Referrals and GDP Ortho assessment Flashcards
What are the differences between conical and tuberculate supernumary teeth?
Conical are early forming and are peg shaped
Tuberculate are late forming and are barrel shaped
What age is considered early orthodontic tx?
Treatment in the mixed dentition (7-10 yrs)
How do you manage unerupted canines?
- 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
What is the importance of early/and or interceptive treatment?
- 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
How can we manage digit sucking?
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
How do you manage a conical supernumary tooth?
- 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
What is infraocclusion? What is aetiology?
Submerged teeth
Aetiology can be idiopathic, genetic, trauma, absence of a successor
What are clinical triggers for further investigations when assessing an ortho pt?
- Delayed eruption
- Crowding
- Increased overjet
- Crossbites
- Submergence
- Palpation of unerupted upper canines (10+yrs)
- Caries
- Deep/Open bite
When does the root form of tuberculate supernumary teeth compared to a permanent incisor?
Root formation delayed compared to permanent incisor
What is the link between supernumerary teeth in the primary and permanent dentition?
35-50% of cases in the primary dentition superseded by supernumerary in the permanent dentition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
In terms of a childs dentition when should you normally treat malocclusion?
Most malocclusions should not be treated until permanent teeth have erupted
How can submerged teeth affect permanent occlusion?
Permanent successors can have delayed eruption, impaction, disturbed root formation and/or cystic change
Where do conical supernumary teeth normally present?
Midline of anterior maxilla
When does the root form of conical supernumerary teeth compared to a permanent incisor?
Ahead or on par with permanent incisor
What is the difference between open and closed exposure tx?
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
What is the difference between complex and compound odontomes?
Complex: haphazard arrangement of dental tissue most commonly anterior maxilla
Compound: discrete tooth like structures (x4 more common than complex)
What type of things should you look for during an ortho assessment that are cause for concern?
- 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
What should be included in a referral letter?
- Your contact details
- The patient’s details
- The details of the patients general medical practitioner
- The patient’s medical history
- If the patient is being referred for treatment / an opinion
- The patient’s concerns
- The salient features of the malocclusion
- Any relevant dental history
- Any recent, relevant radiographs.
- A statement confirming that the patient is dentally fit and oral hygiene is satisfactory
Why do we need to treat localised incisor crossbites early?
Eliminate the displacement
Prevent periodontal trauma to and mobility of opposing tooth
Prevent excessive wear of tooth in crossbite
How do you manage a tuburculate supernumary tooth?
- 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
Why is the role of the GDP important in detecting malocclusion?
- 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’
How do conical supernumary teeth affect permanent incisors?
Do not often impede or cause delayd eruption
When taking a radiograph of an unerupted 3 what should you note down morphologically?
Morphology of apex
Root resorption of adjacent teeth
Size of follicle of canine (cystic change)
Which direction do tuberculate supernumary teeth normally erupt?
Palatally
When taking a radiograph of an unerupted 3 what should you note down in terms of the position of the tooth?
localisation
Buccopalatal position
Height of crown in relation to the occlusal plane
Angle of tooth
Proximity to the midline
What should be assessed during an ortho assessment for a new patient?
- The teeth present
- The incisor relationship
- The buccal occlusion
- The molar relationship
- Are they within normal limit?
What are the tx options for submerged teeth?
- 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
How do tuberculate supernumary teeth affect permanent incisors?
Frequently delays eruption of the upper incisors
