Orthodontic Diagnosis and Early Facial Development Flashcards
What is orthodontics?
- dental specialty dealing with the diagnosis, prevention and correction of malpositioned teeth and jaws.
GDC: development, prevention and correction of irregularities of the teeth, bite and jaws.
What is interceptive orthodontics?
A child patient - any treatment procedure which eliminates or reduces the severity of a developing malocclusion e.g. LL1 protruding uppers
What is the role of the therapist in primary care in ortho?
- monitor dental development and highlight any variations from the expected
- recognise malocclusion, especially in children, as late referrals can negate possibility of interceptive ortho
- GDPs and therapists are the gatekeepers of ortho treatment, having a significant role to play in ensuring the best outcome for their patients
- it is crucial that GDPs/therapists can identify the patients occlusal problem and refer appropriately where required
What are the main points to consider in primary care?
- listen to any concerns the patient has
- look for any abnormalities in the bones, teeth or tissues
- ensure patient is dentally fit with good OH
- REFER
What happens at an orthodontic exam?
- listen to patient
- assess patients facial skeleton
- assess the patients gingival health BPE
- assess the patients oral hygiene
- assess the teeth - number, prognosis, position
- assess if patient qualifies for treatment (IOTN)
- arrange for special investigations
- come to a diagnosis
Which medical history considerations are relevant to ortho treatment?
- treatment choice: epilepsy and removable appliances
- gingivae e.g. medication related gingival overgrowth
- extraction vs non e.g. haemophilia
- cooperation e.g. autistic spectrum disorder
- infection risk e.g. diabetes
- candida risk e.g. asthma
How is the skeletal pattern assessed?
Patient should be at rest with teeth together in position of maximum intercuspation
- anteroposterior (A-P)
- vertical
- transverse
How is the antero-posterior plane measured?
- view patient from the side i.e. profile
- look at the relative position of the maxilla and mandible
- palpate soft tissue point A and B
Class I: mandible is 2-3mm posterior to maxilla
Class II: mandible is retruded relative to the maxilla (fingers point up)
Class III: mandible is protruded relative to maxilla (fingers point down)
What is a vertical plane?
- lower face height: distance from the eyebrow to the base of the nose should be equal to the distance from the base of the nose to the lowermost point on the chin
- frankfort mandibular plane: look at the point of intersection between the mandibular plane and the frankfort plane - they should intersect at the occiput
Classified as average, increased, reduced
What is the transverse plane?
- all faces are asymmetric to a degree, marked discrepancies should be noted
- view from front and above
- an occlusal plane asymmetry (horizontal) is easier to see if the patient bites onto a tongue spatula or mirror end
What considerations should you make with lips and tongue?
Lips:
- form, tone and fullness
- lip competence (do they meet at rest)
- lower lip position relative to upper incisors
- lip trap
- length of upper lip and amount of upper tooth shown
Tongue:
- tongue is used to achieve an anterior oral seal when swallowing
- gross variations in tongue size/shape should be recorded
What effects can digit sucking have on occlusion?
- effect depends on persistence of habit, warn patient and parent about effects, 45% spontaneously improve with early cessation
- increased overjet
- open bite (asymmetrical)
- posterior crossbites
- narrowing of upper arch
What age should you palpate for unerupted canines?
Around 9-10 years
What are the incisor relationships?
Class I: lower incisor edge occlude with or lie below the cingulum plateau of the upper incisors
Class II: lower incisor edge lies posterior to the cingulum plateau
Div 1 - upper central incisors are proclined or of average inclination with an increased overjet
Div 2 - upper central incisors are retroclined and the overjet is usually minimal
Class III: lower incisor edge lie anterior to the cingulum plateau
What is the buccal segment relationship? (Molar relationship)
Class I: mesiobuccal cusp of the upper first molar occludes with the mesiobuccal groove of the lower first molar
Class II: the mesiobuccal cusp occludes mesial to the MB groove
Class III: MB cusp occludes distal to the MB groove
Which radiographs may be taken as further investigations to diagnose malocclusion?
DPT: overall dental assessment, missing teeth, root morphology
Lateral Cephalometric: must bite on posterior teeth, indicated for skeletal discrepancies or where anterior or posterior movement of the incisors is required
Upper anterior occlusal: to investigate the position of an unerupted canine (parallax)
CBCT: 3D assessment of dentition, used for impacted teeth
What is the IOTN?
- purpose is to determine the impact of a malocclusion on an individuals dental health and psychosocial well-being
- comprises dental health and aesthetic component
- DHC scores of 4 or 5 will receive treatment on NHS e.g. overjet >6.5mm, impacted canines
What is the acronym to identify the worst single feature when determining IOTN?
MOCDO
Missing teeth
Overjet
Crossbites
Displacement of contact points
Overbites
What do the grades of the dental health component and aesthetic component mean in terms of IOTN?
DHC:
Grade 1 - no need
Grade 2 - little need
Grade 3 - moderate need
Grade 4 - great need
Grade 5 - very great need
Aesthetic component:
Score 1 or 2 - none
3 or 4 - slight
5, 6 or 7 - moderate/borderline
8, 9, 10 - definite
IOTN cut off scale is 7 or more, may qualify if DHC is 3 and aesthetic component 6
