Orthodontic diagnosis starts with a consultation and history, moves through an extra oral and an intra oral examination, and ends with diagnostic records: an OPG, a lateral cephalogram, photographs and models or scans. The findings are combined into a problem list that drives the treatment plan.
The important conversation: the consultation
The consultation sets the direction of the whole case. Ask what the patient wants changed, what bothers them most, and what result would satisfy them. Note whether the motivation comes from the patient or from a parent or spouse, because motivation predicts cooperation. Record the answers in the patient's own words so they can be revisited at the end of treatment.
Medical and dental history
The medical history screens for conditions and medicines that change how bone and gingiva respond to force or that affect healing, such as bisphosphonates, long term corticosteroids and poorly controlled diabetes, along with allergies to nickel or latex. The dental history covers caries activity, periodontal status, previous orthodontic treatment, trauma, oral habits and any temporomandibular symptoms.
Extra oral examination: the face comes first
Patients judge the result by their face and smile, so the extra oral examination carries real weight in planning. Assess facial symmetry, the profile (convex, straight or concave), lip competence, the nasolabial angle, the lower facial height, and the smile line and smile arc. Profile weightage is the question of how much of the problem sits in the face and how much sits in the teeth. A case with a strong skeletal component will not be solved by moving teeth alone.
Intra oral examination: the soft tissues and the dentition
Begin with the soft tissues: oral hygiene, gingival health, frenal attachments, tongue posture and size. Then examine the dentition: crowding or spacing in millimetres, overjet, overbite, midlines, molar and canine relationships, crossbites, missing, impacted or supernumerary teeth, wear and existing restorations.
From findings to a problem list
Sort what you found by plane: sagittal, vertical and transverse, and note whether each problem is dental or skeletal. Rank the problems by importance to the patient and to health. This problem list, together with the records described in the records guide, becomes the foundation of the treatment plan.
Key takeaways
- Listen first. The consultation decides what success looks like for this patient.
- Screen medical history for conditions and medicines that affect tooth movement.
- Examine the face before the teeth.
- Convert findings into a ranked problem list before planning.
Frequently asked questions
What is the first step in orthodontic diagnosis?
The first step is the consultation, where you establish the chief complaint, the patient's expectations and their motivation, followed by medical and dental history.
Why is the profile examined before the teeth?
Because the facial profile and smile are what patients notice and what limits the possible change. Examining the face first shows how much of the problem is skeletal and how much is dental.