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Tooth Decay / Dental Caries

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In an ideal case, when we close our mouth, the upper teeth fit just over the lower teeth and the pointed ends of the molars in the upper jaw sit comfortably in the grooves of the molars in the lower jaw. The term “occlusion” refers to the teeth alignment pattern on the two dental arches or jaws – the upper and the lower, and the way these two arches close relative to one another. Malocclusion is therefore, any deviation from the normally accepted blocking i.e. mal-alignment of teeth in either or both jaws. A proper alignment is necessary in order to ensure a comfortable bite and also an aesthetic appeal of the dentition. 
Types of Malocculsion
Malocclusion is classified in terms of the severity of the misalignment and the position of teeth. This term was coined by Edward Angle who is considered the “Father of Modern Orthodontics”. He grouped the dentitions into mainly 3 types under “Angle’s classification” based on the position of the maxillary first molar located away from the midline of the face. According to him, the pointed ends of the first molar of the upper jaw should fit in perfectly into the groove of the lower molar. Both the upper and the lower jaw have a smooth occlusion line where all the teeth are arranged. Any variation for this occlusion line can lead to malocclusion of the teeth. According to the angle, the left and right side of the jaw can display different patterns of malocclusion.
The three types of malocclusion are:

Class 1: Neutroclussion: In this condition, the bite is perfectly normal but the upper jaw overlaps the lower jaw slightly. The ideal molar alignment, as determined by the angle, is maintained but the remaining teeth may display spacing, crowding, over eruption or under eruption.
Class 2: Distocclusion:
This condition is also known as retrognathism or overjet. In this condition, the points of the molars on the upper jaw are placed slightly anterior to the grooves on the molars of the lower jaw, leading to severe overlapping of the two arches. This condition can be further divided into two sub classes:
  • Class 2: Division 1: In this division, the molars display the typical class 2 pattern and the anterior teeth tend to protrude.
  • Class 2: Division 2: In this division, class 2 molar alignment is combined with a slight backward tipping of the central teeth and the lateral teeth overlap them.

Class 3: Mesiocclusion: This condition is called prognathism or more commonly as negative overjet. In this case, the points of the upper molar teeth are placed anterior to the grooves of the molars in the lower jaw.  The lower front teeth tend to jut out and are more prominent than the upper front teeth.


The effect of malocclusion depends entirely on the severity of the condition. In the mildest cases, there may be little or no discomfort. There may be abnormal bite patterns associated with a certain type of malocclusion. In more severe cases, abnormality of the face is seen along with a lisp in speech. There may be extreme discomfort in biting and chewing. Sometimes, severe cases of malocclusion can even lead to mouth breathing. It leaves its scars on the sufferer’s personality development too thus, affecting the quality of life.
What causes Malocclusion?
  • Genetics: Malocclusion is often considered to be a condition that is genetic in nature. This means, if there is someone in your family (by genes) who has been treated for malocclusion in the past, there is a good chance that you have inherited it too.
  • Misalignment: Malocclusion results from the difference in the sizes of upper and lower jaws, or due to the size of the teeth. Large teeth may lead to overcrowding or misalignment. The increase or decrease in the number of teeth may also result in malocclusion. In case there is a variation in the structure of the jaw due to conditions like clefts of lip and palate, malocclusion may occur. The distance between the two jaws is essential for a good and comfortable bite. When you have this condition, you notice abnormal bite patterns.
  • Childhood habits: There are many childhood habits that contribute to malocclusion. Thumb sucking, lip biting, mouth breathing, use of pacifier after the age of three or thrusting with the tongue during the growth of teeth can result in malocclusion.
  • External factors: There are several external factors that lead to abnormal bite patterns and misaligned teeth. In case you have had a severe jaw injury in the past or have suffered from tumors in the mouth or jaw, there could be a change in the alignment of your teeth.
Other factors include uneven dental fillings, ill fitted braces and crowns and other improper dental procedures. Sometimes, the growth pattern of the teeth is flawed, leading to extra or abnormally shaped teeth.


Malocclusion is diagnosed with the help of dental X-rays or head and facial X-rays. In some cases, one may have to get plaster moulds of the teeth to determine the malocclusion pattern. If your case is very mild, the dentist can diagnose the condition with a simple routine examination. The primary goal of any malocclusion treatment to reduce the risk of tooth decay and align the teeth in a way that is easier to clean and maintain. An orthodontist performs the procedures necessary to correct malocclusion.
For basic types of malocclusion, braces or simple removable appliances are used to correct the alignment.  Sometimes a metal band may be placed around the teeth along with metallic or ceramic bands on the surface. Wires and springs force the teeth back into position.  In case overcrowding is the issue, extra teeth may be extracted, reshaped or bonded to correct the alignment.
Surgery is recommended only in very severe cases.  Orthodontic surgery can be suggested to reshape the teeth or to lengthen or shorten the jaw. In case the jaw bone is unstable, a wire or plates are used. Sometimes retainers are used to keep the structure stable after surgery.
Both during orthodontic treatment and post operative care involves regular flossing and brushing of the teeth. The specially designed toothbrushes are called Orthodontic brushes. Mouth rinsing may be advised to clean the areas which are not easily accessible by the toothbrush.
Additionally, one must visit the dentist for regular follow up and for the scaling of plaque if necessary.
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