1.

Malocclusion Types
Malocclusion can result from jaw length and/or width discrepancy (skeletal malocclusion),
from tooth malpositioning (dental malocclusion), or a combination of both. The development
of the occlusion is determined by both genetic and environmental factors. Specific genetic
mechanisms regulating malocclusion are unknown. However, a polygenic mechanism is
likely and explains why not all siblings in successive generations are affected by
malocclusion to the same degree, if at all. With a polygenic mechanism, the severity of
clinical signs is linked to the number of defective genes. The most reasonable approach to
evaluate whether malocclusion is hereditary or acquired is as follows:
 Skeletal malocclusion is considered inherited unless a developmental cause can be
reliably identified.
Pure dental malocclusion, unless known to have breed or family predisposition,
should be given the benefit of the doubt and is not necessarily considered to be
inherited.

An outline of the more common types of malocclusion is given below.

Skeletal Malocclusion

Mandibular Prognathic Bite: In the mandibular prognathic bite, often called undershot,
the mandible is longer than the maxilla and some or all of the mandibular teeth are rostral to
their normal position. If the dental interlock prevents the mandible from growing rostrally to
its full genetic potential, lateral or ventral bowing of the mandible may occur to
accommodate the shortening in length. This results in an open bite and is characterized by
increased space between the premolar cusp tips. In addition, the caudal angle of the mandible
is caudal to the temporomandibular joint to accommodate the extra length of the mandible.

Mandibular prognathic (undershot) bite

Mandibular Brachygnathic Bite: A mandibular brachygnathic bite, often called overshot,

and occurs when the mandible is shorter than normal. This often results in the mandibular
canine teeth contacting the palate, causing trauma.

Mandibular brachygnathic (overshot) bite

Wry Bite: A wry bite occurs if one side of the head grows more than the other side. In its
mildest form a one-sided prognathic or brachygnathic bite develops. In more severe cases, a
crooked head and bite develop with a deviated midline. An open bite may also develop in the
incisor region so that the affected teeth are displaced vertically and do not occlude.
 Wry bite

Narrow Mandible: In some animals, the mandible is too narrow with respect to the upper
jaw. The result is that the lower canines impinge on the maxillary gingivae or the hard palate
instead of fitting into the diastema between the upper third incisor and upper canine on either
side. The animal may not be able to close its mouth and injury to the gingivae or palatal
mucosa commonly occurs. In severe, untreated cases an oronasal communication may
develop over time. This condition is seen in both the primary (deciduous) and permanent
dentition. Persistent mandibular primary canines will further exacerbate the condition, as the
permanent mandibular canines erupt medially to their primary counterparts. The incorrect
dental interlock will interfere with the normal growth in width and length of the developing
mandible. The condition can also be caused by persistent primary mandibular canines in a
mandible of normal width.

Dental Malocclusion

Dental malocclusion is malpositioning of teeth where there is no obvious skeletal

abnormality, i.e. there is no jaw length or width discrepancy.

Anterior Crossbite: This is a clinical term used to describe a reverse scissor occlusion of
one, several or all of the incisors. The condition can be secondary to persistent primary
incisors. However, there is probably a skeletal origin as well, since affected animals often
develop a mandibular prognathic bite. In other words, an anterior crossbite in an immature
animal may be the first sign of a developing mandibular prognathism. The cause can either be
a dental malocclusion (i.e. linguoversion of the upper incisors) or a skeletal malocclusion (i.e.
mandibular prognathism or maxillary brachygnathism).

Anterior crossbite
Malocclusion of the Canine Teeth: The two most common abnormalities in canine tooth
position are:

Rostral displacement (mesioversion) of the maxillary canines (also known as lance

canines). Persistent primary canines may be responsible for this condition. A breed
predisposition has been reported in the Shetland sheepdog.
Medial displacement of the lower canines.

Medial displacement of lower canines

Malocclusion of the Premolars and Molars: Posterior crossbite is used to describe an

abnormal relationship of the carnassial teeth, seen commonly in the dolicocephalic breeds,
where the normal buccolingual relationship is reversed.

Classification of Malocclusion
Class 1 Malocclusion

Also called neutroclusion, this describes a normal rostral-caudal relationship of the

maxillary and mandibular dental arches but there is malposition of one or more individual
teeth.

Class 2 Malocclusion

Also called mandibular distoclusion, mandibular brachygnathism or mandibular

retrognathism.

In layman's terms this is referred to as an overshot jaw or a parrot mouth.

This describes an abnormal rostral-caudal relationship between the dental arches in which the
mandibular arch occludes caudal to its normal position relative to the maxillary arch.

Breeds commonly affected include the Rough Collie and the Borzoi.

Class 3 Malocclusion

Also called mandibular mesioclusion, mandibular prognathism.

In layman's terms this is referred to as an undershot jaw.

This describes an abnormal rostral-caudal relationship between the dental arches in which the
mandibular arch occludes rostral to its position relative to the maxillary arch.

One of the breeds most commonly affected is the Boxer.

2. A shallow overbite is when the upper front teeth or upper incisors minimally cover the
lower incisors. When the bite is shallow or open, the teeth in the front barely overlap or do
not touch at all.

3. What are the factors that affect the position of the mandible towards the cranium?

4.
5. clicking and crepitasi

The Basic Make-up Of The TMJ

The jaw (TMJ) is made up of the jaw bone or mandible and the temporal bones of the skull.
The anatomical term for the jaw joint is the temporomandibular joint or TMJ. You would
have a left and right TMJ. The jaw joint (TMJ) is surrounded by a capsule or envelope.
Separating the mandible bone from the temporal bones in each joint is a disc. This serves to
cushion the bones and prevent wear and tear of the bone surfaces. Keeping the disc and joint
in a stable position are a series of ligaments. The jaw functions by virtue of many muscles as
they open close and move the jaw in the necessary movements required for normal function
such as eating & speaking.

What Makes The Noisy Clicking Sound In The Jaw (TMJ)

FIG 1 showing the disc clicking out (2nd picture) and then back into position (3rd picture)

Remember from the description of the jaw above that we said that there was a disc separating
the mandible bone (the lower jaw) from the temporal bone. This disc can become displaced
forwards due to a number of factors. When this disc re-locates back to its normal position a
clicking noise is heard. Clicking thus indicates that there is an issue with the disc position.

What Causes Problems With The Disc Resulting In Clicking?

The back of the disc is secured to the joint by a ligament. If this ligament becomes stretched
as a result of excessive forces on the joint from clenching, grinding, or extended mouth
opening or trauma, then then disc may become dislodged forwards. Another reason the disc
can become dislodged forwards is that a muscle that attaches to the disc (the lateral pterygoid
muscle), can become over active or go into spasm. When this happens it pulls the disc into an
incorrect position. The relocation of the disc into the correct position results in the click.
Clicking that occurs on both opening and closing of the mouth is called a reciprocal click. As
the disc problem becomes more severe, the disc may not be able to be relocated and will
result in a loss of opening of the mouth (jaw locking). When this occurs your clicking will
have stopped as the disc is unable to click back into place. This is a much more severe
problem and requires immediate treatment.

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Crepitus

Crepitus is the scientific word for grinding in the jaw joint. This sound occurs when your
bones are actually grinding together. This occurs when the cushioning disk has been damaged
by wear, constant displacement, injury, or disease. Grinding may also occur when the disk is
displaced and the joint is now resting on the soft tissue designed to hold the disk in place, not
cushion the bones.

One of the most common signs of a TMJ problem is a temporomandibular joint which is
making noise such as clicking, popping or grating sounds. This clicking sound occurs when
the condyle moves forward when the patient opens the mouth and the condyle slips on and
off the dislocated disc. The grating sound, called crepitus, is the sound of bone rubbing on
bone and occurs later on when the dislocated discs become completely deformed. Another
sign of TM joint dysfunction occurs when the jaw either locks open or closed. Our objective
in the treatment of TMJ disorders is to try and correct the problem of the dislocated disc early
in treatment when the jaw is clicking and not wait until the later stages when the grating
sound is louder and the patient may experience an extremely painful situation if the jaw locks
open or closed.

TMJ Anatomy

The temporomandibular joint (TMJ) is the joint connecting the lower jaw (mandible) to the
(temporal bone). The lower jaw and the skull are connected by a number of muscles and
ligaments which function in harmony with each other if the lower jaw is in the correct
position. The head of the jaw bone (lower jaw) is called the condyle and it fits into the
concavity of the temporal bone called the glenoid fossa. The TM joint resembles a ball and
socket with the round condyle being the ball and the glenoid fossa of the temporal bone being
the socket. For normal joint function to occur, a piece of cartilage called an articular disc acts
as a cushion or shock absorber between the two bones.
When the lower jaw opens and closes, the disc stays between the condyle and the glenoid
fossa of the temporal bone at all times. When this happens, this is a normal healthy TMJ and
the patient can open wide without any discomfort and without any noise. With a normal
opening, the patient should be able to get three fingers between the upper and lower front
teeth when the mouth is open as wide as possible. In cases where the TM joint is functioning
normally with the disc in the proper position, the muscles of the head, neck, and shoulders
function relatively pain-free.

Jaw Joint Displacement

Jaw Joint Displacement The position of your teeth can also affect the position of your jaw
joints. Each jaw joint is a ball and socket joint. When functioning properly, the ball and
socket do not actually touch because a thin disc of cartilage rides between them. The disc acts
as a cushion and allows the joint to move smoothly. Each disc is held in place and guided by
muscle. If your bite is not right, the joint is pulled out of alignment. Typically the disc is
pulled forward. Since it no longer serves as a cushion, the joint itself now rubs against the
boney socket and presses on pain fibres. Mild displacements cause a clicking or popping
sound in the jaw joint; more severe displacements can be very painful and eventually can
cause permanent damage to the joint. An unstable bite can cause both jaw joint displacement
and muscle strain and pain. Many seemingly unrelated symptoms result which are
collectively known as craniomandiular dysfunction. When this condition is prolonged, the
body begins to compensate and adapt by involving muscles in the neck, back and sometimes
those of the arms, fingers, pelvis, legs and feet.
6. assesment of this scenario

7. What are the effects if the teeth can not occlude well?

Tooth Decay
Malocclusion (the medical term for over-crowded or crooked teeth) isnt just an issue for the
mirror an overcrowded mouth can actually lead to tooth decay. Because crowded teeth are
much more difficult to clean properly, patients may struggle with oral hygiene despite their
best efforts. Flossing can be challenging if teeth are grouped too tightly, and brushing might
not reach all the hiding places where bacteria live.

At first glance, its easy to think a cavity here or there is a discrete problem affecting only
your mouth, but a growing body of scientific evidence is showing that oral decay is linked to
systemic problems like heart disease and alzheimers!

Worn tooth enamel

This is actually another reason why malocclusion can cause tooth decay. If teeth arent
aligned properly, certain teeth may get worn down simply by talking, chewing, and going
about the business of being a person.

The reason why your Portland orthodontist is concerned about worn tooth enamel is that this
leads to tooth decay; your enamel is the hardest substance in your body, and it protects the
softer parts of your teeth from invasion by microbes. When enamel is broken down by
abnormal wear and tear, your teeth are susceptible to cavities.

Speech problems
The shape of our mouths is critical when it comes to forming words and communicating.
Malocclusion in younger children can lead to speech problems or difficulty in shaping the
words they are just beginning to know.

Speech problems can have a significant impact on a childs self-esteem, social interactions,
and how he or she performs in school. This is a critical example of how widely malocclusion
can affect an individuals life.

Chewing and jaw problems

On top of abnormal wear and tear to teeth, resulting in the uneven erosion of enamel and
consequent susceptibility to cavities, this abnormal wear can also result in jaw pain, or TMJ.
This is because the human jaw has evolved to operate based on a pretty much one type of
tooth arrangement. Uneven teeth can impact the muscles of the jaw, causing long term
problems.

Additionally, patients with malocclusion are actually more vulnerable to poor digestion
because their teeth are less adept at proper chewing. So in addition to a sore jaw, they may
also be suffering from a belly ache!