The paedodontic–orthodontic interface

The long-term management of a child’s developing occlusion often benefits greatly from a good working relationship between the paediatric dentist and the orthodontist. Typical problems range from minimizing damage to the occlusion caused by enforced extraction of poor-quality teeth, through the management of specific local abnormalities such as impacted teeth, to referral for comprehensive treatment of all aspects of the malocclusion. This chapter discusses the principles underlying when to refer to a specialist colleague, and looks at some common clinical situations where collaboration is often needed. From the age of 8 years all children should be screened for the presence of malocclusion when they attend for a routine dental examination. Although orthodontic treatment is usually carried out in the late mixed and early permanent dentition, some conditions benefit from treatment at an earlier stage. The screening need only be a brief clinical assessment, but it should be carried out systematically to ensure that no important findings are overlooked. An outline of a basic orthodontic assessment is given in Table 15.1. With practice this can be carried out quite quickly to give an overall impression of the nature and severity of a malocclusion. In essence, it comprises assessments of the following elements: • the patient’s awareness of their malocclusion (the complaint, if any) • their general level of dental awareness • an extra-oral examination of facial form (skeletal pattern and soft tissues) • general oral condition—oral hygiene, periodontal health, caries risk, and tooth quality • the presence or absence of all teeth • the alignment and form of each arch • the teeth in occlusion. Radiographs are not routinely used when screening for the presence of malocclusion and should only be taken when there is a clinical indication. A panoramic radiograph gives a useful general scan of the dentition and indicates the presence or absence of teeth. Modern digital panoramic radiographs are generally of good enough quality to assess for the presence of any abnormalities or gross caries. Intra-oral views may be indicated if specifically indicated by the history/examination (e.g. dental trauma) or for further investigation of pathology found on a panoramic image. A radiographic assessment must always be made when considering any extractions.