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Module 7 > Orthodontics > Flashcards

Orthodontics Flashcards

Topics covered: patient history, EO and IO assessment, IOTN, Lateral Cephalogram, Canines,

1
Q

Why is important to ask about the patient’s age in an ortho history?

A

Timing for treatment:
- pre-puberty growth spurt
- may wish to delay treatment until the patient has stopped growing
- mixed dentition
- quicker bone remodelling in younger patients (quicker treatment)

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2
Q

Why is it important to ask about the patient’s gender in an ortho history?

A

Growth spurt:
- males and females have different growth rates

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3
Q

List 3 different common complaints in an ortho history:

A
  1. Aesthetics
  2. Function
  3. Trauma
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4
Q

What aesthetic problems might the patient have?

A
  • Crowding
  • Increased overjet/overbite
  • Open bite
  • Spacing
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5
Q

What are the main causes of spacing?

A

Microdontia, hypodontia, periodontal disease

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6
Q

What may you want to ask if the patient has a Class III incisor relationship?

A

If there is a FH of Class III incisor relationship.

(strong genetic component)

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7
Q

If the patients speech or TMJ problems are their biggest concern what must you warn them prior to treatment?

A

That there is no guarantee that speech or TMJ problems will be corrected after treatment.

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8
Q

What questions should you ask the patient regarding their problem?

A
  1. Is the problem getting better or worse?
  2. How long have you been aware of the problem for?
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9
Q

What questions must you ask when taking an ortho DH?

A
  1. OH habits at home
  2. Attendance
  3. Registered with dentist
  4. Dental anxiety
  5. Previous extractions
  6. Previous orthodontic treatment - what appliance, when did they have treatment, did they complete full duration of tx. (if not why not?)
  7. TMJ problems
  8. Caries history/restorations
  9. Anaesthetic for dental procedures - GA or LA, GA
  10. Trauma - has treatment been carried out for it, have the adjacent teeth been affected?
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10
Q

What % of roots will shorten 1-2mm following ortho treatment?

A

90%

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11
Q

What % of roots will shorten significantly following ortho tx?

A

10%

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12
Q

What habits may result in orthodontic issues?

A

Finger/Digit sucking
Dummy sucking
Nail biting
Mouth breathing

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13
Q

What else should you note down when asking a pt about habits?

A

The duration and frequency of the habits

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14
Q

What allergies are especially important to be aware of in orthodontic treatment and why?

A
  1. Latex allergy:
    - gloves, rubber bands
    - important as anaphylaxis is possible
  2. Nickel:
    - important as nickel is present in the majority of orthodontic alloys
    - however IO reactions are very rare
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15
Q

If latex allergy is suspected, where should you refer the patient?

A

To a cardiologist

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16
Q

If the patient is allergic to nickel what alternative material could be used for brackets/wires?

A
  • Ceramic brackets
  • Cephalon wire coating
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17
Q

Why does the SDCEP suggest that you liaise with a cardiologist before providing orthodontic treatment for a patient that has a heart condition such as:

  1. Prosthetic heart valve
  2. Congenital heart disease 3. Previous episode of IE

etc…?

A

As they may require AB cover for ortho procedures/extractions.

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18
Q

What types of ortho appliances might children with hayfever, find difficult to wear in the summer months?

A

Removable appliances

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19
Q

If a patient is using a steroid inhaler for their asthma, what may they also be at increased risk of?

A

Candida

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20
Q

What may you expect to see relative to eruption in a patient that has hyperthyroidism?

A

Faster eruption

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21
Q

What may you expect to see relative to eruption and roots in a patient that has hyporthyroidism?

A

Slower eruption
Shorter roots

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22
Q

If a patient has epilepsy and requires orthodontic treatment, what considerations must be made?

A
  1. If uncontrolled - avoid appliances:
    - can damage self and appliance
  2. Avoid acrylic appliance:
    - choking hazard
  3. Phenytoin used to treat epilepsy can cause gingival hyperplasia
  4. If getting emergency MRI - appliance must be taken off
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23
Q

Why is it important to know the pts height and weight in ortho history?

A

Need to know this if the patient were to have GA for jaw surgery or impacted tooth - BMI must be of healthy weight

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24
Q

What 3 aspects does the EO ortho assessment assess?

A
  1. Skeletal pattern
  2. TMJ
  3. Soft tissues
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25
Q

What 3 planes can the skeletal pattern be assessed in?

A
  1. Anteroposterior
  2. Vertical
  3. Transverse
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26
Q

What 2 methods can be used to assess the anteroposterior plane?

A
  1. Visual assessment
    - using reference points
  2. Bi-digital palpation
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27
Q

From visual assessment of the anteriorposterior plane, what might the skeletal pattern be classified as if the upper lip and chin are touching the zero meridian line and how might you describe this arrangement?

A

Class I Skeletal Pattern

Orthognathic (straight jaw)

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28
Q

From visual assessment of the anteriorposterior plane, what might the skeletal pattern be classified as if the upper lip is ahead of the zero meridian line (prognathic maxilla) or the chin is behind the line (retrognathic mandible), or both?

A

Class II Skeletal Pattern

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29
Q

From visual assessment of the anteriorposterior plane, what might the skeletal pattern be classified as if the upper lip is behind the zero meridian line (retrognathic maxilla) or the chin is in front of the zero meridian line (prognathic mandible) or both?

A

Class III Skeletal pattern

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30
Q

When using bi-digital palpation to assess a patient’s skeletal pattern, which position should the hand be positing in a Class I Skeletal Pattern?

A

Arm sits straight

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31
Q

When using bi-digital palpation to assess a patient’s skeletal pattern, which position should the hand be positing in a Class II Skeletal Pattern?

A

Arm rotates downwards

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32
Q

When using bi-digital palpation to assess a patient’s skeletal pattern, which position should the hand be positing in a Class II Skeletal Pattern?

A

Arm rotates upwards

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33
Q

Which 2 methods can be used to assess the vertical plane?

A
  1. LFH - lower face height
  2. FMPA - Frankfurt mandibular plane angle
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34
Q

Describe how you would assess the lower face height of a patient?

A
  1. Assess in front of the patient
  2. Divide face into thirds:
    - Upper 1/3 - from hairline to Glabella
    - Middle 1/3 - from Glabella to Subnasale
    - Lower 1/3 - from Subnasale to Menton
  3. Ideally, each third should be equal distance
    - can be measured with metal ruler or index finger and thumb
  4. Note down the LFH
    - Average LFH
    - Increased LFH
    - Decreased LFH
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35
Q

Describe how you would assess the FMPA of a patient?

A
  1. Assess from the side of a patient
  2. Using 2 metal rulers, check where the Frankfurt and mandibular planes intercept
  3. Note down the FMPA:
  • Average = planes intercept at occiput
  • Low/Decreased = planes intercept behind the occiput, smaller angle, increased horizontal growth, may see deep overbite
  • High/Increased = planes intercept in front of occiput, greater angle, increased vertical growth, may see anterior open bite, maxilla softer, teeth move easier
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36
Q

Which 2 methods can be used to assess the transverse plane?

A
  1. Birds eye view
  2. Facial fifths
    - reference points: inner canthus, interpupillary points
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37
Q

What might asymmetries be a result of?

A

Maxilla growth causing an occlusal cant/tilt.

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38
Q

What can an orthodontist provide that may help with TMJ issues?

A
  1. Bite raising appliance
    - to allow articular disc to heal
  2. Diet modification advice
  3. Jaw exercises
  4. Botox
  5. Surgery/Minor surgical procedures
    - last resort
    - carried out by maxfax dept
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39
Q

What conditions may cause TMJ pain?

A
  1. Trauma
  2. Rheumatoid Arthritis
  3. Juvenile Idiopathic Arthritis
  4. Crossbites with displacement
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40
Q

Which isolated situation may Orthodontics help reduce TMJ symptoms?

A

If the cause is due to crossbite with displacement.

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41
Q

What does competent/incompetent lips mean?

A

Competent - when the lips are touching each other or showing 1-2mm of maxillary incisors (ideal)

Incompetent - lips are apart and show >4mm of the clinical crown - may be due to proclined/protruded teeth

42
Q

What can incompetent lips result in?

A

A gummy smile

43
Q

What is a normal range for a nasiolabial angle?

A

90-110*

44
Q

What must be assessed as part of the general dental assessment?

A

Perio tissues
OH
Plaque Index
Dental Chart - mixed dentition
Mobility of primary teeth
Traumatised teeth
NCTSL - distribution & description (erosion, abrasion, attrition)
Enamel hypoplasia
Caries risk assessment
Chart carious teeth
Teeth of poor prognosis
Sensibility test - not commonly carried out
Dental anomalies
Other findings - e.g. palpable maxillary canines

45
Q

What are proclined/protruded teeth at higher risk of?

A

Dental trauma

46
Q

When should you be able to palpate canines buccally?

A

From the age of 10 years old

47
Q

List 5 reasons for ectopic canines?

A
  1. Long path of eruption
  2. Later eruption of canines (after premolars)
  3. Supernumerary teeth
  4. Missing laterals or misshapen laterals (due to lack of guidance)
  5. Class II (due to lack of guidance)
48
Q

Name some craniofacial anomalies that may be of relevance in orthodontics:

A
  1. Craniosynostosis:
    - premature fusion of cranial suture
    - can cause facial asymmetry
  2. Cleft lip/palate
49
Q

What does the orthodontic assessment consist of?

A

Assessment of:

  1. Labial segment
    (upper and lower 3-3)
    - inclination
    - aligned/crowded/spaced
    - rotations
  2. Buccal segment
    - aligned/crowded/spaced
  3. Canine Inclination
  4. Mixed dentition analysis
    - if appropriate
50
Q

What is classed as mild crowding?

A

0-4mm (of contact point displacement)

51
Q

What is classed as moderate crowding?

A

4-8mm (of contact point displacement)

52
Q

What is classed as severe crowding?

A

> 8mm (of contact point displacement)

53
Q

What might cause crowding?

A
  1. Supernumeraries
  2. Arch length tooth discrepancy
  3. Retained teeth
  4. Ectopic teeth
  5. Previous extractions of primary teeth
54
Q

What must you account for when measuring crowding?

A

Any permanent teeth that haven’t erupted yet

55
Q

If there is crowding anteriorly and you want to create space what can you do?

A

Extract the 4s and use an ortho appliance to move/align the teeth

Note - you must use another appliance to enable anchorage of the molars to ensure they don’t drift forward and take up the space.

56
Q

What might cause a midline diastema?

A
  1. Supernumaries (mesiodens)
  2. Low-lying labial frenum attachment
  3. Periodontal disease
  4. Racial predilection
  5. Odontome
  6. Cyst
  7. Habits
57
Q

What can you do to check for a low lying labial frenum attachment?

A

Blanch test

OR

Take PA and look for notch between central incisors

58
Q

What might cause generalised spacing?

A
  1. Tongue thrusting
  2. Periodontal disease
  3. Hypodontia
  4. Microdontia
  5. Tooth-size arch discrepancy
  6. Macroglossia
59
Q

What might you see with macroglossia?

A

Scalloping of the tongue
Wide lower arch

60
Q

What must you avoid in patients with macroglossia?

A

Extracting teeth

61
Q

When would you carry out a mixed dentition analysis?

A

If primary canines and molars are present.

62
Q

How would you carry out a mixed dentition analysis?

A
  1. Using a calliper or plastic/metal ruler, measure from the distal of the lateral incisor to the mesial of the 1st permanent molar
  2. If on measurement there is a reduced space then there is risk of future crowding when the permanent teeth erupt
63
Q

What classification system is used for molar relationships?

A

Angles Classification

64
Q

What classification system is used for incisor relationships?

A

BSI Classifcation

65
Q

In a class I canine relationship where does the mesial slope of the upper canine sit?

A

On the distal slope of the lower canine.

(remember this as the upper canine is ALWAYS bigger than the lower canine)

66
Q

How would you measure overjet?

A

From the labial surface of the upper central incisor to the labial surface of the lower central incisor

67
Q

What is an average overbite?

A

Upper incisor covers 30% of the lower incisor

68
Q

What is the most common reason for an anterior open bite?

A

Thumb sucking

69
Q

What might a lingual crossbite also be known as?

A

A scissor bite

70
Q

In what case might a crossbite be an indication for orthodontic treatment?

A

When there is displacement of the jaw on closure due to the presence of crossbite - as it can cause TMJ problems.

71
Q

Where should you measure an open bite from?

A

Where the opening is the widest from the cusp tips

72
Q

What does the IOTN assess and determine?

A

The IOTN assesses the severity of the orthodontic problem

And it determines the likely impact of malocclusion on an individual’s dental health and psychological well-being determining their need for NHS treatment.

73
Q

What does the IOTN consist of?

A
  1. Dental health component (DHC)
  2. Aesthetic component (AC)
74
Q

What is the name to describe the ideal smile arc at the end of treatment?

A

Consonance smile

75
Q

What is the dental health component of the IOTN?

And what does it record?

A

The DHC is a list of various occlusal traits, ranked and grouped in five grades, where Grade 5 is ‘great need for treatment’ and grade 1 is ‘no need for treatment’

It records various traits of a malocclusion that would increase the morbidity of the dentition.

76
Q

In the DHC of the IOTN, each occlusal trait is given a letter.

Identify letters A-D:

A

A - Overjet
B - Reverse Overjet
C - Crossbite
D - Displacement of contact points

77
Q

List some cases in which a Grade 5 would be given for the Dental Health Component?

A

Large overjets
Impacted teeth
Cleft palate.

78
Q

What 2 aids are available to help with the IOTN?

A

MOCDO
IOTN ruler

79
Q

What does MOCDO stand for?

A

M - Missing
O - Overjet
C - Crossbite
D - Contact point displacement
O - Overbite

80
Q

What might be the cause of a missing tooth (excluding extraction)?

A

Congenital absence
Impeded eruption

81
Q

What letter relates to ‘missing’ in the DHC?

A

H (for hypodontia)

82
Q

When would you grade a pt 4h in the DHC?

A

When there is one tooth missing in a quadrant (excluding 3rd molars)

83
Q

When would you grade a patient 5h in the DHC?

A

When there are 2 or more teeth missing in a quadrant (excluding 3rd molars)

84
Q

When would you grade a patient a 5a in the DHC?

A

When they have an overjet >9mm

85
Q

When would you grade a patient a 5m or 4m in the DHC?

A

When there is a reverse overjet of > 3.5mm

*5m or 4m will depend on the presence of speech or masticatory difficulties

86
Q

When would you grade a patient a 4c in the DHC?

A

When there is an anterior crossbite or unilateral buccal crossbite with mandibular displacement > 2mm

87
Q

When would you grade a patient a 4L in the DHC?

A

Presence of scissors bite in one or both buccal segments

88
Q

When would you grade a patient a 4D in the DHC?

A

When there is a contact point displacement >4mm

89
Q

When would you grade a patient a 3D in the DHC?

A

When there is a contact point displacement 2-4mm

90
Q

When would you grade a patient a 2D in the DHC?

A

When there is a contact point displacement >1mm but < or equal to 2mm

91
Q

When measuring contact point displacement, what is not generally recorded as part of the measurement?

A
  1. Spacing
  2. Displacements due to rotations
92
Q

When would you grade a patient a 4F in the DHC?

A

Traumatic overbite

93
Q

When would you grade a patient a 3F in the DHC?

A

Deep and complete overbite

94
Q

When would you grade a patient a 4e, 3e or 2e on the DHC?

A

Anterior open bite / Lateral open bite

  • size dependant
95
Q

When would you grade a patient a 5P in the DHC?

A

Cleft lip and/or palate

96
Q

When would you grade a patient a 5S in the DHC?

A

Submerging deciduous molars

97
Q

What are the risk of orthodontic treatment?

A
  1. Root resorption - Shortening of roots
  2. Pain/discomfort
  3. Mouth ulcers
  4. Perio problems
  5. Caries risk
  6. May not resolve speech problems - not scientifically proven
  7. Life-long retention required as teeth will try to move back
  8. Multiple appointments and commitment
  9. Risk of broken appliances
  10. Costly
98
Q

What are the benefits of orthodontic treatment?

A
  1. Improved function/aesthetics
  2. Can reduce trauma risk
  3. Can improve masticatory function - by reducing anterior open bite/crossbite
  4. May improve speech problems
  5. Improved psychosocial wellbeing
  6. UE impacted teeth - may reduce pathological risk
99
Q

What orthodontic treatment do NHS fund?

A

DHC - 4 and 5

AC - 6 or above
(however, DHC must also be 3 or above)

100
Q

What does IOTN stand for?

A

Index of Orthodontic Treatment Need

101
Q
A

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