Overview

Proper dental health is essential for overall well-being, and one crucial aspect of this is maintaining optimal tooth alignment.¹ The US National Library of Medicine and National Institutes of Health define malocclusion as the improper alignment or positioning of the teeth.² 

Whether the misalignment or improper positioning of the teeth warrants orthodontic treatment, considering the potential negative impacts on the individual's oral health, social functioning, or psychological well-being remains essential.³ This article focuses on the necessity of orthodontic treatment as a misaligned / maloccluded tooth has a negative impact not only on oral health but also on overall health.

What is orthodontics?

It is a specialised treatment of dentistry which corrects misaligned teeth.⁵ The treatment is divided into four types:

• Preventive orthodontics: Preventive orthodontic treatment aims to preserve the integrity of the normal bite configuration at a specific point in time 
• Interceptive orthodontics: The phase of orthodontics focused on recognising and correcting potential irregularities and misalignments in the developing dentofacial complex to establish normal occlusion at a specific time 
• Corrective orthodontics: Corrective orthodontics acknowledges the presence of malocclusion and the necessity of utilising specific technical interventions 
• Surgical orthodontics: Surgical orthodontics, as the term implies, encompasses the surgical procedures performed before, during, or after active orthodontic treatment 

Importance of orthodontic treatment

The decision to recommend orthodontic treatment involves evaluating whether the misalignment of the teeth has or will have negative impacts on the individual's oral health, social well-being, or psychological well-being.³ 

Malocclusion may have unintended negative consequences for oral health, such as an elevated risk of tooth loss (e.g., due to subsequent periodontal disease, cavities, or injury), and problems with the functioning of the temporomandibular joints and muscles. Some bad oral habits like thumb sucking, tongue thrusting, nail biting, and lip biting are responsible for triggering malocclusion. Some genetic factors are also responsible for malocclusion.¹³

Oral health

Properly aligned teeth help in the effective mechanical removal of dental plaque to prevent its accumulation.¹ The entire microbial community within the accumulated plaque on tooth surfaces and in the gingival crevice contributes to the development of dental caries, gingivitis and periodontal disease.⁴ Hence, orthodontic treatment may be necessary to prevent early tooth decay.

Psychological health

Dental malocclusion, a prevalent developmental disorder, can adversely affect the well-being of children and their families. This condition may lead to psychosocial difficulties, speech and chewing challenges, increased risk of injury from accidents or falls, and compromised periodontal health.⁶ So, orthodontic treatment is essential for psychological health.

Systemic health

Periodontal diseases and dental caries are two widespread chronic health conditions that have detrimental effects not just within the mouth, such as tooth loss, facial pain, and dry mouth, but also on the cardiovascular system and pneumonia risk.¹ 

The close link between periodontitis and various systemic conditions has been attributed to multiple factors, including the widespread circulation of periodontal pathogens and the systemic dissemination of local inflammatory mediators.⁷ Periodontal disease is triggered by a diverse community of aerobic and anaerobic bacteria known as dental plaque, which builds up on the tooth surface due to inadequate oral hygiene practices.⁸ 

So, malocclusion has an indirect effect on systemic health through oral diseases, as more plaque accumulates in misaligned teeth.⁹ Treatment of malocclusion by orthodontic treatment may play a crucial role in systemic health as well. 

Temporomandibular joint disorder (TMJ)

The most common signs and symptoms of temporomandibular disorders (TMD) are temporomandibular joint sounds and difficulty in jaw movement. Certain specific types of malocclusions, like open bite, posterior crossbite, and deep bite, are the most prevalent types of malocclusions and are significantly associated with the occurrence of TMD.¹¹

If the patient is experiencing severe TMJ pain, a dental appliance that permits contact only between the front/anterior teeth can provide short-term relief. Additionally, a soft vinyl mouthguard may help cushion the impact on the temporarily misaligned teeth.¹²

Nutritional deficiency 

Malocclusion can also lead to the development of chewing difficulties, including pain in the jaw during mastication. Malocclusion can also present as misaligned teeth, including tilting, protrusion, or crowding. This can negatively impact chewing ability.¹³

Impaired chewing ability can lead to changes in the physical properties of chewed food, which may subsequently impact swallowing function, digestion dynamics, and nutritional status.¹⁴

Benefits of orthodontics on quality of life

Individuals are often preoccupied with their facial region, as it is the primary focus of attention during social interactions and the primary means of communication. Consequently, patients who pursue orthodontic treatment are primarily concerned with enhancing their appearance and social acceptance rather than improving their oral function or health. Improving these quality-of-life aspects is a key motivation for seeking orthodontic intervention.²¹ 

Orthodontic treatment has been shown to have a positive psychological impact, with individuals experiencing significant improvements in self-esteem and social interactions. Additionally, there were notable changes in the functional and aesthetic aspects of quality of life for those who underwent orthodontic treatment. 

The severity of malocclusion negatively affects the quality of life, but significant improvements were observed following orthodontic intervention, regardless of gender.²² A standard of health in the oral and related tissues that enables an individual to eat, speak, and socialise without active disease, discomfort, or embarrassment and which contributes to overall well-being, is called oral health-related quality of life. Malocclusion has an impact on social well-being and behaviour.¹⁰ The quality of life may improve by undergoing orthodontic treatment.

Initial effect of orthodontic treatment

Although minimising patient pain and discomfort is a top priority for clinicians, it has not yet become possible to eliminate all pain, despite major advancements in understanding the mechanisms of pain and the introduction of new pain management approaches. 

Patients experienced initial pain at 2 hours, which reached its maximum intensity at 24 hours and had subsided by the third day.^18,19

Fixed orthodontic treatment initially has a negative effect on patients' overall oral health-related quality of life (OHRQoL) during the first 3 months of therapy. However, OHRQoL scores later returned to pre-treatment levels, and patients also experienced a significant boost in self-esteem because of the orthodontic treatment.²⁰

Prevalence of orthodontic treatment

Conventional occlusal assessments determine orthodontic treatment requirements primarily from a clinician's viewpoint, often disregarding the patients' perceptual, functional, and social needs.¹⁵ However, there has been a growing focus on correlating occlusal indices with individuals' perceptions of their need for orthodontic treatment and its impact on their quality of life. A patient's self-perception significantly influences their desire for and engagement with treatment. Additionally, parents play a crucial role in motivating patients to seek orthodontic care.

Orthodontic patients have aesthetic goals that encompass the final aesthetic outcome as well as the choice of appliances used during treatment. Additionally, patients' personality characteristics can shape their perceptions, selection of treatment options, expectations, adherence, and satisfaction with the treatment results, despite the limited research examining the relationship between personality and orthodontic appliances. An individual's personality characteristics significantly impact their perception of aesthetics and can influence their orthodontic treatment decisions.¹⁶

New research about orthodontic treatment

New research found that orthodontic treatment has been shown to improve oral health-related quality of life (OHRQoL), and the complexity of the orthodontic treatment does not appear to affect OHRQoL significantly. Treatment complexity and malocclusion severity are distinct concepts, yet they both reflect the same underlying condition, consequently, they are interconnected. Individuals with moderately complex orthodontic treatment experienced a notably adverse impact on their psychological well-being compared to those with more complex treatment. However, overall oral health-related quality of life (OHRQoL) was enhanced following the completion of orthodontic therapy.¹⁷ 

It was found that adolescents who finished their orthodontic treatment reported better oral health-related quality of life compared to those still undergoing treatment or those who never received orthodontic care.²³ 

Studies have shown that females generally report poorer oral health-related quality of life compared to males. This gender disparity in perceiving malocclusion may stem from females' greater focus on their appearance, leading them to seek orthodontic care more frequently than males. Additionally, there has been a growing demand for orthodontic treatment among adults, with the primary motivation being the social and psychological benefits associated with orthodontic therapy.¹⁷

Summary

Orthodontic treatment may have a great impact on overall health, as malocclusion causes suffering to patients. Nowadays, the demand for orthodontic treatment has increased not only for functional outcomes but also for aesthetic considerations. In future, new advancements in orthodontic treatment will be necessary to prevent discomfort during the treatment period.