DetailedInstructionsforCompletingthe SalzmannIndexEvaluation

Introduction
Thisassessmentrecord(notanexamination)isintendedtodisclosewhetherahandicapping malocclusionispresentandtoassessitsseverityaccordingtothecriteriaandweights(pointvalues) assignedtothem.Theweightsarebasedontestedclinicalorthodonticvaluesfromthestandpointof theeffectofthemalocclusionondentalhealth,function,andesthetics.Theassessmentisnotdirected toascertainthepresenceofocclusaldeviationsordinarilyincludedinepidemiologicalsurveysof malocclusion.Etiology,diagnosis,planning,complexityoftreatment,andprognosisarenotfactorsin thisassessment. A.IntraArchDeviations Thecastsareplaced,teethupward,indirectview.Whentheassessmentismadedirectlyinthemouth, amouthmirrorisused.ThenumberofteethaffectedisenteredasindicatedintheHandicapping MalocclusionAssessmentRecord.Thescoringcanbeenteredlater. 1. Anteriorsegment:Avalueof2pointsisscoredforeachtoothaffectedinthemaxillaand1 pointinthemandible. Missingteethareassessedbyactualcount.Atoothwithonlytherootsremainingisscored asmissing. Crowdedreferstotoothirregularitiesthatinterruptthecontinuityofthedentalarchwhen thespaceisinsufficientforalignmentwithoutmovingotherteethinthearch.Crowded teethmayormaynotalsoberotated.Atoothscoredascrowdedisnotscoredalsoas rotated. Rotatedreferstotoothirregularitiesthatinterruptthecontinuityofthedentalarchbut thereissufficientspaceforalignment.Atoothscoredasrotatedisnotscoredalsoas crowdedorspaced. Spacing: o Openspacingreferstotoothseparationthatexposestoviewtheinterdentalpapillacon thealveolarcrest.Scorethenumberofpapillaevisible(notteeth). o Closedspacingreferstopartialspaceclosurethatwillnotpermitatoothtocompleteits eruptionwithoutmovingotherteethinthesamearch.Scorethenumberofteeth affected. 2. Posteriorsegment:Avalueof1pointisscoredofeachtoothaffected. Missingteethareassessedbyactualcount.Atoothwithonlytherootsremainingisscored asmissing. Crowdedreferstotoothirregularitiesthatinterruptthecontinuityofthedentalarchwhen thespaceisinsufficientforalignment.Crowdedteethmayormaynotalsoberotated.A toothscoredascrowdedisnotscoredalsoasrotated.

Posteriorsegmentcontinued Rotatedreferstotoothirregularitiesthatinterruptthecontinuityofthedentalarchandall orpartofthelingualorbuccalsurfacefacessomepartoralloftheadjacentproximaltooth surfaces.Thereissufficientspaceforalignment.Atoothscoredasrotatedisnotscoredalso ascrowded. Spacing: o Openspacingreferstointerproximaltoothseparationthatexposestoviewthemesial anddistalpapillaeofatooth.Scorethenumberofteethaffected(Notthespaces). o Closedspacingreferstopartialspaceclosurethatwillnotpermitatoothtoerupt withoutmovingotherteethinthesamearch.Scorethenumberofteethaffected. B.InterarchDeviations Whencastsareassessedforinterarchdeviations,theyfirstareapproximatedinterminal occlusion.Eachsideassessedisheldindirectview.Whentheassessmentismadeinthemouth, terminalocclusionisobtainedbybendingtheheadbackwardasfaraspossiblewhilethemouthisheld wideopen.Thetongueisbentupwardandbackwardonthepalateandtheteetharequicklybrought toterminalocclusionbeforetheheadisagainbroughtdownward.Amouthmirrorisusedtoobtaina moredirectviewinthemouth. 1. Anteriorsegment:Avalueof2pointsisscoredforeachaffectedmaxillarytoothonly. Overjetreferstolabialaxialinclinationofthemaxillaryincisorsinrelationtothemandibular incisor,permittingthelattertooccludeonoroverthepalatalmucosa.Ifthemaxillary incisorsarenotinlabialaxialinclination,theconditionisscoredasoverbiteonly. Overbitereferstotheocclusionofthemaxillaryincisorsonoroverthelabialgingival mucosaofthemandibularincisors,whilethemandibularincisorsthemselvesoccludeonor overthepalatalmucosainbackofthemaxillaryincisors.Whenthemaxillaryincisorsarein labialaxialinclination,thedeviationisscoredalsoasoverjet. Crossbitereferstomaxillaryincisorsthatoccludelingualtotheiropponentsinthe opposingjaw,whentheteethareinterminalocclusion. Openbitereferstoverticalinterachdentalseparationbetweentheupperandlower incisorswhentheposteriorteethareinterminalocclusion.Openbiteisscoredinaddition tooverjetifthemaxillaryincisorteethareabovetheincisaledgesofthemandibular incisorswhentheposteriorteethareinterminalocclusionedgetoedgeocclusioninnot assessedasopenbite. 2. Posteriorsegment:Avalueof1pointisscoredforeachaffectedtooth. Crossbitereferstoteethinthebuccalsegmentthatarepositionedlinguallyorbuccallyout ofentireocclusalcontactwiththeteethintheopposingjawwhenthedentalarchesarein terminalocclusion. Openbitereferstotheverticalinterdentalseparationbetweentheupperandlower segmentswhentheanteriorteethareinterminalocclusion.Cusptocuspocclusionisnot assessedasopenbite. Anteroposteriordeviationreferstotheocclusionforwardorrearwardoftheaccepted normalofthemandibularcanine,firstandsecondpremolars,andfirstmolarinrelationto theopposingmaxillaryteeth.Thedeviationisscoredwhenitextendsafullcuspormorein themolarandthepremolarsandcanineoccludeintheinterproximalareamesialordistal totheacceptednormalposition.

ORTHODONTIC SERVICE SALZMANN EVALUATION INDEX

PATIENTS NAME LAST, FIRST, MIDDLE INITIAL REFERRING DENTIST ORTHODONTISTS NAME Tax ID DATE OF ASSESSMENT Member # Date of Birth

HANDICAPPING MALOCCLUSION ASSESSMENT RECORD

A. Intra Arch Deviation
SCORE TEETH AFFECTED ONLY MAXILLA ANT. POST. ANT. POST. MISSING CROWDED ROTATED SPACING Open Closed NO. POINT VALUE X2 X1 X1 X1 TOTAL SCORE SCORE

MANDIBLE

ANT = Anterior Teeth (4 incisors) POST = Posterior Teeth (Include canine, premolars and first molars) NO. = Number of teeth affected

B. Inter Arch Deviation 1. Anterior Segment

SCORE MAXILLARY TEETH AFFECTED ONLY EXCEPT OVERBITE* OVERJET OVERBITE CROSSBITE OPENBITE NO. POINT VALUE X2 TOTAL SCORE SCORE

*Score Maxillary or Mandibular Incisors No. = Number of teeth affected

2. Posterior Segment
SCORE AFFECTED TEETH ONLY CANINE 1ST PREMOLAR 2ND PREMOLAR 1ST MOLAR RELATE MANDIBULAR TO MAXILLARY TEETH DISTAL MESIAL Right Left Right Left SCORE AFFECTED MAXILLARY TEETH ONLY CROSSBITE OPENBITE Right Left Right Left NO. POINT VALUE X1 X1 X1 X1 TOTAL SCORE SCORE

GRAND TOTAL

No primary teeth may exist and a Salzmann Evaluation Index score of 25 points or more must be achieved to be eligible for comprehensive orthodontic treatment under the Commonwealth of Pennsylvanias CHIP dental program.

PLEASE COMPLETE THE FOLLOWING IN DETAIL:

DESCRIPTION OF PATIENTS CONDITION AND DIAGNOSIS:

DIAGNOSTIC PROCEDURES:

TREATMENT PLAN:

REMARKS: