Clinical Examination Lec 1

Lec.1 Orthodontics Dr.
Hussein Shakir
Clinical examination
An interview at first appointment includes a well-designed patient information

questionnaire: - The name of the patient his address, telephone number, and the
age and by whom he is referred. All these information considered at the first
attachment and conversation with the patient from which we can discover
the pronunciation of the patient whether it is normal or not, and
it represents a simple discussion with the patient to give a general impression
about his mentality. All of these information are important in diagnosis and
treatment planning.
The address:
The address of the patient can share in the type of the orthodontic spring design
used in treatment. For patient living in a far distance from the dentist usually a
supported type of springs is preferable on the ordinary type "self-supported".
Because the rate of activation of this springs are more than the self-supported
springs and this will allow a longer period of appointment is given to the patient.
The age:
The age of the patient is a vital subject in the planning of the orthodontic
treatment:
 If the patient’s age is (one) day?!! Now: what can we do for this patient? Of
course NO THING; but if the patient has a cleft lip and palate, then a
baby plate is important to help the baby in feeding and in orthopedic treatment
for the deformed maxilla.
 A patient at four years of age, he is in the deciduous period of dentition,
what are the types of orthodontic treatment that we can be applied?
-The first and the most important one is: interceptive treatment: which include
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the filling of carious teeth especially Cl.II carious lesion because these
carious lesions will lead to future extraction of these teeth and in the same time
lead to closing of spaces that is present and at the future the available
room for the permanent dentition will be reduced.
- We can treat any premature contact as ex: presence of cross bite (especially
anterior cross bite) and from this respect we will prevent the mandibular
displacement and hence the prevention of unduly problems.
- At the age of four years genetically determined CI III can be observed by the
presence of negative over-jet or by mandibular prognatisim. For such patient, we
can begin with the use of "chin-cap" to prevent the further growth of the
mandible and this will be converted to other direction.
 Another example: suppose you have a patient at 8 years of age. What can you
do for this patient?
- At this period the interceptive treatment continued because the patient is in the
mixed dentition period and in the same time if there is a cross bite, it is
preferable to be corrected, but; a new treatment can be initiated at this age at
about 8 1/2 years which is the serial extraction. So, if there is a crowding at the
upper or lower anterior segment which is more than 6mm, it can be resolved by
the first stage of serial extraction which includes the extraction of (C.es ) .
- Another treatment can be initiated which is the functional appliances,
especially; if the patient with Cl II or Cl III malocclusion. The functional
appliances will provide a good correlation for the skeletal bases in addition to
the dental problems.
- Any presence for the supernumerary teeth should be treated at this age, and if
there is delay in the eruption of the incisors should be checked by X- ray to
exclude the presence of any supernumerary tooth usually tuberculated type.
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 A patient at 15 years of age, at this age:
- All the permanent teeth were erupted, except the third molar, in this period of
age, it is difficult / or not wise to use the serial extraction or the functional
appliances, since the patient passed the maximum growth spurt, so; the question
is: What we can do for this patient? Fixed orthodontic appliances usually used in
cases that require rotation of (90˚), impaction, true intrusion, extrusion, bodily
movement, uprightening and torqueing.
- The removable appliances can be used for the cases that requires tipping tooth
movement, rotation less than 90˚, cross- bite : either anterior or posterior
dental cross- bite , and also for the treatment of labially (i.e mesio-buccal)
inclined canines .
Referred by:
The referred of the patient can give us a good impression about the patient co-
operation, if the patient attend the dentist by himself for orthodontic treatment,
therefore a good co-operation from the patient will be expected, but any patient
pushed for orthodontic treatment by his friends or parents, a poor co- operation
will be expected.
The success of orthodontic treatment depends on three factors: the proper
diagnosis and treatment planning of the orthodontist and the correct follow up of
the case and the good co-operation of the parents to follow up their child, the co-
operation of the patient himself.
Medical history:
The patient should be questioned if he has ever been hospitalized and, if so, for
what reason. For prospective orthodontic patients, a specific question as to
whether the patient has had tonsillectomy, adenoidectomy, or both. This may be
a clue that the patient had an earlier airway problem, which might have affected
jaw and tongue posture. Sometimes the admission to the hospital was the result
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of trauma, and it is important to know whether the jaws, face, or teeth were
involved.
The next issue that must be considered is whether the patient is taking any
medications as phenytoin which used in management of Epilepsy may impede
orthodontic treatment.
In adults being treated for arthritis or osteoporosis, high doses of prostaglandin
inhibitors or resorption-inhibiting agents may impede orthodontic tooth
movement.
Chief complaints:
The patient’s chief complaint should be recorded in his or her own words. This
helps the clinician in identifying the priorities & desires of the patient. Most
patients seek orthodontic care for the reasons of either esthetic or impaired
function.

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Lec.1 Orthodontics Dr.

An interview at first appointment includes a well-designed patient information

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