ETIOLOGY OF

MALOCCLUSION
LECTURE II
15.06.2005
BY

DR. ULFAT BASHIR

MCPS, FCPS (Orthodontics)
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ASSISTANT PROFESSOR
Moyer’s Classification
Heredity
Developmental causes of unknown origin
Trauma
Physical agents
Habits
Disease
Malnutrition

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SALZMAN’S CLASSIFICATION

PRE-NATAL POST-NATAL
Genetic Developmental
Differentiative Functional
Congenital Environmental

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WHITE & GARDINER’S
CLASSIFICATION

Dental Base Abnormalities

Pre-eruption Abnormalities
Post-eruption Abnormalities

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GRABER’S CLASSIFICATION
Generalized Factors
Localized Factors

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 Disturbances in Embryological
Development
Lethal embryological defects effect so early that the
mother is even unaware about her conception

Teratogens:
Chemical & other agents capable of producing
embryological defects if given at the critical time
are called teratogens

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 Disturbances in Embryological
Development
Teratogens:
Aspirin, Cigarette smoke, Cytomegalovirus,
Dialntin, Ethyl alcohol, retinoic acid, Rubella virus,
Thalidomide, X-radiations, Valium, etc

Generally cause:
Cleft lip & palate, Microcephaly, Hydrocephaly,
Hemifacial microsomia, Mid-face deficiency, etc

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Malocclusion status in U.S.A.

1. 5 % cause known
2. 35 % Normal Occlusion
3. 60 % malocclusion cause unknown

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DISTURBANCES IN EMBRYOLOGICAL
DEVELOPMENT

Syndromes:
Down’s
Cleido-cranial Dysplasia
Crouzon’s
Treacher Collin’s
Di George
Pierr Robin Sequence
Apert’s

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 SKELETAL GROWTH DISTURBANCES:
Fetal Molding & Birth Injuries
Injuries are apparent at birth
A. Intra-uterine Molding
a. Deficient Maxilla
Pressure against developing face by any part of the
body
b. Pierr Robin Sequence
Mechanical cause or
Genetic cause
Whatever the cause the features are:
Micrognathia
Cleft palate
Glosso-ptosis
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Respiratory embracement
 B. Birth Trauma
Use of forceps in child birth

Many of the syndromes are blamed to the doctors,

when are seen at birth

Although use of forceps has been reduced for the

last 50 yrs or so, but the prevalence of class II
malocclusions with mandibular deficiency has not
decreased

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 Childhood Fracture of the Jaw
Child fall & mandibular neck fracture

but 75 % children recover well with normal

mandibular growth

Growth of mandible is affected more when

excessive scar tissue restricts the normal growth
movements

Asymmetric growth of jaw may result

Open reduction or early mobilization

is to be decided 12
 Muscle Dysfunction
Excessive or reduced muscle function
Loss of muscle or its nerve supply
a. Muscular dystrophy
b. Cerebral palsy
c. Torticollis
Excessive muscle contraction (Sternocleidomastoid)
can restrict the growth on one side & cause facial
asymmetry
Surgical resection of the muscle at early age is required

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 SKELETAL GROWTH
DISTURBANCES:

Acromegaly

Hemimandibular Hypertrophy (Condylar Hyperplasia)

Hemifacial microsomia

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