What is Orthodontics, Malocclusion?
Orthodontics focus on improving your smile and the function of your teeth by moving them to a more desirable position. The perfect position for your teeth depends on different factors, including the profile of your face, the balance of your face, and your cosmetic concerns.
Orthodontics doesn’t just focus on how your teeth look but also how the teeth in your upper jaw (the maxilla) and lower jaw (the mandible) relate to each other when they meet while biting or chewing. The term “occlusion” refers to how your teeth align or fit together. Over time, experts have reached a consensus on what features are looked upon as the ideal configuration of teeth.
Nevertheless, not many individuals have this perfect arrangement of teeth without undergoing orthodontic treatment. Differences in the size and shape of teeth and the forward or backward position of the jaws create a variety of ways teeth can align for different individuals. Surprisingly, only 8% of people with misaligned teeth (called malocclusion) have a known cause. The rest, around 92%, have unspecified reasons but probably from environmental and genetic factors.
Misalignment of the teeth is classified into various types, beginning with the classification system set up by Dr. Edward Hartley Angle, known as the “father of modern orthodontics”. He classified misalignments according to how the top and bottom back teeth (molars) meet.
In type I (neutroclusion), the teeth on the upper jaw and lower jaw align properly. Type II (mesoclusion) occurs when the upper molars are too far forward, while type III malocclusion (distoclusion) occurs when the upper molars are too far backward.
Type I malocclusion is further divided into three types according to Dewey’s classification system, depending on the location of the front teeth and canines (the sharp teeth next to the front teeth). Another classification system by Anderson further breaks down type I malocclusion into types 4 and 5, based on other specific features.
About one-third of people with malocclusion have a type II malocclusion. This type is where the lower jaw sits further backward compared to the upper jaw. This type is often further classified depending on the alignment of the front teeth.
Type III malocclusion is when the lower jaw sits too far forward compared to the upper jaw. The teeth in the lower jaw may appear to jut out over the teeth in the upper jaw. It is further classified into three types depending on the positioning and alignment of the teeth.
A different classification system by Ackerman and Profitt is used to categorize misalignment of teeth and differences in the position of the jaw. It is divided into classes I to VI based on the alignment and relationship of teeth as well as the position of the jaw.
Several factors can cause malocclusion that may require surgery include disparities in jaw size, facial imbalance, lip and palate clefts, and abnormalities in the bones forming the face and skull. Injuries to the face and jaw, although less common, can also lead to malocclusion. However, do note that surgical treatment is only recommended for severe cases; less invasive treatments like braces are usually tried first. A thorough evaluation by an orthodontist or an oral and maxillofacial surgeon helps decide the best treatment approach.
What Causes Orthodontics, Malocclusion?
Malocclusion, or teeth misalignment, often happens because of a combination of genetic and environmental factors. While we are yet to fully understand the roles our genes play in causing this condition, they are believed to contribute significantly.
Some types of malocclusion, such as Class III mandibular prognathism (where the lower jaw extends in front of the upper jaw), have been shown to be passed down in families through certain genes. For example, the “Hapsburg Jaw”, seen in the European royal Hapsburg family since the 1300s, was a result of these specific genes being passed down many generations.
Other inherited traits can also influence malocclusion. For instance, when there’s a mismatch between the size of the teeth and the jaw, this can lead to overcrowding or spacing of teeth. The size and shape of the maxilla (upper jaw) and mandible (lower jaw) can also cause misalignment of the teeth. These characteristics can be inherited either together or separately. The more separate these characteristics are inherited, the higher the likelihood of developing malocclusion. Interestingly, malocclusion has become more common with increasing intermixing among different human populations. This is because these populations inherit different combinations of tooth and jaw characteristics from their parents.
Environmental factors can also contribute to malocclusion. For example, children who consistently suck their thumbs might develop malocclusion. This is because the pressure against the roof of the mouth from thumb sucking can cause the bottom front teeth and top back teeth to move inward and the top front teeth to move outward. In addition, thumb sucking can also position the jaw downward, which results in back teeth erupting before the front teeth, leading to a gap in the front teeth.
Risk Factors and Frequency for Orthodontics, Malocclusion
Malocclusion, a condition often seen when a child’s teeth start to come in mixed, affects both males and females fairly equally. Interestingly, girls’ teeth tend to grow and mature quicker than boys’, and that’s why girls often get braces or other orthodontic treatments before boys. Research shows that malocclusion is more common in the Black population, but there’s no genetic evidence to back this up.
Signs and Symptoms of Orthodontics, Malocclusion
An ideal bite or “occlusion” has several characteristics. These include having your back teeth (molars) and pointy teeth (canines) fit together in a specific way, with a small amount of spacing between the upper and lower front teeth. There should also be minimal crowding and proper guidance of jaw movements. Furthermore, the biting edges and bulges of your lower teeth should line up to form a smooth curve. Similarly, in the upper jaw, a smooth curve should include the central parts of the back teeth and the bulges of canines and incisors. Other ideal features include having the center lines of the upper and lower jaws align with each other and your face.
Approximately 60% of people show this ideal alignment of the back teeth, also known as the “Class I” relationship. Symptoms of a poor bite or “malocclusion” can range from mild to severe. Signs that your teeth may not align properly include misaligned teeth, difficulty speaking, problems with biting and chewing, switching from nose to mouth breathing, and changes to the structure of your face.
- Your back teeth and pointy teeth fitting together in a specific way
- Small spacing between the upper and lower front teeth
- Minimal crowding of teeth
- Proper guidance of jaw movements
- Lower teeth lining up to form a smooth curve
- Upper teeth forming a similar smooth curve
- Center lines of upper and lower jaws aligning with each other and the face
- Misaligned teeth
- Difficulty speaking
- Problems with biting and chewing
- Switching from nose to mouth breathing
- Changes to the structure of your face
Testing for Orthodontics, Malocclusion
If you’re having issues with the way your teeth are aligned, your usual dentist is often the first person to spot this. This could be a general dentist, a dentist who specializes in children’s teeth, or an orthodontist. If your dentist sees that your teeth aren’t lining up in way that could affect your dental health or your overall quality of life, they might refer you to an orthodontist.
Your dentist will likely do an oral examination to see if your teeth aren’t lining up in the right way, a condition known as malocclusion. They may also take x-rays to get a more thorough look. There are a couple of types of x-rays they might use: one that gives a wide view of your whole jaw, known as a panoramic radiograph, and another, called cone-beam computed tomography, that offers a three-dimensional image of your full face.
The 3D view can be particularly useful because it gives the most accurate picture of how your teeth are aligned. It can also show information about your airway and the joint where your jawbone meets your skull.
There’s another type of x-ray that’s especially useful in orthodontics, a cephalometric projection. This gives a side view of your face that allows the orthodontist to see the relationship between your skull and jaws. This can help them predict your dental age, your potential for jaw growth, and identify any alignment differences. All of this information can help plan your treatment.
Treatment Options for Orthodontics, Malocclusion
If a person has malocclusion, meaning their teeth are not aligned correctly, there are several possible treatments. One common method involves using a device called a ‘palatal expander’ before the braces are placed. It helps to widen a narrow palate and correct issues like overcrowded teeth or a crossbite by applying gentle pressure to the two bones that form the roof of the mouth (the ‘maxillary bones’). The pressure is created by a screw inside the expander that the patient or their orthodontist turns each day. The device works best in younger people, before puberty when the bones in the roof of the mouth have naturally fused together.
Another treatment for malocclusion uses ‘spacers’, which are small devices placed between the molars to create enough room for braces. There are rubber spacers that are typically used for short periods, while metal spacers could be used for longer periods. The rubber spacers usually fall out on their own once enough space has been created.
The most common treatment for malocclusion is braces. There are different varieties, but two well-known types are metal and ceramic braces. Traditional metal braces consist of small squares (or ‘brackets’) that are fixed to the teeth and connected by a wire. When the wire is tightened, it applies pressure to the brackets, which in turn straightens and aligns the teeth. Ceramic braces work the same way as metal ones, but they are colored to match the teeth, making them less noticeable. For those who are concerned about the visibility of their braces, ‘lingual braces’ can be fitted. These are similar to traditional braces, but the brackets are fitted to the inside surfaces of the teeth.
In recent years, clear, removable aligners have increased in popularity since they are less noticeable. Like braces, they help to straighten and align the teeth, but they are clear and can be removed, which some people find more comfortable and convenient. The aligner treatment involves multiple sets of custom-fitted aligners that are created using a digital scan of the patient’s teeth. Each set is worn for one or two weeks, according to the orthodontist’s treatment plan. Clear aligners are a great option for people who want a less noticeable treatment or who can’t frequently visit the orthodontist. The downsides are that they rely on the patient remembering to wear them for at least 22 hours each day and that they may not be suitable for severe cases of malocclusion.
While the methods mentioned here are proven to effectively treat malocclusion, research is ongoing to find even better treatments. Looking to the future, we may see emerging technologies like low-level laser therapy being commonly used to help straighten teeth.
What else can Orthodontics, Malocclusion be?
Malocclusion, or misalignment of the teeth, can have many potential causes. These could be:
- Inherited genetic traits from parents.
- Habits like thumb sucking and prolonged pacifier use.
- Anomalies in the shape or size of the jaw or face.
- Loss of teeth or insufficient space for teeth.
- Dental or facial trauma.
If you have malocclusion, typically, you would need to see an orthodontist for a thorough examination. This could involve sharing your medical history, undergoing a physical examination, and possibly having certain imaging tests, like panoramic radiographs. The results of this examination would help the orthodontist decide on the most suitable treatment plan.
What to expect with Orthodontics, Malocclusion
The treatment for malocclusion, or misaligned teeth, varies for each person. It depends on how severe the misalignment is, how well the patient follows the treatment plan, the amount of space available in both the upper and lower jaws, and the patient’s overall oral health.
Possible Complications When Diagnosed with Orthodontics, Malocclusion
Untreated malocclusion, or misalignment of teeth, can lead to several complications. This includes tooth decay and increased risk of cavities because the crowding of teeth can trap food and make teeth cleaning difficult. It can also lead to gum inflammation, also known as gingivitis, due to the buildup of plaque. Other problems associated with untreated malocclusion can include tooth loss, impacted teeth, which means the teeth are blocked from breaking through the gum, jaw issues, and damage to other teeth.
Common complications:
- Tooth decay
- Increased risk of cavities
- Gingivitis due to plaque buildup
- Loss of teeth
- Impacted teeth
- Jaw problems
- Damage to other teeth
Preventing Orthodontics, Malocclusion
Malocclusion, or the misalignment of teeth, can be identified through a simple visual check and an X-ray of the teeth and face. When a malocclusion is found, the patient is usually recommended to see an orthodontist, a dentist specialized in correcting teeth and jaw alignment. Regular dental check-ups are essential, as they can help spot malocclusion at an early stage, and commence treatment sooner.
Most of the time, malocclusion is hereditary, meaning it’s passed down from parents to children, so it’s not always preventable. However, certain habits can also contribute to the formation of malocclusion. Parents can help prevent this by reducing habits like thumb sucking and encouraging the timely discontinuation of bottle and pacifier use.
