Orthodontic Diagnosis and Early Facial Development Flashcards
What is orthodontics?
- dental specialty dealing with the diagnosis, prevention and correction of malpositioned teeth and jaws.
GDC: development, prevention and correction of irregularities of the teeth, bite and jaws.
What is interceptive orthodontics?
A child patient - any treatment procedure which eliminates or reduces the severity of a developing malocclusion e.g. LL1 protruding uppers
What is the role of the therapist in primary care in ortho?
- monitor dental development and highlight any variations from the expected
- recognise malocclusion, especially in children, as late referrals can negate possibility of interceptive ortho
- GDPs and therapists are the gatekeepers of ortho treatment, having a significant role to play in ensuring the best outcome for their patients
- it is crucial that GDPs/therapists can identify the patients occlusal problem and refer appropriately where required
What are the main points to consider in primary care?
- listen to any concerns the patient has
- look for any abnormalities in the bones, teeth or tissues
- ensure patient is dentally fit with good OH
- REFER
What happens at an orthodontic exam?
- listen to patient
- assess patients facial skeleton
- assess the patients gingival health BPE
- assess the patients oral hygiene
- assess the teeth - number, prognosis, position
- assess if patient qualifies for treatment (IOTN)
- arrange for special investigations
- come to a diagnosis
Which medical history considerations are relevant to ortho treatment?
- treatment choice: epilepsy and removable appliances
- gingivae e.g. medication related gingival overgrowth
- extraction vs non e.g. haemophilia
- cooperation e.g. autistic spectrum disorder
- infection risk e.g. diabetes
- candida risk e.g. asthma
How is the skeletal pattern assessed?
Patient should be at rest with teeth together in position of maximum intercuspation
- anteroposterior (A-P)
- vertical
- transverse
How is the antero-posterior plane measured?
- view patient from the side i.e. profile
- look at the relative position of the maxilla and mandible
- palpate soft tissue point A and B
Class I: mandible is 2-3mm posterior to maxilla
Class II: mandible is retruded relative to the maxilla (fingers point up)
Class III: mandible is protruded relative to maxilla (fingers point down)
What is a vertical plane?
- lower face height: distance from the eyebrow to the base of the nose should be equal to the distance from the base of the nose to the lowermost point on the chin
- frankfort mandibular plane: look at the point of intersection between the mandibular plane and the frankfort plane - they should intersect at the occiput
Classified as average, increased, reduced
What is the transverse plane?
- all faces are asymmetric to a degree, marked discrepancies should be noted
- view from front and above
- an occlusal plane asymmetry (horizontal) is easier to see if the patient bites onto a tongue spatula or mirror end
What considerations should you make with lips and tongue?
Lips:
- form, tone and fullness
- lip competence (do they meet at rest)
- lower lip position relative to upper incisors
- lip trap
- length of upper lip and amount of upper tooth shown
Tongue:
- tongue is used to achieve an anterior oral seal when swallowing
- gross variations in tongue size/shape should be recorded
What effects can digit sucking have on occlusion?
- effect depends on persistence of habit, warn patient and parent about effects, 45% spontaneously improve with early cessation
- increased overjet
- open bite (asymmetrical)
- posterior crossbites
- narrowing of upper arch
What age should you palpate for unerupted canines?
Around 9-10 years
What are the incisor relationships?
Class I: lower incisor edge occlude with or lie below the cingulum plateau of the upper incisors
Class II: lower incisor edge lies posterior to the cingulum plateau
Div 1 - upper central incisors are proclined or of average inclination with an increased overjet
Div 2 - upper central incisors are retroclined and the overjet is usually minimal
Class III: lower incisor edge lie anterior to the cingulum plateau
What is the buccal segment relationship? (Molar relationship)
Class I: mesiobuccal cusp of the upper first molar occludes with the mesiobuccal groove of the lower first molar
Class II: the mesiobuccal cusp occludes mesial to the MB groove
Class III: MB cusp occludes distal to the MB groove
