Orthodontic Diagnosis & Early Facial Development

Question 1

what is orthodontics?

Answer 1

the dental specialty dealing with the diagnosis, prevention and correction of malpositioned. teeth and jaws

Question 2

what wide range of issues does orthodontics cover?

Answer 2

interceptive orthodontics
ectopic/impacted teeth
missing teeth (hypodontia)
cleft lip and palate
craniofacial disharmony
misaligned teeth

Question 3

what is interceptive orthodontics?

Answer 3

any treatment procedure which eliminates or reduces the severity of a developing maloccusion

Question 4

what is the aim of orthodontic treatment?

Answer 4

dental health
aesthetics
psychological wellbeing

Question 5

what is the primary role of GDPs/Therapists in orthodontics?

Answer 5

to monitor dental development and highlight any variations from the expected

Question 6

what can a late referral to ortho cause?

Answer 6

negate the possibility if interceptive orthodontics

Question 7

who are the gatekeepers of orthodontic treatment?

Answer 7

(primary care)
GDPs and therapists

Question 8

what are we listening for in primary care examinations?

Answer 8

patients concerns - e.g squint teeth, gummy smile
family concerns - not as important as patient themselves
social concerns - bullying, trauma

Question 9

what are we looking for in primary care examinations

Answer 9

teeth
- hypodontia, where about?
- teeth of poor prognosis e.g. 6s (MIH)/peg laterals
- tooth position e.g. crowding, spacing
- traumatic occlusion, e.g. mobility
soft tissues
- lip trap - trauma risk
gingival recession/stripping
facial bones
- jaw relationship
- jaw symmetry
- tmj

Question 10

what will be assessed in general practice and what will be assessed by an orthodontic specialist?

Answer 10

gdp
- listen to patient
- assess patients facial skeleton
- assess the patients gingival health (BPE)
- assess the patients oral hygiene
- assess the teeth: number, prognosis, position
orthodontist
- assess if the patient qualifies for tx (IOTN)
- arrange for special investigations
- come to a diagnosis

Question 11

what do we need to find out about the presenting complaint?

Answer 11

• what concerns the patient and why they’re attending?
• what motivates them to seek treatment intrinsic/extrinsic?
• how long have it bothered them, why now?
• have they had tx before?
• is the issue getting worse?
• is this affecting social life?
• what do they want to achieve?

Question 12

what MH components may effect orthodontic treatment?

Answer 12

-epilepsy and removable appliance (lessen chance of breakage during seizure)
- medication related to gingival overgrowth
- haemophilia - extraction?
- cooperation - e.g. Autistic spectrum disorder
- diabetes - infection risk
- asthma - candida risk

Question 13

what dental history is important to take?

Answer 13

• tx experience
  frequency of dental attendance
  caries history
  extraction history
• oral hygeine and diet
  oral hygiene regime
  sugar intake
• trauma history
  what injury was sustained
  when was the injury
  what treatment was carried out

Question 14

what social history is important to take?

Answer 14

• motivation
  parent and child
• habits
  tumb sucking, nail biting, pen chewing
• hobbies
  wind instruments, contact sports
• attendance
  are they regular?

Question 15

what is examined extra orally?

Answer 15

skeletal - the bony framework that supports the dental arches
soft tissues

Question 16

how should the skeletal pattern be examined?

Answer 16

patient should be upright in natural head position - if pt posturing use frankfort plane

teeth should be at rest in position of maximum intercuspation

3 planes:
anteroposterior
vertical
transverse

Question 17

how to examine the anteroposterior part of the skeletal pattern?

Answer 17

view the patient from the side
look at the relative position of the maxilla and mandible
palpate:
soft tissue A point
soft tissue B point

Question 18

skeletal pattern of the anteroposterior can be classified as 3 classes, what are they?

Answer 18

class I : mandible is 2-3 mm posterior to maxilla

class II : mandible is retruded relative to the maxilla

class III : mandible is protruded relative to the maxilla

Question 19

what are the 2 assessments of note for vertical plane of the skeletal pattern?

Answer 19

lower facial height
frankfort mandibular plane angle

Question 20

what is the lower facial height?

Answer 20

distance from the eyebrow to the base of the nose should equal the distance from the base of the nose to the lowermost point of the chin

Question 21

what is the frankfort mandibular plane angle?

Answer 21

look at the point of intersection between the mandibular plane and frankfort plane, they should intersect at the occiput

Question 22

the 2 tests for vertical plane of the skeletal pattern can be classified as what?

Answer 22

average
increased
reduced

Question 23

how is the transverse plane of skeletal pattern measured?

Answer 23

all faces are asymmetric to a small degree
view from the front and above (birdseye)
an occlusal plane asymmetry is easier t see if the patient bites onto a tongue spatula

Question 24

what are you looking out for in the lips?

Answer 24

form, tone and fullness
lip competence (do they meet at rest)
lower lip position relative to the upper incisors
lip trap
length of upper lip and amount of upper tooth shown

Question 25

what are tongue thrusts?

Answer 25

the motion of pushing your tongue forward, against the back of the teeth or between the top and bottom teeth, when swallowing, speaking or relaxing.

Question 26

what do habits such as thumb sucking cause?

Answer 26

increased OJ open bite posterior crossbites narrowing of upper arch

Question 27

what are the incisor relationships?

Answer 27

Class I Class II Class III

Question 28

what is a class I incisor relationship?

Answer 28

the lower incisor edges occlude with or lie below the cingulum plateau of the upper incisor

Question 29

what is a class II incisor relationship?

Answer 29

the lower incisor edges lie posterior to the cingulum plateau. 2 dubdivisions division 1 - the upper central incisors are proclined or of average inclination, and there is an increased overjet division 2 - the upper central incisors are retroclined and the overjet is usually minimal or may be increased

Question 30

what is a class III incisor relationship?

Answer 30

the lower incisor edges lie anterior to the cingulum pateau

Question 31

what are the molar relationship classes?

Answer 31

Class I Class II Class III

Question 32

what is a class I molar relationship?

Answer 32

the mesiobuccal cusp of the upper first molar occludes with the mesiobuccal groove of the lower first molar

Question 33

what is a class II molar relationship?

Answer 33

the mesiobuccal cusp occludes mesial to the groove

Question 34

what is a class III molar relationship?

Answer 34

the mesiobuccal cusp occludes distal to the groove

Question 35

what is the IOTN?

Answer 35

The Index of Orthodontic Treatment Needed

Question 36

what is the purpose of the IOTN?

Answer 36

to help determine the impact of a malocclusion on an individual's dental health and psychosocial well-being

Question 37

the IOTN compromises of 2 elements, what are they?

Answer 37

dental health component aesthetic component

Question 38

a dental health component score of what will receive treatment on the NHS?

Answer 38

4 or 5

Question 39

how do you figure out the dental health component of the IOTN?

Answer 39

the single worst feature of a malocclusion is noted and categorised into one of 5 grades reflecting the need for tx

Question 40

what are the grades of the dental health component?

Answer 40

grade 1 - no need grade 2 - little need grade 3 - moderate need grade 4 - great need grade 5 - very great need

Question 41

what acronym is used to identify the single worst feature to determinE the DHC?

Answer 41

M - missing teeth O - overjet C - crossbites D - displacement of contact points O - overbites

Question 42

what is used to help with the IOTN assessment?

Answer 42

IOTN ruler

Question 43

what is the IOTN aesthetic component?

Answer 43

this index assess the impact posed by a malocclusion and the likely psychological impact set of 10 standard colour photographs grades 1 to 10 (most to least aesthetically pleasing)

Question 44

what are the scores for the aesthetic component?

Answer 44

determine the need for treatment score 1 or 2 - no need score 3 or 4 - slight score 5, 6 or 7 - moderate/borderline score 8, 9 or 10 - definite

Question 45

why is the aesthetic component criticised?

Answer 45

for being subjective the photos are only composed of class I and II cases, not III

Question 46

what is a DPT used to assess?

Answer 46

overall assess missing teeth root morphology

Question 47

what is a lateral ceph used to assess?

Answer 47

indicates skeletal discrepancies incisor relationship soft tissues

Question 48

what is an upper anterior occlusal used to assess?

Answer 48

to investigate the position of an unerupted canine

Question 49

what is a CBCT scan used to assess?

Answer 49

3D assessment of dentition used for impacted teeth in the UK