Malocclusion is an abnormal closure of the dentition caused by maxillofacial deformity. It is manifested by aesthetic defects of appearance, impaired breathing, facial expressions, chewing, speech. It can be a risk factor for the development of frequent respiratory diseases, gastrointestinal diseases, caries. It is diagnosed during an orthodontic examination, including the manufacture and analysis of diagnostic models, TRG, orthopantomography, CT of the jaw. Correction of malocclusion can be carried out with the help of special devices and mouthguards, retainers and bracket systems.
ICD 10
K07.1 K07.2 K07.4
Meaning
Bite is the main parameter of the normal development and functioning of the dental system. Orthognathic bite, in which the upper teeth slightly cover the lower ones, is considered the norm, such a bite occurs in most people. Malocclusion develops due to genetic determinism, in the presence of the habit of sucking a finger, following a chronic violation of nasal breathing. The orthodontist is engaged in bite correction.
Causes
The main reason for the formation of malocclusion is a hereditary predisposition. Improper care of the child during the formation of the bite can lead to various defects of the dental system. During the newborn period, the upper jaw of the child is larger than the lower one. Due to natural feeding, by the end of the first year of life, the jaws are aligned. If the baby is inactive while sucking the breast, then the alignment of the jaws will not occur in full, which is fraught with the development of malocclusion.
Spoiled posture can affect the formation of bite in preschool and primary school age. Due to the incorrect position, the head goes forward of the trunk, which can provoke deformation of the jaw and the formation of an incorrect bite.
Frequent diseases occurring with impaired nasal breathing, in combination with other factors, increase the risk of developing one of the types of malocclusion. The soft tissues of the lips, tongue and cheeks take part in the formation of the jaws, and if nasal breathing is disturbed and the mouth is constantly ajar, the development of the jaws occurs with deviations.
Pathogenesis
There are five periods of formation of the correct orthognathic bite, if there are deviations in any of the periods, then it is possible to form an incorrect bite and other anomalies of the dental system:
- The first period from birth to six months;
- From 6 months to three years, the formation of a temporary bite occurs – this is the second period during which all temporary teeth erupt.
- The third period from 3 to 6 years is preparatory, as the active growth of the jaws begins for further eruption of permanent teeth.
- From the age of 6 to 12, there is an active growth of the jaws and permanent teeth erupt in parallel, therefore this period is called mixed.
- And the fifth period from 12 to 16 years is characterized by the final formation of the bite and the replacement of all temporary teeth with permanent ones.
If there are violations of the growth of the jaws or violations in teething, this can lead to the formation of an incorrect bite. For example, to the crowding of teeth, this happens if the permanent teeth erupted in time and large, and the growth of the jaw stopped. Sometimes a violation of the growth of the jaw can result in the absence of canines, incisors or premolars, or the formation of gaps and diastems.
Classification
Malocclusion due to a violation of the growth of the jaws can manifest itself as a deviation from the normal location of the teeth and the rotation of part of the teeth on one of the jaws. Sometimes the incisors of one jaw significantly overlap the other; in rare cases, an open malocclusion is formed when the incisors do not close at all. Types of malocclusion:
- With distal malocclusion, the upper jaw is excessively developed or vice versa, underdevelopment of the lower jaw is noted.
- With a mesial bite, the lower jaw is pushed forward.
- With a deep bite, the upper teeth cover the lower one by more than half.
- An open malocclusion is formed if most of the teeth do not close when the jaws come into contact.
- If a unilateral underdevelopment of one of the dentition is formed, then such a bite is called a cross bite.
- Dystopia is called malocclusion, in which teeth do not take their place in a row.
Symptoms
Malocclusion is both an aesthetic disadvantage and the cause of nasal breathing disorders, speech and facial disorders. Sometimes malocclusion leads to the development of ENT diseases and frequent respiratory viral infections, which results in the formation of chronic otitis media, sinusitis, sinusitis and pharyngitis.
With an incorrect bite, the food is poorly chewed, since the teeth do not completely close or there is no contact between them at all. This can cause diseases of the gastrointestinal tract and caries, since proper oral care is impossible.
Diagnostics
Orthodontics deals with the diagnosis and correction of malocclusion. At the first stage, preparation for orthodontic treatment takes place, which includes a set of diagnostic measures, the results of which determine the degree of complexity of therapy. To do this, make an orthopantomogram (panoramic image), radiovisiography, or use computed tomography data. The images allow you to see and evaluate the degree of changes in the dental system.
Correction of malocclusion
Before the main treatment, the oral cavity is sanitized: caries treatment and professional oral hygiene. It is important to treat concomitant diseases that may worsen during the installation of braces. For the period of correction of malocclusion, it is necessary to abandon carbonated drinks, viscous food, chewing gum, nuts, sweets and honey, since these products are difficult to peel off from the tooth enamel and can damage the bracket system.
The duration of orthodontic treatment is from six months to 2 years. All this time, it is necessary to pay special attention to the care of orthodontic devices. The effectiveness of malocclusion correction depends on how well and regularly they were cared for.
Installing braces
During the main stage of correction of malocclusion, braces are installed, adhesive composites are used to fix them. However, depending on the type of braces, different installation methods are used. Each vestibular bracket is glued to the front surface of the teeth that need correction, then support rings are attached to them, and a power arc is threaded through the locks. The arc is made of materials that have elasticity and elasticity, due to which it tends to take the shape that it was originally given.
Lingual braces are more difficult to install, since the internal relief of the dentition is more diverse. First, an impression of the dentition is made, after which the bracket system is worked out on this design and only then fixed with glue on the inner surface of the teeth.
The process of installing braces is painless and rarely accompanied by unpleasant sensations. However, during the week, the patient may experience pain syndrome, which is recommended to be stopped with analgesics, in case of severe pain, it is necessary to consult a doctor who is engaged in correcting malocclusion.
When wearing braces, access to the teeth is difficult, which can contribute to the development of caries. Brushing your teeth should be done after each meal and use special brushes for patients undergoing a course of correction of malocclusion. The use of superflosses, which, thanks to the hard tip, are easily threaded between the teeth at the edge of the gum, helps to remove food residues from areas that are inaccessible to brushing with a toothbrush and a brush.
Retention period
The third period is restorative, or retention. The activities carried out during this period are aimed at consolidating the results obtained with the help of braces. In case of an incorrect bite after the abrupt removal of braces, the teeth will regain their position after a while, in order to avoid this, retainers are used, the period of wearing which is 2 times longer than the period of wearing braces.
The duration of wearing retainers depends on the general condition of the dental system, on the age of the patient and on the presence of systemic diseases. Retainers can be removable and non-removable, non-removable devices are attached similarly to braces on the lingual surface of the teeth, which makes them invisible to others. Removable retainers are orthodontic plates that are attached at night. The pressure displacing the lower jaw is created by plastic arches and mouthguards. Silicone retainers are becoming more popular, as they are almost invisible during a conversation and when smiling.
Prevention
With artificial feeding, the hole in the nipple should be small so that the child makes efforts to suck, an excessively large hole does not require active chewing and sucking movements, so the jaw does not develop.
The child should not sleep in the same position all the time, so parents need to monitor the position of the child during sleep. In general, the bed should be comfortable, but not excessively soft, the child’s body relaxed in a dream, in addition, the child should not put a cam or toys under his cheek. It is necessary to stop the child’s bad habits of sucking a finger, a pacifier and foreign objects. This causes the teeth to move as far away as the size of the pacifier allows. As a result, a gap is formed between the upper and lower dentition.