An Overview Of Diagnosis And Management Of Malocclusion: Literature Review

Ibrahim Mesfer Alqahtan¹, Roaa Abdulgader Azizkhan², Lojain Tawfiq Alyawer², Shatha Samry Alanazi³, Razan Ahmed Alzahrani⁴, Lama Salman Alhazmi⁴, Farida Fahad Bsher⁵, Lamar Mohammed Zahran⁴, Rawan Abdulmatloub Aljahdali^4*, Rawan Rashood Alqwizany⁶, Raghad Khaled Tayeb⁴, Abdullah Muneer Kashghari⁴

¹Dental Practitioner, Public Security Medical Center, Riyadh, KSA

²Faculty of Dentistry, Batterjee Medical College, Jeddah, KSA

³Faculty of Dentistry, Jazan University, Jazan, KSA

⁴Faculty of Dentistry, Ibn Sina National College, Jeddah, KSA

⁵Faculty of Dentistry, Princess Noura University, Riyadh, KSA.

⁶Faculty of Dentistry, Al Farabi College, Riyadh, KSA

ABSTRACT

Background: Malocclusion is defined as an improper closure (i.e. contact) of the upper (maxillary) and lower (mandibular) teeth. The resulting misalignment is mostly appropriated during jaw closure when the two dental arches approximate.

Objectives: The literature suggests that clinicians usually overlook malocclusion resulting in unfavorable consequences. It has been shown that occlusal integrity is an important predictor of successful restoration of dental function. Therefore, in this paper, we will review the proper literature discussing

Methodology: We conducted the literature search within the PubMed database using the keywords: “Occlusion” and “Malocclusion” and “Prevalence” and “Types” and “Treatment” with dates from 1990 to 2020.

Review: There are two main categories under which a broad classification of malocclusion can be obtained. This includes intra-arch malocclusion and inter-arch malocclusion. Corrective management of malocclusion is often preferred during the early years of life as it will entail a repair of appropriate occlusion within normal skeletal growth of the body. The management approach of malocclusion is highly dependent on the type of malocclusion.

Conclusion: In conclusion, dental occlusion is a complex and multifactorial condition that extends beyond the physical contact of the biting surface of teeth. The high prevalence of malocclusion requires proper screening by dentists to identify the disease at an early age as management at that young age is associated with favorable outcomes.

Key words: Occlusion; Malocclusion; Prevalence; Types; Treatment.

Introduction

Malocclusion is defined as an improper closure (i.e. contact) of the upper (maxillary) and lower (mandibular) teeth ^1-4. The resulting misalignment is mostly appropriated during jaw closure when the two dental arches approximate. This malocclusion could be observed during dynamic (i.e. movement) or static (i.e. rest) statuses of the dental arches. Oral health is a good indicator of better daily functioning well-being and overall better quality of life ⁵.

Psychological and social development on an individual level is highly determined by facial esthetics. An important component of the facial esthetic is teeth, which greatly influence an individual’s smile ⁵. The presence of my occlusion or mal-alignment provides a less appealing effect on the smile and the face. Lower levels of self-confidence and self-esteem have been observed in individuals suffering from malocclusion. Recent studies suggest that malocclusion is a well-known variable that influences the oral well-being of children. Malocclusion can precipitate the formation of plaque and calculus which further promote inflammation of the gums and periodontitis which leads to bad oral hygiene ⁶.

Several genetic and environmental factors have been thought to contribute directly to the high prevalence rate of malocclusion. Studies suggest that the prevalence of mal-alignment is much higher now when compared to historic data. The physical, social, and psychological effects of malocclusion need to be investigated further to understand the importance of malocclusion on people’s life ⁷. Despite this, the literature suggests that clinicians usually overlook malocclusion resulting in unfavorable consequences ⁸. It has been shown that occlusal integrity is an important predictor of successful restoration of dental function. Therefore, in this paper, we will review the proper literature discussing the definition, types, presentation, and management of malocclusion. 

Methodology:

We conducted the literature search within the PubMed database using the keywords: “Occlusion” and “Malocclusion” and “Prevalence” and “Types” and “Treatment” with dates from 1990 to 2020. We also used the Google Scholar database for additional literature searches. After reading the abstracts, we manually selected the relevant papers for this review. In regards to the inclusion criteria, the articles were selected based on the inclusion of one of the following topics; dental occlusion and malocclusion. Exclusion criteria were all other articles that did not have one of these topics as their primary endpoint.

Review:

Overview:

Primary teeth eruption usually starts at six months of age. At that time, occlusion between the mandibular and maxillary teeth starts to occur. Doing that stage of development, the cheeks, tongue, and lips are usually responsible for holding the erupting teeth into position ⁸. By two years of age, correct alignment and occlusion are usually achieved between the lower and upper primary teeth then by three years of age, complete development of root is usually achieved. After the completion of full teeth development, a space between some of the teeth (also known as a diastema) starts to develop approximately one year later. Diastema is observed in the anterior teeth and it is achieved by four years of age ⁹. The primary function of the spacing is to allow adult teeth to erupt into their proper position and avoid crowding of the permanent teeth ⁵. By approximately 11 years of age permanent premolars begin to erupt and they start to replace primary molars. Table 1 shows the general and local factors contributing to the etiology of malocclusion ⁵.

Table 1. General and local factors contributing to the etiology of malocclusion.

Types of malocclusion

There are two main categories under which a broad classification of malocclusion can be obtained. This includes intra-arch malocclusion and inter-arch malocclusion. Intra-arch malocclusion can be defined as variations in tooth location on an individual level ¹⁰. These variations can affect other teeth groups resulting in a malocclusion that is contained within an arch.

It is possible that one tooth to set in an abnormal position concerning the neighboring teeth. This phenomenon is termed ‘individual tooth malposition’.  Individual teeth malposition could present in an abnormal inclination, abnormal tipping, or abnormal displacements ¹¹. When the root is seated in its normal position while the crown is abnormally tilted, the result is teeth inclination. While as if both the crown and the root are seated in an abnormal location with a similar tilt, the resulting condition is called abnormal displacements ¹⁰. The aforementioned malocclusion conditions are categorized by an abnormal relationship of teeth of different arches. Such interarch malocclusions can present on the sagittal, vertical, or transverse planes of space.

Clinical presentation

In dentistry, malocclusion is not considered an uncommon finding. Despite being relatively widespread, it does not pose a serious threat to dental health and thus mostly does not require treatment ¹⁰. In patients who present with craniofacial anomalies that include a severe form of malocclusion is often the one who be prioritized for treatment. Management for severe malocclusion includes orthodontic management, and/or orthognathic surgery. The therapeutic objective of orthodontic management is the achievement of stable, functional, and aesthetic teeth alignment ^{12, 13}. This could greatly enhance the patients’ oral and overall health and wellbeing ^{14, 15}. The symptomatic features of malocclusion could result from one of its consequences shown in table 2. 

Table 2. Symptoms of dental malocclusion.

Management:

Maintain a normal equilibrium between the different structures that make the dental unit (i.e. nerves, blood vessels, and good dental occlusion) is essential for the normal masticatory process ¹⁶. Thus, any disruption of the dental positioning could lead to malocclusion and thereafter interruption of mastication.

Corrective management of malocclusion is often preferred during the early years of life as it will entail a repair of appropriate occlusion within normal skeletal growth of the body. The management approach of malocclusion is highly dependent on the type of malocclusion. Milder cases of malocclusion are often treated with orthodontics. In contrast, the severe case might require the introduction of fixed appliances ^{17, 18}. Additionally, a more effective approach to the management of malocclusion includes the usage of both appliances and headgear. Although extraction therapy could be used in certain cases, its usage is not preferred as an early line of treatment ^{5, 19}.

Conclusion:

In conclusion, dental occlusion is a complex and multifactorial condition that extends beyond the physical contact of the biting surface of teeth. The high prevalence of malocclusion requires proper screening by dentists to identify the disease at an early age as management at that young age is associated with favorable outcomes.

References

1. Asgari I, Soltani S, Sadeghi S M. Effects of Iron Products on Decay, Tooth Microhardness, and Dental Discoloration: A Systematic Review. Arch. Pharma. Pract. 2020;11(1):60-72.
2. Alamri AM, Alshammery HM, Almughamis MA, Alissa AS, Almadhi WH, Alsharif AM, Sroji DT, Alqarni MA. Dental Recession Aetiology, Classification, and Management. Arch. Pharma. Pract. 2019;10(2):28-31.
3. Kharalampos M, Put V A, Tarasenko S V, Reshetov I V. Comprehensive patient rehabilitation while performing immediate dental implant placement with the use of information-wave therapy (literature overview). J. Adv. Pharm. Educ. Res. 2020;10(2):11-4.
4. Bulgakova AI, Vasilyeva NA, Vasilyev EA. The clinical and immunological rationale for the use of prolonged action dental ointment in periodontology. J. Adv. Pharm. Educ. Res. 2019;9(4):65-9.
5. Guo L, Feng Y, Guo HG, Liu BW, Zhang Y. Consequences of orthodontic treatment in malocclusion patients: clinical and microbial effects in adults and children. BMC oral health. 2016;16(1):112.
6. Heimer MV, Tornisiello Katz CR, Rosenblatt A. Non-nutritive sucking habits, dental malocclusions, and facial morphology in Brazilian children: a longitudinal study. European journal of orthodontics. 2008;30(6):580-5.
7. Zhang GN, Liu Y, Li WY, Fan TT, Wang J, Zhao ZJ. [Correlation between social psychology and personality characteristics and treatment options for adult patients with skeletal malocclusion]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2020 Jun 1;38(3):308-313. Chinese. doi: 10.7518/hxkq.2020.03.014. PMID: 32573140; PMCID: PMC7296382.
8. Naseri N, Baherimoghadam T, Bassagh N, Hamedani S, Bassagh E, Hashemi Z. The impact of general self-efficacy and the severity of malocclusion on acceptance of removable orthodontic appliances in 10- to 12-year-old patients. BMC Oral Health. 2020;20(1):344. Published 2020 Nov 30. doi:10.1186/s12903-020-01293-2
9. Hasan HS, Al Azzawi AM, Kolemen A. Pattern of distribution and etiologies of Midline diastema among Kurdistan-region Population. Journal of clinical and experimental dentistry. 2020;12(10):e938-e43.
10. Sadry S, Koca CG, Kaya I. Evaluation of the relationship of maxillary third molar teeth with pterygomaxillary fissure with cephalometric radygraph. Folia Morphol (Warsz). 2020;5603/FM.a2020.0112. doi:10.5603/FM.a2020.0112
11. Tonni I, Riccardi G, Piancino MG, Stretti C, Constantinides F, Paganelli C. The influence of food hardness on the physiological parameters of mastication: A systematic review. Archives of oral biology. 2020;120:104903.
12. Narayanan RK, Jeseem MT, Kumar TA. Prevalence of Malocclusion among 10-12-year-old Schoolchildren in Kozhikode District, Kerala: An Epidemiological Study. International journal of clinical pediatric dentistry. 2016;9(1):50-5.
13. Mangat SD. Assessment of Malocclusion and Orthodontic Treatment Needs among Subjects with Dental Aesthetic Index: A Clinical Study. Journal of pharmacy & bioallied sciences. 2020;12(Suppl 1): S279-s82.
14. Sun L, Wong HM, McGrath CP. Relationship Between the Severity of Malocclusion and Oral Health-Related Quality of Life: A Systematic Review and Meta-analysis. Oral Health Prev Dent. 2017;15(6):503-517. doi:10.3290/j.ohpd.a38994
15. Deps TD, Carneiro NCR, Nicolau B, Pordeus IA, Borges-Oliveira AC. Oral health-related quality of life of young people with mucopolysaccharidosis: a paired cross-sectional study. Brazilian oral research. 2020;34:e109.
16. Polder BJ, Van't Hof MA, Van der Linden FP, Kuijpers-Jagtman AM. A meta-analysis of the prevalence of dental agenesis of permanent teeth. Community dentistry and oral epidemiology. 2004;32(3):217-26.
17. Hajrasi MK, Al-Fraidi AA, Hatrom AA, Hassan AH. Non extraction Management of Severely Malaligned and Constricted Upper Arch. Case Reports in Dentistry. 2020;2020:8836061. doi: 10.1155/2020/8836061.
18. Patel, M., Henriques, J., Freitas, K., Almeida, R. and Janson, G. Stability of Class II treatment with Pendulum and Jones Jig followed by fixed appliances. Orthodontics & Craniofacial Research. 2020. doi: 10.1111/ocr.12447
19. Mattheeuws N, Dermaut L, Martens G. Has hypodontia increased in Caucasians during the 20th century? A meta-analysis. European journal of orthodontics. 2004;26(1):99-103.

Corresponding Author

Rawan Abdulmatloub Aljahdali

Faculty of Dentistry, Ibn Sina National College, Jeddah, KSA.

Email Id: Rawan.aljahdali @ hotmail.com