Home > Encyclopedia of Nursing & Allied Health > Malocclusion

Definition

Malocclusion is an abnormality in the way the upper and lower teeth fit together in biting or chewing. The word malocclusion literally means "bad bite." The condition may also be referred to as an irregular bite, cross-bite, or overbite.

Description

Malocclusion may be seen as crooked, crowded, or protruding teeth, or disproportionately smaller or larger jaws. Malocclusion can affect a person's appearance, speech, and ability to eat. Usually by age seven, enough of the permanent teeth have come in for dentists to identify current malocclusion and anticipate future problems if teeth and bone are left untreated. Adults and children can be successfully treated for most problems related to malocclusion.

Causes and symptoms

Malocclusions are most often inherited, but may be acquired. Inherited conditions include too many or too few teeth; too much or too little space between teeth; irregular mouth, jaw size, and shape; and atypical formations of the jaws and face, such as a cleft palate. Malocclusions may be acquired from habits like finger or thumb sucking, tongue thrusting, premature loss of teeth from an accident or dental disease, and medical conditions such as enlarged tonsils and adenoids that lead to mouth breathing.

Malocclusions may not have symptoms, or they may produce pain from increased stress on the oral structures.

Teeth may show abnormal signs of wear on the chewing surfaces or decay in areas of tight overlap. Chewing may be difficult. Left untreated, crooked or crowded teeth can become worse, sometimes requiring costly treatment to correct serious problems that develop over time. Orthodontic problems can contribute to conditions that cause tooth decay and gum disease. They can also help cause abnormal wear of tooth surfaces, inefficient chewing function, excessive stress on gum tissue and supporting bone, as well as jaw misalignment, resulting in headaches and face or neck pain.

Diagnosis

Malocclusion is most often found during a dental examination or screening. A dentist or dental hygienist checks a patient's occlusion by watching how the teeth make contact when the patient bites down normally. The dentist asks the patient to bite down on a piece of coated paper placed between the upper and lower teeth; this paper will leave colored marks at the points of contact. When malocclusion is suspected, photographs and x rays of the face and mouth may be taken for further study. To confirm the presence and extent of malocclusion, the dentist makes a plaster study model of the patient's teeth from impressions. These models duplicate the fit of the teeth and are very useful in treatment planning.

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KEY TERMS

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Braces—An orthodontic appliance consisting of brackets cemented to the surface of each tooth and wires of stainless steel or nickel titanium alloy. Braces treat malocclusion by gradually changing the position of the teeth.

Impression—An imprint of the upper or lower teeth made in a pliable material that sets. When this material has hardened, it may be filled with plaster, plastic, or artificial stone to make an exact model of the teeth.

Occlusion—The way the upper and lower teeth fit together in biting or chewing.

Retainer—An orthodontic appliance worn to stabilize teeth in a new position.

Space maintainer—An orthodontic appliance worn to prevent adjacent teeth from moving into the space left by an unerupted or prematurely lost tooth.

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Treatment

Malocclusion may be remedied by orthodontic treatment. Orthodontics is a specialty of dentistry that manages the growth, prevention, and correction of abnormal dental and facial relationships. Braces are the most commonly used orthodontic appliances in the treatment of malocclusion.

Braces apply constant gentle force to slowly change the position of the teeth, straightening them and properly aligning them with the opposing teeth. Braces consist of removable or fixed (cemented or bonded to the teeth) brackets, made of metal, ceramic, or plastic.

In most cases, braces are not removable for daily tooth brushing, so the patient must be especially diligent about keeping the mouth clean and removing bacterial plaque that is easily trapped, in order to prevent tooth decay. Foods that are crunchy should be avoided to minimize the risk of breaking the appliance. Hard fruits, vegetables, and breads must be cut into bite-sized pieces before eating. Foods that are sticky, including chewing gum, should be avoided because they may pull off the brackets or weaken the cement. Carbonated beverages may also weaken the cement, as well as contribute to tooth decay. Teeth should be brushed immediately after eating sweet foods. Special floss threaders are available to make flossing easier.

If overcrowding is creating malocclusion, one or more teeth may be extracted (surgically removed), giving other teeth room to move. If a tooth has not yet erupted or is prematurely lost, the orthodontist may insert an appliance called a space maintainer to keep the other teeth from moving out of their natural position. In severe cases of malocclusion, surgery may be necessary and the patient would be referred to yet another specialist, an oral or maxillofacial surgeon.

Once the teeth have been moved into their new position, the braces are removed and a retainer is worn until the teeth stabilize in that position. Retainers do not move teeth, they only hold them in place.

Orthodontic treatment is the only effective treatment for malocclusion not requiring surgery. However, depending on the cause and severity of the condition, an orthodontist may be able to suggest other appliances as alternatives to braces. Experts recommend early treatment, which can help to guide the growth of the jaw, regulate the widths of the dental arches, correct thumb, finger, and other sucking habits, enhance swallowing and speech, and improve personal appearance and self-esteem. Adults are candidates for orthodontics to correct malocclusion, as well. Healthy teeth can be moved to more desirable positions at any age.

Alternative treatment

There are some techniques of craniosacral therapy that can alter structure. This therapy may allow correction of some cases of malocclusion. If surgery is required, pre-and post-surgical care with natural remedies, as well as vitamin and mineral supplements, may enhance recovery. Night guards and stress management are sometimes recommended to ease the strain on the jaw and to limit teeth grinding.

Prognosis

Depending on the cause and severity of the malocclusion and the appliance used in treatment, a patient should expect correction of the condition to take one to three years. Interceptive, or early treatment procedures, might take months or more. The time required to correct malocclusion depends on the growth of the patient's mouth and face, patient cooperation, and the extent of the problem.

Health care team roles

The general dentist or dental hygienist, during preventive oral care, is often the first health professional to see evidence of a malocclusion. The general dentist usually determines a patient's need to have the problem looked at by a specialist, such as an orthodontist. Dental assistants are ancillary personnel used in dentists' or orthodontists' offices to assist in the procedures.

Prevention

Malocclusion is preventable at times. It can be prevented by space maintenance and may be minimized by controlling habits such as finger or thumb sucking. Initial consultation with an orthodontist before a child is seven years old may lead to appropriate management of the growth and development of the child's dental and facial structures, circumventing many of the factors contributing to malocclusion.

Lisette Hilton