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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
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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.
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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 become ...