Why is orthodontic assessment undertaken?
- determine if any malocclusion present
- identify underlying causes
- decide if treatment is indicated (either refer or devise treatment plan)
When is orthodontic assessment undertaken?
- brief examination often at 9yrs old
- mixed dentition - can often pick up things going wrong early
- (interceptive orthodontics)
- comprehensive examination when pre-molars + canines erupt (11-12yrs)
- when older patients first present
- if a malocclusion develops later in life
- it is never too late to have orthodontic treatment!
What are Andrew’s 6 keys (1972)?
- Molar relationship
- Crown angulation (mesio-distal tip)
- Crown inclination
- No rotations
- No spaces
- Flat occlusal planes
What is one other aspect not inc. in the 6 keys but is vital?
small lateral incisors (or any teeth not in correct proportion)
= wont get ideal occlusion
(all other teeth in that segment will be further forward)
What type of occlusion is a slight variation from ‘ideal occlusion’ but is commonly observed more often?
Normal occlusion
- slight variation from ideal occlusion
- doesn’t req. treatment
- minor deviation - no aesthetic or functional problem
What type of occlusion has more significant deviation from ideal occlusion?
Malocclusion
- more significant deviation from ideal
- considerd unsatisfactory (aesthetically or functionally)
- may req. treatment
What aspects of patient histroy do you take?
- presenting complaint
- how much does it bother the patient?
- history of presenting complaint
- past medical history
- past dental history
- social/family history
When asking the patient about their presenting complaint. If they list multpile things, what do you do?
ask the patient to prioritise them
When asking the patient about the history of present complaint. If the complaint changes rapidly - what could this indicate?
Something that is changing rapidly may indicate pathology
(e.g. spacing in upper anteriors, facail asymmetry)
may be another process going on that req. thourough further investigation
There are few contraindications for orthodontic treatment but list 4 factors that have to be considered as contraindications.
- Allergy (nickel or latex)
- Epilepsy / drugs
- poorly controlled epilepsy - avoid removable appliances
- drugs can cause gingival inflammation - cleansing problems
- Drugs
- Imaging
- pathology req. H+N imaging
- often have to take off fixed appliances
- if this is happeneing before treatment - delay treatment until investigations complete
If patient has to recieve head and neck imaging, what must you consider for their treatment?
- remove fixed appliances
- if imaging is before treatment, delay treatment until all investigations have been done
Orthodontic consideration for someone with poorly controlled epilepsy?
May wish to avoid removable appliances
Some drugs can cause gingival inflammation - difficility cleansing
4 things you want to find out through PDH
- frequency of attendance
- ortho treatment takes ~24 months - need to be comfortable in the dental environment
- nature of prev. treatement
- lots of treatment may indicate high caries experience - not good for ortho treatment … patient needs to improve OH + diet
- cooperation with previous treatment
- trauma to permanent dentition
- root resorption
Why might a traumatised tooth be firm in the socket?
Odontoblasts replace tooth tissue with bone
Therefore tooth can be firm as it is fused to the bone as opposed to sitting in a normal socket
What 4 factors within Social/Family History do you need to consider?
- Travelling distance / time?
- is there somewhere closer?
- Car owner / public transport?
- Parents work?
- are they able to bring the child - important for consent
- School exams?
- often treating patients at an important time in their lives (exams etc.) - organise without disruption
Name 4 habits that can affect occlusion?
- thumb sucking
- proclined upper teeth
- lower lip sucking
- proclined upper teeth
- tongue thrust (when you swallow and push tongue forward)
- influences anterior tooth position
- chewing finger nails
- root resorption
What three things are focused on during extra-oral examination?
skeletal bases
soft tissue
TMJ
During examination, what do you compare between patient and parent?
malocclusion (esp. class III)
growth potential
What are the two cranial bases?
Anterior Cranial Base
Posterior Cranial Base
What cranial base is the maxilla attached to?
Anterior Cranial Base
What cranial base is the mandible attached to?
Posterior Cranial Base
What does it mean is a patient has an ‘increased cranial base angle’
The anterior cranial base + posterior cranial base are at a higher angle
This means the mandible is further back
Increased tendancy for large overjet
After you have taken a patient history…
What is the first thing you do during the extra-oral examination?
Look at the skeletal bases
Compare them all in 3 planes of space…
Antero-postural
Vertical
Transverse
What are the three planes of space that you look at the cranial bases?
Antero-postural
Vertical
Transverse
