Case study A
Answer 1
According to Angle’s classification, Artem’s molar and canine occlusal relation can be classified as Normal occlusion and malocclusion. Malocclusion can be classified as class I. II and III. The classification is done depending on the incorrect relation and misalignment among the teeth for two dental arches while they are oncoming each added as jaws close (Sano et al., 2018). In this case, Carlie Brown have some disorientation in his teeth setup.
Answer 2
In case of Charlie it had been noticed that his incisors are disoriented. The clinical data for Charlie showed that he is having class II Malocclusion. T The deficiency is observed in the clinical pictures demonstrated that Charlie is having proclined upper incisor. The teeth according to FDI number 8, 9, 11 and 6 are protruded whereas 7 and 9 are missing.The image showed that there are deep overbite and excessive overjet’s. The upper arch is V shaped with broad molar and narrow canines (Dellenmark-Blom et al., 2019). The upper lips are shorter showing the failure in the anterior closure of the lip. Teeth numbers seemed to be more in number. Canines seemed shorter with some internal growths observed in the radiograph image.
The deficiency is observed in the Mandible as well as the chin is underdeveloped. The radiographic pictures also showed perplexity the canines and molar show distinct disorientation. The radiographic analysis helped in detected the point of dental upsurge, misplaced supernumerary or stuck teeth, ectopically venting teeth as well as pathological conditions (Feres et al., 2015). The radiographic images showed that Charlie’s teeth are slightly tilted and his upper jaw as well as his lower jaw are not in similar lining.
The dental and orthodontic concern for Charlie case would be disorientation of the face. Charlie have vertical dimensions for class II of malocclusion that can be reduced typically resulting in the absence of occlusion stop for lowering the incisors leading to increase in the overbite. The dental factors involved pre-existing crowding that can be exacerbated due to retroclination of upper central incisors. Charlie is 9 years old and malocclusion causes disorientation of the face. The dental concerns include prevents the forward and downward eruption of the maxillary molar indirectly that enhances the mandibular growth. As there is overlapping of the teeth leads to lack of space (da Fontoura et al., 2015). This would lead to maintenance of good oral hygiene for Charlie. Hence, it would further lead to tooth decay as well as gum disease. As the teeth is disoriented there would be poor alignment of teeth that can be preclude from the comfortability of the jaw closing. The jaws of the orthodontic and dental issues cause concavity and convexity resulting due to the disproportion of the jaw. The convex profile designates that the class II jaw that can have projected maxilla that is mandible as well as forwarded for the backward in the profile concave. The teeth disorientation resulted in either maxilla. The facial disorientation occurs among border of the upper lip and forehead and a disorientated facial figure would project for Charlie for the joining the border of soft tissue and upper lip pogonion. On other hand, this disorientation of the teeth would lead to bullying in classes and schools. Charlie is only 9 years and with times the level of disorientation would increase therefore the level of facial image would change and the social complexity would be faced by Charlie. The malocclusion would also lead difficulty in speaking and eating (Peres et al., 2015). Charlie would also face difficulty in eating as the incisors are not well oriented causing gum problems. This would also cause gum diseases and the joint problems. The joint problem would latter lead to the development of the tooth aces. The tooth aches would also add up to Charlie’s problem. The case mentioned that Charlie is 9 years hence, all his milk teeth or baby teeth had fell of and these are all his permanent teeth. Hence it requires serious attentions.
Malocclusion can lead to in curved, teeming, or protuberant teeth causing periodontal disease, unadorned headaches, in addition sleep disorders. This class 2 malocclusion, is also known as retrognathism or overbite, transpires when the upper jaw in addition teeth rigorously connection the bottom jaw in addition teeth (Batista et al., 2018).
Case study B
Answer 1
There are few conditions that needs to be considered in case of Harry are his bleeding gums which is a sign of poor dental hygiene. The gums develop inflamed besides it bleeds when it leads to build-up of plaque through the gum line. Plaque occurs due to the sticky film that contains bacteria which covers Harry’s teeth in addition gums. On other hand, the clinical images showed a chance of overbite due to which teeth sticks when his mouth is closed. The bleeding of gums and sticking of the teeth is mainly due to overbite (Bilgiç & Gelgör, 2017). The teeth image also showed a protruding teeth shows that the teeth and jaw line does not match. The bleeding of gums is a sign of gingivitis causing red and swollen gums with slight irritation. It also need to be considered that this swollen and redness would be causing rapid bleeding during brushing which might cause improper brushing. This would lead Harry to tooth decay due to decomposition of the bacteria. It also needs to be considered that teeth protrusion would cause pressing on tongue forwards in mouth causing teeth imperfection. This gum problem and tooth sticking is a big indication of the malocclusion. Harry is 10 years old and it is highly common among the children to suffer from malocclusion and this problem continues till adulthood (Kumar et al., 2016).
The implication that might to be considered is the gum bleeding, sticking of the tooth and improper orientation or protrusion of the incisors. All these inferences suggest that Harry needs to go for orthodontic treatment. If the treatment is not done on right time and in correct order Harry might face various social problems due to teeth disorientation, gum disease, tooth decay and inflammation (Yogi et al., 2018). The reduction in gum inflammation are needed as with inflamed gum it becomes difficult for Harry to eat or chew any food, this would cause another health issues. The FDI numbering of the teeth for Harry that is protruding or abnormal is 8 and 9 and 22, 23, 24,25 and 25 are protruding inside giving an improper shape.
Answer 2
Harry’s facial and skeletal type is disoriented. He is having long face with mandibular plane along with steeper occlusal plane as compared to normal (Pontes et al., 2017). The palate if downward tipped. Harry also have increased antero-fcaial height.
Answer 3
Harry is suffering from malocclusion class I. The molar relationship is defined as class I for Harry as he is having normal molar but the teth is not positioned correctly at the occlusion line because of the malposed teeth and is having signs of bites due to improper positioning. The maxillary incisor teeth might be proclaimed or can be inclined normally causing deep overbite in case of him (Hanna et al., 2015). The canines are shaped correct they are greater in number in upper axillary. The Canines are tilted in the left lower maxillary giving abrupt shape to the face.
Answer 4
The key elements that must be noted while designing oral health plan that Harry is having gum bleeding while brushing and his front the tooth sticks. Moreover, the clinical and radiographic image showed that upper incisors are inclined in a lingual way and is overlapped by the upper incisors. There are signs of overbite hence, the front tooth sticks. The upper arch for Harry is broad with mandibular in good size (Šidlauskas, 2015). The oral health plan must include a way to keep his both jaws in proper order and to reduce the bleeding of gum. Gum bleeding is mainly due to gum disease. Moreover, Harry is epileptic and he is taking Dilantine. Dilantine controls seizures that might cause several oral condition such as gingival enlargement else overgrowth of the gingival enhancing the risk of periodontal disease, decay in tooth and infection in the oral. Hence, all these elements must be kept in mind before designing oral health plan for Harry. It might also be due to the fact that Harry is suffering from gum bleeding while brushing is the side effect of Dilantine (Dellenmark-Blom et al., 2019). However, the clinical and radiographic image clearly showed that his teeth orientation is not proper therefore he needs proper oral health plan to avoid further complexities.
Implementation plan: Harry need to keep the teeth clean for this he needs proper education. Doctor must explain the problem and must tell him the cause and help in teaching the right way to brush the teeth and well as in which angle. Plan would also be including educating the parents. The plan implementation would be different for Harry as he is epileptic hence gum bleeding is common. Therefore, the implementation would be gentle. Harry would be suggested to wear braces for that his teeth must be clean and dry and he must not panic. The retractor would be removed and dental arch wear would be installed.
Referral letter to Orthodontist
June 6th, 2020
XYZ (Name)
Orthodontist (Position)
ABC organisation
Address
Dear XYZ,
I am RST, the dental examiner of Harry and I am writing this referral letter informing you about the oral condition of Harry. I did clinical and radiographic examination of Harry and I found that Harry is suffering from malocclusion class II. When I examined his facial and skeletal investigation I observed that his facial profile is convex with short hypotonic upper lip. The Mandibular region is good and plane and he anterior cranial and palate are horizontal and he is having a longer face. His incisors have gaps in addition his upper incisor overlaps his lower incisors.
Harry also informed me that he is suffering from bleeding gums and his front tooth sticks. Bleeding gum might be due to the fact that he is epileptic and he is taking Dilantine. I assumed that bleeding of gums and inflammation might be due to Dilantine side effects.
I strong suggest that Harry needs to make the teeth position correct. Due to improper orientation he is undergoing several problems like tooth sticking etc. He is only 10, and there are chances that he might faces unusual situation in schools. I have recommended him to you.
You can contact me over phone or by email mentioned below. However, as an orthodontist you can understand and provide necessary suggestions regarding his oral health to Harry. To be precise Harry is a gentle kid, he is highly understandable and I strongly believe that you will feel comfortable to take harry as your patient.
With regards
RST
Dental examiner
Phone-1010101010
Email- rst@gmail.com
References
Batista, K., Thiruvenkatachari, B., Harrison, J., & O’Brien, K. (2018). Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children and adolescents. Cochrane Database Of Systematic Reviews. https://doi.org/10.1002/14651858.cd003452.pub4
Bilgiç, F., & Gelgör, İ. (2017). Prevalence of Temporomandibular Dysfunction and its Association with Malocclusion in Children: An Epidemiologic Study. Journal Of Clinical Pediatric Dentistry, 41(2), 161-165. https://doi.org/10.17796/1053-4628-41.2.161
da Fontoura, C., Miller, S., Wehby, G., Amendt, B., Holton, N., & Southard, T. et al. (2015). Candidate Gene Analyses of Skeletal Variation in Malocclusion. Journal Of Dental Research, 94(7), 913-920. https://doi.org/10.1177/0022034515581643
Dellenmark-Blom, M., Sjöström, S., Abrahamsson, K., & Holmdahl, G. (2019). Health-related quality of life among children, adolescents, and adults with bladder exstrophy–epispadias complex: a systematic review of the literature and recommendations for future research. Quality Of Life Research, 28(6), 1389-1412. https://doi.org/10.1007/s11136-019-02119-7
Feres, M., Alhadlaq, A., & El-Bialy, T. (2015). Adjunctive techniques for enhancing mandibular growth in Class II malocclusion. Medical Hypotheses, 84(4), 301-304. https://doi.org/10.1016/j.mehy.2015.01.012
Hanna, A., Chaaya, M., Moukarzel, C., El Asmar, K., Jaffa, M., & Ghafari, J. (2015). Malocclusion in Elementary School Children in Beirut: Severity and Related Social/Behavioral Factors. International Journal Of Dentistry, 2015, 1-10. https://doi.org/10.1155/2015/351231
Kumar, T., Narayanan, R., & Jeseem, M. (2016). Prevalence of Malocclusion among 10–12-year-old Schoolchildren in Kozhikode District, Kerala: An Epidemiological Study. International Journal Of Clinical Pediatric Dentistry, 9(1), 50-55. https://doi.org/10.5005/jp-journals-10005-1333
Peres, K., Cascaes, A., Peres, M., Demarco, F., Santos, I., Matijasevich, A., & Barros, A. (2015). Exclusive Breastfeeding and Risk of Dental Malocclusion. PEDIATRICS, 136(1), e60-e67. https://doi.org/10.1542/peds.2014-3276
Pontes, L., Maia, F., Almeida, M., Flores-Mir, C., & Normando, D. (2017). Mandibular Protraction Appliance Effects in Class II Malocclusion in Children, Adolescents and Young Adults. Brazilian Dental Journal, 28(2), 225-233. https://doi.org/10.1590/0103-6440201701032
Sano, M., Sano, S., Kato, H., Arakawa, K., & Arai, M. (2018). Proposal for a screening questionnaire for detecting habitual mouth breathing, based on a mouth-breathing habit score. BMC Oral Health, 18(1). https://doi.org/10.1186/s12903-018-0672-6
Šidlauskas, M. (2015). Relationships between Malocclusion, Body Posture, and Nasopharyngeal Pathology in Pre-Orthodontic Children. Medical Science Monitor, 21, 1765-1773. https://doi.org/10.12659/msm.893395
Yogi, H., Alves, L., Guedes, R., & Ciamponi, A. (2018). Determinant factors of malocclusion in children and adolescents with cerebral palsy. American Journal Of Orthodontics And Dentofacial Orthopedics, 154(3), 405-411. https://doi.org/10.1016/j.ajodo.2017.11.042
