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patient assessment Flashcards

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1
Q

parts of ortho pt assessment

A 
history
EO assessment
IO assessment
summary
problem list
tx aims
tx plan
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2
Q

whats the ideal occlusion/ gold standard

A

Andrew 6 keys (1972)

  1. Molar relationship: the distal surface of the DB cusp of the U FPM occludes with the mesial surface of the MB cusp of L. 7.
  2. Crown angulation - mesio-distal tip
  3. crown inclination
  4. no rotations
  5. no spaces
  6. flat occlusal planes
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3
Q

C/O- aspect

A

RFA - specific thing?
level of concern
is pt concerned?
appearance
dental health
fct

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4
Q

aspects of MH that can affect ortho

A

epilepsy - avoid URAs
Recurrent aphthous ulcer - tend to manage
diabetes - diet
bisphosphonates - slow tooth movements and ext risk
latex allergy
Nickel allergy - NiTi arch wire ( not on the surface)

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5
Q

DH

A 
regular attender?
prev tx - coped?
caries risk - stabilise
prev ortho? - avoid retx if possible - RR
history of trauma - RR
OH
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6
Q

what habits are important to note in the history?

A

digit sucking
lower lip sucking
tongue thrust
nail biting

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7
Q

features of lip sucking

A

retroclination L incisors

eczematous appearance L lip

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8
Q

SH

A

prior knowledge from friends/siblings?
can they commit to tx - exams, travel, parents/work
wind instruments - can still play but will be more difficult

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9
Q

occlusal features of a digit sucking habit

A

proclination U incisors
retroclination L incisors
localised AOB or incomplete OB
narrow upper arch +/- unilateral posterior CB

but superimposed on existing skeletal pattern and incisor relationship

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10
Q

EO assessment

A

skeletal pattern - AP, V, T
STs
TMJ

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11
Q

ways of assessing AP skeletal pattern

A

visual
palpate skeletal bases
lateral cephalogram

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12
Q

how should the head be positioned for visually assessing the AP skeletal pattern?

A

Frankfort plane parallel to floor

natural head posture

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13
Q

AP class 1

A

mandible 2-3mm behind maxilla

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14
Q

AP class 2

A

mandible >3mm behind maxilla

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15
Q

AP class 3

A

mandible <2mm or in front

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16
Q

ways of assessing V skeletal pattern

A

FMPA
vertical facial proportions
lat ceph

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17
Q

how to assess FMPA clinically

A

Frankfort and mandibular planes

meet at occiput ideally

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18
Q

how to assess FMPA radiographically

A

porion to orbitale = Frankfort plane
gonion to menton = mandibular plane
meet at occiput ideally

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19
Q

landmarks for clinical vertical facial proportions

A

glabella
subnasale
menton

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20
Q

clinical vertical facial ideal proportions

A

50 %
glabella -subnasale / subnasale - menton

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21
Q

landmarks for cephalometric vertical facial proportions

A

nasion
Ant nasla spine
menton

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22
Q

cephalometric vertical facial ideal proportions

A

UAFH 45%

LAFH 55%

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23
Q

transverse skeletal pattern

A

assess symmetry
reference: mid sagittal reference line/ interpupillary line
view from front and above
occlusal cant?

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24
Q

ST features to assess

A

lips
- competent
- trap
- lower lip level & activity

tongue
- position
- habitual
- swallowing

nasolabial angle
smile line

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25
competent lips
meet together at rest with relaxed mentalis muscle
26
lip form
full/thin
27
lip tonicity
hyperactive or little tone
28
what group of patients often have hyperactive lip tonicity?
class 2 div 2 - will retrocline L incisors
29
nasolabial angle
angle formed by tangents to the U lip and columella of the nose
30
what does the nasolabial angle indicate?
upper lip position
31
increased nasolabial angle
protrusive - good for ext
32
average nasolabial angle
100
33
decreased nasolabial angle
retrusive - avoid ext if possible
34
normal smile line
show whole height of U incisors with only the IP gingivae visible at rest lips apart 3-4mm incisal tooth show
35
what are tongue thrusts usually and why?
adaptive (secondary) | to achieve an anterior oral seal when swallowing (AOB)
36
what is the problem with endogenous (primary) tongue thrusts?
harder to treat and more likely to relapse
37
TMJ assessment
ask re symptoms palpate as open/closed and lateral movements note any clicks/crepitus/locking note range of movement inc max opening if symptoms examine MofM
38
can tooth position/appliances cause TMD?
no evidence
39
parts of IO examination
general overview arches in isolation teeth in occlusion
40
features of IO general overview
chart erupted teeth poor prognosis - need stabilisation before tx OH tooth quality - note any **decal areas** PD condition toothwear - sort erosion
41
how can PD condition affect ortho tx?
can accelerate recession | prev loss of support can give **more chance of relapse** post-tx
42
features of assessing the arches in isolation
crowded/aligned/spaced | incisors - proclined/average/retroclined
43
mild degree of crowding
<4mm space short in one arch
44
moderate degree of crowding
4-8mm space short in one arch
45
severe degree of crowding
>8mm space short in one arch
46
methods to assess the degree of crowding
space available/space required overlap technique (of contact points)
47
methods to assess the degree of crowding - space available/space required
arch length or space available - M6 to D2, D2 to M1, M1 to D2, D2 to M6 sum of widths of teeth anterior to 6s (**premolars - premolars**)
48
methods to assess the degree of crowding - overlap technique
of contact points | add together
49
methods to assess the degree of crowding - mixed dentition analysis
``` need to use when permanent teeth still to erupt U arch need 22mm - 3 8mm - 4 7mm - 5 7mm L arch need 21mm - 3 7mm - 4 7mm - 5 7mm ```
50
incisor angulation
Frankfort plane to long axis of U incisor is about 110 degrees
51
things to assess when teeth in occlusion
``` incisor classification OJ OB centre lines molar relationship canine relationship crossbite mandibular displacement? ```
52
BSI class 1 incisors
lower incisor edges occlude with or lie immediately below the cingulum plateau of the U central incisors
53
BSI class 2 div 1 incisors
lower incisor edges lie posterior to cingulum plateau of upper central incisors. U centrals proclined or av inclination, increased OJ
54
BSI class 2 div 2 incisors
lower incisor edges lie posterior to cingulum plateau of U centrals U centrals retroclined OJ usually minimal but may be increased
55
BSI class 3 incisors
lower incisor edges lie anterior to cingulum plateau of U centrals OJ reduced or reversed
56
what is OJ
horizontal distance between the labial surface of the tips of the U incisors and the labial surface of the L incisors
57
measuring the OJ
teeth in ICP usually ruler held parallel to occlusal plane (horizontal) usually measure the greatest OJ on the most prominent U incisor
58
overbite
vertical overlap of the incisor teeth
59
describing OB
* average, increased or decreased * complete or incomplete * complete to tooth/ ST
60
average OB
where the U incisors overlap the incisal 1/2 to 1/3 of the crowns of the L incisors
61
complete / incomplete OB
only for increased OB - complete to tooth - complete to ST - incomplete
62
centre lines
``` look at rest and smiling describe U and L centre lines relative to - midline of face (ref point) - each other coincident, to right, to left look from above, behind and in front ```
63
whats the classification of buccal segment
- Angle's classification - class I, II, III
64
class 1 molars
**MB** cusp of U FPM occludes with **MB** groove of L FPM
65
class 2 molars
MB cusp of U FPM occludes anterior to MB groove of L FPM
66
class 3 molars
MB cusp of U FPM occludes posterior to the MB groove of L FPM
67
class 1 canines
U permanent canine occludes in the embrasure between the L permanent canine and L 4
68
class 2 canines
U permanent canine occludes anterior to the embrasure between the L permanent canine and L4
69
class 3 canines
U permanent canine occludes posterior to the embrasure between the L permanent canine and L4
70
assessing mandibular displacement
check if you see CB or centre line discrepancy check path of closure check for displacement - RCP/ICP discrepancy - curl tongue back as gradually close, stop when feel first tooth contact
71
assessing CB
describe teeth involved | check for mandibular displacement
72
kesling set ups
useful for pt to see | simulate position you think teeth will end up in
73
diagnostic records
``` radiographs study models Kesling set ups photographs sensibility tests CBCT ```
74
what radiograph could you use in ortho
- OPT - maxillary anterior occlusal - lateral cephalogram
75
indications for CBCT
UE teeth multidisciplinary cases bone for implants
76
when do you decide if radiographs are needed?
after clinical examination
77
what is always first in tx aims?
deal with pathology
78
what should be included at the end of the tx plan?
retention

Ortho (22 decks)

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