Chapter 376

Dental occlusion is the term used to describe the relationship of the maxillary and mandibular teeth to each other when in contact and the relationship of the teeth to one another within each jaw. The American Academy of Pediatric Dentistry “recognizes the importance of managing the developing dentition and occlusion and its effect on the well-being of children, adolescents, and adults.” Such management requires the appropriate and timely diagnosis of any developing malocclusion and the ability to either provide the proper treatment or to refer the patient to the appropriate specialist for treatment, with the ultimate goal of obtaining a stable, functional, and esthetically pleasing occlusion in the permanent dentition.1

In order to establish a definitive diagnosis and formulate a comprehensive plan to treat the presenting malocclusion, preliminary information must be acquired from a clinical exam, radiographs, dental casts, and photographs. However, the pediatrician is uniquely positioned to clinically detect many malocclusions in the course of his or her routine medical practice. This chapter covers the stages of dental development and normal occlusion and provides basic knowledge regarding the most common types of malocclusions seen in children. A more detailed description of relevant oral and dental anatomy is provided on the textbook DVD and in eFigure 376.1. The information contained herein is essential if the clinician wishes to recognize malocclusions that may benefit from treatment and to evaluate the effectiveness of any treatment rendered.

###### eFigure 376.1.

Schematic longitudinal section through a tooth and supporting structures.

### Hard Tissues

Tooth tissues grow in a similar manner to skeletal bones. Each tooth has a very specific, genetically determined shape and location (Fig. 376-1). Normal structural development requires that the tissues calcify in a manner somewhat similar to the formation of skeletal bones (eFig. 376.1). Three forms of an organic matrix calcify to varying degrees to form different components of the tooth. The tooth above the gingival margin, known as the crown, is covered by enamel, which is an organic matrix closely resembling hydroxyapatite in bone. When mature, enamel is very hard and is approximately 96% inorganic in an organic matrix. Dentin is the calcified tissue that makes up the bulk of the crown and root of the tooth. It is only 20% organic by weight. Collagen fibers make up about 18% of this weight, and the remaining inorganic portion is in the form of hydroxyapatite crystallites. Cementum is the dental tissue covering the anatomic root of the tooth, from the point at which the enamel layer ends to the apex of the root. The point where the enamel ends and the cementum starts is the cervix of the tooth or the cementoenamel junction (CEJ). The density of cementum is less than that of dentin and is about 50% inorganic. Connective tissue fibers from the periodontal ligament or membrane ...

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