Referrals and GDP Ortho assessment

Question 1

What are the differences between conical and tuberculate supernumary teeth?

Answer 1

Conical are early forming and are peg shaped

Tuberculate are late forming and are barrel shaped

Question 2

What age is considered early orthodontic tx?

Answer 2

Treatment in the mixed dentition (7-10 yrs)

Question 3

How do you manage unerupted canines?

Answer 3

• Take 2 radiographs to locate canine (parallax)
• If close to line of arch, make space for it to erupt by extracting C
• If deciduous canines already lost, this won’t work then refer for specialist help

Question 4

What is the importance of early/and or interceptive treatment?

Answer 4

• Early and/or interceptive treatment may reduce complexity of malocclusion
• Early and/or interceptive treatment may reduce complexity or even eliminate need for orthodontic treatment

Question 5

How can we manage digit sucking?

Answer 5

First educate parents and patients of the effects of a prolonged digit sucking habit

Conservative methods such as a bitter tasting nail polish or thumb guard can be used

Habit breaking appliances can be used only if the patient is compliant and this can be via removable or fixed habit disuaders

Question 6

How do you manage a conical supernumary tooth?

Answer 6

• Can cause malocclusion so normally XLA
• If tooth is high then it is left in situ but regular radiographs are needed to assess any cystic changes

Question 7

What is infraocclusion? What is aetiology?

Answer 7

Submerged teeth
Aetiology can be idiopathic, genetic, trauma, absence of a successor

Question 8

What are clinical triggers for further investigations when assessing an ortho pt?

Answer 8

1. Delayed eruption
2. Crowding
3. Increased overjet
4. Crossbites
5. Submergence
6. Palpation of unerupted upper canines (10+yrs)
7. Caries
8. Deep/Open bite

Question 9

When does the root form of tuberculate supernumary teeth compared to a permanent incisor?

Answer 9

Root formation delayed compared to permanent incisor

Question 10

What is the link between supernumerary teeth in the primary and permanent dentition?

Answer 10

35-50% of cases in the primary dentition superseded by supernumerary in the permanent dentition

Therefore if seen in primary be wareful of same in permanent

Question 11

In terms of a childs dentition when should you normally treat malocclusion?

Answer 11

Most malocclusions should not be treated until permanent teeth have erupted

Question 12

How can submerged teeth affect permanent occlusion?

Answer 12

Permanent successors can have delayed eruption, impaction, disturbed root formation and/or cystic change

Question 13

Where do conical supernumary teeth normally present?

Answer 13

Midline of anterior maxilla

Question 14

When does the root form of conical supernumerary teeth compared to a permanent incisor?

Answer 14

Ahead or on par with permanent incisor

Question 15

What is the difference between open and closed exposure tx?

Answer 15

Open: If the tooth is near the surface place an apically positioned flap and place a bracket

Closed: If the tooth is some distance the surgeon bonds on a gold chain. The tooth is covered with mucosa, which will allow coverage of the crown

Closed exposure

Question 16

What is the difference between complex and compound odontomes?

Answer 16

Complex: haphazard arrangement of dental tissue most commonly anterior maxilla

Compound: discrete tooth like structures (x4 more common than complex)

Question 17

What type of things should you look for during an ortho assessment that are cause for concern?

Answer 17

• Displaced upper canines
• Unerupted upper central incisors
• Severe Class II/Class III malocclusions
• Localised incisor crossbites
• Unilateral posterior crossbites
• Poor prognosis 6s
• Crowding
• Abnormal/missing teeth
• Impacted teeth
• Incisal trauma

Question 18

What should be included in a referral letter?

Answer 18

1. Your contact details
2. The patient’s details
3. The details of the patients general medical practitioner
4. The patient’s medical history
5. If the patient is being referred for treatment / an opinion
6. The patient’s concerns
7. The salient features of the malocclusion
8. Any relevant dental history
9. Any recent, relevant radiographs.
10. A statement confirming that the patient is dentally fit and oral hygiene is satisfactory

Question 19

Why do we need to treat localised incisor crossbites early?

Answer 19

Eliminate the displacement
Prevent periodontal trauma to and mobility of opposing tooth
Prevent excessive wear of tooth in crossbite

Question 20

How do you manage a tuburculate supernumary tooth?

Answer 20

• Need accurate localisation - Parallax
• XLA as early as possible (not before 6 years of age) to minimize damage to the permanent incisor.
• Some may not have cause delayed eruption but may need to be removed prior to orthodontic treatment

Question 21

Why is the role of the GDP important in detecting malocclusion?

Answer 21

• Malocclusion can ‘creep up’ on patients
• Ethical duty to ‘detect’ and ‘inform’
• Early detection can’t be left to patients / parents
• Orthodontists do not have access to section of population that attend for dental check-ups
• GDP has the role of ‘gatekeeper’

Question 22

How do conical supernumary teeth affect permanent incisors?

Answer 22

Do not often impede or cause delayd eruption

Question 23

When taking a radiograph of an unerupted 3 what should you note down morphologically?

Answer 23

Morphology of apex
Root resorption of adjacent teeth
Size of follicle of canine (cystic change)

Question 24

Which direction do tuberculate supernumary teeth normally erupt?

Answer 24

Palatally

Question 25

When taking a radiograph of an unerupted 3 what should you note down in terms of the position of the tooth?

localisation

Answer 25

Buccopalatal position
Height of crown in relation to the occlusal plane
Angle of tooth
Proximity to the midline

Question 26

What should be assessed during an ortho assessment for a new patient?

Answer 26

• The teeth present
• The incisor relationship
• The buccal occlusion
• The molar relationship
• Are they within normal limit?

Question 27

What are the tx options for submerged teeth?

Answer 27

• If patient has not begun the growth spurt and there is 1-2mm infraocclusion then extraction is indicated.
• If left too late can completely be covered and require extensive bone removal.
• Some indicate building the tooth up to occlusion

Question 28

How do tuberculate supernumary teeth affect permanent incisors?

Answer 28

Frequently delays eruption of the upper incisors