- The paedodontic/orthodontic interface - N. E. Carter
14.1 INTRODUCTION
The long-term management of a child's developing occlusion often benefits greatly
from a good working relationship between the paediatric dentist and the orthodontist.
Typical problems range from minimizing damage to the occlusion caused by enforced
extraction of poor quality teeth, through the management of specific local
abnormalities such as impacted teeth, to referral for comprehensive treatment of all
aspects of the malocclusion. This chapter discusses the principles of when to refer to a
specialist colleague, and looks at some common clinical situations where
collaboration is often needed.
14.2 RECOGNITION OF MALOCCLUSION
14.2.1 Orthodontic assessment
All children from the age of 8 years should be screened for the presence of
malocclusion when they attend for a routine dental examination. Although
orthodontic treatment is usually carried out in the late mixed and early permanent
dentition, some conditions do benefit from treatment at an earlier stage. The screening
need only be a brief clinical assessment, but it should be carried out systematically to
ensure that no important findings are overlooked.
An outline of a basic orthodontic assessment is given in 892HTable 14.1. With practice this
can be carried out quite quickly to give an overall impression of the nature and
severity of a malocclusion. In essence, it comprises assessments of the following
elements:
(1) the patient's awareness of their malocclusion (the complaint, if any);
(2) their general level of dental awareness;
(3) an extraoral examination of facial form (skeletal pattern and soft tissues);
(4) general oral condition⎯oral hygiene and tooth quality;
(5) the presence or absence of all teeth;
(6) the alignment and form of each arch;
(7) the teeth in occlusion.
Radiographs are not necessary routinely when screening for the presence of
malocclusion, and should only be taken when there is a clinical indication. A
panoramic radiograph gives a useful general scan of the dentition and indicates the
presence or absence of teeth. Some authorities advise that it should be supplemented
with a naso-occlusal view as the premaxillary region is often poorly shown on
panoramic views and is commonly the site of dental anomalies. But, provided that the
panoramic view is of reasonable quality, intraoral views of this region are only
necessary if there is a specific indication for them, such as delayed eruption of an
incisor or a history of trauma. A radiographic assessment must always be made when
considering any extractions.
Good quality study models are often helpful when planning orthodontic treatment,
and full orthodontic records comprising study models, relevant radiographs, and