Ortho - Examination

Question 1

When are orthodontic assessment routinely carried out?

Answer 1

When the patients approximately 9 years old for an initial assessment.
Then when the patient has all of their permanent teeth for a more comprehensive examination (11-12 years)

Question 2

When taking a patient history, what kind of questions would you ask to gauge there motivation to having braces?

Answer 2

What don’t you like about your teeth? give a list.

Guage if they are motivated for braces (better prognosis) Do you want braces?

Question 3

Possible contraindications to ortho?

Answer 3

There isn't very many.
Poor OH and diet 
Past trauma 
Allergy to Ni or latex (but not really a factor anymore)
Epilepsy 
Drugs

Question 4

Questions relating to dental history?

Answer 4

Have you experienced trauma? (risk of root resorption)
Guage their attendance to the dentist, OH levels and caries risk.
Past treatments are were the co-operative

Question 5

Social history?

Answer 5

Is the practice easily accessed
public transport
Do Mum and dad work? can they get you to appointments?

Question 6

List some possible bad habits which might be of note?

Answer 6

Thumb sucking
Biting of nails (root resorption of UI)
Tongue thrust

Question 7

What are the main areas of consideration for an E/O in ortho?

Answer 7

Skeletal bases
Soft tissues
TMJ
(Look at the parent as can be an indication of how the children will develop and grow)

Question 8

What is the main cause of a class ll div l

Answer 8

In 80% of cases. The mandible isn’t smaller It is just placed further back in the skull.

Question 9

There are 3 planes that are examined in relation to the facial skeletal pattern. What are they?

Answer 9

Anterior posterior dimension
Vertical dimension
Transverse/lateral dimension

Question 10

Before running any facial skeletal assessment what must the Frankfort plane be?

Answer 10

Horizontal

Question 11

What is the Frankfort plane?

Answer 11

It is a line that runs from the superior border of the external auditory meatus to the inferior border of the orbit.

Question 12

The AP skeletal assessment can be classed by what?

Answer 12

The gap between the maxilla and the mandible.
Class l - 2-3mm
class ll - more than 3mm
class lll - less than 2-3mm

Question 13

In growing children how is a class ll fixed to bring the mandible forward?

Answer 13

A functional appliance

Question 14

What is the FMPA?

Answer 14

This is where the Frankfort plane meets the mandibular plane. (runs along the border of the mandible).

Question 15

In a class l relationship, what is the value of FMPA?

Answer 15

25 degrees

Question 16

What are some reasons for the FMPA increasing?

Answer 16

This can be due to a reduced overbite or an anterior open bite.
This causes the mandible to become more vertically angled, increasing the FMPA.

Question 17

What is a possible reason for a decrease in the FMPA?

Answer 17

The patient has a very deep bite.

Causing the mandible to be more horizontal.

Question 18

Name two ways in which you can assess the vertical skeletal relationship?

Answer 18

Anterior face height ratio

FMPA

Question 19

The transverse skeletal relationship is looked at how?

Answer 19

Look at the patient front on, down the mid-sagittal reference line.

Question 20

What is included in an E/O soft tissues assessment?

Answer 20

Lips
Tongue
Habits - thumb sucking etc
Speech

Question 21

What are lips classified by?

Answer 21

Competent (lips meet naturally at rest)

In-competent (lip don’t meet at rest)

Question 22

What can happen with in-competent lips?

Answer 22

A lip trap can occur where the upper incisors rest on the lower lips and can cause them to be pro-clined.

Question 23

What can hyperactive lower lips cause

Answer 23

Lower incisors become retroclined

Question 24

What can tongue thrusting when swallowing cause?

Answer 24

Anterior open bite

Question 25

What assessments of habits are relevant to ortho?

Answer 25

Thumb and digit sucking

Question 26

What can thumb and digit sucking cause in the mouth?

Answer 26

Thumb sucking can cause the uppers to be proclined and lowers retroclined. It can also cause the upper jaw to be smaller as the tongue isn't there to prevent the check and other soft tissues from putting external force on the upper arch. Causing a unilateral posterior crossbite. Which affects occlusion. Localised AOB with finger sucking

Question 27

WIth speech what can happen?

Answer 27

Lisping can occur and the tongue causes spacing and anterior open bite

Question 28

Brief TMJ assessment.

Answer 28

``` Path of closure Range of movement Tenderness of muscle Pain or clicking from joint Deviation on opening mandibular displacement ```

Question 29

RCP stands for

Answer 29

Retruded contact position | This is the first contact before ICP

Question 30

if the patients RCP is the same as the ICP what does this mean?

Answer 30

That there is problems with the patients bite which can severely impact the TMJ and must be treated

Question 31

What is included in the I/O

Answer 31

``` Teeth present Oral hygiene and periodontal health Quality of teeth Assess crowding spacing and rotation Inclination and angulation of teeth Palpate for canines if not erupted Not abnormal sized teeth (peg laterals) ```

Question 32

From what age do you palpate looking for canines and what are you looking for?

Answer 32

9 years of age | Ectopic canines

Question 33

Can you continue ortho if patients have bad OH, caries or periodontal disease

Answer 33

No | As will further decalcification

Question 34

What are the 3 main risks of ortho treatment?

Answer 34

Decalcification Relapse Root resorption

Question 35

What should a normal overbite be %?

Answer 35

33-50%

Question 36

Angles classification of molar buccal segments?

Answer 36

``` Class l - the mesiobuccal cusp of U6 occludes with the mesial buccal groove of the lower 6. class ll - the lower 6 now occludes further back in mouth class lll - the lower 6 occludes more mesial in the mouth ```

Question 37

Canine relationship?

Answer 37

Class l - the upper 3 mesial slope occludes with the lower 3 distal slope. class ll - lower 3's move distally Class lll - lower 3's move mesially

Question 38

What is more important in achieving the perfect canine or molar relationship, and why?

Answer 38

Canine As if the canines are in the right place then the incisors will move into right place also and this is the aesthetic zone

Question 39

Special investigations in ortho?

Answer 39

``` Radiographs - Lateral Cephs - OPT - Maxillary anterior occlusal Scanning Study models Photographs ```

Question 40

What is the score used to assess treatment

Answer 40

IOTN