Chapter 4 Patient assessment

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Temporomandibular Joint
It is important to note the presence of tenderness in the muscles of mastication, clicking or
crepitus in the joints and the range of mandibular movements during orthodontic assessment.
If pathology is found, there may be a history of
parafunction or facial trauma.

INTRAORAL EXAMINATION
The aims of intraoral examination are to:
Assess the mucosal/dental surfaces for
pathology
Determine the level of oral hygiene
Establish whether dental development is
normal
Assess tooth position within and between
the arches.

Assessment for Pathology

Every patient should have a full examination of
the mucosal surfaces during routine assessment. Oral mucosal disease is uncommon in the
majority of patients attending for orthodontic
treatment, however, if left undetected it can be
life-threatening in some circumstances. Dental
pathology can have a significant influence on
treatment planning. Of particular relevance is:

Dental caries
Dental hypoplasia and hypomineralisation
Toothwear
Sequelae of traumatic injuries to the
dentition
Gingivitis, periodontitis and gingival
recession.
All teeth that have previously suffered
trauma, and those with advanced caries or
large restorations should undergo thermal or
electrical vitality testing. Areas of significant
enamel hypoplasia/hypomineralisation should

Figure 4.7 Areas of hypomineralisation and hypoplasia should be identified and documented using
colour photography.

be documented, photographed and highlighted

to the patient/parent(s) (Figure 4.7). Patients
often become more aware of these defects
during treatment as they begin to examine
their teeth more closely, and this can lead
them to incorrectly attribute the previously
unrecognised enamel defects to orthodontic
treatment. All patients should undergo the
Basic Periodontal Examination (BPE) as part of
their routine assessment. All dental disease
must be controlled before contemplating orthodontic treatment and it is important that
patients understand that they must continue to
visit their general practitioner for routine dental
maintenance during orthodontics.

Oral Hygiene
The level of oral hygiene can be assessed by
examining for gingivitis, probing to elicit gingival bleeding, and with visual aids such as
disclosing tablets/solution. The presence of a
line of decalcification that follows the gingival
margins of the teeth is indicative of plaque
accumulation and a cariogenic diet. Poor
hygiene during orthodontic treatment predisposes to decalcification, gingival hyperplasia,
periodontal breakdown and removable
appliance-related stomatitis.