How to Examine the Patient?

Dr. Lim Ratha DDS

BPE Screening
1. Carry out a BPE screen for all new adult patients, and all adult patients without a
diagnosis of periodontitis at each recall appointment.
2. Explain to the patient the reason for the examination.
3. Divide the dentition into 6 sextants (i.e. 17-14, 13-23, 24-27, 47-44, 43-33, 34-37).
4. Examine all teeth in each sextant (excluding third molars unless first and/or second
molars are missing) using a WHO BPE probe (see figure: WHO BPE probe) and
light probing force equivalent to the force required to blanch a fingernail.
5. Record the highest score for each sextant, including any furcation involvement
(noted as * beside the sextant score), as illustrated in table BPE Scoring codes.
BPE Scoring codes
ANGLE’S CLASSIFICATION OF
MALOCCLUSION
A malocclusion is a misalignment or incorrect relation between
the teeth of the two dental arches when they approach each other
as the jaws close. Edward Angle, who is considered the father of
modern orthodontics, was the first to classify malocclusion. He
based his classifications on the relative position of the permanent
MAXILLARY FIRST MOLAR.
• Line of Occlusion: The teeth all fit on a line of occlusion which,
in the upper arch, is a smooth curve through the central fossae
of the posterior teeth and cingulum of the canines and incisors,
and in the lower arch, is a smooth curve through the buccal
cusps of the posterior teeth and incisal edges of the anterior
teeth. There is alignment of the teeth, normal overbite and
overjet and coincident maxillary and mandibular midlines.
• Line of Occlusion: ALTERED in the maxillary and mandibular
arches .
• – Individual tooth irregularities (crowding/spacing/other
localized tooth problems).
• – Inter-arch problems (open bite/deep bite/cross bite)
• Mesognathic: normal, straight face profile with flat facial
appearance.
Normal Occlusion

• Molar Relationship: According to Angle, the mesiobuccal cusp

of the maxillary first molar aligns with the buccal groove of the
mandibular first molar.
• Canine Relationship: The maxillary canine occludes with the
distal half of the mandibular canine and the mesial half of the
mandibular first premolar.
ANGLE Class I: NEUTROOCCLUSION

• Molar Relationship: The mesiobuccal cusp of the maxillary

first permanent molar occludes with the mesiobuccal groove of
the mandibular first permanent molar.
• Canine Relationship: - The mesial incline of the maxillary
canine occludes with the distal incline of the mandibular canine.
The distal incline of the maxillary canine occludes with the
mesial incline of the mandibular first premolar .
ANGLE Class II: DISTOOCCLUSION (overjet)

• Molar relationship: The molar relationship shows the

mesiobuccal groove of the mandibular first molar is DISTALLY
(posteriorly) positioned when in occlusion with the mesiobuccal
cusp of the maxillary first molar. Usually the mesiobuccal cusp
of maxillary first molar rests in between the first mandibular
molar and second premolar.
• Canine Relationship: The mesial incline of the maxillary
canine occludes
• ANTERIORLY with the distal incline of the mandibular canine.
The distal surface of the mandibular canine is POSTERIOR to
the mesial surface of the maxillary canine by at least the width
of a premolar.
• Line of occlusion is not specified but irregular, depending on
facial pattern, overcrowded teeth and space needs.
• Retrognatic: convex face profile resulting from a mandible that
is too small or maxilla that is too large.
• Class II Malocclusion has 2 subtypes to describe the position of
anterior teeth.
– Class II Division 1: The molar relationships are like that of Class II
and the maxillary anterior teeth are protruded. Teeth are proclaimed
and a large overjet is present.
– Class II Division 2: The molar relationships are Class II where the
maxillary central incisors are retroclined. The maxillary lateral incisor
teeth may be proclaimed or normally inclined. Retroclined and a deep
overbite exists.
• CLASS II Sub-division: Class II molar relationship exists on
one side and the other side has a normal Class I molar
relationship.
ANGLE Class III: MESIOOCCLUSION (negative
overjet)
• Molar relationship: The mesiobuccal cusp of the maxillary first
permanent molar occludes DISTALLY (posteriorly) to the
mesiobuccal groove of the mandibular first molar.
• Canine Relationship: Distal surface of the mandibular canines
are mesial to the mesial surface of the maxillary canines by at
least the width of a premolar . Mandibular incisors are in
complete crossbite.
• Line of occlusion is not specified but irregular, depending on
facial pattern, overcrowded teeth and space needs.

• Prognathic: concave face profile with prominent mandible is

associated with Class III malocclusion.
Class III malocclusion has 2 subdivisions

1. TRUE class III malocclusion (SKELETAL) which is genetic in origin

due to excessively large mandible or smaller than normal maxilla.
2. PSEUDO Class III malocclusion (FALSE or postural) which occurs
when mandible shifts anteriorly during final stages of closure due to
premature contact of incisors or the canines. Forward movement of the
mandible during jaw closure can also result from premature loss of
deciduous posterior teeth.

3. Class III Sub-division: Class III molar relationship exists on one side
and the other side as a normal Class I molar relationship.
Incisor Relationship
Crossbite

• A crossbite is a dental condition that affects the way your teeth

are aligned. The main sign of having a crossbite is that upper
teeth fit behind your lower teeth when your mouth is closed or
at rest. This can affect teeth in the front of your mouth or
toward the back of your mouth.
• are
• two classifications of crossbite: anterior and posterior.
– A posterior crossbite refers to the group of lower teeth toward
the back of your mouth fitting over the teeth in your top jaw.
– An anterior crossbite refers to the group of teeth in the bottom front of
your mouth fitting over the teeth of your top jaw.
Overjet

• Overjet (buck teeth) refers to a type of malocclusion (bad bite). It happens when your
upper front teeth stick out further than they should. Overjet (horizontal overlap)
differs from overbite (vertical overlap). You can fix overjet with orthodontics or oral
surgery.
• Overjet describes a type of malocclusion (bad bite). It happens when your upper front
teeth protrude, or stick out, further than they should. Another name for overjet is
“buck teeth.”
• Most people’s upper front teeth protrude past their lower front teeth by about 2
millimeters. That’s what dentists consider normal. But if your teeth stick out more
than 2 millimeters, that’s an overjet.
Overbite

• Overbite refers to a vertical misalignment of your teeth. It happens when your upper
teeth overlap your lower teeth more than they should. Left untreated, overbite can
cause oral health issues like jaw pain, tooth erosion and gum disease. Treatment
options include orthodontics and oral surgery.
• The term overbite does not refer to a specific condition, nor is it a form of
malocclusion. Rather an absent or excess overbite would be a malocclusion. Normal
overbite is not measured in exact terms, but as a proportion (approximately 30–50%
of the height of the mandibular incisors) and is commonly expressed as a percentage.
Dental Midline

• The dental midline is the midsagittal line of maxillary and

mandibular dental arches possessing teeth of ideal size, shape,
and position, when situated in maximum intercuspation. Each
arch also possesses its own midline, which can be used to refer
to the location of contact between the mesial surfaces of the
central incisors. Thus, if an individual's mandibular teeth are
shifted over to the left in a mesial-distal dimension, by 2 mm,
for example, that individual's midline would be said to be
deviated 2 mm to the left.