FREQUENCY OF

MALOCCLUSION AND
ANALYZATION OF
ASSOCIATED RISK FACTORS
UNDER SUPERVISION OF DR.FURQAN AHMED
MEMBERS:
KHALIDA FASEEH
MARRIAM KHAN
ZUMER NAYYER
AMAL SAJID
AYESHA ASIF
YUSRA MASOOD
KARACHI MEDICAL AND DENTAL COLLEGE

INTRODUCTION:

Occlusion is the relationship among all the components of masticatory

system in their function,parafunction and dysfunction, whereas occlusion
which is aesthetically and functionally not acceptable is referred to as
malocclusion.1.Ideally, all upper teeth fit slightly over the lower teeth. The
points of the molars fit the grooves of the opposite molar.The upper teeth
keep the cheeks and lips from being bitten and the lower teeth protect the
tongue.2.The term malocclusion encompasses all deviations of the teeth
and jaws from normal alignment,including a number of distinct conditions,
like discrepanciesbetween tooth and jaw size (crowding and
spacing),malrelationships of the dental arches (sagittal,transverse, and
vertical) and malpositioning of individualteeth.3.There are different
categories of malocclusion.
Class 1 malocclusion is the most common. The bite is normal, but the upper
teeth slightly overlap the lower teeth.
Class 2 malocclusion, called retrognathism or overbite, occurs when the
upper jaw and teeth severely overlap the bottom jaw and teeth.
Class 3 malocclusion, called prognathism or underbite, occurs when the
lower jaw protrudes or juts forward, causing the lower jaw and teeth to
overlap the upper jaw and teeth.4.

Symptoms
Abnormal alignment of teeth
Abnormal appearance of the face
Difficulty or discomfort when biting or chewing
Speech difficulties (rare) including lisp
Mouth breathing (breathing through the mouth without closing the lips)
Signs and tests
Most problems with teeth alignment are discovered by a dentist during a
routine exam. The dentist may pull your cheek outward and ask you to bite
down to check how well your back teeth come together. If there is any
problem, the dentist will usually refer you to an orthodontist for diagnosis
and treatment.
Dental x-rays
head or skull x-rays.5.
Methods of recording and measuring malocclusion can be broadly divided
into two types i.e. qualitative and quantitative.6.while the severity or the
extent to which a malocclusion deviates from the normal or ideal occlusion
can be quantified by using an occlusal index.7. Among the qualitative
methods of recording malocclusion Angles method of classifying
malocclusion with or without modifications is probably the most widely
used.6.

Cephalometric indicators are used to analyze the maxillary and mandibular skeletal
positions. Both angular and linear measurements have been proposed in the
assessment of anteroposterior jaw-base relationships.8.Angles classification of
malocclusions is universally accepted because of its simplicity as a method of
description and communication between dental professionals. Based on the
relationship of the
mandibular first molars to the maxillary first molars, this system characterizes the
Class II malocclusions as having a distal relationship of the mandibular teeth relative
to the maxillaury teeth of more than one-half the width of the cusp. Two distinct types
of Class II malocclusion
exist, differing in the inclination of the maxillary central incisors. Class II Division 1
malocclusions exhibit labially inclined maxillary incisors, an increased overjet with a
vertical incisor overlap varying from a deep overbite to an openbite and the Class II
Division 2 malocclusion showing excessive lingual inclination of the maxillary central
incisors accompanied by a deep overbite and minimal overjet. An Angles Class III
malocclusion means that the mandibular first molar is anteriorly placed in relation to
the maxillary first molar. It is a symptomatic or phenotypic description that uses the
first molars and canines as criteria, and it has nothing to do with the maxillary and
mandibular skeletal bases.Class II molar relationship may occur
unilaterally, depicted or classified as a class II subdivision of the affected side[9] or
a bilaterally Class II on both the sides which is a frequently occurring type of
malocclusion out of these two.[10] Dental malocclusion is present in all societies but
its prevalence varies. There have been several studies investigating the prevalence
of various dentofacial characteristics11-15 but only a few have been conducted on an
orthodontic
population.16,17There is a high incidence of Class I malocclusion in White Americans
(Class I 52.5%, Class II 42.4% & Class III < 5%). Class I malocclusion is also more
prevalent in Black Americans (Class I 71%, Class II 16% & Class III 8.4%).

There are a number of publications that prove the influence of genes on the
development of dentofacial system.18. The environmental factors include
forces and pressures from soft tissues and muscles surrounding the dental
arches, various habits (thumb sucking, nailbiting,etc.), and the effect of
orthodontic appliances.19,20,21. The dentofacial system is also influenced by
the forces resulting from mastication.21,22. Therefore, although the majority of
the etiological factors are clear,malocclusion are one of the most urgent
stomatological problems. Individuals with Down syndrome (DS) and
cerebral palsy (CP) are particularly prone to orofacial disorders.23.
Children with DS and CP have the habit of projecting the tongue against the
teeth and out of the mouth and suffer frequent episodes of upper airway
infection, which leads to a greater prevalence of mouth breathing and
malocclusion.24.
Children with the habit of maintaining their mouth open exhibit abnormal
oromuscular movements and respiration, which compromises the
coordination and articulation of the lips and cheeks during speech and
swallowing.25
Oral habits and pressure on teeth or
the maxilla and mandible are etiological factors in malocclusion.[26,27]

 In the
active skeletal growth,[28] mouthbreathing, finger sucking, thumb sucki
ng, pacifier sucking, onychophagia (nail biting), dermatophagia, pen
biting, pencil biting, abnormalposture, deglutition disorders and other
habits greatly influence the development of the face and dental
arches.[29][30][31][32][33]
Prolonged use of a bottle
Extra teeth, lost teeth, impacted teeth, or abnormally shaped teeth
Ill-fitting dental fillings, crowns, appliances, retainers, or braces
Misalignment of jaw fractures after a severe injury
Tumors of the mouth and jaw
Sociodemographic facrtors
Dental caries
Periapical inflammation.
]

The aim of this study was to determine the frequency/prevalence of

malocclusion and to analyze the risk factors associated with malocclusion in
different age groups in a local samples of patients seeking dental treatment.data
for this study was retrived from the patients who sought dental treatment at dental
O.P.D in Karachi Medical & Dental College.

METHODOLOGY:

This cross-sectional study included patients who visited the Dental OPD, at
Karachi Medical And Dental College,Karachi, from June 2002 to April 2004.
Information regarding age and sex was obtained from the patients record
files. Both males and females were included in this study.
The inclusion criteria for the sample includes those with:
1.Presence with first permanent first molars.
2.Pre-treatment.
3.Orthodontic patients and patients seeking periodontal and operative
treatment.
The exclusion criteria includes patients with:
1.Significant past medical history.
2.Previous orthodontic treatment.
3.Previous prosthodontic treatment.
4.History of maxillofacial and plastic surgery.
5.Mixed dentition.
6.Congenital malformation.

 Patients were clinically examineed and were labelled under the

categories based on Angles classification, Occlusal index and
Incisors classification.
ANGLES CLASSIFICATION:
Angles classificaion categorizes as follows:
CLASS 1: A normal molar relationship exists but there is
crowding, misalignment of the teeth, cross bites, etc.
CLASS 11: Class II Malocclusion has two divisions to
describe the position of the anterior teeth.
Class II Division 1 is when the maxillary anterior teeth are proclined and
a
large overjet is present.

Class II Division 2 is where the maxillary anterior teeth are

retroclined and a deep overbite exists.
CLASS 111: A malocclusion where the molar relationship shows
the buccal groove of the mandibular first molar mesialy positioned to
the mesiobuccal cusp of the maxillary first molar when the teeth are
in occlusion.

 INCISORS CLASSIFICATION:

Incisors were classified according to British Standard Institute (BSI) of

incisor classification.
Class I the lower incisal edges occlude with or lie immediately below the
cingulum plateau of the upper incisors.
Class II the lower incisor edges lie posterior to the cingulum plateau of
the upper central incisors.
Division 1- the overjet is increased, and the upper central incisors are
proclined.
Division 2- the overjet is minimal or increased with retroclined upper central
incisors.
Class III the lower incisor edges lay anterior to the cingulum plateau of
the upper central incisors. The overjet is reduced or reversed.

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