Orthodontic Diagnosis & Early Facial Development Flashcards
what is orthodontics?
the dental specialty dealing with the diagnosis, prevention and correction of malpositioned. teeth and jaws
what wide range of issues does orthodontics cover?
interceptive orthodontics
ectopic/impacted teeth
missing teeth (hypodontia)
cleft lip and palate
craniofacial disharmony
misaligned teeth
what is interceptive orthodontics?
any treatment procedure which eliminates or reduces the severity of a developing maloccusion
what is the aim of orthodontic treatment?
dental health
aesthetics
psychological wellbeing
what is the primary role of GDPs/Therapists in orthodontics?
to monitor dental development and highlight any variations from the expected
what can a late referral to ortho cause?
negate the possibility if interceptive orthodontics
who are the gatekeepers of orthodontic treatment?
(primary care)
GDPs and therapists
what are we listening for in primary care examinations?
patients concerns - e.g squint teeth, gummy smile
family concerns - not as important as patient themselves
social concerns - bullying, trauma
what are we looking for in primary care examinations
teeth
- hypodontia, where about?
- teeth of poor prognosis e.g. 6s (MIH)/peg laterals
- tooth position e.g. crowding, spacing
- traumatic occlusion, e.g. mobility
soft tissues
- lip trap - trauma risk
gingival recession/stripping
facial bones
- jaw relationship
- jaw symmetry
- tmj
what will be assessed in general practice and what will be assessed by an orthodontic specialist?
gdp
- listen to patient
- assess patients facial skeleton
- assess the patients gingival health (BPE)
- assess the patients oral hygiene
- assess the teeth: number, prognosis, position
orthodontist
- assess if the patient qualifies for tx (IOTN)
- arrange for special investigations
- come to a diagnosis
what do we need to find out about the presenting complaint?
- what concerns the patient and why they’re attending?
- what motivates them to seek treatment intrinsic/extrinsic?
- how long have it bothered them, why now?
- have they had tx before?
- is the issue getting worse?
- is this affecting social life?
- what do they want to achieve?
what MH components may effect orthodontic treatment?
-epilepsy and removable appliance (lessen chance of breakage during seizure)
- medication related to gingival overgrowth
- haemophilia - extraction?
- cooperation - e.g. Autistic spectrum disorder
- diabetes - infection risk
- asthma - candida risk
what dental history is important to take?
- tx experience
frequency of dental attendance
caries history
extraction history - oral hygeine and diet
oral hygiene regime
sugar intake - trauma history
what injury was sustained
when was the injury
what treatment was carried out
what social history is important to take?
- motivation
parent and child - habits
tumb sucking, nail biting, pen chewing - hobbies
wind instruments, contact sports - attendance
are they regular?
what is examined extra orally?
skeletal - the bony framework that supports the dental arches
soft tissues
how should the skeletal pattern be examined?
patient should be upright in natural head position - if pt posturing use frankfort plane
teeth should be at rest in position of maximum intercuspation
3 planes:
anteroposterior
vertical
transverse
how to examine the anteroposterior part of the skeletal pattern?
view the patient from the side
look at the relative position of the maxilla and mandible
palpate:
soft tissue A point
soft tissue B point
skeletal pattern of the anteroposterior can be classified as 3 classes, what are they?
class I : mandible is 2-3 mm posterior to maxilla
class II : mandible is retruded relative to the maxilla
class III : mandible is protruded relative to the maxilla
what are the 2 assessments of note for vertical plane of the skeletal pattern?
lower facial height
frankfort mandibular plane angle
what is the lower facial height?
distance from the eyebrow to the base of the nose should equal the distance from the base of the nose to the lowermost point of the chin
what is the frankfort mandibular plane angle?
look at the point of intersection between the mandibular plane and frankfort plane, they should intersect at the occiput
the 2 tests for vertical plane of the skeletal pattern can be classified as what?
average
increased
reduced
how is the transverse plane of skeletal pattern measured?
all faces are asymmetric to a small degree
view from the front and above (birdseye)
an occlusal plane asymmetry is easier t see if the patient bites onto a tongue spatula
what are you looking out for in the lips?
form, tone and fullness
lip competence (do they meet at rest)
lower lip position relative to the upper incisors
lip trap
length of upper lip and amount of upper tooth shown
what are tongue thrusts?
the motion of pushing your tongue forward, against the back of the teeth or between the top and bottom teeth, when swallowing, speaking or relaxing.
what do habits such as thumb sucking cause?
increased OJ
open bite
posterior crossbites
narrowing of upper arch
what are the incisor relationships?
Class I
Class II
Class III
what is a class I incisor relationship?
the lower incisor edges occlude with or lie below the cingulum plateau of the upper incisor
what is a class II incisor relationship?
the lower incisor edges lie posterior to the cingulum plateau. 2 dubdivisions
division 1 - the upper central incisors are proclined or of average inclination, and there is an increased overjet
division 2 - the upper central incisors are retroclined and the overjet is usually minimal or may be increased
what is a class III incisor relationship?
the lower incisor edges lie anterior to the cingulum pateau
what are the molar relationship classes?
Class I
Class II
Class III
what is a class I molar relationship?
the mesiobuccal cusp of the upper first molar occludes with the mesiobuccal groove of the lower first molar
what is a class II molar relationship?
the mesiobuccal cusp occludes mesial to the groove
what is a class III molar relationship?
the mesiobuccal cusp occludes distal to the groove
what is the IOTN?
The Index of Orthodontic Treatment Needed
what is the purpose of the IOTN?
to help determine the impact of a malocclusion on an individual’s dental health and psychosocial well-being
the IOTN compromises of 2 elements, what are they?
dental health component
aesthetic component
a dental health component score of what will receive treatment on the NHS?
4 or 5
how do you figure out the dental health component of the IOTN?
the single worst feature of a malocclusion is noted and categorised into one of 5 grades reflecting the need for tx
what are the grades of the dental health component?
grade 1 - no need
grade 2 - little need
grade 3 - moderate need
grade 4 - great need
grade 5 - very great need
what acronym is used to identify the single worst feature to determinE the DHC?
M - missing teeth
O - overjet
C - crossbites
D - displacement of contact points
O - overbites
what is used to help with the IOTN assessment?
IOTN ruler
what is the IOTN aesthetic component?
this index assess the impact posed by a malocclusion and the likely psychological impact
set of 10 standard colour photographs grades 1 to 10 (most to least aesthetically pleasing)
what are the scores for the aesthetic component?
determine the need for treatment
score 1 or 2 - no need
score 3 or 4 - slight
score 5, 6 or 7 - moderate/borderline
score 8, 9 or 10 - definite
why is the aesthetic component criticised?
for being subjective
the photos are only composed of class I and II cases, not III
what is a DPT used to assess?
overall assess
missing teeth
root morphology
what is a lateral ceph used to assess?
indicates skeletal discrepancies
incisor relationship
soft tissues
what is an upper anterior occlusal used to assess?
to investigate the position of an unerupted canine
what is a CBCT scan used to assess?
3D assessment of dentition
used for impacted teeth in the UK
