Clinical Problem Solving in Orthodontics and Paediatric Dentistry - E-Book

Declan Millett; Richard Welbury

BOOK

Clinical Problem Solving in Orthodontics and Paediatric Dentistry - E-Book

Declan Millett | Richard Welbury

(2010)

Additional Information

Book Details

ISBN: 978-0-7020-4453-3
Edition: 2
Language: English
Pages: 224
Subjects: Dentistry
Databases

Abstract

This is a second edition of a hugely successful practical resource in orthodontics and paediatric dentistry – ideal for undergraduate dental students and post-graduates preparing for the MJDF and similar exams.

Focuses on clinical problem-solving in orthodontics and paediatric dentistry — two closely-related topics that are usually separated into different volumes.

Provides practical help with treatment planning, guiding the reader through the process of safe and effective decision-making.

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.

Uses ‘key-point" Evidence-Based’ boxes systematically to emphasise core knowledge for assessment and provide a rationale for treatment approaches.

Contains valuable ‘mind-maps’, which helps the reader consolidate information prior to exams.

Includes orthodontic sections on severe crowding, additional canine problems, bilateral crossbite covering the use of temporary anchorage devices, incisor root resorption from an impacted maxillary canine, cone beam CT, tooth-size discrepancy assessment, transposition, RME, SARPE and self-ligating brackets

Includes paedriatric dentistry sections on the use of CPP-ACP, indirect pulp caps, caries diagnosis systems, minimally invasive techniques, and the importance of caries risk assessment and appropriate fluoride prescription, and mechanisms for how fluoride works.

Section Title	Page	Action	Price
Front cover	cover
Orthodontics & Paediatric Dentistry	i
Copyright page	iv
Table of Contents	v
Preface to the second edition	vi
Preface to the first edition	vii
Acknowledgements	viii
1 Median diastema	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?	1
� What are the possible causes of the upper median diastema?	2
� Is the dental and occlusal development normal?	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
Clinical	2
Radiographic	2
� The dental panoramic tomogram is shown in Figure 1.3. What do you notice?	3
Diagnosis	3
� What is the diagnosis?	3
� What is the IOTN DHC grade (see p. 203)? 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
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 Figures 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
� 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
Investigation	6
� What investigations are required? Explain why.	6
Clinical	6
Radiographic	6
� How would you determine the position of an unerupted tooth in the anterior premaxilla using vertical parallax?	7
� Neil’s radiographs are shown in Figure 2.3. What do these show?	7
Diagnosis	7
� What is your diagnosis?	7
� What is the IOTN DHC grade (see p. 203)? Explain why.	7
Treatment	7
� What are your aims of treatment?	7
� What is your treatment plan?	7
� What design of upper removable appliance would you use to achieve the desired tooth movements?	8
� Will an upper removable appliance achieve all the treatment objectives?	8
� What is the recommended root filling material for during orthodontic tooth movement?	8
� Does orthodontic tooth movement pose any risk to ?	8
� Are there any precautions you would take during orthodontic treatment to minimize this risk?	8
� How would you ensure long-term stability of following alignment?	9
Recommended reading	9
3 Absent upper lateral incisors	10
Summary	10
History	10
Complaint	10
History of complaint	10
Medical history	10
Dental history	10
Family history	10
Social history	10
� How will her instrument playing impact on orthodontic treatment?	10
Examination	10
Extraoral	10
� What else should you check for?	10
Intraoral	10
� The intraoral views are shown in Figures 3.1 and 3.2. What do these show?	10
� What other clinic assessment would you undertake?	11
� What are the possible causes of the upper labial segment spacing?	11
� What is the most likely cause in this case?	11
� What further investigations would you undertake?	11
Clinical	11
Radiographic	11
Occlusal	12
� What is your diagnosis?	12
� What is the IOTN DHC grade (see p. 203)?	12
� What are the treatment options?	12
� What factors would you consider in deciding between space closure or space opening?	12
� How could the upper buccal segments be moved distally using a removable appliance to achieve a Class I molar relationship?	12
� What force and duration of headgear wear is required for anchorage?	13
� What precautions must be adhered to when prescribing headgear?	13
� What design of upper removable appliance would you consider for these tooth movements?	13
� When space has been created for , what should be done?	13
� What design of resin-retained bridge is required?	13
Recommended reading	13
4 Crowding and buccal upper canines	15
Summary	15
History	15
Complaint	15
History of complaint	15
Medical history	15
Dental history	15
Examination	15
Extraoral	15
� Would you be concerned by the mild facial asymmetry?	15
Intraoral	15
� Gemma’s intraoral views are shown in Figures 4.1 and 4.2. What do you notice?	15
� What are the possible reasons for 3’s erupting buccally?	16
Investigations	16
� What investigations would you request and why?	16
� Gemma’s dental panoramic tomogram is shown in Figure 4.3. What do you notice?	16
� What is your diagnosis?	16
� What is the IOTN DHC grade and why (see p. 203)?	16
Treatment	16
� What treatment is likely to be required in this case? Explain why.	16
� What would you do now?	16
� What aims of treatment do you think will be proposed by the orthodontist?	17
� Describe how you would approach treatment planning.	17
� What possible means are there of creating space?	17
� What factors govern the choice of extraction?	17
� Why are first premolars a common choice of extraction?	17
� What is the final orthodontic treatment plan likely to be?	18
� What risks should the patient be warned of regarding fixed appliance orthodontic treatment?	18
� Gemma’s final occlusion is shown in Figure 4.5. What undesirable sequelae of treatment are visible?	18
� How common is this with fixed appliance therapy and which teeth are affected mostly?	18
� How may the problem be prevented or minimized?	18
� How may these ‘white spots’ be managed?	18
Recommended reading	18
5 Severe crowding	20
Summary	20
History	20
Complaint	20
History of complaint	20
Medical history	20
� What implications does the medical history have for any proposed orthodontic treatment?	20
Dental history	20
Examination	20
Extraoral	20
Intraoral	20
� The intraoral views are shown in Figures 5.1 and 5.2. Describe what you see.	20
� What is the likely cause of the enamel hypoplasia on ?	21
� What are the likely causes of the severe upper arch crowding?	21
� 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?	21
� What are the likely causes of the upper premolar rotations?	22
Investigations	22
� What investigations would you request and why?	22
� What is your diagnosis?	22
� What is the IOTN DHC grade (see p. 203)? Explain why.	22
Treatment	22
� What are the aims of treatment?	22
� What is your treatment plan?	22
� 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?	22
� How would you assess the space required in the upper arch?	22
� Is this sufficient to achieve the treatment objectives?	23
� Finalize your treatment planning.	23
� What is the final orthodontic treatment plan?	23
� Design the upper removable appliance space maintainer.	23
� Are there any alternatives to this appliance?	23
� If all the space from lower premolar extractions had been required for lower labial segment alignment, how could anchorage have been reinforced there?	23
� How effective are TADs at reinforcing anchorage?	24
� Are there any risks with TADs?	24
� At review, 2 weeks after fitting the upper removable appliance, how will you know if it is being worn as instructed?	24
� 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?	25
Recommended reading	25
6 Palatal canines	26
Summary	26
History	26
History of complaint	26
Medical history	26
Dental history	26
Examination	26
Extraoral	26
Intraoral	26
� The intraoral views are shown in Figures 6.1 and 6.2. Describe what you see.	26
� What are the potential causes of c’s being retained?	27
� What factors are implicated in maxillary canine ectopia?	27
� What is the prevalence of TSD and which teeth are most commonly affected?	27
� How would you assess for a TSD?	27
Quick-check method	27
Computational method	27
� What are the implications of a TSD?	27
Investigations	28
� What investigations would you undertake regarding the retained c’s? Explain why.	28
Clinical	28
Radiographic	28
� How does the radiation dose from CBCT compare with that of a DPT?	28
� Are there any disadvantages to CBCT in orthodontics?	28
� Diane’s DPT and upper anterior occlusal radiograph are shown in Figure 6.3. What are the features of note?	28
� Is there any way in which ectopia of 3’s may be intercepted?	28
� What is your diagnosis?	29
� What is the IOTN DHC grade (see p. 203)? Explain why.	29
Treatment	29
� What management options are there for Diane’s unerupted 3’s? What are the indications for each option?	29
� Which option would you favour?	29
� What are the ideal aims of treatment?	29
� How would you proceed with treatment?	29
� Detail the design of a suitable removable appliance.	30
Activation	30
Retention	30
Anchorage	30
Baseplate	30
� What instructions would you give the patient regarding turning of the screw?	30
� When the crossbites on have been corrected what would you do?	30
� What methods of surgical exposure are there?	30
� How may the 3’s be aligned?	30
� What factors may you consider for retaining 3’s in their corrected positions?	31
Recommended reading	31
7 More canine problems	32
Cases 1 and 2	32
Summary	32
� What do you notice in Figure 7.1?	32
� What do you notice in Figure 7.2?	32
� What is the term used to describe the anomaly in position of the canine teeth? How common is this?	32
� Which arch and which teeth are affected mostly? Is there a gender difference in incidence?	32
� What is the aetiology of this anomaly?	33
� Could you classify this anomaly?	33
� What factors would you consider in treatment?	33
� What are the treatment options?	33
� How would you manage Case 1 and Case 2?	33
� What appliance type will be required? Explain why.	33
� How would you check that the positions of the corrected transposed teeth are optimal?	34
Recommended reading	34
Case 3	34
� What do you notice in Figure 7.5?	35
� Why are radiographs requested?	35
� What do you notice on the radiographs (Fig. 7.6)?	35
� What is the most likely cause of the root resorption to 2’s?	35
� What is the incidence of root resorption of 2’s by ectopic 3’s? What sites are most commonly affected? Is it more common in females?	35
� How accurate is the information regarding resorption of 2’s from the radiographs?	35
� How may more detailed information regarding 2’s resorption be obtained?	35
� What other investigations would you do in relation to 2’s?	35
� What are the treatment options in relation to 2’s?	35
� How would you monitor resorption of the upper incisors during orthodontic treatment?	36
� What is the short–medium term prognosis of with the markedly resorbed root?	36
Recommended reading	36
8 Infraoccluded primary molars	37
Summary	37
History	37
Complaint	37
History of complaint	37
Medical history	37
Dental history	37
Family history	37
Examination	37
Extraoral examination	37
Intraoral examination	37
� What do you see?	38
� What is the prevalence of infraocclusion of primary molars?	38
� Why does infraocclusion of primary molars occur?	38
Investigations	38
� What investigations would you undertake? Explain why.	38
Clinical	38
Radiographic	38
� The dental panoramic tomogram is shown in Figure 8.3. What are the findings of note?	38
� Which teeth does hypodontia affect most commonly?	38
� What do these values tell you (see p. 204)?	39
Diagnosis	39
� What is your diagnosis?	39
� What is the IOTN DHC grade (see p. 203)?	39
Treatment	39
� What treatment options are there for the lower arch? Explain why.	39
� What implications do these options have for the upper arch?	39
� If ’s had been present radiographically, what would have been your treatment plan?	39
Recommended reading	40
9 Increased overjet	41
Summary	41
History	41
Complaint	41
History of complaint	41
� Medical history.	41
Examination	41
Extraoral	41
� How would you assess Emma’s skeletal pattern?	41
Intraoral	42
� The intraoral views are shown in Figures 9.1 and 9.3. What do these show?	42
� What are the causes of an increased overjet?	42
Investigations	43
� What radiographs are indicated?	43
� What do these indicate (see p. 204)?	43
� Would you consider any other investigations?	43
Diagnosis	43
� What is the diagnosis?	43
� What is the IOTN DHC grade (see p. 203)?	43
� What factors predispose to upper incisor trauma?	43
� What are the aims of treatment?	43
� What treatment would you advise? Explain why.	43
� Describe the records you would take to allow fabrication of the functional appliance?	43
� On issuing the functional appliance, what instructions would you give Emma?	44
� How does a Twin-Block work and what effects does it produce?	44
Skeletal	44
Dental	44
� Following overjet correction by Twin-Block therapy, what occlusal anomaly is usually manifest posteriorly in the dental arches?	44
� How may this be corrected?	44
� If there is no progress at 6 months, what action would you take?	45
� What other treatment options are there?	45
� What factors govern stability of the corrected overjet?	45
Recommended reading	46
10 Incisor crossbite	47
Summary	47
History	47
Complaint	47
History of complaint	47
Medical history	47
Dental history	47
Examination	47
Extraoral	47
Intraoral	47
� What features are visible on the intraoral views (Figs 10.1 and 10.2)?	47
� What specific features would you check? Explain why.	48
Investigations	48
� What special investigations would you request? Why?	48
� The dental panoramic tomogram taken 6 months prior to this visit is shown in Figure 10.3. What does it show?	48
Diagnosis	48
� What is your diagnosis?	48
� What is the IOTN DHC grade (see p. 203)?	49
� What would you deem to be the prognosis for the labial recession related to ?	49
� Why is in crossbite?	49
Treatment	49
� What treatment would you provide and why?	49
� Describe the appliance design you would use to align .	49
� What will determine stability of crossbite correction on ?	49
Recommended reading	49
11 Reverse overjet	50
Summary	50
History	50
Complaint	50
History of complaint	50
Medical history	50
Family history	50
Examination	50
Extraoral	50
� What other features would you check for?	50
Intraoral	50
� What are your observations from the intraoral views (Figs 11.1 and 11.3)?	50
� What are the possible causes of the reverse overjet?	51
� What radiographic investigations would you request and why?	51
� What is your interpretation of the following cephalometric findings?	51
Diagnosis	51
� What is your orthodontic diagnosis?	51
� What is the IOTN DHC grade (see p. 203)?	51
� What dental health reasons are there for orthodontic treatment?	51
� What factors would you assess in orthodontic treatment planning?	51
Treatment	52
� What orthodontic treatment would you undertake and why?	52
� How would you take a wax registration for this appliance?	52
� How much should Alistair wear this appliance?	52
� What effects will this appliance have?	52
� What other treatment options are there?	52
Prognosis	53
� What factors will influence stability of the corrected incisor relationship?	53
Recommended reading	53
12 Increased overbite	54
Summary	54
History	54
Complaint	54
History of complaint	54
Medical history	54
Dental history	54
Family history	54
Examination	54
Extraoral	54
� Harry’s profile view is shown in Figure 12.2. What do you notice about the anteroposterior skeletal pattern and the lips?	54
Intraoral	54
� The appearance of the mouth is shown in Figures 12.1 and 12.3. What do you see?	54
� What are the possible causes of the traumatic overbite?	55
� What further investigations would you undertake?	55
� What is your interpretation of the following cephalometric findings (see p. 204)?	55
� What is your diagnosis?	56
� What is the IOTN DHC grade (see p. 203)?	56
Treatment	56
� What are your aims of treatment?	56
� How do you propose to achieve these aims?	56
� Describe the design of appliances you would use.	56
� What are the goals of the functional appliance treatment?	56
� Why may a later phase of fixed appliance therapy be required?	56
� What aspects of the corrected occlusion are prone to relapse? How may you try to prevent/minimize relapse?	56
Recommended reading	57
13 Anterior open bite	58
Summary	58
History	58
Complaint	58
History of complaint	58
Medical history	58
Dental history	58
Examination	58
Extraoral	58
� Gerald’s facial profile is shown in Figure 13.2. What do you notice?	58
� What other features should you assess? Explain why.	58
� What occlusal anomalies are associated with speech problems? Are the latter likely to resolve if any underlying malocclusion is treated?	59
Intraoral	59
� What other features do you see (Figs 13.1 and 13.3)?	59
� What are the possible causes of an anterior open bite?	59
� What are the effects of a persistent digit-sucking habit on the occlusion other than creating an anterior open bite?	59
Investigations	59
� What special investigations would you require? Explain why.	59
� What is your interpretation of these findings?	59
Diagnosis	60
� What is your diagnosis?	60
� What is the IOTN DHC grade (see p. 203)?	60
Treatment	60
� What treatment would you consider?	60
� If the anterior open bite had been due to thumb sucking, what treatment would you recommend?	60
� What is the likely prognosis of treatment?	60
� Are there any other treatment options?	61
Recommended reading	61
14 Posterior crossbite	62
Summary	62
History	62
Complaint	62
History of complaint	62
Medical history	62
Family history	62
Examination	62
Extraoral	62
� What other feature would you check for, bearing in mind the history? Explain why.	62
Intraoral	62
� What features are evident on the intraoral views (Figs 14.1 and 14.2)?	62
� How would you assess the centrelines?	63
� What are the possible causes of a lower centreline shift?	63
� What factors may be implicated in the aetiology of the crossbite?	63
� What is the most likely cause of the posterior crossbite in this case?	63
Investigations	63
� What special investigations would you undertake and why?	63
� What does the dental panoramic tomogram show?	63
� What is the most likely reason for the blurred image of the right half of the dental panoramic tomogram?	63
� Why was a right half, rather than a full, dental panoramic tomogram retaken? (Fig. 14.3B)?	64
Diagnosis	64
� What is your diagnosis?	64
� What is the IOTN DHC grade (see p. 203)?	64
Treatment	64
� What treatment plan would you propose?	64
� How may the crossbites be corrected? Describe the design of any appliance you would use.	64
� What will determine if the corrected buccal segment crossbite is likely to be stable?	64
Recommended reading	65
15 Bilateral crossbite	66
Case 1	66
Summary	66
History	66
Complaint	66
History of complaint	66
Medical history	66
� What is the relevance of Jean’s mode of breathing to snoring and to her complaint?	66
Dental history	66
� How may a digit-sucking habit cause a buccal segment crossbite?	66
Social history	66
Examination	66
Extraoral	66
Intraoral	66
� The appearance of the teeth on presentation is shown in Figures 15.1 and 15.2. Describe what you see.	66
� What are the possible causes of bilateral buccal crossbite?	67
Investigations	67
� What investigations would you undertake in relation to the bilateral buccal crossbite? Explain why.	67
Clinical	67
Radiographic	67
� What is your interpretation of these findings?	67
Diagnosis	67
� What is your diagnosis?	67
� What is the IOTN DHC grade (see page 203)?	67
Treatment	67
� What are the aims of treatment?	67
� What treatment would you provide?	67
� What options are there for management of the bilateral buccal crossbite? Which would you choose?	67
� What factors should be checked before using this treatment? What are the chances of opening the mid-palatal suture in this patient?	68
� Describe the design of the appliance you would use. What instructions would you give Jean regarding this appliance?	68
� What should Jean be advised of regarding the effects of expansion?	69
� Describe how the appliance works?	69
� How will you retain the crossbite correction?	69
Recommended reading	69
Case 2	69
Summary	69
� What are the main features of note in Figure 15.5?	69
History of complaint	70
� What makes a smile attractive?	70
Medical and dental history	70
Treatment	70
� Why is RME not feasible?	70
� How is SARPE undertaken?	70
� How stable is SARPE?	70
Recommended reading	71
Case 3	71
Summary	71
� What are the main features of note in Figure 15.8?	71
� Given the position of , what would you enquire about?	72
Extraoral	72
� What are the causes of bilateral lingual crossbite?	72
� What treatment options are there for correction of bilateral lingual crossbite?	72
� Simon was treated with the fixed appliances shown in Figure 15.9. What type of appliance is this? What are its claimed advantages compared with conventional fixed appliance systems?	72
� How does distraction osteogenesis work and what are the complication risks of mandibular midline distraction?	73
Recommended reading	73
16 Late lower incisor crowding	74
Summary	74
History	74
Complaint	74
History of complaint	74
Medical history	74
Dental history	74
Examination	74
Extraoral examination	74
Intraoral examination	74
� What do you notice?	74
� Is development of lower incisor crowding common in the late teens?	74
� What are the possible causes of late lower incisor crowding?	75
Investigations	75
� What investigations would you undertake? Explain why.	75
Radiographic	75
Study models	75
� What do you notice on the dental panoramic tomogram taken pre-orthodontic treatment (Fig. 16.3)?	75
Diagnosis	75
� What is your diagnosis?	75
� What is the IOTN (DHC) grade (see p. 203)? Explain why.	75
� What are the management options for late lower incisor crowding?	75
� Would you advise removal of the lower third molars?	76
� How would you manage the lower incisor crowding?	76
Recommended reading	76
17 Prominent chin and TMJDS	77
Summary	77
History	77
Complaint	77
History of complaint	77
� What questions would you ask about the temporomandibular joint pain?	77
Medical history	77
Dental history	77
Family history	77
Examination	77
Extraoral examination	77
� What do you observe from Jocelyn’s profile view (Fig. 17.1)?	77
� Based on the history, what other aspects would you assess extraorally?	78
Intraoral examination	78
� What do you see?	78
� What is the most likely cause of the considerable spacing in the lower premolar areas with drifted into contact with ?	78
� What occlusal features may predispose to temporomandibular joint dysfunction syndrome?	78
� Why was Jocelyn advised to wait until her late teens for reassessment?	78
Investigations	79
� What investigations are required and why?	79
� What is your interpretation of these findings (see p. 204)?	79
Diagnosis	79
� What is your diagnosis?	79
� What is the IOTN DHC grade (see p. 203)? Explain why.	80
Treatment	80
� What are the aims of treatment?	80
� What treatment is required? Explain why.	80
� How will this case be managed?	80
Short term	80
Longer term	80
� Explain how you would proceed with surgical planning for this case.	80
� Describe the phase of pre-surgical orthodontics.	81
� What surgical procedures are likely to be required?	81
� What form of splint and fixation is likely to be required?	81
� Describe the post-surgical orthodontic phase.	81
� What factors influence post-surgical stability?	81
Recommended reading	82
18 Drifting incisors	83
Summary	83
History	83
Complaint	83
History of complaint	83
Dental history	83
Medical history	83
Social history	83
Examination	83
Extraoral	83
Intraoral	83
� What do you notice in Figures 18.1 and 18.2?	83
� Based on what you know so far, what are the possible factors implicated in respect to mobility and drifting of ?	84
� What would you check for specifically in relation to the history?	84
Investigations	84
� What other investigations would you carry out? Why?	84
� Full-mouth periapical radiographs are shown in Figure 18.3. What do you see?	84
Diagnosis	84
� What is your diagnosis?	84
� With loss of periodontal attachment, how may labial drifting of the incisors occur?	84
� What is the significance of the medical history and social history to the diagnosis?	85
Treatment	85
� What treatment would you advise?	85
� What periodontal treatment do you envisage will be required?	85
� How would you describe the prognosis of Iain’s dentition?	85
� What are the treatment options for the upper labial segment spacing?	85
� What options are there with regard to improving appliance aesthetics in an adult patient?	85
� What special considerations are there with orthodontic treatment in a periodontally compromised dentition?	86
Recommended reading	86
19 Appliance-related problems	87
Case 1	87
Summary	87
History	87
Complaint	87
History of complaint	87
Medical history	87
Examination	87
Extraoral	87
Intraoral	87
� Describe the appearance of the palate.	87
� What are your observations regarding the retainer?	87
� What is the most likely diagnosis based on the information you have so far?	87
� What other condition would produce a similar appearance?	88
� What is the aetiology of ‘denture’ stomatitis?	88
� What factors in this case may have predisposed to ‘denture’ stomatitis?	88
Investigations	88
� How would you confirm the diagnosis?	88
� What stains identify Candida?	88
Treatment	88
� How would you treat this condition?	88
� What is the prognosis for this condition?	88
Recommended reading	88
Cases 2 and 3	89
Summary	89
� What problem do you notice in Figure 19.2A?	89
� Why has this occurred?	89
Treatment	89
� What treatment would you provide? Explain why.	89
� What problem do you notice in Figure 19.3A?	89
� How has this problem arisen?	90
� How would you manage this problem?	90
� As a general dental practitioner, what emergency care would you provide?	90
Recommended reading	90
20 Tooth movement and related problems	91
Case 1	91
Summary	91
� What are the possible reasons for a slow rate of tooth movement?	91
Patient factors	91
Appliance factors	91
Operator factors	91
� What force range is optimal for retraction of by tipping movement?	91
� What cellular response is there following activation of the spring to retract by tipping movement?	91
Pressure zones	91
Tension zones	91
� What is the mechanism for tooth movement?	92
� How would you manage the problem in this case?	92
� What do you notice on the periapical radiograph of another case (Fig. 20.2)?	92
� What treatment would you advise?	92
Recommended reading	92
Case 2	92
Summary	92
� Why is the radiograph ordered?	92
� What do you notice on the film (Fig. 20.3A)?	92
� Which teeth experience most orthodontically-induced root resorption?	93
� What risk factors have been suggested in relation to orthodontically-induced root resorption?	93
� What does current evidence suggest with regard to orthodontically-induced root resorption?	93
� Could root resorption have been prevented?	93
� What must the orthodontist ensure before treatment commences?	93
� What would you do in this case?	94
� What treatment would you provide?	94
Recommended reading	94
Case 3	94
Summary	94
� What do you notice in Figure 20.4?	94
� What does this indicate?	94
� Why has this occurred?	94
Forces from the supporting tissues	94
Forces from the orofacial soft tissues	94
Occlusal factors	95
Post-treatment facial growth	95
Retention regimen	95
� What management options are there for this problem?	95
Recommended reading	95
21 Cleft lip and palate	96
Summary	96
History	96
Complaint	96
History of complaint	96
Medical history	96
Family history	96
� What is the prevalence of cleft lip and palate?	96
� Is there a sex and side variation for cleft lip and palate?	96
� How does this malformation occur?	96
� Why is this? What treatment will have been provided to date and what role have you to play as her general dental practitioner?	96
Neonatal period to 18 months	96
Primary dentition	97
� What skeletal/dental/occlusal problems are commonly found with cleft lip and palate?	97
Examination	97
Extraoral	97
� What do you notice from Figure 21.2?	97
� How is lip closure achieved?	97
Intraoral	97
� The appearance of the teeth is shown in Figures 21.1 and 21.3. What are your observations?	97
� In view of the unilateral crossbite of the right buccal segment, what should you check for? How would you do this?	98
Investigations	98
� What investigations are required? Explain why.	98
� Karen’s dental panoramic tomogram and upper anterior occlusal radiograph are shown in Figure 21.4. What do you notice?	98
Diagnosis	99
� What is your diagnosis?	99
� What is the IOTN DHC grade (see p. 203)? Explain why.	99
Treatment	99
� What are the aims of treatment at this stage?	99
� What would you do at this stage?	99
� What form do you envisage the orthodontic treatment to take?	99
� When is secondary alveolar bone grafting usually undertaken and what advantages does it confer?	99
� The occlusion prior to bone grafting is shown in Figure 21.5. What may you consider at this stage?	99
� What treatment will be required following alveolar bone grafting?	99
Recommended reading	99
22 Nursing and early childhood caries	100
Summary	100
History	100
Medical history	100
Examination	100
� What is the cause of this pattern of decay?	100
� What can cause this?	100
� Why are the teeth affected in this pattern?	100
� What additional factors make the upper primary incisors more predisposed to caries?	100
� What should be your advice about night-time feeding?	101
� How could you identify pre-school children in need of dental care?	101
Treatment	101
� Kelly-Ann is in a high risk for caries group. List all the main factors you can think of for placing someone in the high risk group for dental caries.	101
� What fluoride regimen would you suggest to Kelly-Ann’s mother?	101
� What information is essential before prescribing fluoride supplements?	101
� What is the currently recommended fluoride supplementation regimen in the UK?	101
Professionally applied fluorides	101
� Why can Kelly-Ann not have fluoride mouthwash?	101
� What other forms of preventive care does she need?	101
Toothbrushing instruction	101
Diet analysis	101
� How would you restore the upper incisors?	102
� How would you restore the early cavitation in the first primary molars?	102
� What method of caries removal, without a handpiece, may be applicable here?	102
� How is pain relief best achieved in the child with nursing caries in Figure 22.2?	102
Recommended reading	102
23 High caries risk adolescents	103
Summary	103
History	103
Complaint	103
History of complaint	103
Medical history	103
Dental history	103
� What aspects of the presentation and history help to determine the caries risk category so far?	103
Examination	103
Extraoral	103
Intraoral	103
� What further aspects of the clinical presentation help determine caries risk?	103
� At present what caries risk category would you place Peter in?	104
� What further questions would you ask Peter to complete his caries risk assessment?	104
Fluoride history	104
Dietary history	104
Preventive care and treatment	104
� After the initial bitewing radiographs are taken (see Fig. 23.4), when should Peter have radiographs taken again?	104
� What other forms of preventive care would he benefit from?	104
Strength of fluoride toothpaste	104
Fluoride varnish application	104
Fluoride supplements	105
Diet analysis	105
Fissure sealants	105
� What else might you suggest now that Peter is older that could help reduce his caries risk status further for the future?	106
Higher strength fluoride toothpaste (2800 or 5000 ppm F)	106
Tooth mousse or tooth mousse plus (CPP-ACP or CPP-ACFP)	106
Sugar-free chewing gum (xylitol/CPP-ACP nanocomplexes)	106
Recommended reading	106
24 The uncooperative child	107
Summary	107
� What do you understand by the term behaviour management?	107
� What history is important in Liam’s case?	107
� What main forms of communicative management are there?	107
Voice control	107
Non-verbal communication	107
Tell–show–do	107
Positive reinforcement	107
Distraction	108
Parental presence/absence	108
Examination	108
� What additional help might you consider giving Liam?	108
� What are the indications for general anaesthesia?	109
� What are the contraindications for general anaesthesia?	109
Informed consent	109
Recommended reading	109
25 Disorders of eruption and exfoliation	110
Case 1	110
Summary	110
� What is the correct terminology for these early erupting teeth?	110
� What are the main problems associated with natal and neonatal teeth?	110
� What factors can cause generalized premature eruption but still be considered as ‘normal’?	110
� When is generalized delay in eruption of primary teeth expected?	110
� What conditions may lead to a generalized retarded eruption of teeth in both primary and permanent dentitions?	110
� What specific condition is associated with grossly delayed or failed eruption of teeth in the permanent dentition?	110
� What local factors can account for delayed eruption of permanent teeth?	111
Case 2	111
Summary	111
History	111
Dental history	111
� What causes delayed exfoliation of primary teeth?	111
� How is infraocclusion graded?	112
Treatment options in infraocclusion	112
Recommended reading	112
26 Pain control and carious primary teeth	113
Summary	113
� What questions do you need to ask regarding the pain?	113
� What dressings can help manage pulpitis initially?	113
History	113
Examination	113
� What investigation is essential to allow you to formulate a treatment plan?	113
Treatment	114
� What is your definitive treatment plan for and ?	114
� What types of primary molar pulp treatment are there?	114
� The status of formocresol as a pulpotomy medicament.	114
� What is the appropriate restorative material after pulp treatment?	114
Recommended reading	115
27 Facial swelling and dental abscess	116
Summary	116
� List four symptoms and signs specific to each type of infection.	116
History	116
Examination	116
� What is the major problem with mandibular infections?	116
� What is the basic management of any infection?	116
� What are the criteria for hospital admission with orofacial infection?	117
� What will the hospital management of a severe infection involve?	117
Treatment	118
Recommended reading	118
28 The displaced primary incisor	119
Summary	119
History	119
Complaint	119
History of complaint	119
Medical history	119
Dental history	119
� What specific questions would you ask and why?	119
Examination	119
Extraoral	119
Intraoral	119
� The appearance of the upper anterior teeth is shown in Figure 28.1. What can you see?	119
� What specific signs will you look for in your examination?	119
� What question should dentists keep at the back of their minds when examining children?	119
� What features in the history and examination would lead to suspicions of child physical abuse?	119
Investigations	120
� What investigations would you perform for James? Explain why for each.	120
Diagnosis	120
� What is your diagnosis?	120
Treatment	120
� What are the three key components of the history and examination in primary tooth trauma that will dictate if active treatment is required?	120
� What treatments are usually required for displaced primary incisors?	120
� What radiographs would you take for these displacement injuries?	120
� What are you going to tell James’s mother about the risk to the permanent teeth?	120
� What are the possible effects on the permanent successor teeth?	120
� Can you tell all of these sequelae on a periapical radiograph?	120
� If you retain a luxated primary tooth how often would you review it?	120
� How would you review it?	121
� Does a discoloured primary incisor always need treatment?	121
Recommended reading	121
29 The fractured immature permanent incisor crown	122
Summary	122
History	122
Complaint	122
History of complaint	122
Medical history	122
Dental history	122
� What specific questions would you ask and why?	122
Examination	122
Extraoral	122
� Why is the presence of lip swelling together with a mucosal laceration important?	122
� How would you demonstrate there was a fragment of tooth in the lip?	122
Intraoral	123
� What injuries are visible in Figure 29.1?	123
� Are the roots of and likely to have open or closed apices?	123
� How would you confirm apical status?	123
� What other injuries must you exclude on the periapical radiograph?	123
� What other features of the anterior teeth are important at examination?	123
� What teeth should be examined after trauma affecting only the upper centrals?	123
Investigations	123
Treatment	123
� What is the prime consideration for both the upper central incisors?	123
� What is the appropriate immediate treatment for (that has an enamel-dentine fracture)?	123
� What are the treatment options for (that has a pulpal exposure)?	123
� What are the indications for permanent tooth pulpotomy?	123
� How would you carry out a pulpotomy?	123
� How should the crown of be restored?	124
� How should the upper centrals be reviewed and how often?	124
Recommended reading	124
30 The fractured permanent incisor root	125
Summary	125
History	125
Complaint	125
History of complaint	125
� What does this alert you to?	125
Medical history	125
� What specific questions would you ask and why?	125
Examination	125
Extraoral	125
� What questions and examination would you complete regarding the swelling and bruising under the right eye?	125
Intraoral	125
� What tests would you do prior to repositioning of the teeth?	125
Treatment	125
� What design of splint would you use for , ? You have confirmed on radiography that they have middle third root fractures (Fig. 30.1).	125
� How long should the splint be in place in root fractures?	125
� Do any forms of dentoalveolar injury need to be rigidly splinted?	126
� Describe step by step your procedure for reduction and splinting Andrea’s and .	126
� On removal of the splint how often would you review Andrea?	126
� What tests would you complete at each of these reviews?	126
� Is sensibility testing accurate?	126
� What is the likely radiographic appearance at the fracture line if the coronal tooth portion becomes non-vital?	126
� If the coronal portion of an apical or middle third root fractured tooth became non-vital, how would you root treat the tooth?	126
� What happens to the apical fragment?	127
Is the prognosis good in coronal or gingival third root fractures?	127
� What are the treatment options in coronal or gingival third root fractures?	127
� Can root fractured teeth maintain vitality?	127
� Can root fractured teeth be moved orthodontically?	127
Recommended reading	127
31 The avulsed incisor	128
Summary	128
� 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?	128
� The tooth is brought to the surgery in milk. How would you proceed?	128
� What factors are important when deciding whether root canal treatment is necessary in Kathryn’s case?	128
� What intracanal medicament should be placed in the extirpated tooth?	128
� What factors are important in predicting resorption?	128
� What types of resorption are there?	128
� What is the treatment if inflammatory resorption occurs after trauma?	129
� If resorption in was progressive how would you plan for its ultimate loss?	129
� How does the EADT influence your treatment of the avulsed incisor?	129
Recommended reading	130
32 Poor quality first permanent molars	131
Summary	131
History	131
Medical history	131
Dental history	131
Examination	131
� 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?	131
� What specific questions would you like to ask Lisa’s mother?	132
� What other differential diagnoses might you consider?	132
� Is pain from such molar teeth common?	132
Investigations	133
� What investigations are indicated and why?	133
Treatment	133
� What are the main clinical problems in this case?	133
� What are the treatment options for the HFPMs in this case?	133
Composite/GIC restorations	133
Stainless steel crowns	133
Adhesively retained copings	133
Extraction	133
� What are the treatment options for the incisors in this case?	134
Recommended reading	134
33 Tooth discoloration, hypomineralization and hypoplasia	135
Case 1	135
Summary	135
History	135
� What other questions do you need to ask about the teeth?	135
� Have you also noticed that he has gingival overgrowth?	135
Medical history	135
� What specific questions do you need to ask his mother with regard to potential causes of discoloration?	135
The pregnancy	135
Childhood illnesses	135
Tablets or medications taken during childhood	135
Dental history	136
� What other lines of questioning do we need to explore if we are considering all the possible causes of intrinsic discoloration?	136
� Was there a history of infection and/or extraction for decay of any of the primary teeth?	136
� Was there ever any trauma to the primary teeth?	136
� Fluoride history.	136
Examination	136
� In the major categories for questioning shown in Box 33.1, which are likely to cause generalized discoloration and which are likely to cause localized discoloration?	136
� What is the only method of treatment that will help Simon’s appearance?	136
� If a patient came to you with a single discoloured root-filled incisor, what form of treatment should you consider first?	136
Case 2	137
Summary	137
History	137
� Are there any other causes of extrinsic staining?	137
� How can you confirm your diagnosis of extrinsic discoloration?	138
� What additional clinical signs are there on Figure 33.3 to back up your diagnosis of chromogenic staining secondary to poor oral hygiene?	138
Treatment	138
� How would you treat Tony’s bad breath?	138
� What factors in children and adolescents are important in halitosis (bad breath)?	138
� As well as improving his gingival health with improved toothbrushing, what else could be done with the toothbrush?	138
Recommended reading	138
34 Mottled teeth	139
Summary	139
History	139
� What important questions would you now ask her mother?	139
� Is anyone else in the family affected?	139
� What childhood illnesses and infections did she have, and when?	139
� What is Sophie’s fluoride history?	139
� What is the distribution of the mottling that you can see in Figure 34.1?	139
� Do you know why the labial surfaces of the upper permanent central incisors are often more affected by mottling?	139
� Which part of the enamel does mild fluorosis affect?	139
� How can you use this knowledge to your advantage during your clinical examination?	139
� In some cases of fluorosis there is, in addition to white mottling, some brown stain. What is the cause of the brown staining?	140
� What treatment options for Sophie would you consider for fluorotic mottling?	140
� Has bleaching of teeth any part to play in the treatment of surface enamel discoloration?	140
Recommended reading	142
35 Dental erosion	143
Summary	143
� What do you see (Fig. 35.1)?	143
� How would you define erosion?	143
� What foods and drinks have erosive potential?	143
History	143
� What is the best way to find out about Tom’s diet?	143
� Can the pattern of erosion caused by dietary constituents be related to the manner in which the substrate is consumed?	143
� 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?	143
� What question would you ask to give you an indication that regurgitation was occurring?	144
� What is the common pattern of erosive loss when there is chronic gastric regurgitation?	144
� Is there a specific pattern of erosive loss in recurrent vomiting?	144
� What would you do if you suspect after questioning Tom and his parents that there may be asymptomatic GORD?	144
Summary of Tom’s history	144
� What advice would you give to Tom regarding his high intake of fizzy drinks?	144
Management	144
� Tom only has occasional sensitivity. What treatment, if any, does he need?	144
� Erosion is only one element of tooth surface loss or wear. What are the other elements?	145
� What categories of patient exhibit more attrition than normal?	145
� What restorative materials are the most durable for attritional wear as a result of parafunction?	145
Recommended reading	145
36 Multiple missing and abnormally shaped teeth	146
Case 1	146
Summary	146
History	146
Medical history	146
� What question do you need to ask Ellen’s mother?	146
� How prevalent are missing teeth in the population?	146
� There are a significant number of syndromes of the head and neck that manifest with missing teeth. Can you name some?	146
� What factors would you consider important in the management of dental anomalies?	146
Examination	147
Extraoral	147
Intraoral	147
� What special investigations are required?	147
� What is visible from the radiograph?	147
� What is the condition known as?	147
� What would you do?	147
� What treatment is likely to be required?	147
Case 2	147
Summary	147
Medical and dental history	147
� What can you see in Figure 36.2?	147
� How prevalent do you think double teeth are?	147
� What are the most important clinical aspects of a double tooth in the primary dentition?	147
� What are the important factors that will dictate whether you retain or extract double permanent teeth?	148
� What other types of crown abnormality do you know?	148
� What are the treatment options for a talon cusp on a maxillary tooth?	148
� What abnormalities of root form do you know?	149
� What conditions may taurodontism be associated with?	149
Recommended reading	149
37 Amelogenesis imperfecta	150
Summary	150
� What can you see in Figure 37.1?	150
History	150
� Was there any systemic illness from birth to early childhood?	150
� Were the primary teeth similarly affected?	150
� Is anyone else in the family similarly affected?	150
Medical history	150
Examination	150
� Why is this pattern of enamel hypoplasia unlikely to be caused by systemic (chronological) influences?	150
� What are the main types of AI?	150
Investigations	151
� What investigations are necessary?	151
Dental panoramic tomogram	151
Family examination	151
Treatment	151
Recommended reading	152
38 Dentinogenesis imperfecta	153
Summary	153
History	153
� Was there any systemic illness from birth until early childhood?	153
� Were the primary teeth similarly affected?	153
� Is anyone else in the family similarly affected?	153
� Why is this DI and not amelogenesis imperfecta (AI)?	153
� What investigations do you need to do to confirm your suspicions?	153
Dental panoramic tomogram	153
Family examination	153
DI type II	154
� Is DI more prevalent than AI?	154
� Has DI got as many inheritance patterns as AI?	154
DI type I associated with osteogenesis imperfecta	154
Treatment	154
Recommended reading	155
39 Gingival bleeding and enlargement	156
Summary	156
History	156
Medical history	156
Dental history	156
Examination	156
� What factors are contributing to the chronic marginal gingivitis?	156
� What do you think may have precipitated the initial gingivitis?	157
� What is the other cause of diabetic coma and what are its signs?	157
Treatment	157
� Why is the gingivitis worst in the anterior part of the upper right quadrant?	157
� What other generalized causes of gingival enlargement do you know?	157
� Why is it important to eradicate Kayleigh’s gingivitis?	157
� Why is it important not to leave caries in a diabetic?	157
� Why is the timing of the appointment to restore Kayleigh’s first permanent molar important?	158
� What dietary advice should you give to diabetic patients?	158
� What other oral manifestations can occur in diabetes?	158
Recommended reading	158
40 Oral ulceration	159
Summary	159
History	159
Medical history	159
� Describe the appearance of the upper and lower gingivae in Figure 40.1.	159
� What is the diagnosis?	159
Treatment	159
� What are the reasons given for the reactivation of HSV to produce a cold sore (herpes labialis) (Fig. 40.2)?	160
� How should herpes labialis be treated?	160
� What other viral infection can occur in the mouths of paediatric patients?	160
Varicella zoster virus (VZV)	160
Epstein–Barr virus (EBV)	160
Cytomegalovirus	160
Herpes virus type 8	160
Coxsackie viruses	160
Human papilloma virus (HPV)	160
� What types of aphthae are there?	160
� What aetiological factors are important in recurrent aphthae?	160
� What systemic diseases in children are commonly associated with aphthae?	161
Recommended reading	161
41 Mind Maps	162
Appendices	203
A1 The index of orthodontic treatment need: dental health component	203
A2 Lateral cephalometric analysis	204
Aim and objective of cephalometric analysis	204
Practice of cephalometric analysis	204
Cephalometric interpretation	204
Skeletal relationships	204
Tooth position	204
Soft tissue analysis	205
Index	206
A	206
B	206
C	207
D	207
E	208
F	208
G	208
H	209
I	209
K	209
L	209
M	209
N	210
O	210
P	210
Q	211
R	211
S	212
T	212
U	212
V	212
W	212

Clinical Problem Solving in Orthodontics and Paediatric Dentistry - E-Book

Additional Information

Book Details

Abstract

Table of Contents

Contact Us

Quick Navigation