Malocclusion

In other words, dental malocclusion refers to the abnormal relationship between the teeth of the upper and lower jaw.

Under normal conditions, the dental arches are in such a perfect and balanced relationship that they allow proper chewing and swallowing. On the other hand, dental malocclusion occurs when this ideal relationship between the two arches does not exist.

In these conditions, dental malocclusion can cause problems in other parts of the body. For example, in addition to chewing and phonetic disorders, it can lead to an increased risk of:

• Neck pain.
• Back pain.
• Tinnitus (ringing in the ears).

Symptoms depend on the severity of the condition. Malocclusions that depend on parafunctional habits can be treated with mobile or fixed orthodontic appliances, while more complex malocclusions require corrective orthodontic treatment.

Specifically, the following three categories can be recognized:

• Class I: refers to normal occlusion between the upper and lower teeth. The upper incisors protrude slightly from the lower dental arch. Although there is no dysfunction when biting, there may be other problems related to dental alignment such as crowding, diastemas or malposition of one or more teeth.
• Class II (mandibular retrognathia): the upper arch overlaps the lower arch to a large extent. This may be due to insufficient growth of the mandible or an overdeveloped upper jaw. There is usually dental crowding as it is very likely that, along with the malocclusion, there is also an abnormal position of the teeth and the spaces between them.
• Class III (mandibular prognathism): occurs when the teeth of the mandibular arch are advanced with respect to the arch of the upper jaw and, therefore, there is no alignment of the teeth. This malocclusion condition can lead to significant aesthetic and functional disorders. Intervention by a dentist and orthodontics is absolutely essential.

Malocclusion is not always perceived by the individual, in cases of Class I occlusions, often there are no significant alterations. It is rare to visit the dentist for this reason and it is more likely to be reported by the doctor during check-ups.

Causes of malocclusion

The elements of each dental arch are in close contact with each other and the buccal surfaces of the upper teeth are external to those of the lower teeth. Thus, during chewing, the lips and cheeks are away from the chewing surface of the teeth and, therefore, are not close to the bite.

On the internal side, the arch formed by the lower teeth is narrower than that of the upper teeth; for this reason, the risk of tongue injury during chewing is quite low.

The balance between the individual teeth and between the upper and lower arches as a whole is essential for the proper functioning of both mastication and phonetics.

Although dental malocclusion is sometimes hereditary, in some cases it may be related to other factors:

• Parafunctional habits: certain behaviors established in childhood, such as thumb sucking, prolonged use of pacifiers and bottles and tongue protrusion, may be associated with the development of malocclusions.
• Other pathological conditions: bruxism, improperly performed dental procedures where the point of contact between tooth surfaces is lost, absence of one or more dental elements, early loss of baby teeth, fracture of the jaw at an early age, tumors of the oral cavity.
• Systemic pathologies: in some rare cases, rheumatoid arthritis may be associated with malocclusions.

Symptoms of malocclusion

The symptoms of malocclusion are specific and depend largely on the type of malocclusion. These symptoms can be:

• Aesthetic disorders: when it comes to children at the beginning of their development, this is a problem that should not be underestimated. The social repercussions can sometimes be quite problematic, hence the importance of treating this type of condition as early as possible.
• Headaches.
• Increased risk of developing dental diseasesmalocclusion affects the entire oral cavity, causing complications such as:
  • Dental caries
  • Periodontal disease, due to tartar accumulation.
• Chewing disorders.
• Phonation disorderspronunciation alteration of certain letters such as:
  • the S (sigmatism).
  • the R (rotacism).

Treatment of malocclusion

As mentioned, dental malocclusions do not always require intervention, as some of their variants do not cause any symptoms worthy of therapeutic importance.

On the other hand, complex malocclusions require a more specific intervention:

• The moderate dental malocclusions or infrequent can be corrected according to several approaches:
  • Orthodontic intervention: installation of fixed or removable orthodontic appliances to treat crowding of the teeth.
  • Dental extractions: when the crowding of teeth is due to the presence of one or more teeth without space inside the jaw (upper or lower) that push the rest of the teeth present. In these cases and after the corresponding study, it is necessary to proceed with the extraction.
• Habit correction parafunctional:
  • Splints to correct bruxism (a possible cause of dental malocclusion).
  • Use of special appliances to guide and facilitate masticatory forces.
  • Avoid thumb sucking and bottle drinking (for young children with or predisposed to dental malocclusions).

• Congenital dental malocclusions: usually require surgical treatment, since the bite alteration is especially advanced, and causes health problems to the patient. The type of surgical intervention should be considered depending on the patient's malocclusion.

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Prevention of malocclusion

Prevention of malocclusion begins with early intervention and correction of different parafunctional habits by the pediatrician and dentist, such as: thumb sucking or pacifier use, atypical swallowing, onychophagia (nail biting), lip sucking, etc. and skeletal apparatus alterations that may be genetic in nature.

For the correction of these habits, it is important to intervene in time to solve the problem, with mechanical aids that prevent the child from prolonging the habit, or, more useful, behavioral reeducation, and may even resort to psychological support, with the child's collaboration being necessary.

The prevention of malocclusions, therefore, is based on a careful extraoral and intraoral examination. The latter will allow us to evaluate the correct oral hygiene, the presence of possible soft tissue lesions, the symmetry of the dental arches, the presence or absence of teeth and their correct position as well as the type of dental occlusion, which defines the relationship between the upper and lower molars and the relationship between the incisors.