Improving occlusion and orofacial aesthetics: orthodontics

doi:10.1136/bmj.321.7256.288

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Susan Cunningham,
Elisabeth Horrocks,
Nigel Hunt,
Steven Jones,
Howard Moseley,
Joseph Noar,
Crispian Scully

Malocclusion is the abnormal positioning of the teeth or jaws. It is a variation of growth and development and can affect a person's bite (occlusion), ability to clean teeth properly, gingival health, jaw growth, speech development, and appearance.

Patient with crowded teeth and malocclusion (top) and after orthodontic treatment (bottom)

The shape and size of the face, jaws, and teeth are mainly inherited, but environmental factors can also have an impact. Factors as diverse as skeletal muscle pathology1 and sucking a digit (thumb or finger) can substantially influence the growth of the face and dentition.

Treatment of disorders such as crowded or protruding teeth may improve both aesthetics and oral function. In addition, prominent teeth can be damaged easily during childhood. The dental specialty most concerned with problems of facial growth, development of occlusion, and the prevention and correction of associated anomalies is orthodontics. The improvement of occlusion and aesthetics using restorative dental techniques is discussed in the next article.

Orthodontic care

The demand for orthodontic treatment is increasing to such an extent that an objective index of orthodontic treatment need (IOTN) has been established to ensure that resources are directed to patients with the greatest clinical need and who are likely to benefit most.2 3

Prevention or treatment of malocclusion may help

Aesthetic appearance
Occlusion
Oral health
Reduce dental trauma

Apart from a thorough history and examination, photographs of the face and teeth and models of the teeth are used to provide a record and facilitate treatment planning. Several types of radiograph may also be needed. Most commonly used are panoramic radiographs, which show all the upper and lower teeth in biting position as well as any teeth still developing within the jaws, and a lateral cephalometric radiograph, which shows the relation of the teeth and jaws to the face and base of the skull.