Malocclusion and dentofacial anomalies can easily be corrected through the use of orthodontic therapy. Discuss.

1. WEST AFRICA COLLEGE OF SURGEONS FELLOWSHIP EXAMINATION.
ODEYEMI K.E
QUESTION 3.
“Malocclusion and dentofacial anomalies can easily be corrected through the use of
orthodontic therapy”. Discuss in detail the benefits of orthodontic treatment in the Africa
environment.
Outline:
Definition / Introduction.
General objectives of orthodontic treatment
Orthodontic treatment intervention
Orthodontics therapy.
Benefits of orthodontic treatment in the Africa environment.
Conclusion.
Introduction/Definition
Malocclusion can be described as an irregularity of the teeth or a poor relationship of the
dental arches beyond the range of what is accepted as normal. Malocclusion can impact
quality-of-life causing psychosocial limitations (awkwardness in the social context or
reduced career opportunities) and functional disturbances (affecting mastication,
swallowing and speech); increasing susceptibility to trauma; and increasing prevalence of
dental caries, periodontal disease and temporomandibular joints disorders.
Malocclusion can be differentiated into mild (dentoalveolar) or severe form (skeletal),
which may have an impact on facial appearance. If this is the case, the term “dentofacial
anomaly” is typically used.

2. Dentofacial anomalies (including malocclusion) include the following: Jaw size anomalies
such as Maxillary and Mandibular hyperplasia or hypoplasia; Dental arch anomalies –
open bite, cross bite, over bite; Tooth position of fully erupted tooth or teeth – Crowding,
Spacing, Rotation, Displacement; Dentofacial functional abnormalities – Abnormal jaw
closure, Deviation in opening and closing of the mandible; Temporomandibular joint
disorders – Articular disc disorder, Ankylosis.
General objectives of orthodontic treatment.
Esthetics
Facial esthetics
Dental esthetics
Functional Occlusion
Oral health
Stability.
Orthodontic treatment intervention
Preventive orthodontics: It helps to preserve the integrity of what appears to be a normal
occlusion at a specific time. That phase of the science and art of orthodontics employed to
recognise and eliminate potential irregularities and malpositions in the developing
dentofacial complex. Examples of preventive approach include: Parent education,
management of ankylosed teeth, extraction of supernumeraries, regular dental
checkup/good oral hygiene, caries control, check up for oral habits and habit breaking
appliance if necessary, use of space maintenance etc.
Interceptive orthodontics: Basically refers to measures undertaken to prevent a potential
malocclusion from progressing into a more severe one. Examples of Interceptive approach
include: Serial extractions, control of abnormal habits, space regaining and diastema
closure, removal of soft tissues or bony barrier to facilitate eruption of teeth etc.

3. Corrective orthodontics: Could be surgical or non surgical (use of appliances)
Orthodontic therapy methods
Functional appliances e.g. Frankel, Herbst, Bionator and twin block appliances
Removable appliances
Component: Active, Retentive, Anchorage, Base plate.
Fixed appliances
Component: Bands, Bonds, Orthodontic adhesives, Auxiliaries, Arch wire.
Orthognathic surgery.
Benefits of orthodontic treatment in Africa environment.
Appearance: Dissatisfaction of appearance is often the main reason people seek
orthodontic treatment and, in most cases, treatment is able to deliver a positive change.
Although, improved dental appearance may be cited as the main goal of treatment by
patients, it is likely that the perceived benefit is not a change in appearance per se, but the
anticipated psychosocial benefit associated with improved appearance.
Masticatory function: Patient with intra – arch discrepancy includes anterior open bite
(AOB), markedly increase or reverse over jet often report difficulty with eating,
particularly with incising food, likewise patient with posterior cross bite have difficulty
chewing effectively considering the diet in our environment. Orthodontic intervention will
help to improve masticatory function thereby improving the quality of life.
Speech: Orthodontic treatment correcting the incisor relationship and interdental spacing
may help to reduce lisping, reduce difficulty in production of certain phonation and
improve confidence to talk in public.
Oral habits: Oral habits such as tongue thrusting, lip and thumb sucking can be
discouraged through the use of orthodontics appliances such as palatal crib, tongue rake,
tongue spurs, lip bumper.

4. Localized periodontal problems: Certain occlusal anomalies may predispose individuals to
periodontal problems, particularly where the gingival biotype is thin, and in these cases
orthodontic intervention may have a long-term health benefit. These include:
Crowding where one or more teeth are pushed buccally or lingually out of the
alveolar bony trough, resulting in reduced periodontal support and localized
gingival recession.
Traumatic overbites or deep bite where teeth bite on the gingiva, can lead to
gingival inflammation and loss of periodontal support over time and this is
accelerated by suboptimal plaque control.
Dental trauma: There is evidence that increased overjet is associated with trauma to the
upper incisors. The risk of injury is more than doubled in individuals with an overjet
greater than 3mm and the risk of injury appears to increase with overjet size and lip
incompetence. Orthodontic intervention may reduce the risk of trauma to the upper
incisors. Mouthguards are also important in reducing the risk of dental trauma, particularly
for those participating in contact sports.
Impacted teeth: Tooth impaction occurs when normal tooth eruption is impeded by another
tooth, bone, soft tissues or other pathology. Supernumerary teeth can cause impaction and
if judged to be impeding normal dental development, orthodontic input may be required.
Ectopic teeth are teeth that have formed or subsequently moved, into the wrong position;
often ectopic teeth become impacted. Unerupted impacted teeth may cause localized
pathology, most commonly resorption of adjacent roots or cystic change. This is most
frequently seen in relation to ectopic maxillary canine teeth, which can resorb roots of the
incisors and premolars. Orthodontic management of impacted teeth may be indicated to
reduce the risk of pathology.
Dental Caries: Caries experience is directly influenced by oral hygiene, fluoride exposure
and diet; however, research has failed to demonstrate a significant association between
malocclusion and caries. Caries reduction is therefore rarely an appropriate justification
for orthodontic treatment and placement of placement of orthodontic treatment and
placement of orthodontic appliances in an individual with uncontrolled caries risk factors
is likely to cause significant harm.

5. In caries – susceptible children for example children with special need, misalignment may
reduce the capacity for natural tooth cleansing and potentially increase the risk of caries.
In this case, an orthodontic opinion may be sought to reduce food stagnation by simple
alignment to alleviate localized crowding.
Temporomandibular joint dysfunction syndrome: Minor occlusal imperfection can lead to
abnormal paths of closure and or bruxism which then might result in the development of
TMD. Hence, orthodontic treatment can be instituted to correct the occlusal imperfections.
Psychosocial well-being: Malocclusion has been linked to reduced self-confidence and
self-esteem, with more severe malocclusion and dentofacial deformities causing higher
levels of oral impacts. Dental appearance in our environment has been known to evoke
social judgments that affect peer relations and childhood emotional and social
development. People with an attractive dentofacial appearance have been judged to be
friendlier, more interesting and intelligent, more socially competent, ease of partner
finding and employability. One the other hand, deviation from the norm can cause
stigmatization and a high correlation has been found between victimization, malocclusion,
and quality of life. Orthodontic intervention to correct some malocclusion can help to
improve self-esteem and self-confidence.
Conclusion
Considering the all these, the benefit of orthodontics treatment can be related to
improvement in oral function, oro- facial aesthetics and thus to improve oral health related
quality of life.