Download Peninsula Dental Social Enterprise (PDSE)

Peninsula Dental Social Enterprise
(PDSE)
Orthodontic Checklist for Clinics
Version 2.0
Date approved: December 2015
Approved by: Karen Drage
Review due: December 2016
Page 1 of 9
Index of Orthodontic Treatment Need (IOTN)
The Index of Orthodontic Treatment Need (IOTN) attempts to rank malocclusion in terms
of the significance of various occlusal traits for an individual’s dental health and perceived
aesthetic impairment. It intends to identify those individuals who would most likely benefit
from orthodontic treatment.
IOTN is the measure used in the UK to assess the need and eligibility of children under 18
years of age, for NHS orthodontic treatment on dental health grounds. NHS orthodontic
treatment for adults is not usually available.
The British Orthodontic Society believes that if treatment has to be rationed, then the IOTN
is an objective and reliable way for specialists to select those children who will benefit
most from treatment and is a fair way to prioritise limited NHS resources.
Dentists who refer children for orthodontic advice and/or treatment should be aware of the
IOTN and how it is used to select which children need and are eligible for NHS orthodontic
treatment. Then they can advise their patients and make appropriate referrals.
The accurate use of IOTN requires specialist training. The accurate assessment of dental
health need for orthodontics should be done by a specialist. The consultation is an
opportunity for a thorough check for other abnormalities. Those who do not have a dental
need for treatment will have had the reassurance of an expert opinion on their dental
development.
Page 2 of 9
THE DENTAL HEALTH COMPONENT (DHC)
OF THE INDEX OF ORTHODONTIC TREATMENT NEED (IOTN)
GRADE 5 (Need treatment)
GRADE 3 (Borderline need)
5i
3a
Increased overjet greater than 3.5mm but less
than or equal to 6mm with incompetent lips.
3b
Reverse overjet greater than 1mm but less
than or equal to 3.5mm.
3c
Anterior or posterior crossbites with greater
than 1mm but less than or equal to 2mm
discrepancy between retruded contact
position and intercuspal position.
5h
Impeded eruption of teeth (except for third
molars) due to crowding, displacement, the
presence of supernumerary teeth, retained
deciduous teeth and any pathological cause.
Extensive hypodontia with restorative
implications (more than 1 tooth missing in any
quadrant) requiring pre-restorative orthodontics.
5a
Increased overjet greater than 9mm.
5m
Reverse overjet greater than 3.5mm with
recorded masticatory and speech difficulties.
3d
Contact point displacements greater than
2mm but less than or equal to 4mm.
5p
Defects of cleft lip and palate and other
craniofacial abnormalities.
3e
Lateral or anterior open bite greater than 2mm
but less than or equal to 4mm.
5s
Submerged deciduous teeth.
3f
Deep overbite complete on gingival or palatal
tissues but no trauma.
GRADE 4 (Need treatment)
GRADE 2 (Little)
4h
Less extensive hypodontia requiring prerestorative orthodontics or orthodontic space
closure to obviate the need for a prosthesis.
2a
Increased overjet greater than 3.5mm but less
than or equal to 6mm with competent lips.
2b
4a
Increased overjet greater than 6mm but less
than or equal to 9mm.
Reverse overjet greater than 0mm but less
than or equal to 1mm.
2c
4b
Reverse overjet greater than 3.5mm with no
masticatory or speech difficulties.
Anterior or posterior crossbite with less than
or equal to 1mm discrepancy between
retruded contact position and intercuspal
position.
4m
Reverse overjet greater than 1mm but less than
3.5mm with recorded masticatory and speech
difficulties.
2d
Contact point displacements greater than
1mm but less than or equal to 2mm.
2e
Anterior or posterior openbite greater than
1mm but less than or equal to 2mm.
2f
Increased overbite greater than or equal to
3.5mm without gingival contact.
2g
Pre-normal or post-normal occlusions with no
other anomalies (includes up to half a unit
discrepancy).
4c
Anterior or posterior crossbites with greater than
2mm discrepancy between retruded contact
position and intercuspal position.
4l
Posterior lingual crossbite with no functional
occlusal contact in one or both buccal
segments.
4d
Severe contact point displacements greater
than 4mm.
4e
Extreme lateral or anterior open bites greater
than 4mm.
4f
Increased and complete overbite with gingival
or palatal trauma.
4t
Partially erupted teeth, tipped and impacted
against adjacent teeth.
4x
Presence of supernumerary teeth.
Page 3 of 9
GRADE 1 (None)
1
Extremely minor malocclusions including
contact point displacements less than 1mm.
THE AESTHETIC COMPONENT (AC)
OF THE INDEX OF ORTHODONTIC TREATMENT NEED (IOTN)
The Aesthetic Component is a scale of 10 colour photographs showing different levels of
dental attractiveness. The dental attractiveness of prospective patients can be rated with
reference to this scale.
In the NHS, the AC is used for border-line cases with Grade 3 DHC. If the case has an AC
score of greater or equal to 6, NHS treatment is permissible.
Page 4 of 9
EXAMPLE OF ORTHODONTIC ASSESSMENT PROFORMA
WHICH MAY BE USED AT A SPECIALIST VISIT
Patient’s name and identifying number
…………………………………………………………………
SKELETAL PATTERN
AP
Class I
Class II
Class III
□
□
□
FMPA Average
Reduced
Increased
□
□
□
Mild
Moderate
Severe
□
□
□
LAFH Average
Reduced
Increased
□
□
□
Asymmetry
None
Right
Left
□
□
□
SOFT TISSUES
Lips
Competent
Incompetent
□
□
Speech
Normal
Abnormal
□
□
Lower lip
In front
Below
Behind
□
□
□
Swallow
Normal
Abnormal
□
□
TMJ SYMPTOMS
Habits None
Past
Present
□
□
□
□
□
□
TMJ SIGNS
INTERARCH RELATIONSHIPS
INCISOR RELATIONSHIP
Class I
□
Class II div 1 □
Class II div 2 □
Class III
□
OVERBITE
Increased
Average
Reduced
Edge to edge
□
□
□
□
Complete to tooth
Complete to mucosa
Incomplete
OVERJET ………………………mm
AOB
□
………………mm
CENTRE LINES
□
Correct
Right
□
Left
ANTERIOR CROSSBITE
Yes □…………………..No
DISPLACEMENT
Yes □…………………..No
Upper Lower
□
□
□
□
□
□
…….mm …….mm
CANINES
Class I
½ II
II
½ III
III
Right
□
□
□
□
□
Left
□
□
□
□
□
MOLARS
Class I
½ II
II
½ III
III
Right
□
□
□
□
□
Left
□
□
□
□
□
POSTERIOR CROSSBITE
Yes □…………………..No
DISPLACEMENT
Yes □…………………..No
□
□
Page 5 of 9
LOWER ARCH
□
□
□
INCISORS
Inclination
Average
Retroclined
Proclined
Crowding
Spaced
No crowding/ well aligned
Mild crowding
Moderate crowding
Severe crowding
□
□
□
□
□
Yes □ ………………… No
□
Rotations
CANINES
Mesial
Upright
Distal
Right
□
□
□
Left
□
□
□
BUCCAL SEGS
Spaced
Well aligned
Mild crowding
Moderate crowing
Severe crowding
Right
□
□
□
□
□
Left
□
□
□
□
□
CANINES
Unerupted palpable
Unerupted not palpable
Mesial
Upright
Distal
Right
□
□
□
□
□
Left
□
□
□
□
□
BUCCAL SEGS
Spaced
Well aligned
Mild crowding
Moderate crowding
Severe crowding
Right
□
□
□
□
□
Left
□
□
□
□
□
UPPER ARCH
□
□
□
INCISORS
Inclination
Average
Retroclined
Proclined
Crowding
Spaced
No crowding/ well aligned
Mild crowding
Moderate crowding
Severe crowding
□
□
□
□
□
Rotations
Yes □ ………………… No
□
Diastema
Yes □ ………………… No
□
GENERAL DENTAL
l
Teeth present
---------------------------------------------- -------------------------------------------------
Oral hygiene
Good
□
Fair
□
Poor
□
Trauma/pathology
……………………………………………………………………………………………………
…
JUSTIFICATION FOR TAKING RADIOGRAPHS
RADIOGRAPHS TAKEN AND RELEVANT RADIOGRAPHIC FINDINGS
IOTN
DHC
Aesthetic
Not measurable
(mixed dentition)
OUTCOME OF PATIENT VISIT
Page 6 of 9
BASIC ORTHODONTIC ASSESSMENT CHECKLIST
THAT YOU MIGHT WANT TO USE IN PRACTICE
 What is the PATIENT’S CONCERN?
 What is the SKELETAL PATTERN?
 What is the SOFT TISSUE PATTERN?
 Are there any FINGER OR THUMB SUCKING HABITS?
 Are there any TMJ SYMPTOMS OR SIGNS?
 What is the INCISOR RELATIONSHIP?
 How big is the OVERJET in millimetres?
 Is there an ANTERIOR CROSSBITE (& mandibular displacement)?
 Is the OVERBITE normal, increased or decreased?
 Are the DENTAL CENTRELINES in the middle of the face?
 What is the FIRST MOLAR RELATIONSHIP?
 Are there any POSTERIOR CROSSBITES (and mandibular displacement)?
 Describe the LOWER ARCH
Labial segment
Canines
Buccal segments
 Describe the UPPER ARCH
Labial segment
Canines
Buccal segments
 COUNT THE TEETH
 Are there any UNERUPTED or ECTOPIC teeth?
 What is the standard of the ORAL HYGIENE?
 Is there any DENTAL PATHOLOGY (caries, periodontal disease, trauma)?
 Do you need a RADIOGRAPH to investigate further? (What does this show?)
 What is the IOTN for the patient?
 Do you need to MAKE A REFERRAL?
Page 7 of 9
ORTHODONTIC REFERRAL PROCESS
The NHS offer children under the age of 18 an orthodontic assessment.
The NHS only offers orthodontic treatment to adults in certain complex cases and these
patients should always be referred to a Consultant Orthodontist at Derriford Hospital for
assessment.
The majority of adults will need to be referred on a private basis to an orthodontic specialist
practice. When making a referral, please make sure the patient knows that a fee will be
charged for the orthodontic assessment and for any subsequent treatment.
The referral options for orthodontic assessment/treatment:
1
Referral to Hospital Orthodontic Department
A referral letter is needed to:
Orthodontic Consultant
Orthodontic Department
Level 07
Derriford Hospital
PL6 8DH
01752 432983
Orthodontic Consultant
Orthodontic Department
Royal Devon and Exeter Hospital
Barrack Road
Exeter
EX2 5DW
01392 41161 (please check phone number)
Orthodontic Consultant
Orthodontic Department
Royal Cornwall Hospital (Treliske)
Truro
Cornwall
TR1 3LQ
Please check phone number
2
Referral to Orthodontic specialist practice.
There are 2 orthodontic referral practices in Plymouth currently accepting NHS
patients (under 18) and adults under private contract.
These practices require a referral note (kept in Lead’s office) and a covering letter.
The Crescent Specialist Dental Centre
2 The Crescent
Plymouth
PL1 3AB
01752 222444
Plymouth Orthodontics
60 Lower Compton Road
Plymouth
Page 8 of 9
PL3 5DW
01752 662554
(Truro)
Mr Nick Wenger
Kernow Health Referral Management Service
1st Floor Cudmore House
Treliske Industrial Estate
TRURO
TR1 3LP
An orthodontic referral letter should include the following information:




Patient details and any relevant medical, dental or social history
A brief summary of the patient’s concerns and your reason for referral
A brief description of the malocclusion
Information about any teeth of poor prognosis
Once the necessary paperwork has been completed and you have explained to your patient
that they have been referred for an orthodontic assessment by a specialist, please hand the
referral and the covering letter to your Lead Nurse, who will action it.
A letter will be returned to you from the Orthodontist once the patient had been seen. This
will be reviewed by the Clinical Lead. Reception will then make an appropriate appointment
for any necessary treatment to be carried out.
Page 9 of 9