The Hows and Whys of Orthodontics

Part 4

How To Recognise a Malocclusion

Dentists have divided malocclusion into three main types named Class 1, Class 2 and Class 3 Malocclusion.

Class 1 occlusion presents with a good facial profile with the jaws in the correct skeletal relationship and the teeth meeting correctly.

Class 1 malocclusion presents with good facial profile and the jaws in correct relationship but with twisted or crooked teeth.

Class 2 malocclusion is present when the lower jaw is too far back, which may make the upper front teeth seem too far forward or seem buck-toothed and the teeth do not line up correctly. This is a very common malocclusion that can be successfully treated by orthopaedic and orthodontic appliance therapy.

Class 3 malocclusion presents when the lower jaw seems to be set too far forward in front of the upper jaw. It is important to find out which of the following factors contribute to the problem:

  1. lower jaw being too big
  2. lower jaw being too far forward
  3. upper jaw being too small
  4. upper jaw being too far back

Any combination of the above is possible so a special x-ray called a Cephalometric X-ray is taken. Its analysis will show the dentist exactly how the malocclusion has developed.

Class 3 malocclusions are more difficult to correct, but if treatment is started when the child is young, it may be possible to correct some of them.

Other factors to take into consideration have been mentioned previously such as:

  1. How the child breathes i.e. through its mouth
  2. How the child chews i.e. noisy eating
  3. How the child sounds i.e. speech problems, tooth grinding at night or snoring
  4. How the child feels i.e. headaches, embarrassment about the appearance of its teeth and smile.

What Can The Dentist Do To Correct The Malocclusion?

If you suspect that your child has a malocclusion, it is important that you see your dentist right away. Often the treatment can start at the age of 4 or 5, when the child is mature enough to undergo the treatment.

When the dentist sees your child the first thing they will do is to make a thorough diagnosis of the malocclusion. To do this:

  • X-rays will be taken of the jaws and teeth
  • Study models made of the child's teeth
  • Photographs of the child's face may also be taken
  • A detailed evaluation of the muscles of the lips, cheeks and tongue will be made.

Upon reaching a diagnosis, the dentist will give you a treatment plan that will outline the type of treatment needed, the likely length of the treatment and the cost.

In the treatment of malocclusion there are two fundamental questions that have to be answered:

  1. Are the jaws the correct size and in correct relation to each other?
  2. Are the teeth in the correct alignment with the jaws?

Orthopaedic appliances are used to make the jaws the right size. These come in many types but are usually designed to make the jaws bigger by expanding them - using either a screw or the spring action of a stout wire. The alignment of the jaw is carried out by a functional appliance that harnesses the action of the muscles that are used to chew and swallow.

Remember earlier we noted that the muscle always wins over teeth and bone and so by controlling the forces of the muscles with the appliance, the dentist can change the shape and size of the jaws and their relationship to each other.

Once the jaws are aligned the teeth are moved within the jaws by the use of fixed appliances or 'train tracks' as they are commonly known. These appliances are stuck to the teeth and wires of different size and shape fitted into the appliance. This allows the teeth to be very accurately moved and controlled. These different appliances should not be compared with each other as they carry out quite separate tasks sometimes only one type is required but more often both are needed.

By the combined use of both types of therapy, most treatment can be carried out with out the need to remove teeth. As an adjunct to the appliance therapy, the dentist may choose to undertake a course of myofunctional therapy, to teach the tongue and lips to work in a balanced, co-ordinated fashion and so set up an ideal environment for the dentition to remain stable .

As with so many things that are worthwhile, it takes co-operation and team work to succeed. For orthodontics and orthopaedics to succeed the team is made up of:

  • The child who must understand and appreciate what is happening.
  • The parent who must no only understand, but also encourage their child and make the time to take the child to the dentist.
  • The dentist who must encourage every one and carry out their job to the best of their ability

This is doubly true in the case of orthopaedics and where the appliances are removable - they only work when they are in the mouth and don't work when they are in the pocket.

As a parent, you have a major role to play in the healthy development of your child. It is easier to correct these problems in a young growing child than to sort it out later.

Where to find us
Based in Argyll, on the West Coast of Scotland, Stewart Wright currently practices two days per week in Oban.