Malocclusion in Children

Introduction to Malocclusion in Children

Malocclusion refers to the misalignment of teeth and/or incorrect relation between the teeth of the two dental arches. It is a common developmental condition in children, affecting both primary and permanent dentition.

Key points:

  • Prevalence: Affects approximately 50-70% of children
  • Can involve teeth, jaws, or both
  • May impact aesthetics, function, and oral health
  • Often requires orthodontic intervention
  • Early detection and management are crucial for optimal outcomes

Classification of Malocclusion

The most widely used classification system for malocclusion is Angle's classification, based on the relationship of the first permanent molars:

Angle's Classification:

  1. Class I (Neutrocclusion):
    • Normal molar relationship
    • Malocclusion confined to anterior teeth
  2. Class II (Distocclusion):
    • Lower molar distally positioned relative to upper molar
    • Division 1: Proclined upper incisors
    • Division 2: Retroclined upper central incisors
  3. Class III (Mesiocclusion):
    • Lower molar mesially positioned relative to upper molar

Other Classification Systems:

  • Incisor relationship (British Standards Institute)
  • Skeletal classification (based on jaw relationships)
  • Specific malocclusions: Open bite, crossbite, crowding, spacing

Etiology of Malocclusion in Children

The etiology of malocclusion is multifactorial, involving both genetic and environmental factors:

Genetic Factors:

  • Inherited jaw size and shape
  • Tooth size and number anomalies
  • Syndromes associated with craniofacial anomalies

Environmental Factors:

  • Prolonged non-nutritive sucking habits (e.g., thumb sucking, pacifier use)
  • Mouth breathing due to nasal obstruction
  • Early loss of primary teeth
  • Trauma to teeth or jaws
  • Nutritional deficiencies

Developmental Factors:

  • Abnormal eruption patterns
  • Delayed or premature loss of primary teeth
  • Abnormal muscle function or tongue posture

Often, malocclusion results from a combination of these factors, making each case unique.

Clinical Presentation of Malocclusion in Children

The clinical presentation of malocclusion varies depending on the type and severity:

Common Presentations:

  • Crowding or spacing of teeth
  • Protrusion or retrusion of upper or lower teeth
  • Crossbite (anterior or posterior)
  • Open bite (anterior or posterior)
  • Deep overbite or increased overjet
  • Midline discrepancies
  • Impacted or ectopic teeth

Associated Features:

  • Facial asymmetry
  • Difficulty in biting or chewing
  • Speech problems (e.g., lisping)
  • Temporomandibular joint issues
  • Increased risk of dental caries and periodontal disease
  • Psychological concerns related to aesthetics

The severity and impact of malocclusion can vary significantly between individuals.

Diagnosis of Malocclusion in Children

Diagnosis of malocclusion involves a comprehensive evaluation:

Clinical Examination:

  • Extra-oral assessment: Facial profile, symmetry
  • Intra-oral assessment: Occlusal relationships, tooth alignment
  • Functional examination: TMJ, muscle palpation, mandibular movements

Radiographic Evaluation:

  • Panoramic radiograph: Overall dental status
  • Lateral cephalogram: Skeletal relationships, soft tissue profile
  • Cone-beam CT: For complex cases or impacted teeth

Study Models:

  • Plaster or digital models for detailed analysis

Photographic Records:

  • Facial and intraoral photographs

Special Investigations:

  • Electromyography: For muscle function assessment
  • Airway evaluation: In cases of suspected sleep-disordered breathing

Early diagnosis, ideally by age 7, allows for timely intervention and optimal treatment planning.

Management of Malocclusion in Children

Management of malocclusion is tailored to the individual case and may involve:

Preventive Measures:

  • Early habit cessation (e.g., thumb sucking)
  • Space maintenance after premature loss of primary teeth
  • Oral hygiene education

Interceptive Orthodontics:

  • Expansion devices for crossbites
  • Functional appliances for jaw growth modification
  • Serial extraction in severe crowding cases

Comprehensive Orthodontic Treatment:

  • Fixed appliances (braces)
  • Clear aligner therapy (in suitable cases)
  • Combination with extractions if required

Orthognathic Surgery:

  • For severe skeletal discrepancies in mature patients

Multidisciplinary Approach:

  • Collaboration with other specialists (e.g., oral surgeons, speech therapists)
  • Management of underlying causes (e.g., ENT referral for chronic mouth breathing)

Treatment timing is crucial, with many interventions optimally performed during periods of active growth.

Complications of Malocclusion in Children

Untreated or improperly managed malocclusion can lead to various complications:

Dental Complications:

  • Increased risk of dental caries
  • Periodontal disease
  • Abnormal wear of teeth
  • Tooth fractures

Functional Complications:

  • Masticatory difficulties
  • Speech problems
  • Temporomandibular joint disorders
  • Breathing issues (in severe cases)

Aesthetic Complications:

  • Facial asymmetry
  • Poor smile aesthetics
  • Psychological issues related to appearance

Treatment-related Complications:

  • Root resorption during orthodontic treatment
  • Enamel decalcification
  • Relapse after treatment

Early intervention and proper management can significantly reduce the risk of these complications.

Prognosis of Malocclusion in Children

The prognosis for children with malocclusion is generally good with appropriate and timely intervention:

Factors Affecting Prognosis:

  • Severity and type of malocclusion
  • Age at diagnosis and treatment initiation
  • Patient compliance with treatment
  • Growth pattern and timing
  • Quality of treatment provided

Outcomes:

  • Aesthetic improvement: Enhanced facial and dental appearance
  • Functional improvement: Better bite, easier cleaning, reduced risk of dental problems
  • Psychosocial benefits: Improved self-esteem and social interactions

Long-term Considerations:

  • Retention phase crucial for maintaining results
  • Potential for minor relapse, especially in severe cases
  • Ongoing monitoring through adolescence and into adulthood

With modern orthodontic techniques and a comprehensive approach, most children with malocclusion can achieve significant improvements in their dental and facial aesthetics, as well as overall oral health.



Malocclusion in Children
  • Q1: What is malocclusion?
    A: Misalignment or incorrect relation between the teeth of the upper and lower dental arches.
  • Q2: What are the three main classes of malocclusion according to Angle's classification?
    A: Class I (neutrocclusion), Class II (distocclusion), and Class III (mesiocclusion).
  • Q3: What is an overbite?
    A: Vertical overlap of the upper front teeth over the lower front teeth.
  • Q4: What is an overjet?
    A: Horizontal projection of the upper front teeth beyond the lower front teeth.
  • Q5: What is crossbite?
    A: A condition where upper teeth fit inside the lower teeth, rather than outside.
  • Q6: What is an open bite?
    A: A vertical gap between the upper and lower front or back teeth when the back teeth are closed.
  • Q7: What is the most common cause of malocclusion in children?
    A: Genetics (inherited jaw and tooth size/shape).
  • Q8: Which habit can contribute to the development of an open bite in children?
    A: Prolonged thumb sucking or pacifier use.
  • Q9: What is the term for crowding of teeth due to insufficient space in the dental arch?
    A: Dental crowding.
  • Q10: At what age should a child have their first orthodontic evaluation?
    A: Around 7 years old, according to the American Association of Orthodontists.
  • Q11: What is the purpose of early orthodontic intervention in children?
    A: To guide jaw growth and create space for permanent teeth to erupt properly.
  • Q12: What is a functional appliance in orthodontics?
    A: A removable or fixed appliance designed to modify the growth of the jaws in children.
  • Q13: What is the name of the device used to create more space in the upper dental arch?
    A: Palatal expander.
  • Q14: What is the term for the loss of primary teeth before their natural time of exfoliation?
    A: Premature tooth loss.
  • Q15: How can premature loss of primary teeth affect occlusion?
    A: It can lead to drifting of adjacent teeth, causing space loss and malocclusion.
  • Q16: What is a space maintainer?
    A: A dental device used to keep space open for permanent teeth after premature loss of primary teeth.
  • Q17: What is the most common type of malocclusion?
    A: Class I malocclusion (neutrocclusion).
  • Q18: What is the term for protruding upper front teeth?
    A: Buck teeth or proclined incisors.
  • Q19: What is the name of the imaginary line that divides the face into right and left halves?
    A: Midline.
  • Q20: What is a diastema?
    A: A space or gap between two teeth, most commonly the upper front teeth.
  • Q21: What is the term for teeth that have not erupted into the mouth at their expected time?
    A: Impacted teeth.
  • Q22: Which permanent teeth are most commonly impacted, after wisdom teeth?
    A: Maxillary canines (upper eye teeth).
  • Q23: What is the purpose of orthodontic elastics (rubber bands)?
    A: To apply forces that help align teeth and correct jaw relationships.
  • Q24: What is the term for the removal of permanent teeth to create space during orthodontic treatment?
    A: Therapeutic extraction.
  • Q25: What is the name of the device used after braces to maintain tooth position?
    A: Retainer.
  • Q26: What is the difference between fixed and removable orthodontic appliances?
    A: Fixed appliances are bonded to teeth and can't be removed by the patient, while removable appliances can be taken out.
  • Q27: What is the term for the forward positioning of the lower jaw relative to the upper jaw?
    A: Mandibular prognathism.
  • Q28: What is cephalometric analysis used for in orthodontics?
    A: To assess skeletal and dental relationships and plan treatment.
  • Q29: What is the name of the clear, removable aligners used as an alternative to traditional braces?
    A: Clear aligners (e.g., Invisalign).
  • Q30: What potential health problems can severe malocclusion cause?
    A: Difficulty in chewing and speaking, increased risk of tooth decay and gum disease, jaw pain, and self-esteem issues.


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