The report is available in English with a a French summary - KCE
The report is available in English with a a French summary - KCE
The report is available in English with a a French summary - KCE
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26 Orthodontics <strong>KCE</strong> Reports 77<br />
PERIODONTAL PROBLEMS<br />
Some malocclusion features such as crowd<strong>in</strong>g <strong>with</strong> d<strong>is</strong>placement of the contact-po<strong>in</strong>ts<br />
of the teeth and large overjet and some habits such as mouth breath<strong>in</strong>g have been<br />
related to g<strong>in</strong>givit<strong>is</strong>. However the strength of these associations <strong>is</strong> only weak to<br />
moderate 4 . It should be noted that search description nor appra<strong>is</strong>al criteria of th<strong>is</strong><br />
review were given. Probably there <strong>is</strong> a significant association between these features and<br />
g<strong>in</strong>givit<strong>is</strong>, when the oral hygiene <strong>is</strong> fairly average to poor, as was revealed <strong>in</strong> a study of<br />
A<strong>in</strong>amo (1972) 4 , n<br />
<strong>The</strong> systematic review of the Swed<strong>is</strong>h Council on Technology Assessment <strong>in</strong> Health<br />
Care 2 found <strong>in</strong>sufficient evidence to conclude on the relationship of untreated<br />
malocclusions and periodontal problems.<br />
Because the lack of good evidence, the need for further randomized controlled trials <strong>is</strong><br />
urgent <strong>in</strong> th<strong>is</strong> field.<br />
MALOCCLUSION AND CARIES<br />
Sometimes it <strong>is</strong> claimed that persons <strong>with</strong> certa<strong>in</strong> types of malocclusion, e.g. crowd<strong>in</strong>g,<br />
are more prone to caries because of more difficulties <strong>with</strong> brush<strong>in</strong>g and oral hygiene as<br />
a whole. In these cases, it <strong>is</strong> assumed that orthodontics can help to prevent caries.<br />
However, the systematic review of the Swed<strong>is</strong>h Council on Technology Assessment <strong>in</strong><br />
Health Care 2 found evidence, but only of low quality, for the statement that<br />
malocclusion <strong>is</strong> not associated <strong>with</strong> a higher frequency of caries.<br />
MALOCCLUSION AND SPEECH PROBLEMS<br />
<strong>The</strong> relation between major speech d<strong>is</strong>turbances and malocclusion can rarely be<br />
observed. Consequently a speech d<strong>is</strong>turbance <strong>is</strong> seldom an <strong>in</strong>dication for the onset of<br />
an orthodontic treatment. Children <strong>with</strong> a speech deviation should preferably be<br />
referred to a phonetician or speech therap<strong>is</strong>t 4<br />
In a review Johnson et al (1999) stated that although it <strong>is</strong> accepted that teeth play an<br />
important role <strong>in</strong> speech production, the relationship between tooth position and<br />
speech rema<strong>in</strong>s controversial. <strong>The</strong>re was found no def<strong>in</strong>itive proof that alteration of<br />
tooth position can improve articulation d<strong>is</strong>orders and th<strong>is</strong> while certa<strong>in</strong> dental<br />
irregularities show a relationship <strong>with</strong> speech d<strong>is</strong>orders, th<strong>is</strong> does not appear to<br />
correlate <strong>with</strong> the severity of the malocclusion. <strong>The</strong> most cons<strong>is</strong>tently <strong>report</strong>ed traits<br />
are Class III arch relationship, anterior open bite, <strong>in</strong>creased overjet, and spac<strong>in</strong>g.<br />
However, there <strong>is</strong> no clear evidence of a direct relationship between severity of<br />
malocclusion and severity of m<strong>is</strong>articulation (Johnson et al, 1999).<br />
<strong>The</strong> systematic review of the Swed<strong>is</strong>h Council on Technology Assessment <strong>in</strong> Health<br />
Care 2 found <strong>in</strong>sufficient evidence to conclude on the relationship of untreated<br />
malocclusions and speech problems (only one good quality study).<br />
MALOCCLUSION AND RISK ON TRAUMA OF THE FRONT TEETH<br />
Some limited scientific evidence was found that <strong>in</strong> patients <strong>with</strong> a large overjet and an<br />
upper lip that does not protect the front teeth, the <strong>in</strong>cidence of trauma to the anterior<br />
teeth of the maxilla <strong>is</strong> higher 2 , 9 .<br />
More specifically Nguyen et al (1999) 10 found that children <strong>with</strong> an overjet larger than 3<br />
mm were approximately twice as much at r<strong>is</strong>k of <strong>in</strong>jury to their anterior teeth as were<br />
children who had an overjet of less than 3 mm. Furthermore <strong>with</strong> <strong>in</strong>creas<strong>in</strong>g overjet the<br />
r<strong>is</strong>k of <strong>in</strong>jury <strong>in</strong>creased. <strong>The</strong>re was also a difference between girls and boys, namely that<br />
the effect of <strong>in</strong>jury to anterior teeth <strong>is</strong> less for boys than for girls <strong>in</strong> the same overjet<br />
group. Th<strong>is</strong> meta-analys<strong>is</strong> <strong>is</strong> of good quality. However the conclusions should be<br />
considered <strong>with</strong> some caution because of the heterogenity <strong>in</strong> outcome of some of the<br />
selected studies, the sizes of the control groups which were even lack<strong>in</strong>g <strong>in</strong> some of the<br />
n Th<strong>is</strong> <strong>is</strong> confirmed <strong>in</strong> the review of van Gastel J et al. (2007), which was publ<strong>is</strong>hed <strong>in</strong> 2007, Nov., after the<br />
database search of th<strong>is</strong> <strong>report</strong> had been closed.