The report is available in English with a Dutch summary - KCE

KCE Reports 77 Orthodontics 55
Measures can however be taken to prevent a malocclusion to be aggravated by
environmental factors like tooth loss due to bad oral hygiene and trauma, ... Also
functional factors like tongue habits during deglutition, during speech and in rest, are
claimed to play a role in the development / maintenance of orthodontic problems. The
decreasing use of bite force during mastication due to modern food consistency led to
the hypothesis that the increasing prevalence of malocclusions in present Western
populations is due to increasing soft diet consumption (Corrucini, 1999) gg . On the other
hand, Australian research in twins suggested an increasingly genetic determination of
malocclusion, explained by the environmental withdrawal theory hh . Those theories
remain to be confirmed.
Most measures that can be taken are thus not strictly preventive (to avoid the
malocclusion to develop), but they are interceptive, i.e. already corrective in an early
stage of the primary or mixed dentition in order to 'prevent' a worse situation later on
in the permanent dentition.
The purpose of such measures is thus to prevent more complex malocclusions to
develop and to reduce the need and/or complexity of any orthodontic treatment later
in the permanent dentition 80 , 83 . Basic principles of early intervention are technically
simple and aim to eliminate any primary etiological factors, to manage arch length
discrepancies and to correct mild skeletal deviations 83 .
The percentages of children who would benefit from interceptive orthodontics 109 varies
from 15-20% to even 49%.
These numbers should be treated cautiously, since the review of Wong et al was not
performed systematically, and no critical appraisal of the included references was
performed. In another study 110 , that was performed prospectively, it was estimated that
33% of the children had an interceptive treatment need. However, the evaluation was
performed by orthodontic practitioners, and it has been described that in this case
overestimation of treatment need is not exceptional 74, 76 .
Although many authors claim that the most favourable ages for interception are
between 9 to 11 years, some propose interceptive measures between 4 and 8 years of
age ii . The American Academy of Pediatric Dentistry advises a first screening for
orthodontic need before the age of 6 years.
The most important way to prevent orthodontic problems is a screening around the
age of 9 years, combined with regular dental visits 110 . Some authors propose an earlier
screening between 4 and 6 years of age jj . The preservation of a healthy primary
dentition until the time of normal shedding is of outmost importance of the normal
eruption of premolars and canines 83 .
The interceptive treatment possibilities for crowding include space maintenance, space
management and extractions 110 . However there is poor evidence to recommend for or
against space maintainers 83 , 73 .
Also large overjets > 6 mm, which may predispose for traumatic injuries of the upper
front teeth and forced lateral and protral cross bites are features that may benefit from
interceptive treatment 110 , 109 .
But it was found that the early reduction of an increased overjet was not very
productive 77 .
gg Corrucini R. (1999). How anthropology informs the orthodontic diagnosis of malocclusion's causes.
Mellen Studies in Anthropology, Volume 1; Editor: The Edwin Mellen Press, Lewiston . Queenston.
Lampeter, UK
hh Corrucini R. (1999). How anthropology informs the orthodontic diagnosis of malocclusion's causes.
Mellen Studies in Anthropology, Volume 1; Editor: The Edwin Mellen Press, Lewiston . Queenston.
Lampeter, UK
ii Personal communication, Prof dr M Limme at Expert meeting KCE, the 11th of December 2007.
jj Personal communication, Prof dr M Limme at Expert meeting KCE, the 11th of December 2007.