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patient assessment Flashcards

1
Q

parts of ortho pt assessment

A 
history
EO assessment
IO assessment
summary
problem list
tx aims
tx plan
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2
Q

C/O

A 
RFA - specific thing?
level of concern
is pt concerned?
appearance
dental health
fct
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3
Q

aspects of MH that can affect ortho

A

epilepsy - avoid URAs
RAU - tend to manage
diabetes - diet
bisphosphonates - slow tooth movements and ext risk
latex allergy
Ni allergy - test with one bracket, check severity

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4
Q

DH

A 
regular attender?
prev tx - coped?
prev ortho? - avoid retx if possible - RR
caries risk - stabilise
history of trauma - RR
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5
Q

what habits are important to note in the history?

A

digit sucking

lip sucking

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6
Q

features of lip sucking

A

retroclination L incisors

eczematous appearance L lip

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7
Q

SH

A

prior knowledge from friends/siblings?
can they commit to tx - exams, travel, parents/work
wind instruments - can still play but will be more difficult

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8
Q

occlusal features of a digit sucking habit

A

proclination U incisors
retroclination L incisors
localised AOB or incomplete OB
narrow upper arch +/- unilateral posterior CB

but superimposed on existing skeletal pattern and incisor relationship

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9
Q

EO assessment

A

skeletal pattern - AP, V, T
STs
TMJ

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10
Q

ways of assessing AP skeletal pattern

A

visual
palpate skeletal bases
lateral ceph

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11
Q

how should the head be positioned for visually assessing the AP skeletal pattern?

A

Frankfort plane parallel to floor

natural head posture

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12
Q

AP class 1

A

mandible 2-3mm behind maxilla

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13
Q

AP class 2

A

mandible >2-3mm behind maxilla

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14
Q

AP class 3

A

mandible <2-3mm or in front

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15
Q

ways of assessing V skeletal pattern

A

FMPA
vertical facial proportions
lat ceph

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16
Q

how to assess FMPA clinically

A

Frankfort and mandibular planes

meet at occiput ideally

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17
Q

how to assess FMPA radiographically

A

porion to orbitale = Frankfort plane
gonion to menton = mandibular plane
meet at occiput ideally

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18
Q

landmarks for clinical vertical facial proportions

A

glabella
subnasale
menton

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19
Q

clinical vertical facial ideal proportions

A

UAFH 50%

LAFH 50%

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20
Q

landmarks for cephalometric vertical facial proportions

A

nasion
ANS
menton

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21
Q

cephalometric vertical facial ideal proportions

A

UAFH 45%

LAFH 55%

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22
Q

transverse skeletal pattern

A

assess symmetry
view from front and above
occlusal cant?

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23
Q

ST features to assess

A 
observe in fct as well as at rest
lips competent?
lip trap?
lip form and tonicity
nasolabial angle
smile line
tongue
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24
Q

competent lips

A

meet together at rest without any muscular activity

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25
lip form
full/thin
26
lip tonicity
hyperactive or little tone
27
what group of patients often have hyperactive lip tonicity?
class 2 div 2 - will retrocline L incisors
28
nasolabial angle
angle formed by tangents to the U lip and columella of the nose
29
what does the nasolabial angle indicate?
upper lip position
30
increased nasolabial angle
protrusive - good for ext
31
average nasolabial angle
100
32
decreased nasolabial angle
retrusive - avoid ext if possible
33
normal smile line
show whole height of U incisors with only the IP gingivae visible at rest lips apart 3-4mm incisal tooth show
34
what are tongue thrusts usually and why?
adaptive (secondary) | to achieve an anterior oral seal when swallowing
35
what is the problem with endogenous (primary) tongue thrusts?
harder to treat and more likely to relapse
36
TMJ assessment
``` ask re symptoms palpate as open/closed and lateral movements note any clicks/crepitus/locking note range of movement inc max opening if symptoms examine MofM ```
37
can tooth position/appliances cause TMD?
no evidence
38
parts of IO examination
general overview arches in isolation teeth in occlusion
39
features of IO general overview
``` chart erupted teeth poor prognosis - need stabilisation before tx OH tooth quality - note any decal areas PD condition toothwear - sort erosion ```
40
how can PD condition affect ortho tx?
can accelerate recession | prev loss of support can give more chance of relapse post-tx
41
features of assessing the arches in isolation
crowded/aligned/spaced | incisors - proclaimed/average/retroclined
42
mild degree of crowding
<4mm space short in one arch
43
moderate degree of crowding
4-8mm space short in one arch
44
severe degree of crowding
>8mm space short in one arch
45
methods to assess the degree of crowding
space available/space required mixed dentition analysis overlap technique (of contact points)
46
methods to assess the degree of crowding - space available/space required
arch length or space available - M6 to D2, D2 to M1, M1 to D2, D2 to M6 sum of widths of teeth anterior to 6s
47
methods to assess the degree of crowding - overlap technique
of contact points | add together
48
methods to assess the degree of crowding - mixed dentition analysis
``` need to use when permanent teeth still to erupt U arch need 22mm - 3 8mm - 4 7mm - 5 7mm L arch need 21mm - 3 7mm - 4 7mm - 5 7mm ```
49
incisor angulation
Frankfort plane to long axis of U incisor is about 110 degrees
50
things to assess when teeth in occlusion
``` incisor classification OJ OB centre lines molar relationship canine relationship crossbite mandibular displacement? ```
51
BSI class 1 incisors
lower incisor edges occlude with or lie immediately below the cingulum plateau of the U central incisors
52
BSI class 2 div 1 incisors
lower incisor edges lie posterior to cingulum plateau of upper central incisors. U centrals proclined or av inclination, increased OJ
53
BSI class 2 div 2 incisors
lower incisor edges lie posterior to cingulum plateau of U centrals U centrals retroclined OJ usually minimal but may be increased
54
BSI class 3 incisors
lower incisor edges lie anterior to cingulum plateau of U centrals OJ reduced or reversed
55
OJ
horizontal distance between the labial surface of the tips of the U incisors and the labial surface of the L incisors
56
measuring the OJ
teeth in ICP usually ruler held parallel to occlusal plane (horizontal) usually measure the greatest OJ on the most prominent U incisor
57
overbite
vertical overlap of the incisor teeth
58
describing OB
average, increased or decreased | complete or incomplete
59
average OB
where the U incisors overlap the incisal 1/3 of the crowns of the L incisors
60
complete OB
to tooth or ST
61
centre lines
``` look at rest and smiling describe U and L centre lines relative to - midline of face (ref point) - each other coincident, to right, to left look from above, behind and in front ```
62
class 1 molars
MB cusp of U FPM occludes with MB groove of L FPM
63
class 2 molars
MB cusp of U FPM occludes anterior to MB groove of L FPM
64
class 3 molars
MB cusp of U FPM occludes posterior to the MB groove of L FPM
65
class 1 canines
U permanent canine occludes in the embrasure between the L permanent canine and L 4
66
class 2 canines
U permanent canine occludes anterior to the embrasure between the L permanent canine and L4
67
class 3 canines
U permanent canine occludes posterior to the embrasure between the L permanent canine and L4
68
assessing mandibular displacement
check if you see CB or centre line discrepancy check path of closure check for displacement - RCP/ICP discrepancy - curl tongue back as gradually close, stop when feel first tooth contact
69
assessing CB
describe teeth involved | check for mandibular displacement
70
kesling set ups
useful for pt to see | simulate position you think teeth will end up in
71
diagnostic records
``` radiographs study models Kesling set ups photographs sensibility tests CBCT ```
72
indications for CBCT
UE teeth multidisciplinary cases bone for implants
73
when do you decide if radiographs are needed?
after clinical examination
74
what is always first in tx aims?
deal with pathology
75
what should be included at the end of the tx plan?
retention

Ortho (21 decks)

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