orthodontic diagnosis Flashcards
what is the purpose of orthodontics?
to deal with the diagnosis, prevention and tx of malpositioned teeth, bite and jaws
what is interceptive orthodontics?
orthodontic treatment which eliminates or reduces the severity of developing malocclusion
what is an ectopic canine?
a canine which follows an abnormal path of eruption into the incorrect position
what is the main problem with ectopic canineS?
can cause resorption of roots
what are the 3 aims of orthodontic treatment?
-improve dental health
-improve aesthetics
-improve psychological wellbeing
what sort of things do orthodontists treat?
-ectopic canine
-malocclusions
-craniofacial disharmony
-hypodontia
-cleft lip and palate
what are the roles of primary care GDP/therapists?
-monitor dental development and recognise any variations from the normal
-recognise malocclusion in all patients- recognise early in children to allow interceptive orthodontic treatment.
-once malocclusion problems are identified they must refer early
only refer if….
-caries free for 6 months
-no trauma for at least a year
-good OH
what should be identified during examinations
-patients concerns-very important
-parents concerns-not as important
-social concerns-bullying/trauma
-abnormalities of the bones/teeth/tissues
how may MH influence orthodontics?
-medications affecting gingivae- overgrowth
-extraction or not to extract e.g haemophilia
-epilepsy and removable appliances
-cooperation- autism
-infection risk-diabetes
-candida risk-asthma
how may hx/presenting complaint affect OH?
-must understand pt concerns
-must understand social concerns
-how long has there been an issue
-is issue getting worse
-have they had past tx
-what would they like to get from the tx
how may DH affect orthodontic?
-are they a good attender
-caries history
-previous extractions
-OH
-diet
-trauma- what happened
-when did trauma occur
-what tx has been done for trauma
how may social hx affect orthodontics?
-are they motivated-will they wear appliance
-do they have support (parents)
-habits/hobbies
-good attender?
what does extra oral examination examine?
-skeletal pattern
-soft tissues
how should patients be positioned when assessing the skeletal pattern?
-sitting upright at 90 degrees in dental chair
-head in normal position
-teeth together at rest
what plane should you assess If patient is posturing ?
Frankfurt-mandibular plane
what 3 planes should skeletal pattern be assessed?
-Anteroposterior plane
-vertical plane
-transverse plane
how do you assess the antero-posterior skeletal pattern?
-look at the patient side on (profile)
-look at position of maxilla to the mandible
-palpate soft tissue above upper lip point A and soft tissue below lower lip point b
explain the different classes of skeletal pattern?
class I- maxilla is 2-4mm anterior to the mandible
class II- the mandible is retruded relative to the maxilla
class III- the mandible is protruded relative to the maxilla
what are the two ways of assessing the vertical ?
-lower face height
-frankfurt-mandibular plane angle
what is the lower face height?
the distance from the eyebrows to the base of the nose should be the same as the distance from the base of the nose to the lowermost part of the chin
what is the Frankfurt-mandibular plane?
look at the Frankfurt plane and the mandibular plane- they should intersect at the occipital
how is the vertical classified?
-average
-increased
-decreased
how should you assess the transverse plane?
-standing directly infront of the patient and above the patient (birds eye)
what should be noted about the transverse plane?
any discrepancies in asymmetry
what makes it easier to assess asymmetry of the transverse occlusal plane?
have the pt bite on a tongue spatula
what should you be assessing with the lips?
-lip competence- do they meet at rest
-the lower lip relative to the upper incisors
-the upper lip relative to the amount of upper teeth shown
-lip trap
-form, fullness and tone
what measurement of overjet will require tx?
overjet of more than 6mm
what other EO examination should occur?
-examine TMJ-note any symptoms of TMD
describe class I incisor relationship
-occlusal edge of lower I occlude with cingulum of upper I
descriptive class II incisor relationship
what are the two subdivisions
- the lower incisor edges lie posteriorly to the upper incisor cingulum
subdivision 1- upper incisors are pro-clined and overjet is increased
subdivision 2- upper incisors are retroclined and overjet minimal
what is class III incisor relationship?
- lower incisor edge lies anteriorly to upper incisor cingulum
describe the class I molar relationship
mb cusp of upper 1st molar occludes with buccal groove of lower 1st molar
describe the class II molar relationship
mb cusp of upper 1st occludes mesial to the lower 1st molar buccal groove
describe the class III molar relationship
the mb cusp of the upper 1st molar occludes distal to the buccal groove of lower 1st molar
what orthodontic records are required for tx?
-study models
-radiographs
-photographs
why take study models?
-accurate reproduction of teeth and soft tissues
-used to take measurements and aid diagnosis
what radiographs can be taken and why?
panoramic rg
-teeth present
-root morphology
lateral cephalogram
-skeletal discrepancies
upper anterior occlusal
-position of unerputed canine
-CBCT scan
-impacted teeth
-3d assessment
what score of IOTN will receive NHS tx?
-4/5
-overjet >6mm
-impacted canine
how is DHC graded?
-single worst feature is noted an graded by assess
Missing teeth
Overbite
Crossbite
Displacement of contact pts
Overet
what else can be used for assessment ?
IOTN ruler
give an example of grade 1?
minor malocclusion with displacement of contact pts being <1mm
what does grade 2a mean?
increased overjet greater than 3.5mm but less than 6mm with lip competence.
what does grade 3a mean?
increased overjet greater than 3.5mm but less than 6mm with lip incompetence
what does grade 4a mean?
increased overjet greater than 6mm but less than or equal to 9mm
what does grade 5a mean?
increased overjet greater than 9mm
what does aesthetic component assess?
the likely psychological impact
what AC scores show need for treatment?
8-10
