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ETIOLOGY OF
MALOCCLUSION
GENERAL & LOCAL FACTORS
www.indiandentalacademy.com
The various classification proposed
are:
 White and Gardiner
 Salzmann’s classification
 Moyer’s classification
 Grabe...
Graber’s classification
General factors
1. Heredity
2. Congenital
3. Environment
prenatal
postnatal
4. Predisposing
metabo...
Local factors
 1. Anomalies in number of teeth
 2. Anomalies of tooth size
 3. Anomalies of tooth shape
 4. Abnormal l...
General factors
 Heredity: It includes factors that
result in malocclusion and are
inherited from the parents by the
off ...
Neuromuscular system- There is deformity in
neuromuscular co ordination pattern of
facial,oral and tongue musculature
Dent...
 Skeletal structures- underlying basal
bone and other associated cranial bone
structures are partially inherited
Class II...
Congenital factors
 These malformations are seen at the time of birth
 Mal development of 1st
and 2nd
brachial arches
 ...
Micrognathism ( small jaw)
 congenital variety is usually seen with
congenital heart disease and Pierre
Robin syndrome.
...
 Oligodontia : different teeth seem
to be affected by different degree
with the third molar being most
affected
 Anodont...
 Congenital syphills- syphills of
congenital origin is transmitted from the
infected mother to the child:
 Hutchinson’s ...
 Maternal rubella infections:
dental hypoplasia
retarded eruption of teeth
extensive caries
Cleidocranial dystosis
- unil...
 Cerebral palsy
aberrant muscle activity resulting in
malocclusion
www.indiandentalacademy.com
Environment
Prenatal factors
• Abnormal fetal posture : -
-Interferes with symmetric
development of face
-Not directly ass...
 Maternal infections such as German
measles and use of certain drugs during
pregnancy like thalidomide can cause
congenit...
www.indiandentalacademy.com
Predisposing metabolic climate and
disease
Endocrinal imbalance:
Diseases Features
hypopitutarism - delayed tooth
eruption...
 Hypothyroidism - Growth
retardation
- Delayed
eruption of the
teeth
- Maxillary
protrusion
- Spacing
 Hyperthyroidism -...
 Hypoparathyroidism - retarded
eruption
-early exfoliation
-enamel defects
 Hyperparathyroidism - demineralization
-disa...
Metabolic disturbances
 Acute febrile diseases may also
affect the dentition and its
surrounding hard and soft tissue.
 ...
Infectious diesease
 Bacterial infection
 Osteomyelitis - Bone response to
force is altered
 Congenital syphillis
–unde...
 Viral infection
 Mumps -dental hypoplasia
-retarded eruption
-extensive caries
-Inflammation/
congestion of gingiva
 M...
Dietary problems
 Protein deficiency - delayed eruption
 Vitamin A deficiency -calcification of teeth
is affected
- reta...
 Vitamin C deficiency - disturbed
collagen fibre
formation
- bleeding gums
- loosening of teeth
 Vitamin D -disturbed
ca...
 Hypervitaminosis D - poorly calcified
teeth
-decalcification of
bones
-Increased
osteoclastic
activity
www.indiandentala...
Abnormal pressure habits and
functional aberrations
 Thumb sucking
 Tongue thrust
 Lip and nail biting
 Abnormal swall...
 All these habits are functional
aberrations which produces forces that
are abnormal and these forces are
capable of brin...
Posture
 Poor postural habit
 It may be associated with
maloclusion though not proved
www.indiandentalacademy.com
Accidents and Traumas
 Injuries of the dento alveolar region
may get unnoticed during the early
years of life
 Responsib...
Local factors—anomalies in number
 Supernumerary teeth
–Teeth extra to normal complement
-Most common mesiodens
-may clos...
www.indiandentalacademy.com
supplemental teeth-
-Teeth bear close resemble to a
particular group of teeth
- Erupt close to original site of these
teet...
 Supernumerary teeth can cause-
-Non eruption of adjacent teeth
-Delay the eruption of adjacent teeth
-Deflect the erupti...
 Missing teeth
–more common condition than
supernumerary teeth
Oligodontia- absence of many teeth
Anodontia-absence of al...
 This condition can lead to
- Spacing between the teeth
- Aberrant swallowing patterns
-Abnormal axial inclination of adj...
Anomalies of tooth size
 Microdontia- True generalized
form of microdontia is rare
 Usually seen in cases of pitutary
dw...
Anomalies of tooth shape-
 Fusion
- tooth arises through the union of two
normally seperated tooth bud
-may lead to spaci...
www.indiandentalacademy.com
Abnormal of labial frenum
 - Often associated with maxillary mid
line spacing
 A heavy fibrous frenum is found
attached ...
www.indiandentalacademy.com
 Blanch test- is used to determine the
role of frenum as a casuative factor for
mid line test
 Step 1. The lip is pulled...
Premature loss of deciduous teeth-
-
-Decrease in
total arch length
as the posterior
teeth move
mesially
-Ectopic eruption...
Prolonged retention of deciduous teeth
 Reasons for prolonged retention of
tooth are-
- Absence of any underlying
permane...
 Prolonged
retention of
deciduous teeth
result in lingual or
palatal eruption of
their successors.
www.indiandentalacadem...
Delayed eruption of permanent teeth
 May result in ectopic eruption of
permanent teeth
 The reasons for delayed eruption...
-Presence of heavy mucosal barrier
can prevent the permanent tooth
from emerging into the oral cavity
- Presence of decidu...
Abnormal eruptive path
 Causes for this are:
- Tooth bud displaced from its ideal
position
- Presence of supernumerary te...
 Retained deciduous teeth might force a
tooth to erupt along a path of least
resistance rather than in place of
deciduous...
www.indiandentalacademy.com
 Various reasons for this behavior are-
-Travels the longest distance, from near the
floor of the orbit to cover the arch...
Ankylosis
-Union of the root or part of a root
directly to the bone without the
intervening periodontal ligament
-Associat...
Dental caries
-Proximal caries may result in
reduction of arch length
-Loss of E space
-Migration/ tilting of teeth in the...
Malocclusions caused due to caries
www.indiandentalacademy.com
Improper dental restoration
-Under contoured proximal restoration- decrease
in arch length
-Over contoured restoration- ma...
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Etiology of malocclusion

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Etiology of malocclusion

  1. 1. ETIOLOGY OF MALOCCLUSION GENERAL & LOCAL FACTORS www.indiandentalacademy.com
  2. 2. The various classification proposed are:  White and Gardiner  Salzmann’s classification  Moyer’s classification  Graber’s classification www.indiandentalacademy.com
  3. 3. Graber’s classification General factors 1. Heredity 2. Congenital 3. Environment prenatal postnatal 4. Predisposing metabolic climatic and infectious disease 5. Abnormal pressure habits and functional aberrations— Thumb sucking, Tongue thrust, speech defects etc 6. Dietary problems 7. Posture 8. Trauma and accidents www.indiandentalacademy.com
  4. 4. Local factors  1. Anomalies in number of teeth  2. Anomalies of tooth size  3. Anomalies of tooth shape  4. Abnormal labial frenum  5 Premature loss of deciduous teeth  6. Prolonged retention of deciduous teeth  7. Delayed eruption  8. Abnormal eruptive pathway  9. Ankylosis  10.Dental caries  11.Improper dental restorations www.indiandentalacademy.com
  5. 5. General factors  Heredity: It includes factors that result in malocclusion and are inherited from the parents by the off springs. These factors can influence-  Neuromuscular system  Dentition  Skeletal structures  Soft tissues www.indiandentalacademy.com
  6. 6. Neuromuscular system- There is deformity in neuromuscular co ordination pattern of facial,oral and tongue musculature Dentition- size and shape of the tooth number of teeth primary position of tooth germ shedding of deciduous teeth and sequence of eruption mineralization of teeth www.indiandentalacademy.com
  7. 7.  Skeletal structures- underlying basal bone and other associated cranial bone structures are partially inherited Class III skeletal pattern most commonly show familial tendency  Soft tisuues (other than neuro muscular) Size and shape of frenum Microstomia Ankyloglossia www.indiandentalacademy.com
  8. 8. Congenital factors  These malformations are seen at the time of birth  Mal development of 1st and 2nd brachial arches  Common conditions are: Micrognathism Oligodontia Anodontia Cleft lip and palate congenital syphillis Maternal rubella infections Cleidocranial dystosis Cerebral palsy www.indiandentalacademy.com
  9. 9. Micrognathism ( small jaw)  congenital variety is usually seen with congenital heart disease and Pierre Robin syndrome.  Micrognathia of maxilla is due to deficiency in the pre maxilla  Mandibular retrognathism is characterized by severe retrusion of the chin www.indiandentalacademy.com
  10. 10.  Oligodontia : different teeth seem to be affected by different degree with the third molar being most affected  Anodontia absence of teeth very rare condition  Cleft lip & palate :generally associated with under developed maxilla and related dental disturbanceswww.indiandentalacademy.com
  11. 11.  Congenital syphills- syphills of congenital origin is transmitted from the infected mother to the child:  Hutchinson’s molar  Mulberry molar  Enamel deficiency  Extensive dental decay  Small maxilla  Ant cross bite www.indiandentalacademy.com
  12. 12.  Maternal rubella infections: dental hypoplasia retarded eruption of teeth extensive caries Cleidocranial dystosis - unilateral/bilateral partial/ complete absence of the clavicle - max retrusion and mandibular protrusion -over retained deciduous teeth and retarded eruption of permanent teeth -presence of supernumerary teeth www.indiandentalacademy.com
  13. 13.  Cerebral palsy aberrant muscle activity resulting in malocclusion www.indiandentalacademy.com
  14. 14. Environment Prenatal factors • Abnormal fetal posture : - -Interferes with symmetric development of face -Not directly associated with malocclusion but may be associated with abnormal pressure or imbalance. -Most of the deformities are temporary and disappears with time www.indiandentalacademy.com
  15. 15.  Maternal infections such as German measles and use of certain drugs during pregnancy like thalidomide can cause congenital deformities like cleft  Post natal factors - Trauma - Forceps delivery can result in injury to the TMJ area which can undergo ankylosis retarded mandibular growth www.indiandentalacademy.com
  16. 16. www.indiandentalacademy.com
  17. 17. Predisposing metabolic climate and disease Endocrinal imbalance: Diseases Features hypopitutarism - delayed tooth eruption - incomplete root formation Hyperpitutarism -large mandible -enlarged tongue - accelerated dental development www.indiandentalacademy.com
  18. 18.  Hypothyroidism - Growth retardation - Delayed eruption of the teeth - Maxillary protrusion - Spacing  Hyperthyroidism - Accelerated skeletal growth - Irregular eruption of the teeth -Mild prognathism www.indiandentalacademy.com
  19. 19.  Hypoparathyroidism - retarded eruption -early exfoliation -enamel defects  Hyperparathyroidism - demineralization -disappearance of lamina dura -mobility of teeth www.indiandentalacademy.com
  20. 20. Metabolic disturbances  Acute febrile diseases may also affect the dentition and its surrounding hard and soft tissue.  If severity and duration is not prolonged the child is able to recoup and catch up growth is possible www.indiandentalacademy.com
  21. 21. Infectious diesease  Bacterial infection  Osteomyelitis - Bone response to force is altered  Congenital syphillis –under developed maxilla - narrow maxillary arch - enamel hypoplasia -Defect in shape of teeth www.indiandentalacademy.com
  22. 22.  Viral infection  Mumps -dental hypoplasia -retarded eruption -extensive caries -Inflammation/ congestion of gingiva  Measles -airway obstruction  Rubella -retarded eruption of teeth -congenital malformations including cleft lip and palate www.indiandentalacademy.com
  23. 23. Dietary problems  Protein deficiency - delayed eruption  Vitamin A deficiency -calcification of teeth is affected - retarded eruption  Vitamin B complex - cheilosis - retarded growth - pernicious anaemia www.indiandentalacademy.com
  24. 24.  Vitamin C deficiency - disturbed collagen fibre formation - bleeding gums - loosening of teeth  Vitamin D -disturbed calcification of teeth -poor quality of teeth - narrow maxillary arch - High palatal vault -Under developed mandible www.indiandentalacademy.com
  25. 25.  Hypervitaminosis D - poorly calcified teeth -decalcification of bones -Increased osteoclastic activity www.indiandentalacademy.com
  26. 26. Abnormal pressure habits and functional aberrations  Thumb sucking  Tongue thrust  Lip and nail biting  Abnormal swallowing habits  Speech defects  Respiratory abnormalities  Tonsils and adenoids  Pshychogenic habits and bruxism www.indiandentalacademy.com
  27. 27.  All these habits are functional aberrations which produces forces that are abnormal and these forces are capable of bringing about a permanent deformity in the developing musculo skeletal unit  Deformity depends upon the- - Intensity - Duration - Frequency www.indiandentalacademy.com
  28. 28. Posture  Poor postural habit  It may be associated with maloclusion though not proved www.indiandentalacademy.com
  29. 29. Accidents and Traumas  Injuries of the dento alveolar region may get unnoticed during the early years of life  Responsible for - Non vital teeth - Ankylosed teeth - Injuries at condylar region www.indiandentalacademy.com
  30. 30. Local factors—anomalies in number  Supernumerary teeth –Teeth extra to normal complement -Most common mesiodens -may closely resemble the teeth of the group they belong or bear no resemble supplemental teeth- teeth that bear close resemble to a particular group of teeth and erupt close to original site of these teeth  Most common are-premolar region or the lat regionwww.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com
  32. 32. supplemental teeth- -Teeth bear close resemble to a particular group of teeth - Erupt close to original site of these teeth -Most common are-premolar region or the lateral incisor region www.indiandentalacademy.com
  33. 33.  Supernumerary teeth can cause- -Non eruption of adjacent teeth -Delay the eruption of adjacent teeth -Deflect the erupting tooth into abnormal locations -Crowding www.indiandentalacademy.com
  34. 34.  Missing teeth –more common condition than supernumerary teeth Oligodontia- absence of many teeth Anodontia-absence of all the teeth Hypodontia-presence of few teeth eg-hypo hydrotic ectodermal dysplasia www.indiandentalacademy.com
  35. 35.  This condition can lead to - Spacing between the teeth - Aberrant swallowing patterns -Abnormal axial inclination of adjacent teeth www.indiandentalacademy.com
  36. 36. Anomalies of tooth size  Microdontia- True generalized form of microdontia is rare  Usually seen in cases of pitutary dwarfism  Most common form of localized microdontia is- max lat incisors called-peg lateral www.indiandentalacademy.com
  37. 37. Anomalies of tooth shape-  Fusion - tooth arises through the union of two normally seperated tooth bud -may lead to spacing  Gemination  Twinning  Concrescence  Dilaceration www.indiandentalacademy.com
  38. 38. www.indiandentalacademy.com
  39. 39. Abnormal of labial frenum  - Often associated with maxillary mid line spacing  A heavy fibrous frenum is found attached to inter dental papilla  Can prevent the two max central incisors from approximating each other www.indiandentalacademy.com
  40. 40. www.indiandentalacademy.com
  41. 41.  Blanch test- is used to determine the role of frenum as a casuative factor for mid line test  Step 1. The lip is pulled superiorly and anteriorly  Step 2. Any blanching indicates fibres of the frenum crossing the alveolar ridge  An IOPA will show notching in the inter dental alveolar ridge region www.indiandentalacademy.com
  42. 42. Premature loss of deciduous teeth- - -Decrease in total arch length as the posterior teeth move mesially -Ectopic eruption of teeth -Shift in the midline www.indiandentalacademy.com
  43. 43. Prolonged retention of deciduous teeth  Reasons for prolonged retention of tooth are- - Absence of any underlying permanent teeth - Endocrinal disturbances- Hypothyroidism - Ankylosed deciduous teeth - Non vital teeth that do not resorb www.indiandentalacademy.com
  44. 44.  Prolonged retention of deciduous teeth result in lingual or palatal eruption of their successors. www.indiandentalacademy.com
  45. 45. Delayed eruption of permanent teeth  May result in ectopic eruption of permanent teeth  The reasons for delayed eruption are- -Congenital absence of the permanent tooth -Presence of supernumerary teeth www.indiandentalacademy.com
  46. 46. -Presence of heavy mucosal barrier can prevent the permanent tooth from emerging into the oral cavity - Presence of deciduous root fragments - Endocrinal disturbances - Ankylosed teeth www.indiandentalacademy.com
  47. 47. Abnormal eruptive path  Causes for this are: - Tooth bud displaced from its ideal position - Presence of supernumerary teeth , odontomas, retained tooth may divert a tooth from its eruptive path www.indiandentalacademy.com
  48. 48.  Retained deciduous teeth might force a tooth to erupt along a path of least resistance rather than in place of deciduous teeth  Arch length deficiency or excess of tooth material may cause one or more teeth to deviate from their eruptive path - Most common is max canine www.indiandentalacademy.com
  49. 49. www.indiandentalacademy.com
  50. 50.  Various reasons for this behavior are- -Travels the longest distance, from near the floor of the orbit to cover the arch - It is the last anterior tooth to erupt and loss in arch length- anterior or posterior teeth may impinge on the space required for it to erupt - Abnormal position of the tooth bud www.indiandentalacademy.com
  51. 51. Ankylosis -Union of the root or part of a root directly to the bone without the intervening periodontal ligament -Associated with certain infections, endocrine disorders, and congenital diseases www.indiandentalacademy.com
  52. 52. Dental caries -Proximal caries may result in reduction of arch length -Loss of E space -Migration/ tilting of teeth in the space available -Supra eruption of the teeth in opposing arch www.indiandentalacademy.com
  53. 53. Malocclusions caused due to caries www.indiandentalacademy.com
  54. 54. Improper dental restoration -Under contoured proximal restoration- decrease in arch length -Over contoured restoration- may bulge into the space to be occupied by the succadenous tooth -Overhang or poor proximal contact- periodontal breakdown -Occlusal prematurities due to over contoured occlusal restoration can cause a functional shift of the mandible www.indiandentalacademy.com

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