In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet. The malocclusion classification is based on the relationship of the mesiobuccal cusp of the maxillary first molar and the buccal groove of the mandibular first molar.  If this molar relationship exists, then the teeth can align into normal occlusion. According to Angle, malocclusion is any deviation of the occlusion from the ideal. However, assessment for malocclusion should also take into account aesthetics and the impact on functionality. If these aspects are acceptable to the patient despite meeting the formal definition of malocclusion, then treatment may not be necessary. The aetiology of malocclusion is somewhat contentious however; simply put it is multifactorial, with influences being both genetic and environmental. Malocclusion is already present in one of the Skhul and Qafzeh hominin fossils and other prehistoric human skulls. There are three generally accepted causative factors of malocclusion:nSkeletal factors – the size, shape and relative positions of the upper and lower jaws. Variations can be caused by environmental or behavioral factors such as muscles of mastication, nocturnal mouth breathing, and cleft lip and cleft palate. Muscle factors – the form and function of the muscles that surround the teeth.  This could be impacted by habits such as finger sucking, nail biting, pacifier and tongue thrusting. Dental factors – size of the teeth in relation to the jaw, early loss of teeth could result in spacing or mesial migration causing crowding, abnormal eruption path or timings, extra teeth (supernumeraries), or too few teeth (hypodontia) There is not one single cause of malocclusion, and when planning orthodontic treatment it is often helpful to consider the above factors and the impact they have played on malocclusion. These can also be influenced by oral habits and pressure resulting in malocclusion. In the active skeletal growth, mouthbreathing, finger sucking, thumb sucking, pacifier sucking, onychophagia (nail biting), dermatophagia, pen biting, pencil biting, abnormal posture, deglutition disorders and other habits greatly influence the development of the face and dental arches. Pacifier sucking habits are also correlated with otitis media. Dental caries, periapical inflammation and tooth loss in the deciduous teeth can alter the correct permanent teeth eruptions. Malocclusion is a common finding, although it is not usually serious enough to require treatment. Those who have more severe malocclusions, which present as a part of craniofacial anomalies, may require orthodontic and sometimes surgical treatment (orthognathic surgery) to correct the problem. The ultimate goal of orthodontic treatment is to achieve a stable, functional and aesthetic alignment of teeth which serves to better the patient's dental and total health. The symptoms which arise as a result of malocclusion derive from a deficiency in one or more of these categories.

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Regards,
Catherine
Journal Co-Ordinator
Journal of Orthodontics and Endodontics