The ideal age for the initial orthodontic screening is age seven years as recommended by the American Association of Orthodontists. This can be done in the general practitioners office and a subsequent referral made if any abnormality found.
The British Orthodontic Society state “Malocclusion, like caries and periodontal disease, creeps up on its victims slowly…we have an ethical duty to detect and inform.”
Screening at age 7 years should include the following:
- Skeletal discrepancy : seat the patient in the supine position. Severe A-P skeletal discrepancies are easily noted by comparing soft tissue A and B points. Transverse discrepancies should also be assessed, note any cross bites or scissors bites. Note vertical excess in the maxilla and open bites.
- Soft tissue pattern : Note if lips apart at rest
- Habits : e.g finger sucking or thumb sucking
- Teeth present : Count the teeth. Note ectopic, unerupted or missing teeth. An OPG or intra-oral xrays may be indicated to assist in this.
- Record overjet, overbite, centreline, buccal segments, crowding, spacing.
- Finally record premature contacts or displacement on closure.
At age 9-10 repeat the above and pay particular attention to:
- The canines : The canines should be palpable buccally by 8-10 years. If they are not palpable by 10 years investigate with x-rays. Use parallax x- rays to locate the canine. If the canine is palatally positioned (85% of the time) extraction of the deciduous predecessors between age 10 and 13 results in normalisation 65-91% of the time, with early intervention giving better results. Where the canine is buccally positioned extraction is not usually an advantage. The main risk is root resorption of the lateral incisors due to ectopic position.
- Presence of the lateral incisors and second premolars: these are the most commonly missing teeth and early detection allows for more options in treatment planning.
- Detection of supernumeraries associated with delayed eruption or missing teeth. Mesiodens and supplemental supernumeraries may need extraction.
- Low labial fraenum : May lead to persistent diastema and require orthodontic intervention and fraenectomy.
What is Normal?
- Deciduous dentition (2.5-6 years): Spacing between deciduous incisors, flush distal surfaces of second deciduous molars.
- Mixed dentition (6-13years): Mild Lower incisor crowding, median diastema.
Contact & Referrals we are happy to advise by phone, e-mail or in person
News & Articles latest orthodontic information
Visit our news and articles section for further information.
We would like to keep this section relevant and informative. Any suggestions for topics would be greatly appreciated.