BOOK
Clinical Problem Solving in Orthodontics and Paediatric Dentistry E-Book
(2016)
Additional Information
Book Details
Abstract
Clinical Problem Solving in Orthodontics and Paediatric Dentistry, third edition, provides a unique step-by-step guide to differential diagnosis and treatment planning. The popular ‘Clinical Case’ format helps readers combine different dental procedures into a rational plan of treatment for patients who may have several dental problems requiring attention.
This is a third edition of a hugely successful practical resource in orthodontics and paediatric dentistry which is ideal for undergraduate dental students and postgraduates preparing for the MJDF and similar exams.
- Useful ‘Clinical Case’ format promotes a logical approach to problem solving through history taking, clinical examination and diagnosis
- Contains approximately 350 photographs, 50 line artworks and 40 tables
- Provides two different approaches to the Clinical Cases – some topics include scenarios with questions and answers; others include differential diagnosis with a focus on how to plan and manage treatment effectively
- ‘Key-point’ boxes systematically emphasise core knowledge, assessment and treatment approaches
- Useful Mind Maps® provide a focused framework for learning and revision
- Thoroughly updated text with over 140 new clinical images
- New orthodontic sections covering classification & definitions and referral guide, together with orthodontic problems – including implications of some medical problems, further information on CBCT and TADs, protraction headgear, management of non-nutritive sucking habits, retainer types, retainer problems and retainer first aid
- New authorship to paediatric dentistry section provides comprehensive text revision
- New paediatric dentistry Clinical Cases address behavioural problems in the child and adolescent, the treatment of children with learning difficulties and physical disability, as well as providing coverage of common medical problems in children and assessment of dental trauma
- Updated reading lists include Cochrane reviews
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Half title page | i | ||
| Dedication | ii | ||
| Clinical Problem Solving in Dentistry: Orthodontics and Paediatric Dentistry | iii | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface to the third edition | vii | ||
| Preface to the first edition | viii | ||
| Acknowledgements | ix | ||
| 1 Median diastema and ectopic eruption of an upper first permanent molar | 1 | ||
| Summary | 1 | ||
| History | 1 | ||
| Complaint | 1 | ||
| History of complaint | 1 | ||
| Medical history | 1 | ||
| Dental history | 1 | ||
| Family history | 1 | ||
| Examination | 1 | ||
| Extraoral examination | 1 | ||
| Intraoral examination | 1 | ||
| ■ What do you observe? | 1 | ||
| ■ What is the aetiology of the rotations? | 2 | ||
| ■ What are the possible causes of the upper median diastema? | 2 | ||
| ■ In the developing dentition, how is space created for the upper permanent incisor teeth? | 2 | ||
| Investigations | 2 | ||
| ■ What investigations would you undertake? Explain why. | 2 | ||
| Radiographic | 3 | ||
| ■ The dental panoramic tomogram is shown in Fig. 1.3. What do you notice? | 3 | ||
| Diagnosis | 3 | ||
| ■ What is the diagnosis? | 3 | ||
| ■ What is the IOTN DHC grade (see Appendix 1, p. 264)? Explain why. | 3 | ||
| ■ What treatment would you advise for the labial segment problems? Explain why. | 3 | ||
| ■ How common is impaction of 6? | 3 | ||
| ■ What are the causes of impaction of 6? | 3 | ||
| ■ Describe the clinical features of ectopic eruption of 6 and classification of this anomaly. | 3 | ||
| Treatment | 4 | ||
| ■ What treatment options are there for irreversible ectopic eruption of 6? | 4 | ||
| Without extraction of E | 4 | ||
| With extraction of E | 4 | ||
| ■ How will the orthodontist manage impaction of in this case? | 4 | ||
| Primary resources and recommended reading | 4 | ||
| 2 Unerupted upper central incisor | 5 | ||
| Summary | 5 | ||
| History | 5 | ||
| Complaint | 5 | ||
| History of complaint | 5 | ||
| ■ Is there anything else you would wish to elicit from the history? | 5 | ||
| Medical history | 5 | ||
| Examination | 5 | ||
| Extraoral examination | 5 | ||
| Intraoral examination | 5 | ||
| ■ The appearance of the mouth is shown in Figs 2.1 and 2.2. What do you notice? | 5 | ||
| ■ Why are the centrelines displaced? | 6 | ||
| ■ Could the lower centreline shift have been prevented? | 6 | ||
| ■ With unilateral loss of what other primary tooth, would you consider a balancing extraction to prevent a centerline shift? | 6 | ||
| ■ What are the possible causes of the unerupted ? | 6 | ||
| ■ How would you rate the likelihood in this case of each of the potential causes of unerupted listed in Box 2.1? | 6 | ||
| ■ What is the aetiology of supernumerary teeth? | 7 | ||
| Investigation | 7 | ||
| ■ What investigations are required? Explain why. | 7 | ||
| Clinical | 7 | ||
| Radiographic | 7 | ||
| ■ How would you determine the position of an unerupted tooth in the anterior premaxilla using vertical parallax? | 7 | ||
| ■ Neil’s radiographs are shown in Fig. 2.4. What do these show? | 7 | ||
| ■ Is there any other alternative radiographic investigation you might consider? If so, why? | 8 | ||
| Diagnosis | 8 | ||
| ■ What is your diagnosis? | 8 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 8 | ||
| Treatment | 8 | ||
| ■ What are your aims of treatment? | 8 | ||
| ■ What is your treatment plan? | 8 | ||
| ■ How may space be created for ? | 9 | ||
| ■ Are there any advantages to use of an upper removable appliance over a fixed appliance in this case and at this stage? | 9 | ||
| ■ What design of upper removable appliance would you use to achieve the desired tooth movements? | 9 | ||
| ■ Will an upper removable appliance achieve all the treatment objectives? | 9 | ||
| ■ What is the recommended root filling material for during orthodontic tooth movement? | 9 | ||
| ■ Does orthodontic tooth movement pose any risk to ? | 9 | ||
| ■ Are there any precautions you would take during orthodontic treatment to minimize this risk? | 9 | ||
| ■ How would you ensure long-term stability of following alignment? | 10 | ||
| Primary resources and recommended reading | 10 | ||
| 3 Absent upper lateral incisors | 11 | ||
| Summary | 11 | ||
| History | 11 | ||
| Complaint | 11 | ||
| History of complaint | 11 | ||
| Medical history | 11 | ||
| Dental history | 11 | ||
| Family history | 11 | ||
| Social history | 11 | ||
| ■ How will her instrument playing impact on orthodontic treatment? | 11 | ||
| Examination | 11 | ||
| Extraoral | 11 | ||
| Intraoral | 11 | ||
| ■ The intraoral views are shown in Figs 3.1 and 3.2. What do these show? | 11 | ||
| ■ What other clinic assessment would you undertake? | 12 | ||
| ■ What are the possible causes of the upper labial segment spacing? | 12 | ||
| ■ What is the most likely cause in this case? | 12 | ||
| Investigations | 12 | ||
| ■ What further investigations would you undertake? | 12 | ||
| Radiographic | 12 | ||
| ■ What genes have been linked to hypodontia? | 13 | ||
| ■ How would you rate the severity of the hypodontia? | 13 | ||
| ■ Are there other facial/dental/occlusal features associated with hypodontia? | 13 | ||
| Diagnosis | 13 | ||
| ■ What is your diagnosis? | 13 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 13 | ||
| Treatment | 13 | ||
| ■ What are the treatment options? | 13 | ||
| ■ What factors would you consider in deciding between space closure or space opening? | 13 | ||
| ■ Could treatment time have been shortened by an earlier interceptive measure? | 13 | ||
| ■ How could the upper buccal segments be moved distally using a removable appliance to achieve a Class I molar relationship? | 14 | ||
| ■ What force and duration of headgear wear is required for anchorage? | 14 | ||
| ■ What precautions must be adhered to when prescribing headgear? | 14 | ||
| ■ What design of upper removable appliance would you consider for these tooth movements? | 14 | ||
| ■ When space has been created for , what should be done? | 14 | ||
| ■ What design of resin-retained bridge is required? | 14 | ||
| ■ What additional factors would need to have been considered if replacement of 2’s by implants was the preferred plan? | 15 | ||
| Primary resources and recommended reading | 15 | ||
| 4 Crowding and buccal upper canines | 16 | ||
| Case 1 | 16 | ||
| Summary | 16 | ||
| History | 16 | ||
| Complaint | 16 | ||
| History of complaint | 16 | ||
| Medical history | 16 | ||
| ■ What are the implications for orthodontic treatment with asthma? | 16 | ||
| Dental history | 16 | ||
| Examination | 16 | ||
| Extraoral | 16 | ||
| ■ Would you be concerned by the mild facial asymmetry? | 16 | ||
| Intraoral | 16 | ||
| ■ Gemma’s intraoral views are shown in Figs 4.1 and 4.2. What do you notice? | 16 | ||
| ■ What are the possible reasons for 3’s erupting buccally? | 17 | ||
| Investigations | 17 | ||
| ■ What investigations would you request and why? | 17 | ||
| ■ Gemma’s dental panoramic tomogram is shown in Fig. 4.3. What do you notice? | 17 | ||
| Diagnosis | 17 | ||
| ■ What is your diagnosis? | 17 | ||
| ■ What is the IOTN DHC grade and why (see p. 264)? Explain why. | 17 | ||
| Treatment | 17 | ||
| ■ What treatment is likely to be required in this case? Explain why. | 17 | ||
| ■ What would you do now? | 18 | ||
| ■ What aims of treatment do you think will be proposed by the orthodontist? | 18 | ||
| ■ Describe how you would approach treatment planning. | 18 | ||
| ■ What possible means are there of creating space? | 18 | ||
| ■ What factors govern the choice of extraction? | 18 | ||
| ■ Why are first premolars commonly chosen for extraction? | 18 | ||
| ■ What is the final orthodontic treatment plan likely to be? | 19 | ||
| ■ What risks should the patient be warned of regarding fixed appliance orthodontic treatment? | 19 | ||
| ■ Gemma’s final occlusion is shown in Fig. 4.5. What undesirable sequelae of treatment are visible? | 19 | ||
| ■ How common is this with fixed appliance therapy and which teeth are affected mostly? | 19 | ||
| ■ How may the problem be prevented or minimized? | 19 | ||
| ■ How may these ‘white spots’ be managed? | 19 | ||
| Case 2 | 20 | ||
| Summary | 20 | ||
| ■ How would you deal with the history of a possible nickel allergy? | 20 | ||
| ■ How common is nickel allergy? | 20 | ||
| ■ What implications does a nickel allergy have for orthodontic management? | 20 | ||
| ■ What do you notice on the radiographs shown in Fig. 4.6? | 20 | ||
| ■ Where is located? Explain how this assessment is made and your reasoning. | 20 | ||
| ■ What do you notice in Fig. 4.7? | 20 | ||
| ■ What are the aims of treatment? | 20 | ||
| ■ What types of surgical exposure are there for a buccally positioned canine? | 21 | ||
| ■ How may be aligned? | 21 | ||
| Case 3 | 21 | ||
| Summary | 21 | ||
| ■ What do you notice in Fig. 4.10? | 21 | ||
| ■ Is it possible to make a reliable assessment of the incisor inclination to the underlying dental bases from intraoral images of the dentition in occlusion? | 21 | ||
| ■ What clinical assessment should you undertake of ? | 22 | ||
| Investigations | 22 | ||
| ■ The patient presented with a dental panoramic radiograph taken 6 months previously by her general dental practitioner. What radiographic investigations would you request and why? | 22 | ||
| ■ What is your interpretation of the following cephalometric findings? | 22 | ||
| Diagnosis | 23 | ||
| ■ What is your orthodontic diagnosis? | 23 | ||
| ■ What is the IOTN DHC grade? Explain your reasoning. | 23 | ||
| Treatment | 23 | ||
| ■ What are your aims of treatment? | 23 | ||
| ■ What possible options are there to relieve the upper arch crowding and correct the upper centreline? | 23 | ||
| ■ What appliance is shown in Fig. 4.11A? How is it constructed and how is it activated? | 23 | ||
| ■ What is the most likely initial aligning archwire shown in Fig. 4.11C? What favourable properties has it got for alignment? | 23 | ||
| ■ How would you re-evaluate treatment progress following upper arch expansion and alignment? | 23 | ||
| ■ When is mandibular growth completed? | 24 | ||
| ■ What will determine whether the correction remains stable? | 24 | ||
| Primary resources and recommended reading | 24 | ||
| 5 Severe crowding | 25 | ||
| Case 1 | 25 | ||
| Summary | 25 | ||
| History | 25 | ||
| Complaint | 25 | ||
| History of complaint | 25 | ||
| Medical history | 25 | ||
| ■ What implications does the medical history have for any proposed orthodontic treatment? | 25 | ||
| Dental history | 25 | ||
| Examination | 25 | ||
| Extraoral | 25 | ||
| Intraoral | 25 | ||
| ■ The intraoral views are shown in Figs 5.1 and 5.2. Describe what you see. | 25 | ||
| ■ What is the likely cause of the enamel hypoplasia on ? | 26 | ||
| ■ What are the likely causes of the severe upper arch crowding? | 26 | ||
| ■ What factors influence the rate of space loss following early loss of a primary molar? What are the effects of early loss of a primary molar? | 26 | ||
| ■ What are the likely causes of the upper premolar rotations? | 27 | ||
| Investigations | 27 | ||
| ■ What investigations would you request and why? | 27 | ||
| Diagnosis | 27 | ||
| ■ What is your diagnosis? | 27 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 27 | ||
| Treatment | 27 | ||
| ■ What are the aims of treatment? | 27 | ||
| ■ What is your treatment plan? | 27 | ||
| ■ Explain the treatment options for Amy’s severe upper arch crowding and moderate to severe lower arch crowding. What are the implications of each option? | 27 | ||
| ■ How would you assess the space required in the upper arch? | 27 | ||
| ■ Is this sufficient to achieve the treatment objectives? | 27 | ||
| ■ Finalize your treatment planning. | 28 | ||
| ■ What is the final orthodontic treatment plan? | 28 | ||
| ■ If an upper removable appliance space maintainer were to be considered, what would be your design? What instructions would you issue regarding appliance wear? | 28 | ||
| ■ Describe the alternatives to this appliance. | 28 | ||
| ■ If all the space from lower premolar extractions had been required for lower labial segment alignment, how could anchorage have been reinforced there? | 29 | ||
| ■ How effective are TADs at reinforcing anchorage? How do they compare to other methods of anchorage reinforcement? | 29 | ||
| ■ Are there any risks with TADs? | 29 | ||
| ■ If Amy were issued an upper removable space maintainer with headgear support, how would you know at her 2-week review whether the appliances were being worn as instructed? | 29 | ||
| ■ What is an Essix retainer, and what are its potential advantages over a Hawley retainer in the upper arch? Aside from the usual advice regarding retainers, what specific advice should the patient be given regarding this retainer? | 29 | ||
| Case 2 | 30 | ||
| Summary | 30 | ||
| ■ What do you notice in Fig. 5.6? | 30 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 30 | ||
| ■ What are the possible causes of the crowding and tooth displacements in the upper and lower arches? | 30 | ||
| ■ Why has rotated mesiopalatally? | 30 | ||
| ■ What is unusual about the eruption pattern in the lower arch? | 30 | ||
| ■ What is the likely cause of the lower centreline shift? | 30 | ||
| Investigations | 31 | ||
| ■ A dental panoramic tomogram (DPT) was taken by Roger’s previous dental practitioner a few months ago. You request this by email. What do you notice in Fig. 5.7? | 31 | ||
| ■ Do you require any further radiographs? | 31 | ||
| Diagnosis | 32 | ||
| ■ What is your diagnosis? | 32 | ||
| Treatment | 32 | ||
| ■ What are your aims of treatment? | 32 | ||
| ■ What is your treatment plan? | 32 | ||
| ■ How could the crossbite be corrected on and be derotated? | 32 | ||
| ■ Is there another option you could consider to address his wishes? | 32 | ||
| Case 3 | 32 | ||
| Summary | 32 | ||
| ■ What do you notice in Fig. 5.9? | 32 | ||
| ■ What should you check for with the crossbite on the 2’s? | 32 | ||
| ■ What is the likely cause of the upper and lower arch crowding? | 32 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 33 | ||
| Investigations | 33 | ||
| ■ What investigations would you request and why? | 33 | ||
| ■ How would you assess the long term prognosis of ? | 33 | ||
| ■ What is your interpretation of the cephalometric findings? | 34 | ||
| Diagnosis | 34 | ||
| ■ What is your diagnosis? | 34 | ||
| Treatment | 34 | ||
| ■ What are the aims of treatment? | 34 | ||
| ■ If is removed in view of its guarded prognosis, what implications will that have for treatment and the final outcome? | 34 | ||
| ■ What is your treatment plan? | 34 | ||
| ■ How may anchorage be reinforced in the upper and lower arches? | 34 | ||
| ■ Are there any means by which anchorage demands may be reduced in the upper arch? | 34 | ||
| ■ Does this option have any other potential benefits? Are there any risks? | 34 | ||
| Primary resources and recommended reading | 35 | ||
| 6 Palatal canines | 36 | ||
| Case 1 | 36 | ||
| Summary | 36 | ||
| History | 36 | ||
| History of complaint | 36 | ||
| Medical history | 36 | ||
| Dental history | 36 | ||
| Examination | 36 | ||
| Extraoral | 36 | ||
| Intraoral | 36 | ||
| ■ The intraoral views are shown in Figs 6.1 and 6.2. Describe what you see. | 36 | ||
| ■ What are the potential causes of C’s being retained? | 36 | ||
| ■ What factors are implicated in palatal canine ectopia? | 36 | ||
| ■ What is the prevalence of TSD, and which teeth are most commonly affected? | 37 | ||
| ■ How would you assess for a TSD? | 37 | ||
| Quick-check method | 37 | ||
| Computational method | 37 | ||
| ■ What are the implications of a TSD? | 38 | ||
| Investigations | 38 | ||
| ■ What investigations would you undertake regarding the retained C’s? Explain why. | 38 | ||
| Clinical | 38 | ||
| Radiographic | 38 | ||
| ■ Does CBCT have any other uses in orthodontics aside from assisting with the localization of unerupted teeth and any associated pathology? | 38 | ||
| ■ How does the radiation dose from CBCT compare with that of a DPT? | 38 | ||
| ■ Are there any other disadvantages to CBCT in orthodontics? | 39 | ||
| ■ Diane’s DPT and upper anterior occlusal radiograph are shown in Fig. 6.4. What are the features of note? | 39 | ||
| ■ How may palatal ectopia of 3 be intercepted? | 39 | ||
| ■ How strong is the evidence to support extraction of C’s as an interceptive measure for palatally displaced canines? | 39 | ||
| Diagnosis | 40 | ||
| ■ What is your diagnosis? | 40 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 40 | ||
| Treatment | 40 | ||
| ■ What management options are there for Diane’s unerupted 3’s? What are the indications for each option? | 40 | ||
| ■ Which option would you favour? | 40 | ||
| ■ What are the ideal aims of treatment? | 40 | ||
| ■ How would you proceed with treatment? | 41 | ||
| ■ Detail the design of a suitable removable appliance. | 41 | ||
| Retention | 41 | ||
| Anchorage | 41 | ||
| Baseplate | 41 | ||
| ■ What instructions would you give the patient regarding turning of the screw? | 41 | ||
| ■ When the crossbites on have been corrected, what would you do? | 41 | ||
| ■ What methods of surgical exposure are there? | 41 | ||
| ■ What is the evidence regarding open versus closed exposure of palatally displaced 3’s? | 41 | ||
| ■ How may the 3’s be aligned? | 41 | ||
| ■ What factors may you consider for retaining 3’s in their corrected positions? | 41 | ||
| Case 2 | 42 | ||
| Summary | 42 | ||
| ■ The intraoral views at presentation are shown in Fig. 6.6 and the radiographs in Fig. 6.7. Describe what you see. | 42 | ||
| ■ What risk factor is evident for 3 being palatal? | 42 | ||
| ■ What aspects of Class II division 2 malocclusion have been proposed as predisposing to this risk? | 42 | ||
| ■ Is the position of favourable for orthodontic alignment? | 42 | ||
| ■ What other investigations would you require for treatment planning? | 42 | ||
| ■ What is your interpretation of the following cephalometric findings? | 42 | ||
| ■ What is your diagnosis? | 42 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 42 | ||
| Treatment | 42 | ||
| ■ What are your aims of treatment? | 42 | ||
| ■ How would you relieve lower and upper arch crowding? | 42 | ||
| ■ How could you create space for alignment? | 44 | ||
| ■ When should be surgically exposed? | 44 | ||
| ■ What procedure would you prefer? | 44 | ||
| ■ How may be brought across the occlusion? | 44 | ||
| ■ What are the advantages of nickel–titanium archwires in alignment? | 45 | ||
| ■ What type of retainer would you consider? | 45 | ||
| Primary resources and recommended reading | 45 | ||
| 7 More canine problems | 46 | ||
| Cases 1 and 2 | 46 | ||
| Summary | 46 | ||
| ■ What do you notice in Fig. 7.1? | 46 | ||
| ■ What do you notice in Fig. 7.2? | 46 | ||
| ■ What is the term used to describe the anomaly in position of the canine teeth? How common is this? | 46 | ||
| ■ Which arch and which teeth are affected mostly? Is there a gender difference in incidence? | 47 | ||
| ■ What is the aetiology of this anomaly? | 47 | ||
| ■ Could you classify this anomaly? | 47 | ||
| ■ What factors would you consider in treatment? | 47 | ||
| ■ What are the treatment options? | 47 | ||
| ■ How would you manage Case 1 and Case 2? | 47 | ||
| ■ What appliance type will be required? Explain why. | 47 | ||
| ■ How would you check that the positions of the corrected transposed teeth are optimal? | 48 | ||
| Case 3 | 48 | ||
| Summary | 48 | ||
| ■ What do you notice in Fig. 7.5? | 48 | ||
| ■ Why are radiographs requested? | 48 | ||
| ■ What do you notice on the radiographs (Fig. 7.6)? | 48 | ||
| ■ What is the most likely cause of root resorption of the incisors? | 49 | ||
| ■ What is the incidence of root resorption of 2’s by ectopic 3’s? What sites are most commonly affected? Is there a gender predilection? | 49 | ||
| ■ How accurate is the information regarding resorption of 2’s from the radiographs? | 49 | ||
| ■ How may more detailed information regarding 2’s resorption be obtained? | 49 | ||
| ■ What other investigations would you do in relation to 2’s? | 49 | ||
| ■ What are the treatment options in relation to 2’s? | 49 | ||
| ■ How would you minimize and monitor resorption of the upper incisors during orthodontic treatment? | 50 | ||
| ■ What is the short- to medium-term prognosis of with the markedly resorbed root? | 50 | ||
| Primary resources and recommended reading | 50 | ||
| 8 Infraoccluded primary molars | 51 | ||
| Summary | 51 | ||
| History | 51 | ||
| Complaint | 51 | ||
| History of complaint | 51 | ||
| Medical history | 51 | ||
| ■ What implications does this have for her management? | 51 | ||
| Dental history | 51 | ||
| Family history | 51 | ||
| Examination | 51 | ||
| Extraoral examination | 51 | ||
| Intraoral examination | 51 | ||
| ■ What do you see? | 51 | ||
| ■ What is the prevalence of infraocclusion of primary molars? | 51 | ||
| ■ What is the aetiology of infraocclusion of primary molars? Is it linked to any other anomalies? | 51 | ||
| ■ Why does infraocclusion of primary molars occur? | 52 | ||
| Investigations | 52 | ||
| ■ What investigations would you undertake? Explain why. | 52 | ||
| Radiographic | 52 | ||
| ■ The dental panoramic tomogram is shown in Fig. 8.3. What are the findings of note? | 52 | ||
| ■ What is the prevalence of hypodontia in the permanent dentition? Which teeth and gender does hypodontia affect most commonly? | 52 | ||
| ■ What do these values tell you (see p. 270)? | 53 | ||
| Diagnosis | 53 | ||
| ■ What is your diagnosis? | 53 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 53 | ||
| Treatment | 53 | ||
| ■ What treatment options are there for the lower arch? Explain why. | 53 | ||
| ■ What implications do these options have for the upper arch? | 53 | ||
| ■ What type of fixed appliance is shown in Fig. 8.4? What means are there to close premolar extraction spaces with this appliance type? What method is most effective? | 53 | ||
| ■ If had been present radiographically, what would have been your treatment plan? | 54 | ||
| Primary resources and recommended reading | 54 | ||
| 9 Increased overjet | 55 | ||
| Summary | 55 | ||
| History | 55 | ||
| Complaint | 55 | ||
| History of complaint | 55 | ||
| ■ Is teasing the same as bullying? | 55 | ||
| ■ How common is bullying among school children? What influence do prominent teeth have, and does bullying have any long-term consequences? | 55 | ||
| ■ What is the risk of trauma with an increased overjet? | 55 | ||
| ■ What is the significance of the history of teasing and incisor trauma? | 55 | ||
| Medical history | 55 | ||
| Examination | 55 | ||
| Extraoral | 55 | ||
| ■ How would you assess Emma’s skeletal pattern? | 55 | ||
| Intraoral | 56 | ||
| ■ The intraoral views are shown in Figs 9.1 and 9.3. What do these show? | 56 | ||
| ■ What are the causes of an increased overjet? | 56 | ||
| Investigations | 57 | ||
| ■ What radiographs are indicated? | 57 | ||
| ■ What do these indicate (see p. 270)? | 57 | ||
| ■ What other important information regarding growth potential may be obtained from the lateral cephalometric film? How is this assessed? | 57 | ||
| ■ How valid and reliable is the CVM index? | 57 | ||
| ■ Would you consider any other investigations? | 57 | ||
| Diagnosis | 57 | ||
| ■ What is the diagnosis? | 57 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 58 | ||
| Treatment | 58 | ||
| ■ What factors other than increased overjet predispose to upper incisor trauma? | 58 | ||
| ■ What are the aims of treatment? | 58 | ||
| ■ What treatment would you advise? Explain why. | 58 | ||
| ■ Should Emma have been treated earlier? What evidence is available regarding this? | 58 | ||
| ■ What types of functional appliances are there? Which is the most popular? | 58 | ||
| ■ Describe the records you would take to allow fabrication of a Twin-Block appliance? | 58 | ||
| ■ On issuing the Twin-Block appliance, what instructions would you give Emma? | 58 | ||
| ■ How does a Twin-Block work and what effects does it produce? | 59 | ||
| Skeletal (~20–30%) | 59 | ||
| Dentoalveolar (~70–80%) | 59 | ||
| ■ How do the effects produced by a Twin-Block appliance differ from those of other functional appliances? | 59 | ||
| ■ Following overjet correction by Twin-Block therapy, what occlusal anomaly is usually manifest posteriorly in the dental arches? | 59 | ||
| ■ How may this be corrected? | 59 | ||
| ■ If there is no progress at 6 months, what action would you take? | 60 | ||
| ■ What other treatment options are there? | 60 | ||
| ■ What factors govern stability of the corrected overjet? | 60 | ||
| Primary resources and recommended reading | 61 | ||
| 10 Incisor crossbite | 62 | ||
| Summary | 62 | ||
| History | 62 | ||
| Complaint | 62 | ||
| History of complaint | 62 | ||
| Medical history | 62 | ||
| Dental history | 62 | ||
| Examination | 62 | ||
| Extraoral | 62 | ||
| Intraoral | 62 | ||
| ■ What features are visible on the intraoral views (Figs. 10.1 and 10.2)? | 62 | ||
| ■ What is the prevalence of anterior crossbite reported in the literature? | 63 | ||
| ■ What specific features would you check? Explain why. | 63 | ||
| Investigations | 63 | ||
| ■ What special investigations would you request? Why? | 63 | ||
| ■ The dental panoramic tomogram taken 6 months prior to this visit is shown in Fig. 10.3. What does it show? | 63 | ||
| Diagnosis | 64 | ||
| ■ What is your diagnosis? | 64 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 64 | ||
| ■ What would you deem to be the prognosis for the labial recession related to ? | 64 | ||
| ■ Why is in crossbite? | 64 | ||
| Treatment | 64 | ||
| ■ What treatment would you provide and why? | 64 | ||
| ■ Describe the appliance design you would use to align . | 64 | ||
| ■ What will determine stability of crossbite correction on ? | 64 | ||
| ■ What other treatment possibilities are there? What evidence is there in relation to their effectiveness? | 64 | ||
| Primary resources and recommended reading | 65 | ||
| 11 Reverse overjet | 66 | ||
| Case 1 | 66 | ||
| Summary | 66 | ||
| History | 66 | ||
| Complaint | 66 | ||
| History of complaint | 66 | ||
| Medical history | 66 | ||
| Family history | 66 | ||
| Examination | 66 | ||
| Extraoral | 66 | ||
| ■ What other features would you check for? | 66 | ||
| Intraoral | 66 | ||
| ■ What are your observations from the intraoral views (Figs 11.1 and 11.3)? | 66 | ||
| ■ What are the possible causes of the reverse overjet? | 67 | ||
| ■ What radiographic investigations would you request and why? | 67 | ||
| ■ What is your interpretation of the following cephalometric findings? | 67 | ||
| Diagnosis | 67 | ||
| ■ What is your orthodontic diagnosis? | 67 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 67 | ||
| ■ What dental health reasons are there for orthodontic treatment? | 67 | ||
| ■ What factors would you assess in orthodontic treatment planning? | 67 | ||
| Treatment | 67 | ||
| ■ What orthodontic treatment would you undertake and why? | 67 | ||
| ■ How would you take a wax registration for this appliance? | 68 | ||
| ■ How much should Alistair wear this appliance? | 68 | ||
| ■ What effects will this appliance have? | 68 | ||
| ■ What other treatment options are there? | 68 | ||
| Prognosis | 69 | ||
| ■ What factors will influence stability of the corrected incisor relationship? | 69 | ||
| Case 2 | 69 | ||
| Summary | 69 | ||
| History | 69 | ||
| History of complaint | 69 | ||
| Medical history | 69 | ||
| Dental history | 69 | ||
| Examination | 69 | ||
| Extraoral | 69 | ||
| ■ What do you notice in Fig. 11.6? | 69 | ||
| ■ What radiographic investigations would you request and why? | 69 | ||
| ■ As Daniel is of mixed-race origin, how valuable would cephalometric data be? | 70 | ||
| ■ What is your interpretation of the following cephalometric findings? | 70 | ||
| Diagnosis | 70 | ||
| ■ What is your diagnosis? | 70 | ||
| Treatment | 70 | ||
| ■ What treatment would you consider? Explain why? | 70 | ||
| ■ What is the design of the protraction headgear appliance? | 70 | ||
| ■ How does this work? | 71 | ||
| ■ What effects does it have? | 71 | ||
| ■ Does treatment pose any risk to the jaw joints? Are there any psychological benefits? | 71 | ||
| ■ How successful is facemask treatment for Class III malocclusion in the short term? | 72 | ||
| ■ What is the long-term success rate of this treatment? | 72 | ||
| ■ Are there any alternatives to facemask treatment that may produce the same, or greater, outcome? | 72 | ||
| ■ What are the advantages and disadvantages of BAMP? | 72 | ||
| Primary resources and recommended reading | 72 | ||
| 12 Increased overbite | 73 | ||
| Case 1 | 73 | ||
| Summary | 73 | ||
| History | 73 | ||
| Complaint | 73 | ||
| History of complaint | 73 | ||
| Medical history | 73 | ||
| Dental history | 73 | ||
| Family history | 73 | ||
| Examination | 73 | ||
| Extraoral | 73 | ||
| ■ Harry’s profile view is shown in Fig. 12.2. What do you notice about the anteroposterior skeletal pattern and the lips? | 73 | ||
| Intraoral | 73 | ||
| ■ The appearance of the mouth is shown in Figs 12.1 and 12.3. What do you see? | 73 | ||
| ■ What are the possible causes of the traumatic overbite? | 74 | ||
| ■ What further investigations would you undertake? | 74 | ||
| ■ What is your interpretation of the following cephalometric findings (see p. 270)? | 74 | ||
| Diagnosis | 75 | ||
| ■ What is your diagnosis? | 75 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 75 | ||
| Treatment | 75 | ||
| ■ What are your aims of treatment? | 75 | ||
| ■ How do you propose to achieve these aims? | 75 | ||
| ■ Describe the design of appliances you would use. | 75 | ||
| ■ What are the goals of the functional appliance treatment? | 75 | ||
| ■ Why may a later phase of fixed appliance therapy be required? | 76 | ||
| ■ What aspects of the corrected occlusion are prone to relapse? How may you try to prevent/minimize relapse? | 76 | ||
| Case 2 | 76 | ||
| Summary | 76 | ||
| Examination | 76 | ||
| Extraoral | 76 | ||
| ■ What do you notice in Fig. 12.5? | 76 | ||
| ■ What is your interpretation of the following cephalometric findings? | 77 | ||
| Diagnosis | 77 | ||
| ■ What is your diagnosis? | 77 | ||
| ■ What is the IOTN DHC grade (see Appendix A1)? Explain why. | 77 | ||
| ■ What is the aetiology of the deep overbite? | 77 | ||
| ■ What implications does the lower incisor inclination have on treatment planning? | 78 | ||
| ■ If a non-extraction, approach is adopted for the lower arch, what impact has this for the upper arch? | 78 | ||
| ■ What options are there to reduce the deep overbite? | 78 | ||
| Incisor intrusion | 78 | ||
| Molar eruption | 78 | ||
| Molar extrusion | 78 | ||
| Lower incisor proclination | 78 | ||
| Treatment | 78 | ||
| ■ What are the aims of treatment? | 78 | ||
| ■ How will these be achieved? | 79 | ||
| ■ Why may a non-extraction approach be favoured in Class II division 2 malocclusion? | 79 | ||
| ■ What other non-extraction options are there for the upper arch in Class II division 2 malocclusion? | 79 | ||
| ■ What guidance does the best current evidence provide regarding management of Class II division 2 malocclusion? | 79 | ||
| Primary resources and recommended reading | 80 | ||
| 13 Anterior open bite | 81 | ||
| Summary | 81 | ||
| History | 81 | ||
| Complaint | 81 | ||
| History of complaint | 81 | ||
| Medical history | 81 | ||
| Dental history | 81 | ||
| Examination | 81 | ||
| Extraoral | 81 | ||
| ■ Gerald’s facial profile is shown in Fig. 13.2. What do you notice? | 81 | ||
| ■ What other features should you assess? Explain why. | 81 | ||
| ■ What occlusal anomalies are associated with speech problems? Are the latter likely to resolve if any underlying malocclusion is treated? | 82 | ||
| Intraoral | 82 | ||
| ■ What other features do you see (Figs 13.1 and 13.3)? | 82 | ||
| ■ What are the possible causes of an anterior open bite? | 82 | ||
| ■ How common are non-nutritive sucking habits (NNSHs) in children? | 83 | ||
| ■ Do NNSHs always produce a malocclusion? | 83 | ||
| ■ What are the effects of protracted pacifier use or a persistent digit-sucking habit on the occlusion other than creating an anterior open bite? | 83 | ||
| Investigations | 83 | ||
| ■ What special investigations would you require? Explain why. | 83 | ||
| ■ What is your interpretation of these findings? | 84 | ||
| Diagnosis | 84 | ||
| ■ What is your diagnosis? | 84 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 84 | ||
| Treatment | 84 | ||
| ■ What treatment would you consider? | 84 | ||
| ■ What means have been tried in an attempt to stop a digit-sucking habit? | 84 | ||
| ■ If the anterior open bite had been due to digit sucking, what treatment would you recommend? | 84 | ||
| ■ How would you manage a parent who is concerned about an anterior open bite produced by either a dummy or digit sucking habit in the primary dentition (Figs 3.4 and 3.5)? | 85 | ||
| ■ What is the likely prognosis of treatment in Gerald’s case? | 85 | ||
| ■ Are there any other treatment options? | 85 | ||
| Primary resources and recommended reading | 86 | ||
| 14 Posterior crossbite | 87 | ||
| Summary | 87 | ||
| History | 87 | ||
| Complaint | 87 | ||
| History of complaint | 87 | ||
| Medical history | 87 | ||
| Family history | 87 | ||
| Examination | 87 | ||
| Extraoral | 87 | ||
| ■ What other feature would you check for, bearing in mind the history? Explain why. | 87 | ||
| Intraoral | 87 | ||
| ■ What features are evident on the intraoral views (Figs 14.1 and 14.2)? | 87 | ||
| ■ How would you assess the centrelines? | 88 | ||
| ■ What are the possible causes of a lower centreline shift? | 88 | ||
| ■ What factors may be implicated in the aetiology of the crossbite? | 88 | ||
| ■ What is the most likely cause of the posterior crossbite in this case? | 88 | ||
| ■ What is a possible explanation for the mandibular displacement being on a primary canine rather than on the molars? | 88 | ||
| Investigations | 88 | ||
| ■ What special investigations would you undertake and why? | 88 | ||
| ■ What does the dental panoramic tomogram show? | 88 | ||
| ■ What is the most likely reason for the blurred image on the right half of the dental panoramic tomogram? | 89 | ||
| ■ Why was a right half, rather than a full, dental panoramic tomogram retaken (Fig. 14.3B)? | 89 | ||
| Diagnosis | 89 | ||
| ■ What is your diagnosis? | 89 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 89 | ||
| Treatment | 89 | ||
| ■ What treatment plan would you propose? | 89 | ||
| ■ How may the crossbites be corrected? Describe the design of any appliance you would use. | 89 | ||
| ■ Based on current evidence, what treatment modality is most effective for correction of a buccal segment crossbite in the mixed dentition? | 90 | ||
| ■ What will determine if the corrected buccal segment crossbite is likely to be stable? | 90 | ||
| Primary resources and recommended reading | 90 | ||
| 15 Bilateral crossbite | 91 | ||
| Case 1 | 91 | ||
| Summary | 91 | ||
| History | 91 | ||
| Complaint | 91 | ||
| History of complaint | 91 | ||
| Medical history | 91 | ||
| ■ What is the relevance of Jean’s mode of breathing to snoring and to her complaint? | 91 | ||
| Dental history | 91 | ||
| ■ How may a digit-sucking habit cause a buccal segment crossbite? | 91 | ||
| Social history | 91 | ||
| Examination | 91 | ||
| Extraoral | 91 | ||
| Intraoral | 91 | ||
| ■ The appearance of the teeth on presentation is shown in Figs 15.1 and 15.2. Describe what you see. | 91 | ||
| ■ What are the possible causes of bilateral buccal crossbite? | 92 | ||
| Investigations | 92 | ||
| ■ What investigations would you undertake in relation to the bilateral buccal crossbite? Explain why. | 92 | ||
| Radiographic | 92 | ||
| ■ What is your interpretation of these findings? | 92 | ||
| Diagnosis | 92 | ||
| ■ What is your diagnosis? | 92 | ||
| ■ What is the IOTN (DHC) grade (see p. 264)? Explain why. | 92 | ||
| Treatment | 92 | ||
| ■ What are the aims of treatment? | 92 | ||
| ■ What treatment would you provide? | 93 | ||
| ■ What options are there for management of the bilateral buccal crossbite? Which would you choose? | 93 | ||
| ■ What factors should be checked before using this treatment? What are the chances of opening the mid-palatal suture in this patient? | 93 | ||
| ■ Describe the design of the appliance you would use. What instructions would you give Jean regarding this appliance? | 93 | ||
| ■ What should Jean be advised of regarding the effects of expansion? | 94 | ||
| ■ Describe how the appliance works. | 94 | ||
| ■ How will you retain the crossbite correction? | 94 | ||
| Case 2 | 94 | ||
| Summary | 94 | ||
| ■ What are the main features of note in Fig. 15.5? | 94 | ||
| History | 95 | ||
| Complaint | 95 | ||
| ■ What makes a smile attractive? | 95 | ||
| Medical and dental history | 95 | ||
| Treatment | 95 | ||
| ■ Why is RME not feasible? | 95 | ||
| ■ How is SARPE undertaken? | 95 | ||
| ■ How stable is SARPE? | 95 | ||
| Case 3 | 96 | ||
| Summary | 96 | ||
| ■ What are the main features of note in Fig. 15.8? | 96 | ||
| ■ Given the position of , what would you enquire about? | 96 | ||
| Extraoral | 97 | ||
| ■ What are the causes of bilateral lingual crossbite? | 97 | ||
| ■ What treatment options are there for correction of bilateral lingual crossbite? | 97 | ||
| ■ Simon was treated with the fixed appliances shown in Fig. 15.9. What type of appliance is this? What are its claimed advantages compared with conventional fixed appliance systems? | 97 | ||
| ■ How does distraction osteogenesis work, and what are the complication risks of mandibular midline distraction? | 98 | ||
| Primary resources and recommended reading | 98 | ||
| 16 Late lower incisor crowding | 99 | ||
| Summary | 99 | ||
| History | 99 | ||
| Complaint | 99 | ||
| History of complaint | 99 | ||
| Medical history | 99 | ||
| Dental history | 99 | ||
| Examination | 99 | ||
| Extraoral examination | 99 | ||
| Intraoral examination | 99 | ||
| ■ What do you notice? | 99 | ||
| ■ Is development of lower incisor crowding common in the late teens? | 99 | ||
| ■ What are the possible causes of late lower incisor crowding? | 100 | ||
| Investigations | 100 | ||
| ■ What investigations would you undertake? Explain why. | 100 | ||
| Study models | 100 | ||
| ■ What do you notice on the dental panoramic tomogram taken pre-orthodontic treatment (Fig. 16.3)? | 100 | ||
| Diagnosis | 100 | ||
| ■ What is your diagnosis? | 100 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 100 | ||
| ■ What are the management options for late lower incisor crowding? | 100 | ||
| ■ Aside from enhanced aesthetics, are there other advantages of lingual appliances? | 101 | ||
| ■ Are there any possible undesirable effects from extraction of one permanent lower incisor? | 101 | ||
| ■ Would you advise removal of the lower third molars? | 101 | ||
| ■ How would you manage the lower incisor crowding? | 101 | ||
| Primary resources and recommended reading | 101 | ||
| 17 Prominent chin and TMJDS | 102 | ||
| Summary | 102 | ||
| History | 102 | ||
| Complaint | 102 | ||
| History of complaint | 102 | ||
| ■ What questions would you ask about the temporomandibular joint pain? | 102 | ||
| Medical history | 102 | ||
| Dental history | 102 | ||
| Family history | 102 | ||
| Examination | 102 | ||
| Extraoral examination | 102 | ||
| ■ What do you observe from Jocelyn’s profile view (Fig. 17.1)? | 102 | ||
| ■ Based on the history, what other aspects would you assess extraorally? | 103 | ||
| Intraoral examination | 103 | ||
| ■ What do you see? | 103 | ||
| ■ What is the most likely cause of the considerable spacing in the lower premolar areas with drifted into contact with ? | 103 | ||
| ■ What occlusal features may predispose to temporomandibular joint dysfunction syndrome? | 103 | ||
| ■ Why was Jocelyn advised to wait until her late teens for reassessment? | 103 | ||
| Investigations | 104 | ||
| ■ What investigations are required and why? | 104 | ||
| ■ What is your interpretation of these findings (see p. 270)? | 104 | ||
| Diagnosis | 105 | ||
| ■ What is your diagnosis? | 105 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 105 | ||
| Treatment | 105 | ||
| ■ What are the aims of treatment? | 105 | ||
| ■ What treatment is required? Explain why. | 105 | ||
| ■ How will this case be managed? | 105 | ||
| Short term | 105 | ||
| Longer term | 105 | ||
| ■ Explain how you would proceed with surgical planning for this case. | 105 | ||
| ■ Describe the phase of pre-surgical orthodontics. | 106 | ||
| ■ What surgical procedures are likely to be required? | 106 | ||
| ■ What form of splint and fixation is likely to be required? | 107 | ||
| ■ Describe the post-surgical orthodontic phase. | 107 | ||
| ■ What factors influence post-surgical stability? | 107 | ||
| Primary resources and recommended reading | 107 | ||
| 18 Drifting incisors | 109 | ||
| Summary | 109 | ||
| History | 109 | ||
| Complaint | 109 | ||
| History of complaint | 109 | ||
| Dental history | 109 | ||
| Medical history | 109 | ||
| Social history | 109 | ||
| Examination | 109 | ||
| Extraoral | 109 | ||
| Intraoral | 109 | ||
| ■ What do you notice in Figs 18.1 and 18.2? | 109 | ||
| ■ Based on what you know so far, what are the possible factors implicated with respect to mobility and drifting of ? | 109 | ||
| ■ What would you check for specifically in relation to the history? | 110 | ||
| Investigations | 110 | ||
| ■ What other investigations would you carry out? Why? | 110 | ||
| ■ Full-mouth periapical radiographs are shown in Fig. 18.3. What do you see? | 110 | ||
| Diagnosis | 111 | ||
| ■ What is your diagnosis? | 111 | ||
| ■ With loss of periodontal attachment, how may labial drifting of the incisors occur? | 111 | ||
| ■ What is the significance of the medical history and social history to the diagnosis? | 111 | ||
| Treatment | 111 | ||
| ■ What treatment would you advise? | 111 | ||
| ■ What periodontal treatment do you envisage will be required? | 111 | ||
| ■ How would you describe the prognosis of Iain’s dentition? | 111 | ||
| ■ What are the treatment options for the upper labial segment spacing? | 111 | ||
| ■ What options are there with regard to improving appliance aesthetics in an adult patient? | 111 | ||
| ■ What special considerations are there with orthodontic treatment in a periodontally compromised dentition? | 112 | ||
| Primary resources and recommended reading | 112 | ||
| 19 Appliance-related problems | 113 | ||
| Case 1 | 113 | ||
| Summary | 113 | ||
| History | 113 | ||
| Complaint | 113 | ||
| History of complaint | 113 | ||
| Medical history | 113 | ||
| Examination | 113 | ||
| Extraoral | 113 | ||
| Intraoral | 113 | ||
| ■ Describe the appearance of the palate. | 113 | ||
| ■ What are your observations regarding the upper removable appliance? | 113 | ||
| ■ What is the most likely diagnosis based on the information you have so far? | 114 | ||
| ■ What other condition would produce a similar appearance? | 114 | ||
| ■ What is the aetiology of ‘denture’ stomatitis? | 114 | ||
| ■ What factors in this case may have predisposed Owen to ‘denture’ stomatitis? | 114 | ||
| Investigations | 114 | ||
| ■ How would you confirm the diagnosis? | 114 | ||
| ■ What stains identify Candida? | 114 | ||
| Treatment | 114 | ||
| ■ How would you treat this condition? | 114 | ||
| ■ What is the prognosis for this condition? | 114 | ||
| Cases 2 and 3 | 114 | ||
| Summary | 114 | ||
| ■ What problem do you notice in Fig. 19.2A? | 114 | ||
| ■ Why has this occurred? | 115 | ||
| Treatment | 115 | ||
| ■ What treatment would you provide? Explain why. | 115 | ||
| ■ What problem do you notice in Fig. 19.3A? | 115 | ||
| ■ How has this problem arisen? | 116 | ||
| ■ How would you manage this problem? | 116 | ||
| ■ As a GDP, what emergency care would you provide? | 116 | ||
| Cases 4 and 5 | 116 | ||
| Summary | 116 | ||
| ■ What problem do you notice in Fig. 19.4A? | 116 | ||
| ■ How might this problem have occurred? How may it have been prevented? | 116 | ||
| Treatment | 116 | ||
| ■ As a GDP, what treatment would you provide? Explain why. | 116 | ||
| ■ Could such a problem have been preempted at debond? | 117 | ||
| ■ What problem (arrowed) do you notice in Fig. 19.5A? | 117 | ||
| ■ How has this occurred? | 117 | ||
| ■ How will you manage the problem? | 117 | ||
| ■ In the meantime, what would you do to improve patient comfort? | 117 | ||
| ■ What further treatment do you think will be required? | 117 | ||
| Primary resources and recommended reading | 117 | ||
| 20 Tooth movement and related problems | 118 | ||
| Case 1 | 118 | ||
| Summary | 118 | ||
| ■ What are the possible reasons for a slow rate of orthodontic tooth movement? | 118 | ||
| Patient factors | 118 | ||
| Appliance factors | 118 | ||
| Operator factors | 118 | ||
| ■ What force range is optimal for retraction of by tipping movement? | 118 | ||
| ■ What cellular response is there following activation of the spring to retract by tipping movement? | 118 | ||
| Pressure zones | 118 | ||
| Tension zones | 118 | ||
| ■ What is the mechanism for tooth movement? | 119 | ||
| ■ How would you manage the problem in this case? | 119 | ||
| ■ What do you notice on the periapical radiograph of another case (Fig. 20.2)? | 119 | ||
| ■ What treatment would you advise? | 119 | ||
| Case 2 | 119 | ||
| Summary | 119 | ||
| ■ Why is the radiograph ordered? | 119 | ||
| ■ What do you notice on the film (Fig. 20.3A)? | 119 | ||
| ■ Which teeth experience most orthodontically induced root resorption? | 119 | ||
| ■ What risk factors have been suggested in relation to orthodontically induced root resorption? | 120 | ||
| ■ What does current evidence suggest with regard to orthodontically induced root resorption? | 120 | ||
| ■ Could root resorption have been prevented? | 120 | ||
| ■ What must the orthodontist ensure before treatment commences? | 120 | ||
| ■ What would you do in this case? | 120 | ||
| ■ What treatment would you provide? | 121 | ||
| Case 3 | 121 | ||
| Summary | 121 | ||
| ■ What do you notice in Figure 20.4 A and B? | 121 | ||
| ■ What does this indicate? | 121 | ||
| ■ Why has this occurred? | 121 | ||
| Forces from the supporting tissues | 121 | ||
| Forces from the orofacial soft tissues | 121 | ||
| Occlusal factors | 122 | ||
| Post-treatment facial growth | 122 | ||
| Retention plan | 122 | ||
| ■ What designs are there of fixed and removable retainers? | 122 | ||
| ■ What does current evidence indicate with regard to post-orthodontic retention? | 122 | ||
| ■ How can relapse be prevented long-term? | 122 | ||
| ■ What specific indications are there for a fixed (bonded) retainer over a removable retainer? | 123 | ||
| ■ Has the general dental practitioner (GDP) got a role with regard to orthodontic retention? | 123 | ||
| ■ What oral hygiene measures should the patient be instructed to follow after placement of a bonded retainer? | 123 | ||
| ■ What management options are there for Lisa’s problem? | 124 | ||
| Primary resources and recommended reading | 124 | ||
| 21 Cleft lip and palate | 125 | ||
| Summary | 125 | ||
| History | 125 | ||
| Complaint | 125 | ||
| History of complaint | 125 | ||
| Medical history | 125 | ||
| Family history | 125 | ||
| ■ How common is a family history with cleft lip and palate? Is this the same for cleft palate (CP) only? | 125 | ||
| ■ What is the prevalence of cleft lip and palate? | 125 | ||
| ■ Is there a sex and side variation for CLP? | 125 | ||
| ■ How does this malformation occur? | 125 | ||
| ■ What genetic risk is there of CLP? How does this compare to CP alone? | 125 | ||
| ■ Why is this? What treatment will have been provided to date, and what role have you to play as her general dental practitioner? | 126 | ||
| Neonatal period to 18 months | 126 | ||
| Primary dentition | 126 | ||
| ■ What skeletal/dental/occlusal problems are commonly found with CLP? | 126 | ||
| Examination | 126 | ||
| Extraoral | 126 | ||
| ■ What do you notice from Fig. 21.2? | 126 | ||
| ■ How is lip closure achieved? | 126 | ||
| Intraoral | 126 | ||
| ■ The appearance of the teeth is shown in Figs 21.1 and 21.3. What are your observations? | 126 | ||
| ■ In view of the unilateral crossbite of the right buccal segment, what should you check for? How would you do this? | 127 | ||
| Investigations | 127 | ||
| ■ What investigations are required? Explain why. | 127 | ||
| ■ Karen’s dental panoramic tomogram and upper anterior occlusal radiograph are shown in Fig. 21.4. What do you notice? | 127 | ||
| Diagnosis | 128 | ||
| ■ What is your diagnosis? | 128 | ||
| ■ What is the IOTN DHC grade (see p. 264)? Explain why. | 128 | ||
| Treatment | 128 | ||
| ■ What are the aims of treatment at this stage? | 128 | ||
| ■ What would you do at this stage? | 128 | ||
| ■ What form do you envisage the orthodontic treatment to take? | 128 | ||
| ■ When is secondary alveolar bone grafting usually undertaken and what advantages does it confer? | 128 | ||
| ■ The occlusion prior to bone grafting is shown in Fig. 21.5. What may you consider at this stage? | 128 | ||
| ■ What treatment will be required following alveolar bone grafting? | 128 | ||
| ■ What restorative considerations are there when replaces ? | 129 | ||
| Primary resources and recommended reading | 129 | ||
| 22 Nursing and early childhood caries | 130 | ||
| Summary | 130 | ||
| History | 130 | ||
| Medical history | 130 | ||
| Examination | 130 | ||
| ■ What is the cause of this pattern of decay? | 130 | ||
| ■ What can cause this? | 130 | ||
| ■ Why are the teeth affected in this pattern? | 130 | ||
| ■ What additional factors make the upper primary incisors more predisposed to caries? | 130 | ||
| ■ What should be your advice about night-time feeding? | 131 | ||
| ■ How could you identify pre-school children in need of dental care? | 131 | ||
| Treatment | 131 | ||
| Prevention | 131 | ||
| ■ Kelly-Ann is at high risk for caries. List all the main factors you can think of for placing someone in the high risk group for dental caries. | 131 | ||
| ■ What preventive advice would you provide for Kelly-Ann’s mother? | 131 | ||
| Home based advice | 131 | ||
| Toothbrushing and fluoride toothpaste | 131 | ||
| ■ Why is parental involvement important? | 132 | ||
| ■ What advice should be given if Kelly-Ann does not like strong, mint-flavoured toothpaste? | 132 | ||
| ■ Is there a role for fluoride supplements? | 132 | ||
| Diet advice | 132 | ||
| Medication | 133 | ||
| Professional interventions | 133 | ||
| Why can Kelly-Ann not have fluoride mouthwash? | 133 | ||
| Treatment | 133 | ||
| Restorative care | 133 | ||
| ■ How would you restore the upper incisors? | 133 | ||
| ■ How would you restore the early cavitation in the first primary molars? | 133 | ||
| ■ What method of caries removal, without a handpiece, may be applicable here? | 133 | ||
| ■ How is pain relief best achieved in the child with nursing caries in Fig. 22.2? | 133 | ||
| Primary resources and recommended reading | 134 | ||
| 23 High caries risk adolescents | 135 | ||
| Summary | 135 | ||
| History | 135 | ||
| Complaint | 135 | ||
| History of complaint | 135 | ||
| Medical history | 135 | ||
| Dental history | 135 | ||
| ■ Which aspects of his presentation and history help to determine his caries risk status so far? | 135 | ||
| Examination | 135 | ||
| Extraoral | 135 | ||
| Intraoral | 135 | ||
| ■ Which further aspects of his clinical presentation help determine his caries risk status? | 135 | ||
| Plaque control | 136 | ||
| Saliva | 136 | ||
| ■ At present what caries risk status would you assign Peter to? | 136 | ||
| ■ What further information would you ask Peter to complete his caries risk assessment? | 136 | ||
| Fluoride history | 136 | ||
| Dietary history | 136 | ||
| Preventive care and treatment | 136 | ||
| Radiographs | 136 | ||
| ■ After the initial bitewing radiographs are taken (Fig. 23.4), when should Peter have radiographs taken again? | 136 | ||
| ■ What other forms of preventive care would he benefit from? | 137 | ||
| Toothbrushing instruction | 137 | ||
| Strength of fluoride toothpaste | 137 | ||
| Fluoride varnish application | 137 | ||
| Fluoride supplements | 137 | ||
| Diet analysis | 137 | ||
| Fissure sealants | 137 | ||
| ■ What else might you suggest when Peter is older that could help further reduce his caries risk status for the future? | 138 | ||
| Primary resources and recommended reading | 138 | ||
| 24 Pain control and treatment planning for carious primary teeth | 140 | ||
| Summary | 140 | ||
| ■ What questions do you need to ask regarding the pain? | 140 | ||
| ■ What dressings can help manage pulpitis initially? | 140 | ||
| History | 141 | ||
| Examination | 141 | ||
| ■ What investigation is essential to allow you to formulate a treatment plan? | 141 | ||
| Treatment | 141 | ||
| ■ What is your definitive treatment plan for ? | 141 | ||
| ■ Will local anaesthetic be needed for extracting ? | 142 | ||
| ■ What are the consequences of extracting ? | 142 | ||
| ■ If the was restorable, what other treatment options would be available? | 142 | ||
| Treatment planning | 142 | ||
| ■ How do we undertake treatment planning and devise a plan which is appropriate for each and every patient? | 142 | ||
| Different restorative philosophies | 143 | ||
| Hall crowns and indirect pulp therapy | 143 | ||
| ■ What are Hall crowns? | 143 | ||
| ■ When can I use Hall crowns? | 144 | ||
| ■ What will happen to the child’s occlusion following the placement of a Hall crown? | 144 | ||
| ■ How does indirect pulp therapy (IPT) differ from a Hall crown? | 144 | ||
| Pulpotomies | 144 | ||
| ■ What is a pulpotomy? | 144 | ||
| Primary resources and recommended reading | 144 | ||
| 25 Facial swelling and dental abscess | 146 | ||
| Summary | 146 | ||
| ■ List four symptoms and signs specific to each type of infection | 146 | ||
| History | 146 | ||
| Examination | 146 | ||
| ■ What is the major problem with mandibular infections? | 146 | ||
| ■ What is the basic management of any infection? | 146 | ||
| ■ What are the criteria for hospital admission with orofacial infection? | 147 | ||
| ■ What will the hospital management of a severe infection involve? | 147 | ||
| Treatment | 147 | ||
| Primary resources and recommended reading | 148 | ||
| 26 The uncooperative child and adolescent | 149 | ||
| Case 1 | 149 | ||
| Summary | 149 | ||
| ■ What do you understand by the term behaviour management? | 149 | ||
| ■ What history is important in Liam’s case? | 149 | ||
| ■ What main forms of communicative management are there? | 149 | ||
| Non-verbal communication | 149 | ||
| Tell-show-do | 149 | ||
| Positive reinforcement | 149 | ||
| Distraction | 150 | ||
| Voice control | 150 | ||
| Parental presence/absence | 150 | ||
| Examination | 150 | ||
| ■ What additional help might you consider giving Liam? | 150 | ||
| Case 2 | 151 | ||
| Summary | 151 | ||
| ■ How would you motivate Maria to reduce her caries risk and assess and treat her dental anxiety? | 151 | ||
| Complaint | 151 | ||
| History of complaint | 151 | ||
| Medical history | 151 | ||
| Family history | 151 | ||
| Examination | 151 | ||
| Extraoral examination | 151 | ||
| Intraoral examination | 151 | ||
| ■ What recommendations are used regarding diet, tooth-brushing and fluoride for adolescents? | 151 | ||
| ■ What is the aetiology of dental anxiety? | 152 | ||
| ■ Why should an adolescent be managed differently form a younger child? | 152 | ||
| ■ Can anxiety be measured, and what questions should be asked? | 152 | ||
| Treatment | 152 | ||
| ■ What are the anxiety management options? | 152 | ||
| ■ What is the commonest conscious sedative in children and adolescents? | 153 | ||
| ■ What treatment plan would you propose? | 153 | ||
| VISIT 1 | 153 | ||
| VISIT 2 (preventive advice will continue and expand on 2a, 2b, 2f) | 154 | ||
| VISIT 3 AND 4 (preventive advice will continue and expand on 2a, 2b, 2f) | 154 | ||
| ■ What follow-up does Maria need now? | 154 | ||
| Case 3 | 154 | ||
| Summary | 154 | ||
| ■ What other sedation techniques are available? | 154 | ||
| ■ What are the indications for general anaesthesia? | 154 | ||
| ■ What are the contraindications for general anaesthesia? | 154 | ||
| Informed consent | 155 | ||
| ■ Who can consent for a child? | 155 | ||
| ■ Can an adolescent consent for themselves? | 155 | ||
| Primary resources and recommended reading | 155 | ||
| 27 Children with disabilities and learning difficulties | 157 | ||
| Summary | 157 | ||
| ■ How will you manage him? | 157 | ||
| Complaint | 157 | ||
| History of complaint | 157 | ||
| Medical history | 157 | ||
| Social history | 157 | ||
| ■ What challenges has Sanjeev’s family faced? | 157 | ||
| ■ What can dentists do to assist the family and help them overcome barriers of access to dental care? | 158 | ||
| Examination | 158 | ||
| ■ How will you examine Sanjeev? | 158 | ||
| Extraoral | 158 | ||
| Intraoral | 158 | ||
| Radiographic investigation | 158 | ||
| ■ What is the best radiographic investigation? | 158 | ||
| ■ What is Sanjeev’s dental diagnosis? | 158 | ||
| ■ What are the treatment options for Sanjeev? | 159 | ||
| ■ Can Sanjeev be managed in a primary care setting? | 159 | ||
| ■ What are the dental management options? | 159 | ||
| ■ Would Hall crowns be an appropriate treatment option? | 159 | ||
| ■ When will these primary teeth exofoliate? | 159 | ||
| ■ Does behaviour management work with children with Asperger’s syndrome? | 159 | ||
| ■ Does nitrous oxide inhalation sedation work for children with Asperger’s syndrome? | 159 | ||
| ■ Does Sanjeev need a general anaesthetic? | 160 | ||
| ■ What treatment plan would you propose? | 160 | ||
| Common disabilities | 160 | ||
| ■ What are the common disabilities? | 160 | ||
| ■ How would this plan be altered if Sanjeev’s disability had been more severe? | 160 | ||
| ■ Are there more complications to general anaesthesia for children with a disability? | 160 | ||
| ■ What medical comorbidities can children with a disability commonly present with? | 160 | ||
| ■ How does a dentist communicate with children with a disability? | 160 | ||
| Primary resources and recommended reading | 162 | ||
| 28 Common medical problems in children | 163 | ||
| Case 1 | 163 | ||
| Summary | 163 | ||
| History | 163 | ||
| Medical history | 163 | ||
| Dental history | 163 | ||
| Examination | 163 | ||
| ■ Why are you concerned with this dental history? | 163 | ||
| ■ What are the effects of chemotherapy on cells with a rapid turnover? | 163 | ||
| ■ What further information do you need? | 163 | ||
| Dental information | 163 | ||
| Medical information | 164 | ||
| Treatment | 164 | ||
| ■ What acute treatment does Hannah need? | 164 | ||
| ■ What other dental care does Hannah require? | 164 | ||
| ■ What are the oral implications of childhood cancer treatment? | 164 | ||
| Case 2 | 165 | ||
| Summary | 165 | ||
| History | 165 | ||
| Medical history | 165 | ||
| ■ What is Haemophilia A? | 165 | ||
| ■ What dental treatment does Hugo require? | 165 | ||
| ■ What are the oral implications of Haemophilia A on Hugo’s restorative treatment? | 165 | ||
| ■ What local measures can you take to minimize bleeding? | 165 | ||
| ■ Infiltrations versus inferior alveolar block injection | 166 | ||
| Case 3 | 166 | ||
| Summary | 166 | ||
| History | 166 | ||
| Medical history | 166 | ||
| ■ What are the oral implications of Harriet’s cardiac history? | 166 | ||
| ■ Is antibiotic prophylaxis required for dental procedures? | 166 | ||
| ■ What treatment is appropriate for Harriet? | 166 | ||
| Preventive plan | 166 | ||
| Restorative care | 166 | ||
| Primary resources and recommended reading | 167 | ||
| 29 The displaced primary incisor | 168 | ||
| Summary | 168 | ||
| History | 168 | ||
| Complaint | 168 | ||
| History of complaint | 168 | ||
| Medical history | 168 | ||
| Dental history | 168 | ||
| ■ What specific questions would you ask and why? | 168 | ||
| Examination | 168 | ||
| Extraoral | 168 | ||
| Intraoral | 168 | ||
| ■ The appearance of the upper anterior teeth is shown in Fig. 29.1. What can you see? | 168 | ||
| ■ What specific signs will you look for in your examination? | 169 | ||
| ■ What question should dentists keep at the back of their minds when examining children? | 169 | ||
| ■ What features in the history and examination would lead to suspicions of child physical abuse? | 169 | ||
| Investigations | 169 | ||
| ■ What investigations would you perform for James? Explain why for each. | 169 | ||
| Diagnosis | 169 | ||
| ■ What is your diagnosis? | 169 | ||
| Treatment | 169 | ||
| ■ What are the three key components of the history and examination in primary tooth trauma that will dictate if active treatment is required? | 169 | ||
| ■ What treatments are usually required for displaced primary incisors? | 169 | ||
| ■ What radiographs would you take for these displacement injuries? | 170 | ||
| ■ What are you going to tell James’s mother about the risk to the permanent teeth? | 170 | ||
| ■ What are the possible effects on the permanent successor teeth? | 170 | ||
| ■ Can you tell all of these sequelae on a periapical radiograph? | 170 | ||
| ■ If you retain a luxated primary tooth how often would you review it? | 170 | ||
| ■ How would you review it? | 170 | ||
| ■ Does a discoloured primary incisor always need treatment? | 170 | ||
| Primary resources and recommended reading | 170 | ||
| 30 The fractured immature permanent incisor crown | 171 | ||
| Summary | 171 | ||
| History | 171 | ||
| Complaint | 171 | ||
| History of complaint | 171 | ||
| Medical history | 171 | ||
| Dental history | 171 | ||
| ■ What specific questions would you ask and why? | 171 | ||
| Examination | 171 | ||
| Extraoral | 171 | ||
| ■ Why is the presence of lip swelling together with a mucosal laceration important? | 171 | ||
| ■ How would you demonstrate there was a fragment of tooth in the lip? | 171 | ||
| Intraoral | 171 | ||
| ■ What injuries are visible in Fig. 30.1? | 171 | ||
| ■ Are the roots of and likely to have open or closed apices? | 172 | ||
| ■ How would you confirm apical status? | 172 | ||
| ■ What other injuries must you exclude on the periapical radiograph? | 172 | ||
| ■ What other features of the anterior teeth are important at examination? | 172 | ||
| ■ What teeth should be examined after trauma affecting only the upper centrals? | 172 | ||
| Investigations | 172 | ||
| Treatment | 172 | ||
| ■ What is the prime consideration for both the upper central incisors? | 172 | ||
| ■ What is the appropriate immediate treatment for (that has an enamel-dentine fracture)? | 172 | ||
| ■ What are the treatment options for (that has a pulpal exposure)? | 172 | ||
| ■ What are the indications for permanent tooth pulpotomy? | 172 | ||
| ■ How would you carry out a pulpotomy? | 173 | ||
| ■ How should the crown of be restored? | 173 | ||
| ■ How should the upper centrals be reviewed and how often? | 173 | ||
| Primary resources and recommended reading | 173 | ||
| 31 The root fractured permanent incisor | 175 | ||
| Summary | 175 | ||
| History | 175 | ||
| Complaint | 175 | ||
| History of complaint | 175 | ||
| ■ What does this alert you to? | 175 | ||
| Medical history | 175 | ||
| ■ What specific questions would you ask and why? | 175 | ||
| Examination | 175 | ||
| Extraoral | 175 | ||
| ■ What questions and examination would you complete regarding the swelling and bruising under the right eye? | 175 | ||
| Intraoral | 175 | ||
| ■ What would be the diagnosis based on the clinical findings alone? | 175 | ||
| ■ What tests would you do prior to repositioning the teeth? | 175 | ||
| ■ What is the diagnosis based on the clinical and radiographic findings? | 176 | ||
| Treatment | 176 | ||
| ■ What design of splint would you use for and ? You have confirmed on radiography that they have middle third root fractures (Fig. 31.1). | 176 | ||
| ■ How long should the splint be in place in root fractures? | 176 | ||
| ■ Do any forms of dentoalveolar injury need to be rigidly splinted? | 176 | ||
| ■ Describe step by step your procedure for reduction and splinting Andrea’s and . | 176 | ||
| ■ What materials could be used for splinting? | 176 | ||
| ■ On removal of the splint how often would you review Andrea? | 177 | ||
| ■ What tests would you complete at each of these reviews? | 177 | ||
| ■ Is sensibility testing accurate? | 177 | ||
| ■ What is the likely radiographic appearance at the fracture line if the coronal tooth portion becomes non-vital? | 177 | ||
| ■ If the coronal portion of an apical or middle third root fractured tooth became non-vital, how would you root treat the tooth? | 177 | ||
| ■ What happens to the apical fragment? | 177 | ||
| ■ Is the prognosis good in coronal or gingival third root fractures? | 177 | ||
| ■ What are the treatment options in coronal or gingival third root fractures? | 177 | ||
| ■ Can root fractured teeth maintain vitality? | 177 | ||
| ■ Can root fractured teeth be moved orthodontically? | 177 | ||
| Primary resources and recommended reading | 178 | ||
| 32 The avulsed incisor | 179 | ||
| Case 1 | 179 | ||
| Summary | 179 | ||
| ■ Kathryn’s teacher phones your surgery for advice. She has the tooth in a handkerchief. The accident occurred 10 minutes ago. What is your advice? | 179 | ||
| ■ The tooth is brought to the surgery in milk. How would you proceed? | 179 | ||
| ■ What factors are important when deciding whether root canal treatment is necessary in Kathryn’s case? | 179 | ||
| ■ What factors are important in predicting root resorption? | 180 | ||
| ■ What types of resorption are there? | 180 | ||
| ■ What is the treatment for infection-related resorption following trauma? | 180 | ||
| Case 2 | 181 | ||
| Summary | 181 | ||
| ■ Justin’s parents book an emergency appointment so see you the following day, what will you do? | 181 | ||
| ■ What is the chance of pulp survival? | 182 | ||
| ■ What intracanal medicament should be placed in the extirpated tooth? | 182 | ||
| ■ What are the chances of periodontal healing? | 182 | ||
| ■ What long-term treatment options are available? | 182 | ||
| Primary resources and recommended reading | 183 | ||
| 33 Disorders of eruption and exfoliation | 184 | ||
| Case 1 | 184 | ||
| Summary | 184 | ||
| ■ What is the correct terminology for these early erupting teeth? | 184 | ||
| ■ What are the main problems associated with natal and neonatal teeth? | 184 | ||
| ■ What factors can cause generalized premature eruption but still be considered as ‘normal’? | 184 | ||
| ■ When is generalized delay in eruption of primary teeth expected? | 184 | ||
| ■ What conditions may lead to a generalized delayed eruption of teeth in both primary and permanent dentitions? | 185 | ||
| ■ What specific condition is associated with grossly delayed or failed eruption of teeth in the permanent dentition? | 185 | ||
| ■ What local factors can account for delayed eruption of permanent teeth? | 185 | ||
| Case 2 | 185 | ||
| Summary | 185 | ||
| History | 185 | ||
| Dental history | 185 | ||
| ■ What causes delayed exfoliation of primary teeth? | 186 | ||
| ■ How is infraocclusion graded? | 186 | ||
| Primary resources and recommended reading | 186 | ||
| 34 Poor quality first permanent molars | 187 | ||
| Summary | 187 | ||
| History | 187 | ||
| Medical history | 187 | ||
| Dental history | 187 | ||
| Examination | 187 | ||
| ■ Do you think that the enamel hypomineralization and hypoplasia noted on the first permanent molars and the permanent incisors follows a chronological pattern? If so, at what time was the affected enamel formed? | 188 | ||
| ■ What specific questions would you like to ask Lisa’s mother? | 188 | ||
| ■ What other differential diagnoses might you consider? | 188 | ||
| ■ Is pain from such molar teeth common? | 188 | ||
| Investigations | 189 | ||
| ■ What investigations are indicated and why? | 189 | ||
| Treatment | 189 | ||
| ■ What are the main clinical problems in this case? | 189 | ||
| ■ What are the treatment options for the HFPMs in this case? | 189 | ||
| Sensitivity | 189 | ||
| Composite | 189 | ||
| Stainless steel crowns | 189 | ||
| Adhesively retained copings | 189 | ||
| Extraction | 189 | ||
| ■ What are the treatment options for the incisors in this case? | 190 | ||
| Primary resources and recommended reading | 190 | ||
| 35 Tooth discoloration, hypomineralization and hypoplasia | 191 | ||
| Case 1 | 191 | ||
| Summary | 191 | ||
| History | 191 | ||
| ■ What other questions do you need to ask about the teeth? | 191 | ||
| Medical history | 191 | ||
| ■ What specific questions do you need to ask his mother with regard to potential causes of discoloration? | 191 | ||
| Dental history | 191 | ||
| ■ What other lines of questioning do we need to explore if we are considering all the possible causes of intrinsic discoloration? | 191 | ||
| Examination | 192 | ||
| ■ In the major categories for questioning shown in Box 35.1, which are likely to cause generalized discoloration and which are likely to cause localized discoloration? | 192 | ||
| ■ What is the only method of treatment that will help Simon’s appearance? | 192 | ||
| ■ If a patient came to you with a single discoloured root-filled incisor, what form of treatment should you consider first? | 192 | ||
| Technique | 193 | ||
| Visit 1 | 193 | ||
| Visit 2 | 193 | ||
| Visit 3 | 193 | ||
| Visit 4 | 193 | ||
| Case 2 | 193 | ||
| Summary | 193 | ||
| History | 193 | ||
| ■ Are there any other causes of extrinsic staining? | 193 | ||
| ■ How can you confirm your diagnosis of extrinsic discoloration? | 194 | ||
| ■ What additional clinical signs are there in Fig. 35.2 to back up your diagnosis of chromogenic staining secondary to poor oral hygiene? | 194 | ||
| Treatment | 194 | ||
| ■ How would you treat Tony’s bad breath? | 194 | ||
| ■ What factors in children and adolescents are important in halitosis (bad breath)? | 194 | ||
| ■ As well as improving his gingival health with improved toothbrushing, what else could be done with the toothbrush? | 194 | ||
| Primary resources and recommended reading | 194 | ||
| 36 Mottled teeth | 195 | ||
| Summary | 195 | ||
| History | 195 | ||
| ■ What important questions would you now ask her mother? | 195 | ||
| ■ Is anyone else in the family affected? | 195 | ||
| ■ What childhood illnesses and infections did she have, and when? | 195 | ||
| ■ What is Sophie’s fluoride history? | 195 | ||
| Examination | 195 | ||
| ■ What is the distribution of the mottling that you can see in Fig. 36.1? | 195 | ||
| ■ Do you know why the labial surfaces of the upper permanent central incisors are often more affected by mottling? | 195 | ||
| ■ Which part of the enamel does mild fluorosis affect? | 195 | ||
| ■ How can you use this knowledge to your advantage during your clinical examination? | 195 | ||
| ■ In some cases of fluorosis there is, in addition to white mottling, some brown stain. What is the cause of the brown staining? | 196 | ||
| Treatment | 196 | ||
| ■ What treatment options for Sophie would you consider for fluorotic mottling? | 196 | ||
| ■ Is vital bleaching legal for children? | 197 | ||
| ■ Has bleaching of teeth any part to play in the treatment of surface enamel discoloration? | 197 | ||
| ■ What are the indications for composite veneers? | 197 | ||
| ■ How do you undertake a composite veneer? | 198 | ||
| Primary resources and recommended reading | 198 | ||
| 37 Multiple missing and abnormally shaped teeth | 199 | ||
| Case 1 | 199 | ||
| Summary | 199 | ||
| History | 199 | ||
| Medical history | 199 | ||
| ■ What question do you need to ask Ellen’s mother? | 199 | ||
| ■ How prevalent are missing teeth in the population? | 199 | ||
| ■ There are a significant number of syndromes of the head and neck that manifest with missing teeth. Can you name some? | 199 | ||
| ■ What factors would you consider important in the management of dental anomalies? | 199 | ||
| Examination | 200 | ||
| Extraoral | 200 | ||
| Intraoral | 200 | ||
| ■ What special investigations are required? | 200 | ||
| ■ What is visible from the radiograph? | 200 | ||
| ■ What is the condition known as? | 200 | ||
| ■ What would you do? | 200 | ||
| ■ What treatment is likely to be required? | 200 | ||
| Case 2 | 200 | ||
| Summary | 200 | ||
| Medical and dental history | 200 | ||
| ■ What can you see in Fig. 37.2? | 200 | ||
| ■ How prevalent do you think double teeth are? | 200 | ||
| ■ What are the most important clinical aspects of a double tooth in the primary dentition? | 201 | ||
| ■ What are the important factors that will dictate whether you retain or extract double permanent teeth? | 201 | ||
| ■ What other types of crown abnormalities do you know? | 201 | ||
| ■ What are the treatment options for a talon cusp on a maxillary tooth? | 201 | ||
| ■ What abnormalities of root form do you know? | 202 | ||
| ■ What conditions may taurodontism be associated with? | 202 | ||
| Primary resources and recommended reading | 202 | ||
| 38 Amelogenesis imperfecta | 203 | ||
| Summary | 203 | ||
| ■ What can you see in Fig. 38.1? | 203 | ||
| History | 203 | ||
| ■ Was there any systemic illness from birth to early childhood? | 203 | ||
| ■ Were the primary teeth similarly affected? | 203 | ||
| ■ Is anyone else in the family similarly affected? | 203 | ||
| Medical history | 203 | ||
| Examination | 203 | ||
| ■ Why is this pattern of enamel hypoplasia unlikely to be caused by systemic (chronological) influences? | 203 | ||
| ■ What are the main types of AI? | 204 | ||
| Investigations | 204 | ||
| ■ What investigations are necessary? | 204 | ||
| Dental panoramic tomogram | 204 | ||
| Family examination | 204 | ||
| Referral for genetic testing | 204 | ||
| Treatment | 204 | ||
| Primary resources and recommended reading | 205 | ||
| 39 Dentinogenesis imperfecta | 206 | ||
| Summary | 206 | ||
| History | 206 | ||
| ■ Was there any systemic illness from birth until early childhood? | 206 | ||
| ■ Were the primary teeth similarly affected? | 206 | ||
| ■ Is anyone else in the family similarly affected? | 206 | ||
| ■ Why is this DI and not amelogenesis imperfecta (AI)? | 206 | ||
| ■ What investigations do you need to do to confirm your suspicions? | 206 | ||
| Dental panoramic tomogram | 206 | ||
| Family examination | 207 | ||
| DI type II | 207 | ||
| ■ Is DI more prevalent than AI? | 207 | ||
| ■ Has DI got as many inheritance patterns as AI? | 207 | ||
| DI type I associated with osteogenesis imperfecta | 207 | ||
| Treatment | 207 | ||
| Primary resources and recommended reading | 208 | ||
| 40 Dental erosion | 209 | ||
| Summary | 209 | ||
| ■ What do you see in Fig. 40.1? | 209 | ||
| ■ How would you define erosion? | 209 | ||
| ■ What foods and drinks have erosive potential? | 209 | ||
| History | 209 | ||
| ■ What is the best way to find out about Tom’s diet? | 209 | ||
| ■ Can the pattern of erosion caused by dietary constituents be related to the manner in which the substrate is consumed? | 209 | ||
| ■ You have covered Tom’s dietary history. Is your history now complete, or are there other questions you need to ask with relation to erosion? | 209 | ||
| ■ What question would you ask to give you an indication that regurgitation was occurring? | 209 | ||
| ■ What is the common pattern of erosive loss when there is chronic gastric regurgitation? | 210 | ||
| ■ Is there a specific pattern of erosive loss in recurrent vomiting? | 210 | ||
| ■ What would you do if you suspect, after questioning Tom and his parents, that there may be asymptomatic GORD? | 210 | ||
| Summary of Tom’s history | 210 | ||
| ■ What advice would you give to Tom regarding his high intake of fizzy drinks? | 210 | ||
| Management | 210 | ||
| ■ Tom only has occasional sensitivity. What treatment, if any, does he need? | 210 | ||
| ■ Erosion is only one element of tooth surface loss or wear. What are the other elements? | 211 | ||
| ■ What categories of patient exhibit more attrition than normal? | 211 | ||
| ■ What restorative materials are the most durable for attritional wear as a result of parafunction? | 211 | ||
| Primary resources and recommended reading | 211 | ||
| 41 Gingival bleeding and enlargement | 213 | ||
| Summary | 213 | ||
| History | 213 | ||
| Medical history | 213 | ||
| Dental history | 213 | ||
| Examination | 213 | ||
| ■ What periodontal screening should be undertaken for Kayleigh? | 213 | ||
| ■ What factors are contributing to the chronic marginal gingivitis? | 213 | ||
| ■ What do you think may have precipitated the initial gingivitis? | 213 | ||
| ■ What is the other cause of diabetic coma and what are its signs? | 214 | ||
| Treatment | 214 | ||
| ■ Why is the gingivitis worst in the anterior part of the upper right quadrant? | 214 | ||
| ■ What other generalized causes of gingival enlargement do you know? | 214 | ||
| ■ Why is it important to eradicate Kayleigh’s gingivitis? | 214 | ||
| ■ Why is it important not to leave caries in a diabetic? | 214 | ||
| ■ Why is the timing of the appointment to restore Kayleigh’s first permanent molar important? | 214 | ||
| ■ What dietary advice should you give to diabetic patients? | 215 | ||
| ■ What other oral manifestations can occur in diabetes? | 215 | ||
| Primary resources and recommended reading | 215 | ||
| 42 Oral ulceration | 216 | ||
| Summary | 216 | ||
| History | 216 | ||
| Medical history | 216 | ||
| ■ Describe the appearance of the upper and lower gingivae in Fig. 42.1. | 216 | ||
| ■ What is the diagnosis? | 216 | ||
| Treatment | 216 | ||
| ■ What are the reasons given for the reactivation of HSV to produce a cold sore (herpes labialis) (Fig. 42.2)? | 217 | ||
| ■ How should herpes labialis be treated? | 217 | ||
| ■ What other viral infection can occur in the mouths of paediatric patients? | 217 | ||
| ■ What types of aphthae are there? | 217 | ||
| ■ What aetiological factors are important in recurrent aphthae? | 218 | ||
| ■ What systemic diseases in children are commonly associated with aphthae? | 218 | ||
| Primary resources and recommended reading | 218 | ||
| 43 Mind maps | 219 | ||
| Appendices | 264 | ||
| A1 The index of orthodontic treatment need: dental health component | 264 | ||
| A2 Classification and definitions | 265 | ||
| A3 Orthodontic problems: referral guide | 268 | ||
| Primary resources and recommended reading | 268 | ||
| A4 Implications of some medical problems for orthodontics | 269 | ||
| Primary sources and recommended reading | 270 | ||
| A5 Lateral cephalometric analysis | 271 | ||
| Aim and objective of cephalometric analysis | 271 | ||
| Practice of cephalometric analysis | 271 | ||
| Cephalometric interpretation | 271 | ||
| Skeletal relationships | 271 | ||
| Tooth position | 271 | ||
| Soft tissue analysis | 272 | ||
| A6 A structured dental trauma history form | 273 | ||
| Index | 275 | ||
| A | 275 | ||
| B | 275 | ||
| C | 276 | ||
| D | 276 | ||
| E | 277 | ||
| F | 277 | ||
| G | 278 | ||
| H | 278 | ||
| I | 278 | ||
| J | 279 | ||
| K | 279 | ||
| L | 279 | ||
| M | 279 | ||
| N | 279 | ||
| O | 279 | ||
| P | 280 | ||
| Q | 281 | ||
| R | 281 | ||
| S | 281 | ||
| T | 282 | ||
| U | 282 | ||
| V | 282 | ||
| W | 282 |