(Indices+Oral habits+Teeth relationships)

1. Case History
Dr. Sharon Paul
PG First year
Dept. of Pedodontics and Preventive dentistry

2. TOPICS
COVERED IN
THE PREVIOUS
SEMINARS
• Vital Statistics
• Parental history
• Natal and post-natal history
• Past medical history
• Past dental history
• Methods of oral hygiene maintenance
• Diet and Nutrition
• Behaviour examination
• Clinical examination (Local and General)

3. TABLE OF CONTENTS
• Malocclusion
• Terminal planes
• Canine relationship
• Incisal relationship
• Midline shift
• TMJ evaluation
• Arch length
• Eruption sequence
• Tooth numbering systems
• Cross bite
• Indices
• Plaque index
• Gingival index
• deft index
• Oral habits
• Thumb sucking
• Tongue thrusting
• Mouth breathing

4. MALOCCLUSION
• Classification of malocclusion was first given by Edward.H.Angle in 1899.
• The classification was given based on the relationship of the maxillary 1st molar and the buccal groove of the
mandibular first molar.

5. FACIAL FORMS
CLASS 1 CLASS 2 CLASS 3

6. MOLAR RELATIONSHIP
• It is the mesiodistal relationship between the distal surfaces of maxillary and mandibular 2nd deciduous molars.
TERMINAL PLANES
FLUSH
TERMINAL
MESIAL STEP DISTAL STEP

7. • Most favourable relationship to
guide the permanent molars into
class I
• Seen in 74% cases
• This guides the permanent
molars into a class I
relationship(few can move into
half cusp class III and further full
class III as the mandible grows)
• Seen in 14% cases
• Unfavourable relationship as it
guides the permanent molars
into distal occlusion.
• Seen in 10% cases

8. CANINE RELATIONSHIP
CANINE
RELATIONSHIP
CLASS I
RELATION
Mandibular canine
interdigitates in the
embrasures between the
maxillary lateral incisor and
canine
CLASS II
RELATION
Mandibular canine
interdigitates distal to the
embrasure between the
maxillary lateral incisor and
canine
CLASS III
RELATION
Mandibular canine
interdigitates in any other
relation

9. INCISAL RELATIONSHIP
1. OVERJET: Horizontal distance between the lingual aspect of the maxillary incisors and labial aspect
of the mandibular incisors when the teeth are in centric occlusion. Ideally should be 1-2mm.
2. OVERBITE: Distance which the incisal edge of the maxillary incisors overlaps vertically past the
incisal edge of the mandibular incisors. In primary dentition this is measured as 2mm
3. OPEN BITE: Condition where a space exists between the occlusal or incisal surfaces of the maxillary and
mandibular teeth when the mandible is brought into a habitual or centric location.

10. MIDLINE SHIFT
NORMAL MIDLINE
CORRECTION
DEVIATED MIDLINE

11. TMJ EVALUATION
• Clinical examination of the temporomandibular joint should include
• History of present illness- onset, course of signs and symptoms
• Past illness history-arthritis, parotitis, ear disorders, muscular disorders, past dental
treatment, trauma, oral habits like bruxism etc. which can be predisposing factors for
his/her condition.
• The examinations carried out are:
1.Inspection
2.Palpation
3.Auscultation

12. a,b- Inspection c,d,e- Palpation
AuscultationPalpation

13. Arch length
ARCH LENGTH: Measured from the most labial surface of the primary central incisor to canine and to
primary 2nd molars
Arch length is more than the combined mesio distal width of the teeth present SPACING
Arch length is less than the combined mesio distal width of the teeth present CROWDING

14. ERUPTION SEQUENCE OF DECIDUOUS
TEETH
ZSIGMONDY- PALMER NOTATION
UNIVERSAL NOTATION
FDI NOTATION

15. CROSS BITE
ANTERIOR CROSSBITE POSTERIOR CROSSBITE
SCISSOR BITE/ BRODIE BITE
Crossbite according to Graber was defined as when 1or more teeth are abnormally malposed bucally
or labially with a reference to the opposing teeth.
SCISSOR BITE: Maxillary posterior teeth
occlude entirely on the buccal aspect of the
mandibular posterior teeth
-Occurs when there is excessive Maxillary width
and narrow mandible.

16. PLAQUE INDEX
• Described by Silness P. and Loe H. in 1964
• This index is unique because it ignores the coronal extent of plaque on the tooth surface area and assesses
only the thickness of the plaque at the gingival area of the tooth.
• Surfaces examined are Distofacial, Facial, Mesiofacial and Lingual surfaces.
• Drawback: Subjectivity in estimating the plaque, therefore only 1 examiner is assigned
INSTRUMENTS
USED
• Mouth mirror
• Dental explorer

17. GINGIVAL INDEX
• Described by Silness P. and Loe H. in 1963
• This index was developed solely or the purpose of assessing the severity of gingivitis and its location in 4
possible areas.
• These are- Disto facial papilla, facial margin, mesio facial papilla and entire lingual gingival margin
INSTRUMENTS
USED
• Mouth mirror
• Dental explorer
• Air drying of
the teeth and
gingiva

18. DEFT INDEX
• The caries index used for primary teeth is same as that used in permanent teeth, except that M
factor is replaced with an E.
• The factors seen in this index are:
• d= Decayed primary teeth
• e= Primary teeth indicated for extraction / extracted due to caries only
• f= Primary teeth with permanent restoration due to caries
INSTRUMENTS
USED
• Mouth mirror
• Shepherd’s
hook explorer
• The index can be measured on the basis of two criteria:
• According to the tooth (deft)
• According to the surface of each tooth (defs)
Maximum score:
 deft= 20( max score)
d+e+f for 10 teeth in each
arch
 defs=88( max score)
ds+es+fs for 10 teeth in each arch

19. ORAL HABITS
1. THUMB SUCKING:
• Callus formation on the thumb
• Proclination of the maxillary incisors
• Retroclination of the mandibular incisors
• Open bite
• Deep palate
• Increased clinical crown length of maxillary incisors
• Increased lip incompetence
Callus on the thumb Deep palate
Diagnostic points
ETIOLOGY
1. Socio-economic status
2. Working mother
3. Number of siblings

20. TONGUE THRUSTING
• Anterior open bite
• Incompetent lips
• Hyperactive mentalis activity with puckering of chin
• Proclination of anterior teeth
• Constricted arch
• Increased overjet
• Midline diastema
• Posterior cross bite
ETIOLOGY
2. TONGUE THRUSTING DIAGNOSTIC POINTS
• Retained Infantile swallow
• Disruption of sensory control and coordination of
swallowing
• Tongue size (Macroglossia)

21. MOUTH BREATHING
• Adenoid facies
• Lips held wide apart
• Upper lip short
• Chin is receded
• Narrow maxillary area
• Anterior Open bite
ETIOLOGYDIAGNOSTIC POINTS
• Abnormal development of nasal cavities
• Deviated nasal septum
• Localized benign tumour
• Infection/Inflammation of nasal mucosa
(Rhinits/enlarged tonsils)
• Traumatic injuries of the nasal cavity

22. MOUTH MIRROR TEST
BUTTERFLY COTTON TEST
WATER HOLDING TEST
TESTS FOR DIAGNOSIS

23. NAIL AND LIP BITING
DIAGNOSTIC POINTS
1. Protrusion of the upper incisors and
retrusion of the lower incisors
2. Muscular imbalance
3. Lingual crowding
DIAGNOSTIC POINTS
1. Crowding
2. Rotation
3. Alteration of the Incisal edges
4. Inflammation of nail bed

24. BIBLIOGRAPHY
 Textbook of Pediatric dentistry-3rd Edition –Nikhil Marwah
 Orthodontics: Principles and practice- Basavaraj Phulari
 Textbook of Paedodontics – Shobha Tondan
 Essentials of Preventive and Community Dentistry- Soben Peter
 S Narmada, KP Senthil Kumar, S Raja ,Management of mid-line discrepencies: A review Journal of Indian
Academy of Dental Specialist Researchers | Vol. 2 | Issue 2 | Jul-Dec 2015
 Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Chapter 163The
Temporomandibular Joint Examination- Roger A. Meyer.