Clinical Examination

Question 1

Clinical Examination

Amamnesis is subjective/objective

Answer 1

🔸Subjective
🔸 Facts reported by patient and are frequently imprecise

Question 2

Clinical Examination

Anamnesis provides information about

Answer 2

🔸Origin of malocclusion and how it developed
🔸 Inheritable nature of orthodontic problem and how to access it
🔸Clinical and paraclinical evaluation that needs to be implemented
🔸Patients attitude and expectations

Question 3

Clinical Examination

Manner in which orthodontic anamnesis caried out

Answer 3

🔸Earn trust of patient by being calm and professional
🔸Identify contributing etiological factors that are no longer present
🔸Confidentiality
🔸Avoid anxiety by hiding instruments

Question 4

Clinical Examination

Main Anamnesis elements

Answer 4

🔸Identification data
🔸Anamnesis Morbi- history of malocclusion
🔸Anamnesis vitae-History of life
🔸Family history

Question 5

Clinical Examination

Identification data of patient

Answer 5

🔸Name
🔸Age
🔸Date of birth
🔸Address
🔸Telephone number

Question 6

Clinical Examination

Anamnesis Morbi-History of the present malocclusion

Answer 6

🔸Chief complaint and reason for visit
🔸Onset of malocclusion and how it has developed in time
🔸Reason to seek treatment
🔸Previous consultations
🔸Previous treatment and outcomes

Question 7

Clinical Examination

Anamnesis vitae- history of life

Answer 7

🔸Pregnancy - diseases, medications
🔸Neonatal nutrition- breast feeding/complimentary feeding or both. Type and duration of pacifier use
🔸Eruption time of primary and permanent teeth
🔸Onset of speech and beginning of verbal communication
🔸Oral habits- pacifier, digit sucking, mouth breathing
🔸Systemic conditions- allergies, respiratory diseases, endocrine diseases, hypovitaminosis, immunological diseases

Question 8

Clinical Examination

Examples of hereditary malocclusions

Answer 8

🔸Diastema
🔸Hypodontia
🔸Hyperdontia
🔸Impacted maxillary canines
🔸Mandibular prognathism
🔸Cleft lip and palate

Question 9

Clinical Examination

Estimation methods of inheritance

Answer 9

🔸Horizontal inheritance pattern- Examination of siblings and cousins
🔸Vertical inheritance pattern- Parents, grandparents, uncles and aunts

Question 10

Clinical Examination

Parts of Status(Clinical examination of patient)

Answer 10

🔸General status
🔸Status Localis- Extraoral, intraoral

Question 11

Clinical Examination

General status

Answer 11

🔸Appearance of Patient
🔸Body buildup and musculature
🔸Age appearance
🔸Posture
🔸Hygiene

Question 12

Clinical Examination

Extraoral examination divided into

Answer 12

🔸Frontal view
🔸Profile view

Question 13

Clinical Examination

Frontal view

Answer 13

🔸Symmetry of face
🔸Proportionality of face
🔸Horizontal lines connecting eyebrows, pupils of eyes and corners of mouth should be parallel
🔸Contact point between upper lip in physiological rest position of mandible
🔸Nasolabial and supramental folds

Question 14

Clinical Examination

Symmetry of face

Answer 14

🔸Divided into right and left halves by midline
🔸Made up of Nasion and Subnasale
🔸The two halves compared visually

Question 15

Clinical Examination

Proportionality of face

Vertical heights

Answer 15

🔸3 vertical facial heights
🔸Upper third- Point Trachion to soft tissue Nasion
🔸Middle third- Soft tissue Nasion to Subnasale
🔸Lower-Subnasale to soft tissue Gnathion

Question 16

Clinical Examination

According to Schwartz regarding the lower facial third

Answer 16

It is 5-10 mm higher than the middle face height

Question 17

Clinical Examination

Contact point between the upper and lower lip

Ideal position

Answer 17

🔸Lips ideally in contact in rest position
🔸Upper incisor display of over a third clinical crown means lip is hypotonic

Question 18

Clinical Examination

Nasolabial and supramental folds

Answer 18

Underlined or smoothened

Question 19

Clinical Examination

Profile view

Answer 19

🔸Consists of estimating facial profile by appearance=>
* Correlation between tip of nose, upper lip, chin prominence=>
* Concave(prognathic), straight and convex(retrognathic)
🔸Mandibular angle examined w/ two rulers-one on ramus and one on body to make angle- decreased or increased

Question 20

Clinical Examination

Upper lip is ideally

Answer 20

Ahead of Lower lip

Question 21

Clinical Examination

Positive lip step

Answer 21

Protrusion of lower lip in relation to upper lip

Question 22

Clinical Examination

Negative lip step

Answer 22

Retrusion of lower lip

Question 23

Clinical Examination

Intraoral status features of examination

Answer 23

🔸Present teeth
🔸Dentition-intact or caries prone
🔸Arch form
🔸Symmetry of arches
🔸Tongue- size and pathology
🔸Oral hygiene
🔸Frenulae

Question 24

Clinical Examination

If frenulum linguae is short and thick

Answer 24

Decreases mobility of tongue tip

Question 25

# Clinical Examination Swallowing test

Answer 25

🔸Index and middle fingers under inner margin of mandibular body 🔸Patient swallows 🔸Infantile swallowing if- contraction of extrinsic tongue muscles, tongue thrusts forward against anterior teeth and patient protrudes neck forward (duck)

Question 26

# Clinical Examination Breathing tests

Answer 26

🔸Physiological rest position and lips in contact- cotton under nostrils and patient breaths in and out- positive if moves during breathing 🔸Patient holds mouth of water for 1 minute without spitting 🔸Patient squats w/ mouth closed and lips in contact- positive if doesn’t open mouth

Question 27

# Clinical Examination Aim of Speech tests

Answer 27

🔸Assess phonation of patient during speech 🔸Speech therapist consultation if problem

Question 28

# Clinical Examination Eschler-Bittner test

Answer 28

🔸For **facial asymmetry** 🔸Maximum opening of mouth then slow closing 🔸Assessing if facial asymmetry restored during opening and in what moment it occurs during closing 🔸**Morphological discrepancy** of mandible if asymmetry maintained during opening and closing 🔸**Functional deviation** of mandible if asymmetry occurs and restores during closing