Orthodontic assessment and the dental hygienist

Dental hygienists and the dentist work in partnership with the goal of providing exceptional care to their patients. Lisandra Maisonet, RDH, BS, PHDHP, EFDA, explains the role of the dental hygienist during the preventive appointment and describes exactly what should take place during this time. The exam allows the hygienist to gather information for the dentist that will help determine whether an orthodontic referral is necessary.


Dental hygienists and the dentist work in partnership with the goal of providing exceptional care to their patients. The American Dental Hygienists’ Association defines dental hygiene as the science and practice of recognition, prevention, and treatment of oral disease and conditions as an integral component of total health. It is important when treating patients that hygienists also include an orthodontic assessment in growing children to determine between a developing normal occlusion and potential malocclusion. This examination will allow the hygienist to gather information for the dentist that will help in determining whether an orthodontic referral is necessary.

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During a preventive appointment, the dental hygienist should be examining the oral cavity and making a determination of whether there is crowding or spacing, premature tooth loss, improper alignment of teeth, posterior or anterior cross-bites, protrusion of anterior teeth, or anterior open bites. It is vital for the hygienist to have an understanding of how each of these conditions could be a detriment to a patient’s overall oral health.

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When a child has a mixed dentition, it is important to evaluate the space available in each of the dental arches as a means of determining whether the secondary teeth will be able to erupt properly. At times when crowding is present and there is constriction of the dental arches, an orthodontist may choose to expand the arches or recommend the extraction of some primary teeth in the hopes of facilitating permanent teeth to erupt in the hopes of preventing more complicated orthodontic treatment in the future.

Another area that needs to be determined is the presence of premature tooth loss. For example, if a primary second molar is lost prematurely, then the permanent first molar can drift into the open space. This drifting can lead to a loss of space for permanent tooth eruption and some loss of arch length caused by the mesial drift of the permanent molar. If during the exam it is determined there is premature tooth loss, then the dentist may refer to a specialist for a determination of the type of space maintenance that needs to be implemented, depending on the child’s age.

Misaligned teeth can interfere with proper chewing and make it challenging to keep teeth clean, thus leading to gingival inflammation or tooth decay if plaque adheres to surfaces for long periods of time. Additionally, teeth will be more likely to wear abnormally, or faster than those in proper alignment. When anterior cross-bites are present, teeth should be examined for premature attrition, gingival recession, and mobility. The presence of these conditions may require early intervention. Furthermore, it is important to examine for protruded teeth, as these can be more prone to accidental damage. The presence of overbites and cross-bites can be indicative of oral habits such as thumb sucking, pacifier use, or tongue thrusting. The earlier these habits are discontinued, preferably by age 3, the greater the chance that dentofacial changes will self-correct without orthodontic intervention.

The dental hygienist can serve a crucial role in working together with the dentist in determining orthodontic needs. These efforts will contribute to a healthy dentition.

1. Cameron AC, Widmer RP. Handbook of Pediatric Dentistry. London: Mosby-Wolfe, 1997. Print.

Lisamaisonetrdh124x124Lisa Maisonet, RDH, BS, PHDHP, EFDA, received her AAS degree in dental hygiene from Montgomery County Community College and a BS degree from Pennsylvania College of Technology. She is enrolled in a master’s program in adult education at Penn State University. Further, she is certified as an Expanded Functions Dental Assistant and is an adjunct faculty in the Dental Hygiene Program at Montgomery County Community College. She is currently employed full time for Newtown Dentistry for Kids & Newtown Orthodontics.

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