Facial growth and management of orthodontic problems

This article provides pediatricians with information for recognizing malocclusion of the teeth and associated discrepancies in the relationship between the upper and lower jaws in children and adolescents. It also provides an overview of the treatment recommended for these problems. Additionally, the management of children with special craniofacial needs is reviewed in the context of a team approach. The prevalence of malocclusion in the United States is estimated as 35% to 95% of the population Typically, dental malocclusion reflects normal biological variation, and this wide range in estimated prevalence reflects a lack of defined criteria to characterize malocclusion(9); however, the large-scale National Survey of Health Care Problems and Needs in the United States in 1988-1991 (NHANES III) has provided the first good data set for malocclusion in children and adults.(9) Although prevalence figures are now available, the need for treatment is more difficult to define because psychosocial and facial aesthetic considerations contribute to the desire for orthodontic treatment rather than just dental esthetic and functional occlusal demands. Moderate to severe treatment need is estimated approximately at 30% to 40% of the population, depending on ethnic background.(39) The cause of malocclusion is primarily developmental, with genetic and environmental influences contributing to skeletodental development. Malocclusion and dentofacial deformity are part of a spectrum of variation, with dentofacial deformities being at the extremes, but without a superimposed pathogenesis. Clefts of the lip or palate are the most common craniofacial anomalies, with an incidence of approximately 1 in 700 live births per year.