

Intra-Oral
Examination
 Oral Hygiene Status

 By noting the presence of calculus and plaque
to evaluate the oral hygiene
 Patients with poor oral hygiene should be
given instructions on maintaining a proper oral
hygiene status by using dentrifices and mouth
washes before commencing the treatment.
 Patient with good oral hygiene should be
encouraged to maintain it through out the
treatment period.
B. Intraoral examination:
1. Tongue
• Tongue is examined for shape, color and
configuration.

• Tongue size can be roughly estimated with the
help of a lateral cephalogram.

• An excessively large tongue

(macroglossia) usually
shows imprints on its lateral
margins, which gives the
tongue a scalloped
appearance.
• The lingual frenum should be


examined for tongue tie.

• Tongue tie can lead to

impaired tongue movements.

• Abnormalities of the tongue can

upset muscle balance and
equilibrium leading to
malocclusion.
2. Lip and Cheek Frena
• Maxillary labial frenum is
most commonly the cause
of a malocclusion.

• A thick, fibrous, low labial
frenum prevents upper
central incisors from
approximating each other
leading to a midline
diastema.
• Frenectomy is indicated when the
frenum is inserted deeply with fiber
extensions into the interdental papilla.

• A Periapical x-ray of the area may show

a bony fissure between the roots of the
upper central incisors.
• Blanch test can be done to confirm diagnosis
wherein the upper lip is stretched upward and
outwards.

• Presence of blanching in the papilla region
indicates an abnormal attachment.
• The mandibular labial frenum is less often
associated with a diastema. However, it can
exert a strong pull on the free and attached

gingiva leading to recession in the lower
anterior region.
3. Gingiva
• The gingiva should be examined for the type (thick fibrous or thin
fragile), inflammation and mucogingival lesions.

•

In children, most commonly generalized marginal gingivitis occurs
due to plaque accumulation and can be resolved by improving
the oral hygiene.

• In adults, scaling followed by curettage and sometimes

mucogingival surgery is usually required.

• Local gingival lesions may occur due to occlusal trauma,

abnormal functional loadings or medication (e.g. Dilantin).
• In mouth breathers, open lip posture causes
dryness of the mouth leading to anterior
marginal gingivitis.

Class 1-Marginal tissue recession not
extending beyond mucogingival


junction.No involvement of
interdental bone.

Class 2-Marginal recession

extending beyond the
mucogingival junction.

Class 3-Marginal recession along

with loss of interdental bone
apical to CEJ but coronal to
extent of marginal tissue
recession

Class 4-Loss of interdental

bone apical to marginal
tissue recession
 

The lack of facial or lingual cortical plates, which results in

exposing the cervical root surface and affecting the marginal bone,
represents an alveolar bone defect called dehiscence. When there
is still some bone in the cervical region, the defect is termed
fenestration.
 Mobility


0 No mobility N/A

1 Greater than normal (physiological) Slight mobility

2 <1 mm in buccolingual direction Moderate

mobility

3 >1 mm in buccolingual direction and depressible Severe

4. Palate
• The palatal mucosa is examined for:
a. Pathologic palatal swelling: Indicative of


displaced/ impacted tooth germ, cysts, etc.
b. A traumatic deep bite can lead to mucosal
ulcerations and indentations.
c. Palatal depth and shape varies in accordance with
the facial form, e.g. Brachyfacial patients have
broad and shallower palates as compared to
dolicofacial patients.
d. Presence of clefts of varying degree may be seen.
Scar tissue following palatal surgery prevents normal
development of the maxillary arch
e. Rugae can be used as a diagnostic criterion for


anterior proclination. Third rugae is normally in line
with the canines.
5. Tonsils and Adenoids
• The size and presence of inflammation in the tonsils,
if present, should be examined.
• Prolonged inflammation of the tonsils causes

alteration of the tongue and jaw posture, upsets the
orofacial balance and can result in "Adenoid
facies".
 CLINICAL EXAMINATION
OF THE DENTITION

 The dentition is examined for:

1. The dental status, i.e. number of teeth present,

unerupted or missing.

2. Dental and occlusal anomalies should be

recorded in detail. Carious teeth should be
treated before beginning orthodontic treatment.
Dentition should be examined for other
malformation, hypoplasia, restorations, wear
and discoloration.
3. Assessment of the apical bases:
• Sagittal plane Check whether molar relation is Class
I, II or III.
•

Vertical plane Overjet and overbite are recorded and
variations like deep bite, open bite should be
recorded.
• Transverse plane Should be examined for lateral shift
and cross-bite

4. Midline of the face and its coincidence with the

dental midline should be examined.

5. Individual tooth irregularities, e.g. rotations,

displacements, fractured tooth

6. Shape and symmetry of upper and lower arches.

 Fluorosis

MILD
MODERATE SEVERE
 Size of Teeth

 Microdontia
Microdontia is where teeth appear smaller than
expected.
Classification is dependent on severity. Localized
microdontia describes a singular tooth that is
smaller than normal, relative generalized
microdontia, describes teeth that appear smaller
due to the larger relative size of the maxilla or
mandible, and true generalized microdontia
describes the involvement of the entire dentition
Peg-Shaped Laterals


Occurs when permanent lateral incisors do not fully

develop.
 
 Macrodontia
Macrodontia, also known as megalodontia, has
an unknown etiology; however, genetic and
environmental factors have been attributed to
the development of this condition.
Generalized macrodontia has been attributed to
several conditions, notably insulin-resistant
diabetes, otodental syndrome, and hypophyseal
gigantism.

 Number of Teeth
Present

 To asses the developmental disturbances which
affect the number of teeth such as anodontia and
supernumerary teeth.
 Anodontia is the congenital absence of teeth there
could be Total anodontia and partial anodontia.
 Partial Anodontia is more common than total
anodontia.
 In the increasing order of there prevalence most
common missing teeth are Maxillarylateral
incisors,Maxillary or mandibular 2nd premolars and
third molars
 
 Supernumerary tooth is one that is addition to the normal
series and can be found in almost any region of dental arch.
• Teeth may have:
1. normal morphology
2. rudimentary
3. miniature
Supernumerary permanent dentition-
male> female
maxilla>mandible
 

MESIODENS
 

PARAMOLARS

DISTOMOLAR
Saggital Plane

Canine Relationship

 Incisor
Relationship(Ballard and
Wayman  1964)
 Premolar
Relationship(Katz,199
2)


PREMOLAR CLASS I - upper 1st premolar

fits exactly into the embrasure created by
the distal contact lower 1st premolar.
 

Premolar class II- the upper 1st premolar is

occluding mesial of the embrasure created by the
distal contact of the lower 1st premolar.
 
 PREMOLAR CLASS III- the upper 1st premolar is
occluding distal of the embrasure created by
the distal contact of lower 1st premolar.
 Vertical Plane

 To measure the amount of overbite and
overjet
 Normal overjet is ideally 2-3mm
 Normal overbite is 2-4mm
 Measured as the horizontal and vertical
relationship between the upper and lower
incisors.
 Transverse

 The occlusion is examined in the transverse
plane to evaluate the inclinations of the upper
and lower posterior teeth which oftentimes
can lead to crossbites and scissorbites.
 Hard tissue should also be examined for
caries., occlusal facets or fractures of their
structure.
 Caries can be evaluated visually as well as by

probing using an explorer.
 Occlusal facets and wear can detected by
direct visual inspection

 Maximal Mouth
Opening

 The mean maximal mouth opening for Indian
males is 51.3±8.3 mm and for females is
44.3±6.7 mm.
 The mouth opening seems to decrease with
age.
 The mouth opening of females is significantly
less than the males in all the age groups.
 Measured using a ruler from incisal edges of
upper incisor to the incisal edge of lower
incisors
 Freeway Space

 Freeway space is calculated clinically by
measuring the Vertical relation at rest and
Vertical relation at occlusion and calculating
their difference.
 Ideal range is 3-4mm
 Mid-Lines

 Mid lines should be checked for any
deviations and should be recorded.
 Skeletal mid-line should ideally coincide with
dental mid line
 The midsagittal line should coincide with
dental midlines.
 The midline of upper incisors and lower
incisors should also coincide ideally and any
deviations should be recorded.

 

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