Re: ortho referal

[Guest guest]

thats really helpful ebtisam, well done and keep it up! From: ebtessam <ebtessamhamalawy@...> Sent: Saturday, 31 March 2012, 21:54 Subject: ortho referal

HI ALL

(((( ACCO TO THE BRITISH SOCIETY OF ORTHODONTICS))))

Should I refer? - guidance to dentists

A Guide to referring to a Specialist

Permanent maxillary canines should be palpable buccally by 8-10 years of age. If they cannot be palpated by 10 years, alarm bells should sound. Malposition and damage to the roots of adjacent teeth are the main risks. Interceptive extraction of upper deciduous canines is an option often considered by orthodontists to manage canine malposition. However, early diagnosis is important if this option is to be used and space maintenance may also be needed. What should you do?

X-ray of ectopic canines1. If, from palpation, palatal ectopia is suspected appropriate radiographs (for example, horizontal parallax) will be needed to confirm the diagnosis and to check for possible pathology.

2. Onward referral to a specialist orthodontist for advice on management is appropriate if any abnormality is detected or suspected.

Impacted canines3. If the permanent canine is palatally impacted, extraction of the deciduous canine between ages 10 & 13 years is indicated. This has been shown to result in normalisation of such canines in 65%-91% of cases.

4. Do not extract deciduous canines where your parallax technique has shown the permanent canine to be buccally displaced or in the line of the arch. Extraction will lead to space loss and a deciduous molar/lateral incisor contact.

5. If in doubt, refer to a specialist.

SO OMAR AND KANIKA IN REFERENCE TO THE CASE WE DISCUSSED EARLIER:

Six months ago you saw a child patient, then aged 9 years. His upper right maxillary canine was palpable in the labial sulcus but the upper left was not. The situation is now unchanged, so you have taken two periapicals of the non-palpable tooth. They both show that there is some resorption of the C| root but the permanent canine appears somewhat mesially angled and is more mesial on the more mesially positioned film.

What is your the best course of action?

A. Keep a careful watch on it and take another x-ray in 6 months.

B. Refer to an oral surgeon for early exposure of the permanent canine.

C. Refer to an oral surgeon for early removal of the permanent canine before it damages the lateral incisor.

D. Refer to an orthodontist for a treatment plan.

E. Wait and watch' until the child is 11.

Page 3 of 34

WE WILL STILL WAIT EBC THE TOOTH IS:

1. impacted palatally (((is more mesial on the more mesially positioned film.)))))

2. pt is still only 9

right??????

thanks

ebtisam