DEN4448 Week 1 student notes 2024.docx

**Week 1 Introduction to Orthodontics** **Dental Hygienist and the Orthodontic Setting** CDHO Standards of Practice Pages 2, 4 Page 4: A dental hygienist demonstrates a commitment to professional responsibility by: - **[Adhering]** to healthcare legislation, the CDHO regulations, code of e...

**Week 1 Introduction to Orthodontics** **Dental Hygienist and the Orthodontic Setting** CDHO Standards of Practice Pages 2, 4 Page 4: A dental hygienist demonstrates a commitment to professional responsibility by: - **[Adhering]** to healthcare legislation, the CDHO regulations, code of ethics, practice standards, professional guidelines and policies Page 2: These standards are intended to guide the **[professional]** judgement and actions of dental hygienists and inspire self-reflection and continuous professional development. Controlled Acts - No one, including dental hygienists, is permitted to perform a controlled act without legal authority. - Controlled acts are procedures that contain an inherent risk to them, such as scaling and root planning or restorative or **[orthodontic]** procedures CDHO REGISTRANTS HANDBOOK; Section 3-7 Updated Aug 2012 - *The eleventh controlled act relates to fitting or dispensing a dental prosthesis, orthodontic or periodontal appliance or a device used inside the mouth to protect teeth from **[abnormal functioning.]*** - *It is to enable performance of this controlled act that dental hygienists are authorized to perform orthodontic procedures where there has been an **["order"]** by a dentist* - The use of a **[high-speed]** hand piece is not, in and of itself, a controlled act. It depends on what you do with it. - Removal of **[bonding]** material does not involve a procedure in the surface of a tooth and is not a controlled act - In addition to the thirteen controlled acts, section 32 of the Regulated Health Professions Act also prohibits the design, construction, repair or alteration of a dental prosthetic, restorative or orthodontic device unless the technical aspects are **[supervised]** by a dentist or a dental technologist (or by a denturist for the denturists own clients). **Early Orthodontics** Fathers of Orthodontics: 1728: - Pierre Fauchard published a book called "The Surgeon Dentist" - Included a chapter on ways **[straighten]** teeth - He described an appliance called a **["Bandeau"]** = horseshoe piece of metal to expand arch 1757: - Ettienne Bourdet published a book called "The Dentist's **[Art"]** - He perfected the "Bandeau" - 1^st^ to recommend **[extraction]** of premolars when crowding Edward Angle: - Devised the first simple classification for malocclusion - 1901 -- Founded first **[College]** of Orthodontics Early Braces: Used: - Platinum - **[Silver]** - Gum rubber - **[Wood]** - Ivory - **[18K gold -- because its malleable \[called detailing to bend the wires\]]** **Orthodontics Today =** - Specialty of dentistry concerned with supervision, guidance and **[correction]** of the growing and mature dentofacial structure. - Specialty that deals with prevention, diagnoses and treatment of malocclusion **Diagnostic Records Assembly** **First Step of Orthodontic Treatment = [Assessment]** **Objectives of Assessment** - **[Learn] as much about the client as possible!!** - **[Obtain] initial Dental records** **Components of Orthodontic Records:** **1. Client Interview or [Case History]** Medical = **[Health History]** - Comprehensive overview of physical status For example: - Diabetic \[poor healing\] - Premeds req'd - **[Allergies? \[metals and elastics\] ]** - **[Meds]** - **[Response]** of teeth may be reduced - hormones = bone remodeling is slower - **[Trauma]** - insight into **[skeletal]** asymmetry - Healing of fractures Dental History: - Existing caries, restorations, perio - Previous **[Ortho]** \*\*\*\* FULL **[charting]** required Social History: - Chief Complaint = **[CC \[chief complain\]]** - Main reason for seeking Tx (May need to ask leading questions) - Document in chart -- -- use clients own **[words]** - Ask **[both]** client and parent - Builds initial **[rapport]** - Address needs of client - Assesses **[compliance]** - Client knowledge of ortho - Identify **[barriers]** to treatment **2. Clinical Examination** Extra + intra oral exam used for: - Analysis of oral health - Dental analysis - **[Facial]** analysis - **[Observation]** - Taking Extraoral **[photographs]** The **[Golden]** Rule: Between 14th - 17th Centuries: - **[Golden]** Ratio = Equation was used by renowned artists/architects - used to map out their masterpieces Thousands of years later: - scientists adopted this mathematical formula - helped explain why some people are considered **[beautiful]**...and others are not **Part I:** - **[Length]** and width of face is measured - Length is divided by width - Ideal result = approx. **[1.6]** - Therefore face = **[1.5X]** longer than wider 1. Measures 3 segments of the face - forehead hairline to above **[eye]** - above eye to bottom of nose - bottom of nose to bottom of the **[chin]** 2. Ideal result = numbers should be **[equal]** - Other facial features are measured - Determines **[symmetry]** and proportion - Ideal result: - Length of ear = length of **[nose]** - Width of eye = width between eyes 1. **[Age]** 2. **[Race]** 3. body type 4. symmetry 5. proportion **Extraoral Photographs** **[Frontal]** View: - Bilateral **[symmetry]** - Midline - Vertical ratio Smile vs No Smile - If client does not show **[lower]** dental midline when smiling naturally: - any dental correction in the **[lower]** arch will not be visible - Observe **[lip]** position: Ideally touching or max 3-4mm apart **[Profile]** View: - Position of jaw in an anteroposterior plane - Assess the lip posture: E-line (esthetic line) - Facial vertical proportion - Angle of the inferior border of **[mandible]** **Intraoral Photographs:** Teeth in **[occlusion]** - Frontal view - Right lateral view - Left lateral view Determines: - **[Oral habits \[need to be fixed first\]]** - Overbite / overjet measurements - Crossbite etc. **\ ** **Components of Extra and Intraoral Exam** - Initial Assessment Form (example) ***Client's Last Name \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Client's First Name \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*** ***Client's Date of Birth \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*** ***Referring DDS \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Chief Concern \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*** ***Date of Exam (screening) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*** **Initial Assessment:** +-----------------------+-----------------------+-----------------------+ | Client's Profile | Maxilla | Mandible | | | | | | - Straight | - Normal | - Normal | | | | | | - Prognathic | - Prognathic | - Prognathic | | | | | | - Retrognathic | - Retrognathic | - Retrognathic | +=======================+=======================+=======================+ | Occlusion | Dentition | Overbite | | | | \_\_\_\_\_\_\_\_\_\_\ | | - Class I | - Primary | _\_\_% | | | | | | - Class II Div I | - Permanent | Overjet | | | | \_\_\_\_\_\_\_\_\_\_\ | | - Class II Div II | - Mixed | _\_\_mm | | | | | | - Class II | | Crossbite: | +-----------------------+-----------------------+-----------------------+ | Maxillary Arch | Mandibular Arch | Palatal | | | | | | - Crowding | - Crowding | - Normal Deep | | | | Shallow | | - Spacing | - Spacing | | | | | - Open | | - Adequate | - Adequate | | | | | - Tori | +-----------------------+-----------------------+-----------------------+ | Habits | | | | | | | | - Thumb/finger | | | | Cheek/lip Biting | | | | | | | | - Tongue thrust | | | | Mouth breather | | | | | | | | - Snoring Bruxism | | | +-----------------------+-----------------------+-----------------------+ | Maxillary Frena | Mandibular Frena | | | | | | | - Normal | - Normal | | | | | | | - Moderate | - Moderate | | | | | | | - Heavy | - Heavy | | +-----------------------+-----------------------+-----------------------+ - Hard tissue exam - Soft tissue exam - **[Functional]** exam - Evaluate TMJ - Occlusal function - Tongue thrusting - Mouth breather **Radiographs** Purpose = **[assess current]** dental status: caries, perio etc. Intra oral Radiographs = **[full mouth series]** Extra Oral Radiographs = - **[Panorex]** - impacted teeth - Supernumerary teeth - Mandibular condyles are also evaluated - **[Lateral]** Cephalograph - Skeletal relationship of the jaw - Determines client's skeletal **[age]** - Helps analyze **[growth]** patterns - Also used during treatment to assess changes occurring **Cephalometric: Analysis** Cephalometrics = **[study of the head]** - Mathematical descriptions and measurements of the status of the skull - Orthodontist can determine growth patterns - In turn, this determines the type of **[treatment]** for the client AIM: - note pathologic variations - **[Predict]** future changes that might occur - explain malocclusions by evaluating dentofacial proportions - recognize and evaluate **[changes]** before, during, and after orthodontic treatment Identification of anatomical landmarks - Landmarks = **[stable]** reference structures - Landmarks = both skeletal and dental - Therefore Ceph analysis will graphically **[related]** dento-facial elements to these reference structures **Ceph Analysis:** Evaluates relationships, both horizontal and vertical of 5 major functional components of face: - Cranial base - **[Maxilla]** - **[Mand]** - maxillary/mandibular dento-alveolus **Methods: Two basic approaches** 1\. **[Metric]** approach - Also known as Ceph **[tracing]** - Uses both angular & linear measurements **Materials Needed**: - Pencil/eraser - Red and blue pencils - **[Ruler]** and Protractor - Tape - Tracing paper - **[Ceph]** - Light view box **Steps:** - **[Tracing paper]** is placed over ceph - Write client's name in top corner of paper - Place ceph onto view box - Trace: - **[Soft tissue:]** forehead to chin - Sella turcica - Frontal and nasal bones - **[Orbital]** floor - External auditory meatus - Maxilla, Upper 1^st^ **[molar]** + central incisor - Mandible and mandibular symphysis, - Lower 1^st^ **[molar]** + central incisor Sample ***Source: internet*** **Important Ceph Points:**  **ANS =** **[anterior]** Nasal Spine - Bony nasal process at lower margin of anterior nasal opening **PNS =** **[posterior]** Nasal Spine - Posterior spine of palatine bone, at junction of hard and soft palates **Gnathion (Gn) =** Inferior contour of **[chin]** **Me =** **[Menton]** - Most inferior point on mandibular symphysis (bottom of chin) **Go =** Gonion - Inferior contour of mandibular **[angle]** **Na =** **[Nasion]** - Intersections of frontal and nasal bones **A Point** - Innermost point between anterior nasal spine and max **[incisor]** **B Point** - Innermost point between mand incisor and bony **[chin]** **Important Reference Lines:** \*\*\*\*\*No need to learn the tracing points \*\*\*\*\* 2\. **[Graphic]** approach - "Overlay" of individual's tracing on a reference template - **[Visual]** inspection of degree of variation Limitation of Ceph Analysis: - Stable reference structures are only relatively stable due to validity of **[landmarks]** - **[Error]** in landmark identification - Variability; individual, ethnic, gender **Orthodontic Study Models** Consist of: - Mand and Max **[plater]** models - **[Bite]** registration Used to determine **[symmetry]** - Transparent ruler grid is the simplest tool - Placed over maxillary cast lined up with the mid-palatine **[raphe]** **\ ** **Summary: Diagnostic Records Assembly**