4. Content of the history sheet
âą Age, sex
âą Occupation and
address
Particular of
patiant
âą Dental history
âą Medical history
âą Family history
History
taking
âą Extra oral examination
âą Intra oral examinationexamination
âą Radiography
âą Chephalogram
radiograph
âą Model analysis
Study modelshahajaman saju
6. It includes---
âąName of the patient
âąAge
âąSex
âąAddress & occupation
âąMedical, dental and family history
âąHabit
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7. Name of the patient---
ï¶ For identification
ï¶ For better communication
ï¶ For medical record
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8. Age ---
AGE TREATMENT RECOMMENDED
Primary and Mixed dentition
stage
Preventive and interceptive
procedures
Preadolescent patients in mixed
dentition
Growth modulation procedures
Young adolescent patients Comprehensive therapy with or
without Camouflage
Adult patients Orthognathic surgeries
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9. sex---
ï¶This is important in planning
treatment, as the timing of growth
events such as growth spurts is
different in males and females
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11. Address ---
Helps in determine ethnic pattern of oral
structure
Address helps in future correspondence
such as to intimate appointment.
Find out the epidemic and pandemic
outburst.
01
02
03
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12. Occupation ---
Helps evaluation of socio economic status
of patient
Find out occupational hazards .e.g.
needle bite in taylor
Helps in selection of an appropriate
appliance.
01
02
03
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13. Control of systemic disease
Control of acute conditions
Control of dental disease
Control of dental caries/ Endodontics Initial control of periodontal disease
Initial restorations like fillings Restoration of gingival health
Orthodontic Treatment
Final and permanent restorations
including cast restorations
Periodontal surgeries and
maintenance therapyshahajaman saju
15. Medical history
01 02 03
Diabetic patient
can taken
orthodontic
treatment if it is
control.
pneumonia,
tonsillectomy,
adenoidectomyshould
beexaminedfornasal
obstructionbefore
takingorthodontic
treatment;
Acute debilitating
diseases like
mumps, chicken
pox should be
allowed torecover
beforeorthodontic
treatment.
shahajaman saju
16. Medical history
04 05 06
Patient with
history of allergy
to acrylic resin
might be
managed with
fixed appliance
History of blood
dyscrasias may
need special
management if
extractions are
planned
Epilepsy
patient may
impede
orthodontic
treatment.
shahajaman saju
17. Medical history
07 08 09
History of
blood
dyscrasias may
need special
management if
extractions are
planned
Severely
handicapped child
either mentally or
physically may
require special
management.
Rheumatic fever
or cardiac
anomalies require
antibiotic
coverage.
shahajaman saju
19. Dental history
early fractures of the condylar neck of the mandible
trauma to the teeth
long-term medication
Osteoporosis , uncontrolled diabetes
contraindicates orthoodntic treatment
1
3
2
4
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22. Habit history
Digits in Chronic
Thumb suckers
Hypotonic upper lip
Fibrous roughened callus
ï Clean and chapped
ï Reddened
Digits in acute
Thumb suckers
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23. Habit history
Lip Sucking /lip biting Habit
indentation on lower lips and
hypertrophic vermillion border
Proclined maxillary anterior teeth and
retroclined mandibular anterior teeth
01
02
indentation on lower lips and
hypertrophic vermillion border
01
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25. Mouth breathing
skeletal Skeletal Class II
Narrow palate
Hyperdivergent skeletal pattern
dental Posterior cross bite
Anterior open bite
Deep overjet
fascial Long face
Incompetent lips
Hyper-extended head
Narrow nostrils
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26. Family history
01
Most of the number of
skeletal class II &
class III malocclusion
are inherited and
transmitted through a
dominant gene.
02
Congenital deformities
like cleft, lip & palate
are also transmitted.
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27. Family history
The grandmother The father The son
Family history of Prominent mandible and
hypoplasia of maxilla with thicken lower lip
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33. Color & texture:
ï¶ Normally both the lips are same color &
texture.
ï¶ Low active lips are chapped and light
color.
ï¶ Heavy, reddish, smooth & moist lip,
lower lip is trapped behind the upper
anteriors.
Lowactivelips
TrappedlipNormallipcolour
Lips____
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34. Normally upper lip covers labial surface
of upper anterior teeth except the incisal
2-3 mm.
the lower lip covers the labial surface of
lower anterior teeth & incisal third of the
upper anterior teeth.
NORMAL POSITION
Lips____
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35. Competent lips
lip seal is maintain when muscle of facial
expression are relax position and
mandible in resting position
Incompetent lips
the lips are abnormally short and thus
inadequate to maintain lip seal at rest ,
this may be seen in Skeleton II & III
Potentially incompetent lips
normal lips but fail to form a lip seal
due to proclined upper incisors
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36. Incompetent lips
the lips are abnormally short and thus
inadequate to maintain lip seal at rest ,
this may be seen in Skeleton II & III
seen in bimaxillary proclination
Everted lips
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37. Breathing can be three types â
a. Nasal breathing: When a person
breaths normally through the nose.
b. Mouth breathing: When a
person normally breaths through
the mouth.
c. Oro-nasal breathing: When a
person breaths partly through the
nose &
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38. ï¶ Nasal breathers usually hold the lip contact lightly where as in mouth
breathers lips are apart.
ï¶ Ask the patient to take a deep breath, nasal breathers inspire through the
nose & mouth breathers inspire through the mouth.
ï¶ Ask the patient to take a deep breath, in case of nasal breathers external
nares of the nose is dialates. In case of mouth breathers no change in
external nares.
A double sided mirror is held between the nose & the mouth. Fogging on the
nasal side of the mirror indicates nasal breathing while fogging towards the oral
side indicates oral breathing.
shahajaman saju
39. Ask the patient to fill his mouth with water and retain in for a period of time.
A butterfly shaped piece of cotton is placed over the upper lip below the nostrils.
# No movement of cotton â it indicates mouth breather
# Cotton moves only one side â breathing through only that nostril
# Cotton moves on both sides â breathing through both of the nostrils.
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40. EXAMINATION OFCHIN
MENTALISACTIVITY-
Normaly mentalisisnot activeat rest.
Hyperactive mentalis isseen in
CLASS11DIVISON1CASES.
CHIN POSITIONAND PROMINENCE-
. prominent chinisusually associated with
class 111malocclusion
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41. MentolabialSulcus
Deep
ï It is a fold of soft tissue between lower lip & chin.
ï Affected by-
Facial Height
Overjet
Chin Projection.
Deep sulcus â Class II Div 1
Shallow sulcus â Bimaxillary protrusion
CoNntemoprormaryaorlthodontic 4th editSionhpraofflitlow
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42. ï¶ Basic units- 25 consonants, 14vowels.
ï¶ A s k patient to count 1 to 10 or20.
ï¶ Watch closely adaptation of lips &tongue
Listen to how sounds areproduced.
Speech/articulation
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47. Profile Analysis
Goals of facial profile analysis:
1. Establishing whether the jaws are
proportionately positioned in the
anteroposterior plane of space.
2. Evaluation of lip posture and incisor
prominence
3. Re-evaluation of vertical facial
proportions and evaluation of mandibular
plane angle.
shahajaman saju
48. Straight Profile Convex Profile Concave Profile
Convex Profile-
Skeletal class II
Concave Profile-
Skeletal class III
Nâ
SNâ
Pgâ
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49. ASSESSMENT OF ANTER-POSTERIOR JAW RELATIONSHIP
âą Ideally maxillary skeletal base is 2-3 mm ahead of
the mandibular skeletal base when the teeth are in
occlusion.
âą Estimation is done by placement of index and middle
fingers at the soft tissue point A and point B
respectively.
shahajaman saju
50. âą In apatient with CLASS1 skeletal patternthe
handisat aneven level.
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51. âą In askeletal CLASSII patient, the middle fingeris
aheadof the forefinger or the hand pointsupward.
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52. Ina skeletal CLASS111patient, the middle finger is
ahead of the forefinger or the hand points
downwards.
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53. FACIALSYMMETRY
ï¶ The patientâs facial symmetry is examined to
determine disproportions of the face in transverse
and vertical planes. Gross facial asymmetry can occur
as a resultof:
ï¶ A. congenitaldefects
ï¶ B.hemi-facial atrophy/hypertrophy
ï¶ C.unilateral condylar ankylosisand hyperplasia
shahajaman saju
55. Composite photographs are the best way to indicate normal facial asymmetry.
For this boy, whose mild asymmetry rarely would be noticed and is not a
problem, the true photograph is in the centre. On the right is a composite of the
two right sides, While on the left is a composite of the two left sides. This
technique dramatically illustrates the difference in the two sides. Although the
normal asymmetry usually is less than in this boy, mild asymmetry is the rule
ratherthan the exception.Usually, the rightsideof the faceisalittle larger than
the left ,ratherthan the reverseasin this individual. 22
shahajaman saju
56. vertical facial thirds
âą Distance from
âą the hairline to the
base of the nose,
âą base of nose to
bottom of nose,
âą and nose to chin
should be the same.
shahajaman saju
57. Facialproportionsandsymmetry
thefrontal plane.
ï¶ An ideally proportional face can be divided into
central, medial,andlateral equalfifths.
ï¶ Theseparationof the eyesandthe width of the
eyes, which should be equal ,determine the
central and medial fifths .The nose and chin
shouldbecantered within the centralfifth, with
the width of the nose the same as or slightly
widerthan the centralfifth..
ï¶ Theinter â pupillary distance(dotted lines)should
equal thewidth of themouth.
23
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61. Oral hygine
Oral hygine means absence of any pathology related to
1. the teeth
2. their supporting structure
3. the soft tissue of the mouth
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63. âą The CPITN includes:
A. Code 0
ï¶ No bleeding or pocketing detected
ï¶ No treatment required
B. Code 1
ï¶ Bleeding on probing;
ï¶ no pockets >3.5 mm
ï¶ OHI and prophylaxis
C. Code 2
ï¶ Plaque retentive factors present (includes calculus);
ï¶ No pockets > 3.5 mm.
ï¶ OHI; removal of calculus and plaque retentive margins on restorations
D. Code 3
ï¶ Pockets > 3.5 mm and < 5.5 mm in depth
ï¶ Treatment involves OHI, prophylaxis, removal of plaque retentive factors and root
planning
E. Code 4
ï¶ Pockets > 5.5 mm in depth
ï¶ Treatment involves OHI, prophylaxis, removal of plaque retentive factors and root
planning and periodontal surgery.
shahajaman saju
64. Periodontal examination
by orthodontist
For each adult patient :
ï¶ Cursory 5 minute periodontal screening examination .
ï¶ Probingkey indicator teeth:
1. upper molar interproximal regions
2. buccal furcation
3.lower canine/lateral incisor area especially where
there is crowding.
ï¶ Evaluating attached gingiva.
ï¶ Studing appropriate radiograph.
1. vertical bitewing show crestal bone more clearly.
ï¶ Parafunction:
screen for bruxing or clenchingshahajaman saju
65. Dentition---
ï¶Teeth present, unerupted, missing
ï¶Status of dentition
ï¶Caries, restorations, discolorations
ï¶Molar relation
ï¶Overjet, overbite, open bite, deep bite,
cross bite
ï¶Midline shift
ï¶Rotation, intrusion, extrusion
shahajaman saju
77. Pre-normal occlusion
-mandibular dental arch is
placed anteriorly in centric
occlusion
Post-normal occlusion
-mandibular dental arch is
placed more posteriorly in
centric occlusion
SAGITTAL PLANE MALOCCLUSION
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78. VERTICAL PLANE MALOCCLUSION
Deep bite
Vertical overlap between the
maxillary & mandibular teeth
is in excess than normal
Open bite
Exist in anterior or posterior
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79. TRANSVERSE PLANE MALOCCLUSION
- includes various types of CROSS BITES
- mainly due to constriction of dental arches
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81. Class I canine relationship
the upper permanent
canine occludes in the
embrasure between the
lower permanent canine
and the firstpremolar.
Class II canine relationship
the canine occludes a whole
tooth width further
anteriorly and lies in the
embrasures between the
lower canine and lateral
incisor.
Class III canine relationship
the upper canine occludes a
whole tooth width further
posteriorly than normal and
occludes in the embrasure
between the lower first
and second premolar.
shahajaman saju
83. Anterior gingivitis common in mouth
breathers due to dryness of mouth
caused by open lip posture.
Presence of traumatic occlusion
indicates localized gingival recession.
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84. Upper labial frenum Lower labial frenum Lower lingual freneum
Types of Frenum â
a. Upper labial frenum
b. Lower labial frenum
c. Lower lingual frenum
Examination of Frenal attachments
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85. Upper labial frenum :
Sometimes maxillary labial frenum can be thick, fibrous & attached
relative low. Such an attachment prevent the two maxillary Central
incisors from each other thereby causes midline diastema.
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86. Positive Blanch test
Abnormal frenal attachments are diagnosed by a blanch test where
upper lip is stretched upwards & outwards for a period of time. The
presence of blanching or whitish in the region of the inter-dental
papilla is diagnosed of an abnormal labial frenum or high frenum.
shahajaman saju
87. Lower lingual frenum:
Lower lingual frenum is examined by asking the patient protrude
the tongue. If the patient is unable to protrude the tongue due to
abnormal lingual frenum & it is called Tongue tie or partial
Ankyloglossia.
shahajaman saju
88. Examination of tongue:
Normal position of tongue :
Tongue rests at the occlusion level within the arches, dorsum touching the palate
and the tip of the tongue rests against the lingual surface of the anteroirs.
shahajaman saju
89. Macroglossia
is indicated by â
ï¶ Presence of imprints of the teeth on the lateral margin of the tongue
giving it a scalloped shape.
ï¶ Generalized tooth proclination or generalized spacing
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90. ï¶ A patient whose tongue reaches the
tip of the nose is said to have a long
tongue
shahajaman saju
91. EXAMINATION OF PALATE :-
01
Variation in
palatal
depth
02
Presence of
swelling
03
Mucosal
ulceration
and
indentation
04
Presence of
cleft
shahajaman saju
95. Examination of tonsils & adenoids :
Abnormally inflamed tonsils cause alteration in tongue & jaw
posture that causes the oro-facial imbalance leading to
malocclusion.
shahajaman saju
99. The patient is examined for symptoms of temporo
mandibular joint problems such as clicking, crepitus, pain
in the masticatory muscles, limitation of jaw movement,
hyper mobility and morphological abnormalities.
Inspection
shahajaman saju
101. The first step in functional analysis is examine the
patients maximum jaw opening
For adults â 45 mm
Children - < 45 mm
Mouth opening
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102. . Many authorities consider less
than 40 mm to represent restricted
jaw opening. Brandt considers this
an artificially high threshold for
determining restricted jaw
movements, suggesting that 35 mm
is more appropriate for children and
adolescents.
shahajaman saju
103. EVALUATION OFPATHOFCLOSURE:-
ïą Thepathofclosureisthemovementof themandiblefrom rest
positionto habitual occlusion.
Forwardpathofclosure
Occurs in patients
with mild skeletal
prenormalcy or
edge to edge
incisor contact.
Backwardpathofclosure
class II div.2 cases
exhibit premature
incisor contact
due to retroclined
maxillary incisors.
Lateralpathofclosure
it is associated
with occlusal
prematurity and a
narrow maxillary
arch
backwardpathofclosure
shahajaman saju
104. Forward path of closure Backward path of closure
Lateral path of closure
shahajaman saju
106. ASSESSMENTOF POSTURALRESTPOSITIONANDINTER-OCCLUSAL
CLEARANCE.
The postural restposition of the mandible at
which the muscles that closes the jawand those
that open them are, in state of minimal
contraction to maintain the posture of
mandible.
At postural restposition, a space existsbetween the
upper and lower jaws.
Thisspace isknown as FREEWAYSPACE.
FREEWAY SPACE is3mm in canineregion.shahajaman saju
107. Methodsusedtorecord
theposturalrest position
PHONETIC METHOD; the patient is asked to repeat
some consonants âm or cââ or repeat a word like
Mississippi.
The mandible returns to postural rest position 1-2
seconds after theexercise.
The patient is told not to change the jaw, lip or
tongue position after phonation, as the dentist
parts the lips to study interocclusal space.
shahajaman saju
108. COMMAND METHOD
The patient is asked to perfom
certain functions such as
swallowing.
The mandible tends to return to rest
position following this act.
shahajaman saju
109. Non commandmethod
1 Thepatientisobservedashe speaks
orswallows.
Thepatientisno aware
thathe isbeing examined.
2 Thisisusuallybeing carriedoutby
talkingabout topics unrelated to
the patient while carefully
observing him ornot
shahajaman saju
110. Methods to measureinter-occlusal clearance
VERNIER CALIPERS CAN BEUSED
DIRECTLYIN THEPATIENTâSMOUTHINTHE
CANINEOR
INCISALREGIONTOMEASUREFREEWAY
SPACE.
THIS IDIRECTINTRA ORAL METHOD.
shahajaman saju
116. Periapical radiograph :
Importance of periapical radiograph â
1. Present or absent of permanent teeth.
2. Shape & position of teeth present.
3. In relative state of development of teeth,
4. Extent of calcification of teeth,
5. The path of eruption of permanent teeth,
6. The morphology & inclination of root of permanent teeth,
7. The periodontal ligament space & lamina dura,
.
Height &contour of alveolar
bone
Pattern or root resorption
Path of eruption Apical patology
shahajaman saju
117. Periapical radiograph :
Importance of periapical radiograph â
8. The height & contour of the alveolar bone,
9. Dental caries,
10. Apical infection,
11. Root fractures,
12. Retained deciduous tooth,
13. Pattern & amount of root resorption,
14. The presence of supernumerary teeth.
Height &contour of alveolar
bone
Pattern or root resorption
Path of eruption Apical patology
shahajaman saju
118. ï¶To detect periodontal change
ï¶To study height and contour of alveolar bone
ï¶To detect secondary caries
Bitewing radiograph
shahajaman saju
120. Occlusal
view
OPG
Occlusal radiograph
ï¶They are useful in orthodontic to study the
effect of arch expansion procedure
ï¶To locate impacted or unerupted teeth
ï¶To study bucco-lingual expansion of cortical
bone
ï¶ Supplementary projection tolocate
malposed unerupted teeth.
ï¶ Palatal cleft shahajaman saju
123. Importance of Panoramic radiograph:
1. All present or absent of permanent teeth.
2. Shape & position of teeth present.
3. Extent of calcification of teeth,
4. The path of eruption of all permanent teeth,
5. The morphology & inclination of root of permanent
teeth,
shahajaman saju
124. Importance of Panoramic radiograph:
6. The periodontal ligament space & lamina dura,
7. The height & contour of the alveolar bone,
8. Dental caries,
9. Apical infection,
10. Root fractures, jaw fracture
shahajaman saju
125. Importance of Panoramic radiograph:
11. Retained deciduous tooth,
12. Pattern & amount of root resorption,
13. The presence & absent of multiple
supernumerary teeth
14. They are useful aids in serial extraction
procedures to study the status of erupting teeth.
15. Mixed dentition period to study the status of
unerupted teeth
shahajaman saju
127. CEPHALOMETRIC RADIOGRAPHS
Specialized skull radiograph in
which the head is positioned in a
specially designed head holder
cephalostat.
Itisof two types
1. Lateral cephalogram
2. Postero-anterior cephalogram
shahajaman saju
128. ï¶ anterio posterior jaw relation
ï¶ Growth pattern
ï¶ Details of Maxilla and
mandible
ï¶ Degree of proclination of
maxillary and mandibular
ï¶ soft tissue analysis
CEPHALOMETRIC RADIOGRAPHS
shahajaman saju
130. Facial Photograph :
A facial photograph indicates the soft tissue
morphology & facial expression. Both extra-oral
& intra-oral photograph are useful to diagnostic
records.
Three extra-oral views are taken â
Frontal view
Profile view
Oblique view
shahajaman saju
136. Advantages
1. They are three dimensional records of the patients
dentition.
2. Occlusion can be visualized from lingual aspect.
3. They provide a permanent record of the
intermaxillary relationship.
4. Helps to motivate the patients as they can visualize
the treatment progress.
5. They are needed for comparison purposes at the
end of the treatment and act as a reference for post
treatment changes.
6. They serve as a reminder for the parent and the
patient of the condition present at the start of the
treatment.
7. In case the patient has to be transferred to another
clinician study model are an important record.
shahajaman saju
