Trigger:

Mimi is a 19 years-old female, she came to the Klinik rawatan utama faculty of Dentistry UKM
requesting for braces. You are the dental officer in charge.

Hypothesis:

-Malocclusion

- May have problem on teeth arrangement (misaligned teeth) -lead to speech problem
- Overlapping
- Asymmetrical smile/ Crooked face
- Ectopic and impacted tooth (cause discomfort upon chewing food)
- Mesial drift caused by missing teeth (eg: early extraction, carious teeth)

-Abnormalities of the jaw

- Problem on maxillary and mandibular arch (abnormal skeletal pattern)

Learning issue (highlighted in details)

1. What is the timing of tooth eruption? What tooth should have been erupted at this age?
- What are the processes of permanent tooth eruption and deciduous tooth eruption? How to
differentiate the eruption of permanent and deciduous teeth?
- What are the factors that stimulate tooth eruption?
2. What is exfoliation?
3. What is mesial drift? What are the physiological tooth movement that can contribute to
mesial drift?
4. Why do people request for braces?
5. What are the types of malocclusions?
- What is the type of skeletal patterns?
- What are the causes of impacted tooth?
6. What are the causes of inflammation of gingiva?
7. Why do we perform panoramic radiograph examination?
8. What are the normal anatomical structures that is expected to be examined in the panoramic
radiograph examination?
9. What are the management of patient? (brief) -caries, crowded teeth
- What are the types of braces?

History

Family History

- No similar problems from family members

- All family members are medically fit

Past Dental History

- No history of trauma to the face

 - Patient went for check-up only when the nurses came to school
- Patient had tooth extraction long time ago (cannot remember at what age)
- Patient brush teeth twice daily, no flossing or mouth wash
- Does not have grinding habit/ bruxism
- No biting habits
- No smoking habits

Medical History

- Not taking any medication

Examination

Extraoral examination

- Symmetrical face
- TMJ Examination: No tenderness upon palpation on TMJ, no ‘clicking’ sound upon opening
or closing mouth, no limitation or pain upon opening or closing mouth
- Lip is competent
- No swelling on the face
- Has skeletal pattern class I
- No cleft lip
- No tenderness upon palpation/swelling lymph nodes

Intraoral examination

- Presence of restoration at 46
- There is no extra tooth
- Impacted tooth at the lower arch (35 and 45)
- All teeth present at the mandibular arch except last molar and impacted 35 and 45
- All teeth present at the maxillary arch except missing 23
- Anterior gingival a bit red, some part swollen
- Interdental gingiva between 12 and 13 appears inflamed- maybe to misalignment-
crowding maxillary anterior teeth and mandibular teeth (rotation, underlying 35, 45)
- Caries at mesial of 21

Radiographic examination

- 23 is impacted- in proximity to the roots of tooth 21 and 22

- All teeth developed completely but doesn’t have enough space