Doctors Revision

Oral & Dental Health

Malocclusion

Any deviation from the ideal occlusion (the way upper and lower teeth fit together).

Also known as: Misaligned Teeth, Bad Bite

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Referral and warning signs

When to refer

Refer to Dentist/Orthodontist (RR) for assessment and management if malocclusion causes functional problems, aesthetic concerns, or meets specific criteria for treatment need (e.g., crossbite, deep bite, large overjet). Refer complex skeletal cases for potential orthognathic surgery consult.

Red flags

  • Rapidly developing malocclusion (suspect underlying pathology like tumour).

Signs and symptoms

  • Misaligned, crooked, or crowded teeth.
  • Protruding teeth.
  • Abnormal bite relationship (e.g., crossbite, overbite, underbite, open bite).
  • Difficulty chewing or biting.
  • Speech problems (less common).
  • Aesthetic concerns.
  • Jaw pain or Temporomandibular Joint (TMJ) dysfunction (in some cases).

Risk factors

  • Genetics / Heredity (jaw size, tooth size discrepancy).
  • Childhood habits (thumb sucking, prolonged pacifier use, tongue thrusting).
  • Premature loss of primary (baby) teeth.
  • Impacted teeth.
  • Trauma to jaw or teeth.
  • Tumours of mouth or jaw.
  • Craniofacial anomalies.

Diagnosis

Clinical assessment

Assessment of tooth alignment and bite relationship during dental examination.

Investigations

  • Dental examination.
  • Dental X-rays (e.g., OPG, cephalometric X-ray).
  • Study models (plaster casts) of teeth.
  • Photographs.

Diagnostic criteria

Clinical and radiographic assessment demonstrating deviation from normal occlusion. Classification systems (e.g., Angle's classification) used to describe type.

Management

Orthodontic/Surgical Management

  • Treatment indicated mainly for aesthetic or functional reasons (difficulty chewing, speech issues, increased trauma risk, TMJ issues, periodontal health).
  • Mild cases (mixed dentition): Removable appliances (by Dentist/Orthodontist). (LOC: RR)
  • Moderate to Severe cases (adolescents/adults): Fixed appliances (braces) (by Orthodontist). (LOC: RR)
  • Severe Skeletal Discrepancies: Orthognathic surgery (jaw surgery) combined with orthodontics (by Oral & Maxillofacial Surgeon/Orthodontist team). (LOC: RR)
  • Specific indications needing treatment: Crossbites with functional shift, Deep traumatic overbite, Large overjets (>6-9mm), Severe crowding impacting periodontal health.

Monitoring

Regular follow-up during active orthodontic treatment. Long-term retainer wear often needed after treatment.

Complications

  • Poor aesthetics / Psychosocial impact.
  • Difficulty maintaining oral hygiene -> Increased risk of caries/periodontal disease.
  • Increased risk of trauma to protruding teeth.
  • Temporomandibular Joint (TMJ) dysfunction.
  • Speech difficulties.
  • Chewing inefficiency.

Prevention

  • Discourage prolonged thumb sucking/pacifier use.
  • Early management of premature primary tooth loss (space maintainers).
  • Regular dental check-ups for early detection.

Patient education

  • Explanation of the type of malocclusion.
  • Reasons for treatment (function, aesthetics, health).
  • Treatment options (observation, removable/fixed appliances, surgery).
  • Duration and cost of treatment.
  • Importance of excellent oral hygiene during treatment.
  • Need for retainers after treatment.

Uganda-specific notes

Access to orthodontic and orthognathic surgical care is very limited and primarily available in specialized private or referral centres. Focus is often on managing functional issues.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 23, Section 23.1.3

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