Malocclusion

Editor in Chief: Berna Zorkun DMD [mailto:bernazorkun@gmail.com]

Overview
A malocclusion refers to the misalignment of teeth and/or incorrect relation between the teeth of the two dental arches. The upper arch is called the maxilla and the lower is called the mandible.

Presentation
Most people have some degree of malocclusion, although it isn't usually serious enough to require treatment. Those who have more severe malocclusions may require orthodontic and sometimes surgical treatment (orthognatic surgery) to correct the problem. Correction of malocclusion may reduce risk of tooth decay and help relieve excessive pressure on the temporomandibular joint. Orthodontic treatment is also used to align for aesthetic reasons.

Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate. In these cases the dental problem is, most of the time, derived from the skeletal disharmony.

Classification
Malocclusions can be divided mainly into three types, depending on the sagittal relations of teeth and jaws, by Angle's classification method. However, there are also e.g. crowding of teeth and other conditions, not directly fitting into this classification.

Many authors have tried to classify or modify Angle's classification. This has resulted in many subtypes.

Angle's classification method
Edward Angle, who is considered the father of modern orthodontics, was the first to classify malocclusion. He based his classifications on the relative position of the maxillary first molar. According to Angle, the mesiobuccal cusp of the upper first molar should rest on the mesiobuccal groove of the mandibular first molar. Any variations from this resulted in malocclusion types. It is also possible to have different classes of maloclusion on left and right sides.

It is estimated that approximately 18% of the United States population suffers from an over sided malocclusion, while only 11% suffer from an under malocclusion.


 * Class I: Here the molar relationship of the occlusion is normal or as described for the maxillary first molar, but the other teeth have problems like spacing, crowding, over or under eruption, etc.
 * Class II: ("overbite") In this situation, the upper molars are placed not in the mesiobuccal groove but anteriorly to it. Usually the mesiobuccal cusp rests in between the first mandibular molars and second premolars. There are two subtypes:
 * Class II Division 1: The molar relationships are like that of Class II and the anterior teeth are protruded.
 * Class II Division 2: The molar relationships are class II but the central are retroclined and the lateral teeth are seen overlapping the centrals.
 * Class III: (prognathism, "underbite" or "negative overjet") is when the lower front teeth are more prominent than the upper front teeth. In this case the patient has very often a large mandible or a short maxillary bone.

Crowding of teeth
Crowding of teeth is where there is insufficient room for the normal complement of adult teeth.

Cause
Crowding of teeth is recognized as an affliction that stems in part from a modern western lifestyle. We do not know for sure whether it is due to the consistency of western diets; a result of mouthbreathing; or the result of an early loss of deciduous (milk, baby) teeth due to decay. It is also possible that Homo sapiens have evolved smaller jaws without a reduction in the number of teeth they will house happening at the same time.

Treatment
Crowding of the teeth is treated with orthodontics, often with, tooth extraction, dental braces, followed by growth modification in children or jaw surgery (orthognathic surgery) in adults.

Other conditions
Other kind of malocclusions are due to vertical discrepancies. Long faces may lead to open bite, while short faces can be coupled to a deep bite. However, there are many other more common causes for open bites such as tongue thrusting, thumb sucking, etc, and likewise for deep bites.

Malocclusions can also be secondary to transversal skeletal discrepancy or to a skeletal asymmetry.