Orthodontics · patient case with 1 question
A basketball player with a large overjet
Patient: Male, 14 years old
Chief Complaint: Mother: “His front teeth stick out and he plays basketball three times a week.”
Background: Autism spectrum disorder. Communicates in short repeated phrases, sensitive to bright light and loud noise. Behaviour management has been difficult at previous visits and treatment has been limited to examinations. No medications.
Vital Signs: BP 108/66 mmHg · HR 78 bpm
Findings: Angle Class II division 1 with a 9 mm overjet and incompetent lips. The maxillary incisors are intact but unprotected. No history of dental trauma yet. Oral hygiene is fair with caregiver assistance.
Question 1
What is the most appropriate IMMEDIATE recommendation?
Show answer and explanation
Correct answer: B. A custom-fitted mouthguard for sport
- A. A night guard addresses parafunction during sleep. Nothing in the history suggests bruxism, and it offers no protection during the activity that actually threatens these teeth.
- B. CORRECT. The INCREASED OVERJET is the point of the case. An overjet greater than 3 to 6 mm with INCOMPETENT LIP COVERAGE sharply increases the risk of traumatic injury to the maxillary incisors, and he plays a sport in which dental trauma is common. A CUSTOM-FITTED mouthguard — vacuum-formed or, better, pressure-laminated over a cast — is the immediate protective measure. Custom guards are superior to stock and boil-and-bite types in retention, comfort and speech, and therefore in the only measure that matters: whether the patient actually wears it.
- C. Orthodontic correction of the overjet IS the definitive answer to the underlying risk, and it should be planned. But fixed appliances in a patient with significant behaviour management difficulty require desensitisation, a realistic assessment of hygiene capability and considerable acclimatisation — none of which protects him at training this week.
- D. A retainer retains a completed orthodontic result. There is nothing yet to retain, and it provides no impact protection.
Note: For a patient with autism: tell-show-do, short and predictable appointments, the same operatory and the same clinician each time, reduced sensory load (dimmed lighting, no unnecessary noise or strong smells), visual schedules, and full involvement of the caregiver. A mouthguard requires an IMPRESSION, which for this patient is itself a procedure needing desensitisation — an intra-oral scan may be far better tolerated if available.