Clearly, a full orthodontic assessment is not indicated every time a child is examined.
However, tooth alignment and occlusion should be briefly considered, as these may
provide an early prompt as to the need for interceptive orthodontic treatment. It is
certainly worth noting:
- severe skeletal abnormalities;
- overjet and overbite;
- first molar relationships;
- presence of crowding/spacing;
- deviations/displacements.
There are also two key stages of dental development, when the clinician should be
particularly vigilant in checking tooth eruption and position:
- Age 8-9 years⎯eruption of upper permanent incisors
- increased overjet⎯may predispose to trauma
- cross-bite⎯need for early intervention? (Fig. 3.20)
- traumatic bite⎯associated with localized gingival recession of lower incisor?
- anterior open bite⎯skeletal problem, digit-sucking habit, or tongue thrust? (Fig.
3.21) - failure of eruption⎯presence of a supernumary, crown/root dilaceration, retained
primary incisor, congenitally missing lateral incisors? (Fig. 3.22).
- Age 10+ years⎯eruption of upper permanent canines
- are the permanent canines palpable buccally⎯if not, they may be heading in a
palatal direction - are the primary canines becoming mobile⎯if not, the permanent canines may be
ectopic.
Fig. 3.11 Mucocoele of labial mucosa: an incidental finding.