together at rest
  • potentially competent = position of incisors prevents comfortable lip seal to be obtained at rest, but patients can hold lips together if need be
  • incompetent = require considerably muscular activity to obtain lip seal
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25
Q

what should the nasolabial angle be

A
  • between 90-110 degrees
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26
Q

what needs to be assessed of the tongue

A
  • determine how patients create an anterior seal during swallowing and tongue at rest
  • in patients with incompetent lips, tongue can thrust forward to create an anterior seal = can be fixed by treatment, unless endogenous
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27
Q

what does the intra-oral assessment allow assessment of

A
  • stage of dental development
  • soft tissues and periodontist for pathology
  • oral hygiene
  • overall dental health, including identifying any caries and restorations
  • tooth position within each arch and between arches
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28
Q

what do we need to detect when assessing oral heath

A
  • caries, hypomineralisation, non-vital teeth, tooth wear, teeth of abnormal shape or size, existing restorations which may change the way we can bond to teeth
  • pathology needs to be treated and stabilised before we can start ortho
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29
Q

what is assessed in each dental arch

A
  • crowding
  • alignment of teeth = displacement and rotation
  • inclination of labial segment
  • angulation of canines
  • arch shape and symmetry
  • depth of curve of Spee
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30
Q

what is assessed when arches are in occlusion

A
  • incisor relationship and buccal relationship
  • incisor classification
  • overjet
  • overbite
  • centrelines
  • canine relationship
  • molar relationship
  • cross bite
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31
Q

how is the overjet measured

A
  • measured from labial surface of most prominent incisors to labial surface of mandibular incisor
  • normally is 2-4mm
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32
Q

what are the different levels of crowding

A
  • 0-4mm = mild
  • 4-8mm = moderate
  • > 8mm = severe
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33
Q

how is the overbite measured

A
  • measures how much the maxillary incisors overlap the mandibular incisors
  • 3 features to note = amount of overlap, whether the lower teeth are in contact with the opposing teeth or soft tissues (complete) or if they are not touching anything (incomplete)
  • normal = 1/3 coverage of crown of lower incisor
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34
Q

what is it called if there is no overlap at all between upper incisor and lower

A
  • anterior open bite
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35
Q

what is a crossbite

A
  • discrepancy in the buccolingual relationship of the upper and lower teeth
  • can be anterior or posterior
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36
Q

what is a buccal crossbite

A
  • buccal cusps of the lower teeth occlude buccal to the buccal cusps of the upper teeth
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37
Q

what is a lingual crossbite (scissor bite)

A
  • the buccal cusps of the lower teeth occlude lingual to the lingual cusps of the upper teeth
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38
Q

what happens if there is a displacement of the mandible on closure of the mouth

A
  • caused be premature contact
  • cause mandible to be positioned further anteriorly, or to the left or right to get intercuspation
  • as a result of this there will eb a difference between RCP and ICP
  • in this case, ortho treatment should be based on RCP as this is the position the jaw will return to
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39
Q

what are the extra-oral photograph views taken

A
  • full facial frontal at rest
  • full facial frontal smiling
  • facial 3/4 view
  • facial profile
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40
Q

what are the intra-oral photographs views taken

A
  • frontal occlusion
  • buccal occlusion = left and right
  • occlusal views of upper and lower arch
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41
Q

what radiographs are taken

A
  • DPt
  • cephalometric
  • upper standard occlusal radiograph
  • periapical
  • bitewing
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42
Q

what can radiographs provide information on

A
  • presence or absence of teeth
  • stage of development of permanent dentition
  • root morphology of teeth
  • presence of ectopic or supernumerary teeth
  • presence of disease
  • relationship of the teeth to skeletal dental bases and cranial base
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43
Q

why do we take DPT

A
  • good for presence, position and morphology of unerupted teeth
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44
Q

why do we take upper occlusal radiographs

A
  • view of maxillary incisor region

- assess root form of incisors, detect presence of supernumerary teeth, and located ectopic canine teeth

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45
Q

why do we take periapical radiographs

A
  • assess root form and local pathology
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46
Q

why do we take biting radiographs

A
  • assess caries and condition of restorations
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47
Q

what is a CBCT used

A
  • accurate location of impacted teeth and more accurate assessment of any pathology
  • assess alveolar bone coverage
  • cleft palate
  • assess alveolar bone height and volume
  • TMJ or airway analysis
  • planning of some complex combined ortho and orthognathic surgery cases
  • only use when conventional radiography has failed
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48
Q

why do we take an orthodontic assessment

A
  • to determine if there are any malocclusions present
  • identify any underlying causes
  • decide if treatment is indicated
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49
Q

when do we carry out an orthodontic assessment

A
  • brief examination often at age 9 = mixed dentition
  • comprehensive examination when premolars and canines erupt = age 11-12 but can vary a lot
  • interoceptive orthodontics
  • when older patients first present
  • if a malocclusion develops later in life = periodontal disease can affect malocclusion
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50
Q

what is the ideal occlusion defined by

A
  • gold standard by which occlusal irregularities may be judged off
  • based on Andrews 6 keys
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51
Q

what are Andrews 6 keys

A
  • 1 = molar relationship (distal surface of the disto-buccal cusp of the upper 1st permanent molar occludes with the mesial surface of mesio-buccal cusp of lower 2nd permanent molar
  • 2= crown angulation = mesio-distal tip
  • 3 = crown inclination = tip of teeth
  • 4= no rotations
  • 5 = no spaces
  • 6= flat occlusal plane (no curve of Spee
52
Q

what is not part of Andrew’s keys but is still important

A
  • if patient has a small lateral incisor, then all teeth have to be that little bit further forward
53
Q

what are minor deviations to normal occlusion

A
  • things that do not constitue an aesthetic or functional problem
54
Q

what are malocclusion

A
  • more significant deviations from the ideal that may be considered unsatisfactory
  • can be aesthetically or functionally
  • may require treatment
  • whole spectrum
55
Q

what in history of presenting complaint could indicate pathology

A
  • if something has changed rapidly
56
Q

what conditions are a contraindication to ortho

A
  • allergy to nickel or latex
  • epilepsy/drugs = if poorly controlled then don’t want to give patient removable appliance
  • drugs
  • imaging = delay treatment until these are completed
57
Q

why does the patient need to be comfortable coming to the dentist

A
  • lots of appointments

- long process

58
Q

how can previous treatment influence ortho

A
  • if patient has a heavily restored dentition, then this could indicate that they are not a good candidate for ortho
59
Q

what needs to be considered within social history

A
  • travelling distance/time
  • car owner/public transport
  • parents work
  • school exams = try work around these are ortho can be uncomfortable
60
Q

what habits can affect tooth position and how

A
  • thumb sucking = procline upper teeth
  • lower lip sucking = procline upper teeth
  • tongue thrust = afffect tooth position
  • chewing fingernails = can cause root resorption
61
Q

why must you carefully consider ortho for patients with small roots

A
  • it can lead to further resorption
62
Q

what must you compare the patient to the parent for

A
  • malocclusion

- growth potential = especially in class III malocclusions

63
Q

why must you consider the dente-skeletal relationships

A
  • teeth are on individual skeletal bases
  • mandible is on posterior cranial base
  • if the mandible is further back, then it increases the tendency for an overjet
64
Q

what position does the patients head need to be for an AP assessment

A
  • Frankfurt plane need to be horizontal parallel to the floor
  • top of the ear to the base of the orbit needs to be parallel to the floor
65
Q

how do we assess the AP relationship

A
  • visual assessment = test anterior innermost curvature of the upper lip to give maxillary position, against the innermost curvature of the lower lip for mandibular position
  • palpate skeletal bases
66
Q

what is class I AP relationship

A
  • maxilla is 2-3mm in front of mandible

- this is normal

67
Q

what is class II AP relationship

A
  • maxilla more than 3mm in front of mandible
  • mandible is positioned further back in the skull
  • retrognathic
  • need to bring mandible forwards
68
Q

what is class III AP relationship

A
  • mandible in front of maxilla

- can have a reverse overjet

69
Q

what do we look at in the vertical assessment

A
  • Frankfort Mandibular Plane Angles (FMPA)

- top of ear to point at the base of the orbit compared with eh mandibular place

70
Q

what is the normal FMPA

A
  • lines meet at the back of the head
71
Q

what is an increased FMPA

A
  • lines meet well before the back of the head
  • high angle
  • expect minimal overbite or anterior open bite with no contact at the front teeth as posterior are meeting first
72
Q

what is a reduced FMPA

A
  • lines don’t meet at the back of the he’d

- expect them to have a deep bite

73
Q

how is the lateral assessment done

A
  • mid-sagittal reference line
  • everyone is slightly asymmetrical
  • normall cupids bow is in th midline
  • tip of the nose should be ignored
  • compare where chin point is to that line
  • if you think there is asymmetry look down on patient from above as well
  • good for determining mandibular asymmetry but not maxillary
74
Q

what are competent lips

A
  • lips that meet at rest when there is a relaxed mentalis muscle
75
Q

what are incompetent lips

A
  • lips that do not meet at rest when there is a relaxed mentalis muscle
  • can influence tooth position
  • can get a lip trap
76
Q

what is a lip trap

A
  • may procline upper incisors
  • may lead to relapse of an overjet if persists at the end of treatment
  • has a significant effect on upper teeth
  • when a patient swallow, can still see the upper teeth as the lower lips are behind
  • important to get competent lips at the end of treatment
77
Q

what can lower lip activity cause

A
  • hyperactive lower lip may retrocline lower incisors
  • indicates likely instability at the end of treatment
  • quite rare
  • any attempt to push lower incisors forward will relapse again
78
Q

what can tongue thrust on swallowing be associated with

A
  • anterior open bite
79
Q

what is the normal mechanisms for swallowing

A
  • tongue goes up and back and pushes the bolus to the back of the mouth, then the pharyngeal muscles take over automatically
80
Q

why are we born with an anterior swallow

A
  • because we have no teeth

- but once we have teeth 99.5% of people adapt to push tongue back instead of forward

81
Q

what is the difference between an endogenous and an adaptive tongue thrust

A
  • adaptive = possible to close AOB with treatment and tongue will go back to how it should be
  • endogenous = it will relapse again
  • some people say a lisp is a sign of an endogenous tongue thrust
82
Q

what are the two ways of digit sucking

A
  • thumb sucking = cause asymmetrical problems depending on which side
  • two fingers = cause symmetrical problems
83
Q

what are the occlusal features of a sucking habit

A
  • proclination of upper anteriors
  • retroclination of lower anteriors
  • localised AOB or incomplete OB
  • narrow upper arch +/- unilateral posterior crossbite
84
Q

how does thumb sucking cause narrow upper arch

A
  • because thumb is there, their tongue is much lower and the cheeks are being pushed inwards which pushes molar teeth in
  • upper teeth become narrower
  • patient bites togethers and teeth contact cusp to cusp
  • but then the teeth will move to get intercuspation
  • and this results in a unilateral posterior cross bite
85
Q

can ortho help speech

A
  • no

- need to tell patient this from the start

86
Q

can ortho cause or treat TMJ problems

A
  • no
87
Q

what is mandibular displacement

A
  • when patent comes together in RCP there is movement either left or right or forward to get teeth in ICP
  • 1mm or so is not a problem
  • 2-4mm is ok
  • > 4mm is a problem
  • the more displacement there is in a crossbite, the more urgency there is to treat it to prevent TMJ problems
  • RCP≠ICP
88
Q

what do we need to look at intra-orally in our assessment

A
  • oral hygiene and periodontal health
  • count the teeth - from the back
  • teeth or poor prognosis
  • assess crowding/spacing/rotations
  • inclination/ angulation
  • palpate for canines if not erupted and patient is 10
  • note teeth of abnormal shape/size
89
Q

what is the instance of hypodontia

A
  • 3-4%
90
Q

what is the instance of supernumerary teeth

A

1-2%

91
Q

what is the instance of ecoptic canines

A

1-2%

92
Q

what is the instance of impacted first permanent molars

A
  • 3.5-6.5%
93
Q

why do patients need food OH for ortho

A
  • can get a lot of decalcification around the brackets

- a lot of patients will not get ortho if the risks outweigh the benefits

94
Q

what can the degree of crowding b

A
  • uncrowded, mild, moderate or severe

- if severe, then think about extractions

95
Q

why might you want to extract rotated teeth

A
  • because once you remove the appliance, they will just rotate again
96
Q

how can canines be inclined

A
  • mesial, upright or distal

- if canines are tipped forward it is easy to tip back, but if they are tipped back it is difficult to tip forward

97
Q

how can incisors be angled to the mandibular plane

A
  • upright, proclined, retroclined
  • assess angle alone
  • looking for 90 degrees
98
Q

in the upper arch, how do we assess angulation of incisors

A
  • assess them in relation to the Frankfort plane

- ideally about 110 degrees

99
Q

what is class I incisor relationship

A
  • normal overjet, normal overbite

- lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors

100
Q

how many division of class II incisors relationship are there

A
  • 2
101
Q

what is class II division 1 incisor relationship

A
  • the lower incisor edges lie posterior to the cingulum plateau of the upper incisors
  • dominant features is an increased overjet, front teeth beyond lower
  • upper incisors are proclaimed or of average inclination and there is an increase in overjet
102
Q

what is class II division 2 incisors relationship

A
  • the lower incisor edges lie posterior to the cingulum plateau of the upper incisors
  • central incisors are retroclined
  • overjet is usually minimal of may be increased
103
Q

what is class III incisor relationship

A
  • usually, lower teeth occlude anterior to upper teeth, but can get class 3 just on the edge
  • the lower incisors edges lie anterior to the cingulum plateau of the upper incisors, over is reduced or reversed
104
Q

what is overjet

A
  • the distance between the upper and lower incisors

- measure the biggest

105
Q

how is an overbite measured

A
  • to do with the overlap of the teeth
  • average or normal = upper overlap half to 1/3 of crown of lower incisors
  • if less = reduced
  • if no overlap = anterior open bite
  • if increased = can be contacting tooth or palate, can be complete or incomplete
106
Q

what is another name for the molar relationship classification

A
  • Angle’s classification

- buccal segment relationship

107
Q

what is class I molar relationship

A
  • mesiobuccal cusp of upper 6 occludes with buccal groove of lower 6
  • normal
108
Q

what is class II molar relationship

A
  • mesiobuccal cusp of the upper 6 occludes in front of the buccal groove of lower 6
  • occludes between lower 5 and 6
109
Q

what is class III molar relationship

A
  • mesiobuccal cusp of the upper 6 occludes behind the buccal groove of the lower 6
  • between 6 and 7
110
Q

what is class I canine relationship

A
  • upper canine distal to lower
111
Q

what is class II canine relationship

A
  • anterior to lower canine
112
Q

what is class III canine relationship

A
  • behind lower canine
113
Q

what is the key thing to look for when looking for crossbite

A
  • displacement
114
Q

how are centra lines assessed

A
  • midline of the face

- looking at how you would rated the upper centre line to lower and both to the facial midline

115
Q

what is good about OPT radiographs

A
  • used a lot
  • good view of the dentition
  • used to look for unerupted teeth, stage of development, any pathology and length of roots
116
Q

what is not good about OPT

A
  • not clear in the midline so need another radiograph to get that information
117
Q

what radiograph is often taken along with an OPT

A
  • maxillary anterior occlusal
118
Q

when ar lateral cephalograms used

A
  • more specialised
  • used to perform measurements on angles between points on the skull
  • get more information to allow us to plane treatment by relating skeletal bases to each other and the cranial base
  • gives us more info about teeth angulation from the maxilla and mandible
119
Q

why are study models used

A
  • for monitoring changes in treatment and monitoring development of dentition
  • good if patients got partially erupted tooth and want to see how things change over time
120
Q

why are photographs used

A
  • to monitor changes
121
Q

what do we need to do with the information gathered in our assessment

A
  • summarise the important points
  • assess treatment need = IOTN
  • devise a treatment aim
  • plan treatment
122
Q

what does IOTN stand for

A
  • index of orthodontic treatment need
  • helps decide whether we need to treat patient or not
  • gives an indication of benefit of dental health to treatment and psychosocial benefit
123
Q

what does all this information gathered make up

A
  • the basis of your referral letter
124
Q

what does the AP assessment assess

A
  • mandible to maxilla position
125
Q

what does the vertical assessment assess

A
  • assess Frankfort plane and mandibular plane and see where the lines of each intersect
  • looking at length of face
126
Q

what does the transverse assessment assess

A
  • asymmetries
127
Q

difference between the incisors relationships

A
  • lower incisors edge in relations to the cingulum plateau of upper incisors = difference between class I, II or III
  • incisors angulation = difference between Class II div 1, and class II div 2
  • overjet = difference between class II and class III

BDS3 - Orthodontics (14 decks)

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