– Dr Adith Venugopal
Orthodontic treatment is considered all about straightening teeth and there is a common notion that it adds not much of a significance systemically, apart from being an adjunct cosmetic procedure. Periodontitis, usually resulting from inadequate oral hygiene and care, is a common sequelae of malocclusion or misaligned teeth, and has been proved to be responsible in increasing the risk of coronary heart disease, asthma, premature childbirth, Alzheimer’s disease and diabetes. Persons with craniofacial deformities or jaw imbalances are known to be less socially acceptable and face many psychological challenges. This may add a stress on the role of malocclusion or misaligned teeth in being a key contributor in many significant systemic and psychosocial diseases.
Keywords: Orthodontics; Systemic Diseases; Psychological challenges
Healthy Oral Cavity = Healthy Body
The oral cavity is the most common port of entry for many microbes into the human body. These microbes are suggested to be responsible for many systemic diseases and disorders.1
A study published in the British Medical Journal examined 9760 subjects longitudinally, and reported that, those with periodontitis had 25% increased risk of coronary heart disease in comparison to those with a healthy periodontium.2 DeStefano F et al 2 also suggested that males with periodontitis and younger than 50 years of age, were 72% more likely to develop coronary heart disease.
A study published in the Journal of Periodontology suggested that subjects with gum or periodontal disease were at least 5 times more likely to develop asthma.3 There are also reports of gum disease being associated with premature childbirth 4 and Alzheimer’s disease.5
A very recent study published by Watanabe et al 6 from Tokyo Medical and Dental University concluded that poor oral hygiene was a significant risk factor of metabolic syndrome, increasing the risk for heart disease and diabetes, by altering the composition of the gut microbiome.
How Can Orthodontics Help in Eluding Systemic Diseases?
Assiduous dental care through proper brushing, rinsing and flossing require good alignment of teeth. Misaligned or overlapping teeth make it difficult for all surfaces to be cleaned, resulting in poor oral hygiene. This may subsequently lead to accumulation of plaque, tartar, and harmful microbes, thereby increasing the risk of caries and periodontal diseases.
The U.S. National Library of Medicine has defined malocclusion as, “teeth that aren’t aligned properly”. Many studies have linked malocclusion to bruxism/night grinding, and altered positioning of the mandible with premature occlusal contacts, that may result in tempero-mandibular disorders (TMD), leading to severe clicking, popping and pain in the tempero-mandibular joints (TMJ).7
Orthodontic screening may lead to the diagnosis of several defects that may have a systemic or psychological implication on the patient. A study by Karen Marie Leavy et al 8 published in the American Journal of Orthodontics and Dentofacial Orthopedics suggested that, the more severe or handicapping the malocclusion, the more likely that a speech sound error or impairment will occur.
Mouth breathing is a common finding during routine orthodontic screenings that is commonly associated with hypertrophy of adenoids and tonsils.9 Monika Šidlauskienė et al 10 have reported that, this finding is very common in children (varying from 40% to 60%) and may be directly associated with a further nasopharyngeal pathology. They also concluded that there was a significant association between the sagittal position of the mandible (SNB angle) and kyphotic posture.10
Any deviation from the ‘norm’ in the form of a simple dental anomaly such as protruded front teeth (commonly referred to as buckteeth) or complex craniofacial deformities (for example protruded, retruded upper and/or lower jaws, cleft deformities, etc.) tend to stigmatize the affected person and make them less accepted in social circles. 11,12 In fact, such individuals have been deemed to be less trustworthy, less intelligent, less successful and less ‘desirable’ in general, which can have an effect on mental health and psychological well being.13
Orthodontic treatment has been vastly known to subjectively and objectively benefit the appearance, oral function, and social well-being of patients 14 by improving the quality of life; mentally, socially, and restoring the ability to clean teeth and gums thoroughly, thereby reducing the predisposition to such abovementioned systemic and psychosocial pathologies.
Having crooked teeth alone, do not predispose us to serious pathologies, but their consequences do.
1. Buehlmann M, Bruderer T, Frei R, Widmer AF. Effectiveness of a new decolonisation regimen for eradication of extended-spectrum β-lactamase-producing Enterobacteriaceae. J Hosp Infect. 2011 Feb;77(2):113-7
3. Gomes-Filho I S, Soledade-Marques K R, Seixas da Cruz S et al. Does periodontal infection have an effect on severe asthma in adults? J Periodontol 2013; 10.1902/jop.2013.130509.
4. Saini R, Saini S, Saini SR. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sci Biol Med. 2010 Jul;1(1):40-2. doi: 10.4103/0976-9668.71672. PMID: 22096335; PMCID: PMC3217279.
5. Abbayya K, Puthanakar NY, Naduwinmani S, Chidambar YS. Association between Periodontitis and Alzheimer's Disease. N Am J Med Sci. 2015 Jun;7(6):241-6. doi: 10.4103/1947-2714.159325. PMID: 26199919; PMCID: PMC4488989.
6. Watanabe K, Katagiri S, Takahashi H, Sasaki N, Maekawa S, Komazaki R, Hatasa M, Kitajima Y, Maruyama Y, Shiba T, Komatsu K, Ohsugi Y, Tanaka K, Matsuzawa A, Hirota T, Tohara H, Eguchi Y, Anzai K, Hattori A, Iwata T. Porphyromonas gingivalis impairs glucose uptake in skeletal muscle associated with altering gut microbiota. FASEB J. 2020 Nov 16. doi: 10.1096/fj.202001158R. Epub ahead of print. PMID: 33197074.
7. Okeson J P. Differential diagnosis and management considerations of temporomandibular disorders. In Okeson J P (ed) Orofacial pain: guidelines for assessment, diagnosis and management. pp 113–184. Chicago: Quintessence Publishing Co, Inc, 1996.
8. Leavy KM, Cisneros GJ, LeBlanc EM. Malocclusion and its relationship to speech sound production: Redefining the effect of malocclusal traits on sound production. Am J Orthod Dentofacial Orthop. 2016 Jul;150(1):116-23. doi: 10.1016/j.ajodo.2015.12.015. PMID: 27364213.
10. Šidlauskienė M, Smailienė D, Lopatienė K, Čekanauskas E, Pribuišienė R, Šidlauskas M. Relationships between Malocclusion, Body Posture, and Nasopharyngeal Pathology in Pre-Orthodontic Children. Med Sci Monit. 2015 Jun 18;21:1765-73. doi: 10.12659/MSM.893395.
12. Cunningham S J. The psychology of facial appearance. Dent Update 1999; 26: 438–443.
13. Johal, A., Cheung, M. & Marcenes, W. The impact of two different malocclusion traits on quality of life. Br Dent J 202, E6 (2007). https://doi.org/10.1038/bdj.2007.33
14. Taylor KR, Kiyak A, Huang GJ, Greenlee GM, Jolley CJ, King GJ. Effects of malocclusion and its treatment on the quality of life of adolescents. Am J Orthod Dentofacial Orthop. 2009 Sep;136(3):382-92. doi: 10.1016/j.ajodo.2008.04.022. PMID: 19732673.