MEASURING OTHER CONDITIONS IN ORAL EPIDEMIOLOGY CHAPTER 18 MEASURING OTHER CONDITIONS IN ORAL EPIDEMIOLOGY

MALOCCLUSION Any deviation from the physiologically acceptable relationship of the maxillary teeth to the mandibular teeth The determination of the classification of occlusion is based upon the principles of Edward H. Angle, presented in the early 1900’s. Angle based his system of classification upon the relationship of the first permanent molars Angle defined NORMAL OCCLUSION as: “the normal relations of the occlusal inclined planes of the teeth when the jaws are closed”

MALOCCLUSION In a national survey, it was found that: a) 9% of persons 8-50 years of age had severe crowding of anterior incisors and 25% had no crowding b) 9% of persons had posterior cross-bite most common in non-Hispanic whites c) 8% of persons had severe overbite and over-jet most common in non-Hispanic whites d) fewer than 5% of non-Hispanic whites had an open bite

NORMAL (IDEAL) OCCLUSION MB cusp max. 1st molar occludes B groove mand. 1st molar

CL I = NEUTROCLUSION MB cusp max. 1st molar occludes B groove mand 1st molar Malposition of individual teeth or groups of teeth “Normal” facial profile

TYPES OF CONDITIONS THAT FREQUENTLY OCCUR IN CL I Crowded maxillary or mandibular anterior teeth Protruded or retruded maxillary incisors Anterior crossbite Posterior crossbite Mesial drift of molars resulting from pre-mature loss of teeth

CL II - DISTOCLUSION B groove of mand. 1st molar Distal MB cusp of max 1st molar by width of premolar “Retrognathic” profile - maxilla protrudes; lower lip is full; mandible appears retruded or weak DIVISION 1: mand. is retruded and max. incisors are “protruded” LABIOVERSION DIVISION 2: mand. is retruded and max. incisors are “retruded” LINGUOVERSION

CL II – DISTOCLUSION

CL II - DISTOCLUSION

TYPES OF CONDITIONS THAT FREQUENTLY OCCUR IN CL II CL II Div 1: Deep overbite Excessive overjet Abnormal muscle function (lips) Short mandible Short upper lip CL II Div 2: Maxillary lateral incisors protrude while both central incisors retrude Crowded maxillary anterior teeth Deep overbite

CL III - MESIOCLUSION B groove of mand. 1st molar Mesial MB cusp of max 1st molar by width of premolar “Prognathic” profile - lower lip and mandible are prominent

CL III - MESIOCLUSION

CL III - MESIOCLUSION

TYPES OF CONDITIONS THAT FREQUENTLY OCCUR IN CL III Maxillary incisors are lingual to mandibular incisors in an anterior crossbite Maxillary and mandibular incisors are in edge-to- edge occlusion

EDGE-TO-EDGE BITE Incisal surfaces occlude END-TO-END BITE Molars in cusp-to-cusp occlusion

OVERJET The “horizontal” distance between the mandibular incisors and the maxillary incisors OVERBITE The “vertical” distance by which the maxillary incisors overlap the mandibular incisors

OPEN BITE Lack of incisal or occlusal contact Teeth cannot be brought together and a space remains as a result of the arching of the line of occlusion CROSS BITE Anterior: maxillary incisors are lingual to mandibular incisors Posterior: maxillary or mandibular posterior teeth are either facial or lingual to their normal position

IDENTIFY THE FOLLOWING….

INDEX An index is a systematic way of collecting and arranging data gathered from observations so that they can be quantified, analyzed and understood Accomplished under specifically defined criteria and conditions Eg: record of data collected from periodontal probing

MALALIGNMENT INDEX Assesses rotations and tooth displacement OCCLUSAL FEATURE INDEX Records crowding, cuspal interdigitation, overbite and overjet

OCCLUSAL INDEX (OI) MEASURES THE FOLLOWING: 1) dental age 2) molar relation 3) overbite & overjet 4) posterior crossbite 5) posterior openbite 6) tooth displacement 7) midline relations 8) missing perm. max. incisors

ORTHODONTIC INDEX Developed in late 1980’s Assesses aesthetic rather than clinical measures of function Eg: DENTAL AESTHETIC INDEX (DAI)

DENTAL AESTHETIC INDEX (DAI) RECORDS MALOCCLUSION IN THE FOLLOWING CATEGORIES: 1) missing incisor, canine, and bicuspid 2) incisal crowding in maxillary and mandibular anterior segments 3) spacing in maxillary and mandibular anterior segments 4) diastema between maxillary central incisors 5) rotations or displacements from normal alignments in the maxillary and mandibular incisors 6) overjet and openbite

ORAL CANCER Oral cancer is limited to cancers of the lip, tongue, buccal mucosa, floor of the mouth, and pharynx Most of these tumors are squamous cell carcinomas Does not include cancer of the throat

ORAL CANCER MORTALITY Of the 30,000 new cases of oral cancer diagnosed annually, only 1/2 affected individuals will survive longer than 5 years 3% of new cancers diagnosed in men and 2% in women are oral or pharyngeal cancers

ORAL CANCER OCCURRENCE Varies widely throughout the world, depending on affected sites in the mouth and various environmental factors associated with oral cancer

ORAL CANCER PREVENTION & CONTROL A) Early diagnosis increases the survival rate; thorough examinations of head, neck, and oral cavity can help identify early lesions B) Individuals with confined, localized lesions have a much higher survival rate than those with lesions that have spread to another region C) Individuals with lip cancer have 91% survival rate

ORAL CANCER RISK FACTORS 1) Tobacco use 2) Smoking (more closely associated with lip and pharyngeal cancer) 3) Alcohol consumption, especially in combination with tobacco use 4) Painful and ill-fitting dentures 5) Excessive exposure to sunlight (more closely associated with lip cancer) 6) Chronic inflammation 7) Smokeless tobacco (more closely associated with cancer of buccal mucosa)

DISEASE CONSEQUENCES OF TOBACCO USE A) CANCER: oral cavity, lung, pharynx, esophagus, stomach, bladder, breast B) RESPIRATORY DISEASES: emphysema, bronchitis, asthma, pneumonia, tb, chronic obstructive pulmonary disease (COPD) C) CARDIOVASCULAR DISEASES: hypertension, atherosclerosis, coronary artery disease, aortic aneurysm, arterial thrombosis, cerobrovascular accident (CVA) D) PREGNANCY INFANT HEALTH: fetal neonatdeath, preterm labor, growth retardation, sudden infant death syndrome (SIDS) E) OTHER CONDITIONS: osteoporosis, alzheimer’s disease, wrinkling, early menopause

CLEFT LIP AND/OR PALATE Cleft lip and palate represent a failure of normal fusion of embryonic processes during development in 1st trimester of pregnancy Formation of lip occurs between 4th and 7th week in utero Development of palate takes place during 8th to 12th week Fusion begins in premaxillary region and continues backward toward uvula

Cleft lip - apparent by end of 2nd month in utero Cleft palate - evident by end of 3rd month in utero Occurrence - 1 in 700 births

CLEFT LIP / PALATE TREATMENT Surgical union of cleft lip - before 6 months Surgery to close palate - before 18 months Bone grafting Osseointegrated implant Obturator Orthodontics Speech therapy

ORAL HEALTH & QUALITY OF LIFE “ORAL HEALTH IMPACT PROFILE” is one index that measures social impact of oral conditions as perceived by the individual Individual’s subjective assessment of his/her own oral health is as valid as dentists Derived initially from statements given in interviews with dental patients and later tested for validity and reliability Ranks oral disorders in terms of the impacts on people’s daily lives Boon to both clinical treatment planning and research