Dr. Cullinan believes one of the most important aspects of successful orthodontic treatment begins with a complete and thorough clinical examination. This consists of exploring the following important diagnostic aspects of your oral condition before making the appropriate treatment recommendations.
Review of Complete Medical and Dental Histories and Chief Concerns
Oral Health is an integral part of a patient's overall health and well-being. As such, it is important to review and discuss your medical and dental histories and understand your main concerns and goals for your treatment.
Temporomandibular (Jaw) Joint Evaluation
This phase of the examination will address any history of trauma to the head or neck, any joint noises to include popping or clicking or crepitus (a grating noise within the joints), limitation in range of motion of the lower jaw, and any present symptoms to include muscle soreness or stiffness, pain in the chewing muscles or in and around the temporomandibular (jaw) joints themselves.
A complete Dental evaluation examines the teeth that are present and explores the need to replace missing teeth, documents areas of enamel wear or decalcified enamel, notes any areas of decay or faulty dental restorations and rules out any presence of oral pathology.
The periodontal evaluation encompasses the current condition of the gums and bone that support the existing teeth, to include the level and amount of attached tissue, any presence of swelling or hypertrophy of the tissue, the presence of any mobility of any of the existing teeth, and an assessment of oral hygiene and how well the patient is maintaining their teeth and gums.
During this phase of the examination, the patient's speech is assessed, as well as the way they swallow and breath. In many cases tongue posture, size or mobility, mouth breathing, swallowing or notable oral habits can affect how the teeth and jaws develop during the critical growth and development phase of adolescents.
The manner in which the teeth "fit together" or occlude is a very important aspect of the clinical examination. Specifically, Dr. Cullinan looks at molar position, interdigitation of teeth, alignment of the teeth, midline discrepancies and the current level of overbite and overjet. "Overbite" is the vertical overlap of the upper and lower front teeth; whereas, "Overjet" is the horizontal distance between the back of the upper front teeth and the front of the lower front teeth. There is also an assessment of any crossbite relationship of the teeth, any shift in the jaws when the patient first closes down till they bite into their final tooth contact position, and whether the patient has any prematurity when biting.
A final assessment is made about the patient's facial profile, any muscle strain on lip closure, the relative position of the upper teeth to the upper lip at rest and while smiling, whether there is a "cant" of the bite, and an important assessment of the patient's upper dental midline relationship. All of this information is combined with a radiographic and study model review to determine the proper diagnosis, inform the patient and/or parents about the current orthodontic condition and make the appropriate treatment recommendations.
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