ortho referal

[Guest guest]

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